Outcome evaluation of a pilot CSAM program in Central India: a prospective cohort study

Background Severe Acute Malnutrition (SAM) remains a major public health challenge in India, particularly in Madhya Pradesh, where a significant proportion of under-five children are affected. The Community-Based Management of Acute Malnutrition (CSAM) approach offers a decentralized, cost-effective solution for treating uncomplicated cases through frontline workers and community infrastructure. This study evaluates the outcomes of a pilot CSAM program in a high-burden district in Central India, assesses its effectiveness against international Sphere standards, and identifies key implementation challenges. Methods A prospective cohort study was conducted among 108 children aged 6–59 months with uncomplicated SAM, enrolled from 25 Anganwadi Centers in Babai Block, Madhya Pradesh. The children were followed for a 12-week treatment period. Data on anthropometry, treatment adherence, and program outcomes (recovery, default, non-response rates) were collected from program records and field observations. The program's effectiveness was compared against Sphere Standard benchmarks. Results Out of 108 SAM children enrolled, 32 (29.6%) achieved recovery by the end of 12 weeks. The average weight gain among recovered children was 5.7 g/kg/day, while the mean length of stay was 75 days. The default rate was 18.5% and the non-response rate was 51.9%. Key implementation gaps were identified, including inconsistent use of Take-Home Ration (THR) within households, poor documentation of key clinical metrics (24% of records incomplete), and a low referral rate (7.4%) for non-responsive cases to higher facilities. Conclusion The pilot CSAM program demonstrated operational feasibility but achieved recovery and non-response rates that were below international standards. The high rate of weight gain among the children who did recover suggests the therapeutic protocol is effective when adhered to. Critical implementation gaps in nutritional support adherence, documentation, and referral pathways were primary contributors to the suboptimal outcomes. Strengthening these areas is essential to realize the full potential of community-based management for SAM in India.