Key Stakeholders' Perspectives on Acute Malnutrition Management Programs for Children Under Five in Bangladesh: Qualitative Insights

Acute malnutrition (AM) in children under five is a significant global health concern. Community-based management of AM (CMAM) with provision of specially formulated foods (SFFs) is recommended for treating moderate (MAM) and uncomplicated severe (SAM) cases in outpatient settings. Integrating nutrition counseling and cooking demonstrations (NC&CD) into CMAM programs can improve caregiver knowledge and practices. In our parent trial, we evaluated the effectiveness of enhanced NC&CD without SFFs on MAM management. This study examines perceptions and understanding of CMAM among parents, healthcare providers (HCPs), and policymakers in both CMAM and no-CMAM areas. A purposive sampling technique was used to recruit participants who were reflective and willing to share their experiences with the research team. Data collection involved 30 focus group discussions (FGDs), 34 in-depth interviews (IDIs) with parents, 28 key informant interviews (KIIs) with HCPs in Cox's Bazar, and 16 KIIs with policymakers in Dhaka. Data were analyzed thematically using NVivo, guided by the concepts of the theoretical framework. Parents and HCPs generally valued CMAM for its SFFs, while parents in the MAM trial's intervention arm preferred NC&CD with incentives. Policymakers largely supported combining SFFs with NC&CD, though some advocated for NC&CD alone as a feasible approach. Challenges identified included workforce shortages, policy gaps, and insufficient prioritization. One-third of HCPs in CMAM areas and most HCPs and parents in no-CMAM areas favored NC&CD. The study highlights the need to continue NC&CD-based CMAM programs with incentives and recommends integrating NC&CD into CMAM guidelines to enhance caregiver awareness. Additionally, increased manpower, policy advocacy, strong government leadership, and preventive nutrition initiatives are warranted to ensure the sustainable effect of CMAM in Bangladesh.