Outpatient and Community-based Management of Malnourished Infants aged under Six Months (infants u6m at risk of poor growth & development) : A Scoping Review

Malnourished infants u6m are a vulnerable but not enough-prioritized group, with low consolidated evidence to guide outpatient and community-based care. This study synthesized evidence on outpatient and community-based management of malnourished infants u6m, focusing on intervention strategies, outcomes, barriers, and policy implications. Following the JBI framework and PRISMA guidelines, this review included information about the outpatient or community-based management of malnourished infants u6m or mother-infant dyads, published in English between 2007 and 2025. Four databases and multiple institutional websites were searched, supplemented by grey literature. Data were extracted on various study features, interventions, and outcomes. Total 26 studies were included, only five published after the new 2023 WHO guideline. Evidence was concentrated in sub-Saharan Africa and South Asia. Several included studies described outpatient care as feasible and acceptable in multiple contexts, with reported recovery rates ranging from 65% to 91%; however, methodological heterogeneity limits comparability across studies. Breastfeeding support, maternal health, and culturally adapted interventions were described as important indicators. Tools such as MAMI clinical care pathway, MUAC and the MAMI WAZ look-up chart were described as effective but require further validation and contextual testing. Major barriers mentioned shortages of trained staff, inconsistent protocols, and policy reluctance to scale outpatient models. Outpatient and community-based care for malnourished infants u6m aligns with recent WHO guidance on managing 'at-risk' infants. However, widespread adoption requires stronger evidence-based management or tools, integration into health systems, and national policies. Strengthening research and programmatic consensus will be essential to improve outcomes for this vulnerable population.