Barriers and Factors Associated With Treatment Coverage of Severe Acute Malnutrition Among Children 6–59 Months in Agrarian and Pastoralist Areas of Ethiopia

Severe acute malnutrition remains a major public health concern, yet a large proportion of affected children do not receive appropriate treatment. Understanding the barriers and associated factors is essential for informing targeted, context-specific interventions. A door-to-door screening campaign among children aged 6-59 months was conducted from May to September 2024 in Kersa (agrarian) and Jeldessa (pastoralist) woredas of Ethiopia. The treatment coverage of severe acute malnutrition was 12.8% (95% CI: 9.0%-17.9%). The most frequently reported barriers to treatment included lack of awareness of the child's nutritional status, time and financial constraints, and absence of family permission. Multivariable analysis revealed that household wealth index (aPR: 2.9; 95% CI: 1.5-5.5), use of water treatment methods (aPR: 4.6; 95% CI: 1.7-11.9), recent community MUAC screening (aPR: 12.0; 95% CI: 5.4-26.8), availability of treatment services at a nearby health post (aPR: 3.2; 95% CI: 1.1-9.9), and possession of a vaccination card (aPR: 3.2; 95% CI: 1.1-9.1) were significantly associated with severe acute malnutrition treatment coverage. The findings highlight that severe acute malnutrition treatment coverage in both pastoralist and agrarian settings of Ethiopia remains critically low. Stronger implementation of active screening and treatment services recommended by Ethiopian national guidelines, together with social protection measures for the poorest households, may improve treatment coverage. Trial Registration: ClinicalTrials.gov (NCT06380504).