Background
Severe acute malnutrition (SAM) in children under 5 years of age is a major cause of child mortality during hospital admission worldwide, and is attributed to poor case management. The Outpatient Therapeutic Programme (OTP) is an innovation for treating children with SAM with no medical complications as outpatients within their communities.

The aim of the study was to evaluate the improvement in health outcomes and case fatality rate in children aged 6–59 months diagnosed with SAM and admitted in OTP centres, and to document the barriers to a sustainable OTP intervention in the districts of Eastern Zambia.

Methods
A mixed-methods design was used to assess the health outcomes of OTP intervention. Three districts where OTP centres were operational at the time of study were selected. Records of 390 eligible children admitted with SAM between 2008 and 2010 were reviewed. The health outcomes assessed included recovery and case fatality rates, defaulter rate, and weight gain. Information on the barriers to effective implementation of a sustainable OTP intervention in the districts was collected through semi-structured key-informant interviews with stakeholders. Outcome indicators were compared with the baseline data and recommended minimum standards for therapeutic feeding centres.

Results
Of the 390 children admitted into OTP, 312 (80 %) had recovered on discharge, 11 (2.8 %) died, and 67 (17.2 %) had defaulted. Compared to the baseline data and the recommended minimum standard values, case fatality rate for this study was 2.8 % vs. 7.3 % vs. >10 % respectively, and the recovery rate was 80 % vs. 73 % vs. >75 % respectively. Barriers to effective sustainability of the programme included dependence on donor-funds, consistent stock outs of ready-to-use therapeutic food and other supplies, high volunteer dropout, and inadequate monitoring and feedback on defaulters.

Conclusion
OTP improved health outcomes of SAM children in the Eastern Zambia when compared with accepted minimum standards and previous data. Dependent on donor funding and the resultant regular stock-out of supplies can, however, hamper sustainability in the long-term.