In 2017, nearly 51 million of under-5 children were affected by acute malnutrition worldwide, with more than a quarter of them living in Africa [
1]. The greatest risk of developing malnutrition occurs in the first 1000 days of life, from conception to 24 months of age [
2]. Several factors concur to the incidence of malnutrition, including political and civil conflicts, environmental degradation, natural disasters, poverty, inadequate household access to food, infectious disease, inadequate breastfeeding and complementary feeding practices [
3]. Malnutrition is the underlying cause in over 45% of all deaths among under-5 children [
2]. Nonetheless, malnutrition is often associated with impaired growth and development, with adverse consequences in later life concerning health, intellectual ability, school achievement, work productivity, and earnings of survivors [
2]. Ideally, the health-system infrastructure should integrate both prevention and treatment of malnutrition [
4]. The most effective pathway to prevent malnutrition includes: adequate maternal nutrition before and during pregnancy and lactation; breastfeeding in the first 2 years of life; nutritive, diverse and safe foods in early childhood; healthy environment (i.e. access to basic health, water, hygiene and sanitation services); and opportunities for safe physical activity [
5]. Ready-to-Use Therapeutic or Supplementary Foods (RUTF/RUSF) represent an effective and endorsed tool for the rehabilitation of children with severe and moderate acute malnutrition in both emergency and non-emergency settings, but the recurrent unavailability of these products is a frequent cause of nutrition program failure [
6]. In addition, their long-term adverse effects should be taken into consideration [
7]. Dietary counseling can play an important role in managing malnutrition thus should be an integral part of the treatment plan. However, dietary counseling is often inadequate or absent, and is often performed by health staff or volunteers with poor knowledge and communication skills [
4]. Little emphasis is currently given to the usefulness of local available foods in the rehabilitation of malnourished children and improvements in counseling skills may help in conveying the most appropriate message [
4]. This study aimed to evaluate the adherence to dietary counseling and the impact of changing dietary habits on growth, among children aged 6–24 months who were admitted with acute malnutrition at a rural district hospital, in a low-income setting where therapeutic and supplementary foods were lacking.