Malnutrition underlies 45% of child deaths and has far-reaching educational, economic and health consequences. Mortality among children with complicated severe acute malnutrition (SAM) in sub-Saharan Africa remains unacceptably high, at 10-20% in hospital and 10-15% in the year post-discharge. Nutritional convalescence during hospitalization and following discharge is particularly impaired in children with HIV and SAM compared to SAM alone, leading to higher rates of relapse, more hospital re-admissions, and long-term decrements in growth and neurodevelopment. Other comorbidities apart from HIV also complicate the management of SAM. Children with SAM are discharged to a home environment characterized by poverty and multiple caregiver vulnerabilities including depression, low decision-making autonomy, lack of social support, gender-restricted family relations, and competing demands on scarce resources. This study aims to address the biological and social determinants of multimorbidity in children recovering from complicated SAM by developing multimodal packages of interventions and testing them in a 5-arm adaptive randomized controlled clinical trial, with death/hospitalization/failed nutritional recovery as the composite primary outcome. A total of 1266 (422 in Kenya) eligible children (meeting the following criteria: Age 6-59 months, of either sex; hospitalized with complicated severe acute malnutrition, as per WHO definition; started transition from F75 feeds to RUTF; caregiver willing and able to attend the study clinic for all visits; caregiver able and willing to give informed consent and the absence of acute or chronic condition which mean that receipt of one or more study interventions, or participation in the trial, would not be advisable) will be enrolled from 9 sites in 3 countries (Kenya, Zambia and Zimbabwe) and randomized to a 12-week course of multi-modal packages of interventions [antimicrobial package, Reformulated RUTF, Psychosocial package, combination of all the three and standard-of-care (control) to test the superiority of each intervention arm over the standard of care arm (control). Enrolled children will be followed at 2, 4, 6, 8, 12 and 24 weeks post-randomization in dedicated study clinics (with additional visits at 1, 3 and 5 weeks for caregiver-child pairs receiving the psychosocial intervention). The primary outcome is a composite of death or hospitalization or failed nutritional recovery by 24 weeks post-randomization. Blood and stool samples will be collected from all children at enrollment, weeks 2 (blood only), 12 and 24. Results of this study will inform management strategies to enhance convalescence following hospital treatment of SAM.