Back ground: The community based management of acute malnutrition (CMAM) is an evidencebased intervention with proven effectiveness for treating children with severe acute malnutrition management. There is limited information about the treatment outcomes, challenges and estimating the length of intervention period to reach the minimum SPHERE standard recovery rate in the study area. The findings will have important implications for policy and programme efforts towards improved community based management of acute malnutrition implementation. Objective: To assess community management of acute malnutrition implementation process to determine the outcome and challenges of severe acute malnutrition management in Dessie Zuria Woreda of South Wollo Zone, Amhara region, Ethiopia, July 1/2016 to June 30/ 2017. Methods: Institution based cross sectional retrospective study design was conducted on 399 Outpatient Therapeutic Program(OTP) cards of children treated at 17 health posts from July 1/2016 to June 30/ 2017. Individual cards of children and caretakers were selected using simple random sampling technique and purposively service providers were included based on their service year in the visited OTP centers. Extraction format adapted from standardized indicators and categories for better CMAM reporting was used. Data collectors were HEWs from non OTP centers. The data entry, cleaning and analysis was managed using SPSS v.20. P-Value <0.05 along with the 95% CI was estimated using multivariable logistic regression to identify factors associated with treatment outcome. Results: The recovery rate was revealed as 92.3% and the death rate, default rate, transfer rate, were 1.3%, 1.6%, 4.9%, Weight gain and length of stay were 4.2 g/kg/day, and 7.7 weeks respectively. The chance of recovery was reduced by 99.9% among children who had cough or pneumonia as compared to children who were not coughing (AOR: .02, 95%CI: .01, .22). The likelihood of recovery was 32.40 times higher for children with good appetite than for those with poor appetite good appetite (AOR: 32.40, 95% CI: 1.90, 53.82). Likewise, children provided with amoxicillin were 11.28 times more likely to recover compared to their counterparts (AOR: 11.28, 95% CI: 3.59, 24.89). Conclusions: All the performance indicators are within the SPHERE Standards except length of stay in the program. Being admitted with medical co-morbidities such as, having pneumonia or cough and having poor appetite and without provision of Amoxicillin/Anti-biotic were the main predictors of OTP treatment outcomes. Special focus should be given to predictors of recovery rate such as prompt and appropriate management of co-morbidities through administering lifesaving routine Antibiotics