TY - JOUR
T1 - Impact evaluation of a comprehensive nutrition program for reducing stunting in children aged 6-23 months in rural Malawi
AU - Christian, Parul
AU - Hurley, Kristen M.
AU - Phuka, John
AU - Kang, Yunhee
AU - Ruel-Bergeron, Julie
AU - Buckland, Audrey J.
AU - Mitra, Maithilee
AU - Wu, Lee
AU - Klemm, Rolf
AU - West, Keith P.
N1 - Publisher Copyright:
Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: The prevalence of stunting in central rural Malawi is ∼50%, which prompted a multipronged nutrition program in 1 district from 2014 to 2016. The program distributed a daily, fortified, small-quantity lipid-based nutritional supplement, providing 110 kcal and 2.6 g of protein to children aged 6-23 mo, and behavior change messages around optimal infant and young child feeding (IYCF) and water, sanitation, and hygiene. Objectives: Our objective was to perform an impact evaluation of the program using a neighboring district as comparison. Methods: Using a quasi-experimental study design, with cross-sectional baseline (January-March, 2014; n = 2404) and endline (January-March, 2017; n = 2453) surveys, we evaluated the program's impact using a neighboring district as comparison. Impact on stunting was estimated using propensity score weighted difference-in-differences regression analyses to account for baseline differences between districts. Results: No differences in mean length-for-age z-score or prevalence of stunting were found at endline. However, mean weight, weight-for-length z-score, and mid-upper arm circumference were higher at endline by 150 g,.22, and.19 cm, respectively, in the program compared with the comparison district (all P <.05). Weekly reports of high fever and malaria were also lower by 6.4 and 4.7 percentage points, respectively, in the program compared with the comparison district (both P <.05). There was no impact on anemia. Children's dietary diversity score improved by.17, and caregivers' infant and young child feeding and hand-washing practices improved by 8-11% in the program compared with the comparison district (all P <.05). Conclusions: An impact evaluation of a comprehensive nutrition program in rural Malawi demonstrated benefit for child ponderal growth and health, improved maternal IYCF and hand-washing practices, but a reduction in stunting prevalence was not observed.
AB - Background: The prevalence of stunting in central rural Malawi is ∼50%, which prompted a multipronged nutrition program in 1 district from 2014 to 2016. The program distributed a daily, fortified, small-quantity lipid-based nutritional supplement, providing 110 kcal and 2.6 g of protein to children aged 6-23 mo, and behavior change messages around optimal infant and young child feeding (IYCF) and water, sanitation, and hygiene. Objectives: Our objective was to perform an impact evaluation of the program using a neighboring district as comparison. Methods: Using a quasi-experimental study design, with cross-sectional baseline (January-March, 2014; n = 2404) and endline (January-March, 2017; n = 2453) surveys, we evaluated the program's impact using a neighboring district as comparison. Impact on stunting was estimated using propensity score weighted difference-in-differences regression analyses to account for baseline differences between districts. Results: No differences in mean length-for-age z-score or prevalence of stunting were found at endline. However, mean weight, weight-for-length z-score, and mid-upper arm circumference were higher at endline by 150 g,.22, and.19 cm, respectively, in the program compared with the comparison district (all P <.05). Weekly reports of high fever and malaria were also lower by 6.4 and 4.7 percentage points, respectively, in the program compared with the comparison district (both P <.05). There was no impact on anemia. Children's dietary diversity score improved by.17, and caregivers' infant and young child feeding and hand-washing practices improved by 8-11% in the program compared with the comparison district (all P <.05). Conclusions: An impact evaluation of a comprehensive nutrition program in rural Malawi demonstrated benefit for child ponderal growth and health, improved maternal IYCF and hand-washing practices, but a reduction in stunting prevalence was not observed.
KW - Lipid-based nutrient supplement
KW - Program evaluation
KW - Social and behavior change communication
KW - Stunting
KW - Undernutrition
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U2 - 10.1093/jn/nxaa236
DO - 10.1093/jn/nxaa236
M3 - Article
C2 - 32840613
AN - SCOPUS:85096456744
SN - 0022-3166
VL - 150
SP - 3024
EP - 3032
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 11
ER -