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 - Funding Information:
This study was funded by the Children's Investment Fund Foundation (CIFF), UK. The funding agency had no role in the design of the study, data collection and analysis, or presentation of the results.
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
UR - http://www.scopus.com/inward/record.url?scp=85096456744&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85096456744&partnerID=8YFLogxK
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 -