Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 576

P12-055 - Impact of a 3-year comprehensive nutrition program on nutritional status among children aged 6 to 23 months in rural Malawi

Sunday, Jun 10
8:00 AM – 6:00 PM

Objectives: Given the high prevalence of child stunting, the Government of Malawi, with technical support from World Food Programme, launched a district-wide comprehensive nutrition program. The program provided a daily lipid-based nutrition supplement (LNS) to children 6 to 23 months of age and a social behavior change communications (SBCC) package targeting infant and young child feeding (IYCF) practices and knowledge, and caregivers' hand washing practices. This study evaluated a 3-year program impact on child nutritional status, IYCF and hand washing practices and knowledge, diet, and morbidity and mortality.


Methods: The study design was quasi-experimental with the program district compared to a neighboring comparison district. Data were collected during cross sectional baseline (January-March, 2014; n=2,404) and endline (January-March, 2017; n=2,453) surveys among children in sampled households. Estimates of impact were generated using Kernel Propensity Score Matching Difference-in-Difference (PSM-DID) analyses using baseline and endline data in the program and comparison districts.


Results: Relative to the comparison district, children in the program district had improved mean weight by 149g, mid-upper arm circumference (MUAC) by 0.19cm, weight-for-age z-score (WAZ) by 0.17, weight-for-length z-score (WLZ) by 0.22, and dietary diversity score (consumption of 4 or more food groups in the past 24 hours) by 0.13 points, and lowered underweight (WAZ<-2) by 1.9%, wasting (WLZ<-2) by 2.4%, low-grade fever by 3.2%, high–grade fever by 6.8%, malaria by 3.7%, and eye disease by 2.3% (all p<0.05). Mothers in program district had increased knowledge scores for IYCF by 0.18 points and for hand washing with soap by 0.23 points. No statistically significant changes were seen between districts for indicators of child linear growth, stunting, or overweight/obesity.


Conclusions: A comprehensive nutrition program that included the provision of daily LNS and feeding/hygiene SBCC package was successful in reducing child wasting and underweight, improving child dietary diversity and caregiver hand washing behaviors, and in reducing the risk of child morbidity but not stunting in rural Malawi.



Funding Source:

This study was generously funded by Children's Investment Fund Foundation, UK.

CoAuthors: Kristen Hurley – Johns Hopkins School of Public Health; Audrey Buckland – Johns Hopkins School of Public Health; Julie Ruel-Bergeron – World Bank; Assumpta Bou Monclus – Johns Hopkins School of Public Health; Lee Shu Fune Wu – Johns Hopkins School of Public Health; Maithilee Mitra – Johns Hopkins School of Public Health; John Phuka – University of Malawi, College of Medicine; Rolf Klemm – Johns Hopkins School of Public Health; Keith West – Johns Hopkins School of Public Health; Parul Christian – Bill & Melinda Gates Foundation

Yunhee Kang

Assistant Scientist
Johns Hopkins School of Public Health
Baltimore, Maryland