Program Impact on Nutritional Status among Children Aged 6 to 24 Months in Rural Malawi: Findings from a Longitudinal Cohort Study

Abstract

ObjectiveTo evaluate the 18‐month impact of a program providing a daily lipid‐based nutrient supplement (LNS) and social and behavior change communication (SBCC) to promote infant and young child feeding practices from 6–23 months, on undernutrition (stunting, wasting, and underweight) and linear‐ and ponderal growth [length‐for‐age z‐score (LAZ), weight‐for‐length (WLZ), weight‐for‐age (WAZ) z‐score] in rural Malawi.MethodsTwo cohorts of infants (n=348), aged 6–7 months, were enrolled in the program (n=176) and comparison (n=172) districts, respectively, and followed‐up at 12, 18, and 24 months of age. Child weight and length were taken at each visit and converted to z‐scores using the WHO child growth standards. Multilevel mixed‐effects linear regression models estimated the program impact on growth, accounting for within individual and village correlations, and adjusted for age, sex, and baseline nutritional status.ResultsPercentages of children stunted and wasted were comparable at enrollment in both districts: 42.4% and 1.5% (districts combined), but underweight was higher in the program district (15.4% vs. 6.5%;p<0.01). A trend toward a higher LAZ emerged in the program district at 12 (+0.13 z;p=0.15) and 18 (+0.14 z; p=0.19) months of age, that was significant at 24 (+0.34 z; p=0.003) months. Similarly, significant program impact on WAZ was noted at 12 (+0.20 Z; p=0.03), continued at 18 months (+016 Z; p=0.08), and became larger at 24 months of age (+0.32 Z; p=0.003) in program over comparison district. No statistically significant differences between groups were notable for WLZ at any visit. Further, at 18 and 24 months of age, the percent of children underweight was lower by 8.3% (p=0.04) and 9.8% (p=0.02), respectively, in the program vs. comparison district. No significant reduction in the percent of children stunted or wasted between groups were found at any visit.ConclusionsFindings suggest that a daily provision of LNS and SBCC messaging from 6–23 months of age in rural Malawi may improve linear growth and underweight.Support or Funding InformationThis study was funded by the Children's Investment Fund Foundation, UK.