Determinants of Reductions in Childhood Stunting n Malawi's Community-based Nutrition Programs

Abstract

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Malawi Economic Monitor, December 2020

“…Improvements in water, sanitation, and hygiene were the most significant contributors to reduced stunting from 2013 to 2018 55. Improvements in hand washing from 2013 to 2018 accounted for 71 percent of the reduction in child stunting in Malawi over the two points in time (Osendarp et al, 2019). An analysis of the main factors contributing to the decreased prevalence of child stunting in the period from 2013 to 2018 in Malawi (Box 5) is consistent with results from other countries, which identify improvements in hygiene as a key underlying determinant of nutritional change (Headey et al, 2016;Nguyen et al, 2017).…”

“…In Malawi, stunting commences early in life and is widespread across the country, with the rate having actually increased in some districts over time. Data from the Malawi Demographic and Health Survey (MDHS) 2015-16 and from the integrated community-based nutrition (CBN) program evaluation in 2018 show that 24 percent of children under six months of age are stunted (Osendarp, 2019). From that point, the rate continues to increase until the children reach approximately 30 months, after which there is a decline (Figure 18).…”

“…The immediate factors associated with stunting in under-five children in Malawi include low weight at birth, diarrheal disease, and inadequate diet for the child (Figure 15). 4 This is alarming, given that in the period from 2013 to 2018, there has been a decline in the average diet quality and meal frequency of under-five children (NSO, 2011(NSO, , 2017Osendarp et al, 2019). Specifically, performance in terms of many key infant and young child feeding indicators, namely the proportion of children who consume the minimum number of food groups and meals per day deteriorated from 19.7 percent in 2013 to 12.4 percent in 2018 (Osendarp et al, 2019).…”

“…4 This is alarming, given that in the period from 2013 to 2018, there has been a decline in the average diet quality and meal frequency of under-five children (NSO, 2011(NSO, , 2017Osendarp et al, 2019). Specifically, performance in terms of many key infant and young child feeding indicators, namely the proportion of children who consume the minimum number of food groups and meals per day deteriorated from 19.7 percent in 2013 to 12.4 percent in 2018 (Osendarp et al, 2019). The reason for the decline in performance in terms of the dietary diversity indicator, which occurred despite significant investments and other improvements in nutrition and food security throughout the country, remains unclear and needs to be further investigated.…”

“…This suggests that the potential to achieve further reductions to stunting through WASH interventions may have been exhausted. Instead, future efforts will need to focus more on health and nutrition-specific interventions, together with interventions to improve other determinants of stunting such as household food security and infant and young child feeding practices, as these continue to remain sub-optimal for the majority of young children in Malawi (Osendarp et al, 2019).…”