In 2014, the Government of Malawi, with technical support from WFP, launched a large-scale nutrition program in a rural district, where the prevalence of undernutrition is high. The program provides lipid-based nutrient supplements (LNS) to children 6-<24mo and a social behavior change communications (SBCC) package promoting optimal infant and young child feeding. In an impact evaluation, we characterized infant dietary patterns and evaluated the one-year mid-program impact on feeding frequency and dietary diversity.
The study design was quasi-experimental with a program (P) and comparison (C) district. Cross-sectional data were collected at baseline (BL:January-March,2014; n=2,364) and midline (ML:January-March,2015; n=2,361). Feeding frequency (breastfeeding and meal) and dietary diversity (Dietary Diversity Score [DDS]; range=0-7) were derived using 24-hour dietary recall data. Program impact was estimated using Difference-in-Differences (DID) and Kernel Propensity Score Matching (PSM)-DID analyses.
Program exposure did not significantly reduce mean 24-hour breastfeeding frequency (P:ML=13.9; C:ML=15.4, DID=0.74) or home meal frequency (P:ML=3.4; C:ML=3.8, DID=0.6) (p’s>0.05). DDS remained low at midline with children across districts, but improvements in DDS favored the program district (P:BL=2.3; C:BL=2.6; P:ML=2.4; C:ML=2.6, DID=0.14) (p=0.07).The proportion of children consuming grains, dairy, and meats increased by 3.6%, 1.1%, and 9.2%, respectively, in the program vs. comparison district (p’s<0.05), whereas legume intake decreased by 7.3% (p<0.05). In PSM-DID analyses, food group findings remained significant, while the marginal impact on DDS was attenuated (p=0.22).
LNS combined with SBCC did not displace breastfeeding or home foods (except legumes) and may have led to improved consumption of some food groups.