A promising approach to end stunting in Malawi

Malawi has reached a tipping point in its efforts to end chronic malnutrition among children.

It has acquired the knowledge, partnerships and political will necessary to prevent chronic undernutrition that causes stunting (low growth for age).

Given the importance of good nutrition during the crucial 1000 days between conception and a child’s second birthday, nutrition interventions during this period offer an invaluable opportunity.

The prevalence of undernutrition in children under five in Malawi is alarming: nearly half of all children are stunted, suffering from delays in growth and cognitive development that are often irreversible.

To address this problem, World Food Programme (WFP) recently registered young mothers and children at health centres in Ntchisi District in its stunting prevention programme led by the Malawi Government.

Marita Kasambwe is one of the women registered in the programme. Pregnant with her fourth child, Marita is anxious about her ability to support her growing family.

Although she has given her children plenty to eat over the years, the maize porridge she provides lacks the micronutrients necessary for children to maximise their growth, development and learning potential.

A recent survey showed that six out of every 10 households in Malawi have poor to borderline food consumption, and that 50 percent of children eat items from only one or two food groups (Emergency Food Security Assessment 2013). The World Health Organisation recommends that people eat from a minimum of four food groups for adequate diet diversity and nutrition.

Marita now recognises the effects of inadequate diet diversity on her children’s growth potential, but she doubts she can solve the problem on her own.

WFP’s $10 million Prevention of Stunting project funded by the Children’s Investment Fund Foundation (Ciff) aims to reduce the prevalence of childhood stunting in Ntchisi by five to ten percent.

In giving children the opportunity to survive, thrive and grow into adults, this project should ultimately contribute to national development through greater productivity and higher lifetime earnings. The project targets children up to two years of age and their mothers. Starting in January 2014, it will last for 3.5 years.

“Stunting has been a development issue in Malawi for the past 40 years. It was not until new evidence emerged in 2011, however, that Malawi declared renewed commitment to end stunting and shifted its focus towards tackling this widespread problem,” says Ms. Janet Guta, Ministry of Health, deputy director of Nutrition.

With the financial support of Ciff, WFP and its partner World Vision are working with the Government of Malawi to pilot an innovative approach to address stunting, founded on the latest evidence about the most effective nutrition and hygiene interventions.

This project will deliver the right foods at the right time for preventing undernutrition and aims to improve education about feeding practices as well as access to proper nutrition.

In support of the global Scaling up Nutrition (SUN) movement, one of the aims of Malawi’s programme is to boost delivery of essential interventions in Ntchisi district. WFP is working with the Ministry of Health, Ntchisi District Council and other partners to ensure that a whole package of interventions, including supplementary foods to treat acute malnutrition, iron and folic acid tablets, vitamin A supplements and de-worming tablets, are delivered through Ministry of Health facilities.

The government has also initiated a stunting-focused communications campaign to increase awareness about optimal infant and child feeding practices, hygiene, and the use of a lipid-based nutrient supplement, Nutributter, which will be provided to all registered children aged six to 23 months.

Achieving sustained effectiveness requires a high level of community organisation and empowerment. The project will be implemented through a community-based care group model designed to reach 100 percent coverage of households with children less than two years of age and pregnant and nursing women through a network of community volunteers.

Through the care group volunteers, women will share knowledge on how to provide a diverse diet to their children, practise hygiene and care practices and promote the healthy growth and development of their children. The overnment, in partnership with WFP and World Vision, has enlisted health surveillance assistants in the training and supervision of care group volunteers to ensure a sustainable link between these activities and other health services.

This programme is part of the SUN movement in Malawi and is designed to help achieve the SUN goal of ending stunting in Malawi.

Governmental support for nutrition interventions in Malawi is strong. President Joyce Banda is a member and champion of the Nutrition for Growth Initiative.

WFP is also a partner in the groundbreaking Cost of Hunger in Africa (Coha) study which is currently focusing on Malawi. Early data from the study of other African countries confirmed the huge impact that undernutrition and stunting can have on economies.

—Wilson works for WPF Malawi.