Nationally representative estimates of the cost of adequate diets, nutrient level drivers, and policy options for households in rural Malawi

Impact evaluation of a maternal and child cash transfer intervention, integrated with nutrition, early childhood development, and agriculture messaging (MAZIKO-IE): a study protocol for a cluster-randomised controlled trial

BACKGROUND

Children in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program.

METHODS

We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status.

DISCUSSION

This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes.

TRIAL REGISTRATION

ISRCTN ISRCTN53055824. Registered on 7 March 2022.

Guest Editors' Introduction: The role of policy in reducing malnutrition in sub-Saharan Africa

Sub-Saharan African countries experience various market failures and other constraints in food production, marketing, and food consumption. Consequently, sub-Saharan Africa governments have put in place a myriad of policies to counter these failures. Agricultural, food and nutrition policies address nutrition outcomes, such as hunger, undernourishment, wasting, stunting, child mortality, inadequate food consumption, food insecurity, and volatile food prices, thus improve nutrition outcomes among the population. However, malnutrition persists among the population in the region. To mitigate this challenge, informed, evidence-based policy development and implementation by policy practitioners is of essence. The solutions to the double burden of undernutrition and obesity cut across the agriculture, rural development, and public health sectors. This essay introduces twenty papers of this Special Issue of the Food Policy journal which analyzes 8 policy domains, contributes to the debate on the linkages and pathways through which policies influence food security, nutrition outcomes, and related indicators and points to policy directions in these domains.