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

Childhood malnutrition is still a public health concern in Malawi. Since 2013 the government of Malawi (GoM) has been implementing a large-scale multisectoral nutrition program, which expanded to all districts of the country with the World Bank Group and other donor funding. At the start of this program a national baseline survey was conducted, and in early 2018, an endline survey was conducted. The endline survey followed a mixed-methods approach similar to the 2013 baseline survey, using both quantitative and qualitative data collection measurements. An Oaxaca-Blinder decomposition analysis was used to determine the pathways that contributed most to the program’s success. In addition, a panel dataset was constructed to compare the nutritional outcomes of children within the same household who were born before and after the program intervention. The findings of the endline survey confirm the positive trends observed in childhood malnutrition in Malawi. Between 2013 and 2018, nutrition indicators improved and the percentage of children under age five who were stunted fell from forty-two percent in 2013 to thirty-seven percent in 2018. Improvements were observed in some underlying factors: the percentage of deliveries attended by a skilled birth attendant and handwashing both improved significantly between 2013 and 2018. The findings from the decomposition analysis and cross-sectional and panel data suggest that improvements in water, sanitation, and hygiene (WASH), in particular, handwashing and antenatal care (ANC) practices, were largely responsible for the observed improvements in child nutrition. The findings of the Community-Based Nutrition (CBN) Survey further suggest that the country should consider investing in more coordination and capacity at the district and community levels and should address inequalities in program performance across districts, delivering more context-specific investments and program designs while moving forward