Perceptions of and barriers to participation in a World Food Programme stunting prevention program in Ntchisi, Malawi Open Access

Landon, Kelcie (2015)

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Introduction: To address the high prevalence of chronic malnutrition in Malawi, World Food Programme, in partnership with the Government of Malawi and funded by the Children's Investment Fund Foundation, has implemented a pilot program in Ntchisi district, Malawi, aimed at preventing stunting through the use of small quantity, lipid-based nutritional supplements. This study aimed to develop an understanding of how the community viewed the stunting prevention program 6 months into its implementation, what the barriers to and facilitators of continued participation were, and how the community understood the concept of nutrition.

Methods: This study used qualitative methods. In-depth interviews were carried out with key informants, participant mothers, mothers who were eligible but not participating, participant fathers, and community leaders. Two focus group discussions were conducted with participant mothers; one group was comprised of mothers who had participated consistently since the beginning of the program, and the second of mothers who had participated inconsistently. Data were coded and analyzed using MAXQDA software.

Results: Overall, participants viewed the program positively and believed it was helping their children. Many reasons for inconsistent participation in the program emerged. These included the caregiver being sick or unable to participate because of travel, funerals, or insufficient time due to household chores or the distance to the distribution center. Other obstacles were lack of soap to make oneself presentable, or rumors and stigma associated with the program. Participants also identified inability to register or not knowing when the distribution was to occur and personal beliefs regarding the commodity and its importance as barriers. There was, in general, an incomplete understanding of the overall concept of nutrition, as well as its importance.

Conclusion: Although the community perception of the program was overwhelmingly positive, this study identified a variety of reasons for non-participation as well as larger issues such as a lack of understanding of and lack of importance assigned to nutrition.

Discussion and Recommendations: The understanding and valuing of nutrition was an important barrier to active participation in the program, as the interviews showed that an incomplete understanding of nutrition often led to the undervaluing and under-prioritizing of the program itself. While this program included an extensive behavior change and education plan, this needs to be implemented more promptly and consistently in order for the community to gain a more complete understanding of the programs and the benefits of nutrition in general.

Table of Contents

Introduction. 1

Literature Review. 7

Table 1. 10

Methods. 15

Results. 21

Table 2. 21

Discussion and Public Health Implications. 33

Conclusion. 39

References. 40

Appendices. 45

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