IMPACT EVALUATION OF A COMPREHENSIVE NUTRITION PROGRAM TO PREVENT STUNTING AMONG CHILDREN 6-23 MONTHS OF AGE IN RURAL MALAWI

Background: The Malawian Government launched a comprehensive stunting prevention program with technical and financial support from the World Food Program (WFP) and the Children's Investment Fund Foundation (CIFF), respectively. The program provides a daily lipid-based nutrient supplement (LNS) and social behavior change communication (SBCC) package to improve infant and young child feeding practices (IYCF), targeting children 6-23 months. Objective. To evaluate the impact of the comprehensive program on child nutritional status. Method: A quasi-experimental study design was used to measure nutrition outcomes in one program and comparison district. The impact evaluation included three cross-sectional surveys (baseline, midline, endline) and an imbedded longitudinal cohort of children. Results for the endline survey are being examined and will also be shared during the symposium. Midline evaluation: The one-year (interim) program impact was measured using cross-sectional baseline (January-March, 2014; n=2,404) and midline (January-March, 2015; n=2,378) survey data. Estimates of impact were generated using Kernel Propensity Score Matching Difference-in-Difference (PSM-DID) analyses using both baseline and midline data. Longitudinal evaluation: Two cohorts of infants (n=367), aged 6-7 months, were enrolled in either the program (n=176) or comparison (n=191) district, and followed-up after 6, 12, and 18-months, or at 12, 18, and 24-months of age, respectively. Program impact was estimated using a difference-in-differences (DID) method at 6, 12, and 18-months follow-up, adjusting for confounding variables and study design. Results: Midline evaluation: While the burden of undernutrition remained high at midline (after one-year program exposure) with half of children stunted across both districts, improvements in nutritional status between midline and baseline in child weight, MUAC, WAZ, and WLZ favored the program over comparison district by 0.20kg, 0.29cm, 0.23 Z-score and 0.30 Z-score, respectively (p