GROWING THE EVIDENCE FOR NUTRITION PROGRAMMING: PERCEPTIONS AND IMPLEMENTATION OF A STUNTING PREVENTION PROGRAM RURAL IN MALAWI

The delivery of efficacious nutrition interventions in a programmatic context can hamper the achievement of nutrition impact due to logistical and sociocultural challenges associated with their implementation. Understanding how programs work to improve child nutrition and feeding behaviors is critical for scaling up nutrition interventions globally. To study how a nutrition program in rural Malawi was perceived, accepted, and implemented. Methods: The nutrition program in Malawi includes the monthly distribution of lipid-based nutrient supplements, Nutributter, to all children 6-23 months, and a social behavior change communication campaign to promote optimal infant and young child feeding (IYCF) practices. An independent impact evaluation was led by Johns Hopkins University to measure child nutrition outcomes after 3 years of implementation. This study falls under the impact evaluation, which included a qualitative and a process evaluation study. The qualitative study employed in-depth interviews (IDI) with mothers (n=34) and household members (fathers, n=11; and grandmothers, n=4), focus group discussions (FGD) with village leaders (1 with n=11) and program staff (3 FGD with n=12, n=10, and n=11), to elicit beneficiary and community perceptions of the facilitators and barriers to the uptake of the program's intervention components. Grounded theory guided all study processes, wherein emerging themes were incorporated into continuing data collection, coding, and analysis. The process evaluation study measured the program's conformity to its original design (program fidelity) through direct observations of program activities (n=28), knowledge questionnaires with program staff (n=84), and use of existing data from program monitoring mechanisms (pooled n=2,901). Process indicators were categorized as "working well" (>75%), "needing improvement" (25%-75%), and "not working" (