Fighting Child Malnutrition Around the World

“I have many children but this youngest one I have been playing with him and talking to him and I have made him toys to play with. For sure he is a lot more active/playful and he understands things quicker. Myself, I am amazed at the way he is different from his older siblings.”

—EFFECTS participant from Manyama Village, Mara, Tanzania

Fighting Child Malnutrition Around the World

“I have many children but this youngest one I have been playing with him and talking to him and I have made him toys to play with. For sure he is a lot more active/playful and he understands things quicker. Myself, I am amazed at the way he is different from his older siblings.”

—EFFECTS participant from Manyama Village, Mara, Tanzania

Overview

Around the world, 250 million children will fail to meet their developmental potential in the first five years of life. The first two years of a child’s life is a critical time period during which the foundation for healthy physical, cognitive, language, social, and emotional development is established. Child malnutrition, poor nutrition, and inadequate stimulation have serious consequences on a child’s growth and development. Malnutrition effects include poor cognition and educational performance, low adult wages, lost productivity, and an increased risk of nutrition-related chronic diseases in adult life.

Around 45 percent of deaths among children under five years of age are linked to undernutrition. The developmental, social, and economic consequences of the global burden of malnutrition are serious and lasting for individuals, families, communities, and countries.

Ending chronic malnutrition is a complex problem that requires integrated solutions, such as improving access to health services and nutritious foods, promoting breastfeeding and optimal infant and young child feeding practices, improving water and sanitation, and planning for food shortages and emergencies.

Improving Child Nutrition

PCI implements programs globally that support improvements in child nutrition, parenting, and early childhood development to address health systems gaps, food access, behavior change, and gender norms.

PCI also creates enabling environments by attending to the needs of the caregiver, both mothers and fathers, in order to improve nutrition and developmental outcomes for young children. This includes improving the knowledge, skills, practices, and mental health of caregivers, strengthening the co-parenting relationship, as well as addressing broader barriers to optimal child nutrition services, such as food access and water infrastructure.

mother feeding baby

The Pathways To Change

To address the underlying causes of food insecurity and child malnutrition in Africa, PCI led the Njira “Pathways” development project from 2014-2019. Njira was designed to improve the health and nutrition of pregnant and lactating women and children under age five, with emphasis on the first 1,000 days, in the Balaka and Machinga districts of Malawi.

Using integrated and custom-tailored pathways and a peer group-based participatory behavior change platform, PCI was able to address the specific needs of food insecure populations. PCI worked with participants to construct backyard gardens which improved access to nutrient dense foods, provided skill-based training on processing, preservation, storage, and utilization of nutritious foods, facilitated growth monitoring and promotion sessions, and referred malnourished women and children to available services.

The program reached 70,668 women of reproductive age in 2017 with integrated sanitation and hygiene education, as well as maternal and child nutrition counseling and support. Additionally, PCI worked with 80 father groups to transform gender norms and engage fathers in more equitable household decision-making and increased support for household health, nutrition, and healthy water, sanitation, and hygiene practices.

In the last two years of the project, 144,000 community members participated in care groups designed to improve health and nutrition behaviors for women of reproductive age and children under five.

Helping Children Grow in Guatemala

PCI’s ANIMO, or “Encouragement,” project is an emergency food security program that seeks to reduce short-term hunger and child malnutrition among vulnerable families in the dry corridor of Western Guatemala.

ANIMO provides cash transfers to more than 6,000 vulnerable families in 49 communities to support food security, community resilience, and child nutrition needs. To date, $2,607,865 has been delivered to families, with each transfer having an average value of $65.

In addition to cash transfers, ANIMO provides training to community volunteer groups who monitor the nutritional status of children in participating communities. These volunteers refer cases of moderate or severe malnutrition to local health facilities for treatment, as well as replicate trainings to other volunteers. The volunteers also provide weekly, or biweekly, follow ups on the preparation of nutritional recovery formulas and foods along with personalized counseling for caregivers. In the first year of the program, the team completed over 4,800 home visits.

The project also promotes vegetable production through an integrated farm model that equips families with supplies to produce organic fertilizers, vegetable seeds, rainwater harvesters, and eco-filters for consumption of clean and safe drinking water. In these 49 communities, the prevalence of underweight children has dropped from 13.5 percent to 2.5 percent in just over three years.

Engaging Fathers in Tanzania

PCI designed the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) project – a behavioral randomized controlled trial and implementation research study designed to measure the impact of bundling nutrition and parenting interventions and the impact of engaging fathers in peer group-based nutrition and parenting interventions.

The project will answer two primary research questions:

  1. Does a father’s engagement improve child nutrition and development?
  2. Will integrating child stimulation with nutrition programming improve child nutrition and development more than just nutrition programming alone?

The EFFECTS theory of change, intervention materials, and evaluation design capture a range of behaviors that may improve nutrition and child development outcomes. The study will provide essential insights on: infant and young child feeding; food access; water, sanitation, and hygiene; couples communication; household decision-making; conflict resolution; stress management; family planning; women’s control over household resources; and for parenting: play and communication, responsive caregiving, and praise and positive discipline. Intervention sessions also include interactive skill-building activities such as cooking demonstrations and visits to local community gardens. The packages promote and operationalize World Health Organization child stimulation and UNICEF nutrition guidelines while also addressing the enabling, supportive environment for the practice of optimal nutrition and parenting behaviors.

EFFECTS is funded by the Eleanor Crook Foundation and Conrad N. Hilton Foundation and implemented by PCI in collaboration with the Harvard T.H. Chan School of Public Health, Purdue University, and the Africa Academy of Public Health.

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Strengthening the Parent-Child Relationship in Tanzania

In the Mara region of Tanzania, learning outcomes among primary school students are poor and below the national average. One of many reasons for why boys and girls struggle in school is they were not well prepared when they enter primary school.

Babies start learning from birth, yet it is uncommon for parents in Mara to provide adequate stimulation and early learning activities through play and communication with their children during the early years of 0-4. Additionally, nursery schools or early childhood learning centers are rare. When children’s brains are not adequately stimulated, the consequences on a child’s educational achievement are long-term and start in the pre-primary and primary school years.

To address these early education gaps for young children in Mara, PCI designed an innovative model called Education Cascade Groups that is integrated within PCI’s current Food for Education program.

Through the Education Cascade Groups, PCI is strengthening the parent-child relationship and promoting early learning among children between two and four years of age.

First Teacher Groups engage 12 parents and their children on a weekly basis through lessons and activities facilitated by community volunteers. During the group meets, both children and caregivers learn together through song, play, drawing, counting, and storytelling.

Over time, these efforts build the capacity of parents to provide nurturing, responsive care and early learning opportunities in their home, preparing children for pre-primary school and for success later in life. Home visits are conducted among caregivers to follow up and assess parenting behavior change and child acquisition of key developmental milestones promoted in the group sessions.

In just two years, PCI formed 160 First Teacher Groups in 80 villages. The program has made significant improvements in caregiver parenting and early learning practices, including the availability of playthings in the home.

Engaging Men in India to Improve Nutrition and Family Planning

In the Bihar region of India, under the Jeevika Techincal Support Program funded by the Bill and Melinda Gates Foundation, PCI implements a male engagement project designed to test several innovative solutions for engaging men as a channel for promoting more equitable gender relations, joint household decision-making practices, and improved family planning and nutrition outcomes.

The project leverages the self-help group platform in Bihar, where health and nutrition interventions are emerging as an important pathway to improving reproductive, maternal, newborn, and child health outcomes.

In partnership with Dalberg, PCI is designing creative solutions using Human-Centered Design and other behavioral science approaches. PCI then tests the solutions to generate evidence for use at scale. The project brings in a pool of internal and external thematic experts from the very beginning of the project. These experts, with India-specific and global expertise on domains of male engagement, family planning, nutrition and gender, provide strategic recommendations and guidance in informing, triangulating and fine-tuning the learnings and validating the solution concepts.

Pilot testing of design concepts explores how the user group reacts to and engages with the different ways of engaging men in family planning and nutrition and provides an opportunity to refine them in response to real-world feedback. The final outputs and insights from the research will be shared with a wider audience, filling gaps in the knowledge base on male engagement for family planning and nutrition strategies.

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