Presented by Dr. Mangani Katundu, Associate Professor, Chancellor College, at IFPRI Malawi workshop and policy dialogue, 'Nutrition-sensitive social protection and integrated programs in Malawi: Evidence from a longitudinal study in Zomba spanning the 2016-17 food crises,' in Lilongwe, Malawi, May 17, 2018.

1. Impact results
Pre-school meals as a platform for behavior change at
community level: A cluster randomized trial.
Aulo Gelli (IFPRI), Amy Margolies (JHU), Marco Santacroce (IFPRI), Noora Aberman (IFPRI), Aisha Twalibu (Save the Children),
Natalie Roschnik (Save the Children), Helen Moestue (Save the Children), Mangani Katundu (Chancellor College) and others…

2. Background
• Young children in Malawi face
widespread problems of low-
quality diets and chronic
malnutrition (DHS, 2015)
• A strategy to address malnutrition
involves promotion offood-based
approaches, including dietary
diversification (Tontisirin et al., 2002)

3. The NEEP-IE Study
• One year, rigorous impact evaluation of an ECD center-based
behavior change, and parent and community trainings and
engagement intervention, aimed at improving the diets,
nutrition and development of young children

4. Early Childhood Development (ECD) in Malawi
• Led by the Ministry of Gender, Children
and Social Welfare
- Community-Based Childcare Centers
(CBCCs) are community-initiated and
community-owned
- Parenting groups
• Lack of food is one of the main causes
of absenteeism and CBCC closures

5. NEEP-IE package
• Model driven by community
level actors
• Intervention involves training
and inputs (no food transfers)

6. Integratedintervention
Agriculture
Food production and
processing
Seeds and chicks
Village savings and loans
AGRICULTURE
COMPLEX IMPACT PATHWAYS
Preschool
Parent education
ECD
Meal preparation
Meal provision all year
Feeding young children
NUTRITION
Child care and stimulation
Nutritious preschool meals
all year
Women'stimeallocationanddecisionmaking
Efficient farming techniques
Early learning
Preschool attendance
Improved diets and feeding
practices
More nutritious crops
produced
Child development
Improved food security
Improved nutrition
A C T I V I T I E S O U T C O M E S I M PA C T
All

7. 235 centres in 47 clusters
available for scale-up
86 centres in 20 clusters
screened for study
NEEP + ECD
10 clusters
30 centers
Control (ECD only)
10 clusters
30 centers
597 households
641 children 3-6y
152 children 6-24m
NEEP-IE cluster randomised trial
600 households
655 children 3-6y
162 children 6-24m
Random allocation

8. Results

9. Household food production improved
NEEP Control DID
Indicator 2015 2016 2015 2016 Impact s.e
Crop production diversity score 3.52 3.52 3.53 2.82 0.71*** 0.10
Crop production variety score 6.62 7.87 6.54 5.67 2.14*** 0.35
Production of OFSP (kg) 1.55 5.62 1.47 1.05 4.32*** 0.73
Production of brown beans (kg) 3.71 0.70 2.86 0.70 -0.90** 0.44
Production of pigeon peas (kg) 14.40 22.84 17.53 21.55 4.86** 1.87
Production of groundnuts (kg) 6.59 9.27 7.31 6.68 3.38** 1.63
Production of soya bean (kg) 0.37 1.73 0.16 0.08 1.45*** 0.14
Chickens owned (n.) 2.84 3.40 2.30 1.71 1.16** 0.45
Production of eggs in last 3 months (n) 4.44 5.46 3.83 1.23 3.44** 1.21

10. • Positive effects found on knowledge of different food groups
- “Name the food groups you know?”
- Effects driven by knowledge of foods for growth (beans, groundnuts)
and energy giving foods (fats and oils)
Improved caregiver knowledge of food groups
Notes: Coefficients expressed as odds ratios, except for continuous variable on knowledge score (β). *** significant at the 1% level, ** significant at the 5%
level, n=1,122.
NEEP Control DID
Knowledge of food groups 2015 2016 2015 2016 OR SE
Animal products (milk, meat, chicken, eggs, fish…) 58% 66% 58% 55% 1.63** 0.31
Staples/ carbohydrates (cereals, potatoes, cassava…) 57% 66% 49% 43% 2.19** 0.42
Vegetables (pumpkin leaves, rape, amaranthus…) 61% 69% 60% 57% 1.74** 0.33
Fruits (mangoes, oranges, papaya…) 53% 62% 55% 45% 2.51** 0.48
Added fats and oils (cooking oil, margerine…) 40% 49% 28% 25% 2.03** 0.44
Pulses (groundnuts, soya, pigeon peas….) 49% 57% 35% 33% 1.70*** 0.32
Knowledge of food groups score 2.59 3.68 2.85 3.18 (β) 0.76*** 0.1.6

11. • NEEP CBCCs provided more food and more nutritious meals than in control CBCCs
• But no effect on enrolment or attendance
Improved meal provision in CBCCs
NEEP Control DID
Indicator 2015 2016 2015 2016 Impact s.e
Days ECD centre was open in last 5 days 3.91 3.09 4.08 2.95 0.08** 0.04
ECD centre provided meals in last 5 days? 0.24 0.46 0.29 0.41 0.72*** 0.21
n. of days meal provided in last 5 days 0.75 1.47 0.92 1.13 0.48*** 0.08
ECD centre enrolment 0.92 0.64 0.93 0.60 0.38 0.29
Child ECD centre attendance in last 5 days 3.16 2.37 3.12 2.34 0.00 0.05
Notes: *** significant at the 1% level, ** significant at the 5% level, n=1,122.

12. Children’s (3-6y) intake improved
Energy Protein Iron

13. Younger siblings (6-24m at baseline)
• … their diets were also better
- Mean dietary diversity was 0.31 points greater in intervention
group (p<0.05, mean DDS=3.24 in intervention compared to 2.93
in controls), driven by higher likelihood of consumption of nuts
and pulses, and fruits and vegetables
- Intervention group had a higher percentage of children with
minimum dietary diversity (MDD) in the past 24 hours (39% in
NEEP vs. 28% in control, β=0.11**, SE 0.05)

14. Improved growth in younger siblings
• No impact on HAZ or stunting at endline on children 3-6y
• Positive impact on HAZ (DID 0.44** (SD 0.16)) and prevalence of stunting
(DID -0.18** (SE 0.06)) in secondary reference age group (6-24m) (n=280)
Baseline, midline and endline HAZ score and prevalence of stunting, children 6-24m at baseline

15. Parenting practices and child development
• No statistically significant differences in aggregate indices of
stimulation and parenting practices across study groups at endline
- However, NEEP caregivers had higher frequencies of telling stories and
naming new objects (p<0.05)
• No effect on aggregate Malawi Development Assessment Tool (MDAT)
score but small negative impact in 1 of 4 MDAT domains (language) in
preschoolers

16. Qualitative insights: Diversifying diets
• Households motivated to diversify diets
• Nutritious foods consumed both in households and CBCCs
- Acceptability of crop varieties (orange maize porridge)
- Use of nutritious porridges (groundnut, soya, pigeon pea)
• Challenges included poor harvests, and constraints to purchase
nutritious foods
"We used to give the kids porridge made from maize flour alone, now we are
mixing all the crops like pigeon peas, soy and ground nuts, and it is a good
porridge which even smells good...He [child] has gained weight, he now weighs
19 to 20 kgs, and is not as sickly as he was." -Female respondent, Village 6

17. Pre-school meal platform works
• Despite short timeframe RCT found important effects across diets, nutrition
and agriculture domains
• Plausibility of findings on nutrition supported by impacts on caregiver’s
knowledge of IYCF practices and on strategies to improve diets
• Evidence suggests that pre-schools can provide an effective platform to
scale-up nutrition interventions
• Model driven by contributions by parents and community and may provide
a financially sustainable option for Government scale-up

18. Thank you very much!
• Acknowledgements
- Research by the International Food Policy Research Institute (IFPRI), Save the
Children, Chancellor College at the U. of Malawi and Wadonda Consult Ltd
- Programs implemented by Save the Children with local partner NGOs
- Research funded by NEEP, IMMANA, Save the Children Sponsorship, USAID,
Gender, Agriculture and Assets Project (GAAP), CGIAR Research Program on
Agriculture for Nutrition and Health (A4NH) led by IFPRI
- Program and research participants!