Background
Country context
The standard ECD package
-
CBCC caregivers receive a 2-week training, provided by government-approved trainers, using a standard government-approved training manual when they start. They receive 5-day refresher trainings annually and they are mentored by one visit/month by ECD facilitators
-
CBCCs target all 3–5 year olds in the community. They are managed by the community and are open from 8 a.m. to 11 a.m., 5 days per week. Porridge (mid-morning meal) is provided at about 10 a.m. by parents/facilitators with food contributions from the community
-
CBCC caregivers and mentors received a 3-day training to organise parenting sessions using a standard government parenting education manual
-
The parenting sessions are organised once or twice a month on average. Topics covered by parenting sessions include: child nutrition, stimulation, and parental role in school readiness, amongst others. Parenting sessions target all parents of children aged 0–8 years old with particular focus on children from 0–2 years
-
Agricultural extension workers received a 5-day training to organise parenting sessions using a standard government parenting education manual
-
Trainings were conducted between April and May 2016. The total number of people trained was 437 with 382 women and 55 men
-
Other ECD interventions include children’s corners, mobile phones and interactive radio instructions (IRI)
The integrated agricultural and nutritional intervention
-
Training on nutritious food production, including the following topics: production of foods to use in CBCCs, i.e. production of selected cereals and staples (orange maize, orange-fleshed sweet potato and cassava); selected legumes and nuts (soya beans, pigeon peas, cowpeas and groundnuts); and green leafy vegetables (Amaranthus). In all this the subtopics included: land preparation and planting, weeding and fertiliser application, pests and disease control, harvesting, storage and processing and utilisation in CBCCs. The use of manure as fertiliser was also promoted
-
The CBCC garden was used as a demonstration site. At a demonstration plot, the community prepared the gardens with guidance from the Agriculture Extension District Officers (AEDOs). An AEDO would start a ridge with the correct spacing and the community would take over after that with the AEDOs making sure that the correct spacing is used and the correct type of ridge is made. This would continue until the rest of the garden has been prepared. The same process was adopted for all the gardens. Where the demonstration coincided with the first rains, the planting was also done, again with guidance from the AEDOs. AEDOs and community agents (CAs) monitor the gardens two to three times per month on average
-
The first agricultural production training was facilitated by AEDOs and involved 900 participants in total. Each training session lasted 3 days and included 45 participants. The training took place in December 2015 and farmers (households) began planting soon after the training. The training was two-fold: theory and practice. A second agricultural production training was also facilitated by AEDOs to 120 participants. Each training session lasted 3 days and each session had 20 participants. These trainings took place in August 2016 and covered the following topics: land preparation and planting, weeding and fertiliser application, pests and disease control, harvesting, storage and processing and utilisation in CBCCs for carrots, spinach and tomatoes
Seeds provided | Planting period | Harvest period | Consumption period |
---|---|---|---|
Orange maize | December | March-April | May onwards |
Pigeon peas | December | April | April onwards |
Cow peas | December | March | March onwards |
Beans | December | ||
Groundnuts | December | ||
Soya | December | April | April onwards |
OFSP | January | April-March | April onwards |
Carrots | July | October | October onwards |
Amaranthus
| August | August/September | August onwards |
-
Training CBCC management committee members, caregivers, lead farmers and parents on the nutritional needs of children, healthy meals all year round, food selection, storage and preservation, food hygiene, safety and preparation, waste disposal, hand-washing, meal planning and monitoring of meal provision and recipes for CBCCs and households
-
Each training session lasted 3 days and was provided by AEDOs and nutrition assistants The training combined both theory and practice, including cooking demonstrations. The participants were divided into groups of three to five people. Trainers would introduce selected recipes for nutritious meals, with instructions written on a card that was left with the group. The trainer would facilitate each step of the process. Thereafter, the groups would come together and display what they had cooked. At the display table, a member from each group was selected to explain how they made the meal, how many types of food groups the recipe contained, any alternatives and, lastly, answer any questions from the group. After the display, the participants tasted the food that they had made. The recipes included:1.Porridges: maize flour porridge with groundnut powder, maize flour porridge with dry fish powder, maize flour porridge with dry vegetables, mango porridge, porridge made from a mixture of maize, soya, millet, beans and groundnuts flour, rice porridge with carrot and oil, and rice porridge with groundnut flour2.Milk and soya milk production3.Legume products: pigeon peas sausage, cassava kidos (boiled cassava dipped in eggs and vegetables and fried), soya coffee, sweet potato doughnuts, peanut butter and soya snacks4.Vegetable products: pumpkin leaf meatballs (pumpkin leaves, salt and eggs as ingredients); orange-fleshed sweet potato (OFSP) juice, sweet potato leaf juice, dried vegetables (for preservation); pumpkin leaves and Amaranthus in groundnut powder and sweet potato leaf snack5.Fish products: dry fish with groundnut powder, dry fish with tomato and onion6.Fruit products: pawpaw, guava and lemon juice; pawpaw relish (unripe pawpaw cooked with groundnut powder, tomato and onion) and banana bread
-
Trainings were conducted in February 2016 and CBCC caregivers/communities began putting into practice what they had learned from March 2016. CBCC caregivers and parents were then mentored and supervised by community-based organisations (CBOs) with four visits per month
Study aim and objectives
Methods
Programme theory
Impact on children’s nutrition and health
-
The nutritional impact is mediated by the extent of food substitution effects within the household, and the use of the nutritional intake by the child and their siblings
-
Diversifying diets and increasing the intake of micronutrient-rich foods can have direct effects on attention and cognition
-
Healthier and better-nourished children are then better positioned to learn new skills both at the CBCC and elsewhere
-
All these effects are mediated to some degree by women’s roles in the household, time allocation and decision-making
Impact on agriculture
Main hypotheses and outcome indicators
-
Preschool enrolment and attendance
-
Children’s diets and household diet diversity
-
Infant and young children’s nutritional status and childcare practices
-
Agricultural production
-
Micronutrient status, child development, physical growth
-
Agricultural income
Type | Domain | Indicators |
---|---|---|
Primary | Diets | Individual intake and diet diversity score (children 36–72 m) |
Primary | Childcare practices | WHO IYCF practices |
Primary | CBCC participation | CBCC enrolment and attendance (children 36–72 m) |
Primary | Agriculture | Production output, crop-mix |
Secondary | Health and nutritional status | Anthropometry (weight-for-age, height-for-age, weight-for- age z-scores and MUAC) (children 6–72 m) |
Secondary | Child development | Malawi Development Assessment Tool z-scores (fine motor, gross motor, language and social domains) (children 36–72 m) |
Secondary | Gender | Women’s asset ownership, time use and productivity |
Process | Meal service | Quality of CBCC meals, portion sizes, frequency |
Design of the randomised evaluation
Study site
Study population
Random assignment and manipulation of treatments
Sample sizes
Primary clusters | Communities/CBBCs | Households with children of target age | Children (0–5 y) | Children (3–5 y) | |
---|---|---|---|---|---|
Control | 15 | 30 | 600 | 936 | 648 |
Intervention | 15 | 30 | 600 | 936 | 648 |
Total | 30 | 60 | 1200 | 1872 | 1296 |
Data collection tools
Questionnaire | Module | Description |
---|---|---|
CBCC | Location and access | Identification, location |
Infrastructure | Physical infrastructure, including learning space, water and sanitation, cooking and storage facilities | |
Staff | Staff roster, education and training | |
Curriculum and services | Quality of CBCC activities and related services | |
Caregivers health and nutrition knowledge | Knowledge related to optimal infant and young childcare and feeding practices | |
Health and hygiene practices | Health and hygiene practices of CBCC staff | |
Meal provision | Meal quality, portion sizes, meal planning, management and distribution | |
Food procurement | List of food procured/sourced by the CBCC | |
Garden land | Land used by CBCCs, including ownership and use, size of the plot, crops planted, input and labour for each plot | |
Garden production | Crop production and use | |
Garden sales | Crop sales, volumes and prices | |
Food storage | Food storage infrastructure and practices | |
Household | Roster | Listing of demographic characteristics of household members |
Dwelling characteristics and assets | Basic features of the household’s primary dwelling place, including infrastructure, access to water and electricity | |
Assets | Assets owned (by men and women separately) | |
Land | Land owned and used by household’s women and men, including ownership and use, size of plot, crops planted, labour for each plot | |
Agricultural production | Crop production and use | |
Agricultural marketing | Crop sales, volumes, prices, | |
Agricultural storage | Storage volumes and management | |
Farm investments | On-farm investments and labour | |
Farming practices | Pre- and post-harvest practices | |
Livestock | Livestock holdings, revenue and costs, women ownership | |
Employment and business enterprise | Non-farm sources of income (including employment), costs, male and female members | |
Shocks | Unexpected events that may have influenced household’s wellbeing and responses taken by household | |
Food security | Household vulnerability with respect to food frequency | |
Food expenditures | Food expenditures and quantities consumed at household level | |
Non-food expenditures | Expenditures on household items, clothing and personal expenditures over the last month | |
Caregiver | Caregiver’s health and hygiene | Health- and hygiene-related questions |
Caregiver’s health and nutrition knowledge | Knowledge related to optimal infant and young childcare and feeding practices | |
Caregivers IYCF practices | Infant and child feeding practices | |
Childcare practices | Childcare practices, including support for learning and stimulation | |
Women’s time allocation | Women’s use of time, perceptions on women’s time use | |
Child | Child health | Child immunisation history and health-related questions |
Dietary assessment | Interactive 24-h recall on food intake for children aged 3–5 years | |
Anthropometry | Physical measurements of all children and their parents | |
Development | MDAT scores (fine and gross motor, language and social domains) |