Prevalence, trends and predictors of anaemia and growth faltering in Malawi: A prospective case study of the micronutrient and health programme (1996-2005)
This thesis presents results of studies aimed at assessing the impact of an integrated, community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) and anaemia in rural Malawian children (6.0-59.9 months), and anaemia in women (15-49 years). The programme was implemented by World Vision in collaboration with its local partners in selected rural communities. Using data collected at the baseline (1996), and during evaluation of the programme (2000 and 2004), the results were compared between MICAH and Comparison areas, which only participated in the programme until 1999. Programme interventions included weekly iron supplementation, provision of potable water and sanitation, dietary diversification, promotion of appropriate child feeding practices, and prevention and treatment of parasitic infections. In children, the prevalence of stunting and anaemia was very high in 1996. Although stunting significantly declined in MICAH and Comparison areas in subsequent surveys, the difference between MICAH and Comparison areas was only significant in 2000. As for anaemia, there was a significantly lower prevalence in MICAH than Comparison areas in 2000 and 2004. Factors that were associated with a reduction in the probability of stunting at the baseline or in MICAH/Comparison areas were: increasing household socioeconomic status; children aged >=24 months; household access to protected water; exclusive breastfeeding for 6 months; and, households that raised livestock. For anaemia, factors that were associated with a reduction in childhood anaemia were: children aged >=24 months; children without malaria parasitemia; and, children from households that grew fruit trees. Among women, data were available only for the 2000 and 2004 surveys. There was no significant difference in the prevalence of anaemia in 2000, but significantly fewer women were anaemic in MICAH than Comparison areas in 2004. Women from households that reported using bed nets to prevent malaria; households with increasing socioeconomic status; and surprisingly, women who were diagnosed with malaria parasitemia were less likely to be anaemic. Growing of fruit trees had mixed results. Taken together, the studies showed that the Malawi MICAH programme is a potential model for combating stunting and anaemia in rural areas, particularly if programme interventions are integrated and community-based.