scholarly journals Implementing nutrition interventions in Ghana at district level: Gaps and opportunities

2014 ◽  
Vol 14 (62) ◽  
pp. 8615-8631
Author(s):  
CR Gongwer ◽  
◽  
R Aryeetey
Keyword(s):  
Severe Acute Malnutrition ◽  
National Level ◽  
Scale Up ◽  
District Level ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
High Morbidity ◽  
Nutrition Interventions ◽  
Job Aids ◽  
Nutrition Services

Malnutrition among women and children is an underlying cause of high morbidity and mortality in the developing world. Ghana is one of 36 countries with a high prevalence (> 20%) of chronic stunting in childhood. Although proven and inexpensive technologies and interventions exist to address maternal and child malnutrition, their implementation remains at a low scale in many developing countries, including Ghana. In Ghana, barriers to scaling up nutrition actions have been identified at the national level, yet little is known about the situation at the district and sub-district levels where nutrition interventions are directly delivered. The current study assessed district-level capacity and commitment for accelerating implementation of effective nutrition interventions to address the high burden of maternal and child malnutrition. In June 2010, key informant interviews involving technical officers, clinicians, nurses, and administrative staff, and a desk review of program and administrative reports were conducted in the Omanye District (pseudonym). Using the framework from the WHO landscape analysis of readiness to scale up nutrition actions, interviews explored questions of commitment (financial, planning, collaborations) and capacity (human resources, job aids, skills) to implement nutrition actions in the district. Most key nutrition interventions were being implemented in the Omanye District including growth promotion, micronutrient supplementation, behavior change communication on infant and young child feeding, and a pilot project for community management of severe acute malnutrition. Interventions are challenged, however, by barriers including inadequate financial commitment, low prioritization of nutrition, inadequate personnel, and insufficient job aids. Because nutrition was relatively underfunded in the district, nutrition technical officers had been shifted to perform other or additional tasks. Insufficient investment and inadequate capacity prevents delivery of quality nutrition services in the Omanye District. Interventions that prioritize and improve investment in nutrition actions are needed to optimize nutrition services at the district level in Ghana.

scholarly journals The Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: A Prospective Empirical Study (Preprint)

2018 ◽  
Author(s):  
Sunhea Choi ◽  
Ho Ming Yuen ◽  
Reginald Annan ◽  
Trevor Pickup ◽  
Andrew Pulman ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Professionals ◽  
Severe Acute Malnutrition ◽  
Scale Up ◽  
Health Sector ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
World Health ◽  
Knowledge Gain ◽  
Prospective Longitudinal

BACKGROUND Scaling-up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive Malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to guidelines of the World Health Organization (WHO). OBJECTIVE The study aim was to test whether the Malnutrition eLearning course improves knowledge and skills of in-service and pre-service health professionals in managing children with severe acute malnutrition. METHODS This 2-year prospective, longitudinal, empirical research study took place in Ghana, Guatemala, El Salvador and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 pre-service trainees from 9 academic institutions, and 204 online users participated. Knowledge gain after training and retention over time were measured through pre- and post-assessments, comprising questions pertaining to screening, diagnosis, pathophysiology, and treatment and prevention of malnutrition. Comprehension, application and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS Before the course, awareness of the WHO guidelines was 36.7% (389/1059) overall and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course of 606 participants who had pre-and post-assessment data was 11.8 (95% CI 10.8, 12.9 P<.001) – a relative increase of 41.5%. The proportion who achieved above the pass mark post-training was 58.7% (356/606), compared with 18.2% (110/606) pre-training. Of the in-service professionals, 86% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis and/or management. This group demonstrated significantly increased, retained knowledge 6-months after training (mean difference (SD) from pre-assessment:12.1 (11.8)), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional operational and policy changes were also found. CONCLUSIONS The Malnutrition eLearning course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following completion of the course.

Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children

2009 ◽  
Vol 30 (3_suppl3) ◽  
pp. S434-S463 ◽  
Author(s):  
Saskia de Pee ◽  
Martin W. Bloem
Keyword(s):  
Severe Acute Malnutrition ◽  
Essential Fatty Acids ◽  
Food Supplements ◽  
Complementary Food ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Malnourished Children ◽  
Nutrient Density ◽  
Animal Source ◽  
The Impact

Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources with few animal-source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal-source foods, e.g., milk, or other specific nutrients. Options include using specially formulated foods (fortified blended foods, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn–soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.

scholarly journals Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

2018 ◽  
Vol 15 (9) ◽  
pp. 1807 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Integrated Management ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

scholarly journals Exploring trust in religious leaders and institutions as a mechanism for improving retention in child malnutrition interventions in the Philippines: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036091
Author(s):  
Lincoln Leehang Lau ◽  
Warren Dodd ◽  
Han Lily Qu ◽  
Donald C Cole
Keyword(s):  
Severe Acute Malnutrition ◽  
The Philippines ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Secondary Outcome ◽  
Religious Leaders ◽  
Extreme Poverty ◽  
Factors Associated

ObjectivesIn the context of persistent child malnutrition in the Philippines, the objective of this study was to examine how different dimensions of trust affected programme retention and physiological outcomes when a faith-based organisation (FBO) addressed moderate and severe acute malnutrition among children from households experiencing extreme poverty.SettingWe retrospectively analysed survey data collected by International Care Ministries (ICM) in 2012–2013 across 150 communities in eight provinces (Negros Oriental, Negros Occidental, Bohol, Palawan, Sarangani, South Cotabato, Sultan Kudarat and Zamboanga del Norte) of the Philippines.Study participantsCaregivers of 1192 children experiencing moderate acute malnutrition and severe acute malnutrition between the ages of 6 and 60 months.InterventionA 16-week child malnutrition treatment programme called Malnourished Child Outreach offered by ICM in partnership with local religious leaders and institutions.Primary and secondary outcome measuresProgramme dropout and weight-for-height z-score (WHZ) at the end of the programme for enrolled children were the two outcomes of interest. A logistic mixed-effects model was built to assess factors associated with programme dropout and a linear mixed-effects model for factors associated with WHZ at the end of the programme.ResultsTrust in religious leaders or institutions (−0.87 (95% CI: −1.43,–0.26)) was negatively associated with programme dropout, suggesting that with increasing levels of trust, decreasing proportions of children dropped out of treatment. Retention in the programme led to improved WHZ among participating children (−0.38 (95% CI: −1.43, 0.26)). Various measures of social capital, including trust in religious and public institutions, were not associated with WHZ at the end of the programme.ConclusionsLeveraging pre-existing trust in religious leaders and institutions among households experiencing extreme poverty is one way that ICM, and potentially other FBOs, can promote retention in child nutrition interventions among vulnerable populations.

scholarly journals Filling the Gaps for Community-Based Programs Managing Treatment and Prevention of Child Malnutrition in Non-Emergency Contexts: Results from the Rainbow Project 2015-17 in Zambia

2018 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Program Outcomes ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Evaluation of nutrition programs is essential to guarantee the effectiveness of community-based management of acute malnutrition (CMAM). Methods: The Rainbow Project Supplementary Feeding Programs (SFPs) in Zambia were evaluated between years 2015-17, following implementation of new recommendations based on previous evaluations (years 2012-14). Outcomes of the program were compared with International Standards and with those of 2012-14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: Data for 900 under age 5 years malnourished children (48.8% male; mean age 19.7months &plusmn;9.9) were analyzed. Rainbow 2015-17 program outcomes met International Standards, for general malnutrition or stratified moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). When comparing with 2012-14 outcomes, better performance was noted: mortality rates were reduced by half (5.6% vs 3.1%, p = 0.01; for SAM: 12.4% vs 6.7%, p = 0.006), with significant improvement in average weight gain and mean length of stay (p&lt;0.001), and increased awareness of HIV status (+30%; p &lt; 0.001). HIV infection (5.5; 1.9&ndash;15.9), WAZ &lt; &minus;3 at baseline (4.6; 1.3&ndash;16.1) and kwashiorkor (3.5; 1.2&ndash;9.5) remained the major predictors of mortality. Conclusion: The effectiveness of the Rainbow SFPs for child malnutrition treatment and prevention in Zambia has significantly improved after evaluation and implementation activities, with impressive outcomes which resulted in a 50% reduction in mortality.

scholarly journals Exploring opportunities to enhance effectiveness of mobile health and nutrition strategy for providing health and nutrition services amongst pastoralists in Somali region, Ethiopia

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Olusola Oladeji ◽  
Bibilola Oladeji ◽  
Mohamed Diaaeldin Omer ◽  
Abdifatah Elmi Farah ◽  
Ida M. Ameda ◽  
...  
Keyword(s):  
Mobile Health ◽  
Severe Acute Malnutrition ◽  
Critical Role ◽  
Health Facilities ◽  
Acute Malnutrition ◽  
Access To Health Services ◽  
Somali Region ◽  
Nutrition Services ◽  
Health And Nutrition ◽  
Nutrition Strategy

Background: The health system in Ethiopia’s Somali Region is weak with limited number of health facilities with more than 60% of the population living more than 5 km to the nearest health facilities. The deployment of mobile health and nutrition teams has played critical role in providing essential health and nutrition services.Aim: This study aimed to assess the effectiveness of the mobile health and nutrition strategy in providing health and nutrition services in the targeted woredas (districts).Setting: Somali Region of Ethiopia.Methods: The study was a retrospective chart review of the monthly mobile health and nutrition team and the static health facilities in the 29 woredas between April 2019 and March 2020 and the AccessMod analyses for geographical accessibility to health facilities in the region.Results: 40 (40.4%) out of the 99 woredas in Somali regions have at least 80% of the population living more than 5 km from the nearest health facility out of which 18 (45%) woredas are currently being supported by the mobile health team. The mobile team contributed to increasing access to health services in the targeted woredas with 30.8% of the total children vaccinated for measles and 39% of the total children treated for severe acute malnutrition in the targeted 29 woredas.Conclusion: With mobile health and nutrition strategy being recognised as a useful strategy to deliver health and nutrition services in the region, there is a need to explore opportunities and innovation to enhance the effectiveness of the implementation.

scholarly journals Community-Based Management of Acute Malnutrition in Infants Under 6 Months of Age

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1102-1102
Author(s):  
Maeve Woeltje ◽  
Anastasia Evanoff ◽  
Diana Culbertson ◽  
Beth Helmink ◽  
Kenneth Maleta ◽  
...  
Keyword(s):  
Inpatient Care ◽  
Randomized Clinical Trials ◽  
Severe Acute Malnutrition ◽  
Scale Up ◽  
Retrospective Chart Review ◽  
Acute Malnutrition ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Recovery Rates ◽  
Supplemental Food

Abstract Objectives To examine the outcomes of acutely malnourished infants under 6 months (u6m) who could not be hospitalized or exclusively breastfed and were instead treated under the community management of acute malnutrition (CMAM) model using ready to use therapeutic food (RUTF) or a supplemental food. Methods The study was a retrospective chart review of 323 infants u6m with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) seen across 20 CMAM clinics in rural southern Malawi who could not be admitted to inpatient care, which is the established standard of care for acute malnutrition in infants u6m. Infants with SAM were given 175 kcal/kg/day of RUTF and those with MAM were given 75 kcal/kg/day RUTF or supplemental food, based on availability. Nutritional counseling was provided to the caregivers of all participants, and mothers were counseled about improved breastfeeding practices. Infants were reassessed every two weeks. Outcomes included successful nutritional recovery (achieving WHZ of ≥−2 without edema), failure to achieve recovery after 12 weeks, hospitalization, death, and loss to follow up. Demographic information was also collected. Continuous variables were compared using Student's t test. Categorical variables were compared using Fisher's exact test. Results 130 infants u6m with SAM and 193 with MAM were treated using the same CMAM model used in 6–59 month-old children. About 90% of children in both groups were breastfeeding. Mean duration of therapy was 31.5 days for SAM and 20.8 days for MAM. Recovery rates were high in both groups (SAM 75%; MAM 81%). Recovery rates and other outcomes were similar to older children who were being treated contemporaneously at the same sites in the context of randomized clinical trials. Conclusions When inpatient care is not possible, therapeutic and supplementary foods provided to infants u6m with acute malnutrition is a viable treatment option. Making this option available has the potential to massively scale up the number of infants treated, with acceptable recovery rates, and at a relatively low cost to the health care system. Funding Sources None.

scholarly journals MANAGEMENT OF INFANTS LESS THAN SIX MONTHS WITH SEVERE ACUTE MALNUTRITION (SAM).

2020 ◽  
Vol 27 (06) ◽  
pp. 1113-1118
Author(s):  
Saadia Khan ◽  
Gul Hasan ◽  
Ibad Ali ◽  
Reema Arshad ◽  
Imrana Ali ◽  
...  
Keyword(s):  
Weight Gain ◽  
Breast Feeding ◽  
Maternal Education ◽  
Severe Acute Malnutrition ◽  
National Level ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Average Weight ◽  
Breast Feed ◽  
Study Results

Objectives: To determine the average weight gain after lactation counseling therapy in infants up to six months of age having severe acute malnutrition. Study Design: Quasi experimental trial. Setting: Stabilization Center Unit, the Children’s Hospital & the Institute of Child Health, Multan. Period: 1st October 2015 to 1st October 2016. Material & Methods: A total of 205 children with SAM were included in this study using non-probability consecutive sampling technique. Mothers of these children were motivated for more than 8 feeds/day, positioning and attachment at breast feeding was advised, demonstrated and monitored. All the data obtained was entered and analyzed by SPSS version 20. Results: Of these 205 study cases, 142 (69.3%) were boys and 63 (30.75) were girls. Mean age of our study cases was 3.75 ± 1.39 months (with minimum age of our study cases was 2 months while maximum age was 6 months). Of these 205 study cases, 101 (49.3 %) were from rural areas while 104 (50.7%) were from urban areas. Mothers of 117 (57.1%) study cases were literate while 88 (42.9%) were illiterate. Majority of our study cases i.e. 129 (62.9%) were from middle income background and 76 (37.1%) were from poor social background. Partial breast feeding was positive in 145 (70.7%) of our study cases and no breast feeding was noted in 60 (29.3%). Mean baseline weight was 2737.07± 585.60 grams. Mean weight at discharge was 2995.37 ± 621.97 grams and mean weight gain was 800.0 ± 258. 29 grams. Average daily weight gain was noted to be 11.27 ± 4.73 g/kg/day. Conclusion: Our study results have shown that lactation counseling therapy significantly improves weight gain in children under 6 months of age with severe acute malnutrition. Mothers of infants presenting with malnutrition must be counselled to breast feed to improve their clinical outcomes. Mean weight gain was significantly associated with maternal education and socioeconomic status. Further studies are suggested from different parts of the country to generate our local data at national level which may be incorporated for national health policy guidelines.

scholarly journals Description of a community paediatric strategy offering a package of services to prevent malnutrition among children in one health district in Mali

2021 ◽  
Author(s):  
Thomas Roederer ◽  
Augusto E. Llosa ◽  
Susan Shepherd ◽  
Isabelle Defourny ◽  
Michel-Olivier Lacharité ◽  
...  
Keyword(s):  
One Health ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Scale Up ◽  
Health Indicators ◽  
Food Distribution ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Health Area

AbstractBackgroundWe present results from an intervention case study, the Soins Preventifs de l’Enfant (SPE) project, in Konséguéla health area, Mali. The intervention involved a network of community health workers providing a comprehensive preventive/therapeutic package, ultimately aiming at reducing under 24-month mortality. Associated costs were documented to assess the feasibility of replication and scale-up.MethodsSPE program monitoring data were obtained from booklets specific to the program between 2010 and 2014. Data included sex, age, vaccination status, anthropometric measurements, Ready-To-Use-Supplementary Food distribution, morbidities reported by the mother between visits, hospitalizations over 18 months of follow-up. Cross-sectional surveys in the district of Koutiala, of which Konséguéla is one health area, were conducted yearly between 2010 and 2014 for comparison, using difference-in-difference approach. Ethical approval was granted from the Malian Ethical Committee.ResultsGlobal and Severe Acute Malnutrition prevalences decreased over time in Konséguéla as well as in the rest of the district, but the difference between areas was not significant. Children reaching 24 months were 20% less stunted in Konséguéla than children the same age outside (p<0.001). Mortality rates significantly decreased more in Konséguéla, while vaccination coverage for all antigens significantly increased in the meantime. The package cost approximately USD 95 per child per year; 56% of which was for the RUSF.ConclusionThe results of this case study suggest a sustained impact of a community based, comprehensive health package on major child health indicators. Most notably, while improvements in acute malnutrition were found in the district as a whole, those in the intervention area were more pronounced. Trends for other indicators suggest additional benefits.

scholarly journals Literacy is power: structural drivers of child malnutrition in rural Liberia

2020 ◽  
pp. bmjnph-2020-000140
Author(s):  
Odell W Kumeh ◽  
Mosoka P Fallah ◽  
Ishaan K Desai ◽  
Hannah N Gilbert ◽  
Jason B Silverstein ◽  
...  
Keyword(s):  
Social Protection ◽  
Health Workers ◽  
Virus Disease ◽  
Severe Acute Malnutrition ◽  
Feeding Practices ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Structural Factors ◽  
Structural Barriers ◽  
Depth Interviews

BackgroundIn Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country’s civil war and were further exacerbated by the 2014–2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations.MethodsBetween July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers’ experiences, as well as health workers’ understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data.ResultsMothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition.DiscussionThe lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.

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