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A multi-sector approach for nutrition in school-age children and adolescents in Malawi

This is a summary of a Field Exchange field article that was included in issue 66. The original article was authored by Doreen Matonga, Keisha Nyirenda, Jason Chigamba and Dalitso Kang’ombe 

Doreen Matonga is a Communication for Development Specialist at UNICEF Malawi.

Keisha Nyirenda is a Nutrition Officer at UNICEF Malawi.

Jason Chigamba is a Principal Nutrition Officer at the Department of Nutrition, HIV and AIDS (DNHA) at the Ministry of Health, Malawi.

Dalitso Kang’ombe is Chief Nutrition Officer at the DNHA, Ministry of Health, Malawi.

In Malawi, the government has led the implementation of an integrated multi-sector adolescent nutrition programme including weekly iron and folic acid (IFA) supplementation for adolescent girls and a nutrition sensitive agriculture (NSA) programme.

  • Weekly IFA supplementation has achieved high coverage across many schools but was impacted by COVID-19-related restrictions.
  • The NSA programme led to steady improvements in adolescent girls meeting minimum dietary diversity standards. COVID-19-related impacts were mitigated through migrating learning to mobile phones.
  • The integrated, multi-sector approach has been effective thus far and the Government of Malawi is leading efforts to scale up.

Background

In Malawi, nutrition programming for adolescents is guided by a National Multi-Sector Adolescent Nutrition Strategy (NMSANS) 2019-2023. The NMSANS creates a platform to address the needs of in- and out-of-school adolescents 10-19 years of age through multi-sector collaboration among various government ministries. The responsibilities of the government systems involved are outlined in Table 1.

Two programmes implemented to support improved adolescent nutrition include (1) weekly iron and folic acid (IFA) supplementation for adolescent girls; and (2) a nutrition sensitive agriculture (NSA) programme.

Table 1. Responsibilities of government systems within the adolescent nutrition programme

System

Key stakeholders and their roles and responsibilities

Health system

The Department of Nutrition, HIV and AIDS (DNHA)

  • Convenes and chairs the multi-sector national nutrition committee and coordinates the activities of development partners
  • Coordinates and mobilises resources
  • Trains frontline workers (School Health and Nutrition (SHN) teachers and Health Surveillance Assistants (HSAs))

Community Health Nurses (CHN)

  • Receive and distribute IFA tablets to schools
  • Supervise HSAs
  • Consolidate monthly reports from schools and community platforms for submission to the district

HSAs

  • Administer IFA and deworming tablets to out-of-school adolescent girls at community level
  • Compile monthly reports from community platforms for submission to health facilities
  • Serve as a direct link between the health system and the education system

Education system

Ministry of Education

  • Facilitates the integration of the NMSANS into the existing school health and nutrition platforms
  • Provides a delivery platform for the adolescent nutrition programme

SHN teachers

  • Manage stocks of IFA and deworming tablets in schools
  • Provide health education talks and individual counselling to learners
  • Administer weekly IFA and annual deworming tablets
  • Support capacity-building for in-school adolescent girls in the production of nutritious foods and rearing of small livestock
  • Compile weekly and monthly reports for submission to health facilities

WASH System

Ministry of Agriculture, Irrigation and Water Development

  • Coordinates the water, sanitation and hygiene (WASH) interventions in schools and communities
  • Provides access to safe water supplies and sanitation facilities in schools

Food System

Ministry of Agriculture, Irrigation and Water Development

  • Facilitates the inclusion of adolescent nutrition activities into the agriculture, food and nutrition security strategic documents
  • Creates an enabling environment for the rollout of agriculture sector-specific adolescent nutrition interventions

Agriculture Extension Development Officers (AEDO)

  • Support capacity-building for out-of-school adolescent girls in the production of nutritious foods and rearing of small livestock
  • Promote consumption of diversified, safe and nutritious foods among adolescents using the Malawi ‘six food group’ model1  
  • Promote gain of food processing and meal preparation skills

Weekly IFA supplementation for adolescent girls

In 2019, the Ministry of Health’s Department of Nutrition, HIV and AIDS (DNHA) and the Department of Reproductive Health, with support from UNICEF, rolled out a pilot weekly IFA programme to adolescent girls (10-19 years of age) in six districts2.

In schools, a participatory approach involved adolescent girls assisting teachers in monitoring self-compliance. At community level, adolescent nutrition groups were established during which community volunteers and frontline workers engaged adolescents through nutrition education, counselling, cooking demonstrations, sporting activities and the establishment of nutrition demonstration gardens. Supplementation sessions were conducted under supervision and with the involvement of either a focal teacher in school or an HSA at community level.

NSA programme

With support from the World Bank (WB) and the European Union (EU), the Government of Malawi is implementing NSA programmes in 12 districts where dietary diversity is low3. Within the EU-supported NSA programme, in- and out-of-school adolescents (15-19 years of age) have established nutrition demonstration plots where they learn food production and preservation methods. They are also taught food preparation techniques through cooking demonstrations. To support sustainability, community leaders have contributed farming land for nutrition demonstration plots. Adolescents have also contributed to cooking demonstrations through crops harvested from the demonstration gardens and from the rearing of small livestock. In the WB-supported programme, adolescent girls are given IFA tablets.

The NSA programmes support community social mobilisation and encourage the participation of in- and out-of-school adolescents in community platforms. The programmes are delivered through the internationally recognised care group model, with specific adolescent groups established to promote the engagement of out-of-school adolescents. The frequency of meetings varies from weekly to bimonthly, intensifying during school holidays when more adolescents are present in the community. The groups are led by community nutrition volunteers and peer educators with support from health and agriculture frontline workers and SHN teachers. Nutrition education on dietary diversification using Malawi’s six food group model is provided and is complemented by education on sexual and reproductive health, WASH and other life skills.

Monitoring and evaluation

The Government of Malawi developed various monitoring tools for the IFA programme including:

For the NSA programme, a monitoring and evaluation framework was developed which contributes to the monitoring of national nutrition indicators.

Results

Weekly IFA supplementation

NSA programme

Successes

Challenges

Next steps

Given the effectiveness of the integrated multi-sector approach, the Government of Malawi is leading efforts to scale up the adolescent nutrition programme. The aim is to achieve nationwide coverage in 2022 and efforts are being made to bring more partners on board. In the long term, the Government of Malawi hopes to include the adolescent nutrition programme under the normal government procurement system so that it can be sufficiently budgeted and financed. At district level, this is being lobbied by the Department of Nutrition through the launch of SUN 3.0.

For more information, please contact Doreen Matonga at dmatonga@unicef.org

 

References

FAO and UNICEF (2020) Knowledge, attitude and practices (KAP) survey towards maternal, adolescent, infant and young child nutrition and care practices, water and sanitation and nutrition-sensitive agriculture: Report for the Afikepo Nutrition Programme and Nutrition-sensitive Agriculture component in Malawi. Available at: https://www.unicef.org/malawi/reports/report-afikepo-nutrition-programme-and-nutrition-sensitive-agriculture-component-malawi

FAO and UNICEF (2021) Knowledge, attitude and practices (KAP) survey towards maternal, adolescent, infant and young child nutrition and care practices, water and sanitation and nutrition-sensitive agriculture: Report for the Afikepo Nutrition Programme and Nutrition-sensitive Agriculture component in Malawi. Unpublished

National Statistical Office (NSO) Malawi (2017) Malawi Micronutrient Survey 2015-16. NSO, Community Health Sciences Unit Malawi, Centers for Disease Control and Prevention (CDC) and Emory University: Atlanta, GA, USA. Available at: https://dhsprogram.com/pubs/pdf/FR319/FR319.m.final.pdf

University of Sydney, University of Malawi, UNICEF and FAO (2019) Baseline report for Afikepo Nutrition Program and the Nutrition-sensitive Agriculture component in Malawi. Available at: https://dnhamalawi.org/wp-content/uploads/2020/12/AFIKEPO_Baseline-Report_FINAL-v1-1.pdf

Read more...

1 The Malawi six food group model comprises starches/pulses, animal source foods, legumes, vegetables, fruits and fats and oils

2 Mangochi, Dedza, Salima, Lilongwe, Dowa, Machinga

3 Mwanza, Ntchisi, Chiradzulu, Thyolo, Mulanje, Kasungu, Salima, Nkhotakota, Nkhata Bay, Mzimba, Karonga and Chitipa

4 Four tablets if the month has four weeks and five tablets if the month has five weeks

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Doreen Matonga, Keisha Nyirenda, Jason Chigamba and Dalitso Kang’ombe (). A multi-sector approach for nutrition in school-age children and adolescents in Malawi. FEX 66 Digest , March 2022. www.ennonline.net/fexdigest/66/nutritioninschoolagedchildrenmalawi

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