Improving child nutrition and development through community based childcare centres in Malawi

INTERVENTION: Sixty community‐based childcare centres (CBCCs) in rural communities around Zomba district (Malawi) arerandomly assigned to one of two treatment arms Control group: CBCCs are supported by Save the Children’s ECD program with no nutrition or agricultural support. Intervention group: CBCCs are supported by Save the Children’s ECD program with an integrated nutrition and agricultural intervention for nine months. The integrated nutrition and agriculture intervention is aimed at improving the diets, feeding, health and hygiene knowledge and practices in households with infants and young children. This will include promoting optimal feeding and caring practices through parenting groups; engaging parents, adolescents and other adults in the community in the planning and preparation of meals for children within CBCCs; improving agricultural production of nutritious foods and food diversification by using CBCC gardens as a learning site for communities; forming Village Savings and Loans groups to help communities save and access funds to purchase supplies for the CBCC garden and CBCC meals or to start new home gardens; and by organising farmers into collectives to increase their purchasing and selling power. The training materials and approaches used will draw on existing materials developed and validated. Follow up for all participants involves completion of a household survey and child and caregiver assessments at 9 months. Following collection of the follow up measures, participants in the control group are given the opportunity to take part in the intervention. CONDITION: Low quality diets, poor nutrition and health status ; Nutritional, Metabolic, Endocrine ; Low quality diets, poor nutrition and health status PRIMARY OUTCOME: 1. Dietary intake is measured though 24 hour caregiver recall at baseline and 12 months; 2. Childcare practices are assessed through caregiver recall compared to the WHO IYCF definitions at baseline and 12 months; 3. Pre‐school enrolment and attendance is measured over 7 days through caregiver recall at baseline and 12 months; 4. Household food production is measured through recall of previous harvest at baseline and 12 months SECONDARY OUTCOME: 1. Child’s nutrition status is measured through anthropometry (weight‐for‐age, height‐for‐age, weight‐for‐ age z‐scores and MUAC) at baseline and 12 months; 2. Child development is measured through the Malawi Development Assessment Tool z‐scores (fine motor, gross motor, language and social domains) at baseline and 12 months; INCLUSION CRITERIA: Child INCLUSION CRITERIA: 1. Aged 0‐5 years 2. Living in the catchment area of the targeted preschool 3. Provision of informed consent from parent or guardian Caregiver INCLUSION CRITERIA: Caregiver to a participating child.