1. Effects of Participatory Agriculture and Nutrition project on Child Growth in Northern Malawi

Bezner Kerr, R.,  Berti, P.R. and Shumba, L. 2010 ‘Effects of Participatory Agriculture and Nutrition project on Child Growth in Northern Malawi Public Health Nutrition (Cambridge University Press) doi:10.1017/S1368980010002545


Objective: To investigate whether children in households involved in a participatory agriculture and nutrition intervention had improved growth compared to children in matched comparable households and whether level of involvement and length of time in the project had an effect on child growth.

Design: A prospective quasi-experimental study design comparing baseline and follow-up data in ‘intervention’ villages with matched subjects in ‘comparison’ villages. Mixed model analyses were conducted on standardized child growth scores (weight and height for age Z-scores), controlling for child age and testing for effects of length of time and intensity of village involvement in intervention.

Setting: A participatory agriculture and nutrition project run by a hospital aimed to improve child nutritional status with smallholder farmers in a rural area in northern Malawi. Agricultural interventions involved intercropping legumes and visits from farmer researchers, while nutrition education involved home visits and group meetings.

Subjects: Participants in intervention villages were self-selected, and control participants were matched by child age and household food security status. Nine surveys were conducted, taking 3838 height and weight measures of U5 children over a six-year period.

Results: There was an improvement over initial conditions of up to 0.6 in weight-for-age Z-score (from -0.4+/-0.5 to 0.3+/-0.4 ) for the children in the longest involved villages, and an improvement over initial conditions of 0.8 in weight-for-age Z-score for the children in the most intensely involved villages (from -0.6+/-0.4  to 0.2+/-0.4).

Conclusions: Long-term efforts to improve child nutrition through participatory agricultural interventions had a significant effect on child growth.

For more information, contact our research coordinator Rachel Bezner Kerr, at

2. Breastfeeding and Mixed Feeding Practices in Malawi: Timing, Reasons, Decision Makers, and Child Health Consequences.

Bezner Kerr, R., Berti, P., & Chirwa, M. (2007). Breastfeeding and Mixed Feeding Practices in Malawi: Timing, Reasons, Decision Makers, and Child Health Consequences. Food and Nutrition Bulletin, 28(1), 90-99.


Background – In order to effectively promote exclusive breastfeeding, it is important to first understand who makes child-care and child-feeding decisions, and why those decisions are made; as in most parts of the world, exclusive breastfeeding until 6 months of age is uncommon in Malawi.

Objective – To characterize early infant foods in rural northern Malawi, who the decision-makers are, their motivation, and the consequences for child growth, in order to design a more effective program for improved child health and nutrition.

Methods – In a rural area of northern Malawi, 160 caregivers of children 6 to 48 months of age were asked to recall the child’s age at introduction of 19 common early infant foods, who decided to introduce the food, and why. The heights and weights of the 160 children were measured.

Results – Sixty-five percent of the children were given food in their first month, and only 4% of the children were exclusively breastfed for 6 months. Mzuwula and dawale (two herbal infusions), water, and porridge were common early foods. Grandmothers introduced mzuwula to protect the children from illness; other foods were usually
introduced by mothers or grandmothers in response to perceived hunger. The early introduction of porridge and dawale, but not mzuwula, was associated with worse anthropometric status. Mzuwula, which is not associated with poor growth, is usually made with boiled water and given in small amounts. Conversely, porridge, which is associated with poor child growth, is potentially contaminated and is served in larger amounts, which would displace breastmilk.

Conclusions – Promoters of exclusive breastfeeding should target their messages to appropriate decision makers and consider targeting foods that are most harmful
to child growth.

Breastfeeding and mixed feeding practices in Malawi: Timing, reasons, decision makers, and child health consequences (PDF)

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