The impact of an integrated community-based micronutrient and health programme on stunting in Malawian preschool children

Objective: To assess the impact of the 1996-2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas. Design: Prospective study of three large-scale cross-sectional surveys conducted in 1996, 2000 and 2004 in MICAH and Comparison populations. Setting: Rural areas in Malawi. Subjects: Preschool children (6.0-59.9 months) from randomly selected households (474 from the 1996 baseline survey; 1264 from 2000 MICAH areas; 1500 from 2000 Comparison areas; 1959 from 2004 MICAH areas; and 1008 from 2004 Comparison areas), who responded to a household questionnaire, were weighed and measured using standard protocols. Results: At the baseline in 1996, the prevalence of stunting (60.2%) was very high. By 2000, the prevalence of stunting had declined to 50.6% and 56.0% (chi(2) = 7.8, P=0.005) in MICAH and Comparison areas, respectively. In 2004, the prevalence of stunting did not differ significantly between MICAH and Comparison areas (43.0% v. 45.1%; chi(2) = 1.11, P=0.3). Severe stunting affected 34.7% of children at baseline, which declined to 15.8% and 17.1% (chi(2) = 0.86, P=0.4) in MICAH and Comparison areas, respectively, by 2004. Regional variations existed, with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts. Conclusion: Given the length of implementation, wide-scale coverage and positive impact on child growth in Phase I (1996-2000), the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi, although the catch-up improvement in Comparison areas during Phase II (2000-2004) cannot be adequately explained.