Strengthening Child Nutrition in Malawi: How CIPHER and Partners Adapted Breastfeeding Assessments During COVID-19
Protecting Child Nutrition in a Pandemic
The COVID-19 pandemic disrupted global health systems, but one of its most concerning ripple effects was its potential impact on infant and young child feeding (IYCF) practices. With misinformation about virus transmission and restrictions on healthcare access, ensuring proper breastfeeding and complementary feeding became even more critical.
Recognizing this challenge, CIPHER, in partnership with UNICEF, Kamuzu University of Health Sciences (KUHeS), and the Malawi Ministry of Health, conducted a groundbreaking study to assess and adapt IYCF data collection tools for the pandemic era.
This initiative not only refined breastfeeding assessment methods but also provided crucial insights into how Malawian mothers navigated infant feeding during COVID-19—revealing resilience, challenges, and opportunities for improvement.
The Challenge: Assessing IYCF in a Changing World
Before COVID-19, standard IYCF questionnaires were effective—but the pandemic introduced new complexities:
Misinformation: Fears that breastfeeding could transmit SARS-CoV-2. Healthcare disruptions: Lockdowns and reduced clinic access affected nutrition support. Cultural & linguistic barriers: Some foods in global questionnaires weren’t locally relevant.
To address this, UNICEF updated its “Standard-Set of Breastfeeding Questions”—but would it work in Malawi’s rural and urban communities?
The Study: A Two-Phase Approach
With $31,770 in funding from UNICEF, KUHeS and CIPHER led a mixed-methods study in Lilongwe (urban) and Nkhata-Bay (rural). The research had two key phases:
- Pilot Testing (26 participants)
- 10 enumerators tested the modified questionnaire.
- Exit focus group discussions (FGDs) with mothers and data collectors identified challenges (e.g., translation issues with terms like “cheese” and “fried dough”).
- Large-Scale Assessment (426 mothers/caregivers)
- Evaluated IYCF practices, COVID-19 knowledge, and feeding behaviors.
- Conducted 4 additional FGDs to assess tool usability.
Key Findings: Resilience and Adaptation
- High Breastfeeding Rates Despite COVID-19 Fears
- 90.4% of mothers were still breastfeeding.
- Only 4.6% had stopped—with 22% citing COVID-19 as the reason.
- Most knew about COVID-19 risks but continued breastfeeding safely.
- Complementary Feeding Trends
- Top liquids given to infants (6–24 months): Plain water (96%), formula (96%).
- Common solid foods: Porridge (73%), dark leafy vegetables (77%), fish (38%).
- Success of the Adapted Tool
- Both mothers and enumerators found the revised questionnaire easy to use.
- Minor challenges arose with non-local foods, suggesting a need for further localization.
Why This Matters: A Model for Future Crises
This study proved that:
Localized tools work—Adapting global questionnaires to regional diets improves accuracy. Mothers prioritized nutrition—Despite pandemic fears, breastfeeding rates remained strong. Real-time feedback is key—FGDs helped refine the tool before large-scale use.
Lessons for Global Health
- Invest in culturally sensitive tools to ensure accurate IYCF monitoring.
- Community engagement is vital—Mothers’ insights directly improved the assessment process.
- Malawi’s resilience sets an example—Even during a pandemic, families upheld strong feeding practices.
A Step Forward for Child Health
Thanks to CIPHER, UNICEF, KUHeS, and Malawi’s health leaders, this study didn’t just assess IYCF—it strengthened the tools needed to protect child nutrition in future emergencies.
As the world faces new health crises, Malawi’s experience offers a blueprint: combine global expertise with local knowledge to safeguard the youngest and most vulnerable.
Acknowledgements:
This work was made possible by the collaboration of CIPHER, UNICEF Malawi & HQ, KUHeS, and the Malawi Ministry of Health. Special thanks to the mothers and health workers who shared their experiences.