Conducting Formative Research to Understand Patterns and Determinants of Small‐quantity LNS Utilization in Rural Malawi and Mozambique

Objective To understand household utilization of a 20‐gram, lipid‐based nutrient supplement (LNS) for children 6 – 23 months Methods In Malawi and Mozambique, we conducted home‐feeding trials with small‐quantity, LNS for 8 and 6 weeks, respectively. In‐depth interviews (n = 38), direct meal observations (n = 80), full‐day observations (n = 38), and spot checks of LNS supply (n = 23), were conducted (n = 35 in Malawi; n = 24 in Mozambique) as triangulation. We analyzed data drawing from Grounded Theory with Atlas.ti v7.0 and using basic statistics. Results The LNS was utilized contrary to recommended use, with 50% of households in Malawi running out of stock early and 87% of households in Mozambique either over‐ or under‐using it. Salient patterns of LNS sharing occurred in three ways: 1) caregiver consumption of LNS, 2) caregiver sharing of LNS with children >2 years, and 3) theft by older children due to lack of storage. In Mozambique, it was common for caregivers to not only provide >1 LNS sachet to children 6 – 23 months, but also forget or not be permitted by husbands to provide it. In Malawi, caregivers often gave LNS leftovers to children >2 years. LNS utilization was largely governed by rational decision making in line with core cultural values and as coping mechanisms in light of food insecurity, rather than a mere disregard for program guidelines. Conclusion Interventions need to address reasons behind household choices to over‐ or under‐use a small‐quantity LNS and utilize strategies to intervene at key behavioral decision points to maximize adherence. Funded by Children's Investment Fund Foundation