Experiences of Beneficiary Caregivers in a Supplementary Feeding Program in Southern Malawi

Objective To identify factors affecting successful implementation of a Supplementary Feeding Program (SFP) for treatment of moderate acute malnutrition, based on beneficiary caregivers' perceptions and experiences assessed through qualitative findings of a USAID/FFP funded Tufts University study in Southern Malawi Methods Qualitative data were collected as part of a 2014 feasibility study assessing programmatic changes designed to increase the amount of oil added to corn‐soy blend (CSB) porridge prepared by caregivers of beneficiary children receiving the food for treatment of moderate acute malnutrition. Nine FGDs were conducted using semi‐structured guides, with between 7–10 caregivers participating in each. Interviews were audiotaped, transcribed, de‐ identified, and then analyzed using QSR International's NVivo 10 Software. An inductive, thematic content analysis approach was used to identify common conceptual themes from the data. Consent was obtained from all FGD participants. Results Themes emerged relating to benefits and barriers of participating in the SFP, and its effects within the community. Commonly identified challenges with the SFP described by participants were: (a) poor communication: not knowing when to expect the distribution (e.g. having no fixed date or time, having no advance notice of when the distribution will arrive, or not everyone receives the message about the distribution); (b) problems with distribution: long wait time at the distribution site; distribution not arriving at the planned date or time; or ration not received by the intended beneficiary caregiver. Additionally, it was commonly described that the ration does not last until the next distribution because the child eats the CSB porridge more often than the recommended daily dosage. Among benefits, improvement in the health of the beneficiary children was cited often, as well as happier, more active children, and increased caregiver knowledge of good feeding practices. Participants also described resentment within their community: that the CSB is ‘better’ than other available flours; that beneficiaries are unfairly favored; and that others (not just the beneficiary child) are also entitled to receive the porridge. Several participants described experiencing confrontation with other community members as a result of not sharing their CSB ration. Conclusion The study identifies important contextual issues that may affect implementation of a supplementary feeding program that may be relevant in other settings and helpful in avoiding potential challenges and unintended consequences. Programs should be designed to address barriers to collecting supplementary food rations (distance to distribution site and reliable means of communication). Community perceptions, norms, and economic status of other households potentially creating resentment and the pressure to share with non‐beneficiary households should also be considered. Support or Funding Information This research was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Tufts University under the terms of Contract AFP‐C‐00‐09‐00016‐00 and do not necessarily reflect the views of USAID or the United States Government.