Scaling up support for early child development (MAHAY, Madagascar)
Children in Madagascar have the highest rates of malnutrition in all African countries, and 3 out of 4 children in many regions are malnourished, due to a range of political, economic, historical and cultural factors. Due to the extreme poverty in which they live, many Malagasy children also have limited access to books and toys. My work in Madagascar has taken place in close collaboration with many colleagues, as well as with the Ministries of Health and Nutrition. The goal of the work is to scale up programs that have been shown to work in other cultures and contexts. We are currently building on our MAHAY findings with a new study, the MAHAY-Mikolo study.
Collaborators:
Emanuela Galasso (World Bank), Lisy Ratsifandrihamanana (Early Child Development Specialist, Madagascar ), Ann Weber (University of Nevada, Reno), Christine Powell (University of the West Indies), Christine Stewart (UC Davis).
Findings:
In this study, we used a cluster-randomized controlled trial of options to address undernutrition in Madagascar (protocol: BMC Public Health). Our findings were that the youngest children who were fully exposed to the child nutrient supplement had the best growth outcomes (Lancet Global Health), and also effects on anemia (Journal of Nutrition). We are currently working in partnership with the Ministry of Health in Madagascar to roll out nutritional supplementation country-wide, a program initiated as a consequence of our results. We have also examined how child development trajectories are affected by poverty and poor nutrition in the shorter term when children are 3-6 years old (Developmental Science) and also when they are older (The World Bank Economic Review). In addition, we integrated data from multiple time points in order to examine the challenges of scaling up large-scale nutrition efforts (Maternal and Child Nutrition). In a final paper (BMC Public Health), we examined parental perceptions of child development to explore the role that parental preference and attitude plays in parenting.
Publications (sorted by recency):
Stewart, C. P., Fernald, L.C.H., Arnold, C., Weber, A., and Galasso, E. Impact of lipid-based supplementation on child anemia and micronutrient status in Madagascar: a multi-arm cluster randomized controlled trial J Nutrition (2020)
Chung, E.O., Fernald, L.C.H., Galasso, E., Ratsifandrihamanana, and Weber, A.M. Caregiver perceptions of child development in rural Madagascar: a cross-sectional study. BMC Public Health. (2019)
Galasso, E., Weber, A., Stewart, C. P., Ratsifandrihamanana, L. and Fernald, L.C.H. Impact of MAHAY trial on child growth and development outcomes: a cluster-randomized trial. Lancet Global Health (2019).
Weber, A., Fernald, L.C.H., Galasso, E. The perils of scaling up: Long term effects of a community nutrition program in Madagascar. Maternal and Child Nutrition (2019) Jan;15 Suppl 1:e12715
Galasso, E., Fernald, L.C.H., Weber, A.M. Dynamics of child development: Socio-economic gradients in a longitudinal cohort living in extreme poverty. The World Bank Economic Review (2017). January 9.
Fernald, L.C.H., Galasso, E., Qamruddin, J., Ranaivoson, C., Ratsifandrihamanana, L., Stewart, C., Weber, A. A cluster-randomized controlled trial of nutritional supplementation and promotion of responsive parenting in Madagascar: the MAHAY study design and rationale. BMC Public Health (2016) Jun 3;16:466
Weber, A.M., Fernald, L.C.H., Galasso, E. and Ratsifandrihamanana, L. Performance of a Receptive Language Test among Young Children in Madagascar. PLoS One (2015) Apr 1;10(4):e0121767
Fernald, L.C.H., Weber, A., Galasso, E., and Ratsifandrihamanana, L. Socio-economic gradients and child development in a very low income population: Evidence from Madagascar. Developmental Science. (2011) Jul;14(4):832-47.
Funders:
NICHD, the World Bank, and the Strategic Impact Evaluation Fund