Liberia Child Stunting Research

Stunting has been measured at 35.5% at the national level in Liberia, with peaks of 41% in Grand Bassa and 38% in Rivercess counties.

The results of this Barrier Analysis (BA), along with Nutritional Causal Analysis and Cost of Diet Assessments results will inform the development of a Social Behaviour Change Communication (SBCC) framework that will be developed and promoted for adoption across future and current programmes.

This research is a part of a project funded by Irish Aid, designed through a consultative process with the Liberia WASH Consortium members as well as other key stakeholders. The specific objectives of the project are to formulate a strategy and Theory of Change (ToC) to address child stunting in a holistic, integrated and sustainable way and to conduct advocacy for the nutrition actions based on the experiences of the formative research. The aim of the project is to contribute to the improvement of nutritional security with replicable multi-sector interventions.

In order to design a high-impact, sustainable and replicable project design to reduce stunting, the programme was designed in three phases. The first phase, implemented in the period from September 2019 to May 2020, focused on formative research to better understand the context-specific causes of stunting and determinants of related behaviours. The key findings drawn from the analysis will inform the design of the second and third phases of the project, supported by awareness raising and advocacy efforts, in order to develop an integrated optimal response aimed at reducing rates of stunting in the study area.

Barrier Analysis

The Barrier Analysis study sought to identify the factors preventing the priority groups (people who are supposed to practice the behaviour) from adopting key behaviours, as well as identifying the enablers facilitating the adoption of those behaviours. Discussions with the consortium partners settled on six priority behaviours around water, sanitation and hygiene (WASH), health and nutrition sectors. These included (1) exclusive breastfeeding, (2) minimum dietary diversity (3) handwashing (4) use of modern family planning (5) use of latrines and (6) safe water storage all relevant to the programmes the partners are currently implementing in their areas of operations.

Link Nutrition Causal Analysis

A Link Nutrition Causal Analysis (Link NCA) is a method for analyzing the multi-causality of undernutrition, as a starting point for improving the relevance and effectiveness of multi-sectoral nutrition security programming in a given context. It is a structured, participatory and holistic study that builds on UNICEF’s conceptual framework with an objective to build an evidence-based consensus on plausible causes of undernutrition in a local context.

Cost of Diet Research

The Cost of the Diet (CoD) methodology and software estimates the combination and amount of locally available foods needed to provide either individuals or a household with enough food to meet their average energy needs and recommended intakes of protein, fat and micronutrients. The software estimates the hypothetical minimum amount a typical household would need to spend to meet all nutrient requirements using foods available in local markets.

Two Cost of Diet analyses were carried out - the first in December 2019 with an addendum in April 2020 that looked at a dry season assessment of the same markets where the first assessment was conducted during the rainy season. The purpose of these assessments was to identify seasonal differences and provide amore thorough understanding of the availability and cost of nutritious foods, helping to better understand the causes determining sub-optimal feeding and to explore the acceptability and economic feasibility of identified options to improve consumption of nutritionally diverse foods of households in the studied communities.

Key findings

• Even before COVID-19 struck poor and very poor households in Liberia simply cannot afford nutritious diets, COVID-19 has made this very real struggle more difficult
• Poor nutrition of mothers, limited time, and lack of knowledge are the key barriers to exclusive breastfeeding - a crucial step in breaking the cycle of malnutrition

What has Concern done to respond to the findings?

In response to the findings of this research, Concern has partnered with Government to agree a response. These are some of the immediate actions that have been taken to address the findings of this research to reduce stunting and malnutrition in children in Liberia:

• Concern collaborated with the Ministry of Health to develop Social Behavior Communication materials to promote home fortification using Micro Nutrient Powders.
• Concern led in the development of a training guide for Small Holder Farmers aimed at integrating nutrition with agriculture with the support of the European Union. The training guide will be adopted by the Ministry of Health to guide integration of nutrition in agriculture among Small Holder Farmers in Liberia.
• Concern engaged the Ministry of Health to develop a recipe booklet intended to guide complementary feeding practices in Liberia. The booklet provides a set of locally available recipes and food preparation methods to guide and promote adequate complementary feeding for children 6-24 months. The booklet also gives information on suitable food combinations for children 6-8 months, 9-11 months and 12-23 months.
• Concern has partnered with GiveDirectly and USAID to give emergency cash to those most in need.
• Concern supported 143 Community Savings and Loans Associations (CSLAs) to cope with the economic shock of the Covid-19 pandemic. CSLAs build community spirit, support saving money and starting businesses, empowering communities to decide paths to a better future.
• Concern has set up mothers groups to support the nutrition of 4,203 mothers this year alone, addressing the needs of their children and engaging men and boys with the gender equality agenda.
• Concern has supported 2,224 kitchen gardens in 2020 to help households grow more diverse and nutritious foods.

Impact of Covid-19 on healthy diets in Liberia

The findings from the research outlined above give the picture before the affects of the Covid-19 pandemic were visible. The research shows that before Covid-19, people living in poverty in Liberia could not afford a healthy diet. The World Bank has estimated that an additional 526,000 Liberians are at risk of falling into poverty as a result of the pandemic, increasing the percentage of people in Liberia living below the national poverty line from 55.5 percent in 2019 to 68.9 percent in 2020. As the lockdown in Liberia did not end until August 2020, the effects of communities being shut off from markets until then is only starting to be fully understood. Feedback from communities Concern is working with on the ground in Liberia though is that things are very serious and people are struggling to afford healthy diets now even more than when the research was conducted.

The ideas, opinions and comments herein are entirely the responsibility of the author(s) and do not necessarily represent or reflect Irish Aid policy.