Cracking the Combination in Effectively Preventing Malnutrition

Natan Last
Jun 19, 2017 · 4 min read

The trick is to fortify the rice: mix rice powder with micronutrients, then reconstitute it into rich, nutritious kernels that would fool any connoisseur of carbs.

A community health worker demonstrates how to properly mix a fortifier.

No — livelihoods are key: Let’s get farmers to grow more vitamin-packed foods, give them access to crops that power through droughts, have them form cooperatives to sell to bigger markets, at better prices. That’s finally a solution!

Actually scratch that, and think even earlier: what if we incorporated nutrition education into family planning, tackling the dual problem of malnutrition and girls’ education in one fell swoop?


Team Sprout traveled through Dakar, Senegal, meeting with movers and shakers in the malnutrition world, navigating the thorny problem of prevention. At the end of every session, we gave our interlocutors a $2m bill and asked them to design their dream program. The answers we got were so disparate -- and not for lack of ambition! Rather, it confirmed the multitude of factors that influence nutrition and just how many opinions there are on which combination is the most effective.

An auntie prepares a seafood medley.
Palm nuts and dried beans on sale at the market.

What we gleaned from experts in Dakar were insights like working across sectors that contribute to severe acute malnutrition (SAM), thinking about malnutrition well before it arises, and linking nutrition to existing interventions like income boosters and girls’ education. With these expert insights in mind, we then traveled to Liberia to talk to parents. We bumped over unpaved roads and passed by farmers clinging onto treetops, cutting down palm. Our car only broke down twice. Here’s what we learned:

1. Mothers know the right things to do, but that doesn’t necessarily make it easier to do them.

We talked to mother after mother who could recite the most important messages about feeding: exclusively breastfeed from 0-6 months, or give macronutrient-packed foods like peanut butter to growing kids. When we dug a little deeper, however, it turned out mothers had to return to work in the fields three months or so after the baby was born. The child would be left with the grandmother, who would understandably give the baby water. Similarly, distance or lack of cash meant that picking up dried fish or peanut butter at the market was a tall order. We have to find a way to meet mothers where they are -- chirping health messages at them with an “all-or-nothing” approach does more to shame them than help them meet their child’s needs.

2. There is an abundance of strong networks, where we can build on existing relationships to talk about nutrition.

Parents definitely have the support -- grandmothers usually tend after children, a post-Ebola Liberia has come to understand the importance of going to health centers, and communities are formed around religion as well as savings and farming-cooperative groups. Why not then, for example, when grandmothers escort pregnant mothers to clinics, or savings groups meet up to troubleshoot mobile money issues, we add a few key messages about malnutrition? Orienting established groups around better nutrition felt much more fruitful than starting a new, likely tedious, meet up.

3. Families have the desire for strong, healthy children, but it’s not always clear what to look for.

We met mothers at clinics who would come in because their child’s skin was hot -- a clear sign of fever, and maybe malaria, is coming on. Indeed, for lots of maladies, it’s easy to read the signs and act accordingly. A child on the path to malnutrition, however, doesn’t actually get that well-known over-thin look until things have gotten far too serious. Mothers knew big, strong children were good -- one mother even asked us how it was that people in other parts of the world grew so tall! How could we design for this desire in a way that positively reinforced, or even ritualized, a growing child? Think of the notches on the wall that marked how tall you’d gotten each year as a kid, while throwing in warning signs if growth had become dangerously slow.

Red rice stalks. Soon to contribute to the Liberian saying, “If you haven’t eaten rice, you haven’t eaten!”

Unsurprisingly, what we learned from experts and implementers in Senegal was totally different from what parents told us in Liberia. Still, having come back and starting to dig through these insights, we see fertile places of overlap. For instance, if fortification is key, and improved livelihoods smooth over financial troubles in the child’s early months, why not get local women to help fortify local foods? This is just one idea, and we’re still making our way through what we’ve learned, but we’re excited to see what ideas lie ahead and begin our prototyping.

For that phase, we’ll pick an idea and build out a simple model, keeping the core components but leaving out the bells and whistles for a full-scale pilot. Following Airbel’s R&D process, we will bring a rough instantiation of an idea, solicit feedback from parents and implementers, and turn that feedback into tangible improvements. Rather than rushing into a pilot, we can ensure communities have a hand in shaping anything we roll out to them, and be sure that, ultimately, the idea focuses on their needs first.

The Airbel Impact Lab

The Airbel Impact Lab designs, tests, and scales life-changing solutions for people affected by conflict and disaster. Our aim is to find the most impactful and cost-effective products, services, and delivery systems possible.

Natan Last

Written by

Research and Strategy for the R&D center at the International Rescue Committee. Striving for rigor and nonpaternalism in refugee aid.

The Airbel Impact Lab

The Airbel Impact Lab designs, tests, and scales life-changing solutions for people affected by conflict and disaster. Our aim is to find the most impactful and cost-effective products, services, and delivery systems possible.

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