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Preparing for a community-based agriculture-to-nutrition trial in rural Malawi: formative research to assess feasibility and inform design and implementation decisions

  • Chiutsi-Phiri, Gabriella1
  • Kalimbira, Alexander A.2
  • Banda, Leonard2
  • Nalivata, Patson C.2
  • Sanuka, Marion1
  • Kalumikiza, Zione2
  • Matandika, Limbanazo3
  • Mfutso-Bengo, Joseph3
  • Allen, Elizabeth4
  • Ferguson, Elaine4
  • Sturgess, Joanna4
  • Broadley, Martin R.5
  • Langley-Evans, Simon5
  • Millar, Kate5
  • Gashu, Dawd6
  • Joy, Edward J. M.4
  • 1 Lilongwe University of Agriculture and Natural Resources, Natural Resources College, Lilongwe, Malawi , Lilongwe (Malawi)
  • 2 Lilongwe University of Agriculture and Natural Resources, Bunda College, Lilongwe, Malawi , Lilongwe (Malawi)
  • 3 University of Malawi, Blantyre, Malawi , Blantyre (Malawi)
  • 4 London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK , London (United Kingdom)
  • 5 University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK , Loughborough (United Kingdom)
  • 6 Addis Ababa University, Addis Ababa, Ethiopia , Addis Ababa (Ethiopia)
Published Article
Pilot and Feasibility Studies
BioMed Central
Publication Date
Jul 07, 2021
DOI: 10.1186/s40814-021-00877-1
Springer Nature
  • Research


BackgroundThis study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium or control flour not biofortified with selenium for a period of 10 weeks, after which blood samples were taken to measure selenium status.MethodsFormative research was conducted in villages near to the AHHA trial study site 1 year before the planned intervention. A short questionnaire with adult women (n = 50), focus group discussions with male (n groups = 3) and female (n groups = 3) community members, and in-depth key informant interviews (n = 7) were conducted to understand community practices and perceptions.FindingsMeals were typically cooked and eaten at home in this community, while participants reported that maize flour would be less readily sold than maize grain – important considerations for the design of the trial. Regarding intervention delivery, we identified potential concerns around effects on fertility, links between blood sampling and witchcraft, and the potential for social stigma if community members considered participants lazy for receiving free flour. Participants reported that involvement of the Malawi government partners including health extension workers would increase trust.InterpretationFollowing the formative research, the AHHA trial appeared feasible. However, community sensitisation would be essential to address potential fears and concerns; effective sensitisation would support recruitment and treatment adherence, and would protect the safety and wellbeing of participants and researchers. People in positions of authority and trust including village headmen, religious leaders, health and agriculture extension workers, and community care groups should be involved in community sensitisation.

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