Table 1 : Sampling Framework

1. Over 200 million children <5 yrs do not reach their developmental potential worldwide. 40-60% of the population of <5s in Malawi are stunted with loss of developmental potential being high . Effective interventions which provide cognitive stimulation and nutritional support work synergistically and have been shown to improve outcomes in terms of child development, growth and maternal-child interaction in a number of settings. The feasibility of such interventions in rural African settings have not been tested. The College of Medicine University of Malawi Caring for Child Development ; How does this work for communities in Malawi?.M. Gladstone1, K. Maleta2, A. Rahman3, R. Thindwa2, J. Phuka21 . Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool. 2 Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi. 3 Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom THEMES BACKGROUND . OBJECTIVES We aimed to understand the attitudes, beliefs and barriers which caregivers and community health workers in Malawi have with regards to feeding and stimulation of their children in rural and urban settings. METHODS Figure 3: Interaction between positive effects of mother and barriers to play, communication and feeding. Purposive sampling methods. Topic guides adapted - grounded theory. Thematic content analysis. Play as a REFLECTION of a “healthy child” – an OUTPUT... not an INPUT * Children not to be played to/with for learning or brain growth. • Link between Health and PLAY – nutrition and its effect on play. • Need to FEED and Bathe...before PLAY • Mothers critical to target – “responsibility lies with mother” • “This gives us the confidence to know that a mother is a doctor who knows about a child’s life because ....she’s the one who knows”. • “when the child is crying we men don’t know why ..but the mother knows..” • RESPONSIVENESS • “there could be a way how God made especially to women that they are able to understand each other even though they are not speaking and also making some signs” • HOW to PLAY/USE of TOYS • “If a child does not like playing, it is up to you as a parent to give it dolls...” • “small cars, water, small cars out of wire” • “These children play with toys, taking Mvunguti (indigenous tree) and carry them at their backs as children” • WHO to PLAY WITH (Siblings, Dads, Grannies..) • “Most of the times....get a small child and leave him/her with the baby maybe because they have gone to the field or to do other things so it makes those children to fail to get food properly because this child can not manage to prepare food for the other child” • “When you are busy, you let him have the child so that the child should as well know his/her father and he then plays with him/her and when you are done with the house work, you take the child back ..” • Time pressures... • * “Most of the times its like what I said before that they are busy with other things like field work for example in politics and they just leave the baby with a fellow kid so they can e free to do the other things” Mangochi Chilomoni Figure 1: PAR group in Mangochi District Figure 2: Map of Malawi Table 1 : Sampling Framework FGD = Focus group discussion DI = In depth interview PAR = Participatory groups Obs = Obserrvational CONCLUSIONS AND RECOMMENDATIONS To promote effective interventions, a programme of care must take into consideration the positive behaviours already present in Malawi as well as the barriers perceived by carers and health care workers if it is to be sustainable in this setting. Barriers within community and gender systems but also due to poverty, lack of resources and time pressures. Health care workers have no training and many pressures. Social welfare staff may be better trained but unable to work at individual level.