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Research
benefits to programmes and communities.
Targets for research output should be set (e.g.
one or two research papers each year submitted
to a peer-reviewed journal), with financial
and technical support continued when targets
have been met and termination of support if
targets have been missed. Young national
researchers should have the opportunity to
present scientific abstracts and participate at
regional and international conferences, and
more attention should be paid to teaching the
principles of how to write scientific papers
and to mentoring.
Rachel Bezner Kerr, Malawi, 2011
Attention must also be paid to the problem
of poor access to up-to-date scientific literature,
and despite laudable initiatives (such as the
Health InterNetwork Access to Research
Initiative), this remains a barrier in low-income
countries. Free and open access for all articles of
interest to low-income countries is urgently
needed. For example, Médecins Sans Frontières
(MSF) has negotiated with publishers to allow
free access to all articles written by its staff.
The distinct role for NGOs in operational
research should be recognised for two main
reasons. First, NGOs such as MSF often work
in conflict settings, with marginalised and
vulnerable populations, or with neglected
diseases. Academics rarely have access to such
settings, and national programmes might
decide they do not have sufficient resources to
study them. Research in these areas is, nevertheless,
needed to better understand how to
manage questions such as mental health issues
in war zones, treatment and diagnosis of
neglected diseases, or offering of HIV/AIDS
care in slum settings. Secondly, NGOs are, by
mandate, implementers and can thus be
involved in the translation of research findings
into policy and practice. If they have skills in
research and advocacy as well as sufficient
financial and human resources, then they
probably have the potential to actively engage
in operational research and help change practice.
However, NGOs are sometimes not the
appropriate entities for designing or implementing
research. They might lack the
institutional support, culture, and skills for
interacting with national programmes and
decision makers. NGO focus might be on solving
localised, short-term problems, they might
have had little exposure to systems thinking
.and they might lack the training and capacity
to do rigorous research. They might also have
a rapid turnover of staff, which hinders the
sustainability of research and the ability to
build up trust and understanding with country
partners. These points might explain why
NGOs rarely undertake research, are rarely
asked by country programmes to do so, and
why the research they do undertake is sometimes
badly done, with little or no programme
impact.
The authors conclude that they have made
the case for the importance of operational
research as a necessary component of health
programming in low-income countries. What
is needed now is further development of operational-research
capacity, allocation of specific
resources, and the need for different participants
such as international and national
academic institutions, national programme
managers, and NGOs to work together in
promoting operational research.
Margaret Shonga, participating farmer, her
husband Donald Gondwe and their baby,
standing in a field of sorghum
Effects of agricultural and nutrition
education projects on child health in
Malawi Summary of published research 1
A recent study set out to investigate
whether children in households involved
in a participatory agriculture and nutrition
intervention had improved growth
compared to children in matched comparable
households. The study also explored
whether the level of involvement and
length of time in the project had an effect
on child growth.
The Soils, Food and Healthy
Communities project (SFHC) was initiated
by Ekwendeni Hospital and aimed to
improve child nutritional status amongst
smallholder farmers in a rural area in
northern Malawi. In villages surrounding
Ekwendeni, a town in Mzimba district,
Esnai Ngwira, participating farmer, and
her children, standing beside her maize
field grown after legume residue buried
into the ground
Rachel Bezner Kerr, Malawi, 2011
over half of the smallholder families experience
food insecurity every year. Malaria
is endemic and child malnutrition rates are
similar to the national average at 48%.
Agricultural interventions involved intercropping
legumes and visits from farmer
researchers, while nutrition education
involved home visits and group meetings.
The study employed a prospective
quasi-experimental approach comparing
baseline and follow up data in intervention
villages with matched subjects in comparison
villages. Mixed model analyses were
conducted on standardised child growth
scores (weight- and height-for-age Z-
scores), controlling for child age and
testing for effects of length of time and
intensity of village involvement in the
intervention.
Participants in intervention villages
were self-selected and control participants
were matched by age and household food
security status of the child. Over a six year
period, nine surveys were conducted
taking 3,838 height and weight measures of
children under the age of 3 years.
The study found that there was an
improvement over initial conditions of up
to 0.6 in weight-for-age (WAZ) Z-score
(WAZ: from -0.4 (sd 0.5) to 0.3 (sd 0.4)) for
children in the longest involved villages,
and an improvement over initial conditions
of 0.8 in WAZ for children in the most
intensely involved villages (from -0.6 (sd
0.4) to 0.2 (sd 0.4)).
The authors conclude that longterm
efforts to improve child nutrition through
participatory agricultural interventions
had a significant effect on child growth.
1
Bezner Kerr R, Berti P and Shumba L (2011). Effects
of a participatory agriculture and nutrition education
project on child growth in northern Malawi. Public
Health Nutrition 14 (8), 1466-1472
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