Evaluating the role that Care Groups play in providing breastfeeding and infant feeding support at community level: a qualitative study in Dedza district in Malawi.

Background: Promoting exclusive breastfeeding is a key nutrition policy objective in Malawi. This study assesses the role that Care Group Volunteers (CGVs) play in providing breastfeeding and infant feeding support at community level. Care Groups are a peer-to-peer learning approach, which has been part of Malawi's nutrition policy since 2012, its role within community-level nutrition support remains under-researched. Methods: In July 2021, we conducted 60 qualitative semi structured interviews in Dedza District with village leaders, Health Surveillance Assistants (HSAs), CGVs and district health officials, mothers with at least one child under two (n=36) who were purposively selected. All interviews were recorded, transcribed and translated into English and then analysed using qualitative data analysis software. Thematic analysis was used to elicit key themes. Results: Only eight out of 36 women reported receiving breastfeeding support from care groups. All mothers reported receiving breastfeeding support at the health facility where they delivered their baby(ies) and some (n=24) also at ante-natal care clinics. In total, 18 interviewees reported interacting with the Care Groups, mostly during cooking demonstrations or receiving home visits. Little interaction was observed by interviewees between HSAs and CGVs and no evidence suggested coordination between HSAs and CGVs around (vulnerable) newborn baby visits, as described by one HSA. Conclusions: This research shows that Care Groups, despite being well-known, remain an under-appreciated and un-integrated volunteer cadre. Policy reform in relation to Care Groups in Malawi is needed to improve volunteer engagement regarding breastfeeding and overall support of newborns and vulnerable infants.