Community-driven Nutrition Interventions in Mali: Effectiveness, Barriers, and Lessons from the Dioila Health District

Abstract

Background: Malnutrition continues to threaten the health and survival of children and women in sub-Saharan Africa. Mali faces persistent undernutrition despite multiple national initiatives. The Ministry of Health established Nutrition Support Groups (Groupes de Soutien à l’alimentation et à la Nutrition – NSGs) to enhance infant and young child feeding (IYCF) and household nutrition through peer-led, community-based interventions. Using the Consolidated Framework for Implementation Research (CFIR) and Social Cognitive Theory (SCT), this study explored the effectiveness, barriers, and lessons learned from the operationalization of GSANs in the Dioila Health District, Mali.
Objective: The objective of this study was to assess the effectiveness and operationalization of Nutrition Support Groups (NSGs) in improving community nutrition outcomes in the Dioila Health District of Mali. Specifically, the study aimed to explore the perceived effectiveness, enabling factors, barriers, and sustainability mechanisms influencing NSG implementation. Using an integrated Consolidated Framework for Implementation Research (CFIR) and Social Cognitive Theory (SCT) approach, the study sought to understand how structural determinants and behavioral processes interact to shape nutrition-related practices and community empowerment.
Methods: We employed a descriptive qualitative design between January and June 2024. Six focus group discussions (FGDs) were conducted with 48 participants (24 mothers, 16 facilitators, and 8 community leaders). Data were transcribed, translated, and thematically analyzed using NVivo 12, guided by CFIR domains and SCT constructs. Trustworthiness was ensured through triangulation, member checking, and reflexivity.
Results: Five main themes emerged: (1) Enhanced awareness and behavioral change; (2) Women’s empowerment and peer learning; (3) Economic and time constraints; (4) Influence of cultural norms on feeding practices; and (5) Sustainability challenges and weak supervision. NSGs increased nutrition awareness and self-efficacy but were limited by insufficient resources, irregular monitoring, and social norms restricting women’s autonomy.
Conclusion: NSGs demonstrate strong potential to improve maternal and child nutrition outcomes through social learning, peer influence, and empowerment. However, sustainability and equity require institutional support, community financing mechanisms, and culturally responsive interventions. Integrating Nutrition Support Groups (NSGs) within district health plans and strengthening supervision will improve long-term outcomes.