The Three Delays Model is a conceptual model traditionally used to understand contributing factors of maternal mortality. It posits that most barriers to health services utilisation occur in relation to one of three delays: (1) Delay 1: delayed decision to seek care; (2) Delay 2: delayed arrival at health facility and (3) Delay 3: delayed provision of adequate care. We applied this model to understand why a community-based management of acute malnutrition (CMAM) services may have low coverage.

We conducted a Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) over three phases using mixed methods to estimate programme coverage and barriers to care. In this manuscript, we present findings from fifty-one semi-structured interviews with caregivers and programme staff, as well as seventy-two structured interviews among caregivers only. Recurring themes were organised and interpreted using the Three Delays Model.

Madaoua, Niger.

Totally, 123 caregivers and CMAM program staff.

Overall, eleven barriers to CMAM services were identified in this setting. Five barriers contribute to Delay 1, including lack of knowledge around malnutrition and CMAM services, as well as limited family support, variable screening services and alternative treatment options. High travel costs, far distances, poor roads and competing demands were challenges associated with accessing care (Delay 2). Finally, upon arrival to health facilities, differential caregiver experiences around quality of care contributed to Delay 3.

The Three Delays Model was a useful model to conceptualise the factors associated with CMAM uptake in this context, enabling implementing agencies to address specific barriers through targeted activities.

To elucidate the factors influencing food intake and preferences for potential nutritional supplements to treat mild and moderate malnutrition among adult people living with HIV (PLHIV).

Qualitative research using in-depth interviews with a triangulation of participants and an iterative approach to data collection.

The study was conducted in a health clinic of rural Chilomoni, a southern town of Blantyre district, Malawi.

Male and female participants, aged 18–49 years (n 24), affected by HIV; health surveillance assistants of Chilomoni clinic (n 8).

Six themes emerged from the in-depth interviews: (i) PLHIV perceived having a poor-quality diet; (ii) health challenges determine the preferences of PLHIV for food; (iii) liquid–thick, soft textures and subtle natural colours and flavours are preferred; (iv) preferred organoleptic characteristics of nutritional supplements resemble those of local foods; (v) food insecurity may contribute to intra-household sharing of nutritional supplements; and (vi) health surveillance assistants and family members influence PLHIV’s dietary behaviours. No differences by sex were found. The emergent themes were corroborated by health surveillance assistants through participant triangulation.

In this setting, a thickened liquid supplement, slightly sweet and sour, may be well accepted. A combination of quantitative and qualitative methods for data collection should follow to further develop the nutritional supplement and to fine tune the organoleptic characteristics of the product to the taste and requirements of PLHIV. Results of the present study provide a first approach to elucidate the factors influencing food intake and preferences for potential nutritional supplements among adult PLHIV.