Small-quantity, lipid-based nutrient supplements (SQ-LNS) show promise to improve the quality of maternal and
child diets, particularly during the first 1000 days of life. The potential of SQ-LNS to impact positively upon nutritional
status relies on numerous factors, including complementary dietary intake, disease prevalence and dynamics
of household utilization, including sharing practices. Therefore, this study sought to elucidate the patterns and determinants
of SQ-LNS utilization among children 6–23 months and potential sharing practices of other household
members prior to intervention development. In Ntchisi, Malawi and Cabo Delgado, Mozambique, both rural, agricultural
settings, we conducted two home-feeding trials of 8 and 6 weeks, respectively, nested within a larger multiphase,
emergent formative research design. Multiple methods, including in-depth interviews (n = 38), direct meal
observations (n = 80), full-day child observations (n = 38) and spot checks of SQ-LNS supply (n = 23), were conducted
with households (n = 35 in Malawi; n = 24 in Mozambique). Overall, the SQ-LNS was utilized contrary to
its recommended use, with 50% of households in Malawi reporting running out of stock too early and 87% of households
in Mozambique either overusing or underusing the product. Utilization of SQ-LNS was manifested in four
patterns of overuse and two of underuse and was determined by factors at multiple levels of influence. Maternal
and child health efforts need to consider the reasons behind choices by households to overuse or underuse
SQ-LNS and design intervention strategies to increase the likelihood of its appropriate utilization.