Drawing on a semi-quantitative evaluation of access and coverage (SQUEAC) approach, this report examines the blockages to preventing malnutrition in Kambia district, Sierra Leone. It finds that the issues causing malnutrition are both multifactorial and complex, suggesting a range of initiatives are needed in order to prevent it. Many of these initiatives already exist at community level, but they require strengthening and expansion. Our evidence also suggests that, in order to achieve sustained behaviour change at the local level, there is a need to target key decision-makers within the household, such as fathers and elders, and to engage seriously with traditional practices. This output forms part of a wider package of research conducted by the SLRC in Sierra Leone. Together with a forthcoming qualitative report, it seeks to answer the country programme’s second overarching research question: What are the blockages to preventing malnutrition at the local level?.