A Community based approach in ending malnutrition- Positive Deviance (PD) Hearth Initiative
Background
Results
APHIAPlus has been supporting nutrition activities in Western Kenya with many gains being realized through improvement of key nutrition indicators.
Program established 15 hearths with 116 malnourished children. Hearths at different levels of follow up; 11 almost completing fourth follow-up. Four (colored green) are new ones that absorbed the drop-out beneficiaries after conducting an FGD with community members to clear any misunderstanding of the program.
However in 2015, some sub-counties were still recording high rates of malnutrition. These included Ugunja (9%) and Nambale (8%) in Siaya and Busia Counties respectively. In 2016 the project proposed a sustainable intervention of reducing malnutrition in these areas; Positive Deviance (PD) Hearth Initiative . PD Hearth program is a home-based and neighborhood-based nutrition program for children at risk of malnutrition. The program uses the “positive deviance” approach to identify behaviors practiced by mothers or caretakers of well-nourished children from poor families and transfer such positive practices to others in the community. The “Hearth” or home is the location for the nutrition education and rehabilitation sessions.
Objectives
To quickly rehabilitate children identified as malnourished. To enable families to sustain the rehabilitation of such children at home on their own. To prevent future malnutrition among all children born in the community by changing norms in childcare, feeding and health-seeking practices.
Below is a graph showing and overview of the hearths’ performance. No. of malnour- No. of HEARTH ished chil- drop dren en- outs rolled
A meeting with CHMT, SCHMT and key community leaders was held to facilitate understanding of the concept and ensure ownership. An intensive 6-day training for community health volunteers and CHEWs on basics of PD hearth followed.
Active Hearth members
No. No. that No. with that reduced constant added weight Weight weight
Weight gain range (gms)
% with weight gain (of active)
Sigomere
10
0
10
4
1
5
200-900
50
Madungu
9
0
9
1
0
8
200-800
89
Sikalame Tingare East Kilimo
9
0
9
1
0
8
200-1000
89
14
2
12
0
0
12
200-2000
100
9
1
8
0
0
8
300-1500
100
Khwiralie
6
0
6
0
0
6
400-1000
100
Musokoto Kamusogon
9
0
9
2
0
7
100-800
78
7
0
7
1
1
5
100-950
71
Otekwa
5
0
5
0
0
5
300-1900
100
Forest
4
0
4
0
0
4
500-1900
100
Kajuku
6
0
6
0
0
6
700-1900
100
Mudembu
6
0
6
0
0
6
100-400
100
Buloma
5
0
5
0
0
5
300-400
100
7
0
7
0
0
7
100-300
100
10
0
10
0
0
10
100-300
100
116
3
113
Namisi East Namisi West TOTAL
Methods
Recommendations
102
Strategy that should be scaled up to areas experiencing high rates of malnutrition because it is an intervention ‘by the people for the people’ i.e. it is totally community run hence better outcomes, sustainable and acceptable.
Challenges Drop outs due to misconceptions-Proper education to the community must be done to ensure acceptability and success of the program.
Drop-outs wanting to come back after seeing positive results from beneficiaries hence that time difference can lead to worse category of malnutrition.
90
Program now well accepted by the beneficiaries; 90% of them have added weight since it started. The (10%) of the beneficiaries had 8% of them reduce weight and 2% have constant weight. This was due to sickness experienced during the follow up sessions by children from different hearths. The follow ups are ongoing and graduations planned to be done at the end of the quarter.
A Hearth session in Musokoto, Nambale Sub-County
At a glance
Nutrition assessment for children 6-36 months was done at 6 link facilities. Immunization, Vitamin A supplementation and deworming also done.
A 12 day hearth session followed for each of the identified hearths.
Located in a home setting, community volunteers and caregivers practiced new cooking, feeding, hygiene and caring behaviors successful for rehabilitating malnourished children. After the sessions, weights for all children was taken and recorded. A 21-day follow up session was done, then a 30 day where weights were taken and recorded.
Children feeding at the Hearth
PD Hearth program is a home-based and neighborhood-based nutrition program for children at risk of malnutrition. 15 Hearths established with 116 malnourished children. 90 percent of beneficiaries have added weight since the program began.