Abstract:
A Positive Deviance (PD) Hearth intervention is a home and neighborhood-based
nutrition program for children who are at risk for protein-energy malnutrition in a low
resource community. The intervention uses the ‘Positive Deviance’ approach to
identify those behaviors practiced by the mothers or caretakers of well-nourished
children from poor families and transfers such positive practices to other mothers who
are equally disadvantaged economically. Positive Deviance Hearth intervention is
designed to treat malnourished children, enable the families to sustain their
rehabilitation at home on their own and to prevent malnutrition in younger siblings.
However, PD Hearth intervention monitoring system in Migori only assesses a
program’s ability to treat, one of the three PD Hearth objectives. Thus, there was need
for impact evaluation to measure outcomes of the PD Hearth intervention to sustain
rehabilitation and prevent malnutrition in younger siblings. The objectives of the study
were to determine the level to which PD Hearth enables families to sustain
rehabilitation at home on their own and to identify the practices which influence PD
Hearth outcomes. The study was designed as a pipeline quasi-experimental and mixed
method was used to collect data and perform statistical analyses. Single stage cluster
sampling was used to identify 53 and 54 children on the intervention and comparison
group in five communities. Weight measurements of the children on the intervention
aged 6 to 59 months at the entry, exit and graduation stages were retrieved from Kenya
Medical Research Institute Family AIDS Care and Education Services programme
activities reports. Anthropometry (height measurements) for the children on the
intervention and comparison children was taken. Caregivers filled in a questionnaire,
assisted by the researchers as necessary. At entry, 18.9% children on the intervention
had moderate underweight while 43.4% had mild underweight. At current status
though, 3.8% and 34.0% had moderate and mild underweight respectively. The
regression model predicted that Weight-for-Height (WAZ) of the children on the
intervention at current status lied on 51.5 percentile, thus, normal for underweight.
Increased feeding frequency made the largest contribution to weight gain than other
caregiver practices. Therefore, the Migori County government in collaboration with the
Ministry of Health needs to scale up PD Hearth intervention to reverse cases of
Moderate Acute Malnutrition (MAM) and prevent Severe Acute Malnutrition (SAM) in
the County.