Prevention of Moderate Acute Malnutrition (MAM) Positive Deviance Hearth (PDH) Approach in Burundi

Full text: Background and Objectives: PDH approach utilizes local resources and solutions to rehabilitate and prevent future malnutrition in children under five. Although PDH focuses on addressing underweight, PDH includes children with MAM and may have potential to address and prevent MAM where community-based management of acute malnutrition (CMAM), specifically targeted supplementary feeding component, may not be appropriate. The objectives are: 1) to assess the effectiveness of PDH to reduce moderate and severe underweight in participant children as well as prevent malnutrition in younger siblings of participant children; and 2) to assess PDH's effectiveness for treatment and prevention of MAM in ten villages in Burundi. Methods: Starting September to November 2012, PDH was implemented by trained community volunteers in the ten villages. A "positive deviant" inquiry identified local practices that positively impact child nutritional status. These practices were transferred to families of malnourished children through experiential learning during 12 days of "Hearth" sessions. Two weeks of home visits followed Hearth. Mid-upper arm circumference of participant children (n = 70) were measured on the first day of Hearth, with appropriate referral for cases of severe acute malnutrition. Weights of children were assessed at Day 1 (n = 94), 12 (n = 94), 30 (n = 74) and one year after the start of Hearth (n = 92). Weight gain of children at Day 12 and 30 were compared with standard weight gains for PDH (200-250 grams for Day 12 and 400 grams for Day 30). Younger siblings were also weighed at the one year follow-up (n = 73). Results: Mean weight-for-age z-scores (WAZ) of the children improved from -3.1±0.2 to -1.1±0.1 (p<0.001), showing sustained catch-up growth at home. Almost all children achieved the standard weight gain on Day 12 and Day 30 (92.6% (87/94) and 98.6% (73/74), respectively). Within one year, severe and moderate underweight decreased from 77% to 21% in participant children (p = 0.001). Moreover, all younger siblings were of normal weight-for-age status at one year follow-up. Of children identified with MAM on the first day of Hearth (n = 21), two thirds (n = 14) had normal WAZ by one year follow-up; all but one child achieved improved WAZ at one year. Conclusion: PDH is effective in reducing underweight in participant children under five as well as preventing malnutrition in younger siblings. Due to limited monitoring data, it is unclear whether all children identified with MAM at baseline were treated. However, it is convincing that two thirds of the children were treated as they are normal for weight-for-age status by one year. All but one child with MAM at baseline has improved WAZ by one year, showing improved nutritional status and catch-up growth. Further analysis is required for assessing the adequacy of PDH in rehabilitating children with MAM, but the improved nutritional status of both participant children and their younger siblings indicates potential of using PDH for MAM prevention. (author)