Adaptation of the Positive Deviance Hearth Approach in Urban Slums, Phnom Penh, for the Prevention and Treatment of Moderate Malnutrition

Full text: Objective: To sustainably rehabilitate malnourished children living in poor urban communities, and prevent future child malnutrition. Methods: Survey data shows an increase in young child malnutrition in urban areas. During the last decade there has been a huge influx of poor rural migrant families to Phnom Penh. Migrant parents work long hours in factories or construction sites, while their young children are cared for by grandmothers or older relatives. Housing conditions are basic with limited sanitation facilities. Following a situational analysis in the target communities, an adapted Positive Deviance approach was implemented. At the beginning of the program 1,127 children aged 0-36 months were weighed; 29% or 328 children were mild and moderately underweight. The following steps were conducted: community mobilization around the issue of child malnutrition, positive deviance inquiry, training of community volunteers, implementation of positive deviance hearth sessions, follow up home visits and ongoing community growth monitoring. Innovations introduced to the project were: mobilization and training of local food vendors to promote, prepare and sell safe, nutritious and affordable locally available complementary foods. The food vendor's menus were also promoted during the Hearth sessions. In addition mobile phone messages were sent to the caregivers to reinforce key infant and young child care and feeding practices. The length of hearth sessions were adapted to the urban context with five days, then five day practice of new behaviors at home, followed by five additional days of Hearth sessions, to share experiences and challenges for practicing the new behaviors. Despite their low income all the caregivers were able to contribute food for the preparation of complementary food, such as meat, vegetables and rice. Caregiver also actively participated in cooking nutritious foods and discussions about the importance of food variety, amounts and frequency of feeding; good hygiene and responsive feeding practices. Results: Since the program commenced in mid 2013, 38 malnourished children and caregivers have completed Hearth sessions and 30 out of 38 (79%) of mild and moderate malnourished children gain weighed after the 15 days program. Twenty out of the 30 children gained from 200 up to 1000 grams, whereas 10 children gained 100 g. The food vendors have adapted new behaviors for preparation of safe and nutritious foods, and the caregivers have demonstrated that despite multiple challenges they are committed to attend regular Hearth sessions and practice new practices. Conclusion: The preliminary results from the adapted PD Hearth approach show that this approach has the potential to successfully address child malnutrition in urban slum areas. The positive results have also boosted the confidence and motivation of the community. The next step is to continue close follow up of the children who have graduated from the session, re-admit the children who still need to gain weight and continue to involve the community in monitoring all the children under five years old. (author)