Rapid sustained childhood malnutrition alleviation through a positive-deviance approach in rural Vietnam: preliminary findings.

The weight-for-age of children born during program year 2 after NERPS had ceased was the same as or better than counterparts born during year 1, and local solutions alleviated childhood malnutrition significantly rapidly and sustainably amid settings of generalized poverty.

Abstract

Positive-deviance strategies may circumvent the delay in attacking the root cause of multifactorial childhood malnutrition. Save the Children Foundation (SCF) implemented a 2-year Poverty Alleviation and Nutrition Program (PANP) from 1993 to 1995 in 4 communes with a population of 26057 in Vietnams Thanh Hoa province. Using existing infrastructure they trained health volunteers to perform a baseline census make rosters of all children under age 3 years (U3s) conduct growth monitoring and promotion (GMP) sessions perform positive deviance studies deworm children and supervise Nutritional Education and Rehabilitation Programs (NERPs) for seriously malnourished children. Positive-deviance studies identified behaviors among poor families likely to explain their childrens good nutrition such as feeding them paddy shellfish and greens. This information guided NERP education. Weight-for-age and international reference standards were used. Overall weight-for-age of 1893 U3s improved: 0.36 Z-scores (from -2.14 to -1.78; p < 0.001) without sex difference or baseline nutritional category. Those who were severely malnourished (< -3 Z) improved 1.44 Z-scores (from -3.58 to -2.14; p. < 0.001). Severely malnourished children decreased 85% in program year 1 from 434 to 68 with an additional 50% decreasing during year 2 (from 68 to 33). The prevalence of severe malnutrition decreased from 23% to 6% (p < 0.001); the prevalence of normal weight-for-age increased from 42% to 56% (p < 0.001). Children between 18 and 23 months at baseline (n = 244) improved their weight-for-age (mean Z-score: -2.475 at baseline vs. -1.844 after year 1; p < 0.001) and maintained the improvement after graduating from the program. The weight-for-age of children born during program year 2 after NERPS had ceased was the same as or better than counterparts born during year 1. Local solutions alleviated childhood malnutrition significantly rapidly and sustainably amid settings of generalized poverty. Up to 12 deaths may have been averted therefore this the approach deserves wide consideration.