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Ti Foyer (Hearth) community-based nutrition activities informed by the positive deviance approach in Leogane, Haiti:
Kathryn Bolles1, Catherine Speraw, Gretchen Berggren
1Programme de Nutrition, Hôpital Sainte Croix, Leogane, Haiti.
Insights
The "Hearth" program successfully improved child nutrition in Haiti by using positive deviance strategies. Malnourished children gained weight effectively, showing the approach
Area of Science:
- Global Health
- Pediatric Nutrition
- Community Health Programs
Background:
- Child malnutrition remains a significant public health issue in resource-limited settings.
- Effective nutritional rehabilitation strategies are crucial for improving child health outcomes.
- The positive deviance approach offers a unique framework for identifying and scaling successful local practices.
Purpose of the Study:
- To detail the design and implementation of a positive deviance-informed "Hearth" approach for nutritional rehabilitation.
- To assess the effectiveness of the Hearth program in improving the nutritional status of malnourished children in Leogane, Haiti.
Main Methods:
- A "Hearth" program involving daily nutritional and health education sessions for small groups of malnourished children over two weeks.
- Utilizing positive deviance principles to inform health messages and meal components based on successful local practices.
- Community-based follow-up for six months by trained local women ("monitrices") to monitor child weight gain and provide support.
Main Results:
- High rates of sustained weight gain were observed in participating children post-program.
- 100% of children in eight villages and 66% in five other villages met or exceeded the international standard median for weight gain six months after the program.
- Program modifications, including a microcredit option, were implemented based on participant and community feedback.
Conclusions:
- The positive deviance-informed "Hearth" approach is an effective model for the nutritional rehabilitation of malnourished children.
- Community-based implementation and local adaptation are key components for successful program outcomes.
- The program demonstrated significant positive impact on child weight gain and community engagement.
Abstract:
This paper details the steps to design and implement a positive deviance-informed, "Hearth" approach for the nutritional rehabilitation of malnourished children in the district of Leogane, Haiti. Groups of four to five children met daily for two weeks at the home of a local volunteer mother for nutritional and health messages and a well-balanced meal. Health messages and meal components were determined using information gathered from interviews with the mothers of positive deviant children in the community who are well nourished despite their family's limited economic resources. Hearth participants were then followed for six months in their own home by the program "monitrices," women hired from each village and intensively trained to supervise the Hearth program, periodically weigh the children to evaluate their progress, and liaise between the hospital and the community. Monitoring from the first cycle indicated that 100% of children in eight villages and 66% of children in the remaining five villages continued to gain weight as fast or faster than the international standard median six months after participating in a Hearth program. At the conclusion of this cycle, programmers interviewed participant and non-participant families and made six modifications to the model, including the addition of a microcredit option for participating mothers.