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Identification of model newborn care practices through a positive deviance inquiry to guide behavior-change
David R Marsh1, Monique Sternin, Rolla Khadduri
1Save the Children Federation/US, Westport, Conn., USA.
Insights
Positive Deviance (PD) inquiries identified beneficial newborn care practices among Afghan refugees and Pakistani communities. This approach can be adapted to improve newborn health globally.
Area of Science:
- Global Health
- Public Health Interventions
- Maternal and Child Health
Background:
- Positive Deviance (PD) inquiries are effective for child malnutrition but underexplored for newborn health.
- Save the Children Federation/US (SC) implemented PD cycles in Pakistan among Afghan refugees and local populations.
Purpose of the Study:
- To adapt the Positive Deviance (PD) approach for improving newborn health in diverse community settings.
- To identify and promote uncommon, effective newborn care practices.
Main Methods:
- Conducted PD cycles involving planning, community orientation, situation analysis, in-depth interviews, and community feedback.
- Identified positive deviances (PDs) related to newborn care among surviving asphyxiated newborns, thriving low birthweight babies, and newborns with danger signs.
Main Results:
- Afghan caregivers demonstrated better service utilization and household practices compared to Pakistani counterparts, potentially due to longer program presence.
- While general newborn care practices (clean delivery, thermal control, breastfeeding, father involvement) were weak, specific PDs in maternal and newborn care were identified.
- Communities actively committed to behavior change, forming support groups and demanding hygienic delivery practices.
Conclusions:
- The Positive Deviance (PD) approach is adaptable for newborn care, though more complex than for child nutrition.
- This pilot study established a framework, tools, and methods for household newborn care PD inquiries.
- The initiative mobilized communities and staff, highlighting the potential for improved newborn health outcomes through PD.
Abstract:
A positive deviance (PD) inquiry identifies uncommon, model practices that a follow-on program can spread. PD has been used to rehabilitate malnourished children, but not for improving newborn health. Save the Children Federation/US (SC) conducted newborn PD cycles in communities (total population about 5,000 each) in two project areas in Haripur District, Pakistan among Afghan refugees and among local Pakistanis. Each PD cycle included planning, community orientation, situation analysis, PD inquiries, and community feedback with action planning. PD inquiries were in-depth interviews to identify uncommon behaviors among surviving asphyxiated newborns, thriving low birthweight babies, surviving newborns who had danger signs, and normal newborns. The Afghan caregivers showed better use of services and some household practices than their Pakistani counterparts, consistent with duration of SC presence (15 years vs. 18 months, respectively). The practices of both groups for clean delivery, thermal control, immediate and exclusive breastfeeding, and fathers' involvement were weak. But PD individuals, families, and/or birth attendants modeled good maternal care and immediate, routine and special newborn care. Communities enthusiastically committed to change behavior and form neighborhood support groups for better newborn care, including a demand for hygienic delivery. The PD approach for the newborn is more complex than for child nutrition. Yet this pilot-test proposed a conceptual framework for household newborn care, suggested tools and methods for information gathering, identified PDs in two settings of different risk, galvanized SC staff to the potential of the approach, mobilized communities for better newborn health, and drafted a newborn PD training curricula.