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A nutrition programme using positive deviance approach to reduce undernutrition among urban poor children under-five
Lok Poh Chek1, Wan Ying Gan1, Yit Siew Chin1,2
1Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
Insights
This study protocol outlines a nutrition program using the positive deviance approach to combat childhood undernutrition in urban poor children. The program aims to improve maternal feeding practices and child nutritional status.
Area of Science:
- Public Health
- Nutrition Science
- Pediatrics
Background:
- Childhood undernutrition poses significant public health challenges, with severe consequences for urban poor children.
- The COVID-19 pandemic has exacerbated undernutrition risks in vulnerable populations.
- There is an urgent need for effective interventions to address childhood undernutrition.
Purpose of the Study:
- To describe the study protocol for a nutrition program.
- To evaluate the effectiveness of a positive deviance-based nutrition program.
- To target urban poor children aged 3 to 5 years.
Main Methods:
- A mixed-method study in two phases conducted in Kuala Lumpur.
- Phase one: Focus group discussions and interviews to understand maternal feeding practices.
- Phase two: A cluster randomized controlled trial evaluating a 3-month intervention (educational lessons, cooking demonstrations, rehabilitation, growth monitoring).
Main Results:
- The positive deviance approach identifies unique feeding practices and local wisdom.
- Mothers can learn from peers to adopt improved feeding behaviors.
- The program aims for healthy weight gain in children.
Conclusions:
- The study protocol details a novel nutrition intervention for urban poor children.
- The positive deviance approach offers a culturally sensitive method for improving child nutrition.
- Peer-led learning and empowerment are key components for sustainable behavior change.
Background:
Childhood undernutrition remains a public health issue that can lead to unfavourable effects in later life. These effects tend to be more devastating among urban poor young children, especially in light of the recent COVID-19 pandemic. There is an immediate need to introduce interventions to reduce childhood undernutrition. This paper described the study protocol of a nutrition programme that was developed based on the positive deviance approach and the evaluation of the effectiveness of the programme among urban poor children aged 3 to 5 years old.
Methods:
This mixed-method study will be conducted in two phases at low-cost flats in Kuala Lumpur. Phase one will involve a focus group discussion with semi-structured interviews to explore maternal feeding practices and the types of food fed to the children. Phase two will involve a two-armed cluster randomised controlled trial to evaluate the effectiveness of a programme developed based on the positive deviance approach. The programme will consist of educational lessons with peer-led cooking demonstrations, rehabilitation, and growth monitoring sessions. Intervention group will participate in the programme conducted by the researcher for three months whereas the comparison group will only receive all the education materials and menus used in the programme after data collection has been completed. For both groups, data including height, weight, and dietary intake of children as well as the nutritional knowledge and food security status of mothers will be collected at baseline, immediate post-intervention, and 3-month post-intervention.
Expected Results:
The positive deviance approach helps to recognise the common feeding practices and the local wisdom unique to the urban poor population. Through this programme, mothers may learn from and be empowered by their peers to adopt new feeding behaviours so that their children can achieve healthy weight gain.
Trial Registration:
This study was registered with clinicaltrials.gov: NCT04688515 on 29 December 2020, https://www.clinicaltrials.gov/ct2/show/NCT04688515.
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