Transcript Slide 1
Keno Parbo Na
A community based strategy
for reduction of undernutrition
in young children
Why Positive Deviance?
• Malnutrition in young children is more due to incorrect
feeding and caring practices rather than only lack of
availability of food
• Preventing Malnutrition as early as possible and
Promoting Early Child Development is crucial and there
needs to be a focus on under-three children
• Lancet says that a single change in behavior can bring
down the IMR by 13% and that behavior is Exclusive
Breast Feeding
Who is a Positive Deviant?
• A positive deviant child is a healthy and developed child
in a poor, disadvantaged and distressed family
• A positive deviant family is one which has PD children
• The special practices of a PD family which enables a
child to grow and develop well inspite of poor
socioeconomic conditions are called PD practices
• The attempt is to find out these practices in the
community and formulate strategies and activities which
motivate all families with children to adopt these best
practices through participatory learning
How Positive Deviance Works
• Making Malnutrition Visible to the families and
community through weighing of children and using
colour-coded charts, maps and other tools
• Finding out prevalent child care and feeding practices in
the area – both good and bad and identifying young
children who have good or bad (Grade 2,3,4) nutritional
status as a result of these practices
• Bringing the moderate to severe malnourished young
children (0-3 years) and their care-givers regularly to the
AWCs (Nutrition Counseling and Child Care SessionNCCS). AWWs along with community, positive deviant
mothers & SHGs and teach them the correct feeding and
care practices through hands-on demonstration and urge
them to follow the same care practices at home
• Close monitoring and follow up
Steps of Positive Deviance
• Sensitisation workshop at the district and block level
• Training – Joint Training on Community Mobilization & PD
approach for AWWs, ANMs, PRI members, SHGs
• Community Mobilization at the village level to make
malnutrition visible
• Identifying prevalent common practices – Focus Group
Discussion (FGD)
• Identifying PD Child / Families – PD Inquiry
• Sharing findings with Community by VHC/ SHGs/ ICDS
• Setting up Nutrition Counseling & Childcare Session (NCCS)12 days monthly session at AWCs, followed by 18 days homebased practice on child feeding and care
• Monitoring and follow-up
• For implementation, AWWs and supervisors take lead role,
assisted by PRI members, ANMs, SHG members, community
and care-givers in the family
Making Malnutrition Visible &
Family Monitoring...
Family level Mascot
Family level M & C Card
Tools for Community
Monitoring
Community level Resource Map
Areas where Positive Deviance is
Operational in West Bengal
U DINAJPUR
D DINAJPUR
MURSHIDABAD
BIRBHUM
PURULI
A
PD will be Operational in 2
new districts Bankura and
Paschim Medinipur with
State support (SW) in 2007.
BANKURA
PASCHIM
MEDINIPUR
PD Operational with
UNICEF support in
Murshidabad (10 blocks)
Dakshin Dinajpur,
Purulia, South 24 PGs (4
blocks) & with State
support (RCH) in Uttar
Dinajpur & Birbhum.
24 PG (S)
Discussions on with Jalpaiguri to
start in selected blocks with RCH
funds
Operational Structure
• Implemented through ICDS, using its regular staff
• In Purulia- Zilla Parishad also implementing with ICDS
• In D Dinajpur facilitated by NGO (SPCO) ; In 3 blocks of
Murshidabad facilitated by NGO (ASHA)
• In all districts, Programme and/or MIS Coordinators at
district level coordinate and assist DPO-ICDS to
implement the project. They report to the district
administration
• In some districts, facilitators present at block level
coordinate and help in monitoring and reporting
Is PD making any change?
• National Institute of Nutrition conducted an independent
evaluation in 2006
• Survey done in about 1000 children in 40 AWCs
implementing PD for atleast one year and compared with
equal no.s in matched non PD control areas
• Positive impact found in:
– Young child care and feeding practices
– Utilization of health & nutrition services, quality improvement of
ICDS
– Improved community participation in PD areas
• Relatively better nutrition status of children in PD areas:
– Better mean heights and weights of <3 yr children,
– Lower prevalence of stunting and underweight in 12-17
months children
Distribution (%) of < 12 months Children according to
Breast-feeding Practices
%
100
80
PD
** 90.0
Control
81.5
** 76.4
** : P<0.01
65.4
60
44.1
40
**22.1
20
0
Prelactal Feed given
Initiation of BFwithin 3 hrs.
Colostrum Fed
Distribution (%) of 12-35 months Children receiving
Complementary feeding at 6 months of age
: By Age Group (Months)
%
60
PD
Control
** : P<0.01
44.0 **
50
45.3
**
40
28.8
30
22.7
20
15.2
11.5
10
0
6-12
12-23
Age group (Months)
24-35
Distribution (%) of Children (12-23 months) according to
Coverage for Immunization *
%
100
98
97
92
97
94
91
90
PD
94
91
90
89
86
83
82
76
75
80
Control
71
68
60
40
20
0
BCG
DPT-1
DPT-2
DPT-3
OPV1
OPV2
OPV3
Measles Complete
Immunization
* Coverage for all immunizations are significantly (p<0.01) higher in PD area
Distribution (%) of 18-35 months Children according to
Receipt of Massive Dose of Vitamin A
%
70
PD
Control
60
** p<0.01
**
50.2
50
40.7
40
34.2
33.0
26.2**
30
15.6
20
10
0
1 Dose
2 Doses
Not Received + DNK
Distribution of 0-3 year old children according
to recpt of treatment for diarrhoea and ARI
80
75
70
70
48 **
60
41
50
40
30
20
26
**
**
13
14
18
10
0
Recd ORS for Recd ORS from Recd treatment Recd treatment
diarrhoea
ANM/AWW
for ARI
from Govt
functionary
PD
Control
Distribution (%) of Anganwadi Centers by type of social
organizations functioning in the village
TYPE OF AREA
PARTICULARS
PD
CONTROL
Self Help Groups
82.5
70.0
Village Education Committee
60.0
65.0
Youth club
55.0
55.0
Mahila Mandal
45.0**
5.0
Mother’s Committees
45.0**
12.5
Women’s Working group
25.0**
5.0
Village Health Committee
25.0**
5.0
Adolescent Girls Working group
10.0
2.5
Cultural Organization
7.5
7.5
Type of Social Organizations
** p< 0.01
Distribution (%) of <3 Yrs. Children according to
Nutritional Status : By SD Classification (<Median-2SD)
50
43.0
44.8
PD
Control
40
Per cent
32.0
*
26.5
30
20
13.8
12.3
10
0
Underweight
* Statistically significant
Stunting
Wasting
Distribution (%) of <3 Yrs. Children according to
Weight for Age: IAP Classification
50
PD
45.5
Control
Per cent
40
36.7
45.3
35.7
30
20
15.4
15.5
10
0.7
0.5
1.7
3.0
0
Grade IV
Grade III
Grade II
Grade I
Normal
Statistically significant difference
among 12-17 months children
• IAP Classification: Undernutrition
• PD area-55%
• non-PD area- 64%
• SD Classification:
– Undernutrition:
• PD area- 45.6%
• Non-PD area- 63.2%
– Stunting:
• PD area- 25.2%
• Non-PD area- 37.4%
In conclusion
• Positive Deviance has been accepted as a best
practice in ICDS in the state
• It is now being replicated in different districts
using funds from the state
• The challenges are
– To maintain the quality of intervention with up-scaling
– To mainstream the PD strategy for improving quality
of ICDS, especially focusing on care and feeding
practices of under-three children and involving the
community in monitoring and combating malnutrition