![In Burundi, PD mothers are about seven times more likely to have given their child salt [in foods] in the past 24 hours. (Probably effect of iodine or just improved flavor) 7 times seven times](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Local Determinants of Malnutrition: An Expanded Positive Deviance Study
- 1. Local Determinants of Malnutrition: An Expanded Positive Deviance Study Presenter: Julie Hettinger, MS RD Maternal and Child Nutrition Specialist, Food for the Hungry April 29, 2010
- 2. In Burundi, PD mothers are about seven times more likely to have given their child salt [in foods] in the past 24 hours. (Probably effect of iodine or just improved flavor) 7 times seven times
- 18. Data Collection
- 19. Data Collection
- 20. Data Collection
- 21. Data Collection
- 27. KEY MESSAGE: The Milk Changes during Breastfeeding . The longer the child breastfeeds on one breast the richer the milk becomes in protein and fat. The FIRST milk (watery milk) The THIRD Milk (creamy) The SECOND Milk (normal)
- 28. Monitoring of Behaviors and Beliefs related to Exclusive BF PD Behavior
- 39. Decrease in Malnutrition All districts at or above project target for EBF.
- 41. SUBHEADING The sidebar summary
Editor's Notes
- When and How to do this study. A local determinants of malnutrition study has a specific time and place in a program cycle when it is most useful.
- Differ from area to area, supplement what we see in literature
- Look to see if they exist in other countries
- In the case of depression, World Vision recently carried out a low-cost project in Uganda using Interpersonal Therapy for Groups to decrease depression. Community-level workers were taught to work with people in groups for “talk therapy” which decreased depression by 92%.
- Or potential causes
- Now I am going to present to you the study methodology. The first step was a literature review…
- Point 3: Local staff developed fishbone diagrams of the causes of malnutrition that they suspected. In some fields, we added questions to the questionnaire to take into account their ideas on local causes. Also, staff saw the questionnaire ahead of time and were given the opportunity to add questions. In Ethiopia, for example, they had done previous, smaller PD studies as part of Hearth trainings, and they suggested adding the questions on removing milk teeth and uvulectomy.
- One of the questions (Question 25) examines certain foods that the child may or may not eat during a normal week…
- Training materials were put together and then we started doing workshops with our staff in several of our field offices. The multi-day workshops were designed to include time to use the questionnaire to collect the data for the study as well as analyze it. In Ethiopia the workshop lasted 8 days and included 2 days of training, 3 days of data collection, 2 days of data entry and analysis, and 1 day to discuss the results and potential application.
- The WAZ (weight for age Z-score) cut-off for PD children varied from country to country. The protocol called for having a PD population of at least 15% and starting with a cut-off of WAZ>0. In regions where finding well nourished children was extremely difficult at those higher levels, we lowered it to -0.5 or -1.0, but never lower than -1.0.
- Supervisor checks child’s age, makes sure the mother is at a similar socio-economic level as her neighbors.
- Triage persons weigh child, supervisor consults chart and determines if child qualifies for study as Mal or PD.
- Interviewer conducts interview in a private place where others cannot hear the mother’s answers
- Afterwards a health talk (not about themes in the questionnaire) is given to the remaining mothers and community members.
- It was not difficult for workshop participants to learn how to interpret 2x2 tables and do Analysis of Variance with Epi-Info. In fact, because they had been involved in the data collection, they had a vested interest in learning how the data was analyzed.
- Mention that we have the LDMS methodology written up, including the questionnaires, and we can make that available on the SBCWG website if people are interested.
- This is a program planning tool that gives us a shorter list of things that are much more likely to be driving malnutrition in a program area so that we can make changes to our program to address each possible cause. Also, when we find findings that are contrary to the current thinking, we do not move ahead with programming concerning that, but instead, look into the reasons for it.
- A local determinants of malnutrition study has a specific time and place in a program cycle when it is most useful.
- When we looked into the context of result #2, we realized that some of the malnourished children had a really late introduction to solid foods (i.e. 24m, 36m) which seems to indicate that prolonged breastfeeding beyond 2y was a coping mechanism for minimal or lack of food. While discussing how to apply this result, we talked about an intervention that focused on the techniques of appropriate breastfeeding and appropriate complementary feeding. Q: Did you do multivariate analysis? A: No, but we did look for confounding on some variables. We didn’t have the time for multivariate analysis, the skills on staff, and given our small sample size, did not think that multivariate analysis would yield very much anyway.