DOCSLIB.ORG

Positive Deviance an Asset-Based Approach to Improve Malaria Outcomes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Positive Deviance an Asset-Based Approach to Improve Malaria Outcomes LEARNING PAPER Positive deviance An asset-based approach to improve malaria outcomes Learning Paper 1 BACKGROUND Learning paper series Since starting operations in 2003, Malaria Consortium disease management and control. Collaboration and has gained a great deal of experience and knowledge cooperation with others through our work has been through technical and operational programmes and paramount and much of what we have learned has activities relating to the control of malaria and other been achieved through our partnerships. infectious childhood and neglected tropical diseases. Organisationally, we are dedicated to ensuring our This series of learning papers aims to capture and collate work remains grounded in the lessons we learn some of the knowledge, learning and, where possible, through implementation. We explore beyond the evidence around the focus and effectiveness of our current practice, to try out innovative ways – work. By sharing this learning, we hope to provide new Community members in through research, implementation and policy knowledge on public health development that will help Sampov Luon District gather for a positive deviance development – to achieve effective and sustainable influence and advance both policy and practice. meeting Contents AUTHOR Muhammad Shafique 2. Introduction Malaria Consortium 4. What is positive deviance? Sue George Consultant 6. Section 1: CONTRIBUTORS Arantxa Roca Feltrer Background to the positive deviance project Malaria Consortium 9. Planning the project EDITOR Portia Reyes 10. Section 2: Malaria Consortium The positive deviance project DESIGN 12. Phase 1 – one-week positive deviance process Transmission Art direction & Design 16. Phase 2 – six-month positive deviance www.thisistransmission.com Andrew Lyons Cover illustration implementation Cristina Ortiz Graphic illustration 17. Advocacy event CONTACT [email protected] 20. Section 3: What worked well Citation: Shafique, M and George, S (2014) Positive deviance: An asset-based approach to improve malaria outcomes 22. Lessons learned and challenges www.malariaconsortium.org/ learningpapers 23. Conclusions and recommendations COPYRIGHT Malaria Consortium 23. References PUBLISHED April 2014 24. About Malaria Consortium © 2014 This learning paper was produced by Malaria Consortium and is licensed under a Creative Commons Attribution No-Derivs 3.0 Unported Licence. It is permitted to copy, distribute and transmit the work commercially or otherwise under the following conditions: the work must be attributed in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work; the work may not be altered, transformed, or built upon. These conditions can be waived if permission is granted in writing by Malaria Consortium. For other details relating to this licence, please visit http:// creativecommons.org/licenses/by-nd/3.0/. For any reuse or distribution, please make clear the licence terms of this paper by linking to it via www.malariaconsortium.org/resources/ publications/add-type/learning-papers Learning Paper 1 BACKGROUND Introduction This learning paper describes a pilot project in north-west Cambodia that used positive deviance as a method of behaviour change communication for malaria control Positive deviance is a behaviour and social change Positive deviance approach that helps identify existing model behaviours within a community that can be shared and amplified identifies the solutions by the rest of the community. of the problems today. It identifies the role It rests on the observation that in every community, there are certain individuals whose uncommon models who, despite all behaviours enable them to find better solutions to odds, living in similar problems than their neighbours who have access to the conditions, sharing 1-3 same resources . similar resources, The project discussed in this learning paper focused on have managed to mobile and migrant workers and resident communities have better health in three villages in Sampov Luon, north-west Cambodia. This work was carried out by Cambodia’s National outcomes than their Centre for Parasitology, Entomology and Malaria neighbours. Positive Control (CNM), with the technical support of Malaria deviance can be a very Consortium and funding from the Bill & Melinda Gates Foundation. effective interpersonal communication tool The positive deviance project involved selecting role for hard to reach models from within the community who practised uncommon but positive behaviour with regards to populations, such as malaria prevention and control. These role models then mobile and migrant worked within the community to show other individuals workers, to better and families how they could act in similar ways, in order to improve malaria prevention and enhance understand and reach malaria treatment. The project ended with a large out to them. advocacy event that symbolically handed the project Muhammed Shafique, over to the community. Malaria Consortium This paper looks closely at what this project involved, discusses what worked well, what lessons were learned and the challenges met during the period it was running. At the end of this paper are recommendations for future malaria control work using positive deviance. The positive deviance project targeted the local community and migrant populations 2 Learning Paper Learning Paper 3 BACKGROUND What is positive deviance? The term ‘positive deviance’* means uncommon but positive behaviours within a community that could be used more widely for the benefit of others. Positive deviance individuals and their families have After learning from more effective solutions to health problems than do their neighbours, with whom they share similar resources1–3. the positive deviance In positive deviance, these individuals are used to model role model, we follow behaviours for other members of the community. her behaviour. We Positive deviance is a behaviour change approach that wear long-sleeved builds on the existing strengths of communities. The clothes and sleep positive deviance approach starts with a community under the mosquito net dialogue; it respects local wisdom and provides social proof by identifying positive practices from within the every night to protect community that ensures acceptance and speeds up ourselves from malaria. the process of behaviour change. It allows community Female community members to be active beneficiaries, engaged as full partners to play a role in their own health and member protection from malaria. Positive deviance has also been used to identify positive behaviours associated with maternal and newborn health, family planning, female genital mutilation, preventing trafficking of women and HIV/AIDS3, 7-10. The project detailed here is the first time positive deviance has been used for malaria prevention and control. As the phrase ‘positive deviance’ has some negative connotations in the areas of Cambodia where the programme run, the term ‘role model’ was often used instead in this programme in order for it to remain culturally appropriate. A positive deviance role *The term ‘positive deviance’ first appeared in nutrition research in 1970s4,5. The positive deviance concept model in Khtum Reay Kaeut was first operationalised in the field by Jerry and Monique Sternin on nutrition in Vietnam in 1990s6,7. village 4 Learning Paper Learning Paper 5 SECTION 1 Background Cambodia, which lies in the centre of the Indo-China peninsula in Southeast Asia, has a population of 13,386,910* consisting of 2.2 million households, in 13,406 villages in 24 provinces. Malaria remains a public health concern in Cambodia. Cambodia has witnessed a steady reduction in the cases were recorded). As seen in the figure below, total number of malaria cases and deaths. According similar incidence trends were observed during the to the latest CNM annual report 2013, a total of 24,135 same period. At the same time, an even more dramatic malaria episodes were treated by the public health decrease of around 95 percent of the malaria deaths services during 2013, a dramatic decrease of more than reported in 2000 was observed during the last 13 years 81 percent of the cases reported in 2000 (when 129,167 (from 608 to 12 deaths in 2013). Number of malaria treated cases, severe cases and deaths, Cambodia 2000 to 2013 Number of cases Number of deaths 140,000 700 120,000 600 100,000 500 80,000 400 60,000 300 40,000 200 20,000 100 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Treated cases Severe cases Deaths Source: National Centre for Parasitology, Entomology and Malaria Control Incidence rate of malaria treated cases per 1000 population, Cambodia 2000 to 2013 Number of malaria treated cases Incidence rate per 1000 population 140,000 14 120,000 12 100,000 10 80,000 8 60,000 6 40,000 4 20,000 2 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 A migrant worker packing Treated cases Incidence rate per 1000 corn. Many migrant workers seek temporary work during Source: National Centre for Parasitology, Entomology and Malaria Control *Cambodia Census, 2008 planting or harvesting season 6 Learning Paper Learning Paper 7 SECTION 1 Farming and forest areas Despite the decrease in malaria as a whole, there is This area has many migrant workers coming to work growing evidence for the emergence of artemisinin in the villages during the planting or harvesting season resistance along the Cambodia-Thailand border area. to find
Load more

Recommended publications
  • Combating Malnutrition
    POSITIVE DEVIANCE INITIATIVE Combating Malnutrition CC in the Land of a Thousand Rice Fields com Positive Deviance Grows Roots in Vietnam¹ by Arvind Singhal, Jerry Sternin, & Lucía Durá photo: Modifed from original by Chris Feser @ fickr. @ fromphoto: Modifed Feser original by Chris Rice farmingRice in Vietnam Positive Deviance Wisdom Series, Number 1, 2009 www.positivedeviance.org POSITIVE DEVIANCE enables communities to discover the wisdom they already have, and then to act on it. “Sternin, you have six months to show results,” noted Mr. Nuu, a high-ranking offcial in the Vietnamese Ministry of Foreign Affairs. “What? Six months? Six months to demonstrate impact?” Jerry Sternin could not believe his ears. “Yes, Sternin, six months to show impact, or else, I will not be able to extend your visa.” In December 1990, Jerry Sternin, accompanied by his malnutrition would not yield quick and sustainable wife Monique and ten-year old son Sam, arrived in Hanoi results, the Sternins wondered if the construct of to open an offce for Save the Children, a U.S.-based Positive Deviance, coined a few years previously by NGO. His mission: To implement a large scale program Tufts University nutrition professor Marian Zeitlin,¹ to combat childhood malnutrition in a country where might hold promise. two thirds of all children under the age of fve suffered from malnutrition. Zeitlin broached the notion of PD as she tried to understand why children in some poor households, The Vietnamese government had learned from experience without access to any special resources, were better that results achieved by traditional supplemental feeding nourished than children in other households.
    [Show full text]
  • Impact of Positive Deviance Approach on Breastfeeding Practices Among Tribal Pregnant Women -A Before-After Intervention Study
    See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/333566194 Impact of positive deviance approach on breastfeeding practices among tribal pregnant women -A before-after intervention study Preprint · June 2019 CITATIONS READS 0 6 2 authors, including: Sudip Bhattacharya Himalayan Institute of Medical Sciences 76 PUBLICATIONS 69 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Thesis View project Implementation of skill development programme in PGIMER, Dietetics Department through video based training and administrative measures on food handlers to improve personal hygiene. View project All content following this page was uploaded by Sudip Bhattacharya on 23 November 2019. The user has requested enhancement of the downloaded file. [Downloaded free from http://www.cjhr.org on Saturday, November 23, 2019, IP: 139.167.85.198] Original Article Impact of the Positive Deviance Approach on Breastfeeding Practices among Tribal Pregnant Women: A Before – After Intervention Study Abstract Abhay Srivastava, Introduction: Breastfeeding is very important for the infant and for the mother. Breastfeeding Kanchan Gwande1, practices in India and abroad are not up to the mark, and they pose serious health risk to the Sudip Bhattacharya, mothers and the babies. Methodology: This single‑group before–after intervention study was 2 conducted to assess the impact of positive deviance (PD) approach on knowledge about exclusive Vijay Kumar Singh breastfeeding (EBF) practices among tribal pregnant women. The sample size was 376. Data were Department of Community collected using convenient sampling method. At first, we identified eight positive deviants from that Medicine, Himalayan Institute of Medical Sciences, Dehradun, area.
    [Show full text]
  • Positive Deviance and Hand Hygiene of Nurses in a Quebec Hospital: What Can We Learn from the Best?
    ARTICLE IN PRESS American Journal of Infection Control ■■ (2017) ■■-■■ Contents lists available at ScienceDirect American Journal of Infection Control American Journal of Infection Control journal homepage: www.ajicjournal.org Major Article Positive deviance and hand hygiene of nurses in a Quebec hospital: What can we learn from the best? Josiane Létourneau MPH a,b,c,*, Marie Alderson PhD a,b,d, Annette Leibing PhD a,b,c,e,f a Faculté des sciences infirmières, Université de Montréal, Montréal, QC, Canada b Quebec Nursing Intervention Research Network, Montréal, QC, Canada c Institut de recherche en santé publique, Université de Montréal, Montréal, QC, Canada d Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada e Research group Meos (Le médicament comme objet social), Geneva, Switzerland f CREGÉS (Centre de recherche et d’expertise en gérontologie sociale), Montréal, QC, Canada Key Words: Background: Although it is well known that hand hygiene is the most effective measure to prevent health Positive deviance care–associated infections, hand hygiene adherence is low in Quebec, as it is elsewhere. For this study, hand hygiene an innovative framework was used to explore the clinical practice of nurses regarding hand hygiene and nurses the factors that influence it: positive deviance, or the idea that there are people who find better solu- focused ethnography tions to problems than their peers. This study investigated positive deviance at the level of the care team to shed light on group dynamics. Methods: We conducted focused ethnographies on 2 care units—a medical-surgery unit and a palliative care unit—at a Montreal university hospital.
    [Show full text]
  • Toward a Theory of Positive Deviance
    University of New Hampshire University of New Hampshire Scholars' Repository Doctoral Dissertations Student Scholarship Spring 1985 TOWARD A THEORY OF POSITIVE DEVIANCE DRUANN MARIA HECKERT University of New Hampshire, Durham Follow this and additional works at: https://scholars.unh.edu/dissertation Recommended Citation HECKERT, DRUANN MARIA, "TOWARD A THEORY OF POSITIVE DEVIANCE" (1985). Doctoral Dissertations. 1450. https://scholars.unh.edu/dissertation/1450 This Dissertation is brought to you for free and open access by the Student Scholarship at University of New Hampshire Scholars' Repository. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of University of New Hampshire Scholars' Repository. For more information, please contact [email protected]. INFORMATION TO USERS This reproduction was made from a copy of a document sent to us for microfilming. While the most advanced technology has been used to photograph and reproduce this document, the quality of the reproduction is heavily dependent upon the quality of the material submitted. The following explanation of techniques is provided to help clarify markings or notations which may appear on this reproduction. 1.The sign or “target” for pages apparently lacking from the document photographed is “Missing Page(s)”. If it was possible to obtain the missing page(s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting through an image and duplicating adjacent pages to assure complete continuity. i i 2. When an image on the film is obliterated with a round black mark, it is an indication of either blurred copy because of movement during exposure, duplicate copy, or copyrighted materials that should not have been filmed.
    [Show full text]
  • Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
    Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] Outline: From Food Insecurity Food Security Sustainability Food Security – Insecurity 47pp Global Nutrition Index – Triple burden of <Mal>nutrition Coping with Food Insecurity – Bélanger & Pilling The Sociotype & >175 experts 576pp Positive Deviance Olivier De Schutter & 250 experts Sustainability and Sustainable Food 112pp Systems What Policy Makers can do… Food Security is a Fundamental Human Right How Positive Deviance Changed my life … COPING: Practical Steps LEARN FROM THE POSITIVE DEVIANTS 1 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] The P o w e r of Positive Deviance Solutions before our very eyes!! The Premise: Indian Face or Eskimo? In every community there are certain individuals whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources Marsh et al. BMJ 329, 1177, 2004 Positive Deviance (PD) Approach Identifying Solutions to Community Problems Within the Community - Today The Key Question? What enables some members of the community (the “Positive Deviants”) to find these better solutions? 2 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] [Mal]nutrition in Vietnam PD Inquiry How are some children well-nourished?? Gathering vegetables “Stealing” “TBU” Money from outside “TBU” All family thin…. “TBU” Cf Antonovsky Breast feeding etc Salutogenesis Project aim Setting PD Behaviors Child Vietnam Eating Fruits & Vegs, Shrimp Malnutrition 1999 - snails, Breast milk, beans, 2000 peanuts Boiling Drinking water 5-6 meals/d active feeding Mosquito bed net Immunization Food Nutr Bull 2002, Daily bath 23 suppl 4, 36 Early care seeking for illness 3 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] AlthoughPD most Enables problems have complex, us to underlying Act causes TODAY .
    [Show full text]
  • 1 Applying a Deviance Framework to Understand How Place Shapes
    Applying a Deviance Framework to Understand How Place Shapes Modern Contraceptive Use in Sub-Saharan Africa Tamar Goldenberg 1, 2 and Rob Stephenson,2, 3 1Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, 48109 2Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, 48109 3Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, 48109 1 ABSTRACT: Increasing modern contraception use is important for improving maternal and child health and achieving economic growth and development goals. However, high unmet need for modern contraception in Sub-Saharan Africa warrants new understandings of the drivers of modern contraceptive use. Using data from Demographic Health Surveys from 29 Sub-Saharan African countries, we examine how a woman’s deviation from community norms is associated with modern contraception use. Stepwise analysis was conducted and then separate random- effects logistic regression models were fitted to examine relationships between modern contraception use and positive and negative deviance on socioeconomic characteristics, gender and fertility norms, and health knowledge and media exposure. Results suggest that deviance in all three domains is associated with modern contraception use; however, relationships between deviance and modern contraception use vary by variable and by place. Findings highlight the importance of using context-specific deviance approaches for improving public
    [Show full text]
  • Oxford Research Encyclopedia of Communication
    Positive Deviance: A Non-Normative Approach to Health and Risk Messaging Oxford Research Encyclopedia of Communication Positive Deviance: A Non-Normative Approach to Health and Risk Messaging Arvind Singhal and Lucia Dura Subject: Communication Theory, Health and Risk Communication Online Publication Date: Mar 2017 DOI: 10.1093/acrefore/9780190228613.013.248 Summary and Keywords The Positive Deviance (PD) approach is based on the premise that every community has individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers although everyone has access to the same resources and challenges. In contrast to traditional problem-solving approaches that begin with an expert- driven analysis of “what is not working” with people—their explicit needs, deficits, problems, and risks—followed by attempts to plug those gaps, the PD approach focuses on identifying “what is working.” PD offers a systematic framework to identify assets, indigenous knowledge, and home-grown solutions, and to amplify them for wider adoption. The PD approach was operationalized and systematized in the early 1990s in Vietnam to address malnutrition. At the time, 65% of children under five were malnourished. Instead of looking for the causes and applying best practices, PD pioneers looked for children from very poor families who were well-nourished. Through community-led efforts, they determined the existence of positive deviants, identified their behaviors and strategies, and amplified them. The process was replicated across 14 villages—each identifying its own batch of local practices—and malnutrition decreased by 85%. These actions led to PD as we know it today in the form of the “6 Ds”: Define, Determine, Discover, Design, Discern, and Disseminate.
    [Show full text]
  • Learning from Positive Deviants to Improve the Quality and Safety of Healthcare
    Learning from positive deviants to improve the quality and safety of healthcare. Ruth Mary Baxter Submitted in accordance with the requirements for the degree of Doctor of Philosophy The University of Leeds School of Psychology November 2016 ii The candidate confirms that the work submitted is her own, except where work which has formed part of jointly authored publications has been included. The contribution of the candidate and the other authors to this work has been explicitly indicated below. The candidate confirms that appropriate credit has been given within the thesis where reference has been made to the work of others. The systematic review reported in Chapter 2 and a protocol paper for the secondary care study (Chapters 3 and 4) have been published: Baxter, R., Taylor, N., Kellar, I., & Lawton, R. (2015). What methods are used to apply positive deviance within healthcare organisations? A systematic review. BMJ Quality and Safety, Published online first 20th November. doi: 10.1136/bmjqs-2015-004386 Baxter, R., Taylor, N., Kellar, I. and Lawton, R. (2015). Learning from positively deviant wards to improve patient safety: an observational study protocol. BMJ Open; 5:e009650. doi:10.1136/bmjopen-2015-009650 All authors developed the concept for the systematic review. RB designed the study and conducted the searches, screening, data extraction and analysis with input from IK, NT and RL. RB drafted the publication and thesis manuscript. All authors provided comments and approved final versions. All authors contributed to the conception of the secondary care study. RB designed the study which was critically assessed and approved by all the other authors.
    [Show full text]
  • Chapter 3 Practice Positive Deviance for Extraordinary Social And
    CHAPTER 3 PRACTICE POSITIVE DEVIANCE FOR EXTRAORDINARY SOCIAL AND ORGANIZATIONAL CHANGE Jerry Sternin ABSTRACT In his own words, Jerry Sternin, widely known as "the father of applied Positive Deviance, " explains the story of how an acute crisis led him to the practice of Positive Deviance (PD). He tells how he was propelled, over a twelve-year period to develop and amplify the approach which has enabled communities of more than 2.2 million people in Vietnam to sustain the reduction of childhood malnutrition and has been replicated in 24 other countries around the world. The chapter includes a step-by step approach to positive deviance, a formula for positive deviance, exceptional stories of change within societies, and a "how to" and "what-to-do" approach to positive deviance that could be applied within organizations, institutions, or your own society. SUMMARY Positive Deviance (PD) is based on the belief that in every community there are certain individuals/entities whose special practices or strategies enable them to find a better solution to a pervasive problem than their neighbors who have access to exactly the same resources. We call these individuals "positive deviants". The PD design provides a tool to enable the community to discover the positive deviants' uncommon, but demonstrably successful strategies. The community then analyzes those strategies retaining only those that are accessible to all its members. Finally, the community designs an intervention, enabling all its members to access and practice the newly discovered PD strategies. PRACTICE POSITIVE DEVIANCE FOR EXTRAORDINARY SOCIAL AND ORGANIZATIONAL CHANGE 21 INTRODUCTION Nasirudin, the great Sufi mystic, appears in different guises in different stories.
    [Show full text]
  • PD Hearth Elements Text.Indd
    Positive Deviance/Hearth Essential Elements A Resource Guide for Sustainably Rehabilitating Malnourished Children (Addendum) June 2005 The CORE Group is a membership association of international nongovernmental organizations registered in the United States whose mission is to improve the health and well being of children and women in developing countries through collaborative NGO action and learning. For more information: CORE Group www.coregroup.org Recommended Citation Nutrition Working Group, CORE Group, Positive Deviance / Hearth Essential Elements: A Resource Guide for Sus- tainably Rehabilitating Malnourished Children (Addendum), Washington, D.C: June 2005. Acknowledgements This publication was written by Judiann McNulty, a consultant to the CORE Group. Abstract A Positive Deviance/Hearth Nutrition Program is a home- and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in developing countries. The program uses the “positive deviance” approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and to transfer such positive practices to others in the community with malnourished children. The “Hearth” or home is the location for the nutrition education and rehabilitation sessions. This Addendum updates the CORE Group’s February 2003 Positive Deviance/Hearth Manual. It gives an overview of appropriate settings for and essential elements of a PD/Hearth intervention. This publication was made possible by support from the Bureau for Global Health, United States Agency for Interna- tional Development (USAID) under cooperative agreement FAO-A-00-98-00030. This publication does not necessarily represent the views or opinion of USAID. It may be reproduced if credit is properly given.
    [Show full text]
  • Positive Deviance Hearth Resource Guide
    Positive Deviance/Hearth: A Resource Guide for Sustainably PPositiveositive DevianceDeviance /Hearth/Hearth Rehabilitating Malnourished Children Positive Deviance/Hearth is a successful home-based & neighborhood-based nutrition program for children who are at risk for malnutrition in developing countries. It has enabled hundreds of communities to reduce their levels of childhood malnutrition and to prevent malnutrition years after the program’s completion. The “positive deviance” approach is used to find uncommon, beneficial practices by mothers or caretakers of well-nourished children from impoverished families. Once identified, ways are sought to spread these practices and behaviours to others in the community with malnourished children. A “Hearth” is the setting of the nutrition education and rehabilitation part of the program. Suggesting a family around a fireplace or kitchen, Hearths are carried out in home settings where caretakers and volunteers prepare “positive deviant foods”. They practice beneficial childcare behaviors and feed malnourished children with extra energy-rich/calorie-dense supplemental meals. Sprinkled with helpful field examples, useful tools and ideas, this guide explains step by step how to: ♥ identify at-risk children AA RResourceesource GuideGuide ♥ conduct a Positive Deviance Inquiry forfor SustainablySustainably RRehabilitatingehabilitating ♥ conduct Hearth sessions and ♥ set up a monitoring and evaluation system MalnourishedMalnourished ChildrenChildren CORE Incorporated 220 I Street, NE Suite 270 Washington DC 20002 (USA) telephone (202) 608-1830 / fax (202) 543-0121 Child Survival Collaborations and Resources Group www.coregroup.org Nutrition Working Group February 2003 The CORE Group he Child Survival Collaborations and Resources Group (The CORE T Group) is a membership association of more than 35 U.S.
    [Show full text]
  • Determinants of Normal Haemoglobin Concentration Among Children In
    www.nature.com/scientificreports OPEN Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data Dickson A. Amugsi Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance. Anaemia, defned as blood haemoglobin concentration lower than normal1,2 is a pervasive problem among chil- dren under fve years of age.
    [Show full text]