Summaryobjectives The Positive Deviance ⁄ Hearth approach aims to rehabilitate malnourished children using practices from mothers in the community who have well-nourished children despite living in poverty. This study assesses its effectiveness in a range of settings.methods Systematic review of peer reviewed intervention trials and grey literature evaluation reports of child malnutrition programs using the Positive Deviance ⁄ Hearth approach.results Ten peer reviewed studies and 14 grey literature reports met the inclusion criteria. These described results for 17 unique Positive Deviance ⁄ Hearth programs in 12 countries. Nine programs used a pre-and post-test design without a control, which limited the conclusions that could be drawn. Eight used more robust designs such as non-randomized trials, non-randomized cross-sectional sibling studies and randomized controlled trials (RCTs). Of the eight programs that reported nutritional outcomes, five reported some type of positive result in terms of nutritional status -although the improvement was not always as large as predicted, or across the entire target population. Both the two RCTs demonstrated improvements in carer feeding practices. Qualitative results unanimously reported high levels of satisfaction from participants and recipient communities.conclusions Overall this study shows mixed results in terms of program effectiveness, although some Positive Deviance ⁄ Hearth programs have clearly been successful in particular settings. Sibling studies suggest that the Positive Deviance ⁄ Hearth approach may have a role in preventing malnutrition, not just rehabilitation. Further research is needed using more robust study designs and larger sample sizes. Issues related to community participation and consistency in reporting results need to be addressed.
Multinationals and the for-profit sector evoke a range of responses from public health professionals - from enthusiasm through to distain and anger. Several sessions at the conferences of the International Union for Health Promotion and Education (IUHPE) and of the American Public Health Association (APHA) in 2010 addressed issues related to multinationals, trade and public-private partnerships. However, there was no representation from the for-profit sector at any of these events. This commentary argues that, regardless of whether public health professionals agree or disagree with the actions of multinationals, maintaining a dialogue with them is essential. Recommendations are given for engaging effectively with the for-profit sector.
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