Age differences in the impact of a Positive Deviance/Hearth programme on the nutritional status of children in rural Bangladesh

Abstract

Objective: To examine the difference in the rehabilitation rate from underweight by child age at enrolment in the Positive Deviance (PD)/Hearth programme. Design: This secondary data analysis used programme monitoring records of underweight children aged 6–60 months attending a 2-week PD/Hearth session and followed up for 6 months in Sep. 2018–Mar. 2019. Data were analysed using multi-level mixed-effect regression and poisson regression with robust variance. Setting: Rajshahi Division, Bangladesh Participants: A total of 5,227 underweight (weight-for-age z-score [WAZ]<-2) children who attended the PD/Hearth sessions. Results: From enrolment to six months follow-up, the mean WAZ improved from −2.80 to −2.09, and the percentage of underweight children decreased to 54.5%. Compared to the enrolment age of 6-11 months, the estimated monthly change in WAZ at six months of follow-up were 0.05 lower for 12-23 months, 0.06 lower for 24-35 months, and 0.09 lower for 36-60 months of the enrolment age (all p<0.001). The probability of rehabilitation at six months of follow-up were lower by 16.7% for 12-23 months (RR=0.83; 95% CI: 0.77, 0.91), 15.5% for 24-35 months (RR=0.84; 95% CI: 0.78, 0.92), and 34.9% for 36-60 months of the enrolment age (RR=0.65; 95% CI: 0.59, 0.72), compared to the enrolment age of 6-11 months. Conclusions: Enrolment in the PD/Hearth programme at a younger age had the advantage of greater rehabilitation from underweight than older age. Our findings provide a better understanding of the successes and failures of the PD/Hearth programme to achieve more sustainable and cost-effective impacts.

Adaptive Implementation of a Community Nutrition and Asset Transfer Program during the COVID-19 Pandemic in Rural Bangladesh

“…In terms of child nutrition status, short-term outcomes among direct program participants did not differ from before the pandemic to during the prevention measures. In addition, the PD/Hearth program had a longer-term (i.e., 6 mo) impact on reducing underweight among program participants ( 24 ). As previously stated, the project team chose to raise people's awareness of the COVID-19 situation with the help of CGs/CSGs and thus reduced the number of participants per session while maintaining the quality of the program as much as possible.…”

“…The weight of the children was converted to weight-for-age z - score (WAZ) and calculated for underweight (WAZ <-2) status. We defined the short-term outcomes of the PD/Hearth program at the participant/beneficiary level as weight gain over 200 g at 12 d or over 400 g at 1 mo after enrollment into the PD/Hearth sessions, which is routinely used in many PD/Hearth programs ( 14 ), and percentage change in underweight between enrollment and 12 d and between enrollment and 30 d ( 24 ). The changes in percentage underweight and weight gain at 12 d and 30 d after enrollment were assessed both in a total and as stratified by year (2018, 2019, and 2020).…”

Impact evaluation of a community nutrition and livelihood program on child nutrition in rural Bangladesh

“…A total of 11,984 children enrolled in PD/Hearth sessions in BRDMCN. A nested research study based on weight monitoring data of approximately 6500 PD/Hearth children indicated that PD/Hearth participation held a greater benefit for children enrolled at a younger age (Kim, Biswas, et al, 2021).…”

“…The PD/Hearth programs showed positive impacts on child nutritional status in other program settings (Kang et al, 2017;Roche et al, 2017;Young et al, 2021). for children enrolled at a younger age (Kim, Biswas, et al, 2021).…”

Implementasi Positive Deviance/Hearth sebagai Intervensi Gizi Guna Menurunkan Kekurangan Gizi pada Anak : Literature Review

“…PDH membutuhkan waktu untuk rehabilitasi cepat anak kekurangan gizi yaitu 10-12 hari berturut-turut. Sehingga, sangat membutuhkan komitmen yang kuat dari pengasuh untuk mengikuti program (27).…”