Positive deviance in child malnutrition of urban poor of Mumbai, India: A longitudinal analysis

Abstract

Background Maharashtra has the largest share of urban population in India (13.5%) and is home to the largest slums. Malnutrition rates in these settlements are very high due to insufficient feeding, poverty, poor water quality and sanitation. The Foundation for Mother and Child Health (FMCH) has been working on reducing malnutrition in the urban slums of Mumbai for about 14 years now. Longitudinal data (2014-2019) collected by them was used in this analysis. Objectives To analyze the nutritional status of children before and after the intervention of FMCH and identify underlying factors associated with positive deviance in them. Methods NFHS-4 urban data of the lowest wealth quintile was used to analyze nutritional status of urban poor in India. Primary data of 4634 children (age 0-5) from the slums of Mumbai was analyzed for nutritional status during baseline and end line using ENA software. Descriptive statistical methods and binary logistic regression model were applied on selected 1583 cases using SPSS. Results Malnutrition rates in these children were lesser than national averages until 2 years of age. From baseline to end line, 48% reduction was observed in wasting within the first 6 months of age. Binary logistic regression reveals that age at registration (Odds ratio, OR = 0.94, p-value=0.04) and area of residence (p-value=0.00) are two most significant factors contributing to positive deviance in the child's nutritional status. Another univariate logistic regression on categorized breastfeeding score reveals that a higher score results in higher odds (OR = 1.561, p-value=0.01) of positive deviance in nutritional status of the child. Conclusions Since the strategy in each area is different, the most successful strategy is thus identified. The importance of early identification and intervention for effective tackling of malnutrition is highlighted through this analysis. Also, the role of effective breastfeeding techniques has emerged to be extremely significant. Key messages Impacting over 4000 children, the right nutrition in the first 1000 days and regular monitoring resulted in almost 50% reduction in wasting. Effective breastfeeding techniques were found to be extremely significant in the improvement of child's nutritional status.