Positive deviance approach in improving child health outcomes: assessment of child feeding practices in Marsabit County, Kenya

Rose Chepkorir; Agatha Christine Onyango; David Masinde; Caroline Patricia Musita

doi:10.18203/2394-6040.ijcmph20250599

Authors

Rose Chepkorir Department of Public Health, Maseno University, Kisumu, Kenya
Agatha Christine Onyango Department of Nutrition and Health, Maseno University, Kisumu, Kenya
David Masinde Department of Public Health, Maseno University, Kisumu, Kenya
Caroline Patricia Musita School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kisumu, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20250599

Keywords:

Deviant child feeding practices, Maternal knowledge, Positive deviance approach in improving child health outcomes

Abstract

Background: Child feeding practice is considered one of the determinants of malnutrition in under-fives. In Kenya, inadequate infant and young child feeding practices contribute to high rates of malnutrition. In Marsabit County, undernutrition prevalence varies in different sub-counties. There are areas where malnutrition is very high whereas other areas are relatively low. This study aimed to assess maternal knowledge of child-feeding practices and to determine the deviant child-feeding practices among mothers of children aged 6-24 months.

Methods: This study adopted a cross-sectional study design. Three-stage sampling technique was used to randomly select 278 eligible households with children aged 6-24 months for participatory assessment of child feeding practices. A questionnaire was used for quantitative data and Focus Group Discussion and guides for qualitative data. Univariate analysis was used to obtain the frequency distribution of maternal knowledge and deviant practices.

Results: The study found that maternal knowledge has a significant effect on child-feeding practices in Marsabit County, Kenya. Mothers have a good understanding of the changing food systems. Due to the scarcity of cow’s milk, brought about by drought, unavailability in the market, and increasing food prices, other affordable substitutes are being given like, porridge, fruits, soup (meat), and eggs.

Conclusions: The study concludes that maternal knowledge has a significant effect on child-feeding practices in Marsabit County, Kenya. The study concludes that deviant child-feeding practices have a significant effect on child-feeding practices in Marsabit County, Kenya.

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Author Biographies

Agatha Christine Onyango, Department of Nutrition and Health, Maseno University, Kisumu, Kenya

Lecturer, Department of Nutrition and Health, Maseno University

David Masinde, Department of Public Health, Maseno University, Kisumu, Kenya

Lecturer, Department of Public Health, Maseno University

Caroline Patricia Musita, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kisumu, Kenya

Lecturer, School of Public Health, Jomo Kenyatta University of Agriculture and Technology

References

United Nations Children’s Fund. The state of the world’s children. UNICEF annual report; 2019. Available at: https://www.unicef.org/media/74016/file/UNICEF-annual-report-2019.pdf. Accessed 01 November 2024.

Khomsan A. Access food, hygiene, sanitation, and coping strategies for households in slum areas. Min Agricul Environm Poli. 2014;1(2):59-66.

World Health Organization. Global strategy for infant and young child feeding; 2003. Available at: https://www.who.int/publications/i/item/9241562218. Accessed 01 November 2024.

Goldbohm R, Rubingh C, Lanting C, Joosten K. Food consumption and nutrient intake by children aged 10 to 48 months attending daycare in The Netherlands. Nutrients. 2016;8(7):428-437. DOI: https://doi.org/10.3390/nu8070428

Mc’Nulty J. The Core Group. Positive deviance/Hearth essential elements: A resource guide for sustainably rehabilitating malnourished children (Addendum). Washington, D.C: The CORE Group Publications; 2005.

Lapping K, Marsh RD, Rosenbaum J, Swedberg E, Sternin J, Sternin M, Schroeder G. The positive deviance approach: Challenges and opportunities for the future. Food Nutr Bull. 2002;23(4):128-35. DOI: https://doi.org/10.1177/15648265020234S117

Piroska A, Bullen B. The positive deviance/hearth approach to reducing child malnutrition: systematic review. Trop Med Int Health. 2011;16(11):1354-66. DOI: https://doi.org/10.1111/j.1365-3156.2011.02839.x

Padilla D. A community-based positive deviance/hearth intervention to promote community empowerment and improve childhood malnutrition in rural Nicaragua. 2018.

Merita M, Sari M, Hesty H. The positive deviance of feeding practices and caring with nutritional status of toddlers among poor families. J Kesehatan Masyarakat. 2017;1(3):106-12. DOI: https://doi.org/10.15294/kemas.v13i1.7919

Saha C, Nambiar V. Identification of positive deviant behaviors regarding infant and young child feeding (IYCF) among rural mothers for improving child health and nutrition-a cross-sectional study. Indian J Public Health Res Dev. 2018;43(3):161-164. DOI: https://doi.org/10.5958/0976-5506.2018.00608.3

Popovic Z, Matic R, Bojovic S, Stefanovic M, Vidakovic V. Ethnobotany and herbal medicine in modern complementary and alternative medicine: An overview of publications in the field of I & C medicine 2001-2013. J Ethnopharmacol. 2016;181(11):182-192. DOI: https://doi.org/10.1016/j.jep.2016.01.034

World Health Organization. Complementary feeding. World Vision Food Security End Phase Report. Nyatike IPA Reports. 2015;6(2014):34-9.

Ritika M, Honey M, Namrata S, Priya P, Trilok A. Using a positive deviance approach to study the food and health-related practices of rural and urban parents of children (6-19 years). 2021.

Le’Roux M, Le’Roux K, Comulada S, Greco M, Desmond A, Mbewu N, et al. Home visits by neighbourhood mentor mothers provide timely recovery from childhood malnutrition in South Africa: Results from a randomized controlled trial. Nutr J. 2010;9(56):1-10. DOI: https://doi.org/10.1186/1475-2891-9-56

Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, N.J: Prentice-Hall; 1989.

Ministry of Health (Kenya), UNICEF. Standardized Monitoring and Assessment of Relief and Transitions (SMART) nutrition survey report for Marsabit County, Kenya. 2022.

Fisher R. The design of experiments. Oliver & Boyd; 1935.

Mutuku J, Ochola S, Osero J. Maternal knowledge and complementary feeding practices and their relationship with nutritional status among children 6-23 months old in the pastoral community of Marsabit County, Kenya: A cross-sectional study. Curr Res Nutr Food Sci J. 2020;8(3):862-76. DOI: https://doi.org/10.12944/CRNFSJ.8.3.17

Bujang M. A step-by-step process on sample size determination for medical research. Malays J Med Sci. 2021;28(2):15-27. DOI: https://doi.org/10.21315/mjms2021.28.2.2

Perneger T, Courvoisier D, Hudelson P, Gayet AA. The sample size for pre-tests of questionnaires. Qual Life Res. 2014;24(10):1-12. DOI: https://doi.org/10.1007/s11136-014-0752-2

IBM Corp. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp; 2017.

Sulaiman S, Muhammad AG, Muhammad AS, Abubakar H, Abubakar SM. Assessment of nutritional status, knowledge, attitude, and practices of infant and young child feeding in Kumbotso Local Government Area, Kano State, Nigeria. Pak J Nutr. 2020;19(1):444-50. DOI: https://doi.org/10.3923/pjn.2020.444.450

Siraneh Y, Woldie M, Birhanu Z. Effectiveness of positive deviance approach to promote exclusive breastfeeding practice: A cluster randomized controlled trial. Risk Manag Health Policy. 2021;14(1):3483-503. DOI: https://doi.org/10.2147/RMHP.S324762

World Health Organization. Infant and young child feeding, 2018. Available at: https://www.who.int/ news-room/fact-sheets/detail/ infant-and-young-child-feeding. Accessed 01 November 2024.

United Nations Children’s Fund. The State of the World’s Children 2019. Children, food, and nutrition: Growing well in a changing world. New York: UNICEF; 2019.

Zakaria Z, Rauf S, Sirajuddin S, Salim A, Bohari B. Physical and chemical properties of instant porridge with added moringa leaf flour. Nutr Clín Diet Hosp. 2024;44(3):311-6. DOI: https://doi.org/10.12873/443zakaria

World Health Organization. Indicators for assessing infant and young child feeding practices: part 1: definitions: conclusions of a consensus meeting held 6-8 November 2007 in Washington DC, USA. Geneva: WHO; 2008. Available at: https://www.who.int/publications/i/item/9789241596664. Accessed 01 November 2024.

United Nations Children's Fund, World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: The revised Baby‐Friendly Hospital Initiative. Geneva: UNICEF, WHO; 2018. Available at: https://www.who.int/publications/ i/item/9789241513807. Accessed 01 November 2024.

United States Agency for International Development. Kenya: Nutrition profile, 2018. Available at: https://www.usaid.gov/sites/. Accessed 01 November 2024.