Keno Parbo Na A community based strategy for reduction of undernutrition in young children

Why Positive Deviance? Malnutrition in young children is more due to incorrect feeding and caring practices rather than only lack of availability of food Preventing Malnutrition as early as possible and Promoting Early Child Development is crucial and there needs to be a focus on under-three children Lancet says that a single change in behavior can bring down the IMR by 13% and that behavior is Exclusive Breast Feeding

Who is a Positive Deviant? A positive deviant child is a healthy and developed child in a poor, disadvantaged and distressed family A positive deviant family is one which has PD children The special practices of a PD family which enables a child to grow and develop well inspite of poor socioeconomic conditions are called PD practices The attempt is to find out these practices in the community and formulate strategies and activities which motivate all families with children to adopt these best practices through participatory learning

How Positive Deviance Works Making Malnutrition Visible to the families and community through weighing of children and using colour-coded charts, maps and other tools Finding out prevalent child care and feeding practices in the area – both good and bad and identifying young children who have good or bad (Grade 2,3,4) nutritional status as a result of these practices Bringing the moderate to severe malnourished young children (0-3 years) and their care-givers regularly to the AWCs (Nutrition Counseling and Child Care Session- NCCS). AWWs along with community, positive deviant mothers & SHGs and teach them the correct feeding and care practices through hands-on demonstration and urge them to follow the same care practices at home Close monitoring and follow up

Steps of Positive Deviance Sensitisation workshop at the district and block level Training – Joint Training on Community Mobilization & PD approach for AWWs, ANMs, PRI members, SHGs Community Mobilization at the village level to make malnutrition visible Identifying prevalent common practices – Focus Group Discussion (FGD) Identifying PD Child / Families – PD Inquiry Sharing findings with Community by VHC/ SHGs/ ICDS Setting up Nutrition Counseling & Childcare Session (NCCS)- 12 days monthly session at AWCs, followed by 18 days home- based practice on child feeding and care Monitoring and follow-up For implementation, AWWs and supervisors take lead role, assisted by PRI members, ANMs, SHG members, community and care-givers in the family

Making Malnutrition Visible & Family Monitoring... Family level MascotFamily level M & C Card

Tools for Community Monitoring Community level Resource Map

BANKURA PURULI A PASCHIM MEDINIPUR 24 PG (S) D DINAJPUR MURSHIDABAD U DINAJPUR PD Operational with UNICEF support in Murshidabad (10 blocks) Dakshin Dinajpur, Purulia, South 24 PGs (4 blocks) & with State support (RCH) in Uttar Dinajpur & Birbhum. PD will be Operational in 2 new districts Bankura and Paschim Medinipur with State support (SW) in BIRBHUM Areas where Positive Deviance is Operational in West Bengal Discussions on with Jalpaiguri to start in selected blocks with RCH funds

Operational Structure Implemented through ICDS, using its regular staff In Purulia- Zilla Parishad also implementing with ICDS In D Dinajpur facilitated by NGO (SPCO) ; In 3 blocks of Murshidabad facilitated by NGO (ASHA) In all districts, Programme and/or MIS Coordinators at district level coordinate and assist DPO-ICDS to implement the project. They report to the district administration In some districts, facilitators present at block level coordinate and help in monitoring and reporting

Is PD making any change? National Institute of Nutrition conducted an independent evaluation in 2006 Survey done in about 1000 children in 40 AWCs implementing PD for atleast one year and compared with equal no.s in matched non PD control areas Positive impact found in: –Young child care and feeding practices –Utilization of health & nutrition services, quality improvement of ICDS – Improved community participation in PD areas Relatively better nutrition status of children in PD areas: –Better mean heights and weights of <3 yr children, –Lower prevalence of stunting and underweight in months children

Distribution (%) of < 12 months Children according to Breast-feeding Practices ** : P<0.01 ** %

Distribution (%) of months Children receiving Complementary feeding at 6 months of age : By Age Group (Months) Age group (Months) ** : P<0.01 ** %

Distribution (%) of Children (12-23 months) according to Coverage for Immunization * Complete Immunization % * Coverage for all immunizations are significantly (p<0.01) higher in PD area

Distribution (%) of months Children according to Receipt of Massive Dose of Vitamin A ** p<0.01 ** %

Distribution of 0-3 year old children according to recpt of treatment for diarrhoea and ARI **

Distribution (%) of Anganwadi Centers by type of social organizations functioning in the village PARTICULARS TYPE OF AREA PDCONTROL Type of Social Organizations Self Help Groups Village Education Committee Youth club55.0 Mahila Mandal45.0**5.0 Mother’s Committees45.0**12.5 Women’s Working group25.0**5.0 Village Health Committee25.0**5.0 Adolescent Girls Working group Cultural Organization7.5 ** p< 0.01

Distribution (%) of <3 Yrs. Children according to Nutritional Status : By SD Classification (<Median-2SD) * * Statistically significant

Distribution (%) of <3 Yrs. Children according to Weight for Age: IAP Classification

Statistically significant difference among months children IAP Classification: Undernutrition PD area-55% non-PD area- 64% SD Classification: –Undernutrition: PD area- 45.6% Non-PD area- 63.2% –Stunting: PD area- 25.2% Non-PD area- 37.4%

In conclusion Positive Deviance has been accepted as a best practice in ICDS in the state It is now being replicated in different districts using funds from the state The challenges are –To maintain the quality of intervention with up-scaling –To mainstream the PD strategy for improving quality of ICDS, especially focusing on care and feeding practices of under-three children and involving the community in monitoring and combating malnutrition