Malnutrition rehabilitation and prevention in Rwandan children: Measuring impact and sustainability of a rural intervention

Objectives: Over five million children die annually in developing nations because of being underweight. Effective programs that reduce child malnourishment need to be identified to reach established Millennium Development Goals by 2015. This study examines program impacts of the Positive Deviance/Hearth (PD/H) model used to combat malnutrition in rural Rwanda.

Methods: In a concurrent mixed methods study, malnutrition rehabilitation and prevention were examined in the PD/H model targeting 4,854 Rwandan children. Proximal and socio-economic variables impacting child nutritional status were compared between cross-sectional groups of intervention participants (n = 128) and non-participants (n = 156), using logistic and linear regression. Weight-for-age of youngest siblings of intervention participants and non-participants was used as a proxy measure for nutritional status. Qualitative data was examined from sixty-three focus groups of intervention participants and key community stakeholders (N = 526) to explore program sustainability.

Results: Malnutrition rehabilitation rates averaged 68%. Child illness (diarrhea and/or fever), frequency of meals, and timing of breastfeeding following birth significantly impacted nutritional status of intervention children. No significant difference was found between nutritional status of younger siblings of intervention participants versus controls. Focus group responses indicate sustainability of PD/H in the community, even at the termination of the child survival program in 2006.

Conclusions: PD/H appears effective in rehabilitating malnourished children in rural Rwanda and impacting prevention of malnutrition through a community dispersion effect. Policy implications include the necessity of integrating participant tracking into PD/H programs in order to more effectively assess program impacts.