A community-based approach for improving child nutrition: Experiences from a Positive Deviance/Hearth program in Kampong Chhnang, Cambodia

A positive deviance (PD)/Hearth program was implemented in 32 rural villages in the Kampong Chhnang Province to address the high rates of moderate and severe malnutrition among children 6-36 months of age. The program involved rehabilitating the underweight children through the identification and sharing of existing community best practices. Positive child feeding, hygiene and sanitation, and health-seeking behaviors practiced by poor families with healthy children were identified through a PD Inquiry. These practices were shared through mother support groups, male caretaker sessions, and 10-day community-led rehabilitation feedings. Routine growth monitoring and promotion occurred bimonthly for each child during a 14-month period. A total of 372 children were enrolled in the PD/Hearth program during two rounds, each including 16 villages. In the first round, the percentage of severe and moderate malnutrition decreased from 21% to 5% and 79% to 28%, respectively. In the second group, severe and moderate rates reduced from 12% to 2% and 89% to 34%, respectively. The average weight-for-age Z score for children 6-23 months increased from -3.38 at baseline to -1.82 after 14 months, with continued improvement six months after completing the program. The PD/Hearth program was successful in improving the nutritional status of moderately and severely underweight infants and young children in this setting. Using an integrated approach that addressed the multiple determinants of child malnutrition was effective. More efforts are needed to achieve community ownership of the PD/Hearth program in this context.