Using Positive Deviance to Understand the Uptake of Optimal Infant and Young Child Feeding Practices by Mothers in an Ur
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Using Positive Deviance to Understand the Uptake of Optimal Infant and Young Child Feeding Practices by Mothers in an Urban Slum of Mumbai M. R. D’Alimonte1 • D. Deshmukh2 • A. Jayaraman2 • S. Chanani2 D. L. Humphries1
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Springer Science+Business Media New York 2015
Abstract Objectives Positive deviance research seeks out well-nourished children living in disadvantaged contexts to understand local growth-promoting behaviors. This study explored the factors that influence the uptake of infant and young child feeding behaviors among mothers. Methods Children with a height-for-age z-score (HAZ) [ 0 (n = 10) or a HAZ \ -2.0 (n = 12) were purposefully selected from households enrolled in a community management of acute malnutrition (CMAM) program in an urban slum of Mumbai, India. Qualitative methods were employed by means of semi-structured key informant interviews with positive and non-positive deviant mothers. Eligibility was restricted to households with limited resources and more than one child. A 24-h dietary recall and anthropometric measurements were taken for the index child. An observation checklist assessed household hygiene. Data analysis was based on the Grounded Theory of qualitative research. Results Positive deviant mothers (those with children with a HAZ [ 0) largely exhibited optimal infant and young child feeding practices explained by maternal information seeking behaviors; mothers acknowledging the importance of & M. R. D’Alimonte [email protected] D. Deshmukh [email protected] A. Jayaraman [email protected] D. L. Humphries [email protected] 1
Yale School of Public Health, New Haven, CT 06520-8034, USA
2
Society for Nutrition, Education and Health Action, Dharavi, Mumbai 400017, India
maternal health; and social support. The relationship between mother and health worker seemed to influence how well they listened to the health workers’ recommendations. Across all households, the daily consumption of high-energy, processed foods was apparent. Conclusions Practical considerations include exploring how to tailor CMAM programs to include social support and counseling training for health workers to engage more closely with mothers; exploring the feasibility of a women’s social group for mothers to share information on child rearing; and teaching mothers about healthy eating and the link between nutrition and health. Keywords Positive deviance Nutrition Infant and young child feeding practices CMAM Implementation research
Significance Statement The purpose of this study was to explore positive, growthpromoting behaviors and practices that mothers use in child rearing in the context of a community management of acute malnutrition (CMAM) program in an urban slum of Mumbai, India. India faces a severe, persistent problem of chronic malnutrition, and while there are global recommendations on which nutrition interventions to scale-up, not a lot is known about what works programmatically. This is especially true for urban settlements in large Indian cities where little progr
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