Jul 14, 2014

The experts on malnutrition

Based on studies and observations this book argues that a point of departure to reduce malnutrition is to determine who the experts are; and indicates that the mothers with well-nourished children living in poor conditions are the experts. We should then examine what they are doing differently. They are called positive deviant cases. 
[In Vietnam] [t]he two standout practices related to the content of the diet and the way food was administered. In every positive deviant family, the mother or father was collecting a number of tiny shrimp, crabs, or snails -- making for a portion 'the size of one joint of one finger' -- from the rice paddies and adding these to the child's diet. 'Although readily available and free for the taking, the conventional wisdom held these foods dangerous, for young children.'11 Families also varied the frequency and method of feeding. Other families fed young children only twice a day, before parents headed to the rice fields early in the morning and in the late afternoon after returning from a working day. Because these children had small stomachs, they could only eat a small amount of the available food at each sitting. The positive deviant families, however, instructed the home babysitter (an older sibling, a grandparent, or a neighbour) to feed the child regularly, four or even five times a day. Using exactly the same amount of rice, their children were getting twice the amount of calories as their neighbours who had access to exactly the same recourse. Other key factor included atypically high levels of hand hygiene in positive deviant families. p. 274

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