Effectiveness of a Positive Deviance Program in Reducing Childhood Undernutrition

NCT04688515 | Completed

• 1 other identifier: JKEUPM-2020-349
• Study Type: interventional
• Target: 74
• Locations: 1 country
• Sites: 1

Brief Summary

Globally, childhood malnutrition remains a public health concern. Malnutrition can be diverse from undernutrition to overnutrition. A young child, primarily refers to those under the age of 5, is suffering from undernutrition when the child is lacking of adequate nutrition that necessary for proper growth and health due to direct or indirect causes such as not having enough food. In fully urbanized area such as Kuala Lumpur, urban poor children tend to face greater deprivations such as lower education and poor health which significantly influence their daily diet and nutritional status. Hence, urban poor children who are living and growing up in such underprivileged environment should not be neglected. Since young children are generally depending on maternal feeding for daily diet, intervention that focus on encouraging positive change in maternal feeding practices might be efficient in reducing childhood undernutrition. The positive deviance (PD) approach may consider as a better alternative to empower mothers by promoting new behaviour to feed their children. Hence, this study aims to evaluate the effectiveness of a nutrition program using PD approach in reducing undernutrition among urban poor children aged 3 to 5 years old in Kuala Lumpur.

Conditions

Malnutrition, Child

Keywords

Child undernutrition; Positive deviance; Urban poor children; Stunting; Wasting; Weight gain

Outcome Measures

Primary Outcomes (6)

• Changes in body weight after 3 months of intervention in children

  body weight in kg

  3 months

• Changes in weight-for-age z score after 3 months of intervention in children

  weight-for-age z score in standard deviation

  3 months

• Changes in height-for-age z score after 3 months of intervention in children

  height-for-age z score in standard deviation

  3 months

• Changes in weight-for-height z score after 3 months of intervention in children

  weight-for-height z score in standard deviation

  3 months

• Changes in dietary intake after 3 months of intervention in children

  24-hour diet recall (3 days) in kcal

  3 months

• Changes in diet quality after 3 months of intervention in children

  Healthy Eating Index (HEI) for Malaysians; composite HEI scores range from 0 to 100%; score \<51% indicates poor diet quality, 51 to 80% indicates diet required improvement, and \>80% indicates good diet quality

  3 months

Secondary Outcomes (2)

• Changes in nutrition knowledge after 3 months of intervention in mothers

  3 months

• Assessment of food security level after 3 months of intervention in mothers

  3 months

Study Arms (2)

Intervention group

EXPERIMENTAL

Intervention group refers to mother-child dyads who will be participating in a nutrition program consisting of nutrition education and cooking sessions for 3 months.

Behavioral: Nutrition program developed using positive deviance approach

Comparison group

NO INTERVENTION

The comparison group will not receive any intervention but will be provided with the developed educational materials used in the program after the program has been completed.

Interventions

Nutrition program developed using positive deviance approach BEHAVIORAL

It is a 3-month nutrition program including nutrition education session and rehabilitation session. The education session consists of half hour education lesson and one and half hours peer-led cooking session. The cooking demonstration will be led by volunteers from PD family. Participating mothers will need to bring along their children during this session, prepare meal according to pre-planned menu and feed their children with the prepared meal after cooking as snack or additional meal. The rehabilitation session will be the rest of the days following each education session until the next education session. Growth monitoring session will also be conducted in each session, whereby mothers will be taught and trained to weigh their children.

Intervention group

Eligibility Criteria

• Age: 3 Years - 5 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Malaysian
• Children aged 3 to 5 years old
• Mothers aged above 18 years old
• Living in public low-cost PPR flat

You may not qualify if:

• Children who are taken care by other adults rather than mothers such as father, grandparents and caregivers
• Mothers with mental disabilities
• Children with history of chronic diseases including congenital heart disease, liver disease, renal failure or sickle cell disease and any congenital abnormalities
• Children who are under treatment for communicable disease such as measles and chickenpox
• Children with learning disabilities
• Mother-child dyads involved in any other intervention or clinical research
• Children who are overweight or obese

Sponsors & Collaborators

• Universiti Putra Malaysia: lead

Study Sites (1)

PPR

Kuala Lumpur, Malaysia

Location

Related Publications (6)

• Albanna, B., & Heeks, R. (2019). Positive deviance, big data, and development: A systematic literature review. Electronic Journal of Information Systems in Developing Countries, 85(1), e12063. https://doi.org/10.1002/isd2.12063

  BACKGROUND

• Herington, M. J., & Fliert, E. Van De. (2017). Positive deviance in theory and practice : A conceptual review. Deviant Behavior, 39(5), 664-678. https://doi.org/10.1080/01639625.2017.1286194

  BACKGROUND

• Schooley J, Morales L. Learning from the community to improve maternal-child health and nutrition: the Positive Deviance/Hearth approach. J Midwifery Womens Health. 2007 Jul-Aug;52(4):376-83. doi: 10.1016/j.jmwh.2007.03.001.

  PMID: 17603960 BACKGROUND

• Sternin, M., Sternin, J., & Marsh, D. (1998). Designing a community-based nutrition program using the hearth model and the positive deviance approach - A field guide. Save the Children Federation.

  BACKGROUND

• The CORE group. (2002). Positive deviance / Hearth essential elements: A resource guide for sustainably rehabilitating malnourished children. CORE group.

  BACKGROUND

• Chek LP, Gan WY, Chin YS, Sulaiman N. A nutrition programme using positive deviance approach to reduce undernutrition among urban poor children under-five in Malaysia: A cluster randomised controlled trial protocol. PLoS One. 2022 Oct 13;17(10):e0275357. doi: 10.1371/journal.pone.0275357. eCollection 2022.

  PMID: 36227928 DERIVED

MeSH Terms

Conditions

Child Nutrition Disorders; Growth Disorders; Cachexia; Weight Gain

Condition Hierarchy (Ancestors)

Nutrition Disorders; Nutritional and Metabolic Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Weight Loss; Body Weight Changes; Body Weight; Signs and Symptoms; Thinness

Study Officials

• Wan Ying Gan, PhD

  Universiti Putra Malaysia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: December 20, 2020
• First Posted: December 30, 2020
• Study Start: March 9, 2022
• Primary Completion: July 31, 2023
• Study Completion: March 10, 2024
• Last Updated: May 8, 2024

Record last verified: 2024-05

Data Sharing

• IPD Sharing: Will not share

Locations

MY (1)