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Health & Nutrition Education for MothersModified Positive Deviance Programme
A significant factor in under-nourishment, experts agree, is a lack of knowledge on the part of the caregiver about what constitutes good nutrition. Some mothers just don't know what to feed their children. Another important factor is mothers’ behavior during feeding practices. Basic nutritional education for mothers is therefore one of the most important activities at FMCH. Firstly, three days each week, mothers bring their children for meals at the feeding programme, they observe the different types of nutritious food prepared by the Foundation for their children. Mothers also attend weekly general health and nutrition lessons. Through games and other interactive teaching methods, mothers learn about the importance of certain types of food, breastfeeding, feeding practices, how to treat various illnesses such as children's diarrhoea, and amongst other things, the importance of immunizations in preventing common diseases. Mothers whose children do not need to participate in the feeding programme but have children attending one of the Foundation’s preschools also receive health education and nutrition classes once a week. Some families with which FMCH work, live in very deprived conditions on garbage dumps. Children from these very impoverished areas are offered a place on an FMCH early learning centre nearby and their mothers are given access to regular health education and nutrition classes. The health and nutrition curriculum is the same for every mother whether they have children attending the feeding programme, attending one of our early learning centres or whether living on a garbage dump.
Modified Positive Deviance Programme FMCH ApproachFor a fourth year running, the Foundation for Mother and Child Health (FMCH) carried out the Positive Deviance approach with all its moderately and severely underweight children enrolled in the programme. The main focus of activity for the mothers centres around cooking and health education sessions together in small neighbourhood units every day over a 12-day period. Objectives
Outcomes
Changes in mothers
Changes in community health volunteers:
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Undernutrition
in Indonesia results from a web of complex causes only one of which is
lack of access to food due to economic constraints. In other words, poverty
is only one of many reasons for undernutrition. Often, undernourished
children in urban Jakarta live right next door to healthy children of
the same income level.
Then,
once each week, the mothers learn to cook healthy meals. Community Health
Workers (CHWs) facilitate the cooking sessions. Community Health Workers
only use equipment the mothers already have in their own urban homes and
use ingredients that the mothers can easily obtain and afford.
The
use of the Positive Deviance or Hearth Model approach has been used in
nutrition programmes for many years. It is based on the premise that within
poor communities with the same resources, there are children with good
nutritional status and some that are malnourished. A critical assessment
of the children with good nutritional status, involves identification
of mothers who are positively feeding their children, care for their children
and seek out health care within their community. In assessing these mothers,
positive traits that can be used as a model for the rest of the community
are identified. This is typically a community-based project and hence
devolves some control to the community. It involves fathers, community
leaders and the whole neighbourhood. This method can be particularly effective
as the approach involves the community discussing and finding their own
solutions.
After
the community cooking sessions, children eat together. Mothers, assisted
by the Community Health Workers and FMCH Health Educators, play nutritional
and health education games with simple and short messages. Each neighbourhood
unit consists of six to ten mothers. Every session two mothers are responsible
for cooking: one mother cooks enriched porridge and the other cooks nutritious
food for toddlers using similar ingredients. The health education topics
covered during PD include: Optimal breastfeeding, Optimal Complementary
Feeding, FADUA: Frequency, Amount, Density, Utilization, and Active Feeding,
Food Variety, Food Safety, Child Care, Personal and Environmental Hygiene,
Management of Illnesses, Malnutrition and Overcoming cultural barriers.
The
expected outcome of the nutritional status of moderately and severely
underweight children is: