Abstract:
Malnutrition remains a critical public health issue in Kenya, particularly among
children under five years. In Rabai Sub-County, Kilifi County, high levels of stunting,
wasting, and underweight persist despite ongoing nutrition programs. This study
aimed to evaluate the effectiveness of the Positive Deviance Hearth (PDH) model in
improving nutritional outcomes among children aged 6–59 months. The study
employed a quasi-experimental design conducted in six geographically distinct sites
in Ruruma and Mwawesa Wards. A total of 750 caregiver-child pairs were selected
using multistage sampling, enrolled and assigned to intervention and control groups
based on geographic separation to minimize contamination. The intervention group
underwent a 12-day PDH session followed by six months of monitoring by
community health volunteers (CHVs), while the control group received standard
nutritional counselling. Data were collected through structured questionnaires and
anthropometric measurements, with ethical approvals and informed consent
procedures strictly observed. Results showed significant nutritional improvements
among children in the intervention group, with wasting rates declining from 48.8% to
38.8% and underweight prevalence dropping from 50.8% to 37.2%. Conversely, the
control group experienced worsening conditions, with wasting increasing from
51.5% to 61.5% and underweight from 47.2% to 59.0%. Caregivers in the
intervention group also exhibited improved knowledge and practices related to
nutrition and hygiene, as reflected in better dietary diversity and feeding behaviours
post-intervention. However, the study found that several socio-economic and cultural
factors moderated the impact of the PDH model. These included male caregiver
status, high maternal parity, low education, unemployment, low household income,
food insecurity, and restrictive cultural beliefs. Each factor was statistically
associated with continued undernutrition, indicating the need for a multifaceted
approach. In conclusion, the PDH model proved effective in enhancing child
nutrition and caregiver behaviour through a community-based, participatory
approach. Nonetheless, addressing broader socio-economic and cultural barriers is
essential for sustaining and scaling the model’s impact.
