Effectiveness of the Positive Deviance Health Model in Improving Nutritional Status of Children Aged 6-59 Months in Rabai Sub County, Kilifi County, Kenya

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.