- April 22, 2017
Stunting in children is an important issue in Cambodia. According to the 2009 Food Security Trend and Analysis report, 40% of children under age 5 are stunted, and 14% are severely stunted. Analysis by age group indicates that stunting is apparent even among children less than 6 months of age (10%). There is very little difference in the level of stunting by gender, but the disparity in stunting prevalence between rural and urban children is substantial: 42% of rural children are stunted, as compared with 28% of urban children. Two of CHEC’s target areas, Kampong Cham and Prey Veng, are amongst the regions with the highest percentage of undernourishment.
When addressing children’s nutrition and stunting, the period from birth to 2 years of age is critical. During this period, children who do not receive adequate nutrition can be susceptible to growth faltering, micronutrient deficiencies, and common childhood illnesses such as diarrhea and acute respiratory infections. To address this issue, UNICEF has recently launched a national campaign in partnership with the Ministry of Health on complementary feeding for children 6-24 months. As part of the campaign, TV spots, video and printed training materials have been developed, to show mothers how to cook a nutritious porridge that is suitable for children 6-24 months old, and provides all the nutrients they require in addition to breast milk.
Through this project, CHEC has combined the UNICEF training materials with the Positive Deviance Approach to increase the number of parents in the CHEC target areas making complementary porridge for their 6-24 month old children. Positive deviance is the idea that "in every community or organization, there are a few individuals who have found uncommon practices and behaviors that enable them to achieve better solutions to problems than their neighbors who face the same challenges and barriers".
For example, in many villages there will already be some poor, rural, parents who have found affordable ways to make nutritious porridge for their children, and as a result their children will be a healthy weight despite being from a very poor family.
The aim of this project was to find these individuals (“positive deviants”) and ask them to help demonstrate their porridge making techniques to other mothers and fathers in the village (with help from the CHEC peer educators). Because these positive deviant parents are already making porridge, the ingredients they use are more likely to be affordable, acceptable and available to families locally. Seeing other poor families who have successfully made porridge (and have healthy children as a result) will also make the training more convincing, and will make attendees more likely to continue practicing the behaviour in the long term. A recent systematic review found that this Positive Deviance Approach to child nutrition programs often resulted in a large reduction in malnutrition that, in some cases, was sustained 3-5 years after the intervention had ended. It is because of these highly successful and sustainable results in other countries that CHEC was proposing to use this approach in Cambodia.
The Positive Deviant or Role Model approach is a critical success factor to demonstrate good nutrition habits, in particular sharing their porridge-making (Bobor Khab Krop Kroeung) techniques with other parents in their communities (with help from CHEC peer educators).
CHEC has trained 104 Peer Educators and through them, the mothers and fathers in the community, by using the demonstration sessions for introducing the nutrition of complementary feeding. The 385 positive deviant parents have identified and they are already making porridge, the ingredients they use are more likely to be affordable, acceptable and available to families locally. 385 demonstration sessions have been conducted in 385 villages with 11,427 participants attended (demonstrations are run by the positive deviance parent with help from peer educators). During the demonstration, the peer educators used simple methods when showing how to make “Bobor Khap Khrop Kroung” to ensure ease of learning for the mothers. The method of making “ Bobor Khap Khrop Kroung” for children aged 6- 24 months can be used with simple ingredients which could be taken from the home.
The project run 3 years from May 2013 to May 2016 with funding support from the Department for Foreign Aid and Trade (DFAT). The end-line survey was conducted in April 2016 and the key findings are as follows:
Based in the results presented that the mothers and other care givers used porridge for their children increased to the last end line survey in April 2015, the intervention groups has increased by 1.9% from 96.8% to 98.7%; it has also increased by 8.7% from 82.8% to 91.3% for control groups.
If comparing to the results of end line in 2015 and end line in 2016 indicated that the rate of intervention groups who made plain porridge with rice, salt and water were decreased by 11% from 44.7% to 33.7% and it was decreased by 50.3% (84.0% to 33.7%) of the result baseline in 2013. And the rate of who cooked plain porridge with using ingredients such as meat, fishes, vegetable and eggs for their children aged from 6 months to 24 months were increased by 11% from to 55.7% to 66.3% and it has increased by 53.3% (12% to 66.3%) for the period of three years project implementation from May 2013 to April 2016.
If compare to the results of end line in 2015 the rates of intervention groups who had known the main food groups were increased from 86.2% to 89.3% and it was also increased for control groups from 33.7% to 44.7% after one year of project implementation from May 2015 to April 2016.
Among of those 357 positive deviances mothers, 49.1% (175/357) of positive deviances used skills practice for home garden to show the role model for other caregiver and community members. It has increased by 25.1% from 24.0% to 49.1% to the end line survey in 2015.
Outcome and Impacts
|Outcomes and Outputs||Baseline in Nov. 2013||Impact Monitoring in June 2015||Change in Rates from April 2016|
|Objective 1: 40% increase in the number og parents with children aged from 6-24 months who follow the UNICEF/National Guideline for complementary feeding using porridge in the target areas by 2014||0%||43%||66.3% increase in number of women with children aged 6-24 months that use porridge for complementary feeding.|
|Objective 2: 20% increase the number of positive deviant parents involve in the home gardening to increase nutritional value.||0%||24%||59% increase the number of positive deviant parents involve in the home gardening to increase nutritional addition.|