Before 3-year-old Chantal and her mother, Jacqueline, registered with the International Medical Corps Positive Deviance/Hearth (PDH) model program in northern Burundi, the toddler had been trapped in a cycle of supplementary feeding programs and bouts of malnutrition. Today, Jacqueline is confident that Chantal will never again be malnourished.
Born during an acute food shortage in the region, Chantal was breastfed for 12 months until Jacqueline became ill and couldn’t produce enough breast milk. The baby began eating solid foods grown on the poverty-stricken family’s farm which only produced a very limited variety of crops. She quickly began to lose weight and upon screening at 24 months, was found to be suffering from moderate acute malnutrition. Chantal was treated for moderate malnutrition with supplementary feeding twice in quick sucession. Two months after the second course of feeding, she once again became dangerously malnourished leaving her exhausted, pregnant mother feeling powerless and unable to break the cycle.
In November 2010, volunteer community-based health activists (VCBHAs) advised Jacqueline that she and her baby could both benefit from International Medical Corps’ center run by Lead Mothers in Ndava Village. The center is close to Jacqueline’s home and provides a convenient, accessible and culturally-appropriate program to educate local families on nutrition issues.
Part of the Multi-year Assistance Program (MYAP), International Medical Corps has implemented the PDH program in the three northern provinces of Burundi through funding from the United States Agency for International Development’s (USAID’s) Food For Peace initiative. Through the MYAP, International Medical Corps is using two cross-cutting strategies:
- Encouraging local solutions through behavior change communication
- Strengthening capacity by training local health service providers and VCBHAs
The PDH program is run by women elected by the community from identified ‘Positive Deviant Households’ – households which have access to the same resources as malnourished neighbors, but remain unaffected by malnutrition due to effective infant feeding practices. These women are known as ‘Méres Lumières’ or ‘Lead Mothers’ – a special status which confers great prestige. The program consists of 12 days of PDH sessions during which malnourished children are fed while their mothers/caregivers are taught how to use a variety of locally produced foods to prevent malnutrition. Upon completion of the course, children are assessed to see if they have gained weight. After 30 days, mothers/caregivers return to the PDH sites with their children for a second weight gain check-up. Implemented at the community-level and run by community members, the PDH program has proven to be a comfortable and relaxing setting for mothers to learn new feeding practices from their peers. The program has achieved high recovery and low defaulting rates compared to facility-based care for malnutrition.
Chantal and Jacqueline completed a full course of PDH sessions after which weight checks showed that Chantal had gained 800 grams. Further checks one month later, during which her mother had put her new feeding skills into practice, put Chantal’s gain at 1000 grams. Jacqueline now uses locally available, nutritious foods for her family and is supplementing the food supply on the family’s farm with a farming for cash program. She is now able to get access to a variety of foods so her family can have a nutritious and balanced diet and Chantal will no longer struggle with malnutrition. Inspired by the ‘Lead Mothers’ on the course, Jacqueline has set her sights on becoming one herself as soon as possible after giving birth.
Through PDHM intervention in Burundi, International Medical Corps will continue to:
- Rehabilitate children with moderate malnutrition at the community-level using locally produced foods.
- Improve nutritional practices using existing solutions within the target community.
- Avoid dependency on food aids in solving nutritional problems in the community.
- Promote cross-learning opportunities among beneficiaries.
International Medical Corps has worked in Burundi since 1995 and today administers programs in primary health care, prevention of sexual and gender-based violence and a variety of nutrition programs ranging from treatment of acute malnutrition to the prevention of malnutrition in children under 2 by improving mother-to-child interaction.