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Using PD Hearth in place of SFP

This question was posted the Prevention and treatment of moderate acute malnutrition forum area and has 3 replies. You can also reply via email – be sure to leave the subject unchanged.

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Anonymous 2812

Children's Nutrition Program of Haiti

Normal user

6 Feb 2015, 16:11

Has anyone had any experience with using PD Hearth in place of SFP for treating/preventing moderate malnutrition?

Óscar Serrano Oria

Unicef UK. Nutrition and ECD Programmes Specialist

Normal user

6 Feb 2015, 22:00

Hi Taryn.
There are multiple settings in which PD Heart can be used, it is similar to NIPP or Mother Light, all based in the positive deviance model.
Just have this CORE idea into account:
These models tackle the poor infant and child care practices, therefore, lack of knowledge about the best way to provide care and feed infants: Exclusive breastfeeding, complementary feeding, diet variety, etc. BUT it does NOT WORK if the main problem for AM is food insecurity. You will find this explanation in their core Model description at WV website.
These approaches are a NO INPUT model, nothing is given to the participants, but knowledge about feeding infants < 6 months, and what (already available and affordable in the market) can be used for the feeding of 6 to 59 weeks children to ensure a good dietary variety that can help prevent stunting/long term chronic malnutrition. NIPP and other models have also an approach of micro gardening, basic seed of vegetables are provided to the HH (carrots, tomatoes, kassava...) in order to have a small private production of those nutrient rich vegetables that will enrich the family diet (not for income generating purposes), but that will reach very late that MAM child you want to treat if the purpose is to replace those foods they can't afford.

So, if the reason for your beneficiaries being malnourished is a problem of access/availability/affordability (droughts, conflict, IDP/refugees, floods) of nutrient rich foods, it WILL NOT work, and it can't replace the SFP, which is a therapeutic program for an acute "disease". I have the experience and my colleagues being with GOAL for much longer can provide further advice on this.
In the other hand, if food is at reach of the households, but the problem is the knowledge on how to cook rich and varied meals, then it will be a promising approach, not just for that MAM child but in the longer term for the next generations to come, acting within the 1000 days time frame and fighting stunting at its core.

I hope it is clear, but please do not hesitate to ask more if needing more guidance here.

Charulatha Banerjee

Terre des hommes Foundation

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9 Feb 2015, 05:14

Dear Taryn,

The PD Hearth Model has been used extensively in West Bengal India and successfully when it was introduced nearly 10 years ago- It was introduced by UNICEF within the state system. The main purpose was reduction of moderate and severe underweight- as weight is the only measurement done at the Village level Nutrition Centre where Monthly Growth monitoring and Promotion sessions are held. The links to the reports are available also - this programme also was evaluated by the National Institute of Nutrition in 2006 after 1 year of implementation of the programme and they found in addition to improved child care and feeding practices also that mean height of children in the area was higher than in the non PD areas and stunting prevalence was lower. I do not have more details on the evaluation to give you but from what I recall it sure made a difference. I agree fully with Oscar on the point that this is to be considered only in an area where there is enough food and the main change that is to be achieved is in care and feeding practices. Having said this, it might be of great value in prevention of MAM in a food secure area or perhaps even as a method to bring women with children below 2 together in areas where there is blanket distribution of food to ensure proper IYCF practice.

I am sure you have located the Field Guide available on this link http://www.positivedeviance.org/pdf/fieldguide.pdf The India- West Bengal experience is captured briefly in this link
http://www.unicef.org/india/nutrition_1557.htm


Hope this helps
Warm Regards
Charulatha Banerjee

Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

10 Feb 2015, 11:05

Dear Taryn,

SFP's (in their various guises) most certainly have their place in the package of nutrition interventions that we have at our disposal. However, alternatives to SFP should be explored in contexts of chronic emergencies, given that SFPs are not currently deemed sustainable without significant investment into innovative approaches for local production of supplementary food at low cost (this does not exist in most sub-Saharan countries at present). Added to which, at present governments do not have the requisite budgets to viably fund supplementary feeding for their MAM caseloads on any sort of a sustainable basis. In addition to the financial limitations, there are negative issues surrounding the dependence that enduring food hand-outs lead to, and our understanding (according to a senior UNICEF nut’ advisor NY) ‘that studies have shown that food hand outs in sub-Saharan African have had a deleterious effect on the erosion of traditional coping strategies and had no impact on rates of acute MN’. (Note: STC-UK are collecting research data on the issue of SFP and impact through the Minimum Reporting Package).To illustrate the inability of governments to fund supplementary food rations, as of 2010 38% of countries (#23) providing CMAM for SAM were 100% dependant on UNICEF to provide RUTF and 62% of countries (#37) were 80% dependant on UNICEF. If you consider that your MAM caseload is typically twice that of the SAM caseload, there is little chance that any government (where MAM is significant problem) could would or could budget to integrate SFP as a development initiative - and donors/WFP cannot be relied upon to provide the vast shortfall as a sustainable, long-term strategy, whose funding in turn is very vulnerable to external factors out of their control; namely fluxes in global annual yields and food prices etc. To support the quote by the snr UNICEF nut’ advisor re. food-aid having little/no impact on under-nutrition; this is illustrated by UNICEF’s ‘Improving Child Nutrition’ Apr’13 publication, outlining in sub-Saharan Africa, progress on reducing stunting since 1990 has been limited (? 2%) (falling way behind achievements in Asia & the Pacific where the average global decline is 36%), plus there has been minimal progress on the reduction of wasting, with a very small % ? from 10% in 1990 to 9% in 2011, but where the number of wasted children as a proportion of the world’s total has actually increased.

As such, as Oscar has mentioned, GOAL have also sought to find alternatives to SFP in both contexts of chronic emergencies and in operational areas with persistently high rates of acute and chronic MN. Consequently we are implementing a model called the NIPP program (Nutrition Impact & Positive Practice program) in 5 countries, with the aim of treating and preventing MAM, stunting and reducing IUGR. We aim to achieve these results through tackling a multi-sectoral package of the key causes of MN identified through formative research. But instead of trying to pull sectors together to work collaboratively on a single project, the project in itself is designed as an encompassing multi-sectoral initiative (usually run over a 12wk cycle). This is not a shameless plug for the NIPP, rather you might find it helpful in drawing comparisons between PDH and the NIPP model’s potential use as an alternative to SFP. Indeed the NIPP project is centred around PD Hearth, in that it is community based, uses positive deviance volunteers and peer education. In addition however there are a number of other ‘elements’ that have been added which we thought were lacking from PDH (in our operational contexts). See the following link that outlines some of the key differences between an IBSFP (integrated BSFP – which is rather like a traditional BSFP with added extras, providing the usual food aid, but also hygiene-san’ education and cooking demos of fortified food products distributed): http://www.en-net.org/question/1076.aspx

Although we collect a whole host of longitudinal indicators (anthro’, feeding practices (for children, infants and PLW), hygiene-san, LLH, HIV), to give you a very crude example of MUAC results (which I’m assuming you will be most interested in, as a direct comparable to SFP, we’re currently have the following data for U5s and PLWs (<23cm):

B=Baseline no. of samples with data collected / E=End-line no. of samples with data collected
Column 1 - Cure Rate - % improvement of U5s admitted with MAM discharged non-Column 2 - MAM Cure Rate - % improvement of PLW admitted with MAM discharged non-MAM
2013 Baliet (South Sudan) 63% (B-41 E-41) 73% (B-15 E-15)
2013 Ulang (South Sudan) 55% (B-11 E-11) 61% (B-33 E-33)
2013 Agok (South Sudan) 41% (B-117 E-117) 68% (B=51 E-31)
2013 Twic (South Sudan) 94% (B-28 E-28) NA
2014 Agok (South Sudan) 72% (B-88 E-29) 71% (B-94 E-25)
2013 Kutum (Sudan) 83% (B-224 E-224) 35% (B-43 E-43)
2013 Kassala (Sudan) 99% (B-137 E-137) 53% (B-15 E-15)
2013 Khartoum (Sudan) 100% (B-12 E-12) NA
2014 Kutum (Sudan) 83% (B-559 E-356) 55% (B-171 E-171)
2014 KRT (Sudan) – partner Almanar 100% (B-80 E -80) 50% (B-8 E-8)
2014 Kassala (Sudan) – partner WOD 96% (B-24 E-24) 50% (B-6 E-6)
2014 Nsanje & Balaka (Malawi) pilot 63% (B-8 E-8) 0% (B-2 E-2)
2013 & 2014 Hurungwe (Zimbabwe) 50% (B-12 E-12) 13% (B-15 E-15)
2013 & 2014 Nyanga(Zimbabwe) 65% (B-20 E-20) 60% (B-15 E-15)
2013 & 2014 Makoni (Zimbabwe) 45% (B-11 E-11) 0% (B-5 E-5)
TOTALS:
U5: 78% Cure Rate for MAM. At baseline we had - 1,372 children 6-59m with data and at End-line we had – 1,110 children 6-59m with data)
PLW: 57% Cure Rate for MAM. At baseline we had -473 PLW with data and at End-line we had - 384 PLW with data)

I do want to stress though (already flagged above) that these sorts of initiatives are only possible where basic food security is ensured. NIPPs do not provide any non-sustainable inputs or incentives to maximise their sustainability and replicability. As such, if basic or underlying food security is a key cause of MN, this needs to be addressed through alternative/parallel means.

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