How to fix malnutrition? Try community-based education

MANILA, Philippines – Supplemental feeding projects like those conducted in schools where children eat porridge, champorado, pancakes, and other healthy snacks can address the need to attain normal weight among children experiencing hunger for a long period of time.

This is according to Kim Mandigma, nutritionist from Children International Manila (CI Manila).

“As an intervention, the food given should be well-calculated. It should provide an additional 300 calories/feeding day on top of the meals a child receives at home. This should be given for 120 days,” Mandigma explained.

Supplemental feeding is a common intervention to rehabilitate malnourished children. Mandigma observed, however, that this is usually unsustainable. (READ: PH gov’t school feeding programs)

Children lose what they gain after the course of the feeding period.  

There were 15.6 million malnourished Filipinos in 2013, according to the World Food Insecurity Report of the Food and Agriculture Organization (FAO).

Malnutrition is commonly associated with lack of food, but FAO emphasized that malnutrition can also result from poor childcare practices, insufficient health services, and unhealthy environments. These are not given much emphasis in supplemental feeding programs.

‘Positive Deviance Hearth’

One approach that can address all factors of malnutrition is a community-based intervention program called “Positive Deviance Hearth” (PDH).

“Positive Deviance” refers to practices of parents or caregivers of well-nourished children in a community. Caregivers of healthy children are identified and their practices are shared with parents of malnourished children.

“Hearth” alludes to the intimate participatory setting of the sessions – a house or any venue in the neighborhood. 30 parents/caregivers attend a total of 12 sessions. Each session runs for 2-4 hours.

Two of the 30 participants are parents of children with normal nutritional status; the rest are parents of undernourished kids. Trained volunteers facilitate the sessions that have, as topics, feeding, caring, hygiene, and health-seeking practices.

Participants prepare simple and inexpensive nutrient-packed meals using ingredients brought by the parents. Another group of volunteers facilitate fun learning activities for the children, encouraging healthy eating habits and proper hygiene.

The sessions end with the children being served with the meal of the day.

Instant meals

Marissa, a mother of 7, admitted that before she attended the PDH sessions, she used to prepare “instant meals” for her children like coffee, bread or instant noodles for breakfast, and canned sardines for lunch and supper.

She felt that she did not have to exert too much effort in cooking since her children already liked the instant meals.

She prepared the same kinds of meals and cooked them in the same way – fried – because she usually does not have enough time, money, or energy to cook.

After the sessions, Marissa realized the following:

• With only P30, her family can already have delicious, filling, and nutritious meals like bowls of mung beans with pechay (Chinese cabbage) or malunggay.
• Planning meals enables you to stick to your budget.
• Eating together can encourage children to eat more.
• If children do not like vegetables, slicing them in small thin strips and mixing them with food they like can make them enjoy it more.
• Giving children a bath and clean cut nails are important in making children healthy.
• The house must be kept clean, yards swept, water containers covered.
• Buying paracetamol is not enough to remedy a child’s fever.

After the sessions, Marissa’s two children became more aware of their personal hygiene. “When their fingernails are long, for example, they show them to me to indicate they need cutting. And in the morning, they remind me to give them a bath.”

“The rights of children were also discussed during the sessions, I became more attentive to their needs and talk to them rather than scold them,” Marissa added.

Changing behaviors 

After 12 days, Marissa’s youngest child gained close to 3 kilos, while her other child attained a normal nutritional status just after a month.

Shiela Borja, one of the barangay volunteers in PDH, visited houses for another two weeks after the sessions ended. This was to make sure that the mothers continued the proper childcare lessons they learned.

Mandigma said that the goal of PDH is to address the “behavioral roots of malnutrition.”

“Once a person is educated, the knowledge acquired can no longer be taken away, and once established as a habit, positive change occurs in a household,” she said.

The beauty of PDH also lies in its cultural-appropriateness, it does not introduce foreign ideas or methods, making the session truly adaptable and doable in different community settings.

Caloocan City

Barangay 179 in North Caloocan City is one of the communities funding the implementation of PDH.

“PDH is a very unique program because education precedes the feeding of children. It trains the parents how to provide proper nutrition to their children,” chairman Marlon Palmere observed.

The experience of CI Manila with PDH in North Caloocan City indicated several strengths: 

1. 100% of children gain significant weight and at least 80% attain normal nutrition status within a month
2. Children maintain the improved nutritional status
3. There is general improvement in the health and hygiene of all children in the family
4. Improvement in the health-seeking behavior of parents
5. It is not costly to implement

CI Manila

CI Manila has been implementing PDH in North Caloocan City since 2010. Four barangays currently fund this approach while CI Manila provides training and technical support. 

CI Manila is a non-profit organization implementing health, nutrition, education, and youth development interventions that encourage young people to become self-reliant and productive adults.

Its programs benefit the disadvantaged communities in Quezon City, Caloocan City, and Bulacan. Aside from PDH, CI Manila implements supplemental feeding and nutri-kiddie class programs for school-age children, as part of its comprehensive response to hunger and malnutrition. The latter is in partnership with the Nutrition Council of the Philippines. – Rappler.com

To learn more about Children International Manila, support their program and explore partnerships with them. Email director@mla.children.org.ph or call 417-4079 loc 201. Joel Abelinde is a Communications Coordinator in CI Manila. He spent the past 7 years reporting on CI Manila’s health, education, children protection, youth development and disaster response programs. He is also a freelance writer. 

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