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Village Science: Positive deviance helps fight malnutrition


Three young mothers from the tiny island of Meradhoo Feydhoo take shade under the high steel roof of an Early Childhood Development Veranda. Infant children in their arms, they smile broadly, dark hair peeking out from brightly-coloured red and green headscarves, as they discuss what their children have eaten today.

It's hard to imagine what Sueda, Zahira, and Nazima – who probably have never seen a cow – have in common with milkmaids in 18th-century smallpox-ravaged England. Yet the two groups have a lot more in common than one might think.

When smallpox brought death to the England in the 18th century, the only survivors were often milkmaids. When one survived, villagers said, “What a lucky girl.” When ten survived, people feared the milkmaids had caused the illness, perhaps through witchcraft. Finally, a country doctor sat everybody down to find out what the milkmaids were doing that was different. It turned out the milkmaids who'd survived had all previously been sick with cowpox, a mild illness spread by cows that confers smallpox immunity. Instead of being the cause of the problem, these young women were the solution. The antibodies in their blood eventually saved millions of lives and eradicated a terrible disease. That is village science: ordinary people sharing their experiences to solve the problems of daily life.

Today, UNICEF is applying the same logic to fight malnutrition on islands across the Maldives. Using an approach called “positive deviance,” health workers bring together groups of mothers to feed their children together, observe each other, compare notes, and ask a question that few of them would probably think of as scientific: “Why are some children, in the same village, with the same family income, thriving while others are malnourished?” These women strive to figure out how the most successful mums are deviating from the norm. When they come up with an answer – the “positive deviance” behaviour that has led to healthier children – they try it out. If it works, they keep doing it. If it doesn't, they find new theories to test. It may not be rocket science, but it is village science, and it can lead to dramatic results –  as long as there are children growing at different rates and mothers sharing their experiences and asking, “Why?”

UNICEF aims to improve nutrition practices through the introduction of positive deviance. The mothers with malnourished children meet to cook a collective meal, feed their children together, and share their experiences of caring for infants and toddlers.

Today, some mums from the island's Integrated Early Childhood Development Committee, the positive deviance group organisers, are off cooking lunch while another group of mums sit and share their experiences. Sueda's, Zahira's, and Nazima's children were all star performers in their first six months, when they were exclusively breastfeeding, but are now mildly malnourished. Although everyone has seen their diligence as mothers, they talk their way together through a list of practices that might be contributing to the problem.

Nazima remembers that her daughter Aminath briefly gained weight in the beginning of the year, after taking treatment for intestinal worms, but then stopped gaining. One mother remembers that the same thing happened to her son. “Maybe she got worms again,” suggests one of the women. They agree that this is a good hypothesis, but it must be tested with another de-worming pill.

The other two women have a more difficult problem. As Sueda puts it, “When I had my first child and knew nothing about childcare, she was scrawny and listless. My second child, Aishath, is curious, energetic, and talkative, but so stubborn – she doesn’t want to eat.”

It's a more difficult problem than de-worming, but fortunately, children can also model positive deviance for each other. Half an hour later, when lunch is served – a healthy mixture of leafy greens, tuna and rice, followed by fruit salad – three-year-old Aishath wrinkles her nose and turns away from the spoon her mother holds to her mouth. Just minutes later, though, she sees her friend Aminath stuffing her cheeks with food and decides to give it a try herself.

 

 

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