It is well established that linear growth outcomes in sub-Saharan Africa are determined by a complex interaction of genetic, social, economic, and environmental factors. This study sought to identify positive deviants among poor households in terms of weight management and to explore the basic determinants of child linear growth outcomes in this setting. A cross-sectional survey was conducted among 539 households in four rural villages of Ghana. Sociodemographic characteristics, Perceptions about the criticality of weight management for child growth, and weight management practices were assessed. Outcomes of interest were weight-for-age z-scores (WAZ) and height-for-age z-scores (HAZ) of children under 5 years old. Bivariate and multivariate logistic regression analyses were used to identify factors associated with being a positive deviant in weight management.
A total of 539 households with at least one child under 5 years old were surveyed. The median age of the mothers was 32 years (IQR: 26-38), and the median number of children under 5 years old per household was two (IQR: 1-3). The majority of households were nuclear (71.8%), had a monthly income below US$50 (78.7%), and had the mother as the primary caretaker (84.4%). Most mothers had primary education or less (76.1%), were married or in a union (88.5%), and reported having decision-making power in the household (78.4%).
One-third of households (33.6%) had at least one child who was a positive deviant in terms of weight management, defined as having a WAZ or HAZ above the median for their age and sex. Factors associated with being a positive deviant in weight management included having a higher level of education (OR = 2.21, 95% CI: 1.11-4.39), being employed (OR = 2.57, 95% CI: 1.21-5.45), having a larger household size (OR = 1.68, 95% CI: 1.02-2.75), and perceiving weight management to be critical for child growth (OR = 3.64, 95% CI: 2.07-6.40).
This study provides important insights into the basic determinants of child linear growth outcomes in a poor, rural setting in sub-Saharan Africa. The findings highlight the importance of weight management practices and perceptions in determining these outcomes. Positive deviants in weight management may serve as a valuable resource for interventions to improve child linear growth outcomes in this setting.
Recent evidence suggests that undernutrition is a major contributor to child linear growth outcomes in sub-Saharan Africa. Given the high burden of undernutrition in the region, there is an urgent need to identify effective interventions to improve child growth. The Positive Deviance Approach has been shown to be an effective tool for identifying and scaling up effective interventions in resource-poor contexts.
The aim of this study was to use the Positive Deviance Approach to identify effective interventions for improving child linear growth in poor households in sub-Saharan Africa. A cross-sectional survey was conducted in four countries in the region (Burkina Faso, Ghana, Kenya, and Tanzania). A total of 1,509 households were surveyed, and data were collected on child linear growth outcomes, household socioeconomic status, and child care and feeding practices.
Households were classified as positive deviants if they had at least one child in the highest quartile of the child growth distribution, and as negative deviants if they had at least one child in the lowest quartile. A total of 34% of households were classified as positive deviants.
Child linear growth outcomes were significantly better in positive deviant households than in negative deviant households. Positive deviant households were more likely to provide their children with adequate nutrition and care, and to have better sanitation and hygiene practices. They were also more likely to have higher incomes and more educated mothers.
This study highlights the importance of the Positive Deviance Approach for identifying effective interventions to improve child linear growth outcomes in poor households in sub-Saharan Africa. Future research should focus on replicating these findings in other settings and on developing and testing interventions to scale up effective practices identified by the Positive Deviance Approach.