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Using Positive Deviance to Understand the Uptake of Optimal Infant and Young Child Feeding Practices by Mothers in an Urban Slum of Mumbai

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Abstract

Objectives Positive deviance research seeks out well-nourished children living in disadvantaged contexts to understand local growth-promoting behaviors. This study explored the factors that influence the uptake of infant and young child feeding behaviors among mothers. Methods Children with a height-for-age z-score (HAZ) > 0 (n = 10) or a HAZ < −2.0 (n = 12) were purposefully selected from households enrolled in a community management of acute malnutrition (CMAM) program in an urban slum of Mumbai, India. Qualitative methods were employed by means of semi-structured key informant interviews with positive and non-positive deviant mothers. Eligibility was restricted to households with limited resources and more than one child. A 24-h dietary recall and anthropometric measurements were taken for the index child. An observation checklist assessed household hygiene. Data analysis was based on the Grounded Theory of qualitative research. Results Positive deviant mothers (those with children with a HAZ > 0) largely exhibited optimal infant and young child feeding practices explained by maternal information seeking behaviors; mothers acknowledging the importance of maternal health; and social support. The relationship between mother and health worker seemed to influence how well they listened to the health workers’ recommendations. Across all households, the daily consumption of high-energy, processed foods was apparent. Conclusions Practical considerations include exploring how to tailor CMAM programs to include social support and counseling training for health workers to engage more closely with mothers; exploring the feasibility of a women’s social group for mothers to share information on child rearing; and teaching mothers about healthy eating and the link between nutrition and health.

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Acknowledgments

This project was funded by the Wilbur G. Downs International Health Student Travel Fellowship and the Office of Student Research at the Yale School of Medicine.

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Authors and Affiliations

  1. Yale School of Public Health, New Haven, CT, 06520-8034, USA

    M. R. D’Alimonte & D. L. Humphries

  2. Society for Nutrition, Education and Health Action, Dharavi, Mumbai, 400017, India

    D. Deshmukh, A. Jayaraman & S. Chanani

Authors
  1. M. R. D’Alimonte
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  2. D. Deshmukh
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  3. A. Jayaraman
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  4. S. Chanani
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  5. D. L. Humphries
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Correspondence to M. R. D’Alimonte.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Yale University Institutional Review Board Human Subjects Committee, and received local ethical approval from the partner organization in India. Protocol was conducted within ethical standards held by each institution.

Appendix

Appendix

See Table 3.

Table 3 Semi-structured interview guide
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D’Alimonte, M.R., Deshmukh, D., Jayaraman, A. et al. Using Positive Deviance to Understand the Uptake of Optimal Infant and Young Child Feeding Practices by Mothers in an Urban Slum of Mumbai. Matern Child Health J 20, 1133–1142 (2016). https://doi.org/10.1007/s10995-015-1899-3

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