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0099 - Positive Deviance/Hearth (PDH), a food-based approach to increase consumption of vitamin A and iron-rich foods and rehabilitate malnourished children in Shribordi, Bangladesh


  • Baik, Diane 
  • Rahman, Md. Mezanur 
  • Tse, Carmen 


Use food-based approach to improve vitamin A (VA)- and iron-intake and rehabilitate underweight children.


An analysis was conducted to identify locally-available, micronutrient-rich, low-cost foods, and the findings informed rehabilitation menu designs. From March-October 2015, 515 underweight children and their caregivers participated in a 12-day experiential learning session, practicing positive behaviours, contributing food, cooking and feeding participant children Hearth menus. Children’s weights were collected at Days 1, 12, 30, and 3 and 6 months. Potential contribution to VA- and iron-intake was assessed by comparing average contribution of PDH menus with Recommended Nutrient Intake (RNI) of children 6-36 months and Ready-to-Use-Therapeutic-Foods (RUTF).


The average Hearth meal meets RNIs for 7-12 months and 13-36 months for vitamins A and C and iron, and is comparable to nutrient breakdown of RUTF at less than half the cost (0.17USD/meal). At Day 12, average weight gain (AWG) was 403g and 91.7% (n=515) of children gained adequate weight (=200g); Day 30, AWG was 782g and 59.5% (n=513) gained adequate weight (=400g); 3 months, AWG was 1227g and 64.1% (n=514) gained adequate weight (=900g). Overall rehabilitation rate was 57.4% (n=514) at 3 months.


Hearth meals are effective in rehabilitating underweight. The Hearth menu, in addition to regular feeding patterns, meets RNIs of children 6-36 months to support rehabilitation affordably at home. World Vision has scaled up PDH in Bangladesh, admitting more than 32,000 children in 2015. Further studies are recommended assessing the effectiveness of Hearth meals as an alternative to costly therapeutic-foods on micronutrient status.

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