Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-Supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women

Ndiaye, Mamadou Lamine; Siekmans, Kendra; Haddad, Slim; Receveur, Olivier

doi:10.1177/156482650903000204

Cited by 30 publications

(40 citation statements)

References 24 publications

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“…Ndiaye et al (32) 2009 Senegal Monthly health promotion sessions for pregnant women through community volunteers…”

Section: Strengths Of Community-based Distribution Of Ironfolic Acid mentioning

confidence: 99%

“…Six studies found that CBD of IFA supplementation can increase ANC attendance through community agents encouraging earlier and consistent ANC visits (25,26,28,(30)(31)(32) . In Nepal, a programme with community volunteers that distributed IFA supplements found a substantial increase in compliance (defined as those taking 80 % of the recommended number of supplements) and increased ANC attendance through community volunteers, which dispelled a common local belief that community distribution would discourage women from seeking care at health facilities (33) .…”

Section: Strengths Of Community-based Distribution Of Ironfolic Acid mentioning

confidence: 99%

“…Cost in relation to compliance Six studies reported IFA supplementation was provided free of charge through CBD (17,19,25,32,36,38) . A few studies assessed the impact of cost in relation to compliance and in relation to purchasing IFA tablets through private pharmacies.…”

Section: Barriers To Successful Roll-out Of Community-based Distributmentioning

confidence: 99%

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Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

Kavle

Landry

2017

Public Health Nutr.

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Objective: The present literature review aimed to review the evidence for community-based distribution (CBD) of iron-folic acid (IFA) supplementation as a feasible approach to improve anaemia rates in low-and middle-income countries. Design: The literature review included peer-reviewed studies and grey literature from PubMed, Cochrane Library, LILAC and Scopus databases. Setting: Low-and middle-income countries. Subjects: Non-pregnant women, pregnant women, and girls. Results: CBD programmes had moderate success with midwives and community health workers (CHW) who counselled on health benefits and compliance with IFA supplementation. CHW were more likely to identify and reach a greater number of women earlier in pregnancy, as women tended to present late to antenatal care. CBD channels had greater consistency in terms of adequate supplies of IFA in comparison to clinics and vendors, who faced stock outages. Targeting women of reproductive age through school and community settings showed high compliance and demonstrated reductions in anaemia. Conclusions: CBD of IFA supplementation can be a valuable platform for improving knowledge about anaemia, addressing compliance and temporary side-effects of IFA supplements, and increasing access and coverage of IFA supplementation. Programmatic efforts focusing on community-based platforms should complement services and information provided at the health facility level. Provision of training and supportive supervision for CHW on how to counsel women on benefits, side-effects, and when, why, and how to take IFA supplements, as part of behaviour change communication, can be strengthened, alongside logistics and supply systems to ensure consistent supplies of IFA tablets at both the facility and community levels. Globally, anaemia affects 29 % of pregnant women and 38 % of non-pregnant women (1) and is associated with one-fifth of maternal deaths (2) . Anaemia puts women at greater risk of mortality, morbidity, postpartum haemorrhage and poor birth outcomes, including preterm births and low birth weight (3,4) . The WHO recommends daily iron-folic acid (IFA) supplementation (30-60 mg iron, 0·4 g folic acid) initiated as early as possible and continued throughout pregnancy for all adolescent and adult women as a key intervention to reduce the risk of maternal anaemia, iron deficiency and infants born with low birth weight (5) . According to findings from a recent meta-analysis, IFA supplementation would increase the mean blood Hb concentration by 10·2 (95% CI 6·1, 14·2) g/l in pregnant women and by 8·6 (95% CI 3·9, 13·4) g/l in non-pregnant women (aged 19-21 years) (6) . Applying these shifts to estimated blood Hb concentrations indicates that about 50 % of anaemia in women could be eliminated by IFA supplementation (6) .

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“…Ndiaye et al (32) 2009 Senegal Monthly health promotion sessions for pregnant women through community volunteers…”

Section: Strengths Of Community-based Distribution Of Ironfolic Acid mentioning

confidence: 99%

Section: Strengths Of Community-based Distribution Of Ironfolic Acid mentioning

confidence: 99%

See 1 more Smart Citation

Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

Kavle

Landry

2017

Public Health Nutr.

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“…This theory posits that there are some individuals who may thrive despite an adverse environment and without extra resources. This approach has been tested and has proven successful in addressing malnutrition, 9 iron deficiency anemia, 10 and recently adult obesity. 11 The benefit of a positive deviance strategy is that it utilizes local resources and people, deriving solutions from the community, thus enhancing both acceptability and sustainability in the community.…”

Section: Introductionmentioning

confidence: 99%

A Positive Deviance Approach to Early Childhood Obesity: Cross-Sectional Characterization of Positive Outliers

et al. 2015

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Objective: Positive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices.Methods: In a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight.Results: Interviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups.Conclusions: We found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.

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“…A study by Ndiaye M. et al which compared positive deviance approach with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area found that a community-based strategy, such as the positive deviance approach, could contribute to improving the effectiveness of iron supplementation during pregnancy. 29 In India, some interventions used the "positive deviance approach" (e.g., the Adolescent Anemia Control Program for Girls in Vadodara District and the UMANG Project in Uttar Pradesh) with significant results and this approach should be further implemented and documented.…”

Section: Using Positive Deviance Approach As a Toolmentioning

confidence: 99%

Unrelenting burden of anaemia in India: Highlighting possible prevention strategies

Upadhyay¹,

Chinnakali²,

Kulkarni³

2012

IJMEDPH

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Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-Supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women

Abstract: (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53).Conclusions. This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.

Cited by 30 publications

References 24 publications

Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

A Positive Deviance Approach to Early Childhood Obesity: Cross-Sectional Characterization of Positive Outliers

Unrelenting burden of anaemia in India: Highlighting possible prevention strategies

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