title: Comparison of a positive deviance inquiry with a case-control study to identify factors associated with nutritional status among Afghan refugee children in Pakistan.
abstract: We compared the positive deviance (PD) approach in Save the Children's field guide with a case-control study (CCS) to identify behaviors associated with good nutritional status in Afghan refugee children 6 to 24 months of age in the Northwest Frontier Province (NWFP), Pakistan. The positive deviance inquiry (PDI), utilizing observations and interviews with mothers, fathers, and secondary caregivers in eight households, identified 12 feeding, caring, and health-seeking behaviors that were not widely practiced. The CCS, using the same selection criteria and content as the PDI with 50 mother-child pairs not in the PDI, yielded six significant associations with good nutritional status. Both the PDI and CCS detected feeding behaviors. The PDI alone identified complex phenomena (active feeding and maternal affect). The CCS alone confirmed the beneficial use of health services. The PD approach was an affordable, participatory, and valid method to identify feeding behaviors and other factors associated with good nutrition in this context.
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Medford, Mass., USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Lapping
authors.forename: Dirk
authors.initials: D
authors.lastname: Schroeder
authors.forename: David R
authors.initials: DR
authors.lastname: Marsh
authors.forename: Rachel
authors.initials: R
authors.lastname: Albalak
authors.forename: Mohammad Zahir
authors.initials: MZ
authors.lastname: Jabarkhil
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000208:ethnology; D000367:Age Factors; D001942:Breast Feeding; D016022:Case-Control Studies; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D005247:Feeding Behavior; D005260:Female; D006285:Health Planning / Q000379:methods*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000523:psychology; D008297:Male; D009749:Nutrition Surveys; D009752:Nutritional Status; D010154:Pakistan / Q000453:epidemiology; D010290:Parents / Q000193:education / Q000523:psychology*; D011203:Poverty; D012036:Refugees; D012307:Risk Factors