An Effective Method of Combating Malnutrition

By Adesanwo Oluwaseyi Rachel, Global Health Analyst

The PD/Hearth Model is a community-based program designed to reduce the incidences of malnutrition in children and to sustain their improved nutritional status. It was developed by private voluntary organizations and has been successfully applied in some of the poorest countries in the world, including Haiti, Vietnam, Nepal, Bangladesh, and Mozambique.  While many organizations acknowledge the necessary time commitment in reducing the root causes of malnutrition, such as poverty and a lack of adequate access to health care, the PD/Hearth approach can enable communities to strategically reduce the impacts of malnutrition by implementing cost effective management practices.  Because malnourishment has such a profound impact on children’s growth and development, implementing these practices is necessary for underdeveloped communities to prosper over the long-term.


The program has three core dimensions:

  • Rehabilitation: heal and provide caring for malnourished children
  • Education: teach families how to sustain their children’s enhanced nutritional status
  • Prevention: reduce future malnutrition among children through mitigation strategies and risk reduction


PD/Hearth helps raise community awareness of malnutrition, empowers the community to seek existing local solutions, and teaches families healthy behaviors.


Almost invariably, not all children in a targeted community are malnourished.  Despite stark poverty and food scarcity, some parents find ways to feed their children well and sustain a well-nourished family. These households are referred to as the ‘positively deviant families’. Identifying the strategies of these positively deviant families is key to developing a successful PD/Hearth program for a particular community.




In the context of nutrition, a positive deviant is a person who successfully nourishes their children, running against the norm of accepting or allowing malnutrition within a family. The overall goal of the PD /Hearth Nutrition Program is to help enable poor communities to independently address the problems of malnutrition through Positive Deviance Inquiry and organizing Hearth sessions.


  • Positive Deviance Inquiry  is a community’s self-discovery process to witness practices of neighbors with well-nourished children and identify these successful practices, through observations of those children who thrive under similar conditions, and have adopted coping mechanisms that can be emulated within the community. There are three basic categories of behaviors that are observed: Food behavior, caring behaviors and health promoting behaviors.


  • Hearth Session  -A gathering at a local hearth, where caretakers and volunteers prepare an extra energy-rich/calorie-dense meal and snack, feed it to their malnourished child, daily for two weeks.  The menu is based on specific positive deviant food identified through PDI and contributed by attending caretakers.


Overall, PD/Hearth activities can have a profound impact on community food security. It’s therefore recommended that particular governments should implement some of these techniques.

Adesanwo Oluwaseyi Rachel is a Global Health Analyst with CDS and is currently based in Lagos, Nigeria. She holds her bachelor’s degree in Nutrition and Dietetics from the Federal University of Agriculture, Abeokuta. 

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