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.

Validation Child nutrition Pakistan Positive Deviance Formative research

education Parents Pakistan Afghanistan Child Nutrition Disorders refugee health care planning psychological aspect methodology poverty human Refugees Infant Care strategic approach nutritional disorder comparative study feeding behavior ethnology Breast Feeding Humans male preschool child female Infant risk factor Risk Factors Child, Preschool Article nutrition adult Health Planning age Nutrition Surveys Age Factors Case-Control Studies case control study nutritional status child care parent