Health & Nutrition Technical Brief: Positive Deviance Hearth Plus (+) Project Model – Bangladesh


Globally, child and maternal malnutrition underlie 45 percent of all child deaths. Undernutrition increases mortality and morbidity and increases expenditure on health overall. Undernutrition has further economic costs through cognitive delays in children, compromised learningperformance, andlowereconomicproductivity in adults. Causes of lower economic productivity include lower physical strength, lower wages, and more days away from work due to illness among adults. As a result, there is a greater than 10% reduction in lifetime earnings for each malnourished individual and approximately 8% loss in GDP. The causes of undernutrition are complex, with immediate determinants related to disease and inadequate food intake. Moreover, micronutrient deficiencies (often called “hidden hunger” as they may not be visible to the naked eye) are widespread, especially amongst women and children. These causes in turn are due to underlying determinantssuch asfood insecurity, inadequate care and feeding practices (many times affected by poor household support for ‘unpaid care work’ and poor mental health of women due to traditional gender norms), poor access to health services, and unhealthy household environments including poor water and sanitation.9 Furthermore, there is poor coverage of health and nutrition services including poor screening coverage and referral systems (Growth Monitoring and Promotion) because these are usually conducted at health centres, which can be hard to access (physical distance) Poorly functioning rehabilitation programs are also contributing factors to high rates of malnutrition. Nutrition rehabilitation programs are often costly, the quality of care poor, and are many times dependent on supplements, which have frequent stockouts. Therefore, interventions to strengthen preventative nutrition services are required, and a more sustainable food-based approach is needed to address malnutrition.

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