April 9, 2025
Along the dirt roads deep inside Bar Agulu Village in Siaya County, freshly plowed farms are ready for planting season during the March to June rainy season. Several mango trees can be seen in almost every grass thatched or semi-permanent house within the homesteads. At one of the homesteads, six caregivers and seven children have their morning snack, porridge, under a blend of shade from a house and a mango tree. This is Uhuru Positive Deviance Hearth (PD Hearth), a 12-day community-based behavior change program aimed at rehabilitating underweight and moderately malnourished children.
These children, aged between six and 36 months, were selected with their caregivers for the PD Hearth program after measurements including the height, weight, and mid-upper arm circumference (MUAC) fell below program criteria. Some were discovered to be weighing as low as 9kgs at 24 months, indicating moderate malnourishment. Others could not eat and were too weak even to play with other children. The target during the 12-day PD Hearth program is for the children to gain at least 200 grams and to provide caregivers education on how to feed them with diversified local foods in well-rounded, complete meals to better their health without badly straining family budgets.
The mapping of the moderately malnourished children within Bar Agulu village was conducted by the Community Health Promoters (CHP), Community Health Assistants (CHA) and the Sub-County Nutritionist supporting the CHAMPS data to action program. Caregivers receive support throughout the program from the Child Health and Mortality Prevention Surveillance CHAMPS International Association of National Public Health Institute (IANPHI) program in collaboration with HJFMRI, the Kenya Medical Research Institute (KEMRI) and the Siaya County Department of Health.
Each day, caregivers converge at a selected home (hearth) at 9 am with their children. They distribute roles and start preparing food they brought, for their children. Some start to prepare porridge, their snack, while others ensure that the children are actively playing using their locally made toys. Others begin putting together firewood for preparation of the foods they brought. All this is done with guidance from the County Nutritionist alongside the primary healthcare personnel.
“We make meal plans every evening for the next day’s meal. The menu is well balanced and can meet the demands of the children. We have children who can take only mashed foods while others take family foods. So, we ensure we encompass all of them when preparing the menu.” Said Christine Okoth, Nutritionist at the Siaya County Referral Hospital.
Caregivers rotate roles each day, so everyone gains a variety of new experiences at the hearth. “At first, they thought this process was hard, but they have learnt on how to prepare healthy meals for their children. They have further taken the knowledge home and are educating their neighbors and community.” Sharon, a Community Health Assistant. She explained that while poverty is a contributor to malnutrition, lack of knowledge on nutrition and food preparation is a bigger issue.
At Dondi PD Hearth, another setting within the village, we meet Beatrice, a 28-year-old, who cares for her two-and-a-half-year-old niece. Before coming to the PD Hearth, the child was too weak to walk or play. During the program, Beatrice has seen great improvements in her niece and on the other children.
“We have learnt that, as much as the group is for improving the health of the children, they have also positively changed socially. They play a lot with each other and as a result improves their general wellbeing.” Beatrice said.
Alice Awour, a 20-year-old mother of a one-year-old girl, is grateful since her child has gained 400 grams during the 12-day session at Uhuru PD Hearth. Tiffany was weighing 6.1 kgs when being enrolled and couldn’t feed. “Previously my baby would just sit all day but right now she plays a lot with other children while at the PD Hearth and, at home she crawls a lot. Before she couldn’t eat, but now I have noticed changes. She can take porridge and feed on other solid food that previously she couldn’t.” Alice happily stated.
