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Appendices

Table A. Countries included in regional groupings
Table B. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: rural areas only
Table C. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: urban areas only
Table D. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: overall
Table E. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: opinion scores by setting mean (SD)
Table F. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: opinion scores by region, mean (SD)
Table G. Summary of observations, suggestions, and comments from the questionnaire
Names and Addresses of Positive-deviance Mail-survey Respondents

Appendix 1. Descriptive Statistics from Positive-deviance Mail Survey

Table A. Countries included in regional groupings

1. Suh-Saharan Africa (East and West Africa)
Kenya, Lesotho, Tanzania, Cameroon, Senegal, Sierra Leone, Gambia (11)
2. Middle South Asia
Bangladesh, Nepal, India, Sri Lanka, Turkey (14)
3. South-East and East Asia
Thailand, Philippines, Taiwan, Malaysia, China (10)
4. Latin America (Middle America and South America)
Mexico, Argentina, Brazil, Chile, Colombia, Ecuador, Peru (15)
5. Other developing
Haiti, St. Kitts, North American Eskimo, Papua New Guinea, Tunisia (11)
6. Industrialized
In most instances respondents in this group probably based their answers on experience with developing-country populations, but neglected to specify these groups in the questionnaire:

Greece, Germany, Sweden, New Zealand, Japan, United States (7)

Table B. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: rural areas only

  Percentage responding Number responding to item Number mentioning information source
  Very unimportant Very important    
A. BEHAVIOURAL, PSYCHOSOCIAL, AND CULTURAL FACTORS
1. Mother-child interactions 0 1 2 3 4   a b c d
Early bonding between mother and infant 0 5.6 15.6 44.4 44.4 18 1 4 1 1
Positive "affect" or smiling happy mood between mother/child 0 5.9 11.8 29.4 52.9 17 1 17 1 1
Prompt response to child's hunger cues 0 0 11.1 44.4 44.4 18 1 16 1 1
Mother's coaxing or stimulating child to cat 11.8 11.8 11.8 47.1 17.6 17 1 17 1 1
Mother feeding older infant rather than letting infant feed self 13.3 26.7 26.7 20 13.3 15 0 16 1 1
Frequent close physical contact 0 5.9 5.9 41.2 47.1 17 1 14 2 3
Frequent physical care, 11.1 5.6 23.3 38.9 11.1 18 1 14 1 2
Frequent psychosocial stimulation 10.5 0 15.8 21. I 52.6 19 0 15 1 4
Lack of prolonged separation of child from mother 6.3 6.3 0 31.3 56.3 16 2 12 1 2
Consistent reinforcement of child's developmental achievements 7.1 0 35.7 28.6 28.6 14 0 12 1 2
2. Behavioural characteristics of the child
Strong sucking reflex (ininfants) 0 18.2 18.2 27.3 36.4 11 0 14 0 2
High neo-natal assessment score 16.7 16.7 33.3 16.7 16.7 6 0 10 0 1
Large appetite 6.7 0 26.7 26.7 40 15 0 14 2 0
Willingness to eat new foods or variety of foods 6.7 6.7 13.3 40 33.3 15 0 15 0 0
Well-defined hunger cues 8.3 0 0 66.7 25 12 0 13 0 0
Aggressive approach to obtaining food 0 14.3 14.3 28.6 42.9 14 0 13 0 0
Regular sleeping pattern 16.7 0 25 41.7 16.7 12 0 11 0 0
Rapid adaption to new stimuli 0 0 22.2 66.7 11.1 9 0 9 0 1
Enjoys interacting with people 0 0 26.7 40 33.3 15 0 13 0 1
3. Psychosocial characteristics of the mother
Satisfaction with her life in general 5.6 16.7 22.2 16.7 38.9 18 1 15 1 0
Low levels of psychological stress 0 15.4 23.1 15.4 46.2 13 0 12 1 0
Not overburdened by work 5.6 11.1 22.2 11.1 50 18 2 14 1 0
Ability to put child's needs before her own needs or desires 0 0 28.6 21.4 50 14 0 11 1 1
Good relationship with child's father 0 5.9 17.6 47.1 29.4 17 1 14 1 1
Absence of psychiatric problems (anxiety, depression, etc.) 0 0 20 40 40 10 0 12 0 0
Enterprising, non-fatalistic attitude 7.7 7.7 7.7 46.2 30.8 13 0 12 1 0
Positive attitude towards child 0 0 6.3 25 68.8 16 1 14 1 1
Positive attitude (child born at desired time) 13.3 6.7 6.7 53.5 20 15 1 13 1 0
Less practice of favouritism or discrimination against female child 6.7 13.3 6.7 26.7 46.7 15 0 12 3 2
Maturity: 20 years old or more 6.3 6.3 12.5 25 50 16 0 12 1 1
Life-stage: not older than 35 6.3 25 18.8 25 25 16 0 12 2 1
Higher educational level 6.3 6.3 43.8 31.3 12.5 16 0 12 3 0
Higher natural intelligence 8.3 0 41.7 25 25 12 0 12 1 0
Greater contact with the world outside the home 11.1 5.6 33.3 38.9 11.1 18 1 15 1 0
4. Preventive health care
Attention to hygiene and sanitary conditions of child's environment 5.9 0 5.9 29.4 58.8 17 1 15 1 4
Greater use of modern preventive health services(e.g. pre-natal care, immunization) 11.8 0 11.8 23.5 52.9 17 1 13 1 3
Less use of traditional preventive measures(e.g. charms, amulets) 30.8 7.7 38.5 7.7 15.4 13 0 15 1 1
Less practice of dietary taboos 22.2 22.2 16.7 1.1 27.8 18 4 15 1 4
5. Curative health care
Prompt visit to modern health services 5.9 5.9 17.6 35.3 35.3 17 2 7 1 2
Continuing to seek help until child recovered 6.3 0 12.5 56.3 25 16 2 13 2 2
Fewer visits to traditional healers 37.5 12.5 18.8 25 6.3 16 3 12 3 1
Continuing to give prescribed care 7.1 7.1 0 57.1 28.6 14 2 12 1 1
Fewer home remedies 14.3 28.6 35.7 7.1 14.3 14 2 13 1 1
Fewer restrictions on diet during illness 7.1 0 7.1 28.6 57.1 14 1 12 3 1
Mother stays with sick child - does not leave with others when sick 0 0 26.7 46.7 26.7 15 2 13 1 0
6. Characteristics of other caretakers
Mature, at least 15 years old 14.3 0 7.1 57.1 21.4 14 0 13 1 2
Experienced in child care 21.4 7.1 21.4 28.6 21.4 14 0 13 1 1
Better educated 26.7 20 20 26.7 6.7 15 0 13 1 1
Less burdened by other tasks 15.4 15.4 30.8 23.1 15.4 13 0 12 1 1
7. Father's role
Living at home 11.1 5.6 27.8 27.8 27.8 18 2 14 1 2
One wife only 14.3 7.1 28.6 14.3 35.7 14 3 15 1 0
Providing financial support for child 0 6.3 0 37.5 56.3 16 1 12 3 4
Better educated 11.8 17.6 17.6 35.3 17.6 17 2 13 2 1
8. Family size/structure
Children separated by birth interval of at least three years 0 6.7 0 53.3 40 15 1 12 3 3
Not more than four children 0 0 0 64.3 35.7 14 1 11 4 2
Higher ratio of adults to young children 25 0 33.3 41.7 0 12 0 11 0 1
Presence of siblings old enough to help mother 6.3 6 3 12.5 50 25 16 0 14 0 2
9. Family attitudes
No preference for male and older family members in distribution of food 0 11.8 11.8 52.9 23.5 17 2 13 1 1
Recognition of special nutritional needs of child 7.1 0 14.3 35.7 42.9 14 1 13 0 1
Ambitions for child to receive post-primary education 7.1 0 21.4 50 21.4 14 0 12 0 0
Ambition for child to succeed in modern occupation 7.1 7.1 23.1 53.8 7.7 13 0 12 0 0
10. Household resources                    
Significant hidden/intangible resources (given the low socio-economic status of the family) 7.7 7.7 15.4 23.1 46.2 13 1 9 1 0
Greater access to community services 7.1 0 0 50 42.9 14 1 11 1 0
Presence of informal social network whose support the mother can draw upon 6.7 0 0 40 53.5 15 1 10 2 0
Small amount of supplemental income earned by enterprising mother 7.1 0 14.3 35.7 42.9 14 0 10 0 2
B. GENETIC AND PHYSIOLOGICAL FACTORS
1. Maternal nutritional factors 0 1 2 3 4 N a b c d
Height 7.7 15.4 7.7 30.8 38.5 13 0 8 5 0
Pre-pregnancy weight-for-height 0 9.1 18.2 27.3 45.5 11 0 8 2 1
Weight gain during pregnancy 9.1 9.1 9.1 18.2 54.5 11 0 8 1 1
Weight-for-height during lactation 7.1 7.1 14.3 57.1 14.3 14 0 8 2 2
Female obesity (contributing protective effect to infant nutrition in some societies 33.3 33.3 0 0 33.3 9 0 7 1 2
Iron status 0 11.1 33.3 33.3 22.2 9 0 7 0 1
2. Dietary intake during pregnancy
Calories 0 8.3 8.3 16.7 66.7 12 1 7 2 3
Protein 9.1 0 9.1 27.3 54.5 11 0 7 1 2
Iron 0 9.1 9.1 36.4 45.5 11 0 7 1 2
Folate 0 9.1 18.2 54.5 18.2 11 0 7 1 2
3. Dietary intake during lactation
Calories 0 0 22.2 11.1 66.7 9 1 7 1 1
Protein 0 22.2 11.1 33.3 33.3 11 1 8 0 1
Iron 0 20 20 20 40 10 1 8 0 1
Folate 0 11.1 22.2 44.4 22.2 9 1 8 0 1
Fluids 0 22.2 0 44.4 33.3 9 1 8 0 1
4. Child characteristics
Birth weight (large or average weight-for-date) 0 0 8.3 33.3 58 3 12 0 9 2 2
Normal gestational age (38-42 weeks) 0 0 0 33.3 66.7 12 0 9 1 4
Absence of complication/stress during pregnancy 0 0 0 41.7 58.3 12 0 10 1 2
Age supplementary food started 0 0 0 25 75 16 1 11 3 4
Age breast-feeding started 5.6 0 16 7 27.8 50 18 2 12 2 3
Age other milk stopped 21.4 7.1 42.9 14.3 14.3 14 0 10 1 2
Calories in supplementary food 0 0 5.9 23.5 70.6 17 1 11 2 3
Protein in supplementary food 11.8 11.8 0 41.2 35.5 17 1 10 2 4
Lower than average activity level 15.4 15.4 15.4 30.8 23.1 13 0 9 0 1
Greater than average stress tolerance 0 37.5 12.5 25 25 8 0 7 0 0
Lower than average caloric requirement 20 30 20 20 10 10 0 8 0 0
Lower than average protein requirement 10 40 20 20 10 10 0 8 0 0
5. Child's resistance to infections
Diarrhoeal 0 0 6.3 6.3 87.5 16 1 11 2 5
Respiratory 0 0 6.7 20 73.3 15 0 10 2 4
Parasitic 0 7.7 15.4 38.5 38.5 13 1 10 2 3
Measles 0 7.1 0 35.7 57 1 14 1 11 2 4

a = anecdotal reports; b = personal observation; c = unpublished research; d = published research.

Table C. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: urban areas only

  Frequencies for urban areas only (setting eq. 2)
  0 1 2 3 4 N a b c d
A. BEHAVIOURAL, PSYCHOSOCIAL, AND CULTURAL FACTORS
1. Mother-child interactions                    
Early bonding between mother and infant 0 0 7.7 23.1 69.2 13 0 7 0 9
Positive "affect" or smiling happy mood between mother/child 0 0 23.1 38.5 38.5 13 1 8 1 5
Prompt response to child's hunger cues 0 0 15.4 23.1 61.5 13 1 9 1 1
Mother's coaxing or stimulating child to eat 9.1 36.4 18.2 18.2 18.2 11 3 9 0 1
Mother feeding older infant rather than letting infant feed self 40 20 20 10 10 10 1 9 0 1
Frequent close physical contact 0 0 23.1 46.2 30.8 13 1 8 0 5
Frequent physical care, cleaning, grooming 0 15.4 30.8 38.5 15.4 13 2 9 0 2
Frequent psychosocial stimulation 7.7 7.7 7.7 38.5 38.5 13 0 8 1 7
Lack of prolonged separation of child from mother 10 0 20 40 30 10 0 7 1 4
Consistent reinforcement of child's developmental achievements 16.7 0 25 41.7 16.7 12 0 10 0 4
2. Behavioural characteristics of the child
Strong sucking reflex (in infants) 0 8.3 33.3 41.7 16.7 14 2 10 0 3
High neo-natal assessment score 8.3 8.3 16.7 58.3 8.3 12 0 7 0 3
Large appetite 8.3 8.3 16.7 33.3 33.3 12 1 9 0 2
Willingness to eat new foods or variety of foods 7.1 7.1 28.6 42.9 14.3 14 1 11 0 0
Well-defined hunger cues 7.1 7.7 30.8 38.5 15.4 13 1 9 0 0
Aggressive approach to obtaining food 0 20 20 40 20 10 0 9 0 0
Regular sleeping pattern 0 9.1 9.1 72.7 9.1 14 0 9 0 1
Rapid adaption to new stimuli 0 0 0 30 70 10 0 9 0 1
Enjoys interacting with people 0 30 10 40 20 10 0 8 0 1
3. Psychosocial characteristics of the mother
Satisfaction with her life in general 0 0 0 41.7 58.3 12 1 7 0 3
Low levels of psychological stress 0 0 23.1 30.8 46.2 14 0 7 0 4
Not overburdened by work 0 0 25 50 25 12 0 7 1 2
Ability to put child's needs before her own needs or desires 0 0 16.7 33.3 50 12 1 7 0 3
Good relationship with child's father 0 0 0 69.2 30.8 13 1 7 0 3
Absence of psychiatric problems (anxiety, depression, etc.) 0 7.7 0 30.8 61.5 13 0 7 0 5
Enterprising, non-fatalistic attitude 11.1 11.1 0 55.6 22.2 9 0 6 0 2
Positive attitude towards child (child of desired sex) 0 0 8.3 66.7 25 12 1 6 0 3
Positive attitude (child born at desired time) 0 0 0 69.2 30.8 13 0 9 0 2
Less practice of favouritism or discrimination against female child 9.1 9.1 18.2 45.5 18.2 11 1 7 1 1
Maturity: 20 years old or more 0 7.7 15.4 38.5 38.5 13 0 8 1 4
Life-stage: not older than 35 14.3 14.3 14.3 35.7 21.4 14 1 7 2 3
Higher educational level 0 7.7 23.1 46.2 23.1 13 0 6 2 5
Higher natural intelligence 7.7 7.7 23.1 30.8 30.8 13 0 9 1 2
Greater contact with the world outside the home 0 0 28.6 57.1 14.3 14 0 10 2 3
4. Preventive health care
Attention to hygiene and sanitary conditions of child's environment 0 7.1 0 35.7 57.1 14 1 4 2 9
Greater use of modern preventive health services (e.g. pre-natalcare, immunization) 0 7.1 0 35.7 57.1 14 1 5 1 9
Less use of traditional preventive measures (e.g. charms, amulets) 16.7 16.7 8.3 16.7 41.7 12 2 6 1 3
Less practice of dietary taboos 14.3 7.1 14.3 14.3 50 14 2 7 1 4
5. Curative health care
Prompt visit to modem health services 7.1 0 21.4 7.1 64.3 14 1 8 0 4
Continuing to seek help until child recovered 0 7.1 7.1 35.7 50 14 0 8 1 3
Fewer visits to traditional healers 10 10 10 50 20 10 0 8 0 1
Continuing to give prescribed care and medication throughout the illness 0 7.7 7.7 30.8 53.8 13 0 8 1 3
Fewer home remedies 8.3 0 16.7 50 25 12 0 7 1 2
Fewer restrictions on diet during illness 8.3 0 16.7 25 50 12 0 7 1 2
Mother stays with sick child - does not leave with others when sick 0 7.7 15.4 30.8 46.2 13 1 9 1 1
6. Characteristics of other caretakers
Mature, at least 15 years old 9.1 0 9.1 54.5 27.3 11 0 8 0 0
Experienced in child care 8.3 0 8.3 50 33.3 12 0 8 0 1
Better educated 16.7 0 16.7 50 16.7 12 1 9 0 0
Less burdened by other tasks 0 0 18.2 45.5 36.4 11 0 7 1 0
7. Father's role
Living at home 7.7 15.4 15.4 38.5 23.1 13 0 9 2 2
One wife only 8.3 8.3 8.3 33.3 41.7 12 2 7 0 1
Providing financial support for child 0 7.1 7.1 35.7 50 14 0 9 1 2
Better educated 7.1 0 21.4 42.9 28.6 14 1 9 1 1
8. Family size/structure
Children separated by birth interval of at least three years 0 0 7.7 61.5 30.8 13 0 9 1 4
Not more than four children 9.1 9.1 0 45.5 36.4 11 0 8 0 2
Higher ratio of adults to young children 0 36.4 9.1 54.5 0 11 2 8 1 1
Presence of siblings old enough to help mother 15.4 15.4 53.8 7.7 7.7 13 1 9 0 1
9. Family attitudes
No preference for male and older family members in distribution of food 7.7 0 7.7 38.5 46.2 13 1 8 0 2
Recognition of special nutritional needs of young child 7.1 0 14.3 28.6 50 14 2 8 1 2
Ambitions for child to receive post-primary education 15.4 7.7 30.8 30.8 15.4 13 2 8 0 1
Ambition for child to succeed in modern occupation 15.4 0 38.5 30.8 15.4 13 2 8 0 1
10. Household Resources
Significant hidden/intangible resources (given the low socio-economic statue of the family) 11.1 0 11.1 55.6 22.2 9 1 7 0 0
Greater access to community services 0 7.7 7.7 46.2 38.5 13 1 8 1 2
Presence of informal social network whose support the mother can draw upon 0 20 10 30 40 10 0 7 2 2
Small amount of supplemental income earned by enterprising mother 10 0 30 40 20 10 1 8 0 0
B. GENETIC AND PHYSIOLOGICAL FACTORS
1. Maternal nutritional status 0 1 2 3 4 N        
Height 25 0 8.3 33.3 33.3 12 0 7 1 5
Pre-pregnancy weight-for-height 9.1 0 9.1 36.4 45.5 11 0 5 1 7
Weight gain during pregnancy 9.1 0 18.2 18.2 54.5 11 0 4 1 7
Weight-for-height during lactation 9.1 9.1 9.1 45.5 27.3 11 0 5 1 5
Female obesity (contributing protective effect to infant nutrition in some societies) 27.3 27.3 18.2 18.2 9.1 11 0 5 2 3
Iron status 9.1 0 18.2 27.3 45.5 11 0 5 1 4
2. Dietary intake during pregnancy
Calories 9.1 0 0 9.1 81.8 11 1 4 1 6
Protein 9.1 9.1 0 45.5 36.4 11 1 4 1 6
Iron 9.1 0 0 27.3 63.6 1 1 3 1 4
Folate 9.1 9.1 9.1 18.2 54.5 11 1 3 1 4
3. Dietary intake during lactation
Calories 9.1 0 9.1 9.1 72.7 11 1 3 1 7
Protein 9.1 9.1 9.1 18.2 54.5 11 1 3 1 7
Iron 9.1 9.1 18.2 18.2 45.5 11 1 3 1 7
Folate 9.1 9.1 36.4 9.1 36.4 11 1 3 0 7
Fluids 9.1 0 18.2 27.3 45.5 11 1 4 0 7
4. Child characteristics
Birth weight (large or average weight-for-date) 7.1 7.1 7.1 35.7 42.9 14 2 5 1 7
Normal gestational age (38-42 weeks) 7.1 7.1 7.1 35.7 42.9 14 1 5 0 8
Absence of complication/stress during pregnancy 7.7 0 7.7 61.5 23.1 13 1 6 0 6
Age supplementary food started 14.3 0 14.3 35.7 35.7 14 0 9 2 4
Age breast-feeding stopped 7.1 0 14.3 14.3 64.3 14 0 9 2 2
Age other milk stopped 15.4 15.4 15.4 38.5 15.4 13 0 9 2 2
Calories in supplementary food 7.7 0 7.7 30.8 53.8 13 0 8 2 3
Protein in supplementary food 7.7 7.7 15.4 30.8 38.5 13 0 8 2 3
Lower than average activity level 18.2 18.2 36.4 18.2 9.1 11 0 7 0 3
Greater than average stress tolerance 11.1 0 11.1 11.1 66.7 9 0 6 0 2
Lower than average caloric requirement 18.2 36.4 0 27.3 18.2 11 0 7 1 1
Lower than average protein requirement 22.2 44.4 22.2 11.1 0 9 0 5 0 2
5. Child's resistance to infections
Diarrhoeal 7.7 0 0 7.7 84.6 13 1 6 2 5
Respiratory 7.7 0 0 23.1 69.2 13 1 6 2 5
Parasitic 7.7 7.7 23.1 7.7 53.8 13 1 5 3 5
Measles 8.3 8.3 8.3 25 50 12 1 5 2 4

a = anecdotal reports; b = personal observation; c = unpublished research. d = published research.

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