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Table D. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: overall

  Per cent labelling N Absolute numbers
  0 1 2 3 4   a b c d
A. BEHAVIOURAL, PSYCHOSOCIAL, AND CULTURAL FACTORS
1. Morher-child interactions
Early bonding between mother and infant 0 1.7 10.2 25.4 62.7 59 3 40 5 17
Positive "affect" or smiling happy mood between mother/ child 0 1.7 10.7 35.7 51.8 56 3 41 5 10
Prompt response to child's hunger cues 0 1.7 11.7 33.3 53.3 60 4 46 4 4
Mother's coaxing or stimulating child to eat 7.4 18.5 18.5 27.8 27.8 54 6 46 3 3
Mother feeding older infant rather than letting infant feed self 17 21.3 23.4 17 21.3 47 4 40 1 5
Frequent close physical contact 0 3.4 8.5 39 49.2 59 4 41 5 1
Frequent physical care, cleaning, grooming 3.4 6.8 32.2 28.8 28.8 59 7 41 5 5
Frequent psychosocial stimulation 5.1 5.1 13.6 23.7 52.5 59 4 39 4 17
Lack of prolonged separation of child from mother 5.5 1.8 7.3 27.3 58.2 55 5 35 6 11
Consistent reinforcement of child's developmental achievements 5.6 3.7 18.5 31.5 40.7 54 4 36 3 9
2. Behavioural characteristics of the child
Strong sucking reflex (in infants) 0 8.9 20 31.1 40 45 4 39 1 10
High neo-natal assessment score 5.4 8.1 16.2 43.2 27 37 1 32 1 7
Large appetite 7.8 3.9 17.6 31.4 39.2 51 3 42 2 4
Willingness to eat new foods or variety of foods 5.6 3.7 24.1 31.5 35.2 54 5 44 1 1
Well-defined hunger cues 6.3 4.2 16.7 43.8 29.2 48 6 35 1 1
Aggressive approach to obtaining food 3.9 9.8 17.6 37.3 31.4 51 2 41 0 1
Regular sleeping pattern 6.4 6.4 21.3 38.3 27.7 47 2 36 1 4
Rapid adaption to new stimuli 0 4.8 16.7 47.6 31 42 3 35 0 5
Enjoys interacting with people 0 8.3 14.6 43.8 33.3 48 3 37 1 3
3. Psychosocial characteristics of the mother
Satisfaction with her life in general 1.7 8.6 17.2 20.7 51.7 58 5 42 3 6
Low levels of psychological stress 2 9.8 13.7 23.5 51 51 3 36 3 7
Not overburdened by work 3.4 6.8 18.6 27.1 44.1 59 6 39 4 7
Ability to put child's needs before her own needs or desires 0 1.9 18.9 26.4 52.8 53 3 38 2 6
Good relationship with child's father 1.7 3.4 10.3 46.6 37.9 58 5 38 2 8
Absence of psychiatric problems (anxiety, depression. etc. ) 2 4 8 42 44 50 3 37 2 7
Enterprising, non-fatalistic attitude 7 4.7 2.3 41.9 44.2 43 3 32 3 4
Positive attitude towards child (child of desired sex) 0 5.5 7.3 36.4 50.9 55 5 37 2 9
Positive attitude (child born at desired time) 3.6 9.1 14.5 43.6 29.1 55 4 35 3 7
Less practice of favouritism or discrimination against female child 10.2 8.7 28.2 38.8 34.7 49 3 35 6 7
Maturity: 20 years old or more 3.8 7.5 22.6 30.2 35.8 53 3 35 5 9
Life-stage: not older than 35 15.1 17 20.8 30.2 17 53 2 35 6 9
Higher educational level 5.7 5.2 27.6 29.3 32.8 58 2 34 9 16
Higher natural intelligence 10 2 26 22 40 50 3 38 3 4
Greater contact with the world outside the home 7.1 10.7 23.2 35.7 23.2 56 5 43 5 9
4. Preventive health care
Attention to hygiene and sanitary conditions of child's environment 3.7 1.6 3.2 29 62 9 62 4 34 6 28
Greater use of modern preventive health services (e.g. pre-natal care, immunization) 4.7 4.7 6.3 23.4 60.9 64 4 35 6 22
Less use of traditional preventive measures (e.g. charms, amulets) 17.1 13.5 17.3 21.2 30.8 52 2 40 3 9
Less practice of dietary taboos 15.5 10.3 15.5 17.2 41.4 58 6 37 7 15
5. Curative health care
Prompt visit to modern health services 7.9 4.8 17.5 17.5 52.4 63 7 38 7 12
Continuing to seek help until child recovered 1.9 5.7 11.3 34 47.2 53 4 38 5 6
Fewer visits to traditional healers 21.2 11.5 17.3 28.8 21.2 52 7 36 3 4
Continuing to give prescribed care and medication throughout the illness 5.5 5.5 10.9 29.1 49.1 55 6 40 5 7
Fewer home remedies 14.3 16.3 26.5 20.4 22.4 49 6 36 3 4
Fewer restrictions on diet during illness 5.6 1.9 14.8 24.1 53.7 54 3 41 6 5
Mother stays with sick child - does not leave with others when sick 0 4 18 34 44 50 5 38 2 1
6. Characteristics of other caretakers
Mature, at least 15 years old 6.3 0 10.4 41.7 41.7 48 2 37 2 5
Experienced in child care 8.9 1.8 14.3 30.4 44.6 56 1 41 6 5
Better educated 14 5.3 19.3 38.6 22.8 57 2 42 6 6
Less burdened by other tasks 5 8 5 8 23.1 26.9 38.5 52 2 38 5 4
7. Father's role
Living at home 8.3 10 21.7 23.3 36.7 60 5 42 7 6
One wife only 8.7 6.5 21.7 23.9 39.1 46 8 37 3 3
Providing financial support for child 0 3.3 6.7 30 60 60 3 42 7 6
Better educated 6.8 6.8 20.3 35.6 30.5 59 5 42 6 8
8. Family size/structure
Children separated by birth interval of at least three years 0 3 7 11.1 37 48.1 54 2 37 8 15
Not more than four children 4.1 2 8.2 38.8 46.9 49 2 34 8 11
Higher ratio of adults to young children 8.9 13.3 15.6 44.4 17.8 45 5 32 3 6
Presence of siblings old enough to help mother 12 16 24 30 18 50 3 37 0 4
9. Family attitudes
No preference for male and older family members in distribution of food 8.6 10 3 5.2 36.2 39.7 58 9 38 4 9
Recognition of special nutritional needs of young child 6.9 1.7 8.6 24.1 58.6 58 6 39 4 9
Ambitions for child to receive post-primary education 9.4 5.7 22.6 32.1 30.2 53 4 39 0 2
Ambition for child to succeed in modern occupation 11.5 5.8 23.1 30.8 28.8 52 4 39 0 3
10. Household resources
Significant hidden/intangible resources (given the low socio-economic status of the family) 8.5 6.4 10 6 31.9 42.6 47 6 31 4 4
Greater access to community services 3.6 3.6 7.1 37.5 48.2 56 5 39 7 5
Presence of informal social network whose support the mother can draw upon 3.7 7.4 9.3 35.2 44.4 54 4 38 8 4
Small amount of supplemental income earned by enterprising mother 4.3 2.2 23.9 30.4 39.1 56 4 33 2 5
B. GENETIC AND PHYSIOLOGICAL FACTORS
1. Maternal nutritional status
Height 13.5 5.8 21.2 28.8 30.8 52 0 28 8 16
Pre-pregnancy weight-for-height 4.3 6.5 17.4 30.4 41.3 46 0 27 5 19
Weight gain during pregnancy 4.3 8.5 14.9 27.7 44.7 41 1 28 5 17
Weight-for-height during lactation 6.5 6.5 15.2 39.1 32.6 46 0 27 4 15
Female obesity contributing protective effect to infant nutrition in some societies 25.6 17.9 20.5 20.5 15.4 39 1 26 4 10
Iron status 9.1 4.5 15.9 27.3 43.2 44 1 27 2 14
2. Dietary intake during pregnancy
Calories 2.1 4.2 6.3 22.9 64.6 48 2 25 6 18
Protein 5.5 6.5 4.3 32.6 50 46 1 25 5 16
Iron 2.3 2.3 9.1 38.6 47.7 44 1 23 4 14
Folate 2.3 7 16.3 37.2 37.2 43 1 23 4 13
3. Dietary intake during lactation
Calories 2.2 0 8.9 17.8 71.1 45 4 20 6 16
Protein 2.3 7 7 25.6 58.1 43 3 22 5 13
Iron 2.3 6.8 15.9 29.5 45.5 44 4 23 3 14
Folate 2.3 4.7 25.6 27.9 39.5 45 3 25 1 14
Fluids 2.3 4.7 20.9 25.6 46.5 45 3 24 1 15
4. Child characteristics
Birth weight (large or average weight-for-date) 3.6 1.8 9.1 38.2 47.3 55 2 28 8 19
Normal gestational age (38-42 weeks) 1.9 1.9 5.6 40.7 50 54 4 31 5 20
Absence of complication/stress during pregnancy 2 0 4 52 42 50 5 33 3 13
Age supplementary food started 7.4 1.9 9.3 27.8 53.7 54 4 32 7 18
Age breast-feeding stopped 5.2 5.2 20.7 22.4 46.6 58 3 34 8 12
Age other milk stopped 12.5 14.6 27.1 25 20.8 48 0 31 5 9
Calories in supplementary food 1.9 1.9 9.4 24 5 62.3 53 1 31 6 14
Protein in supplementary food 5 8 7.7 9.6 36.5 40.4 52 2 31 5 12
Lower than average activity level 11.1 13.3 26.7 20 28.9 45 2 29 1 7
Greater than average stress tolerance 5.4 10.8 21.6 18.9 43.2 37 0 28 1 6
Lower than average caloric requirement 12.5 25 7.5 375 17.5 40 0 25 3 9
Lower than average protein requirement 11.4 31 4 229 22.9 11.4 35 0 22 1 6
5 Child's resistance to infections
Diarrhoeal 1 7 0 1 7 13.6 83.1 59 5 32 4 24
Respiratory 1.9 0 1.9 15.4 80.8 52 3 30 4 17
Parasitic 1 9 7.5 9.4 26.4 54.7 53 4 29 7 18
Measles 4.1 4.1 2 22.4 67.3 49 7 30 5 15

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

Table E. Survey of expert knowledge and opinion on positive deviance in nutrition of young children: opinion scores by setting mean (SD)

  Rural Urban Total N
A. BEHAVIOURAL, PSYCHOSOCIAL. AND CULTURAL FEATURES
1. Mother-child interactions
Early bonding between mother and infant 3.28 (0.83) 3.62 (0.65) 3.42 (0.76) 59
Positive "effect'' or smiling happy mood between mother/child 3.29 (0.92) 3.15 (0.80) 3.23 (0.86) 56
Prompt response to child's hunger cues 3.33 (0 69) 3.46 (0.78) 3.39 (0.72) 60
Mother's coaxing or stimulating child to cat 2.47(1.28) 2.00 (1.34) 2.29 (1.30) 54
Mother feeding older infant rather than letting infant feed self 1.93 (1.28) 1.30 (1.42) 1.68 (1.35) 47
Frequent close physical contact 3.29 (0.85) 3.08 (0.76) 3.20 (0.8I) 59
Frequent physical care. cleaning. grooming 2.33 (1.14) 2.54 (0.97) 2.42 (1.06) 59
Frequent psychosocial stimulation 3.05 (1.31) 2.92 (1.26) 3.00 (1.27) 59
Lack of prolonged separation of child from mother 3.25 (1.18) 2.80 (1.23) 3.08 (1.19) 55
Consistent reinforcement of child's developmental achievements 2.71 (1.391 2.42 (1.31) 2.58(1.21) 54
2. Behavioural characteristics of the child
Strong sucking reflex (in infants) 2.82 ( 1.17) 2.67 (0.89) 2.74 ( 1.00) 45
High neo-natal assessment score 2.(8) (1.41) 2.50 ( 1.09) 2.33 ( 1.19) 37
Large appetite 2.93 ( 1.16) 2.75 (1.29) 2.85 (1.20) 51
Willingness to eat new foods or variety of foods 2.87 (1.19) 2.50 (1.09) 2.69 (1.13) 54
Well-defined hunger cues 3 00 (1.04) 2.46 (1.13) 2.72 (1.10) 48
Aggressive approach to obtaining food 3 00 (1.10) 2.60 (1.08) 2.83 (1.09) 51
Regular sleeping pattern 2.42 (1.31) 2.82 (0.75) 2.61 (1.08) 47
Rapid adaption to new stimuli 2.89 (0.60) 2.70 (0.48) 2.79 (0.53) 42
Enjoys interacting with people 3.07 (0.80) 2.50 (1.18) 2.84 (0.99) 48
3. Psychosocial characteristics of the mother
Satisfaction with her life in general 2.67(1.33) 3.58 (0.51) 3.03 (1.16) 58
Low levels of psychological stress 2.92(1.19) 3.23 (0.83) 3.08 (1.01) 51
Not overburdened with work 2.89 (1.32) 3.00 (0.74) 2.93 (1.11) 59
Ability to put child's needs before her own needs or desires 3.21 (0.89) 3.33 (0.78) 3.27 (0.83) 53
Good relationship with child's father 3.00 (0.87) 3.31 (0.48) 3.13 (0.73) 58
Absence of psychiatric problems (anxiety, depression, etc.) 3.20 (0.79) 3.46 (0.88) 3.35 (O.83) 50
Enterprising, non-fatalistic attitude 2.85(1 2l) 2.67(1.32) 2.77(1.23) 43
Positive attitude towards child (child of desired sex) 3.63 (0.62) 3.17 (0 58)b 3.43 (0.63) 55
Positive attitude (child born at desired time) 2.60 (1.30) 3.30 (0.48)b 2.93 (1.05) 55
Less practice of favouritism or discrimination against female child 2.93 (1.33) 2.55 (1.21) 2.77 (1.27) 49
Maturity: 20 years old or more 3.06 (1.24) 3.07 (0.95) 3.07 ( 1.10) 53
Life-stage: not older than 35 2.38 (1.31) 2.36 (1.39) 2.37 (1.33) 53
Higher educational level 2.37 (1.02) 2.85 (0.90) 2.59 (0.98) 58
Higher natural intelligence 2.58 (1.16) 2.69 (1.25) 2.64 (1.19) 50
Greater contact with the world outside the home 2.33 (1.14) 2.86 (0.66)c 2.56 (0.98) 56
4. Preventive health care
Attention to hygiene and sanitary conditions of child's environment 3.35 (1.06) 3.43 (0.85) 3.39 (0.95) 62
Greater use of modern preventive health services (e.g. pre-natal care, immunization) 3.06 (1.34) 3.43 (0.85) 3.23 (1.15) 64
Less use of traditional preventive measures (e.g. charms, amulets) 1.69 (1.44) 2.50 (1.62) 2.08 (1.55) 52
Less practice of dietary taboos 2.00 (1.57) 2.79 (1.52) 2.34 (1.58) 56
5. Curative health care
Prompt visit to modern health services 2.88 (1.17) 3.21(1.25) 3.03(1.20) 63
Continuing to seek help until child recovered 2.94 (0.10) 3.29 (0.91) 3.10(0.96) 53
Fewer visits to traditional healers 1.50 (1.41) 2.60 (1.26)b 1.92(1.44) 52
Continuing to give prescribed care and medication throughout the illness 2.93 (1.14) 3.31 (0.95) 3.11(1.05) 55
Fewer home remedies 1.79 (1.25) 2.83 (1.11)b 2.27(1.28) 49
Fewer restrictions on diet during illness 3.29 (1.14) 3.08 (1.24) 3.19(1.17) 54
Mother stays with sick child - does not leave with others when sick 3.00 (0.76) 3.15(0.99) 3.07(0.99) 50
6. Characteristics of other caretakers
Mature, at least 15 years old 2.71(1.27) 2.91(1.14) 2.80(1.19) 48
Experienced in child care 2.21(1.48) 3.00(1.13)c 2.57(1.36) 56
Better educated 1.67(1.35) 2.50(1.31)a 2.04(1.37) 57
Less burdened by other tasks 2.08(1.32) 3.18(0.76)a 2.58(1.21) 52
7. Father's role
Living at home 2.56(1.29) 2.54(1.27) 2.55(1.26) 46
One wife only 2.50(1.45) 2.92(1.31) 2.69(1.38) 60
Providing financial support for child 3.44(0.81) 3.29(0.91) 3.67(0.85) 60
Better educated 2.94(1.31) 2.86(1.10) 2.55(1.23) 59
8. Family size /structure
Children separated by birth interval of at least three years 3.27(0.80) 3.23(0.60) 3.25(0.70) 54
Not more than four children 3.36 (0.50) 2.90(1.30) 3.16(0.94) 49
Higher ratio of adults to young children 1.92(1.24) 2.18(0.98) 2.04(1.12) 45
Presence of siblings old enough to help mother 2.81(1.10) 1.77(1.09)a 2.34(1.20) 50
9. Family attitudes
No preference for male and older family members in distribution of food 2.88(0.93) 3.15(1.14) 3.00(1.01) 58
Recognition of special nutritional needs of young child 3.07(1.14) 3.14(1.17) 3.10(1.13) 58
Ambitions for child to receive post primary education 2.79 (1.05) 2.23 (1.30) 2.52 (1.19) 53
Ambition for child to succeed in modern occupation 2.46(1.05) 2.31 (1.25) 2.38(1.13) 52
10. Household resources
Significant hidden/intangible resources(given the low socio-economic status of the family) 2.92 (1.32) 2.78 (1.20) 2.86 (1.25) 47
Greater access to community services 3.21 (1.05) 3.15 (0.91)) 3.19 (0.96) 56
Presence of informal social network whose support 3.33 (1.05) 2.90 (1.20) 3.16 (1.10) 54
Small amount of supplemental income earned by enterprising mother        
B. GENETIC AND PHYSIOLOGICAL FACTORS
1. Maternal nutritional status
Height 2.77 (1.36) 2.50 (1.62) 2.64 (1.47) 52
Pre-pregnancy weight-for-height 3.09 (1.04) 3.09 (1.22) 3.09 (1.10) 46
Weight gain during pregnancy 3.00 (1.41) 3.09 (1.30) 3.05 (1.33) 47
Weight-for-height during lactation 2.64 (1.08) 2.73 (1.28) 2.70 (1.14) 46
Female obesity (contributing protective effect to infant nutrition in some societies) 1.67(1.80) 1.54(1.37) 1.60(1.54) 39
Iron status 2.67(1.00) 3.00(1.27) 2.85(1.14) 44
2. Dietary intake during pregnancy
Calories 3.42 (1.08) 3.55 (1.21) 3.48 (1.08) 48
Protein 3.09 (1.37) 2.90 (1.30) 3.00 (1.31) 46
Iron 3.18 (0.98) 3.36 (1.21) 3.27 (1.08) 44
Folate 2.82 (0.87) 3.00 (1.41) 2.41 (1.15) 43
3. Dietary intake during lactation
Calories 3 44(0.88) 3.36(1.29) 3.40(1.10) 45
Protein 2.78(1.20) 3.00(1.41) 2.90(1.29) 43
Iron 2.80(1.23) 2.81 (1.40) 2.80(1.29) 44
Folate 2.78(0.97) 2.55(1.37) 2.65(1.18) 43
Fluids 2.89 (1.17) 3.00 (1.27) 2.95 (1.19) 43
4. Child characteristics
Birth weight (large or average weight for-date) 3.50 (0.67) 3.00(1.24) 3.23(1.03) 55
Normal gestational age (38-42 weeks) 3.67 (0.49) 3.00 (1.24) 3.31 (1.01) 54
Absence of complication/stress during pregnancy 3.58 (0.51) 2.92(1.04)b 3.24(0.88) 50
Age supplementary food started 3.75 (0.45) 2.79 (I 37)b 3.30 (1.09) 54
Age breast-feeding stopped 3 17 (1.10) 3.29(1.20)b 3.22(1.13) 58
Age other milk stopped 1.93 (1.33) 2.23 (1.36) 2.07 (1.33) 48
Calories in supplementary food 3.65(0.61) 3.23(1.17) 3.47(0.90) 53
Protein in supplementary food 2.77(1.39) 2.85(1.28) 2.80(1.31) 52
Lower than average activity level 2.(18(1.35) 2.30(1.44) 1.81 (1.25) 45
Greater than average stress tolerance 2.38(1.30) 3.22(1.39) 2.82(1.38) 37
Lower than average caloric requirement 1 70(1.34) 1.91 (1.51) 1.81 (1.40) 40
Lower than average protein requirement 1.8011.23) 1.22(0.97) 1.53(1.12) 35
5. Child's resistance to infections
Diarrhoeal 3.81 (0.54) 3.62 (1.12) 3.72 (0.54) 59
Respiratory 3 67 (0.62) 3.46 (1.13) 3.57 (0.88) 52
Parasitic 2.42 (1.38) 3.08 (0.95) 3.00 (1.16) 53
Measles 3.42 (0.85) 3.00 (1.35) 3.23 (1.11) 49

a=p<0.05; b=p<0.1 c=p<0.15.

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