Researchers in Uganda tested two community-based training programs designed to help caregivers improve nutrition for children with cerebral palsy who were underweight. One program, called “positive deviance,” teaches families to learn from neighbors who are successfully feeding their children well. The other, “parent facilitator training,” provides direct instruction to caregivers. The study found that the positive deviance approach worked better at helping kids gain weight and improve their overall nutrition status. When both programs were combined, children gained even more weight. These findings suggest that simple, community-based training programs led by parents and neighbors could be an effective way to fight malnutrition in low-income countries.

The Quick Take

  • What they studied: Whether two different caregiver training programs could help children and young people with cerebral palsy who were malnourished gain weight and improve their nutrition
  • Who participated: 124 pairs of caregivers and malnourished children/youth (ages 2-24 years) with cerebral palsy living in rural Eastern Uganda. All participants were from low-income families in a rural health surveillance area
  • Key finding: Children who received the positive deviance training gained significantly more weight (about 1.1 pounds over 3 months) and showed better overall nutrition scores compared to those who didn’t receive it. When both training programs were combined, children gained even more weight (about 1.7 pounds)
  • What it means for you: If you’re a caregiver for a child with cerebral palsy in a low-income setting, learning from successful neighbors (positive deviance) appears to be an effective way to improve your child’s nutrition and weight gain. This suggests that simple, community-based approaches may work better than formal training alone, though more research in different settings is needed

The Research Details

Researchers in Uganda conducted a carefully designed study with 124 pairs of caregivers and children with cerebral palsy. They randomly assigned families to receive one of four options: positive deviance training only, parent facilitator training only, both programs combined, or neither program (control group). Positive deviance works by having community health workers identify families in the neighborhood who are successfully feeding their children well despite having limited resources, then teaching other families to learn from and copy these successful practices. Parent facilitator training involves direct instruction where trained facilitators teach caregivers specific nutrition and feeding techniques. The study lasted three months and measured how much weight children gained and tracked changes in their nutrition status using standard medical measurements.

This research approach is important because it tests two different strategies that could realistically be used in poor rural communities where formal nutrition services are limited. By comparing the programs separately and together, researchers could see which approach works best and whether combining them creates even better results. This type of practical testing helps determine which strategies communities should invest in with their limited resources

The study used a quasi-randomized design, meaning families were assigned to groups in a structured way, which is stronger than just observing what happens naturally. The researchers adjusted their analysis for starting differences between groups, which helps ensure fair comparisons. The study was conducted in a real community setting rather than a controlled lab, making the results more applicable to real life. However, the sample size was relatively small (124 pairs), and the study only lasted three months, so longer-term effects are unknown. The study was limited to one region of Uganda, so results may not apply everywhere

What the Results Show

Children who received positive deviance training gained an average of 520 grams (about 1.1 pounds) more weight over three months compared to those who didn’t receive it. This difference was statistically significant, meaning it’s unlikely to have happened by chance. These children also showed meaningful improvements in their body mass index (BMI) for their age, a standard measure of whether children are at a healthy weight. In contrast, children who received parent facilitator training alone showed improvements in their weight-for-age scores but didn’t gain as much actual weight. When researchers combined both interventions, children gained even more weight—about 770 grams (1.7 pounds)—and showed the best improvements in BMI scores. The positive deviance approach appeared to be the most effective single intervention for helping children gain weight.

The study found that the two interventions didn’t interact in a negative way—meaning giving both programs together didn’t reduce the benefit of either one alone. Instead, combining them appeared to create an additive benefit, with children gaining more weight when they received both programs. This suggests that the two approaches work through different mechanisms and could complement each other. The improvements in weight and BMI were consistent across the different measurement methods used, strengthening confidence in the findings

Previous research has shown that malnutrition is a serious problem for children with cerebral palsy in low-income countries, but there has been limited evidence about which community-based solutions actually work. This study adds important evidence that positive deviance—learning from successful neighbors—may be more effective than traditional training approaches. The positive deviance method aligns with other research showing that peer learning and community-based approaches can be powerful for behavior change, especially in resource-limited settings where formal services are scarce

The study only lasted three months, so we don’t know if the weight gains continue over longer periods. The sample size of 124 pairs is relatively small, which limits how confident we can be in the results. The study was conducted only in rural Eastern Uganda, so the results may not apply to other regions or countries with different cultures and resources. The study didn’t measure other important outcomes like whether children’s overall health or development improved. Some families may have dropped out or not fully participated, which could affect the results. The study couldn’t be completely blinded (where participants don’t know which group they’re in), which could introduce some bias

The Bottom Line

For caregivers of children with cerebral palsy in low-income rural settings: The positive deviance approach—learning nutrition and feeding strategies from successful neighbors in your community—appears to be an effective strategy for improving your child’s weight and nutrition (moderate confidence based on this single study). Parent facilitator training alone appears less effective for weight gain but may still have benefits. Combining both approaches may offer the best results. These recommendations are most applicable to rural, low-income communities similar to where the study was conducted

This research is most relevant for: caregivers of children with cerebral palsy in low-income rural areas, community health workers and nutrition programs in developing countries, and public health officials planning nutrition interventions. It may be less directly applicable to families in high-income countries with access to formal nutrition services and medical care. Families should discuss any nutrition changes with their healthcare provider, especially for children with cerebral palsy who may have specific feeding challenges

In this study, measurable weight gains appeared within three months. However, this is a relatively short timeframe, and we don’t know if these improvements continue beyond three months or if they lead to long-term health benefits. Realistic expectations would be to see gradual weight improvements over several months, but patience and consistency with the program are important

Want to Apply This Research?

  • Track your child’s weight weekly or bi-weekly (same time of day, same scale if possible) and record it in the app. Also track specific feeding practices learned from the positive deviance approach, such as number of meals per day, types of foods offered, and any feeding challenges encountered. This creates a clear record of progress and helps identify what’s working
  • Use the app to connect with other caregivers in your community who are successfully feeding their children well (positive deviance network). Share and document specific feeding strategies, recipes using locally available foods, and problem-solving approaches. Set weekly goals for trying one new feeding technique learned from successful neighbors, and track completion in the app
  • Create a monthly summary view in the app showing weight trend over time, nutrition improvements, and which feeding strategies are being consistently used. Set reminders for weekly weigh-ins and monthly check-ins with community health workers. Track adherence to the positive deviance practices and adjust strategies based on what’s working. Share progress reports with healthcare providers at regular intervals

This research describes findings from a single study conducted in rural Uganda and should not replace professional medical advice. Children with cerebral palsy often have complex feeding and nutritional needs that require individualized assessment by healthcare providers. Before making significant changes to your child’s diet or feeding practices, consult with your pediatrician, nutritionist, or healthcare provider, especially if your child has swallowing difficulties, allergies, or other medical conditions. This study shows promising results for community-based approaches but is not a substitute for professional medical care. Results from this study may not apply to all populations or settings.