Rethinking Malnutrition Prevention and Treatment

As the world engages in the Nutrition for Growth summit, Diane Baik considers how local, food-based approaches empower families and provide sustainable solutions.

21 March, 2025

The search for sustainable solutions to prevent and treat acute malnutrition has never been more urgent. With shrinking funding, the most severe form of undernutrition, is on the rise, increasing the risk of death and long-term developmental issues for children. Rising rates of acute malnutrition due to funding shortages, pandemics, conflict, climate change, and food insecurity highlight the need for responses to go beyond emergency aid and empower families to address undernutrition at home and in their communities.

Acute malnutrition is typically treated with specially formulated foods, such as Ready-to-Use Therapeutic Foods, which are designed to give children life-saving medicine to meet their nutritional needs while their immune systems are weak. However, use of specially formulated foods has expanded to also treat moderate acute malnutrition under simplified approaches.

Because specially formulated foods are almost always produced outside the countries where they are needed, they must be imported, causing frequent stockouts, complex logistics, high production and distribution costs, and poor access. Additionally, 70% of acutely malnourished children live in relatively food-secure areas in Southeast Asia, not in humanitarian contexts. Yet, most research focuses on Africa and specially formulated foods-based solutions, with limited studies on non- specially formulated foods treatments for acute malnutrition in Asia. More sustainable, food-based solutions are needed for to prevent and treat acute malnutrition, and to ensure sustainable rehabilitation and recovery for these children. 

Positive Deviance Hearth Plus (PDH+) is a community-based approach that uses locally-available foods to treat uncomplicated malnutrition in children instead of specially formulated foods. It identifies “positive deviants” — low-income families with well-nourished children — and applies their successful feeding and care practices using locally available, low-cost, nutrient-dense foods. Caregivers in the community then participate in 12-day education sessions, contributing local ingredients to prepare culturally appropriate, nutrient-rich meals to rehabilitate their undernourished children. Volunteer follow-up visits reinforce behavior changes at home. PDH+ also integrates micronutrient supplementation, climate-smart agriculture, social transformation and male inclusion, and other food security and livelihoods interventions to build resilience. 

World Vision has implemented PDH+ in more than 40 countries since 1999. In Burundi’s PDH program, World Vision reduced underweight prevalence by 36.5%in just 3 months, and the prevalence of acute malnutrition dropped from 19% to 9% in just 12 days. In Niger (2022–2023), 62% of children recovered in only 12 days and 92% recovered in 3 months. Similarly, in DRC, 94% of acutely malnourished children recovered in 12 days and 96% recovered in 3 months, with minimal relapse. This data highlights the effectiveness of food-based approaches to prevent, treat, and sustain recovery malnourished children in fragile contexts with relative food security.

While specially-formulated foods remain a vital lifeline in some settings, PDH+ shows strong potential as a sustainable, low-cost alternative for uncomplicated acute malnutrition treatment in relatively food-secure areas. Further research and protocol adjustments could enhance its scalability and impact. 

ENDS

To learn more about PDH+ click here

Diane Baik is a Senior Technical Advisor and has over 15 years of experience in nutrition programme design, management, evaluation, and proposal writing for development and humanitarian contexts. She is an expert in behaviour change communication, information systems, implementation research (quantitative and qualitative), advocacy, evaluations, and multi-sectoral programming, as well as in technical leadership, project management, and technical assistance. She develops training curricula and builds capacity of local World Vision and Ministry of Health staff in various nutrition interventions, develops country strategies, rolls-out standardized monitoring systems, including Digital Health solutions for nutrition and is involved in external engagements with external partners. She has travelled to 60+ countries (mostly Africa and Asia). Diane has previously worked with the World Bank and Sprinkles Global Health Initiative. She holds an HBSc in three majors, including Nutrition from University of Toronto, Canada, and an MSc in Public Health from London School of Hygiene and Tropical Medicine, UK.