Use of participatory approaches to design, implement, and evaluate a sustainable community-based nutrition education delivery system in the Fatick region of Senegal

In Senegal as well as in other Sub-saharan African countries, malnutrition due to inadequate dietary intake, affects one third of children under five years of age. Most programs to prevent malnutrition rely heavily on nutrition education, but successful and sustainable educational interventions have been scarce. Lack of involvement of the intended audience in the design and delivery of the messages has been cited as a main reason.;Based on a qualitative and quantitative needs assessment, a series of three sequentially integrated studies were conducted in 9 villages of the Fatick region of Senegal. (1) Feeding problems and potential recommendations to solve them were identified through a 12 hour home observation and analysis of caretakers' feeding practices of 53 children suffering or convalescent from diarrhea or malnutrition, identified via a census. (2) The appropriateness of the given recommendations was evaluated in household trial. (3) Their wider applicability was assessed in 6 focused group discussions with other women.;The above studies led to the development of a set of counselling cards used as communication tools and to the training of a cadre of nutrition promoters from the villages to use them. This resulted in three integrated and sustainable village-based nutrition education delivery systems including monthly growth monitoring sessions run by two or three women from and for their own community. Today, 18 months after complete autonomy from the researcher's input, more than 70% of all children under thirty-six months of age in the three villages involved, are enrolled and their caretakers receive adequate nutrition counselling.;Critical reflection on the research implementation process yielded a grounded theory for participatory action research called Negotiation-Participation-Integration Learning-by-Doing-while-Observing (NPI/LDO). This theory enunciates the fundamental and necessary principles of inquiry that enables people with diverse program interests to join together to find common ground for mutual learning and sustainable action.;This study used participatory methods to investigate the feasibility of an innovative sustainable community-based nutrition education delivery system and the possibility of improving these education activities in the health posts.