The epidemiology of good nutritional status among children from a population with a high prevalence of malnutrition.

Objectives: To identify socio-economic demographic and environmental factors that predict better height-for-age for children under 5 years of age in a Dhaka slum population.
Design: A panel survey, conducted between 1995 and 1997. A random sample of households was selected. Socio-economic, demographic and environmental variables were collected monthly by questionnaire and nutritional status was assessed.
Setting: Dhaka slums in Bangladesh.
Subjects: Three hundred and ninety-two children, surveyed in September-November 1996.
Main Outcome Measures: Height-for-age Z-score (HAZ) above -2.
Results: Thirty-one per cent of children had HAZ >-2. Logistic regression adjusted for cluster sampling showed that better nourished children were more likely to have taller mothers, to be from female-headed households and from families with higher income, electricity in the home, better latrines, more floor space and living in Central Mohammadpur. Better nourished children were less likely to have fathers who have taken days off from work due to illness. CONCLUSIONS Interest in 'positive deviance' is motivated by the recognition that a focus on the malnourished only--the bottom tail of the distribution--provides indications of how families fail, but not of how they succeed in maintaining child nutrition in the face of adversity. Our analysis provides an alternative perspective on nutrition and vulnerability in an urban slum setting.