To investigate the nutritional impact of a community-based programme that focused on social cohesion and action.

The change in nutritional status of children aged 12–60 months was examined over a period of 3 years in Makueni District in Eastern Province of Kenya in six communities in which an intervention programme of Participatory Learning and Action was introduced and in ten communities in which only basic preparations were made but no intervention was started.

The intervention was part of the Government of Kenya Community Based Nutrition Programme and was supported by the Government of Denmark.

Children aged 12–60 months.

Among communities without intervention there were similar levels of underweight (mean Z-score: −1·63 v. −1·50 (NS); % with Z-score < –2: 36·6 % v. 34·5 % (NS)) and stunting (mean Z-score: −2·0 v. −1·99 (NS); % with Z-score < –2: 44·3 % and 47·4 % (NS)) at baseline and after 3 years. By contrast, among communities who had received interventions, there were significant improvements after 3 years in the levels of underweight (mean Z-score: −1·66 v. −1·37 (P < 0·02); % with Z-score < –2: 42·9 % v. 31·4 % (P < 0·035)) and stunting (mean Z-score: −2·05 v. −1·59 (P < 0·05); % with Z-score < –2: 52·7 % v. 39·7 % (P < 0·02)).

The results indicate considerable potential for using Participatory Learning and Action as a community-based approach to effectively address child undernutrition. It is suggested that these interventions are developed, implemented and evaluated more widely as a mean of tackling childhood undernutrition and improving child survival and development.

A Knowledge, Attitudes and Practices (KAP) study was conducted in three villages of Bekily District in southern Madagascar prior to the implementation of a health education programme with children. The participatory learning concept of the Child-to-Child approach was followed to involve the children in the planning and implementation of the programme, which was covered by the German Agency for Technical Cooperation.

To this effect, qualitative research methods such as Participatory Learning and Action techniques (focus group discussions, mapping and matrix ranking, etc.) were applied.

The survey was conducted between August and December 1999. It involved a total of 55 school-aged children (6–14 years) along with 21 mothers and 34 fathers, representing different ethnic groups and educational backgrounds.

The results show that children's KAP related to health and nutrition strongly reflect those of adults. They are not aware of a possible link between bad hygiene and the occurrence of diseases. According to them, diarrhoea or malaria is caused by consuming too large amounts of certain foods. Even if they know about certain elementary hygiene behaviours, they do not practise this in their everyday life.

A major objective of the health education programme for children should be to tackle the discrepancy between hygiene-related knowledge and behaviour. Through the participatory study approach the children revealed their ability to contribute to the programme development. In using appropriate communication channels, the Child-to-Child health education programme is expected to influence the health behaviours of both adults and children. The health education programme should be combined with a literacy programme to address the children's desire to learn reading and writing.