‘It was caused by the carelessness of the parents’: cultural models of child malnutrition in southern Malawi

Abstract

Parents' conceptions of child growth, health and malnutrition are culturally bound, making information about local understandings of malnutrition and its causes necessary for designing effective nutrition programmes. This study used ethnographic methods to elucidate cultural models of child care and malnutrition among the Yao of southern Malawi. Data were collected in six rural villages from 28 key informant interviews with village chiefs and traditional healers among others and 18 focus group discussions with parents and grandmothers of young children. For the Yao, lack of parental care is a key cause of poor child health and can lead to thinness (kunyililika) or swelling (kuimbangana). Parents are said to be careless if they are not attentive to the child's needs, are unable to provide adequate quality or quantity of food, or fail to follow sexual abstinence rules. Maintaining abstinence protects the family and failure to do so causes the transfer of 'heat' from a sexually active parent to a 'cold' child and results in child health problems, including signs and symptoms of malnutrition. These findings indicate that the Yao understanding of care is much broader than the concept of care during feeding described in the nutrition literature. In addition, the Yao note the importance of several key feeding practices supported by international agencies and understand the influence of illness on child nutritional status. These congruencies with the public health frame should be used together with information about the cultural context to design more socially and emotionally relevant care and nutrition programmes among the Yao.

Stigma as a barrier to treatment for child acute malnutrition in Marsabit County, Kenya

“…). A more recent ethnographic study from southern Malawi found that among the Yao people, child malnutrition can be seen as an indication of inadequate parental care, such as poor food provisioning or failure to abide by rules governing sexual abstinence (Flax ).…”

“…). A final hypothesis, as seen among mothers of wasted children in Pakistan, some communities that stigmatize epilepsy, and the recent ethnography from Malawi, involves the presence of a belief system that views the condition as a form of supernatural or spiritual punishment (Mull ; Baskind & Birbeck ; Flax ).…”

“…witchcraft has been documented as a perceived cause of poor health, namely epilepsy, and its consequential stigmatization in Kenya and across sub-Saharan Africa (Baskind & Birbeck 2005;Sharkawy et al 2006). A more recent ethnographic study from southern Malawi found that among the Yao people, child malnutrition can be seen as an indication of inadequate parental care, such as poor food provisioning or failure to abide by rules governing sexual abstinence (Flax 2013).…”

“…A third hypothesis is that 'stigma by association', or stigma associated with HIV/AIDS infection, occurs among caregivers of visibly wasted children; this phenomenon has been documented for tuberculosis (Coreil et al 2010). A final hypothesis, as seen among mothers of wasted children in Pakistan, some communities that stigmatize epilepsy, and the recent ethnography from Malawi, involves the presence of a belief system that views the condition as a form of supernatural or spiritual punishment (Mull 1991;Baskind & Birbeck 2005;Flax 2013).…”

Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi

“…Factors, such as lack of funds for transport to a health facility or need to obtain permission from a male relative, often delay or may even thwart health care seeking (Geldsetzer et al, 2014; Kalembo & Zgambo, 2012). Cultural models of illness that blame parents when a child has signs of severe acute malnutrition, such as wasting or edema, can influence the type and timing of health care seeking (Flax, 2015; Howard & Millard, 1997; Mull, 1991). The ability of parents to identify that their child is undernourished based on perceptions of child body size or other physical signs may also play a role in decisions to seek care for the child.…”