Health-seeking behaviour and community perceptions of childhood undernutrition and a community management of acute malnutrition (CMAM) programme in rural Bihar, India

A qualitative study

Bibliographic Data

ID15096883
AuthorsDoris Burtscher (0000-0003-3035-5884, Médecins Sans Frontières), Sakib Burza (0000-0001-7886-8633, Médecins Sans Frontières, corresponding author)
Year2015
Volume18
Issue17
Pages3234-3243
Publication date2015-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePublic Health Nutrition (JOURNAL)
Journal identifiersISSN: 1368-9800 • E-ISSN: 1475-2727
PublisherCambridge University Press (CUP) (PUBLISHER)
DOI10.1017/s1368980015000440
PMID25753193
OpenAlexW2112128581
LanguageEN
Citations received15
References cited32

Obj ective Since 2009, Médecins Sans Frontières has implemented a community management of acute malnutrition (CMAM) programme in rural Biraul block, Bihar State, India that has admitted over 10 000 severely malnourished children but has struggled with poor coverage and default rates. With the aim of improving programme outcomes we undertook a qualitative study to understand community perceptions of childhood undernutrition, the CMAM programme and how these affected health-seeking behaviour. Design Semi-structured and narrative interviews were undertaken with families of severely malnourished children, non-undernourished children and traditional and allopathic health-care workers. Analysis of transcripts was by qualitative content analysis. Setting Biraul, Bihar State, India, 2010. Subjects One hundred and fifty people were interviewed in individual or group discussions during fifty-eight interviews. Results Undernutrition was not viewed as a disease; instead, local disease concepts were identified that described the clinical spectrum of undernutrition. These concepts informed perception, so caregivers were unlikely to consult health workers if children were ‘only skinny’. Hindu and Muslim priests and other traditional health practitioners were more regularly consulted and perceived as easier to access than allopathic health facilities. Senior family members and village elders had significant influence on the health-seeking behaviour of parents of severely malnourished children. Conclusions The results reaffirm how health education and CMAM programmes should encompass local disease concepts, beliefs and motivations to improve awareness that undernutrition is a disease and one that can be treated. CMAM is well accepted by the community; however, programmes must do better to engage communities, including traditional healers, to enable development of a holistic approach within existing social structures

Community health · Environmental health · Family medicine · Malnutrition · Public health · Qualitative research · Severe Acute Malnutrition · Social science · Sociology · Child Nutrition and Water Access · Food Security and Health in Diverse Populations · Global Maternal and Child Health · Medicine · Nursing

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