Path to severe acute malnutrition in children below 2 years of age: Findings of qualitative research in Uttar Pradesh, North India

Abstract

Introduction: Malnutrition in infancy contributes to high mortality and morbidity. In India, government has established nutrition rehabilitation centres for managing children with severe acute malnutrition. The study was conducted with aim to understand how community perceived malnutrition and how child's size at birth, infant and young child feeding related behaviours and child's illness were associated with decline in the child's growth or health. Methods: Qualitative research employing focused ethnographic methodologies was used. From February–December 2016, cases studies and in-depth interviews were conducted with 12 mothers of malnourished children <24 months of age (cases), purposively recruited from nutrition rehabilitation centre of 3 districts in Uttar Pradesh, North India. Twenty-four mothers of gender and age matched well-nourished controls from village of cases were also interviewed. Focus group discussion was done with community health workers from villages of cases. Data were coded and after analysis and data triangulation, emerging concepts were grouped into core themes linked with malnutrition. Results: Grounded on experience of participants, emerging themes were that importance of exclusive breastfeeding was neither understood nor emphasized, there was no concept of complementary feeding, family food lacked diversity, malnutrition was not recognised as a health hazard, and there was lack of autonomy of females in reproductive and general health issues. Conclusion: Given these paths to malnutrition in infancy, there is an urgent need to create community awareness about malnutrition as a disease as well as about optimal breastfeeding and complementary feeding practices in infancy by using innovative behaviour change communication strategies.