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

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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.

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Responsive feeding is embedded in a theoretical framework of responsive parenting.

Frances Aboud, K. M. Black (2011)

Children throughout the world are confronted with growth problems ranging from underweight and stunting to overweight and obesity. The development of healthy eating behaviors depends on both healthy food and responsive parenting behaviors. With origins from anthropology, psychology, and nutrition, responsive parenting reflects reciprocity between child and caregiver, conceptualized as a 4-step mutually responsive process: 1) the caregiver creates a routine, structure, expectations, and emotional context that promote interaction; 2) the child responds and signals to the caregiver; 3) the caregiver responds promptly in a manner that is emotionally supportive, contingent, and developmentally appropriate; and 4) the child experiences predictable responses. This paper examines evidence for the practice and developmental benefits of responsive parenting with a view to providing a theoretical basis for responsive feeding. Recommendations are made that future efforts to promote healthy growth and to prevent underweight and overweight among young children incorporate and evaluate responsive feeding.

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"We grandmothers know plenty": breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi.

Marko Chirwa, Laifolo Dakishoni, Rachel Kerr … (2008)

This paper has two purposes: first of all, we examine grandmothers' role and views of child feeding practices in northern Malawi, and their influence on younger women's practices. Secondly, we consider the implications of these findings for health promotion activities and models of health education. Data were collected from semi-structured interviews, focus groups and a participatory workshop. Findings demonstrate that, to address child feeding practices which have an effect on nutrition, attention must be paid to the broader context that influences child nutrition, including extended family relations. Paternal grandmothers have a powerful and multifaceted role within the extended family in northern Malawi, both in terms of childcare and in other arenas such as agricultural practices and marital relations. Grandmothers often differ in their ideas about early child feeding from conventional Western medicine. Some practices have existed in the area at least since colonial times, and have strong cultural significance. Despite the important integrated role, older women have within households and communities in this part of Malawi, hospital personnel often have disparaging and paternalistic attitudes towards 'grannies' and their knowledge. Health education rarely involves grandmothers, and even if they are involved, their perspectives are not taken into consideration. Hospital staff often reject grandmother knowledge as part of a broader modernization paradigm which views 'traditional knowledge' as backward. Grandmothers view current child health conditions within a broader context of changing livelihood conditions and a high prevalence of HIV/AIDS. The paper concludes by discussing the challenges of involving grandmothers in health education, and the difficulties of incorporating local knowledge into a medical system that largely rejects it.