Cargando…

Literacy is power: structural drivers of child malnutrition in rural Liberia

BACKGROUND: In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country’s civil war and were further exacerbated by the 2014–2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices...

Descripción completa

Detalles Bibliográficos
Autores principales: Kumeh, Odell W, Fallah, Mosoka P, Desai, Ishaan K, Gilbert, Hannah N, Silverstein, Jason B, Beste, Sara, Beste, Jason, Mukherjee, Joia S, Richardson, Eugene T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841815/
https://www.ncbi.nlm.nih.gov/pubmed/33521541
http://dx.doi.org/10.1136/bmjnph-2020-000140
_version_ 1783643882393698304
author Kumeh, Odell W
Fallah, Mosoka P
Desai, Ishaan K
Gilbert, Hannah N
Silverstein, Jason B
Beste, Sara
Beste, Jason
Mukherjee, Joia S
Richardson, Eugene T
author_facet Kumeh, Odell W
Fallah, Mosoka P
Desai, Ishaan K
Gilbert, Hannah N
Silverstein, Jason B
Beste, Sara
Beste, Jason
Mukherjee, Joia S
Richardson, Eugene T
author_sort Kumeh, Odell W
collection PubMed
description BACKGROUND: In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country’s civil war and were further exacerbated by the 2014–2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations. METHODS: Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers’ experiences, as well as health workers’ understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data. RESULTS: Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition. DISCUSSION: The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.
format Online
Article
Text
id pubmed-7841815
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-78418152021-01-29 Literacy is power: structural drivers of child malnutrition in rural Liberia Kumeh, Odell W Fallah, Mosoka P Desai, Ishaan K Gilbert, Hannah N Silverstein, Jason B Beste, Sara Beste, Jason Mukherjee, Joia S Richardson, Eugene T BMJ Nutr Prev Health Original Research BACKGROUND: In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country’s civil war and were further exacerbated by the 2014–2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations. METHODS: Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers’ experiences, as well as health workers’ understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data. RESULTS: Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition. DISCUSSION: The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective. BMJ Publishing Group 2020-12-01 /pmc/articles/PMC7841815/ /pubmed/33521541 http://dx.doi.org/10.1136/bmjnph-2020-000140 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Kumeh, Odell W
Fallah, Mosoka P
Desai, Ishaan K
Gilbert, Hannah N
Silverstein, Jason B
Beste, Sara
Beste, Jason
Mukherjee, Joia S
Richardson, Eugene T
Literacy is power: structural drivers of child malnutrition in rural Liberia
title Literacy is power: structural drivers of child malnutrition in rural Liberia
title_full Literacy is power: structural drivers of child malnutrition in rural Liberia
title_fullStr Literacy is power: structural drivers of child malnutrition in rural Liberia
title_full_unstemmed Literacy is power: structural drivers of child malnutrition in rural Liberia
title_short Literacy is power: structural drivers of child malnutrition in rural Liberia
title_sort literacy is power: structural drivers of child malnutrition in rural liberia
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841815/
https://www.ncbi.nlm.nih.gov/pubmed/33521541
http://dx.doi.org/10.1136/bmjnph-2020-000140
work_keys_str_mv AT kumehodellw literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT fallahmosokap literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT desaiishaank literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT gilberthannahn literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT silversteinjasonb literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT bestesara literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT bestejason literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT mukherjeejoias literacyispowerstructuraldriversofchildmalnutritioninruralliberia
AT richardsoneugenet literacyispowerstructuraldriversofchildmalnutritioninruralliberia