Perceptions and experiences of caregivers of severely malnourished children receiving inpatient care in Malawi: An exploratory study

• Published in: Malawi medical journal Vol. 30; no. 3
• Main Authors: Ware, Selena Gleadow, Daniel, Allison I, Bandawe, Chiwoza, Mulaheya, Yohane Paulo, Nkunika, Sylvester, Nkhoma, Dumisani, Kokota, Demoubly, Stewart, Robert C, Voskuijl, Wieger
• Format: Journal Article
• Language: English
• Published: College of Medicine, University of Malawi and Medical Association of Malawi 27-05-2019
• Subjects: caregiver experience; maternal mental health; nutritional rehabilitation unit; severe malnutrition
• ISSN: 1995-7262

BackgroundSevere acute malnutrition (SAM) affects approximately 18
million children under the age of five and is associated with more than
500 thousand deaths per year. Existing research has indicated that a
high number of caregivers of children admitted for inpatient treatment
of SAM experience psychological distress, depressive symptoms, and
suicidality. However, no published studies in Malawi have been
undertaken to qualitatively explore caregivers' perceptions and
experiences regarding their children's malnutrition and inpatient
treatment. Aim To explore caregivers' perceptions and experiences
surrounding childhood acute malnutrition and the experience of
inpatient care in Malawi. MethodsInterviews were conducted utilising a
semi-structured topic guide and were coded using thematic analysis.
ResultsCaregivers (N=30) gave informed consent to participate in
interviews. Caregiver understanding and perceptions of their
children's illness varied. Some caregivers identified a physical
cause, with a minority identifying lack of dietary protein. Other
narratives were around characteristics of the infant, other
circumstantial events and religious and spiritual influences. One-third
of caregivers described their own health difficulties and marital and
relationship stressors. Challenges such as poverty, lack of access to
food, poor food variability and competing demands for caregiver time
were explained. Both positive and negative experiences of family and
community support and hospital-based care were reported. Conclusion The
themes identified contribute to a greater contextual understanding of
the multifactorial and integrated approaches required to address
malnutrition. This study indicates that healthcare providers need to
take a multi-faceted view of malnutrition and be aware of the many
factors that may influence healthcare experience and response to
treatment. Acknowledging pluralistic belief systems may improve
engagement with care. This demands a broader appreciation of
perceptions and experiences of malnutrition, hospital-based care,
sources of support and stressors within the caregiver, family and
community environment as well as consideration of social determinants
such as poverty and how these influences present within a clinical
context.