Perceptions and experiences of caregivers of severely malnourished children receiving inpatient care in Malawi: An exploratory study|
Ware, Selena Gleadow; Daniel, Allison I; Bandawe, Chiwoza; Mulaheya, Yohane Paulo; Nkunika, Sylvester; Nkhoma, Dumisani; Kokota, Demoubly; Stewart, Robert C & Voskuijl, Wieger
Severe 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
To explore caregivers’ perceptions and experiences surrounding childhood acute malnutrition and the experience of inpatient care
Interviews were conducted utilising a semi-structured topic guide and were coded using thematic analysis.
Caregivers (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.
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.
maternal mental health; nutritional rehabilitation unit; severe malnutrition; caregiver experience