'He usually has what we call normal fevers’: Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry
Autoři:
Zaina Mchome aff001; Ajay Bailey aff003; Shrinivas Darak aff005; Flora Kessy aff006; Hinke Haisma aff001
Působiště autorů:
Department of Demography, Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands
aff001; National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
aff002; Department of Human Geography and Spatial Planning, International Development Studies, Utrecht University, Utrecht, the Netherlands
aff003; Manipal Academy of Higher Education, Manipal, India
aff004; Amrita Clinic, Prayas Health Group, Pune, India
aff005; Tanzanian Training Center for International Health, Morogoro, Tanzania
aff006; International Union for Nutrition Sciences Task Force ‘Toward Multi-dimensional Indicators of Child Growth and Development, London, United Kingdom
aff007
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222231
Souhrn
Introduction
While parents’ construction of and actions around child growth are embedded in their cultural framework, the discourse on child growth monitoring (CGM) has been using indicators grounded in the biomedical model. We believe that for CGM to be effective, it should also incorporate other relevant socio-cultural constructs. To contribute to the further development of CGM to ensure that it reflects the local context, we report on the cultural conceptualization of healthy child growth in rural Tanzania. Specifically, we examine how caregivers describe and recognize healthy growth in young children, and the meanings they attach to these cultural markers of healthy growth.
Methods
Caregivers of under-five children, including mothers, fathers, elderly women, and community health workers, were recruited from a rural community in Kilosa District, Southeastern Tanzania. Using an ethnographic approach and the cultural schemas theory, data for the study were collected through 19 focus group discussions, 30 in-depth interviews, and five key informant interviews. Both inductive and deductive approaches were used in the data analysis.
Results
Participants reported using multiple markers for ascertaining healthy growth. These include ‘being bonge’ (chubby), ‘being free of illness’, ‘eating well’, ‘growing in height’, as well as ‘having good kilos’ (weight). Despite the integration of some biomedical concepts into the local conceptualization of growth, the meanings attached to these concepts are largely rooted in the participants’ cultural framework. For instance, a child’s weight is ascribed to the parents’ adherence to postpartum sex taboos and to the nature of a child’s bones. The study noted conceptual differences between the meanings attached to height from a biomedical and a local perspective. Whereas from a biomedical perspective the height increment is considered an outcome of growth, the participants did not see height as linked to nutrition, and did not believe that they have control over their child’s height.
Conclusions
To provide context-sensitive advice to mothers during CGM appointments, health workers should use a tool that takes into account the mothers’ constructs derived from their cultural framework of healthy growth. The use of this approach should facilitate communication between health professionals and caregivers during CGM activities, increase the uptake and utilization of CGM services, and, eventually, contribute to reduced levels of childhood malnutrition in the community.
Klíčová slova:
Medicine and health sciences – Pediatrics – Child development – Child growth – Child health – Public and occupational health – Parasitic diseases – Malaria – Tropical diseases – Diagnostic medicine – Signs and symptoms – Fevers – Pathology and laboratory medicine – Social sciences – Sociology – Culture – People and places – Geographical locations – Africa – Tanzania – Population groupings – Families – Mothers – Age groups – Children
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