'He usually has what we call normal fevers’: Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry

English version

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
prolekare.web.journal.doi_sk: 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:

Social sciences – Sociology – People and places – Population groupings – Geographical locations – Medicine and health sciences – Pathology and laboratory medicine – Pediatrics – Diagnostic medicine – Signs and symptoms – Africa – Tropical diseases – Public and occupational health – Parasitic diseases – Age groups – Children – Families – Child development – Child growth – Child health – Malaria – Fevers – Culture – Tanzania – Mothers

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