Poster Topical Area: Methods and Protocols
Location: Hall D
Poster Board Number: 672
Objective: Moderate acute malnutrition (MAM) in children under 5 is treated with specially formulated supplementary foods such as corn-soy blended flours that require the addition of oil and/or water in specific ratios. While trained personnel carry out MAM screening and health monitoring at health facilities, the burden of preparing food and providing MAM treatment falls to caregivers at home. We aimed to understand barriers to knowledge uptake and recipe adherence among caregivers and to identify messages that clinic staff and community health workers could communicate when counseling on proper food preparation.
Methods: We conducted 8 focus group discussions (FGD) of 12 participants at 4 locations in Pujehun District, Sierra Leone. Participants were purposively selected by community role. Using a Mende or Krio-adapted semi-structured guide, 4 FGDs discussed malnutrition causes, common complementary food preparation methods, and barriers to changing those methods; 4 discussed modes of communication and community entry points. All participants were not currently participating in the supplementary feeding program (SFP). Interviews were audio-recorded and translated into English. Subsequently, a workshop convened experts in the nutrition and health community to review barriers-to-change and propose messages, which were then pre-tested among current SFP beneficiaries. Messages were revised based on results, and final messages were tested among current SFP beneficiaries.
Results: 96 individuals participated in FGDs. MAM children were not perceived as ill even among health workers; food was not viewed (in any form) as a mode of treatment; health workers often considered caregivers "lazy". These perceptions influenced caregiver behavior around sharing, dosage, and recipe preparation. Though caregivers were recognized as the primary cooks in households, husbands, neighbors, secondary caregivers, and mothers-in-law influenced their sense of power to prepare the food as instructed by SFP staff. Final messages were framed in a way to relate "malnutrition" with "illness" and the "food" with "treatment."
Conclusion: Gaps between SFP messaging and community knowledge created barriers to recipe adherence among caregivers.