Nutrition rehabilitation and the importance of the perception of malnutrition in the follow-up of rehabilitated children

Nutrition rehabilitation of malnourished children remains a challenge for health services. This paper reports the results of an evaluation of the nutrition component of a mother and child health program in Nepal. The treatment of severely malnourished children was very satisfactory: case fatality rate varied from 4 to 9 % between projects. Follow-up, however, was found to be very poor: only one percent of the discharged children came for a follow-up visit after the first two weeks. The perception of malnutrition within the communities was identified as one of the possible determinants for a successful follow-up and small scale qualitative investigations were organized to gain insight in the topic. Results are quite revealing regarding the perception of nutrition problems. If for severe cases (kwashiorkor and marasmus) awareness of malnutrition did exist in the community, chronic malnutrition seems to be considered as a normal state of being. When a problem is perceived (in severe cases) people will seldom think of it as a nutrition related disease. Results show that the aetiology used by the people differs significantly from the western paradigm, and that traditional convictions put the causes at natural, supra-natural or social levels. The striking point is that no relation is established in the traditional framework between malnutrition (either severe or mild) and food intake of the children. Perception of malnutrition and of its causes influences health seeking behaviour in terms of prevention and treatment. Traditional healers play an important curative role and will often be the first to be contacted. The absence of perception of the links between the shape of the body and nutrients is put forward as one of the possible explaining mechanisms for low follow-up rates observed. An implication of this study would be to revise the health messages delivered to the communities in order to make them culturally more appropriate and relevant.