Abstract:
Background: World Health Organization guidelines advise community-based care (CBC)
for "uncomplicated" severe acute malnutrition (SAM) infants <6 months old (u6m),
whereas current national protocols refer to inpatient care. Our aim was to inform and
shape future management strategies by understanding caregivers' and different
stakeholders' perceptions on malnutrition among infants u6m on barriers/facilitators to
future CBC.
Methods: The methods used in this study are as follows: in-depth interviews and focus
group discussions (FGDs) in southern Bangladesh, thematic analysis of transcripts, and
sample size by data saturation.
Results: We conducted 5 FGDs with 29 caregivers, 4 with 29 health care workers, 4 key
informant interviews each with community leaders and health supervisors. Five themes
emerged. 1) Identification of SAM infants and care-seeking behavior: malnutrition was
not noticed until severe, caregivers focused on clinical symptoms. Both allopathic and
traditional healers were consulted. (2) Perceived causes of infant malnutrition:
underlying illness, poor feeding practices, poverty, and local superstitions. (3) Views and
preferences on treatment: hospitals and doctors were perceived as offering the best
treatment, health care workers were also important, and respondents highlighted the need
care of the caregiver/mother along with the infant. (4) Perceived benefits and risks of
CBC: lower cost and greater accessibility were appreciated but worried about quality. (5)
Community networks: wider family and social support networks were considered
important aspects of care.
Conclusions: There is considerable potential for CBC but needs to be better and earlier
identification of at-risk infants, strengthening of health systems to avoid community
options being perceived as "second best," engagement with families and communities to
tackle "upstream" determinants of SAM, and care for mother-infant pairs.