Mull D S
Department of Family Medicine, University of California, Irvine, 92717.
Soc Sci Med. 1991;32(2):175-91. doi: 10.1016/0277-9536(91)90058-k.
One hundred and fifty mothers of under-5 children clinically identified as malnourished were interviewed in their homes in katchi abadis (squatter settlements) of Karachi. A variety of ethnic and religious groups were represented. Mothers were shown a photograph of a child with third-degree malnutrition (marasmus) and were asked what might be wrong with the child. Virtually of the mothers said that they had seen the condition, typically identifying it as sukhay ki bimari (Urdu: 'the disease of dryness and thinness'). The majority said that diarrhea predisposed to sukhay ki bimari, and vice versa, but only 3 of the 150 mothers said that diarrhea and/or lack of food could, in themselves, cause the condition. Instead, most said that the usual cause was contact with a woman who had a marasmic child or was otherwise in a state of ritual impurity. The mediating factor was said to be a saya ('shadow, influence') emanating from such a person and ultimately linked with the spirit world. Although the condition was judged to have a very poor prognosis, mothers described various magico-religious therapies that could be tried. Treatment by physicians or by giving more food was considered ineffective or even detrimental, and hiding of such children was reportedly common because of social stigma. Subsequent inquiries carried out by the author in Chitral in northwestern Pakistan produced similar findings except that there, the condition was known as moordasip and was more overtly associated with fright and spirit possession. In Karachi, 45 of the 150 mothers interviewed had children with third-degree malnutrition according to weight-for-age criteria, 15 of whom died in the course of the study. In these 45 families especially, early bottlefeeding had occurred, sometimes reportedly because of fear that the mother was a carrier of a saya and could pass it on through her milk. Most mothers had only sketchy knowledge of suitable weaning foods and an appropriate timetable for introducing such foods, and many showed little awareness of what their children were eating once they reached the toddler stage. Implications for the identification and treatment of marasmic children are discussed. A brief summary of crosscultural beliefs surrounding marasmus and the 'hard to raise' child is included.
在卡拉奇的卡奇阿巴迪（棚户区），研究人员走访了150位家中有5岁以下临床确诊为营养不良儿童的母亲。这些母亲来自不同的种族和宗教群体。研究人员向她们展示了一张患有三度营养不良（消瘦症）儿童的照片，并询问孩子可能得了什么病。几乎所有母亲都说她们见过这种情况，通常将其称为sukhay ki bimari（乌尔都语：“干燥消瘦病”）。大多数母亲表示腹泻会引发sukhay ki bimari，反之亦然，但150位母亲中只有3人认为腹泻和/或食物短缺本身会导致这种情况。相反，大多数人认为常见病因是接触了有患消瘦症孩子的女性或处于仪式不洁状态的女性。中介因素据说是来自这样一个人的saya（“影子，影响”），最终与精神世界有关。尽管这种情况被认为预后非常差，但母亲们描述了各种可以尝试的神奇宗教疗法。由医生治疗或提供更多食物被认为无效甚至有害，据报道，由于社会耻辱感，隐藏这类儿童的情况很常见。作者随后在巴基斯坦西北部的奇特拉尔进行的调查也得出了类似的结果，只是在那里，这种情况被称为moordasip，并且更明显地与惊吓和被鬼魂附身有关。在卡拉奇，根据年龄别体重标准，接受采访的150位母亲中有45人的孩子患有三度营养不良，其中15名儿童在研究过程中死亡。特别是在这45个家庭中，早期就进行了奶瓶喂养，据报道，有时是因为担心母亲是saya的携带者，会通过母乳将其传染给孩子。大多数母亲对合适的断奶食品以及引入此类食品的适当时间表只有粗略的了解，而且许多母亲在孩子进入幼儿期后，对他们吃什么几乎没有意识。文中讨论了对消瘦症儿童的识别和治疗的影响。还包括了关于消瘦症和“难养”儿童的跨文化信仰的简要总结。
