Mchome Zaina, Bailey Ajay, Kessy Flora, Darak Shrinivas, Haisma Hinke
Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania.
Matern Child Nutr. 2020 Oct;16(4):e13048. doi: 10.1111/mcn.13048. Epub 2020 Jul 7.
The social context and cultural meaning systems shape caregivers' perceptions about child growth and inform their attention to episodes of poor growth. Thus, understanding community members' beliefs about the aetiology of poor child growth is important for effective responses to child malnutrition. We present an analysis of caregivers' narratives on the risks surrounding child growth during postpartum period and highlight how the meanings attached to these risks shape child care practices. We collected data using 19 focus group discussions, 30 in-depth interviews and five key informant interviews with caregivers of under-five children in south-eastern Tanzania. Parental non-adherence to postpartum sexual abstinence norms was a dominant cultural explanation for poor growth and development in a child, including different forms of malnutrition. In case sexual abstinence is not maintained or when a mother conceives while still lactating, caregivers would wean their infants abruptly and completely to prevent poor growth. Mothers whose babies were growing poorly were often stigmatized for breaking sex taboos by the community and by health care workers. The stigma that mothers face reduced their self-esteem and deterred them from taking their children to the child health clinics. Traditional rather than biomedical care was often sought to remedy growth problems in children, particularly when violation of sexual abstinence was suspected. When designing culturally sensitive interventions aimed at promoting healthy child growth and effective breastfeeding in the community, it is important to recognize and address people's existing misconceptions about early resumption of sexual intercourse and a new pregnancy during lactation period.
社会背景和文化意义系统塑造了照顾者对儿童成长的认知，并影响他们对儿童生长发育不良情况的关注。因此，了解社区成员对儿童生长发育不良病因的看法对于有效应对儿童营养不良至关重要。我们对照顾者关于产后儿童成长风险的叙述进行了分析，并强调了这些风险所附着的意义如何塑造儿童护理实践。我们通过对坦桑尼亚东南部五岁以下儿童的照顾者进行19次焦点小组讨论、30次深入访谈和5次关键 informant 访谈来收集数据。父母不遵守产后性禁欲规范是儿童生长发育不良（包括不同形式的营养不良）的主要文化解释。如果性禁欲未得到维持，或者母亲在仍在哺乳时怀孕，照顾者会突然完全断奶以防止生长发育不良。婴儿生长不良的母亲往往会因违反性禁忌而受到社区和医护人员的污名化。母亲所面临的污名降低了她们的自尊，并阻止她们带孩子去儿童健康诊所。人们通常寻求传统而非生物医学护理来解决儿童的生长问题，尤其是在怀疑违反性禁欲的情况下。在设计旨在促进社区儿童健康成长和有效母乳喂养的具有文化敏感性的干预措施时，重要的是要认识并解决人们对哺乳期过早恢复性交和再次怀孕的现有误解。
