Dettwyler K A
Soc Sci Med. 1986;23(7):651-64. doi: 10.1016/0277-9536(86)90112-7.
Research conducted in Mali during 1982 and 1983 reveals a wide range of variation in both the growth and development of infants and infant feeding practices. Overall, growth patterns of the Malian children (N = 136) are similar to those reported for children in other West African urban or rural poor populations. However, the use of the averages of growth measures disguises the fact that some children are severely malnourished, while others are growing at or above the 50th percentile of NCHS standards. Socio-economic status, as an indicator of the family's financial ability to provide food and medical care, does not account for the variation in nutritional status. From a series of open-ended interviews with mothers, fathers and other relatives of children in the study, as well as observation of mealtimes, several fundamental beliefs regarding infant feeding can be identified: (1) a child does not need to eat solid food before approx. 8 months; (2) if a child is hungry, he will eat, if he does not want to eat he should not be forced to eat; and (3) only the child himself knows when he is hungry and when he is full. These beliefs are expressed in the community in a variety of specific practices and behaviors. Additionally, mothers differ with respect to the importance they attach to medical care for sick children. These various beliefs and practices concerning infant feeding and, tangentially, medical care, tend to form divergent clusters, which allows the ranking of women on a three level scale of 'maternal attitude.' In the sample, growth performance, as indicated by membership in 'low weight' or 'high weight' groups, is positively correlated with maternal attitude (Chi2 = 13.85, P = 0.001). It is clear that in Mali, the cultural belief system regarding infant feeding and the variations in implementation of this system reflected in maternal attitudes, play an important role in determining the nutritional status and growth patterns of children, primarily through their effect on diet, and secondarily through their effect on medical care. The data show that within the same general cultural framework, and in the face of abject poverty, subtle differences in maternal attitudes result in some children who thrive, while others suffer varying degrees of malnutrition.
1982年和1983年在马里开展的研究揭示，婴儿的生长发育以及婴儿喂养方式存在广泛差异。总体而言，马里儿童（N = 136）的生长模式与其他西非城市或农村贫困人口中儿童的生长模式相似。然而，使用生长指标的平均值掩盖了这样一个事实，即一些儿童严重营养不良，而另一些儿童的生长水平达到或高于美国国家卫生统计中心（NCHS）标准的第50百分位。社会经济地位作为家庭提供食物和医疗护理经济能力的指标，并不能解释营养状况的差异。通过对研究中儿童的母亲、父亲和其他亲属进行一系列开放式访谈，以及对用餐时间的观察，可以确定关于婴儿喂养的几个基本观念：（1）大约8个月前儿童无需食用固体食物；（2）如果孩子饿了，他会吃，如果不想吃，不应强迫他吃；（3）只有孩子自己知道何时饿了、何时吃饱了。这些观念在社区中通过各种具体做法和行为表现出来。此外，母亲们在对患病儿童医疗护理的重视程度上存在差异。这些关于婴儿喂养以及附带的医疗护理的各种观念和做法往往形成不同的群体，这使得可以根据“母亲态度”的三级量表对女性进行排名。在样本中，如“低体重”或“高体重”组所示的生长表现与母亲态度呈正相关（卡方 = 13.85，P = 0.001）。显然，在马里，关于婴儿喂养的文化信仰体系以及母亲态度所反映的该体系实施方式的差异，在决定儿童营养状况和生长模式方面发挥着重要作用，主要通过对饮食的影响，其次通过对医疗护理的影响。数据表明，在相同的总体文化框架内，面对赤贫状况，母亲态度的细微差异导致一些儿童茁壮成长，而另一些儿童则遭受不同程度的营养不良。
