Perceptions, Causes and Treatment of Severe Acute Malnutrition, Mbuji-Mayi, Kasai-Oriental, Democratic Republic of the Congo.

The effective management of severe acute malnutrition (SAM) is contingent upon the perceptions of the affected communities, and preferred therapeutic pathways, object of the present research. A qualitative survey collected 54 semistructured individual interviews, 10 focus groups, and 6 direct observations in Mbujimayi town, Kasaï Oriental province, Democratic Republic of Congo. The deductive approach was used to analyse the data. Cultural and religious beliefs, as well as lived experience, influence perceptions of SAM. The latter is perceived as a shameful disease, a curse, or divine punishment by communities. Food insecurity and poverty following the bankruptcy of Bakwanga diamond Mining (MIBA), then food taboos, women's heavy workloads, poor childcare practices, low birth spacing and lack of access to drinking water were the main causes perceived. Traditional healers are the primary source of care and consider SAM resulting from curses or witchcraft, needing special preparations. Religious leaders regard SAM as a spiritual illness requiring prayers even if modern medicine is administered. Some families turn to prayer, hoping for a therapeutic convocation of the sacred, or self-medication. Modern medicine is the final recourse, frequently combined with the other modalities. For health workers, SAM is linked to nutritional and socioeconomic factors which must be addressed with modern medicine including RUTF. Community awareness and access to education for women is needed to change perceptions. Nutrition programmes would benefit of co-designing their communication and behaviour change strategies with key influential community members of therapeutic pathways of children suffering from SAM.