Differential Risk Perceptions toward Illness guide development of a prevention of stunting intervention in rural Mozambique (LB477)

Abstract

Objective: To inform the behavior change communication (BCC) component of a stunting prevention program in Cabo Delgado, Mozambique, the World Food Programme (WFP) supported the government’s Scaling Up Nutrition (SUN) movement to understand how community members perceive the risk of young children’s illnesses associated with poor nutritional status.Methods: Among community leaders and caretakers of children under 2 years in Macua and Mwani cultural groups, data were collected in a three‐phase, iterative process from May ‐ August 2013 using free listing (n = 80), pile sorting (n = 67), and in‐depth interviewing (n = 34). Free list illness terms were analyzed for statistical salience and pile sort data were analyzed using multi‐dimensional scaling (MDS). Interview data were coded inductively using a Grounded Theory approach.Results: Biomedical nutrition illness terms are largely absent from the cultural domains of the groups studied. The most important illnesses to the Macua group include malaria, stomachache, and headache, whereas the most salient illnesses to the Mwani group are cough, stomachache, and fever. Community members do not associate the causes of these illnesses with food and nutrition, but do categorize their signs and symptoms in relation to perceived severity. Stunted growth, wasted or emaciated appearance, and slowed cognitive development are perceived to be less severe than other disease signs and symptoms.Conclusion: Behavior change models posit that a person’s perceived susceptibility and severity of a health problem are important for his or her behavior change. Because our results indicated that among these cultural groups, illnesses associated with poor nutritional status were not considered important threats to a child’s health, WFP supported the government to develop a BCC strategy that appeals to other core cultural values of the ethnic groups rather than solely focusing on the program’s potential impact upon nutritional status. Widespread sensitization efforts were also made around chronic malnutrition prior to intervention roll out.