Abstract
High levels of child malnutrition have been observed in Malawi for over two decades, and have been linked to infant and complementary feeding practices. Previous research in northern Malawi indicated that early introduction of non-breast milk foods and liquids had negative effects on child growth, and grandmothers were actively involved in early child feeding decisions (Bezner Kerr, Berti, & Chirwa 2007; Bezner Kerr, Dakishoni, Shumba, Msachi, & Chirwa. 2008). The objectives of this study were to examine local child care practices, knowledge of childhood illnesses and the underlying explanatory theories that give meaning to people’s practices and observations when children become ill. Sixty-eight qualitative, in-depth interviews, two focus groups, ethnographic observation and participatory workshops were held over a 4 year period as part of an ongoing participatory agriculture and nutrition research project in Mzimba district, Malawi, in the region surrounding the town of Ekwendeni. The purpose of the research was to understand child feeding practices and concepts in order to develop a culturally appropriate strategy for the prevention and treatment of child malnutrition. One child illness, called ‘moto’, which means fire or heat in chiTumbuka, is considered a syndrome of symptoms including fever, coughing, weight loss and diarrhoea that affects primarily young children and sometimes elderly people. The cause of this illness is conceptualised as ‘wajumpikha’or the idea of ‘crossing over’ cultural taboos and expectations. In this case, crossing the boundary refers to having sex, either postpartum (considered a ‘taboo’ period for marital sexual relations) or extra-maritally. These types of sexual practices were considered to have dire effects on the health of young children, and had a direct impact on child feeding practices and care. This chapter discusses these research findings in relation to Malawi’s high HIV prevalence and chronic food shortages, discusses areas of further inquiry and the possible implications for community-based nutrition education programs.
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Notes
- 1.
Epidemiological data shows that more than 12 percent of children from rural Malawi die before their fifth birthday (MICS 2006[0]). Significantly, Malawi has the fourth[0] highest stunting rate in the world; 46 percent of under-five children are too short for their age, an indication of chronic undernutrition over an extended period of time (MICS 2006). The most common causes of death in young children are first acute respiratory infection, diarrhoea and undernutrition, malaria and HIV[0]. Some of the major immediate causes of child mortality and undernutrition include low exclusive breastfeeding rates (57 percent) and dietary deficiencies in micronutrients (Black et al.2008a).
- 2.
A‘culture bound syndrome’ by definition is a set of psychiatric and/or bodily symptoms that are classified as a disease in one culture but not in others. The concept first developed in psychiatry (Yap1967) and was later used by anthropologists and sociologists the late 1970s and 1980s. Although considerable debate still exists about the term (Guarnaccia & Rogler 1999) Young’s research on post-traumatic stress disorder among Vietnam war veterans demonstrates the importance of examining the social, geographical and historical context of any disease whether it is recognised by biomedicine or not (Young1995, see also Lock1995 and Kalipeni et al.2004 for other examples).
- 3.
In this context, two of the markers indicating a transition from ‘newborn’ status to ‘child’ is that the child develops ‘curly’ hair and begins to smell ‘human’. This transition usually occurs at 1-2 months of age when the child’s newborn (straight) hair is shaved.
- 4.
During 2008-09 fieldwork by the first author, there were persistent rumours of children being kidnapped by witches in their sleep to be tortured and/or trained to be witches. One rationale given for this increase in child kidnapping is that parents are not protecting their children with mzuwula anymore.
- 5.
In an earlier paper, we reported on the disparaging attitudes that nurses and hospital staff had towards local beliefs around child feeding (Bezner Kerr et al.2008).
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Sikstrom, L., Bezner Kerr, R., Dakishoni, L. (2011). Fluid Boundaries: Multiple Meanings of the Illness ‘Moto’ in Northern Malawi. In: Liamputtong, P. (eds) Infant Feeding Practices. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6873-9_13
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