Perceptions of Underlying Factors and Consequences of Childhood Malnutrition and Care-Seeking Behaviour for Children Under 5 Years With Acute Malnutrition: A Qualitative Study in Rural Bangladesh.

Abstract

Acute Malnutrition affects 45 million children under five globally, with Bangladesh contributing more than 1.7 million cases. While community-based management of acute malnutrition (CMAM) guidelines in Bangladesh exist, they primarily emphasise nutritional counselling and face challenges in coverage and implementations. It is important to understand barriers to CMAM uptake and implementation. This study aims to explore the perceptions of acute malnutrition's underlying factors and consequences among parents, healthcare providers, and policymakers, alongside parents' care-seeking behaviours for under-five children with acute malnutrition. Conducted in areas with and without CMAM programs, the research follows a phenomenological design with thematic analysis of focus group discussions (FGDs) and key informant interviews (KIIs). Thirty FGDs with parents, 28 KIIs with healthcare providers, and 16 KIIs with policymakers were conducted. Identified causes of acute malnutrition included infections, diseases, lack of awareness about nutritious foods, supernatural beliefs, poverty, and inadequate care and feeding practices. Consequences included stunted growth, impaired mental development, and increased illness risk. Although parents acknowledged the urgency of treating acute malnutrition, they sought care at healthcare facilities regardless of illness. Factors influencing care-seeking behaviour were inability in problem prioritisation, transportation cost and availability, healthcare access, wage loss, and out-of-pocket expenses. Despite awareness of acute malnutrition's underlying factors and consequences, parental care-seeking remains limited. The study recommends integrating acute malnutrition guidelines with communicable disease programs, implementing targeted social and behavioural change programs, addressing superstitions, fostering collaboration with traditional healers strengthening social safety nets, and empowering women in healthcare decision-making.