Contributing factors for undernutrition in children admitted to Nutrition Rehabilitation Units (NRUs) in Malawi : A follow-up descriptive case study from Mangochi District, Malawi

Background: Child undernutrition is a major health problem and an important risk factor for child mortality as more than 50% of deaths among children under five are either a direct or indirect attributable to undernutrition. Nutrition Rehabilitation Units (NRU`s) have been established where severely undernourished children come in for therapeutic feeding and their caregivers are offered education on child feeding. Few follow-up studies have been done to investigate their long-term prospects after discharge. It is well recognised that caring practices are important factors in order to maintain good health and nutrition in the children, however adequate caring practices require time, knowledge, economic resources and motivation. Possible obstacles of the caregiver’s possibility to maintain the nutritional status of the child is important to identify in order to contribute to the understanding of ways to implement supportive measures both in prevention of undernutrition and to maintain the child’s health status after rehabilitation. Objective: The aim was to explore how various caring practices can contribute to severe undernutrition in the children admitted to the NRU. Further, to examine possible obstacles for the caregiver to provide adequate care to the child before admittance and after discharge. Design: A descriptive case study was conducted using a structured questionnaire and taking of anthropometric measurements on admission to the NRU and one month after discharge. In addition, qualitative interviews were conducted with both caregivers of the children and staff at the NRU. Setting: A total number of 70 patients and their caregivers admitted to three NRUs in Mangochi District in Malawi were included. Results: Lack of resources of different kinds seemed to be a limiting factor for the caregivers to provide adequate care to the children. These resources were related to support, time, knowledge, a healthy environment and access to medical assistance. After discharge, the nutritional status improved for 67 % of the children who were followed up after discharge. The failure of improvement for the remaining seemed to be both due to lack of resources in the household and problems related to compliance to the follow-up system. Conclusion: Severe undernutrition may be determined to a large extent by the caregivers resources available to give adequate care to their child. Education on child health and nutrition must be improved in the community through community based services in order to prevent illness and undernutrition in children. Incorporating treatment of undernourished children and supplementary feeding programs into such community based services might increase the success rates