BeAM project

BACKGROUND AND OBJECTIVES

With the lenses of the social representations, the BeAM (Behaviours for Acute Malnutrition) project explores some of underlying causes of severe acute malnutrition (SAM) that lies in the etiology of folk beliefs, social mechanisms and parental attitudes towards malnutrition. The objective is to have a better appreciation of the caretakers’ behaviours in case of SAM and a better understanding of traditional beliefs about health issues, malnutrition, children’s development and mother’s care practices.

In the frame of this project, we seek to understand the meanings people themselves attribute to SAM: what do people know? How does medical knowledge echo or contradict with cultural knowledge? How feelings towards SAM can lead to deny, to minimization of risks? Moreover, this study proposes to understand on which cultural and social resources the health staff can built on in order to improve health-seeking behaviours: what motivates the caretakers who came to the Outpatient Treatment programme (OTP) centres? What are the obstacles they had overcome and how?

More concretely, the analysis of social representations of SAM and related emotions allowed the health staff to take into account the knowledge of caretakers and their family in order to better support them to bring children to nutrition centres.

METHODS

We compared mothers and their families from two districts (Saptari and Nuwakot) in Nepal and we analysed the organisation of social representations of SAM through knowledge, emotions, practices, source of information, perceived barriers, and motivations.

In order to collect those information:

• We conducted Focus group discussions with mothers of SAM children as it also allows understanding the world from people’s point of view.
• We interviewed health staff from the OTP centres in order to understand the challenges faced by health professionals, the difficulties they perceive, successful strategies, etc.

We collected quantitative data from different social actors (parents, grand-parents, health staff members, etc.) in order to understand the multiple representations of SAM.

FINDINGS

Result 1. The spontaneous discourse about the child affected with SAM varies depending on the health advices: those who advise to see a healthcare provider focus their discourse on the child and the illness, whereas those who advise to give food or treatment describe a thin and deformed body of a dehumanized child and those adopting other strategies are centred on their own emotions (e.g. sad, fear, love for the child).

Result 2. In both district, the same relevant health advices are associated to different representations about malnutrition: in Saptari, more than in Nuwakot, community members who advise to see a healthcare provider evoke the idea that other community members would suggest the mother to go to hospital, revealing the importance of social norms. Moreover, the relevant health advices are associated in Saptari to a discourse about malnutrition caused by medical complications sourcing in specific family conditions (bad relationships), whereas in Nuwakot, relevant health advices concerning malnutrition are associated to the idea that malnutrition is due to poverty causing a “lack of” (food, care, hygiene, medical check-up).

Result 3. conveys that medical discourse is not systematically associated to relevant health advices: medical discourse associated to negative stereotypes about the family (careless, irresponsible) is associated to advising to give better food. Those who adopt other strategies develop a medical discourse about causes in the same time as a discourse about black magic or religion (god’s punishment).

DISCUSSION AND RECOMMENDATIONS

All in one, in each district the mothers of SAM children expressed a huge burden to be ‘mother’ and faced a stigmatic discourse regarding their children’s malnutrition (which sourced in the modern/tradition opposition and circulates at a more global level). Thus, they gave meaning to their own child situation in a way that may protect their own identity.

Despite some limitations, these results outline that promoting medical knowledge in communities may not always have positive issues as it does not substitute to other forms of knowledge (stereotypes, traditional beliefs). Thus, health promotion should also take into account other forms of knowledge circulating in the community as well as cultural specificities that underpin relevant health seeking behaviours in different cultural contexts.

PROJECT-RELATED PUBLICATIONS

Caillaud, S., Ginguene, S., Leroy, T., Man Maharjan, S., Koirala, G., Le Roch, K. (2025). When communities face malnutrition: how context shapes the factors predicting relevant health advice in Nepal. Community Psychology in Global Perspective, North America. Available at: http://siba-ese.unisalento.it/index.php/cpgp/article/view/28788

Caillaud, S., Ginguené, S., Maharjan, S. M., Koirala, G., Tonon, B., & Le Roch, K. (2022). Social representations of the undernourished child and health-seeking behaviour in Nepal: From othering to different types of otherness. Journal of Community & Applied Social Psychology, 32(2), 273–287. https://doi.org/10.1002/casp.2576

Caillaud, S., & Payotte, S. (2024). ‘Hunger happens elsewhere, here malnutrition results from lack of proper care’: Social representations of malnutrition and processes of othering in the Nepalese press. European Journal of Social Psychology, 54(6), 1280–1295. https://doi.org/10.1002/ejsp.3087

Caillaud, S., Le Roch, K. & Tonon, B. (2024). A guide to explore and understand social representations of malnutrition and their role in health seeking behaviours. Paris: Action contre la Faim. Available at :