Social representations of the undernourished child and health-seeking behaviour in Nepal

Severe acute malnutrition (SAM) in children under five years old is a major global health issue and one of the main causes of child mortality and morbidity (Pravana et al., 2017).

In Nepal, 27% of children are underweight and 36% have stunted development, figures that are considered critical. Despite some significant progress in developing programmes to tackle child undernutrition in Nepal, a gap in coverage still persists (Cunningham et al., 2017).

For about a decade, a community-based approach for the treatment of SAM has been implemented in Nepal by Action Against Hunger in collaboration with the Ministry of Health and Population in order to facilitate access to health services and to enhance knowledge transmission in the community. These programmes (Choudhury et al., 2014) tend to disseminate biomedical knowledge about undernutrition, often not considering or integrating traditional beliefs, which are widespread in Nepalese communities (Van Teijlingen et al., 2015). This state of affairs has been found wanting by multisector programme stakeholders in Nepal, who feel that local beliefs should be taken into account to develop more effective health-related communications (Gaihre et al., 2019). Indeed, lack of knowledge about undernutrition is often considered a major impediment to appropriate health behaviour (Puett & Guerrerro, 2015). Furthermore, worldwide, undernutrition in children is associated with feelings of shame in caregivers (Jaffré, 1996; Howard & Millard, 1997) and with stigmatization and othering by community members (Castillo-Carniglia et al., 2010), which also creates barriers to healthseeking behaviour (Bliss et al., 2016).