Nutritional Influences on the Health of Women and Children in Cabo Delgado, Mozambique: A Qualitative Study
Abstract
:1. Background Information
2. Methodology
3. Data Analysis
4. Findings
- Lack of food diversity and harmful weaning customs;
- Eat a pig and give birth to a pig: Intersection between lack of knowledge and social and cultural influences on food consumption;
- Food choices determined by accessibility;
- Economic influences on food choices and consumption;
- Differential gendered influence on food consumption and allocation.
4.1. Lack of Food Diversity and Harmful Weaning Customs
We cook and we all eat the same food. There is no food for children or for adults. We all eat the same food. (Meluco, FGD, Mothers with babies under 6 months, 20–40 yrs.)
…There are no other foods to give these children we give to them what we have to eat…. (Macomia, FGD, Mothers with children under 2 years, 20–39 yrs.)
… I give the child this sort of food, because that is the food I have. If I have cassava pap, I prepare it to eat with my son…. (Quissanga, FGD, Adult pregnant woman, 24–36 yrs.)
We generally give them “muatranca”. It does not matter if one is 1 year old or 2 years old. We do not have a choice. (Macomia, KII -AG-1).
Here we eat cassava porridge and maize porridge. This is the food we are used to… Every year the same food and because we produce the same food, we cook the same food all the time, and the child eats this same food and grows. (Meluco, IDI, Pregnant adolescent, 19 yrs.)
We give them porridge, cassava dough that is why they get weak and do not develop because they are not yet old enough to eat, they must be at least six months old. (Macomia, IDI, breastfeeding women).
Respondent 1: When I wean the child, I buy refreshment with cookies for him/her. When he/she asks for me to breastfeed him/her, I just give this to him/her, in the evenings too. So, when she eats, she forgets about the breast milk. (Macomia, FGD, Pregnant Adult Women, 24–36 yrs.)
Respondent 2: They take adhesive and stick on the breast for the child to be afraid. They also put red flowers around and lie that is blood and the child stops nursing because he is afraid of these things the mother has put. (Macomia, FGD, Pregnant Adult Women, 24–36 yrs.)
Respondent 3: Others come to the point of rubbing piripiri [pepper] for the child to feel bitter/hot and think that is dangerous and then the child gives up. (Macomia, FGD, Pregnant Adult Women, 24–36 yrs.)
4.2. Eat a Pig and Give Birth to a Pig: The Intersection Between Lack of Knowledge and Social Cultural Influences on Food Consumption
…The family says she should not eat this or whatever; I have been to a province, in which, to consume the flour made in Tete, it has to be put into water for two up to 3 days and grind. All nutrients disappear. Let me tell you this. Maize flour is delicious. I love that, but it has no nutrients. …. they prefer that flour due to the food habits. They eat that flour with dry fish. For them, to mix greens, it means to break the flavour. Those are the food habits which people have, and they disseminate it to all generations, consequently it gets difficult. … it is not just in the rural communities, but also in the urban ones. There is lack of nutrition understanding. We have to know eating a lot does not mean to eat well. … They prefer not to take vegetables, various greens which are nutritional (Maputo, Key Informant, Government official)
Interviewer: …what do you think are the main difficulties affecting access to nutritious foods for pregnant women, mothers and children under 2 in rural communities?
Respondent: The first difficulty is lack of knowledge concerning what these nutritious foods should be; the second difficulty is the acquisition of products.
Interviewer: What are the difficulties for pregnant women and infants under 2 years old to adopt good nutritional practices?
Respondent: One of the difficulties is the myths and beliefs people have: pregnant woman must not eat this, child must not eat this, and this makes pregnant woman lose some essential nutrients and then poor nutrition of pregnancy begins. Besides this, they introduce food very early. They start to give drinks very early because they say that the child is thirsty. In short, these myths are the matters that lead to bad practices and not only but also the lack of knowledge, but if we convey the information that this is right and that is wrong, and I do believe we can reduce the issue of myths and beliefs in communities. (Pemba, Key Informant, Nutritionist)
The healthy food that provides health to people is “Celeste” pap with cassava leaves. We eat rice with fish for being poor, for not having a choice; it is unhealthy food. (Quissanga, FGD, Fathers with children under 2 years, 20–45 yrs.)
The food that strengthens is “sorghum”, cassava leaves with peanuts and beans. This food does not only strengthen, but it also increases blood. (Quissanga, FGD, Mothers with children under 2 years, 20–31 yrs.)
… our food is Xima, cassava Xima, we buy at 200 mts, and we clean it and take it for grinding and we find vitamins. (Metuge, FGD, Pregnant adolescent women, 15–19 yrs.)
Here the food that we rely on a lot and we eat with our heart is only porridge from maize. When we eat Xima [porridge] we feel happy and the body feels good. But when we eat rice and xima of cassava, we only eat for the sake of eating only. That maize is what we like the most. (Macomia, KII, Male community leader)
In some places, there are myths. For example, you must not eat an egg, otherwise, you will give birth to a bald child among others. It has to do with the areas; food habits in the coast area. People are used to eating fishes with cassava flour while it is bad for them, because it has no nutrients, especially for pregnant women. It ends up affecting the babies from 0 up to 24 months old. (Pemba, IDI, a government official)
These ideas come from the elders of our community. They know about the harms caused by those habits in the past and… (Macomia, KII, Male, Community Health activist)
Elders are the ones who tell us. After you are pregnant, elders let you know, ‘You are pregnant, you ought not to eat things like this.’ They tell you. You do not eat, because you have been warned. (Macomia, FGD, Pregnant adolescents, 15–19 yrs.)
Usually the elders are the ones who tell us what a pregnant woman does not eat because they have seen these things happen, and if a person has ears to listen, she won’t eat, but if she insists that they are old ideas and eats, what the elders said would happen does happen. (Meluco FGD, Pregnant adolescents, 15–19 yrs.)
We eat any food, whatever comes along because no one has ever told us that we should eat this food when you have a child who is 6 months or under. (Macomia FGD, Mothers with babies under 6 months, 20–40 yrs.)
Some do, but like I said earlier not everyone understands. Therefore, we go little by little. People will not understand you at once, on the first time. We have a health agent, every Friday and Monday holds lectures to explain to people that they have to eat this, … this, to have energy. On the days we hold meeting here in the community, we explain to women who are pregnant, those who are breastfeeding that they should eat this, this, this, this, which I just mentioned. (Macomia, KII, Male, Community nutrition group leader)
4.3. Food Choices Determined by Accessibility
We get food such as “sorghum”, “Celeste” flour even “nhemba” beans every year. Papayas, bananas and other food are hard to find. (Quissanga FGD, Mothers with children under 2 years, 20–31 yrs.)
I have not eaten anything since morning and, at home, there is not pap for porridge, only cassava pap. My sons/daughters’ father is absent who could go work to bring maize pap. We eat cassava pap that we cultivate. This year, there is no rice, not even maize, only cassava. So, I breastfeed and my heart aches. I cry. (Metuge FGD, Mothers with children under 2 years, 23–43 yrs.)
The nutritious and energetic food is the paste of pounded cassava in its majority, maize flour, sorghum, but rice is not frequent, these are the only foods we use. (Meluco, KII, Female, Community group leader)
It must be maize porridge because it gives strength; oil builds the body, with beans leaves because they build the body. (Macomia, FGD, Mothers with babies under 6 months, 20–40 yrs)
For food with vitamins we have cassava leaves, mooring with peanuts, oil is nothing but with peanuts, onion, salt with cornmeal/porridge. After a while you prepare lettuce and eat, if you have an orange, banana, cashew you can eat. (Quissanga, FGD, Pregnant adolescents, 15–19 yrs.)
Food that will give you strength is maize with cassava leaves because and to diversify we when we put aside muantopa [porridge made of cassava flour] we eat this to have strength. (Meluco, FGD, Mothers with children under 2 years, 20–44 yrs.)
4.4. Economic Influences on Food Choices and Consumptions
Our husbands go fishing. The day they get fish, they get no clients unless people from Pemba or Montepuez come to purchase them. The day he does not succeed in selling, he puts the fishes to dry so that he can eat with the family. (Quissanga, FGD, Mothers with babies under 6 months, 20–36 yrs.)
Selling food is difficult because those who come to buy fix very low prices that do not befit us and we end up losing. (Meluco, FGD, Fathers with children under 2 years, 28–45 yrs.)
There is a shortage of money here in the village; you can make cakes to sell but no one buys. (Metuge IDI, Adult Pregnant woman, 34 yrs.)
Young people cut wood, but their wood takes a long time to sell. Here it is difficult to have money, even when making cakes; you do not finish [selling them] because there is no money in this community. (Meluco, KII, Female, Nutritional leader, 28 yrs.)
Respondent 8: It depends on the financial condition of each person. Some eat rice; others eat cassava porridge, because they cannot afford other products. This is what makes the difference, others can only eat porridge while others eat meat.
Respondent 1: There are differences on eating habits because of the financial conditions; others can have cassava leaves accompanied with cassava porridge. Those who are blessed by God eat rice with fish, while you eat cassava leaves, that is the destiny [suffering] God gave you.
Respondent 5: People have different fortunes. Some will eat cassava vegetables with cassava porridge, but we also would like to eat rice, but it is difficult to have it. (Macomia, FGD, Pregnant Adult Woman)
…This in Makonde is called poverty. If you do not have money you will have difficulty to eat, you will eat poor food. But those who have money eat the food they want because money allows you to eat well at home…those with money do not eat cassava, sorghum. People with money always eat rice…eating well differs because of not having money. (Macomia, KII, Male, Community leader)
First the food rich people—those who have money—eat, which we, the poor cannot afford because we don’t have money is manufactured or industrialized food because it is very difficult to find it like the case of spaghetti… things you may feel like eating but either you can’t find or afford them, like milk, for example. (Macomia, KII, Male, Community nutrition group leader)
We eat cassava pap, because we do not have maize pap. Who gets money, purchase maize pap that costs 1500 Meticais to 2000 Meticais each cup or rice which costs more. It depends on your money, if it is a lot or little. If you do not have, cook cassava pap. (Metuge FGD, Mothers with children under 2 years, 23–43 yrs.)
There is rice, macaroni, sardines, oil, and spice. When they start cooking, it smells pleasantly and we, who do not have it… our cassava leaves will not be all right even though we will take it and cook with “muatranca”…. (Meluco FGD, Mothers with children under 2 years, 20–44 yrs.)
4.5. Differential Gendered Influence on Food Consumption and Allocation
There is no difference; they all eat the same quantity. The thing is their mother considers a certain quantity of porridge to be sufficient and that the children will feel satisfied. (Quissanga FGD, Mothers with children under 2 years, 20–31 yrs.)
I do not separate because in this village we do not usually give each child their plate. I have 4 children; they all eat in the same dish. Only the father has in his plate. I and my children eat together. (Meluco FGD, Pregnant adolescents, 15–19 yrs.)
There is no difference, they both eat the same food. If we are to eat bran both male and female children we eat bran. (Macomia FGD, Fathers with children under 2 years, 20–31 yrs.)
Each child eats taking into account the age. I divide like this: I serve two serving spoons for the 5-years-old child and 1 serving spoon for the 2-years-old child. I mean, it depends on the ages. The amount of food that I serve for an adult person differs from the one I serve for 5-years-old child. (Quissanga FGD, Mothers with children under 2 years, 20–31 yrs.)
It is not divided equally. It depends on each one’s age. Children have a different food amount from elders. (Macomia KII, Male, Community leader]
Yes, I did. He is the one who buys the food. There are men that do not allow children to be served first. (Quissanga FGD, Mothers with children under 2 years, 20–31 yrs.)
We give the best part for men because they are who cultivate so we put them before women…We give much cassava dough to men and we get the less part because they say men cultivate more, but we cultivate too. (Macomia FGD, Mothers with children under 2 years, 20–39 yrs.)
I commence serving my husband and I seat with my sons/daughters and we eat together. I always start with my husband. (Metuge FGD, Mothers with children under 2 years, 23–43 yrs.)
When preparing food should start with the father, but because the father may be away, I cook the food inside, and I serve the children to eat. (Meluco FGD, Pregnant adolescents, 15–19 yrs.)
…In principle priority is given to the man. You serve him water, food, and he is the first to eat. After serving the man the woman eats. Normally in this village the man is the first. (Meluco FGD, Fathers with children under 2 years, 28–45 yrs.)
…Men are the first eating; women cook and when they finish, they call for the boys to take food to the men. Women are always the last ones eating. (Macomia KII, youth, 22 yrs.)
There are men who when they get money, they buy cassava leaves, oil, and give them to the woman and eat. (Meluco FGD, Mothers with babies under 6 months, 20–40 yrs.)
There are men who do not want to be asked; they give you money to go buy what you want, and he eats without queries. (Metuge, FGD, Mothers with babies under 6 months, 20–27 yrs.)
It is the woman who makes the decisions…The woman knows what is missing at home. (Quissanga, KII, Male, Nutrition focal point, 45 yrs.)
Women are the ones who make this decision [to purchase food] because they are the ones who cook. (Macomia, KII, Male, Youth/Gender focal Point)
5. Discussion
6. Proposed Recommendations
7. Proposed Research
8. Conclusions
9. Study Limitations and Strength
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Data Availability
Abbreviations and Acronyms
AKFC | Aga Khan Foundation Canada |
AKFM | Aga Khan Foundation Mozambique |
AKU | Aga Khan University |
AQCESS | Access to Quality Care through Extending and Strengthening |
COEWCH | Center for Excellence in Women and Child Health |
FGD | Focus Group Discussion |
GoM | Government of Mozambique |
ICRH | International Centre for Reproductive Health |
IDI | In-depth Interview |
INS | Instituto Nacional de Saúde |
KI | Key Informant |
KII | Key Informant Interviews |
NGO | Non Governmental Organisation |
Appendix A. Informed Consent Form
Appendix B. Study Tools
Appendix B.1. Question Guide for Key Informant in-Depth Interviews with CHWs, Leaders of Community Groups, Community Elders, Gender and Youth Focal Persons
Appendix B.2. Question Guide for In-Depth Interviews (IDIs) with Pregnant Women, Breastfeeding Mothers and Women with Children under Two Years of Age
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Type of Respondent | Sites | |||
---|---|---|---|---|
Ibo | Metuge | Meluco | Macomia | |
Key informants Including 5 KIs with government officials | 4 | 4 | 4 | 4 |
In-depth interviews with mothers | 4 | 4 | 4 | 4 |
Focus group discussions (8–10 members) | ||||
With pregnant adolescent women | 1 | 1 | 1 | 1 |
With pregnant women >20 yrs | 1 | 1 | 1 | 1 |
With women >20 yrs with babies <6 mths who were not practicing exclusive breastfeeding | 1 | 1 | 1 | 1 |
With women >20 yrs of children <2 yrs | 1 | 1 | 1 | 1 |
With fathers of children <2 yrs | 1 | 1 | 1 | 1 |
CODES | CATEGORIES | THEMES |
---|---|---|
1. We have no specific food for a child. We share same food with children. We feed our children cassava. Our children are fed maize meal. We feed children cookies and sodas during weaning. We put pepper on our breasts to wean children. We put adhesive stuff on our breasts to wean children. | Limited food choices for children; Starchy foods. Harmful traditions on child weaning. | Lack of food diversity and harmful weaning customs |
2. We prefer xima and porridge. Strong myths and beliefs about food preparation. Food preparation influenced by myths. Food consumptions passed on from generation to generation. Starchy food preferred for energy. Myths about protein foods. Eat a pig and give birth to a pig. Eat buffalo and you miscarry your child. | Beliefs, myths, lack of information on healthy food preparation. Lack of knowledge. Intergenerational food habits. | Eat a pig and give birth to a pig: Intersection between lack of knowledge on appropriate food preparation and social cultural influences on food consumption |
3. More cassava and sorghum are available. Pounded cassava is nutritious. Maize meal gives energy. Maize porridge is good for strength. Maize meal and cassava are readily available. | Accessibility misconstrued for nutritional food. Lack of knowledge on what constitutes nutritious food. | Food choices determined by accessibility |
4. Exclusive food is for rich people. Rice, spaghetti and fish are for rich people. Majority of the population is poor. No customers to buy our fish. No customers to buy our cakes. No customers to buy our wood. Cannot afford fortified flour. Our people are poor. No money to buy unhealthy food. | Poverty. Variation in socio- economic class. | Economic influences on food choices and consumptions |
5. Child’s father served food first. Food in the household served based on age. Both women and men make decisions on food choices. Men work and buy food. Men deserve more food. | Age and gender determine food allocation. Patriarchy (men served first). | Differential gendered influence on food consumption and allocation |
Food | Beliefs |
---|---|
Pig | A child would be born looking like a pig |
Octopus | If she ate it, she had to cut its tail, since it caused stomachache, and one could die. A pregnant woman found having eaten it would also be labelled a sorcerer |
Buffalo | Causes miscarriage |
Shrimp | Causes tummy aches |
Sea turtle | A child would bite the mother’s breasts while breast feeding |
Meat of an animal that had just given birth | A child would be weak, lack good health A child would have a bad tongue |
Animal intestines | They terminate the pregnancy, or the woman would have difficulties during delivery |
Eggs | Bald or hairless child |
Little bird | A child would have a bad mouth |
Coconut | A child would be born “whitish” |
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Share and Cite
Lusambili, A.; Naanyu, V.; Manda, G.; Mossman, L.; Wisofschi, S.; Pell, R.; Jadavji, S.; Obure, J.; Temmerman, M. Nutritional Influences on the Health of Women and Children in Cabo Delgado, Mozambique: A Qualitative Study. Int. J. Environ. Res. Public Health 2020, 17, 6205. https://doi.org/10.3390/ijerph17176205
Lusambili A, Naanyu V, Manda G, Mossman L, Wisofschi S, Pell R, Jadavji S, Obure J, Temmerman M. Nutritional Influences on the Health of Women and Children in Cabo Delgado, Mozambique: A Qualitative Study. International Journal of Environmental Research and Public Health. 2020; 17(17):6205. https://doi.org/10.3390/ijerph17176205
Chicago/Turabian StyleLusambili, Adelaide, Violet Naanyu, Gibson Manda, Lindsay Mossman, Stefania Wisofschi, Rachel Pell, Sofia Jadavji, Jerim Obure, and Marleen Temmerman. 2020. "Nutritional Influences on the Health of Women and Children in Cabo Delgado, Mozambique: A Qualitative Study" International Journal of Environmental Research and Public Health 17, no. 17: 6205. https://doi.org/10.3390/ijerph17176205