Filial factors of kwashiorkor survival in urban Ghana: Rediscovering the roles of the extended family

Abstract

This paper discusses the findings of two field studies in urban Accra, Ghana that investigated the social and familial factors that were associated with survival of childhood kwashiorkor, a protein-caloric deficiency form of malnutrition that is endemic in that nation. Data was collected from qualitative interviews with family groups that included teenaged survivors of kwashiorkor, and the adults who were involved in the young person’s childhood rearing, including those who were  responsible for compliance with the Ghana Ministry of Health malnutrition  rehabilitation effort. Extensive interviews were documented in audio and video tape and field notes by a team that included the fields of social work, public health, nursing and sociology. All members of the participating families who were involved in the data collection were offered compensation for their time as well as full protection of privacy through the human subjects informed consent protocol and oversight of the University of Ghana, Eastern Michigan University and Wayne State University. The findings included reporting of a consistently critical role of the grandmothers and other senior women in the family units. The senior women either managed the economics and maintenance of the extended household, or took  principal responsibility for sustaining the malnourished children’s participation in rehabilitation efforts. In some cases, the mothers were deceased and two or more senior women in the family carried out roles of parenting as well as familial  economic support and coordination of care for the afflicted child. The findings  suggest that full compliance with rehabilitation efforts for a single mother with multiple children and no extended familial support system would be very difficult and more likely to result in non-compliance and failure of the child to survive.   Suggestions are offered for family oriented, community health education regarding the irony of this form of malnutrition being endemic in communities that do not lack appropriate food. Implications for increased recognition and support for the elderly and senior family members to enhance child survival are discussed within the  context of changing social and epidemiological profiles of urban centers in Ghana and elsewhere among developing nations of sub- Saharan Africa.

Keywords: Kwashiorkor, Malnutrition, Rehabilitation compliance, Grandmothers, Endemic malnutrition