A qualitative study of mothers' health literacy related to malnutrition in under 5-year-old children in southern Mozambique

Objective: To explore mothers' perceptions of malnutrition and its causes in U-5's in Mozambique, as well as their ability to recognise, prevent and act on signs of malnutrition. Design: A qualitative exploratory inquiry using focus group discussions and individual interviews analysed using Nutbeam's health literacy themes. Setting: Manhica District Hospital in Manhica, Mozambique. Participants: Mothers of U-5's (n 53) attending the in- and out-patient paediatric wards. Results: Different malnutrition literacy levels were identified in mothers' responses. Mothers' reflections on the causes of malnutrition in U-5's were more elaborate compared to those of recognition, prevention and treatment strategies. Only severe forms of acute malnutrition were recognised by mothers, while early signs of undernutrition and stunting largely went undetected or unmentioned. Limited knowledge, time and financial resources were mentioned as contributors to suboptimal practices resulting in malnutrition. The district hospital, rather than community resources or local health posts, was indicated as the place mothers would go to seek advice and treatment for malnutrition. All mothers requested additional information on how to prevent and treat malnutrition. Conclusions: The varying literacy levels among mothers, the lack of references to community health workers as a resource in identifying and managing malnutrition, and the identification of poverty and sociocultural conditions as contributors to suboptimal practices indicate the need for in-depth research focused on the social determinants of malnutrition. A more comprehensive understanding of mothers' health literacy would contribute to the development of holistic programmes aiming to improve community management of malnutrition.