Understanding malnutrition and health choices at the community level in Sierra Leone
This report looks at the challenges faced in preventing malnutrition in Sierra Leone from a localised perspective and find that:
- Promoting good child nutrition must go beyond dissemination of infant and young child feeding practices to engage with key influences on mothers’ behaviour.
- ‘Exclusive’ breastfeeding is rarely exclusive, with traditional remedies frequently given to infants. Decision-making around food distribution, household finances and when to stop breastfeeding is deeply gendered, influencing the ability of women to act on knowledge about appropriate feeding practices.
- These social conditions that sustain malnutrition are exacerbated during ‘lean seasons’, when there are greater labour demands, compromised sanitation, and limited coping mechanisms.
- Sierra Leone is characterised by a plural health system, combining state and non-state health providers. Citizens navigate this plurality according to a number of factors, including proximity, cost, tradition, perceived effectiveness, experience of treatment and household power relations.
- The dominant paths of healthcare access varied across research sites and interventions to improve healthcare will need to understand how the above factors play out in different contexts and tailor programmes accordingly.
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