This study aims to investigate the knowledge, perception and practices related to health, nutrition, care practices, and their effect on nutrition health-seeking behaviour. In order to have maximum representation, we divided Chakradharpur block in Jharkhand state into three zones (north, south and centre regions) and purposively selected 2 Ambulatory Therapeutic Feeding Centre (ATFC) clusters from each zone, along with 2 villages per ATFC (12 villages from 6 ATFCs in total). In-depth interviews and natural group discussions were conducted with mothers/caregivers, frontline health workers (FHWs), Medicins Sans Frontieres (MSF) staff, community representatives, and social leaders from selected villages. We found that the community demonstrates a strong dependence on traditional and cultural practices for health care and nutrition for newborns, infants and young children. Furthermore, the community relies on alternative systems of medicine for treatment of childhood illnesses such as malnutrition. The study indicated that there was limited access to and utilization of local health services by the community. Lack of adequate social safety nets, limited livelihood opportunities, inadequate child care support and care, and seasonal male migration leave mothers and caregivers vulnerable and limit proper child care and feeding practices. With respect to continuum of care, services linking care across households to facilities are fragmented. Limited knowledge of child nutrition amongst mothers and caregivers as well as fragmented service provision contribute to the limited utilization of local health services. Government FHWs and MSF field staff do not have a robust understanding of screening methods, referral pathways, and counselling. Additionally, collaboration between MSF and FHWs regarding cases treated at the ATFC is lacking, disrupting the follow up process with discharged cases in the community. For caregivers, there is a need to focus on capacity building in the area of child nutrition and health care provision post-discharge. It is also recommended that children identified as having moderate acute malnutrition be supported to prevent them from slipping into severe acute malnutrition, even if they do not qualify for admission at ATFCs. Community education and engagement are critical components of a successful CMAM program.

中文翻译：

---

贾坎德邦 Chakradharpur 的营养不良：对印度观念和护理实践的人类学研究

本研究旨在调查与健康、营养、护理实践相关的知识、认知和实践，以及它们对寻求营养健康行为的影响。为了获得最大的代表性，我们将贾坎德邦的 Chakradharpur 街区划分为三个区域（北部、南部和中部区域），并有目的地从每个区域中选择 2 个流动治疗喂养中心（ATFC）集群，以及每个 ATFC 2 个村庄（12 个村庄）总共 6 个 ATFC）。与来自选定村庄的母亲/护理人员、一线卫生工作者 (FHW)、无国界医生 (MSF) 工作人员、社区代表和社会领袖进行了深入访谈和自然小组讨论。我们发现社区表现出对新生儿保健和营养的传统和文化习俗的强烈依赖，婴儿和幼儿。此外，社区依靠替代药物系统来治疗营养不良等儿童疾病。研究表明，社区获得和利用当地卫生服务的机会有限。缺乏足够的社会安全网、有限的生计机会、儿童保育支持和照料不足以及季节性男性移徙使母亲和照料者易受伤害，并限制了适当的儿童保育和喂养做法。关于连续护理，将家庭护理与设施联系起来的服务是分散的。母亲和看护者对儿童营养的了解有限以及服务提供的分散导致当地卫生服务的利用有限。政府 FHW 和 MSF 外勤人员对筛查方法、转诊途径和咨询没有深入的了解。此外，在 ATFC 治疗的病例方面，无国界医生和 FHW 之间缺乏合作，扰乱了社区出院病例的跟进过程。对于看护者来说，需要关注儿童营养和出院后医疗保健领域的能力建设。还建议支持被确定患有中度急性营养不良的儿童，以防止他们陷入严重急性营养不良，即使他们没有资格进入 ATFC。社区教育和参与是成功的 CMAM 计划的关键组成部分。无国界医生与 FHW 就 ATFC 治疗的病例缺乏合作，扰乱了社区出院病例的跟进过程。对于看护者来说，需要关注儿童营养和出院后医疗保健领域的能力建设。还建议支持被确定患有中度急性营养不良的儿童，以防止他们陷入严重急性营养不良，即使他们没有资格进入 ATFC。社区教育和参与是成功的 CMAM 计划的关键组成部分。无国界医生与 FHW 就 ATFC 治疗的病例缺乏合作，扰乱了社区出院病例的跟进过程。对于看护者来说，需要关注儿童营养和出院后医疗保健领域的能力建设。还建议支持被确定患有中度急性营养不良的儿童，以防止他们陷入严重急性营养不良，即使他们没有资格进入 ATFC。社区教育和参与是成功的 CMAM 计划的关键组成部分。还建议支持被确定患有中度急性营养不良的儿童，以防止他们陷入严重急性营养不良，即使他们没有资格进入 ATFC。社区教育和参与是成功的 CMAM 计划的关键组成部分。还建议支持被确定患有中度急性营养不良的儿童，以防止他们陷入严重急性营养不良，即使他们没有资格进入 ATFC。社区教育和参与是成功的 CMAM 计划的关键组成部分。