The Role of Grandmothers and Older Women in the Survival of Children with Kwashiorkor in Urban Accra, Ghana

Abstract

In this article, we present findings from field studies conducted during 1999 and 2002 in Accra, Ghana on the role of Ghanaian grandmothers in the survival of childhood kwashiorkor. Qualitative family interviews were conducted to describe the identification, intervention, and development of malnourished ethnic Ga children. Childhood malnutrition in its various forms continues to be a major cause of mortality and challenges child development in emerging nations such as Ghana. This is generally, but not exclusively, true among the poor. Efforts that promote nutrition education, or dietary intervention, have often failed because intervention requires a more sophisticated understanding of malnutrition than a simplistic relationship to poverty or the lack of available food supplies. We present evidence that survival of protein-caloric malnutrition, kwashiorkor, is directly related to compliance in nutritional rehabilitation programs, and such compliance is associated with collective familial decision making that includes the significant involvement of grandmothers and other senior women within the family.

ACKNOWLEDGMENTS

Our work was conducted with financial support of the College of Health and Human Services of Eastern Michigan University and the Fulbright Program, Commission for the International Exchange of Scholars, U.S. Department of State. We express our gratitude to Professor Edward Garrison of Dine College in New Mexico and Professor Bruce Owusu of the University of Ghana who were instrumental in the 1999 pilot study. The research team included Professor Phyllis Antwi, School of Public Health of the University of Ghana, who participated in the family interviews and helped to design the format and sequencing of questions as well as with methods for consolidation of field notes and observations. Professor Nana Araba Apt, formerly of the University of Ghana and now Dean of Academic Affairs at Ashesi University in Ghana, helped to formulate our understanding of the traditional and emerging roles of older women and, especially, of grandmothers in Ghana. Beatrice Addo, our principal community health nurse, whose base is the Princess Marie Louise Children's Hospital in Accra, and Mr. Frank Ampougah helped in too many ways to list. Finally, three American undergraduate students, Mary Dankwa and Elizabeth Brant, of Eastern Michigan University, and Carlyn Scheinfeld of the University of California, Santa Cruz, participated as research assistants.

Richard L. Douglass is Professor of Health Administration, School of Health Sciences, College of Health and Human Services, Eastern Michigan University; Senior Fulbright Lecturer and Visiting Scholar, School of Public Health, University of Ghana, Legon, Accra, Ghana (2001–2002); and Fulbright Senior Specialist, Ashesi University College, Accra, Ghana (2007). Brenda F. McGadney-Douglass is Associate Professor, Physician Assistant Program, University of Toledo, Health Science Campus, Toledo, OH; Visiting Scholar, School of Social Work, University of Ghana, Legon, Accra, Ghana (2001–2002); and Sessional Lecturer, Department of Social Work, University of Windsor, Faculty of Arts and Sciences, Windsor, Ontario, Canada.

Informed consent research protocol were approved by the Institutional Review Boards of Eastern Michigan University (1999, 2001), Wayne State University (1999), and the University of Ghana Medical School at Korle-Bu (1999). Each family member who was interviewed was paid $20 for his or her participation.

Notes

¹Also in African dialect Kwashiorkor means ‘deposed child’ – referring to a child ‘deposed’ from the mother's breast by a newborn sibling. Food Reference Website: http://www.foodreference.com/html/fkwashiorkor.html

Ghana Ministry of Health. (2001). National health statistics profile. Department of Pathology, Korle Bu Teaching Hospital, Accra, Ghana.

Ghana Human Development Report 2000. (2001). Science, Technology & Human Development, U.N. Development Programme (UNDP), Accra, Ghana. Institute of Statistical, Social and Economic Research (ISSER), University of Ghana.