Samenvatting

Introduction: Malnutrition is a persistent problem in Ghana, with high rates of underweight children, stunting and wasting. One of the NGOs that is trying to turn this situation around is Project Share. Through their nutrition centre, they have already rehabilitated over 300 children since 2009. They are undertaking several educational activities like in-facility education, outreaches and food demonstrations. Built on five years of experience, the supposition rises that beliefs, attitudes and perceptions of the Dagomba women (their main target group) are a major influence on the high prevalence rate. Several practical examples and literature studies show a correlation between a person’s belief system and food intake.
Aim: The organisation wants to know how the beliefs, attitudes and perceptions could be addressed in their educational activities, in a respectful but effective way.
Method: A total of six group discussions have been held in three different villages with both mothers and grandmothers. Furthermore, four in-depth interviews have been held with a mother, a nutritionist and some traditional healers. To get additional information on possible educational approaches, a literature review was performed.
Results: The perception of God’s will and plans seemed to have a large impact on perceived causes and treatment outcomes. This, together with a focus mainly on treatment, led to a certain ignorance towards prevention. In some cases this also led to patients seeking help (too) late or not at all. The two main treatment options were the traditional healers and the modern medicine, which were both seen as valuable and equally important, and would both be tried to find the most successful treatment. Food taboos were not highly extensive or strongly upheld, but personal preference or tolerance seemed to be the guide. The perceived poverty was very high, which, among others, led to a low perceived self-efficacy. The nutrition centre is viewed as a place with experts with means beyond the reach of local people.. Literature showed that it is important to talk about perceptions and beliefs in a constructive, positive, encouraging and empowering way. Several approaches were found that could be useful in addressing beliefs, attitudes and perceptions.
Conclusion: The strong influence of world view and perceptions of God should not be ignored or condemned. Opportunities should be created to discuss beliefs and perceptions. Positive experiences should both be created and used as examples, and mothers of successfully rehabilitated children should be encouraged to share their experience and knowledge with the family and community. The PD/Hearth method could, with some adjustments and additions, form a good foundation to build the educational programmes on.
Implementation: Further (quantitative) research is recommended, supported by case-studies and follow up. A KAP-questionnaire could be used, together with ‘positive deviance inquiries’ and ‘trials of improved practice’ to get more insight into the distribution of beliefs and practices. In the education, a questionnaire could be used to open the discussion and the perceived poverty could be addressed by involving the women in a solution-seeking approach. An ‘ambassadors’-system could be set up by making use of powerful example stories and pictures.