Barriers to child feeding during and after illness in the Democratic Republic of the Congo: Results from a qualitative study through the lens of behavioral science

Abstract

Abstract Objective: For young children experiencing an illness, adequate nutrition is critical for recovery and to prevent malnutrition, yet many children do not receive the recommended quantities of food during illness and recuperation. Our research applied a behavioral science lens to identify drivers of feeding behaviors, including barriers inhibiting caregivers from following the feeding guidelines. Design: In 2021, we conducted qualitative research informed by the behavioral design process. Data from in-depth interviews and observations were analyzed for themes. Setting: Research was conducted in South Kivu, Democratic Republic of the Congo. Participants: Research participants included caregivers of young children, other family members, health workers, and other community members. Results: Five key findings about behavioral drivers emerged: 1) poverty and scarcity impose practical constraints and a cognitive and emotional burden on caregivers; 2) health providers are distracted and discouraged from counseling on feeding during sick visits; 3) a focus on quality and hesitations about quantity obscure benefits of feeding greater amounts of available foods; 4) perceptions of inappropriate foods limit caregivers’ choices; and 5) deference to a child’s limited appetite leads to missed opportunities to encourage them to eat. Conclusions: Each of these behavioral drivers is triggered by one or more addressable features in caregivers’ and health workers’ environment, suggesting concrete opportunities for programs to support caregivers and health workers to improve feeding of young children during illness and recovery. In other settings where these features of the environment are similar, the insights and programming implications are likely to translate.