Barriers to Completion of Facility-based Nutrition Rehabilitation and Treatment of Complicated Cases of Severe Acute Malnutrition Among Pre-school Tribal Children: A Case of Nandurbar, Maharashtra, India

Tribal children in the central tribal belt of India face the highest rates of childhood severe acute malnutrition (SAM) in India. Understanding how this community accesses and navigates treatment for SAM is critical to identifying barriers that delay timely hospital-based nutritional rehabilitation. Hence, the present mixed-methods study aims to examine the patterns of maternal healthcare-seeking throughout the entire care pathway for tribal children under the age of 5 years with complicated SAM in Nandurbar, Maharashtra. The study was conducted among 215 mothers of SAM children aged 6–60 months, with complications, admitted to three hospital-based nutrition rehabilitation centres (NRCs). The study data indicate that admitting SAM children to hospital-based NRCs was more difficult than completing rehabilitation in the hospital itself. Among mothers who could recall the duration ( n = 126), 26.2% of mothers reported an interval greater than 60 days between the first care-seeking from any provider and NRC admission. Treatment-seeking for SAM was constrained by the lack of recognition of relevant symptoms. Multiple-source treatment-seeking was also evident for complicated SAM; 32.7% visited a private practitioner, 34.1% a government facility and 20.6% a traditional healer immediately prior to the NRC admission ( n = 214), contributing to delays. Qualitative data further demonstrated that multiple-source care-seeking is driven by the pursuit of effective treatment, culturally shaped perceptions of symptoms and causation and difficult physical terrain that limits treatment provider options. In the two government NRCs, completion of treatment depended on the timing of admission, the type of NRC setup, and the availability of family support to complete admission. Data also indicate that a culturally tailored strategy with inclusion of local nursing staff or interpreters could reduce dropout rates in government NRCs.