Co-SAM, funded by the National Institute for Health and Care Research, UK (NIHR), aims to define causal pathways underlying recovery from complicated SAM, particularly in children with comorbidities such as HIV, and to develop and test multimodal interventions addressing the biological and social factors preventing convalescence, to ensure that all children can survive and thrive. The project brings together two networks of researchers from southern (Zvitambo – Zimbabwe, TROPGAN – Zambia) and east Africa (CHAIN Network – Kenya) with extensive experience of SAM.
The Home Environment work package, which is covered in these reports, builds upon previous work which documents that recovery from SAM requires a conducive home environment to promote nutritional rehabilitation (Kabongo et al., 2021). However, children are routinely discharged back to home environments characterised by economic precarity, entrenched poverty, food insecurity and hunger, which are root causes of SAM. Caregivers themselves are often contending with the effects of living with HIV, including shame and stigma, as well as with other chronic health conditions, including depression.
Female caregivers may lack decision-making autonomy within their households because of gendered and generational social relations and are at risk from gender-based violence. They often undertake seasonal and/or risky employment (e.g., sex work) to sustain themselves and their children. Mothers living in such precarious economic and social circumstances are often highly mobile within and between urban and rural areas, but the spatial and temporal mobility of children may differ due to extended networks of carers.
Recognising the impact of multiple social and environmental determinants on the context in which child convalescence occurs, a ‘rapid appraisal’ has been undertaken across the three countries. The rapid appraisal technique has been readily adapted to the kinds of contexts we are working in and is widely used as a cost-effective tool for providing a quick assessment of local conditions and for informing the design of subsequent interventions. The rapid appraisal was co-ordinated across the three countries, with local social scientists and trained lay workers undertaking the research at each site. A mixed-method approach has been deployed, with some variation across each of the study sites, combining: Baseline survey, Household observation and semi-structured interviews, and Focus Groups Discussions.
The two reports present project findings taken from the Zimbabwean study site in Harare.
Professor Tim Brown 