Nutrition and the Dinka 2010
Childhood Malnutrition and the Dinka
Cultural and social determinants in children under 5 in Tonj South County
Victoria Groves. World Vision, 2010
The findings of this report identify the following cultural characteristics as having a particular influence on levels of nutrition amongst children, pregnant women or lactating mothers in Tonj South County:
- Sharing food
‘Sharing is part of a Dinka’, and the practice of sharing food with neighbours, kin and visitors is practised widely. This practice serves to create and strengthen social relationships, solidify group membership and reinforce social ties. It also acts as an important strategy for accessing food when stores are limited. This practice however, threatens the nutritional status of permanent members of the household by reducing the quantity of food available for permanent members, including children. Targeting food aid is also made particularly difficult as there is a definite discrepancy between the number of persons technically ‘living’ within a household and the actual number of people eating at that household.
- Understanding of nutrition and malnutrition
Local understanding of the connection between diet and health is limited and there is little or no knowledge of the components or the importance of a balanced diet. Explanations of malnutrition are surrounded by traditional, animist beliefs that focus on the need to please the disgruntled spirits of ancestors who are thought to be making children become ‘thin, old-in-the-face, and sick’. These beliefs affect treatment patterns and choices as well as the speed at which health centres or Community Therapeutic Care (CTC)/Community Management of Acute Malnutrition (CMAM) services are sought.
- Hygiene practices and awareness
Poor water quality, sanitation and hygiene practices are widespread in this region with little basic understanding of hygiene or how germs are spread. In cases where there is some understanding and desire for soap, many families are limited in what they can afford to buy and how much access to water they have.
- Cultivation and diet
There are a limited number of crops currently grown in this region. This is due to both a lack of knowledge of other crops and how they are grown, and the limited availability of, and access to, new seedlings. In addition, sporadic conflicts have undoubtedly had a dramatic impact on recent harvests, displacing communities at times traditionally set aside for planting or harvesting. The Dinka staple diet of durra, or sorghum, pounded into a thick porridge accompanied with dried okra, dried fish or meat, ground nuts and water is not nutritionally diverse. Whilst people do eat a varied range of ‘wild fruits’, particularly when food stocks are low, access to them differs significantly between household members and at different times of the year.
- Distribution of food at the household level
At the household level, patterns regarding the distribution of food, including the ways in which food and people are divided into groups and served in a designated order, has an impact on the nutritional status of household members. This can have a particularly negative affect when portion size is gender-biased in adults. Ideally Dinka families will eat three times a day, however the most common coping strategy for dealing with limited food availability is for households to reduce their number of meal times to twice or even one meal per day. As children typically eat with the rest of the household they become particularly vulnerable to malnutrition when this strategy is implemented, as they are physically unable to ingest sufficient quantities of food in one sitting.
- Treatment of illegitimate children
The treatment of illegitimate children amongst the Dinka is highly dependent on the community the child is born into. Different communities will either embrace or stigmatise such children. Some illegitimate children are mistreated physically and others have limited/reduced access to food. Many of the children living on the streets of the big towns are illegitimate children who have run away from home and their communities.
- Cattle camps
Most Dinka children are sent to the cattle camp to be weaned and to ‘forget their mothers’, where their diet is restricted to cow’s milk only, although porridge is sometimes introduced. Microbial contamination of cow’s milk is common and often results in intestinal irritations and infections that lead to diarrhoea, constipation or other illnesses.
- Cultural beliefs and practices of and towards pregnant women, in regards to diet, behaviour and work ethic
Women consistently perform the same daily duties (including walking long distances for water or firewood, pounding sorghum, sweeping the compound and cooking) up until the day of delivery. Diet remains as it was before pregnancy. No supplements in food groups or quantity are made. Pregnant women are also governed by a number of food taboos that limit sources of protein, which is particularly dangerous during the months of the year when cow’s milk is unavailable to supplement this deficiency. The nutritional status of mothers before and during pregnancy is important for the quantity and quality of her milk (specifically in regards to vitamin and mineral content) and the nutritional status and birth weight of new born babies.
- Introduction of water to babies who would otherwise be exclusively breastfeeding
Breastfeeding is typically exclusive of solid foods for children aged 0-6 months, but due to the very hot climatic conditions, water is often introduced before six months. This water tends to be untreated and given from ‘dirty’ jerry cans or cups, thereby exposing young children to pathogens that affect their health and nutritional status.
- Polygamy
Dinka society is polygamous and most men have more than one wife. By having multiple wives men are able to have more children and larger families who can provide security and protection for the household. The number of wives a husband has affects how much time he spends within that household, if he has many wives he will split his time between them, which in turn impacts the quantity of food available for other family members at meal times. It also affects the age at which children are weaned, with children likely to be weaned earlier in households where the husband has fewer wives and spends greater time. Children who are weaned earlier are generally sent to the cattle camps at a younger age where their diet and nutritional intake is potentially restricted. In this instance, polygamy therefore, can have a favourable impact on the nutritional status of children. However, favouritism between wives is also common and can lead to the unequal distribution of a husband’s often limited resources - resources may include cattle or money which in turn impacts the wife’s access to milk and purchasing power – thereby negatively impacting nutritional status.
- Adult education levels
Adult education levels across southern Sudan are particularly low. The significance of a balanced diet, importance and maintenance of hygiene, what to do when your child develops symptoms of an illness and the importance of continuing treatment after symptoms disappear are all areas that are currently not well understood. School attendance rates among Dinka children are unlikely to dramatically increase in times of peace because of the cattle camp culture.
- Migration away from villages to urban centres
People in this region are increasingly moving away from the villages to urban centres in search of paid employment. This represents a cultural shift from traditional subsistence village life to a consumerism mentality where value is placed on receiving a regular income to purchase goods. A lack of job opportunities has led to a perceived increase in cattle-raiding as a means of getting money and threatens family nutrition levels.
- Perceived increase in cattle-raiding and revenge attacks
Rek Dinka are a proud people who aren’t afraid to fight for what they need. It is perceived, though there is no recorded data, that cattle-raiding and revenge attacks have increased in recent months.This has resulted in a pronounced number of displaced persons without reliable access to food.
The report concludes that these cultural practices can and must be targeted in nutrition programming to reduce the levels of childhood malnutrition in the region. The following key recommendations would significantly contribute to effectively tackling malnutrition in children under the age of five years amongst the Rek Dinka in this region:
1. Stronger focus on community mobilisation, education and promotion of behavioural changewithin the current World Vision CTC/CMAM programme. This should include:
- Nutritional education targeted at pregnant and lactating women that emphasises the importance of a balanced diet of adequate proportions during pregnancy and the postpartum period.
- Further nutrition education targeted at men and grandmothers, as the primary caregivers of children at the cattle camps, with nutrition and behaviour change communications.
- Monitoring of Infant and Young Child Feeding (IYCF) principles with emphasis placed on the importance of assisting younger children to eat smaller, more frequent meals.
- Collaboration with village executive chiefs to be explored as a means of disseminating key messages.
- Inclusion of some diet, nutrition and basic hygiene topics to be included in the state curriculum for schools.
2. Greater education component for mothers currently using World Vision CTC/CMAM services and visiting health centres; behaviour change cannot happen unless mothers fully understand what has gone wrong.
3. Further and more comprehensive training for World Vision CTC staff in Tonj South. Local staff must understand the fundamental causes of malnutrition and not just how to weigh andmeasure for the symptoms of it. Local staff are the public voice of World Vision and must lead behavioural change by example.
4. Further research on maternal nutrition status and adult malnutrition prevalence in the region with particular emphasis placed on micronutrient deficiencies.
5. Further anthropological study focused on different sub-clans of Dinka from different regions at different periods of the year is needed to build a fuller understanding of the socio-cultural aspects of malnutrition and the variety of coping mechanism used by the larger Dinka ethnic group. This study offers a valuable insight into the cultural traits of the Rek Dinka in Tonj South County between the months of November and February. It cannot be assumed that all Dinka sub-clans behave in the same way and it must be recognised that behavioural patterns will change at different times of the year.
6. Target key household decision makers as agents of dietary change.
7. Develop and expand current livelihood projects to other regions of Tonj South that go beyond the provision of tools and seeds. Projects should include the promotion of crop diversification, the introduction of different farming methods and irrigation techniques, the introduction of new seeds and crops to the region and the promotion of groups or clubs for women, older males and youths.
8. Develop hygiene promotion campaigns that focus on the basic science of hygiene and disease transmission.
9. Support and partner with government ministries and private organisations to provide a multi-sectoral approach to improving health and nutrition in the region.
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