Caregiver perceptions of children's linear growth in Bangladesh: a qualitative analysis.

OBJECTIVE To understand caregivers' perceptions of children's linear growth and to identify the cultural meanings and perceptions of risk associated with poor height attainment. DESIGN Three investigators from Bangladesh conducted twelve focus group discussions. SETTING The study was conducted in rural and slum settings in Bangladesh. SUBJECTS Participants included mothers and alternative caregivers (n 81) who were recruited by household screening. No eligible, recruited subjects refused participation. RESULTS Caregivers reported limited experience with growth monitoring services from the health system. Caregivers mainly use visual cues and developmental milestones to understand if children are growing properly, and recognize that children normally experience both weight gain and linear growth with age. Mothers expressed concern over children's malnutrition and short stature, but did not discuss children's failure to attain a 'growth potential' or distinguish inherited short stature from stunting. Caregivers interpret the consequences of poor height attainment as primarily social and economic and cite few health risks. CONCLUSIONS Linear growth interpretation is determined more by community norms than by guidance from nutrition programming or the health system. Interventions to prevent or reduce linear growth failure may be perceived to have limited value where appropriate linear growth in children is determined by comparison to peers and siblings. Such perceptions may be significant barriers to programmes addressing stunting prevention in settings where many children are stunted. Efforts to raise awareness about the risks of linear growth faltering may need to consider delivering messages to caregivers that emphasize the social and economic consequences of stunting.