Abstract
BACKGROUND AND OBJECTIVES: Despite some progress made in the fight against malnutrition in Madagascar, hospitals' mortality due to severe acute malnutrition (SAM) remains high. This study explores the risk factors for SAM among children hospitalized with SAM in the Analamanga region of Madagascar. METHODS: We conducted an interview based qualitative study of 14 mothers of under-five children with SAM admitted to the hospital's pediatric unit and living in the Analamanga region. Data were analyzed using thematic analysis method. RESULTS: There were direct, intermediate and basic causes of malnutrition shared with other health care settings. Low health literacy such as limited knowledge and optimistic perception of malnutrition, and lack of health service information resulted in delayed hospital visit for care of SAM. Vulnerable working mothers do not benefit from available community support structure. Mothers are unable to practice what they learned because financial difficulties at the household level occupy their time. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Consideration of vulnerable working mothers' access to existing health services and interventions to address health literacy are important to prevent SAM at the community level. Study findings would be of interest to practitioners and policy makers in the region and perhaps in other resource limited settings.