title: The social context of severe child malnutrition: a qualitative household case study from a rural area of the Democratic Republic of Congo.
abstract: BACKGROUND
  The magnitude of child malnutrition including severe child malnutrition is especially high in the rural areas of the Democratic Republic of Congo (the DRC). The aim of this qualitative study is to describe the social context of malnutrition in a rural part of the DRC and explore how some households succeed in ensuring that their children are well-nourished while others do not.
  
  
  METHODS
  This study is based on participant observation, key informant interviews, group discussions and in-depth interviews with four households with malnourished children and four with well-nourished children. We apply social field theory to link individual child nutritional outcomes to processes at local level and to the wider socio-economic environment.
  
  
  RESULTS
  We identified four social fields that have implications for food security and child nutritional outcomes: 1) household size and composition which determined vulnerability to child malnutrition, 2) inter-household cooperation in the form of 'gbisa work party' which buffered scarcity of labour in peak seasons and facilitated capital accumulation, 3) the village associated with usufruct rights to land, and 4) the local NGO providing access to agricultural support, clean drinking water and health care.
  
  
  CONCLUSIONS
  Households that participated in inter-household cooperation were able to improve food and nutrition security. Children living in households with high pressure on productive members were at danger of food insecurity and malnutrition. Nutrition interventions need to involve local institutions for inter-household cooperation and address the problem of social inequalities in service provision. They should have special focus on households with few resources in the form of land, labour and capital.
authors.affiliation: Centre for International Health, University of Bergen, 5009, Bergen, Norway. hallgeir.kismul@cih.uib.no.
authors.forename: Hallgeir
authors.initials: H
authors.lastname: Kismul
authors.affiliation: Fafo, Box 2947, Tøyen, 0608, Oslo, Norway. Anne.Hatloy@fafo.no.
authors.forename: Anne
authors.initials: A
authors.lastname: Hatløy
authors.affiliation: Department of Geography, University of Bergen, 5020, Bergen, Norway. peter.andersen@geog.uib.no.
authors.forename: Peter
authors.initials: P
authors.lastname: Andersen
authors.affiliation: School of Public Health, University of Kinshasa, Kinshasa 1, Democratic Republic of Congo. mapatanow@yahoo.fr.
authors.forename: Mala
authors.initials: M
authors.lastname: Mapatano
authors.affiliation: Centre for International Health, University of Bergen, 5009, Bergen, Norway. hallgeir.kismul@cih.uib.no.
authors.forename: Jan
authors.initials: J
authors.lastname: Van den Broeck
authors.affiliation: Centre for International Health, University of Bergen, 5009, Bergen, Norway. karen.moland@cih.uib.no.
authors.forename: Karen Marie
authors.initials: KM
authors.lastname: Moland
mesh_terms: D015362:Child Nutrition Disorders / Q000209:etiology*; D002675:Child, Preschool; D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D011634:Public Health; D036301:Qualitative Research; D012423:Rural Health; D064890:Social Determinants of Health