Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards

In a previous study we found a very high prevalence of psychological distress in mothers of children admitted to a nutritional rehabilitation unit (NRU) in Malawi, Africa. The objective of this study was to compare the prevalence and severity of maternal distress within the NRU with that in other paediatric wards. Given the known association between poor maternal psychological well-being and child undernutrition in low- and middle-income countries, we hypothesised that distress would be higher among NRU mothers. Mothers of consecutive paediatric inpatients in a NRU, a high-dependency (and research) unit and an oncology ward were assessed for psychological distress using the Self-Reporting Questionnaire (SRQ). Two hundred sixty-eight mothers were interviewed (90.3% of eligible). The prevalence of SRQ score ≥8 was 35/150 {23.3% [95% confidence interval (CI) 16.8- 30.9%]} on the NRU, 13/84 [15.5% (95% CI 8.5-25.0%)] on the high-dependency unit and 7/34 [20.6% (95% CI 8.7-37.9%)] on the oncology ward (χ(2)  = 2.04, P = 0.36). In linear regression analysis, the correlates of higher SRQ score were child diarrhoea on admission, child diagnosed with tuberculosis, and maternal experience of abuse by partner; child height-for-age z-score fell only just outside significance (P = 0.05). In summary, we found no evidence of greater maternal distress among the mothers of severely malnourished children within the NRU compared with mothers of paediatric inpatients with other severe illnesses. However, in support of previous research findings, we found some evidence that poor maternal psychological well-being is associated with child stunting and diarrhoea.

Whose sins do the Brethren confess? The problem of sin as the problem of expiation

Among Brethren fisher families in Gamrie, northeast Scotland, professional clergy and written liturgy are held to be blasphemous denials of the true workings of the Holy Spirit. God, I was told, chooses to speak through all born-again (male) persons, unrestricted by the vain repetitions of lettered clerics and their prayer books. In this context, confession of one’s own sin is a private and pointedly interior affair. In Gamrie, not only did every man seek to be his own skipper, but also his own priest. Yet, much of Brethren worship is given over to ritualised acts of confession. So whose sins do the Brethren confess, and to what end? This article argues that among the Brethren of Gamrie, such acts involve confessing not one’s own sin, but the sins of a ‘sick’ and ‘fallen’ world. More than this, by attending to the sociological (as opposed to theological) processes of confessing the sins of another, we see a collapse in the distinction between confiteor and credo that has so dogged anthropological studies of Christianity. In Brethren prayer and bible study, as well as in everyday gossip, the “I confess” of the confiteor and the “I believe” of credo co-constitute one another in and through evidences of the ‘lostness’ of ‘this present age’. But how, if at all, does this solve ‘the problem of sin’? This article suggests that, with the ritual gaze of confession turned radically outward, Brethren announcements of global wickedness enact (in a deliberate tautology) both a totalising call for repentance from sin, and a millenarian creed of the imminent apocalypse. Here, the problem of ritual can be understood as the problem of (partially failed) expiation.