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James S, Moulton JE, Assifi A, Botfield J, Black K, Hanson M, Mazza D. Women's needs for lifestyle risk reduction engagement during the interconception period: a scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:274-281. [PMID: 36849222 DOI: 10.1136/bmjsrh-2022-201699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Unhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women's needs for lifestyle risk reduction engagement during the interconception period. METHODS The JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers' reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach. RESULTS A total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women's self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks. CONCLUSIONS There is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women's preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.
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Affiliation(s)
- Sharon James
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Jessica E Moulton
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Anisa Assifi
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Jessica Botfield
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Kirsten Black
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Hanson
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, UK
| | - Danielle Mazza
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
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Killeen SL, Donnellan N, O'Reilly SL, Hanson MA, Rosser ML, Medina VP, Jacob CM, Divakar H, Hod M, Poon LC, Bergman L, O'Brien P, Kapur A, Jacobsson B, Maxwell CV, McIntyre HD, Regan L, Algurjia E, Ma RC, Adam S, McAuliffe FM. Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals. Int J Gynaecol Obstet 2023; 160 Suppl 1:10-21. [PMID: 36635083 PMCID: PMC10108324 DOI: 10.1002/ijgo.14539] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health-promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.
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Affiliation(s)
- Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Niamh Donnellan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of Health, Universidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | | | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital, University of Toronto, Toronto, Canada
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | | | - Esraa Algurjia
- The World Association of Trainees in Obstetrics & Gynecology, Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Menezes R, Lelijveld N, Wrottesley SV, Brennan E, Mates E, James PT. Integrating Women and Girls' Nutrition Services into Health Systems in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2022; 14:4488. [PMID: 36364750 PMCID: PMC9657561 DOI: 10.3390/nu14214488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 08/16/2023] Open
Abstract
Women's nutrition has been highlighted as a global priority to ensure the health and well-being of both them and future generations. This systematic review summarises the available literature on the integration of nutrition services for girls and women of reproductive age (GWRA) into existing public health systems across low- and middle-income countries, as well as any barriers to integration. We searched PubMed and Cochrane Database of Systematic Reviews for articles published since 2011 according to eligibility criteria. A total of 69 articles were included. Evidence suggested that several services for GWRA are well integrated into public health systems, including antenatal care services, nutrition education and counselling, and micronutrient supplementation programmes. However, there was limited evidence on the integration of family planning, adolescent health, and reproductive health services. Barriers to integration fell into five main themes: lack of training and capacity building, poor multisectoral linkages and coordination, weak advocacy, lack of M&E systems, and inequity. We identified a lack of evidence and services for non-pregnant GWRA and for women postpartum. Addressing barriers to integration and gaps in nutrition services for GWRA would increase service coverage and contribute to improving health outcomes for GWRA and future generations.
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Kavle JA. Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes. Public Health Nutr 2022; 26:1-18. [PMID: 36210775 DOI: 10.1017/s1368980022002129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery. DESIGN A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis. SETTING Low-, middle- and high-income country contexts. PARTICIPANTS Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis. RESULTS Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy. CONCLUSIONS Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.
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Affiliation(s)
- Justine A Kavle
- Kavle Consulting, LLC, 200 Massachusetts Ave NW, Washington, DC20001, USA
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Shaker‐Berbari L, Qahoush Tyler V, Akik C, Jamaluddine Z, Ghattas H. Predictors of complementary feeding practices among children aged 6-23 months in five countries in the Middle East and North Africa region. MATERNAL & CHILD NUTRITION 2021; 17:e13223. [PMID: 34137179 PMCID: PMC8476411 DOI: 10.1111/mcn.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low- and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.
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Affiliation(s)
- Linda Shaker‐Berbari
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Vilma Qahoush Tyler
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Zeina Jamaluddine
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
- London School of Hygiene and Tropical MedicineLondonUK
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
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Implementing a Novel Facility-Community Intervention for Strengthening Integration of Infant Nutrition and Family Planning in Mara and Kagera, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084105. [PMID: 33924578 PMCID: PMC8069723 DOI: 10.3390/ijerph18084105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.
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Pires LA, Junior AF, Chagas CA, Manaia JH, Gameiro VS, Babinski MA. Maternal undernutrition during lactation leads to reduction in skull size and thickness of adult-aged Wistar rats. Arch Med Sci 2021; 17:1093-1099. [PMID: 34336037 PMCID: PMC8314403 DOI: 10.5114/aoms.2020.92433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION It is known that the quality and quantity of milk is directly related to the dietary habits of the mother. Despite that, the rates of maternal malnutrition during lactation are increasing in several countries; thus, observing its effects on the offspring is relevant. The present study aims to verify the effects of maternal malnutrition during breastfeeding on the skulls of adult-aged Wistar rats. MATERIAL AND METHODS Thirty-six newborn rats were divided in three groups: the control group, in which the mother received a regular commercial diet containing 23% protein in unlimited amounts; the protein-energy restriction group, in which the dam received a commercial diet containing 8% protein in unlimited amounts; the energy restricted group, in which the dam received a commercial diet containing 23% of protein in limited amounts. After weaning, all rats received the same diet as the control group until 180 days of age. Then, the rats were euthanized, and their crania were excised and measured in radiographic images. Afterwards, their skull was decalcified with nitric acid (5%) and histological samples were obtained and the thickness of the diploe was verified. Descriptive statistics and ANOVA followed by the Newman-Keuls test were performed for comparison purposes. RESULTS It was observed that the skull from the protein-energy restriction and energy-restriction groups was smaller and thinner than that of the control group in several parameters. CONCLUSIONS Maternal malnutrition during the lactation period caused long-term effects in skull morphology of Wistar rats. These effects could not be reversed after regulation of the diet.
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Affiliation(s)
- Lucas A.S. Pires
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
- Medical Sciences Post Graduation Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Albino Fonseca Junior
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
- Medical Sciences Post Graduation Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | - Jorge H.M. Manaia
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
- Medical Sciences Post Graduation Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Vinicius S. Gameiro
- Medical Sciences Post Graduation Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Marcio A. Babinski
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
- Medical Sciences Post Graduation Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Dietary Knowledge and Myths Vary by Age and Years of Schooling in Pregnant Mexico City Residents. Nutrients 2020; 12:nu12020362. [PMID: 32019156 PMCID: PMC7071333 DOI: 10.3390/nu12020362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/09/2023] Open
Abstract
Pregnancy is a stage in a woman’s life when she is more open to receiving health advice, especially related to diet. However, women are often caught between receiving scientifically unfounded myths and concrete empirical knowledge. Culturally perpetuated myths may be acted upon more than knowledge, but research on these concepts, especially in the Americas, is scarce. This cross-sectional study aimed to describe the frequency of diet and nutrition myths and knowledge and describe the associated factors in pregnant mothers receiving care in Mexico City. A total of 695 pregnant adults and 322 pregnant adolescents participated in this study, in which they responded to a questionnaire on nutrition and diet myths, knowledge, and practice during pregnancy and breastfeeding. The myths were examined individually, but for the purposes of statistical analysis, a score was obtained. We compared means of variables that could be associated to myth and knowledge scores, then calculated linear and logistical regressions. Forty-six percent of participants had below the mean myth scores. Ninety-two percent of participants had a knowledge score below the mean. Age (β = 0.025, SE 0.007, 95% CI 0.011–0.040, p = 0.001) and years of education (β = 0.166, SE 0.024, 95% CI 0.119–0.213, p = 0.001) explained the myth’s score, while age explained the knowledge score (β = 0.011, SE 0.020, 95% CI −0.032–−0.008, p = 0.002). We found that although most women reported not believing in the myths, they acted on them. The probability of practicing such myths as “You must eat for two during pregnancy” was associated with being an adolescent (OR 1.76, p = 0.001) and being married (OR 1.47, p = 0.007), “Not satisfying cravings leave a mark on the infant’s body” with being adolescent (OR 1.59, p = 0.003) and low socioeconomic level (OR 1.41, p = 0.038), “A frightened or angry mother should not nurse her baby” with being adult (OR 2.61, p = 0.004), and “Drinking atole or beer enhances breast milk production” with being single (OR 2.07, p = 0.001). The probability of not acting on some knowledge was associated with being an adolescent (p ≤ 0.003) and having a high school education or below (p ≤ 0.046). Almost all of our participants held at least one myth about nutrition and diet during pregnancy and breastfeeding; younger participants showed a higher frequency of holding myths. Years of schooling and age were associated with acting on myths and not acting on correct knowledge.
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Strengthening counseling on barriers to exclusive breastfeeding through use of job aids in Nampula, Mozambique. PLoS One 2019; 14:e0224939. [PMID: 31790430 PMCID: PMC6886792 DOI: 10.1371/journal.pone.0224939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/24/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction While the Government of Mozambique has galvanized action around exclusive breastfeeding (EBF) as a national priority, only 43% of Mozambican children under six months of age are exclusively breastfed. In the absence of skilled lactation support, challenges mothers experience with breastfeeding may inhibit initiation, exclusivity and duration. There is insufficient evidence on how to strengthen health providers’ competencies to address breastfeeding challenges in low- and middle-income countries. The objectives of this study were to 1) assess EBF challenges, from the perspectives of health providers and mothers; 2) ascertain the quality of health provider counseling to address EBF challenges; and 3) gain an understanding of the usefulness of job aids to improve counseling within routine health contact points in Nampula, Mozambique. Methods This implementation science study was conducted in Meconta and Mogovolas districts, Nampula province, Mozambique from July-November 2018. In Phase 1, 46 in-depth interviews with mothers and providers, and 11 observations of counseling sessions were conducted. In Phase 2, health providers were trained to use three job aids (i.e., facility, community or maternity contacts) to identify and address EBF problems during routine health services. In Phase 3, 30 in-depth interviews with mothers and providers were conducted to assess the experience with job aid use. In both Phase 1 and 3, we conducted a thematic analysis using a grounded theory approach involving a step-wise coding process. Results Poor latch and positioning, perceived insufficient breastmilk and breast engorgement emerged as barriers to EBF. Providers often lacked the knowledge, skillset, and self-efficacy to manage EBF problems, with little counseling provided at community or facility levels. Following job aid rollout, providers reported improved assessment of breastfeeding technique, and increased self-efficacy and motivation to identify and resolve EBF problems. Conclusions Integration of job aids, with clear lactation management guidance, into maternal and child health training curricula and supportive supervision is critical to building providers’ skillsets and competencies to provide quality lactation counseling and support.
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Pérez-Escamilla R, Engmann C. Integrating nutrition services into health care systems platforms: Where are we and where do we go from here. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 1:e12743. [PMID: 30748115 DOI: 10.1111/mcn.12743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Abstract
Integrating maternal-child nutrition into health care services is a desirable but complex task that requires implementation research studies. This special supplement, entitled "How to Strengthen Nutrition into the Health Platform: Programmatic Evidence and Experience from Low- and Middle-Income Countries" presents a collection of mixed-methods research and case studies mostly conducted in sub-Saharan Africa that help us gain a better understanding of the barriers and facilitators for this integration to happen. Collectively, the evidence confirms that integrating nutrition services as part of health care systems and other platforms is feasible, but for that to be successful, there is a need to address strong barriers related to all six key health care systems building blocks identified by the World Health Organization. These include financing, health information systems, health workforce, supplies and technology, governance, and service delivery. Moving forward, it is crucial that more robust implementation science research is conducted within the rough and tumble of real-world programming to better understand how to best integrate and scale up nutrition services across health care systems and other platforms based on dynamic complex adaptive systems frameworks. This research can help better understand how the key health care systems building blocks need to interlock and communicate with each other to improve the policymakers' ability to integrate and scale up nutrition services in a more timely and cost-effective way.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Cyril Engmann
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA.,Maternal, Newborn, Child Health & Nutrition, PATH, Seattle, Washington, USA
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11
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Cooper CM, Kavle JA, Nyoni J, Drake M, Lemwayi R, Mabuga L, Pfitzer A. Perspectives on maternal, infant, and young child nutrition and family planning: Considerations for rollout of integrated services in Mara and Kagera, Tanzania. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 1:e12735. [PMID: 30748120 PMCID: PMC6593746 DOI: 10.1111/mcn.12735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Abstract
In Lake Zone, Tanzania, low contraceptive prevalence, closely spaced births, and child stunting are common. Synergies exist between postpartum family planning (PPFP) and maternal, infant, and young child nutrition (MIYCN), yet health services are often provided in silos. This qualitative formative research study aimed to identify barriers and facilitating factors for optimal nutrition and PPFP practices in Mara and Kagera, Tanzania. Results informed the program design of an integrated nutrition and family planning (FP) implementation approach. The study involved in‐depth interviews with mothers of infants under 1 year (n = 24), grandmothers (n = 12), health providers (n = 6), and traditional birth attendants (n = 12), and 14 focus group discussions with community health workers, fathers, and community leaders. Findings reveal that breastfeeding initiation was often delayed, and prelacteal feeding was common. Respondents linked insufficient breast milk to inadequate maternal nutrition—in terms of the quality of the diet and small quantities of food consumed by mothers. Breast milk insufficiency was addressed through early introduction of foods and liquids. Mothers believed that breastfeeding prevents pregnancy, regardless of the frequency or duration of breastfeeding, yet were generally not aware of the lactational amenorrhea method (LAM) of FP. Joint decision‐making on FP was viewed as important, and women often discussed it with their partner. Future programming should address misconceptions about return to fecundity1 knowledge gaps and concerns about FP methods including LAM; and perceptions regarding insufficient breast milk and early introduction of foods which are impediments to optimal MIYCN and FP practices.
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Affiliation(s)
- Chelsea M Cooper
- USAID's Maternal and Child Survival Program/Jhpiego, Washington, DC, USA
| | - Justine A Kavle
- USAID's Maternal and Child Survival Program/PATH, Washington, DC, USA
| | - Joyce Nyoni
- The Department of Sociology and Anthropology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Mary Drake
- USAID's Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
| | - Ruth Lemwayi
- USAID's Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
| | - Lemmy Mabuga
- USAID's Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
| | - Anne Pfitzer
- USAID's Maternal and Child Survival Program/Jhpiego, Washington, DC, USA
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Kidd M, Hnatiuk M, Barber J, Woolgar MJ, Mackay MP. "Something is wrong with your milk": Qualitative study of maternal dietary restriction and beliefs about infant colic. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:204-211. [PMID: 30867180 PMCID: PMC6515974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate new mothers' perceptions about the role of maternal diet in infant fuss-cry behaviour, and to explore patterns of food restriction in breastfeeding women. DESIGN Qualitative study. SETTING Calgary, Alta. PARTICIPANTS Twenty-one mothers of healthy singleton infants aged 6 months and younger. METHODS Focus groups and one-on-one interviews with a semistructured interview guide, followed by content analysis. MAIN FINDINGS Most respondents believed that infant cry-fuss behaviour was related to abdominal pain linked to feeding and had eliminated items from their diet in an attempt to change infant behaviour. Typical targets of elimination were caffeine, cruciferous vegetables (eg, broccoli and cabbage), garlic and onions, spicy foods, gluten, and beans. Women commonly viewed elimination diets as an extension of neutral or benign choices made during pregnancy, even when it led to extreme diet restrictions. Participants reported feeling appraised by society for their infant-feeding choices, and often harshly judged. Many women reported feeling confused by conflicting sources of reliable information on breastfeeding and preferred advice from trusted friends and family to that from health care providers or the Internet. CONCLUSION The breastfeeding women in this study believed that maternal diet influenced infant cry-fuss behaviour, in spite of scientific evidence demonstrating the contrary. An understandable desire for a calm baby, as well as to be favourably judged by friends and family, can drive breastfeeding women to restrict their diet, often to the point of hardship.
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Affiliation(s)
- Monica Kidd
- Family physician whose scope of practice includes intrapartum care in Calgary, Alta.
| | | | - Jocelyn Barber
- Family medicine resident at the University of Saskatchewan in Saskatoon
| | | | - Maria Palacios Mackay
- Adjunct researcher at the University of Calgary and Dean of the Faculty of Health Sciences at Universidad San Sebastián in Chile
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Kavle JA, Mehanna S, Khan G, Hassan M, Saleh G, Engmann C. Program considerations for integration of nutrition and family planning: Beliefs around maternal diet and breastfeeding within the context of the nutrition transition in Egypt. MATERNAL & CHILD NUTRITION 2018; 14:e12469. [PMID: 28597475 PMCID: PMC6866077 DOI: 10.1111/mcn.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
In Egypt, rising maternal overweight and obesity is consistent with the transition to westernized diets and a growing reliance on energy-dense, low nutrient foods. Although the first 1,000 days of life are the focus of many programmes designed to prevent many forms of malnutrition, little attention has been paid to maternal dietary practices and weight gain during pregnancy. This study used in-depth interviews with pregnant women (N = 40), lactating women (N = 40), and nonlactating women (N = 40) to gain an understanding of behaviours, perceptions, and cultural beliefs in relation to maternal dietary intake during pregnancy, lactation, and nonlactation; weight gain during pregnancy; birth spacing; and family planning. Study findings reveal that food choice was driven by affordability, favoured foods, or foods considered appropriate for a specific life stage (pregnant, lactating, and nonlactating). Knowledge of weight gain during pregnancy is limited, especially with regards to excessive weight gain during pregnancy. Diet is often modified during lactation to support breast milk production, and a normal diet resumed when breastfeeding ceases. Within the context of breastfeeding, the lactational amenorrhea method provides an opportunity to improve exclusive breastfeeding practices, maternal diet during lactation, and the transition to other family planning methods by 6 months postpartum. Health care providers should discuss limiting maternal consumption of low nutrient foods such as junk foods, soda, and teas during pregnancy and postpartum. Dietary counselling should accompany information on appropriate weight gain during pregnancy and exercise to prevent excessive weight gain, in the context of the nutrition transition.
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Affiliation(s)
- Justine A. Kavle
- Maternal and Child Survival Program (MCSP)Washington, DCUSA
- Maternal, Newborn, Child Health and NutritionPATHWashington, DCUSA
- Department of Prevention and Community Health, Milken Institute School of Public HealthGeorge Washington UniversityWashington, DCUSA
| | - Sohair Mehanna
- Social Research CenterAmerican University in CairoCairoEgypt
| | - Ghada Khan
- Department of Prevention and Community Health, Milken Institute School of Public HealthGeorge Washington UniversityWashington, DCUSA
| | - Mohamed Hassan
- Social Research CenterAmerican University in CairoCairoEgypt
| | - Gulsen Saleh
- National Nutrition Institute of EgyptCairoEgypt
- SMART Project Maternal and Child Health Integrated Program (MCHIP)CairoEgypt
| | - Cyril Engmann
- School of Public Health Global HealthUniversity of WashingtonSeattleWashingtonUSA
- School of Medicine PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Maternal, Newborn, Child Health and NutritionPATHSeattleWAUSA
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