Beliefs, attitudes and behaviours of pregnant women in Bali

Intervention Effects in Using an Application Compared with a Module with Pictures on Knowledge, Attitude, and Practice of the Pregnant Women in North Sumatra, Indonesia

BACKGROUND: Pregnancy period is a crucial period for the maternal and infant health. Unfortunately, there are still many pregnant women having low knowledge, attitude, and practice (KAP). Meanwhile, the advanced technology and the occurrence of pandemic should have created change toward the method to provide education. AIM: This research aims to compare the KAP of the pregnant women provided by an application with those provided with a module with pictures. METHODS: This research was conducted in Deli Serdang Regency, North Sumatera Province. There were two groups of pregnant women, each of which consists of 32 people chosen from the pregnant women registered in two Public Health Centers. One group used the application and the other used the module with pictures. After 3 months, the KAP of those two groups was measured in accordance with the content of the module. RESULTS: Those two groups had the profile of the same age and education, but their occupation was different, where the application users were mostly housewives, while the most of the module users were self-employed. The pregnant women using the application had a higher KAP than the pregnant women using the module with pictures. CONCLUSION: The use of the application and the module with pictures is an important alternative to increase the KAP of the pregnant women.

Heat loss responses at rest and during exercise in pregnancy: A scoping review

BACKGROUND

The teratogenic risk associated with maternal hyperthermia (i.e., core temperature ≥39.0 °C) has been a crucial motive in understanding thermoregulatory responses in pregnancy. To date, a substantial number of studies have focused on core temperature responses in a wide range of exercise intensities, duration, and ambient temperatures. Fortunately, none have reported core temperatures exceeding 39.0 °C. Nonetheless, there are limited studies that have provided substantial insight into both dry and evaporative heat loss mechanisms involved in facilitating the maintenance of core temperature (≥39.0 °C) during heat stress in pregnant women. The purpose of this scoping review was to summarize the available literature that has assessed heat loss responses in studies of human pregnancy.

METHODS

A search strategy was developed combining the terms pregnancy, thermoregulation, and adaptation. A systematic search was performed in the following databases: PubMed, Embase, Scopus, and ProQuest. Studies eligible for inclusion included pregnant women between the ages of 18-40 years old, and at least one measurement of the following: sweating, blood flow, skin temperature, and behavioural responses. Retrieved data were categorized as evaporative (sweating), dry or behavioural heat loss responses and summarized narratively.

RESULTS

Thirty-three studies were included in this review (twenty-nine measured physiological responses and four measured behavioural responses). Studies suggest that during exercise, evaporative (sweating) and dry (skin blood flow and temperature) heat loss responses increase from early to late pregnancy in addition to greater cardiac output, blood volume and reduced vascular resistance. Behavioural practices related to heat loss responses are also influenced by cultural/religious expectations, personal preferences and sociodemographics.

CONCLUSION

The findings from this review suggest that pregnancy modifies evaporative (sweating), dry and behavioural heat loss. However, future studies have an opportunity to compare heat loss measurements accounting for gestational weight gain and thermal sensation/comfort scale to associate physiological responses with perceptual responses across pregnancy.

Sources of nutrition information for Indonesian women during pregnancy: how is information sought and provided?

OBJECTIVE

Adequate and appropriate nutrition education is expected to contribute towards preventing risk of child stunting and maternal overweight/obesity. Understanding women's information-seeking behaviours is an important key step for health professionals and departments of health in order to improve the development of optimal and targeted nutrition education during pregnancy. This study investigated the experience of Indonesian women in seeking and receiving nutritional information during pregnancy and its relationship to women's socio-demographic and pregnancy characteristics.

DESIGN

An online cross-sectional study.

SETTING

Malang City, Indonesia.

PARTICIPANTS

Women who had given birth within the past 2 years (n 335).

RESULTS

All women in this study sought or received food and nutrition information from multiple sources, including social and health professional contacts and media sources. The women frequently discussed nutrition issues with their family, particularly their husband (98·2 %) and mother or mother-in-law (91·6 %). This study identified four groups of sources based on women's search habits. Women from high socio-economic strata were more likely to discuss food and nutrition issues or received nutrition information from obstetricians, their family or online sources (adjusted R2 = 26·3 %). Women from low socio-economic strata were more likely to receive nutrition information from midwives, health volunteers or Maternal and Child Health books (adjusted R2 = 14·5 %).

CONCLUSIONS

A variety of nutrition information sources needs to be provided for women from different socio-economic strata. Involvement of family members in antenatal nutrition education may improve the communication and effectiveness of young mothers' dietary and nutrition education.

Health-Seeking Behavior of People in Indonesia: A Narrative Review

This review aims to locate existing studies on health-seeking behavior of people in Indonesia, identify gaps, and highlight important findings. Articles were retrieved from Medline, Scopus, Web of Science, Academic Search Complete (via Ebsco), and ProQuest with a number of key words and various combinations. Articles from Indonesian journals were also searched for with Google Scholar. A total of 56 articles from peer-reviewed journal databases and 19 articles from Indonesian journals were reviewed. Quantitative designs were applied more frequently than qualitative, and mixed methods designs were used in some studies. The majority gathered retrospective information about people's behaviors. Communicable diseases and maternity care were the most frequently studied conditions, in contrast to noncommunicable diseases. In terms of geographical distribution, most research was conducted on Java island, with very few in outside Java. Important findings are a model of Indonesian care-seeking pathways, an understanding of determinants of people's care choices, and the role of sociocultural beliefs. The findings from this narrative review provide insight to what and how Indonesians make decisions to manage their illness and why. This makes an important contribution to understanding the problem of underutilization of medical services despite the government's extensive efforts to improve accessibility.

Factors affecting maternal nutrition and health: A qualitative study in a matrilineal community in Indonesia

The Minangkabau people of West Sumatra in Indonesia are renowned for their matrilineal culture with property and land passing down from mother to daughter. Despite there being a fairly balanced social status for women in the community, the impact of health inequalities is uneven. This study was therefore carried out to explore the relationship between the social, cultural and economic contexts in such a distinctive community with maternal nutrition and pregnancy-related health outcomes, from the perspectives of the mothers, fathers and care providers. Qualitative methods were used to undertake this study in collaboration with partners from the University of Andalas in a suburban area of Padang district. The data collection method was qualitative, semi-structured interviews (n = 19) with women, men, midwives and community health workers. The data were recorded with informed consent, transcribed in the local language and then translated into English prior to being thematically analysed. The major themes which emerged from the data included ‘Minangkabau matrilineality and role of women’; ‘culture and supportive attitude towards pregnant women’; ‘dietary patterns, attitude and access to food’; and ‘limited access to information about food and nutrition’. The findings showed healthy dietary patterns such as regular consumption of vegetables and fruit among the participants. However, the issues of poverty, access to food, dietary taboos and inadequate nutritional information remained major challenges for the mothers and the families who participated in the study. The evidence from this study suggests that the matrilineal culture of the Minangkabau promotes the empowerment of women and offers an encouraging environment for enhancing reproductive health. This lends itself to co-developing locally sensitive and sustainable complex interventions incorporating professional support and building on family and community back-up, enhancing knowledge and demystifying dietary misinformation to improve maternal health and nutrition.

Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies.   

Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking.

Results: A total of 159 observational and qualitative studies met the inclusion criteria. The review of observational and qualitative studies identified social, cultural and health services factors that contribute to delays in health care seeking, and influence decisions to seek care. Timely recognition of danger signs, availability of finances to arrange for transport and affordability of health care cost, and accessibility to a health facility were some of these factors.

Conclusions: Effective dealing of factors that contribute to delays in health care seeking would lead to significant improvements in mortality, morbidity and care seeking outcomes, particularly in countries that share a major brunt of maternal and newborn morbidity and mortality.

Registration: PROSPERO CRD42012003236.

Animal-based food taboos during pregnancy and the postpartum period of Southeast Asian women - A review of literature

This paper gives an overview of the various taboos on animal products and the reasons behind such practices among women in the member countries of the Association of Southeast Asian Nations (ASEAN), while they are pregnant, during their postpartum period, and while breastfeeding. Three data search engines, Google® Scholar, PubMed and Scopus, were used one after the other, to generate the papers for this review. The online searches using the term food taboo, its synonyms, and truncations, in combination with the terms pregnancy, postpartum, and breastfeeding, and with the country name, were conducted from January to February 2017. In total, 28 papers were pooled and included in this review. The taboos and the justification for avoidance were collated and grouped per their occurrence, and according to the country where they are practiced. Nine papers provided information on the food taboos during pregnancy, 16 on postpartum food taboos, and six on breastfeeding. The food taboos included various river or seafood, meat from terrestrial animals, and derived products like fish paste, blood and internal organs. Healthcare providers should be aware of the food taboos being adhered to in the region to provide the right information and guidance to the women practicing them. There is a need to educate the public in general, and women, in particular, about the risk of malnutrition when food taboos are followed, and to support their nutritional requirements during pregnancy and the postpartum period by promoting dietary diversification. More research could be conducted to fill in the gap in information with regards to the food taboos and their impact in some of the ASEAN members. Culture-sensitive health interventions based on timely research work can contribute to the attainment of the sustainable development goal of reducing the maternal and under-five mortality ratios in Southeast Asia.

Determinants of dietary practices during pregnancy: A longitudinal qualitative study in Niger

Undernutrition is associated with maternal morbidity and poor pregnancy outcomes. This qualitative study seeks to understand the multilevel factors influencing maternal dietary practices in Niger, including the impact of pregnancy illnesses on diet. Criterion-based, purposive sampling was used to select pregnant women and household members from 24 villages in a rural district of the Maradi Region in south-central Niger. Semistructured interviews (n = 153) and focus group discussions (n = 38) explored 4 primary themes: (a) perceptions of ideal diet during pregnancy, (b) barriers to consuming the ideal diet, (c) coping strategies including dietary responses related to pregnancy illnesses, and (d) changes in perceptions from early to late pregnancy. Longitudinal data collection allowed for repeated interviews of pregnant women to document changes in dietary practices throughout pregnancy. Transcripts were coded using an inductive approach informed by grounded theory methodology. Participants categorized foods into 4 primary dietary taxonomies when discussing ideal maternal diets but cited constraints related to accessibility and availability impeding routine consumption of these foods. Perceptions of "modern," urban foods as healthy, coupled with key structural barriers such as food costs, were identified. Maternal morbidity influenced food consumption, as women reported reducing food intake early in pregnancy in response to illness episodes. Although awareness of optimal foods for supporting healthy pregnancies was moderately high, some misconceptions were observed and multilevel barriers to food security restricted opportunities for consuming these foods. Nutrition-specific and nutrition-sensitive interventions could improve access and availability of acceptable foods for supporting increased dietary intake during pregnancy.

Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: a systematic review of qualitative studies

BACKGROUND

The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process.

METHODS

Seven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995-2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives.

RESULTS

A total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified (n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines (n = 3), and micronutrient supplements (n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys.

CONCLUSIONS

Pregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies' and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women's health care choices including CMP use.

Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women

In order to inform large scale supplementation programme design, we review and summarize the barriers and enablers for improved coverage and utilization of iron and folic acid (IFA) supplements by pregnant women in 7 countries in Africa and Asia. Mixed methods were used to analyse IFA supplementation programmes in Afghanistan, Bangladesh, Indonesia, Ethiopia, Kenya, Nigeria, and Senegal based on formative research conducted in 2012–2013. Qualitative data from focus‐group discussions and interviews with women and service providers were used for content analysis to elicit common themes on barriers and enablers at internal, external, and relational levels. Anaemia symptoms in pregnancy are well known among women and health care providers in all countries, yet many women do not feel personally at risk. Broad awareness and increased coverage of facility‐based antenatal care (ANC) make it an efficient delivery channel for IFA; however, first trimester access to IFA is hindered by beliefs about when to first attend ANC and preferences for disclosing pregnancy status. Variable access and poor quality ANC services, including insufficient IFA supplies and inadequate counselling to encourage consumption, are barriers to both coverage and adherence. Community‐based delivery of IFA and referral to ANC provides earlier and more frequent access and opportunities for follow‐up. Improving ANC access and quality is needed to facilitate IFA supplementation during pregnancy. Community‐based delivery and counselling can address problems of timely and continuous access to supplements. Renewed investment in training for service providers and effective behaviour change designs are urgently needed to achieve the desired impact.

Eating practices during pregnancy: perceptions of select Maasai women in Northern Tanzania

Background

Globally, pregnant women are challenged to meet sufficient and necessary dietary intake in order to improve maternal and neonatal outcomes. These challenges are amplified in traditional communities, such as the Maasai, where the historical and cultural practices may further curtail, or impact on this dyad’s potential success. The research is intended to enhance understanding of Maasai women’s pregnancy and nutrition traditions as well as their beliefs.

Method

Interviews with 12 pregnant Maasai women, all originally from the (Ngorongoro Conservation Area Authority NCAA) area and have spent most or all of their adult lives in the NCAA, sought to answer two research questions: how do these women describe their current dietary pattern and what do they believe is the role of nutrition during pregnancy.

Results

Interpretive description methodology was used to reveal five themes: (1) Eating less food makes baby come easier, (2) Not producing food means more dependence, (3) Working hard harms my baby, (4) Knowing what is needed for a good pregnancy and (5) Preferring our traditional ways for pregnancy and birth.

Conclusions

There is an imperative to address nutrition throughout the perinatal period within the Maasai population and the women recognize how important nutrition is for them and their babies. Opportunities to incorporate cultural values and practices must be embedded in programmes/services to achieve success and sustainability. It is important for future prenatal programming with the Maasai in northern Tanzania and other vulnerable groups of pregnant women to build on the women’s knowledge of what leads to good pregnancy outcomes.

Experiences and perceptions of Ghanaian midwives on labour pain and religious beliefs and practices influencing their care of women in labour

Background

Beliefs surrounding pain during childbirth has biblical foundations that contribute to labour pain being viewed as a natural phenomenon. Contemporary health care promotes evidence-based labour pain management but the faith of the midwife may influence her midwifery practice regarding labour pain management. Therefore this study sought to gain in-depth insight into the experiences and perceptions of midwives regarding labour pain and the religious beliefs and practices influencing their care of women in labour in Ghana.

Methods

The design of the study was an interpretive phenomenology using individual in-depth interviews. The study participants were 27 Ghanaian female midwives of various religious backgrounds. Interviews were conducted in English, audio-taped and transcribed verbatim. Colaizzi’s qualitative analysis procedures were employed concurrently with data collection.

Results

Three major themes were generated: religious beliefs about labour pain, religious practices in labour and religious artefacts used in labour. The midwives’ faith and their experiences during their midwifery practice were inter-connected. The midwives believed labour pain was natural and religious practices are important to prevent complications. Religious artefacts used in labour included anointing oil and water, necklaces, rubber bands, bracelets, stickers and beads.

Conclusion

It is important that midwives provide an enabling environment for women in labour to practice their faith and they should employ context-appropriate strategies to effectively manage labour pain that takes into account the religious beliefs and practices of women.

Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries

BACKGROUND

The perinatal period, i.e. pregnancy, childbirth and early infancy, is a significant transition period where the biological and the social strongly intersect. In low and middle-income countries the disease burden arising from the perinatal period, is still substantial. The perinatal period is also a crucial window of opportunity for reducing undernutrition and its long term adverse effects.

METHODS

We explored qualitative research conducted in low resource settings around the perinatal continuum over the past two decades, with a particular focus on the 'cultural' realm, to identify common themes influencing maternal and infant nutrition. We systematically searched electronic databases from 1990 to 2014, including MEDLINE, EMBASE, PsycINFO, Scopus and Cumulative Index to Nursing and Allied Health Literature, using relevant search terms including traditional beliefs, practices, pregnancy, childbirth, developing countries etc. Adapted Consolidated Criteria for Reporting Qualitative Health Research and Critical Appraisal Skills Programme criteria were used to determine quality of studies. We synthesised the literature thematically, enabled by NVivo 10 software.

RESULTS

Most studies showed cultural support for breastfeeding, although most traditional societies delayed breastfeeding due to colostrum being considered 'dirty'. A range of restrictive practices through pregnancy and the post- partum period were revealed in Asia, Latin America and Africa. There was a strong cultural understanding of the healing power of everyday foods. A wide range of good foods and bad foods continued to have currency through the perinatal continuum, with little consensus between groups of what was beneficial versus harmful. Cross-cutting themes that emerged were 1) the role of the woman/mother/wife as strong and good; 2) poverty restricting women's nutrition choices; 3) change being constant, but the direction of change unpredictable.

CONCLUSIONS

A rich and diverse repertoire of cultural practices and beliefs influenced perinatal nutrition. Results from this synthesis should influence public health policymakers and practitioners, to tailor contextually specific, culturally responsive perinatal nutrition interventions to optimise health and wellbeing of mother-infant dyads. Ideally these interventions should build on culturally sanctioned life affirming behaviours such as breastfeeding, promoting post-partum rest and recovery, while modifying the potentially harmful aspects of other cultural practices in the perinatal period.

LOCAL GOVERNMENT AND COMMUNITY LEADERS' PERSPECTIVES ON CHILD HEALTH AND MORTALITY AND INEQUITY ISSUES IN RURAL EASTERN INDONESIA

Since 2001 a decentralization policy has increased the responsibility placed on local government for improving child health in Indonesia. This paper explores local government and community leaders' perspectives on child health in a rural district in Indonesia, using a qualitative approach. Focus group discussions were held in May 2013. The issues probed relate to health personnel skills and motivation, service availability, the influence of traditional beliefs, and health care and gender inequity. The participants identify weak leadership, inefficient health management and inadequate child health budgets as important issues. The lack of health staff in rural areas is seen as the reason for promoting the use of traditional birth attendants. Midwifery graduates and village midwives are perceived as lacking motivation to work in rural areas. Some local traditions are seen as detrimental to child health. Husbands provide little support to their wives. These results highlight the need for a harmonization and alignment of the efforts of local government agencies and local community leaders to address child health care and gender inequity issues.

Maternal use of probiotics during pregnancy and effects on their offspring's health in an unselected population

Probiotics are used by women in the perinatal period and may improve balance of microbiota, with possible health benefits for both mother and baby. Characteristics and (health) behaviour patterns of mothers using probiotics during pregnancy, and health effects on their offspring, were investigated. Differences between mothers using probiotics during pregnancy and those who did not, were assessed. In total, 341 out of 2491 (13.7%) mothers reported use of probiotics during pregnancy. There were no significant differences in maternal features (gestation, age, ethnicity, education) between users and non-users. Logistic regression analyses showed that consumption of probiotics was significantly associated with use of homeopathic products [odds ratio (OR) 1.65, 95% confidence interval (CI) 1.17-2.33, p = 0.005], maternal history of smoking (OR 1.72, 95% CI 1.25-2.37, p = 0.001) and paternal history of smoking (OR 1.39, 95% CI 1.01-1.89, p = 0.05). Common disease symptoms during the first year of life in the offspring did not differ between both groups.

CONCLUSION

The use of probiotics or other health-related products without doctor's prescription during pregnancy might point to compensation for types of less favourable behaviour. Probiotic use during pregnancy does not seem to induce positive health effects in the offspring in an unselected population.

WHAT IS KNOWN

Aberrant microbiota compositions have been detected during critical periods when early programming occurs including pregnancy and early neonatal life. Probiotics modulate intestinal microbiota composition and are associated with positive health effects.

WHAT IS NEW

The use of probiotics or other health-related products without doctor's prescription during pregnancy is associated with and might point to compensation for types of less favourable behaviour. Probiotic use during pregnancy does not induce positive health effects in the offspring in this unselected population.

A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives

BACKGROUND

Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with anaemia in Public Health Centres.

METHODS

We conducted a qualitative study with semi-structured face to face interviews from November 2011 to February 2012 with 23 nurse-midwives in five districts in Yogyakarta Special Province. Data analysis was thematic, using the constant comparison method, making comparison between participants and supported by ATLAS.ti software.

RESULTS

Twelve nurse-midwives included in the interviews had less than or equal to 10 years' working experience (junior nurse-midwives) and 11 nurse-midwives had more than 10 years' working experience (senior nurse-midwives) in Public Health Centres. The senior nurse-midwives mostly worked as coordinators in Public Health Centres. Three main themes emerged: 1) the lack of competence and clinical skill; 2) cultural beliefs and low participation of family in antenatal care programme; 3) insufficient facilities and skilled support staff in Public Health Centres. The nurse-midwives realized that they need to improve their communication and clinical skills to manage pregnant women with anaemia. The husband and family involvement in antenatal care was constrained by the strength of cultural beliefs and lack of health information. Moreover, unfavourable work environment of the Public Health Centres made it difficult to apply antenatal care the pregnant womens' need.

CONCLUSIONS

The availability of facilities and skilled staffs in Public Health Centre as well as pregnant women's husbands or family members contribute to the success of managing anaemia in pregnancy. Nurse-midwives and pregnant women need to be empowered to achieve the optimum result of anaemia management. We recommend a more comprehensive approach in managing pregnant women with anaemia, which synergizes the available resources and empowers nurse-midwives and pregnant women.

Advocate program for healthy traditional houses, Ume Kbubu, in a Timor community: preserving traditional behavior and promoting improved health outcomes

Families in the Timor society of Indonesia have customarily used traditional houses, called Ume Kbubu, for confinement practices of a newborn baby and the mother during the first 40 days after birth. The practice, known as Sei (smoke) tradition, involves retaining heat, which is believed to foster healing, inside the house by continuously burning a wood burning stove. Exacerbated by inadequate ventilation in the traditional house, this practice results in poor indoor air quality and negatively affects the health of the mother and baby. Preliminary findings from a baseline study conducted in 2009 identified high levels of indoor air pollution in Ume Kbubu where mothers practiced the Sei tradition. Many respondents expressed that they suffered from respiratory health problems during the practice. On the basis of those results, a follow-up study was conducted in 2011 to develop and test a communication-focused behavior change intervention that would foster conversion of traditional houses into healthy Ume Kbubu and promote changes to traditional practices for better health outcomes. The study suggests that redesigning an Ume Kbubu house could promote better air quality inside the house and involving the community in the health intervention program led to positive changes in the Sei practice (i.e., decreasing the Sei period's length from 40 days to 4 days on average and attempting to reduce household air pollution). The study resulted in several recommendations in relation to sustained transformation to improve health behaviors.

Maternal Experiences of Their Unborn Child's Spiritual Care: Patterns of Abstinence in Iran

Preparing for pregnancy and childbirth has significant association with spirituality. Review of the literature shows that the spirituality of the "unborn child" has not yet attracted much critical attention. This study was conducted with the aim of exploration of maternal behaviors associated with the spiritual health of the unborn child. A qualitative approach was used to investigate the research question. Twenty-seven in-depth unstructured interviews were conducted with 22 Iranian mothers in Tehran city (Iran) who were pregnant or had experienced pregnancy in 2012-2013. Data analysis was carried out using a conventional content analysis approach. "Refusing to eat forbidden food," "Overcoming mental adversity," "Regulating one's social interactions," "Preventing the effects of harmful environments on the senses," "Avoidance of using insulting and abusive language," "Keeping one's mind and spirit free from evil traits," and "Refraining from damaging behaviors" were important experiences that the mothers used for "Holistic Abstinence." The results provide new information about the subjective experiences of Iranian women on the patterns of abstinence for the midwives, research community, policy makers, and planners of maternal and child health care services in order to contribute to holistic, culturally, and religiously competent prenatal care for Muslim pregnant women throughout the world.

Newborn care in Indonesia, Lao People's Democratic Republic and the Philippines: a comprehensive needs assessment

Background

Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People’s Democratic Republic (PDR) and the Philippines.

Methods

We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns’ health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival.

Results

Main findings: (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable.

Conclusions

Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.

Health and nutrition knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics in Western Kenya: a cross-sectional analysis

Background

Antenatal care (ANC) is a key strategy to decreasing maternal mortality in low-resource settings. ANC clinics provide resources to improve nutrition and health knowledge and promote preventive health practices. We sought to compare the knowledge, attitude and practices (KAP) among women seeking and not-seeking ANC in rural Kenya.

Methods

Data from a community-based cross-sectional survey conducted in Western Province, Kenya were used. Nutrition knowledge (NKS), health knowledge (HKS), attitude score (AS), and dietary diversity score (DDS) were constructed indices. χ² test and Student’s t-test were used to compare proportions and means, respectively, to assess the difference in KAP among pregnant women attending and not-attending ANC clinics. Multiple regression analyses were used to assess the impact of the number of ANC visits (none, <4, ≥4) on knowledge and practice scores, adjusting for maternal socio-demographic confounders, such as age, gestational age, education level and household wealth index.

Results

Among the 979 pregnant women in the survey, 59% had attended ANC clinics while 39% had not. The mean (±SD) NKS was 4.6 (1.9) out of 11, HKS was 6.2 (1.7) out of 12, DDS was 4.9 (1.4) out of 12, and AS was 7.4 (2.2) out of 10. Nutrition knowledge, attitudes, and DDS were not significantly different between ANC clinic attending and non-attending women. Among women who attended ANC clinics, 82.6% received malaria and/or antihelmintic treatment, compared to 29.6% of ANC clinic non-attendees. Higher number of ANC clinic visits and higher maternal education level were significantly positively associated with maternal health knowledge.

Conclusions

Substantial opportunities exist for antenatal KAP improvement among women in Western Kenya, some of which could occur with greater ANC attendance. Further research is needed to understand multi-level factors that may affect maternal knowledge and practices.

Rural Indonesia women's traditional beliefs about antenatal care

Background

The Indonesia Maternal Mortality Rate (MMR) of 420/100.00 live births remains among the highest in East Asia while coverage of births assisted by skilled providers is still low. Traditional beliefs have been a key factor associated with the choice between midwives or traditional birth attendants (TBA) and the low number of antenatal care visits in rural West Sumatra.

Methods

We conducted three focus groups with 16 women from rural West Java to describe their perception regarding issues related to traditional beliefs. Focus group discussions provided data for the content analysis.

Results

The majority of the 16 women interviewed was from Village Dago, West Java and had only an elementary school education. Their ages ranged from 19 to 40 years. Most were multiparous housewives with an income of IDR 918.750 per month, which was lower than the monthly income in West Java (IDR. 1.172.060). Emerging from the focus group discussion were four main themes regarding their pregnancy and traditional beliefs: 1) pregnancy was a normal cycle in women’s life (pregnancy is a natural phenomena, not a sickness; no recognition of danger signs during pregnancy and death of baby or mother during pregnancy was brought about by God’s will); 2) women followed the traditional beliefs (positive motivation to follow the traditional beliefs and fear of not following the traditional beliefs); 3) relying on TBA called paraji rather than midwife (parajis are kind, tolerant and patient and have more experience than midwives; more accessibility than midwives and encouragement of natural birth) and 4) midwives are more secure than paraji; (they use a medical standard of care).

Conclusions

Women’s beliefs grounded in religion and tradition permeated the village culture making it difficult to counter their long held health practices with practices based on recent advances in health care. Use of TBA in this village was still dominant and women believed that following traditional beliefs led to a healthy pregnancy therefore, they also followed all relatives’ suggestions. Understanding the complexities of local culture is the first step to improving women’s awareness of how to preserve their pregnancy and prevent complications.