Increasing use of prenatal care in Ladakh (India): the roles of ecological and cultural factors

Mothers employed in paid work and their predictors for home delivery in Pakistan

Background

Pakistan has one of the highest rates of maternal and neonatal mortality in the world. It is assumed that employed mothers in paid work will be more empowered to opt for safer institutional deliveries. There is a need to understand the predictors of home deliveries in order to plan policies to encourage institutional deliveries in the region.

Methods

The study aimed to ascertain the predictors for home deliveries among mothers employed in paid work in Pakistan. Data analysis is based on secondary data taken from the Pakistan Demographic Health Survey 2012–13. Bivariate and multivariate logistic regression models were conducted.

Results

The findings show that the majority (53.6%) of employed mothers in Pakistan give birth at home. Employed mothers in paid work with the following characteristics had higher chances for delivering at home: (i) women from rural areas (AOR 1.26; 95% CI: 0.94–1.71), or specific regions within Pakistan, (ii) those occupied in unskilled work (AOR 2.61; 95% CI: 1.76–3.88), (iii) women married to uneducated (AOR 1.70; 95% CI: 1.08–2.66), unemployed (AOR 1.69; 95% CI: 1.21–2.35), or unskilled men (AOR 2.02; 95% CI: 1.49–2.72), (iv) women with more than 7 children (AOR 1.57; 95% CI: 1.05–2.35), (v) women who are unable in the prenatal period to have an institutional check-up (AOR 4.84; 95% CI: 3.53–6.65), take assistance from a physician (AOR 3.98; 95% CI: 3.03–5.20), have a blood analysis (AOR 2.63; 95% CI: 1.95–3.57), urine analysis (AOR 2.48; 95% CI: 1.84–3.33) or taken iron tablets (AOR 2.64; 95% CI: 2.06–3.38), and (vi) are unable to make autonomous decisions with regard to spending their earnings (AOR 1.82; 95% CI: 1.27–2.59) and healthcare (AOR 1.12; 95% CI: 0.75–1.65).

Conclusions

Greater efforts by the central and provincial state bodies are needed to encourage institutional deliveries and institutional access, quality and cost. Maternal and paternal benefits are needed for workers in both the formal and informal sectors of the economy. Finally, cultural change, through education, media and religious authorities, is necessary to support institutional deliveries and formal sector paid employment and out of home work opportunities for mothers of Pakistan.

Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications

Adequate maternal nutrition during the "first 1,000 days" window is critical from conception through the first 6 months of life to improve nutritional status and reduce the risk of poor birth outcomes, such as low birthweight and preterm birth. Unfortunately, many programmes have targeted implementation and monitoring of nutrition interventions to infants and young children, rather than to women during pregnancy or post-partum. A literature review was conducted to identify barriers to food choice and consumption during pregnancy and lactation and to examine how low- and middle-income countries have addressed maternal nutrition in programmes. A literature review of peer-reviewed and grey literature was conducted, and titles and abstracts reviewed by authors. Twenty-three studies were included in this review. Barriers to adequate nutrition during pregnancy included cultural beliefs related to knowledge of quantity of food to eat during pregnancy, amount of weight to gain during pregnancy, and "eating down" during pregnancy for fear of delivering a large baby. Foods considered inappropriate for consumption during pregnancy or lactation contributed to food restriction. Drivers of food choice were influenced by food aversions, economic constraints, and household food availability. Counselling on maternal diet and weight gain during pregnancy was seldom carried out. Programming to support healthy maternal diet and gestational weight gain during pregnancy is scant. Tailored, culturally resonant nutrition education and counselling on diet during pregnancy and lactation and weight gain during pregnancy, as well as monitoring of progress in maternal nutrition, are areas of needed attention.

Mountain Child: Systematic Literature Review

Objectives This systematic review identifies and reviews both peer-reviewed and 'grey' literature, across a range of disciplines and from diverse sources, relating to the condition of children living in mountain communities in low- and middle-income countries. Findings The literature on poverty in these communities does not generally focus on the particular vulnerabilities of children or the impact of intersecting vulnerabilities on the most marginalised members of communities. However, this literature does contribute analyses of the broader context and variety of factors impacting on human development in mountainous areas. The literature on other areas of children's lives-health, nutrition, child mortality, education, and child labour-focuses more specifically on children's particular vulnerabilities or experiences. However, it sometimes lacks the broader analysis of the many interrelated characteristics of a mountainous environment which impact on children's situations. Themes Nevertheless, certain themes recur across many disciplines and types of literature, and point to some general conclusions: mountain poverty is influenced by the very local specificities of the physical environment; mountain communities are often politically and economically marginalised, particularly for the most vulnerable within these communities, including children; and mountain communities themselves are an important locus for challenging and interrupting cycles of increasing inequality and disadvantage. While this broad-scale review represents a modest first step, its findings provide the basis for further investigation.

Development and preliminary validation of the Traditional Chinese Antenatal Practice Scale among pregnant Hong Kong Chinese women

BACKGROUND AND PURPOSE

There have been no valid assessment tools to measure traditional Chinese antenatal practice of safeguarding fetuses from danger. This study developed the Traditional Chinese Antenatal Practice Scale (TCAPS) and evaluated the preliminary psychometric characteristics.

METHODS

The TCAPS was developed in 2 phases. Phase I consisted of developing the TCAPS based on an extensive literature review followed by 3 focus groups, and then using a panel of 5 experts to test its content validity. Phase II established the preliminary psychometric properties of the TCAPS among 2,178 pregnant women.

RESULTS

Content validity was confirmed by a satisfactory level of agreement with content validity index (CVI) of 0.91. Structural validity testing achieved by exploratory factor analysis (EFA) revealed a 3-factor structure of the 13-item scale. A confirmatory factor analysis (CFA) was conducted using linear structural relations (LISREL) to confirm the structure. Further, convergent validity and known-groups analyses were used to support the good validity. The test-retest reliability and Cronbach's alpha of the TCAPS are .83 and .81, respectively, which suggests satisfactory reliability.

CONCLUSIONS

Our data demonstrated good validity and reliability of the TCAPS that health professionals could use in clinical situations to acquire a more comprehensive view of Chinese women.

Decomposing the gap in childhood undernutrition between poor and non-poor in urban India, 2005-06

Background

Despite the growing evidence from other developing countries, intra-urban inequality in childhood undernutrition is poorly researched in India. Additionally, the factors contributing to the poor/non-poor gap in childhood undernutrition have not been explored. This study aims to quantify the contribution of factors that explain the poor/non-poor gap in underweight, stunting, and wasting among children aged less than five years in urban India.

Methods

We used cross-sectional data from the third round of the National Family Health Survey conducted during 2005–06. Descriptive statistics were used to understand the gap in childhood undernutrition between the urban poor and non-poor, and across the selected covariates. Blinder–Oaxaca decomposition technique was used to explain the factors contributing to the average gap in undernutrition between poor and non-poor children in urban India.

Result

Considerable proportions of urban children were found to be underweight (33%), stunted (40%), and wasted (17%) in 2005–06. The undernutrition gap between the poor and non-poor was stark in urban India. For all the three indicators, the main contributing factors were underutilization of health care services, poor body mass index of the mothers, and lower level of parental education among those living in poverty.

Conclusions

The findings indicate that children belonging to poor households are undernourished due to limited use of health care services, poor health of mothers, and poor educational status of their parents. Based on the findings the study suggests that improving the public services such as basic health care and the education level of the mothers among urban poor can ameliorate the negative impact of poverty on childhood undernutrition.

The role and influence of grandmothers on child nutrition: culturally designated advisors and caregivers

Improving the nutritional status of infants and young children in developing countries depends to a significant extent on adoption of optimal nutrition-related practices within the context of the household. Most policies, research and programmes on child nutrition in non-Western societies focus narrowly on the mother-child dyad and fail to consider the wider household and community environments in which other actors, hierarchical patterns of authority and informal communication networks operate and influence such practices. In particular, the role and influence of senior women, or grandmothers, has received limited attention. Research dealing with child nutrition from numerous socio-cultural settings in Africa, Asia and Latin America reveals three common patterns related to the social dynamics and decision-making within households and communities. First, grandmothers play a central role as advisers to younger women and as caregivers of both women and children on nutrition and health issues. Second, grandmother social networks exercise collective influence on maternal and child nutrition-related practices, specifically regarding pregnancy, feeding and care of infants, young children and sick children. Third, men play a relatively limited role in day-to-day child nutrition within family systems. The research reviewed supports the need to re-conceptualize the parameters considered in nutritional policies and programmes by expanding the focus beyond the mother-child dyad to include grandmothers given their role as culturally designated advisers and caregivers.

Tibetan medicine: a unique heritage of person-centered medicine

With a history going back approximately 2,500 years, the Tibetan medicine, known as Sowa Rigpa in the Tibetan language, is one of the world’s oldest known traditional medicine. It originally developed during the pre-Buddhist era in the kingdom known as Shang Shung. As a traditional medicine, the future development of Tibetan medicine in Western countries is linked to being recognized as a popular and viable healthcare option providing an alternative clinical reality. Its inherent ability to incorparate predictive diagnostics, targeted prevention, and the creation of individualized medical treatment give Tibetan medicine great potential for assessing and treating patients.

Assessment of the health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands of the Tibetan plateau

The health status of Tibetan herders in the Sanjiangyuan region of the Tibetan Plateau, in southwest Qinghai Province, is assessed in this paper. The field study was conducted in 2002 in the context of a broader community development and research framework, the ultimate goal of which is to achieve an effective region-specific programme of preventative health care and training for Tibetan pastoralists. Specifically, the authors analysed the impact of a number of potentially health-related environmental and lifestyle risk factors on self-reported health indicators, with a special emphasis on mother and child health. Several health status indicators were used, including a general morbidity index and a measurement of functional incapacity due to illness in the sample households. Maternal and child health findings were alarming with high rates of miscarriage and infant loss, with no traditional midwives to assist in pregnancy and delivery. Preventable childhood illnesses were also common. Other debilitating diseases included hepatitis, tuberculosis, arthritis (gout), gall bladder disease, peptic ulcers and back pain. Finally, binary logistic regression analysis showed a significant link between general morbidity and the time it takes to obtain water. The survey findings, validated by the focus groups, indicate a real need for increased accessibility and quality of health service provision to women and men and effective preventative health strategies.

Having a "safe delivery": conflicting views from Tibet

In the Tibetan Autonomous Region (TAR) of the People's Republic of China (PRC) maternal mortality ratios remain among the highest in the world. Although traditional Tibetan medical theory, practice, and pharmacology include information on maternal and child health care, Tibet is one of the few societies in the world that does not have traditional birth attendants or midwives. Using ethnographic methods, we gathered data from individual interviews with rural Tibetan women (N=38) about their beliefs and behaviors surrounding pregnancy and childbirth. Additional data were gathered through interviews with prefecture, county, and township health care providers. These data were used to develop a culturally appropriate village birth attendant training program in rural Tibet. We describe Tibetan women's perspectives of "having a safe delivery" in relation to concepts about "safe delivery" according to evidence-based medicine in the West. Our work also provides an example of the benefits and challenges that arise when ethnographic research methods are used to design and implement health care interventions.

Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change

The vast majority of community nutrition/health programs in developing countries focus on women of reproductive age (WRA) and a few explicitly involve senior women, or grandmothers. In Senegal, as in many other places, older, experienced women play an influential role in household maternal and child health (MCH) matters. Formative research in Serer villages revealed their importance and this was taken into account in an action research nutrition education (NE) project in which grandmothers were encouraged to promote improved nutritional practices related to pregnancy (e.g. decreased work and improved diet) and infant feeding (e.g. breastfeeding and complementary feeding). A participatory communication/empowerment education approach was used involving songs, stories and group discussion. Quantitative and qualitative data were collected to both document and evaluate the intervention. Triangulation of the evaluation data suggests that 12 months after the intervention was initiated there were significant improvements in grandmothers' nutritional knowledge, in their advice to WRA, and in the nutrition-related practices of these younger women associated both with pregnancy and infant feeding. For example, in the pre-test only 20% of grandmothers stated that they advise pregnant women to decrease their workload whereas in the post-test 87% reported giving this advice. At the same time, 91% of WRA in villages with the grandmother strategy reported having decreased their workload during their last pregnancy whereas in villages with NE activities for WRA but not with grandmothers, only 34% of younger women reported having done so. These findings provide evidence of grandmothers' ability to learn, to integrate new information into their practices and to positively influence the practices of WRA. These results support the need for future MCH programs, in different cultural contexts, to involve grandmothers and in so doing to build on their intrinsic commitment to family well-being.