[Women's dietary habits during pregnancy and breastfeeding in Amoron'i Mania region, Madagascar: a qualitative study]

A Comparative Analysis of Maternal Nutrition Decision-Making Autonomy During Pregnancy-An Application of the Food Choice Process Model in Burkina Faso and Madagascar

BACKGROUND

Adequate nutrition has been cited as one of the most critical components for optimal health outcomes during pregnancy. Women in Burkina Faso and Madagascar experience high rates of undernutrition due to lack of knowledge, finances, cultural norms, and autonomy. Therefore, this study aimed (1) to describe typical maternal diets during pregnancy in Burkina Faso and Madagascar, (2) to understand the multilevel factors that influence women's nutrition decision-making, and (3) to explore the extent to which women have nutrition decision-making autonomy during pregnancy.

METHODS

This study was conducted between October 2020 and February 2021 in Burkina Faso and Madagascar. Semi-structured interviews, focus group interviews, and free lists were conducted among women of reproductive age and pregnant and lactating women. Textual data from interviews were recorded and translated verbatim from local languages into French. The Food Choice Process Model guided textual content analysis using Dedoose software. Free list data were analyzed using cultural domain analysis approaches.

RESULTS

In Burkina Faso and Madagascar, women primarily consumed staple foods such as rice and tô during pregnancy. Participants cited eating fruits and vegetables when available, while the animal source foods were rarely consumed. Across both contexts, nutrition during pregnancy was influenced by factors that impact food choices, such as social factors, resources, ideals, and personal factors. While women and men in Madagascar had more shared decision-making on critical domains such as finances, men were the primary decision-makers in most areas of inquiry (eg, finances) in Burkina Faso.

CONCLUSIONS

The lack of adequate diverse diet consumed during pregnancy is primarily due to important factors including social factors and resources. Understanding the ability for women to consume optimal diets during pregnancy is needed to target behavioral change in maternal nutrition programming.

Novel Foods and Sustainability as Means to Counteract Malnutrition in Madagascar

Although the trends of international reports show an increase in overweight and obesity, even in developing countries, there are still areas of the world, such as Sub-Saharan Africa, strongly affected by undernutrition. Specifically, in Madagascar, the percentage of stunted children under 5 is extremely high. Furthermore, the COVID-19 pandemic is expected to increase the risk of all forms of malnutrition, especially in low-income countries, including Madagascar, with serious intergenerational repercussions. This narrative review aims at investigating eating habits and cooking methods of the Malagasy population, addressing sustainable healthy diets through promotion of novel foods. While novel foods are a recent concept, there are data that describe how they may contribute to counteract food insecurity and malnutrition considering context and place. Efforts to promote native, traditional foods as Moringa oleifera, an indigenous plant in Asia and Africa including Madagascar, rich in protein and micronutrients, as well as edible insects, alternative sustainable source of protein, lipids, iron, and zinc, would provide not only nutritional but also cultural and economic benefits. The potential synergies between food traditions and agroecology have the potential to impact health addressing larger issues of sustainability and food security. Regional, national, and international policies are needed to develop and support one health approach actions.

Appréciation des interventions de lutte contre la malnutrition maternelle par la population à Madagascar

INTRODUCTION

Madagascar has adopted strategies to fight against maternal malnutrition, but the evaluation of their implementation is not effective.Purpose of research: The present study aims to describe beneficiary appreciation of interventions to fight maternal malnutrition and to identify their expectations.

METHOD

A qualitative study was conducted in the Amoron’i Mania region, Madagascar. The study included mothers of children under 5, pregnant women, and other family members and community members (fathers, grandmothers, matrons and community workers). Six focus groups and 16 individual interviews were conducted to collect the data. The thematic analysis was used.

RESULTS

Food supplementation, improved production of agriculture and livestock, and nutrition education, operated by NGOs, are the best-known interventions. The health centers were not mentioned as interveners and their interventions were ignored. The effectiveness of the intervention is generally judged on the benefits perceived by the beneficiaries. Interveners working on a project basis were assessed as unsustainable. Two main problems were mentioned: first, the insufficiency of agricultural production resulting in the inaccessibility of the ingredients required for the nutrition education, and second the low coverage of the interventions. The improvement of agricultural production is the main suggestion mentioned to fight against maternal undernutrition.

CONCLUSIONS

Beneficiaries thought that existing interventions in the region are insufficient to address the problem of malnutrition among mothers.

Food consumption and undernutrition variations among mothers during the post-harvest and lean seasons in Amoron'i Mania Region, Madagascar

BACKGROUND

Seasonal variation affects nutrition particularly in contexts where people's food consumption depends on their production of food. Assessing the effect of the season on nutrition status can help us to identify strategies to address undernutrition. This study aims to measure the variations in food consumption and the incidence of undernutrition according to season, and to identify the factors associated with the incidence of undernutrition.

METHODS

A cohort study was conducted among 608 mothers aged between 18 and 45 years living in the Amoron'i Mania Region of Madagascar. Inclusion in the study occurred during the post-harvest season, and mothers were followed until the end of the next lean period (7 months). A dichotomous variable of the frequency of consumption of various foods was used to establish variation in food consumption. Body Mass Index < 18.5 kg/m2 and Middle Upper Arm Circumference < 220 mm were used to measure incidence of undernutrition. A generalized linear model was used to identify factors associated with the incidence of undernutrition and to derive relative risks.

RESULTS

During the lean season, the frequency of consumption of leafy green vegetables, peanuts, fish, and eggs decreased significantly. In contrast, the frequency of fruit, legumes, and non-leafy green vegetables consumption increased significantly. The prevalence of undernutrition (based on the BMI and/or MUAC) among mothers increased from 19.6% in the post-harvest period to 27.1% in the lean period (p < 0.001). The incidence of undernutrition (based on the BMI and/or MUAC) during the follow-up was 12.2%. The factors related to undernutrition were low and medium score of movable property possession (Adjusted RR = 3.26 [1.33-7.94] and Adjusted RR = 2.48 [1.01-6.10]), no toilet (Adjusted RR = 1.76 [1.07-2.91]), and pregnancy (Adjusted RR = 2.92 [1.42-6.04]) (based on the MUAC only for pregnancy).

CONCLUSION

This study highlights the variation in the frequency and type of food consumption and subsequent deterioration in mothers' nutritional status during the lean season. Economic, hygiene, and reproductive factors were associated with undernutrition. Analyzing the existing interventions to fight maternal undernutrition is necessary to determine whether or not seasonality is considered and addressed.