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Belachew DZ, Melese T, Negese K, Abebe GF, Kassa ZY. Antenatal physical exercise level and its associated factors among pregnant women in Hawassa city, Sidama Region, Ethiopia. PLoS One 2023; 18:e0280220. [PMID: 37115792 PMCID: PMC10146453 DOI: 10.1371/journal.pone.0280220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/26/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Antenatal physical exercise has roles in health maintenance, prevention, and treatment of disease for pregnant women and fetuses. Different organizations and medical institutions prescribe regular physical exercise during the antenatal period. Despite this, the pregnant populations are less active and decrease their exercise levels during pregnancy than in their non-pregnant state. Therefore, this study aimed to assess antenatal physical exercise level and its associated factors among pregnant women in Hawassa city, Sidama regional state, Ethiopia. METHODS Institutional based cross-sectional study design was employed, and 600 study participants were interviewed using a systematic sampling technique from 25th September/2021 to 25th November/2021. Data entry was made using Epi-Data software version 3.1 and exported to SPSS version 25 for analysis. A bivariate logistic regression assessed the association between each independent variable and the outcome variable. Explanatory variables with a p-value of less than 0.25 were a candidate for the multivariable logistic regression. Finally, variables with a p-value of less than 0.05 were declared as statistically significant and reported with their AOR and 95% CI. RESULT In this study, 25.5% of pregnant women had an adequate practice of antenatal physical exercise while 43.7% of pregnant women had an adequate level of knowledge on antenatal physical exercise An adequate practice of women's antenatal exercise is more likely to occur in women who are exposed to mass media (AOR: 2.43, 95% CI: 1.57, 3.78), Husband college and above educational level (AOR 1.57, 95% CI: 1.05, 6.12), having an adequate level of knowledge (AOR 2.12, 95% CI: 1.13, 3.37), and have of supporting facility (AOR: 2.29, 95% CI: 1.49, 3.51). CONCLUSION In this study, three fourth of the study participants had an inadequate level of practice in antenatal physical exercise than the global standard. It shall be beneficial if the city health administration works towards improving pregnant women's knowledge and practice level on physical exercise by providing information using different media outlets. Healthcare providers should broadcast antenatal physical exercise prescriptions in integration with health-related programs.
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Affiliation(s)
- Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia
| | - Teshome Melese
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Ketemaw Negese
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia
| | - Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia
| | - Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Banda J, Bunn C, Crampin AC, Gill JMR, Gray CM. Qualitative study of practices and attitudes towards physical activity among prediabetic men and women in urban and rural Malawi. BMJ Open 2023; 13:e058261. [PMID: 36653056 PMCID: PMC9853122 DOI: 10.1136/bmjopen-2021-058261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Given the decline in physical activity levels in Malawi, like other sub-Saharan African countries, and its implication for non-communicable disease (NCD) prevention, this study aimed to compare and contrast accounts of practices and attitudes towards physical activity among Malawian men and women (previously identified as having pre-diabetes) in urban and rural settings. SETTING Two communities: one urban (Lilongwe) and one rural (Karonga). PARTICIPANTS 14 men (urban N=6, rural N=8) and 18 women (urban N=9, rural N=9) classified as prediabetic during their participation in an NCD survey 3-5 years previously. DESIGN A qualitative focus group study (N=4) and thematic analysis, with the ecological model used as a framework to characterise the types of physical activity people engaged in and potential ways to support them to exercise more. RESULTS Participants reported undertaking different types of physical activity across all ecological model domains (household, occupational, transport, recreational). Rural participants reported more vigorous physical activities than urban participants, and women reported more household activities than men. Many participants recognised a need to promote physical activity in Malawi, and the health benefits of doing so, including the importance of physical activity in helping them stay strong to maintain physical functioning. Barriers to physical activity included competing priorities (especially urban men), societal expectations around wealth, use of motorised transport, lack of accessible facilities for women, ageing and ill health. CONCLUSIONS Physical activity is declining in Malawi as working and transport practices change in response to economic development, making promotion of alternative forms of physical activity a public health priority. Multilevel interventions emphasising the personal benefits/value of physical activity for all ages, and routine and group-based exercising, as well as investment in accessible recreational facilities (including for women) and active travel infrastructure should be considered to improve physical activity levels in Malawi.
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Affiliation(s)
- Jethro Banda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Christopher Bunn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jason M R Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Cindy M Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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McKeough R, Blanchard C, Piccinini-Vallis H. Pregnant and Postpartum Women's Perceptions of Barriers to and Enablers of Physical Activity During Pregnancy: A Qualitative Systematic Review. J Midwifery Womens Health 2022; 67:448-462. [PMID: 35621324 DOI: 10.1111/jmwh.13375] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Physical activity throughout pregnancy has been shown to have health benefits for the pregnant person, including reductions in the risk of preeclampsia and gestational weight gain and improvements in blood pressure regulation. Despite the benefits, many pregnant women do not meet the guidelines for physical activity throughout pregnancy. Therefore, it is important to determine what influences women's activity levels during pregnancy. This systematic review of the qualitative literature aimed to determine pregnant and postpartum women's perceptions of barriers to and enablers of physical activity, specifically during pregnancy. METHODS MEDLINE, PsycINFO, CINAHL, and Embase were searched systematically to identify qualitative studies investigating pregnant or postpartum women's perceptions of barriers to and enablers of physical activity during pregnancy. Included studies were limited to populations of pregnant or postpartum women, the majority of whom were aged 18 to 40 years, and studies published from 1985 onward. Data quality was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were extracted using NVivo software and subsequently mapped on the COM-B framework. RESULTS Twenty-five qualitative studies were included in this systematic review. Sixteen themes were identified that mapped onto 6 components of the COM-B framework. Commonly reported barriers to physical activity during pregnancy included pregnancy symptoms, lack of knowledge of what constitutes safe activity, and the opinions of women's social circles. Commonly reported enablers of physical activity during pregnancy were social support and the experienced benefits, including physiologic, psychological, and social benefits. DISCUSSION The results of this systematic review have clinical implications for perinatal care providers, as the overall benefits of physical activity during pregnancy have been well documented in previous studies. The authors recommend clinicians aim to explore pregnant women's perspectives on physical activity during pregnancy in order to be able to address their perceived barriers to and enablers of physical activity during pregnancy.
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Affiliation(s)
- Regan McKeough
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Christopher Blanchard
- Department of Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Helena Piccinini-Vallis
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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Okafor UB, Goon DT. Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis. Front Public Health 2022; 10:697386. [PMID: 35433615 PMCID: PMC9010665 DOI: 10.3389/fpubh.2022.697386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.MethodsThis was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.ResultsThe results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.ConclusionThe major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, Alice, South Africa
- *Correspondence: Uchenna Benedine Okafor
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, Alice, South Africa
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Perceptions of physical activity during pregnancy among women: A descriptive qualitative study. Midwifery 2022; 107:103264. [DOI: 10.1016/j.midw.2022.103264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/02/2021] [Accepted: 01/27/2022] [Indexed: 01/21/2023]
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Okafor UB, Goon DT. Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa. Healthcare (Basel) 2021; 9:healthcare9111445. [PMID: 34828491 PMCID: PMC8622375 DOI: 10.3390/healthcare9111445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022] Open
Abstract
Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, East London 5201, South Africa
- Correspondence:
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London 5201, South Africa;
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Dieberger AM, van Poppel MNM, Watson ED. Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5869. [PMID: 34070723 PMCID: PMC8198094 DOI: 10.3390/ijerph18115869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.
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Affiliation(s)
- Anna M. Dieberger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Mireille N. M. van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria;
| | - Estelle D. Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrews Road, Parktown, Johannesburg 2193, South Africa;
- Department of Exercise Sciences, Faculty of Science, The University of Auckland, Building 907, Suiter Street, Newmarket, Auckland 1142, New Zealand
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Okafor UB, Goon DT. Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review. Healthcare (Basel) 2021; 9:609. [PMID: 34069474 PMCID: PMC8159082 DOI: 10.3390/healthcare9050609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010-2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, East London 5021, South Africa
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5021, South Africa;
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Ballard AM, Davis A, Hoffner CA. The Impact of Health Narratives on Persuasion in African American Women: A Systematic Review and Meta-Analysis. HEALTH COMMUNICATION 2021; 36:560-571. [PMID: 32122156 DOI: 10.1080/10410236.2020.1731936] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
African American women (AAW) experience higher burdens of disease and have the highest rate of heart disease, cancer, stroke, and diabetes when compared to females of other ethnic groups. Health narratives are a communication strategy that has been used to improve population health outcomes. Narrative storytelling is considered to be effective for improving health outcomes in African Americans because of the strong cultural storytelling background. The purpose of this study was to determine if health narratives have a significant effect on persuasion among AAW, as measured by changes in attitudes, beliefs, intentions, and behaviors. Meta-analysis of health narrative experiments (k = 13) for AAW (N = 2,746) revealed that health narratives have a significant overall effect on persuasion (d = .243; p < .01). Sub-group analyses revealed no significant difference between audio-visual and written-based narratives, and no significant difference between general health topics and cancer topics. Narrative communication was effective for promoting health in AAW. These findings imply that narratives can effectively be used as an audio-visual or written-based communication for AAW, and that health topic may not impact outcomes of narrative communication.
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Affiliation(s)
- Anjulyn M Ballard
- Department of Communication, Georgia State University
- Department of Kinesiology & Health, Georgia State University
| | - Ashlee Davis
- Department of Kinesiology & Health, Georgia State University
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Okafor UB, Goon DT. Physical Activity in Pregnancy: Beliefs, Benefits, and Information-Seeking Practices of Pregnant Women in South Africa. J Multidiscip Healthc 2021; 14:787-798. [PMID: 33859477 PMCID: PMC8043848 DOI: 10.2147/jmdh.s287109] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background Notwithstanding the benefits of physical activity (PA) during pregnancy, anecdotal evidence suggests ignorance, unscientific beliefs, and lack of awareness about PA among pregnant South African women. Aim This study examined the beliefs, perceived benefits, and sources of information on PA during pregnancy. Methods A cross-sectional descriptive study was employed between June and September 2019 using an interviewer-administered questionnaire with 1,082 pregnant women. These women were attending antenatal primary health–care clinics in Buffalo City, Eastern Cape, South Africa. A self-designed questionnaire solicited information on beliefs, benefits, and sources of information regarding PA during pregnancy. Results A majority of the participants held positive beliefs concerning PA during pregnancy. They maintained that PA was safe for mother and fetus, improved labor and delivery (93.1%), promoted energy (89.0%), and should be discontinued when tired (76.6%). Most held negative convictions that PA during pregnancy increased body temperature (64.5%) and that pregnancy was a time to rest and refrain from PA (56.5%). Predominantl sources of information received about PA during pregnancy were television, the radio, and other media (70.2%). Most participants were aware of the benefits of PA during pregnancy —— reduction in infant weight (61.4%), lessening of moodiness (90.4), and decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). An overwhelming majority affirmed that PA improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%). Conclusion Our findings suggested that women hold positive beliefs and perceive PA as beneficial to their health and the baby; however, they received most of their information from the Internet. Most women regarded pregnancy as a period to relax and rest. Interventions to promote PA during pregnancy are needed.
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Affiliation(s)
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London, South Africa
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Ludwig A, Miani C, Breckenkamp J, Sauzet O, Borde T, Doyle IM, Brenne S, Höller-Holtrichter C, David M, Spallek J, Razum O. Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies. Matern Child Health J 2021; 24:943-952. [PMID: 32388767 PMCID: PMC7261266 DOI: 10.1007/s10995-020-02937-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. METHODS Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. RESULTS In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. CONCLUSIONS FOR PRACTICE Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.
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Affiliation(s)
- Angelique Ludwig
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany. .,Center for Innovation in Health Economics (ZIG OWL), Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,Centre for Statistics, Bielefeld University, Bielefeld, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Ina-Merle Doyle
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Silke Brenne
- Institute of General Practice, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Chantal Höller-Holtrichter
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Matthias David
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Ghasemi S, Rayyani M, Farokhzadian J. General health and self-efficacy for health practices of pregnant women: is it important for motherhood? J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Okafor UB, Goon DT. Applying the Ecological Model to understand pregnant women's perspectives on the modifiable constraints to physical activity during pregnancy: A qualitative research study. Medicine (Baltimore) 2020; 99:e23431. [PMID: 33285736 PMCID: PMC7717830 DOI: 10.1097/md.0000000000023431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/19/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
The benefits of physical activity (PA) during pregnancy are widely reported; however, PA practice is seemingly not a valued habit among pregnant women attending public antenatal health centres in the Eastern Cape of South Africa. Guided by the ecological model, we sought to explore modifiable barriers to PA among pregnant women.Semi-structured interviews involved a purposive sample of 15 pregnant women. Interview questions were guided by the ecological model constructs at intrapersonal, interpersonal, and environmental level. Thematic analysis was applied to summarise the modifiable barriers to PA during pregnancy.Three main themes emerged, based on the modifiable barriers to PA during pregnancy that belong to the varying Ecological Model constructs. On the intrapersonal level, 5 themes emerged, namely, time-constraint beliefs, feeling of tiredness, low energy, lack of motivation, and a lack of knowledge on benefits and types of PA. Two themes emerged for the interpersonal level, lack of PA advice and lack of information on PA recommendations and guidelines. Another theme defined the environmental level lacking resources. Most themes related to individual factors, which prevent PA-promoting behaviour.Overall, intrapersonal factors relating to tiredness and exhaustion, lack of time beliefs, work and household commitments, and lack of motivation were key modifiable barriers to PA by the women. The findings provide insights into possible interventional strategies to optimise PA during pregnancy among women in this setting. Appropriate knowledge, education and advice on the benefits, types, and intensity of PA in pregnancy are needed.
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Affiliation(s)
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London, South Africa
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Okafor UB, Goon DT. Physical activity and exercise during pregnancy in Africa: a review of the literature. BMC Pregnancy Childbirth 2020; 20:732. [PMID: 33238920 PMCID: PMC7691114 DOI: 10.1186/s12884-020-03439-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa. METHODS This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review. RESULTS Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings. CONCLUSIONS While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa.
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 05 Oxford Street, East London, South Africa
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Okafor UB, Goon DT. Physical Activity Level during Pregnancy in South Africa: A Facility-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7928. [PMID: 33137931 PMCID: PMC7663401 DOI: 10.3390/ijerph17217928] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
Physical activity participation during pregnancy confers many maternal and foetal health benefits to the woman and her infant and is recommended by various health bodies and institutions. However, in South Africa, scant information exists about the physical activity status and its determinants among pregnant women. The aim of this study was to assess the physical activity level and associated factors among pregnant women. This cross-sectional study enrolled 1082 pregnant women attending public health facilities in Buffalo City Municipality, Eastern Cape, South Africa. Information on socio-demographic and maternal characteristics were obtained, and the Pregnancy Physical Activity Questionnaire was used to assess physical activity during pregnancy. Multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels. Statistical significance was set at p < 0.05. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate-vigorous physical activity was 151.6 min (95% CI: 147.2-156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8-67.0), and 47.6% (95% CI: 46.3-48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Factors negatively associated with prenatal physical activity were lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16-0.76), semi-urban residence (AOR = 0.8; CI: 0.55-1.03), lower educational level (AOR = 0.5; CI: 0.20-0.71), unemployment (AOR = 0.5; CI: 0.29-0.77) and nulliparity (AOR = 0.6; CI: 0.28-1.31). However, prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06-3.31) compared to other trimesters. The findings of this study demonstrated low levels of physical activity during pregnancy in South Africa. The majority of women did not meet the recommendation of 150 min of moderate intensity activity per week. Light intensity and household activities were the most preferred form of activity. The factors affecting physical activity of women in this present study include lower age, semi-urban setting, low educational level, unemployment and nulliparity. In order to increase activity levels, future work should seek to improve knowledge, access and support for physical activity in pregnant women in South Africa. This should include education and advocacy regarding physical activity for professionals involved in maternal health provision.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, East London, 5201, South Africa
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5201, South Africa;
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Okafor UB, Goon DT. Developing a Physical Activity Intervention Strategy for Pregnant Women in Buffalo City Municipality, South Africa: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6694. [PMID: 32937983 PMCID: PMC7557735 DOI: 10.3390/ijerph17186694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023]
Abstract
Despite global awareness about the importance and health benefits of physical activity (PA) during pregnancy, several studies have reported a low prevalence of PA participation among pregnant women in both developed and developing countries. This means that most pregnant women do not meet the current PA recommended guideline of 150 min of moderate intensity PA per week. The global call to prioritise PA participation levels in the general population necessitates evaluating the factors affecting PA practice. Seemingly, pregnant women mostly from low-to-middle income countries like South Africa are often predisposed to adverse pregnancy outcomes, possibly because of limited access to, and knowledge of, improved pregnancy and health outcomes as a result of PA participation. Physical activity has been sparsely studied among pregnant South African women, and specifically, there is no known study that assesses the PA levels, patterns, beliefs, sources of information, perceived benefits, barriers, attitudes of pregnant women concerning PA and exercise participation; nor one that explores the perspectives of healthcare providers regarding prenatal PA in the Eastern Cape Province. In addition, no PA intervention strategy exists to promote PA participation in the region. This study, in attempting to fill these gaps in knowledge, adopts two phases. In Phase I, a concurrent mixed-method (quantitative and qualitative) approach assesses the following factors related to PA participation in pregnant women: participation levels, beliefs, attitudes, perceived benefits, barriers to uptake and sources of information. It further ascertains if healthcare professionals are sufficiently informed about PA and if they are advising pregnant women about the need for PA participation during pregnancy. Data will be collected through a structured questionnaire, interviews and focus group discussions. Information on socio-demographic and maternal characteristics will be obtained, and the Pregnancy Physical Activity Questionnaire (PPAQ) will assess PA during pregnancy. A sample size of 384 pregnant women is the required minimum sample for an infinite population at a confidence level of 95%, a precision level of ± 5% and at a prevalence of PA or exercise during pregnancy of 50% (p < 0.05); however, a sample size larger than the minimum number necessary will be recruited to account for possible attrition and to protect against possible data loss. Data will be analysed using a multiple logistic regression to determine the factors that predict sedentary or moderate PA levels and chi-squared analysis to determine the associations between the PA levels of the participants and socio-demographic and clinical variables. The study will assess the data collected on the above-mentioned variables and draw conclusions based on patterns and themes that emerge during analysis. Phase II of the study focuses on strategy development and validation to facilitate the promotion of PA during pregnancy. The developed strategy will be validated through the application of the Delphi technique and the administration of a checklist to selected key stakeholders through organised workshops. Understanding the level and correlates of PA participation among this special population is fundamental to designing intervention strategies to enhance their understanding of, and participation in, PA and exercise. Furthermore, this study's findings will inform facility-based healthcare providers about the need to integrate health education on PA and pregnancy into antenatal and postnatal care visits in the setting.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Sciences, University of Fort Hare, 50 Church Street, East London 5201, South Africa
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5201, South Africa;
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Determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa: a systematic review. Br J Nutr 2020; 124:761-772. [DOI: 10.1017/s0007114520001828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractUrban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy-dense nutrient-poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesise available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, Embase, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomised controlled studies published in English from January 2000 to September 2018. Studies conducted within general populations of women aged 18–49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID = CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, twenty-three studies were retained and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included: convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy-dense confectionery, salt or fat-rich foods. Physical activity is influenced by the fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereotypes. Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further, especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.
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A qualitative research synthesis of contextual factors contributing to female overweight and obesity over the life course in sub-Saharan Africa. PLoS One 2019; 14:e0224612. [PMID: 31682622 PMCID: PMC6827897 DOI: 10.1371/journal.pone.0224612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/18/2019] [Indexed: 01/15/2023] Open
Abstract
Objective Adult women are disproportionately affected by overweight and obesity in Sub-Saharan African (SSA) countries. Existing evidence on the sociocultural context remains unconsolidated. In this qualitative research synthesis, we aggregate research literature on contextual factors that potentially predispose adult women and adolescent girls to overweight and obesity to inform research, policies and programs over the life course. Methods PubMed, CINAHL, PsychInfo, ProQuest Central, EMBASE, and Web of Science were searched to locate qualitative research articles conducted in SSA countries beginning in the year 2000. After assessment for eligibility and critical appraisal, 17 studies were included in the synthesis. Textual data and quotes were synthesized using meta-aggregation methods proposed by the Joanna Briggs Institute. Results The synthesized studies were conducted in South Africa, Ghana, Kenya and Botswana. The three overarching themes across these studies were body size and shape ideals, barriers to healthy eating, and barriers to physical activity, with cultural and social factors as cross-cutting influences within the major themes. Culturally, the supposedly ideal African woman was expected to be overweight or obese, and voluptuous, and this was associated with their identity. Although being overweight or obese was not acceptable to adolescent girls, they desired to be voluptuous. Healthy food choices among women and adolescent girls were hampered by several factors including affordability of nutritious foods and peer victimization. Both adult women and adolescent girls experienced ageism as a barrier to physical activity. Significance This is the first qualitative research synthesis to amplify the voices of women and girls in SSA countries highlighting the challenges they face in maintaining a healthy body weight. Sociocultural, institutional and peer-related factors were powerful forces shaping body size preferences, food choices and participation in physical activity. Our study findings provide insights for the design of contextually appropriate obesity prevention interventions and lay the foundation for further research studies.
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Heim MA, Miquelutti MA, Makuch MY. Perspective of pregnant women regarding antenatal preparation: A qualitative study. Women Birth 2018; 32:558-563. [PMID: 30528818 DOI: 10.1016/j.wombi.2018.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/24/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Antenatal Education programs have been recommended for pregnant women to help them during gestation, childbirth and development of parenthood. Evidence on the perspectives and expectations of pregnant women regarding antenatal education in hospital settings, specifically in developing countries is still scarce. In-depth understanding is a key issue to organize interventions. AIM Identify experiences, needs and expectations of a group of pregnant women regarding antenatal education. METHODS A qualitative study was conducted. Data were collected through semi-structured interviews at the antenatal clinic of a public maternity teaching hospital in the southeastern region of Brazil. The interviews were recorded, transcribed verbatim and thematic analysis was performed. Twenty-two pregnant women were recruited following the logic of purposive sampling. FINDINGS All the participants reported they would like to receive guidance on non-pharmacological techniques for pain management during labor. The participants reported barriers to performed physical exercise; however, they also said that if they were encouraged by healthcare professionals they would exercise. According to the majority, the exercises should be of low intensity, and the improvement of general wellbeing was the most commented benefit. Also participants said that antenatal education meetings should be linked to antenatal consultations to facilitate participation. According to some participants, knowledge about antenatal education was acquired in conversations with other women, from lay media, and some reported a lack of guidance during antenatal consultation. CONCLUSION The participants of our study reported they would like to participate in antenatal education groups to receive guidance on non-pharmacological techniques to use during labor and childbirth.
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Affiliation(s)
- Maria Augusta Heim
- University of Campinas Medical School (UNICAMP), Departament of Obstetrics and Gynecology, Brazil
| | - Maria Amelia Miquelutti
- University of Campinas Medical School (UNICAMP), Departament of Obstetrics and Gynecology, Brazil
| | - Maria Y Makuch
- University of Campinas Medical School (UNICAMP), Departament of Obstetrics and Gynecology, Brazil.
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Sytsma TT, Zimmerman KP, Manning JB, Jenkins SM, Nelson NC, Clark MM, Boldt K, Borowski KS. Perceived Barriers to Exercise in the First Trimester of Pregnancy. J Perinat Educ 2018; 27:198-206. [PMID: 31073266 PMCID: PMC6491162 DOI: 10.1891/1058-1243.27.4.198] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Regular physical activity has been shown to improve pregnancy outcomes. We sought to identify barriers to exercise during the first trimester of pregnancy. Five hundred forty-nine pregnant women in their first trimester rated barriers to exercise on a scale of 1 (not a barrier) to 5 (a huge barrier) and recorded physical activity (minutes/week). Women were placed into one of three classifications, nonexercisers (zero exercise), infrequent exercisers (<150 minutes/week), or exercisers (≥150 minutes/week). The greatest barriers (mean) were nausea/fatigue (3.0) and lack of time (2.6). Exercisers reported significantly lower barrier levels. Nausea/fatigue was a greater barrier for nonexercisers compared to exercisers (3.6 vs 2.8, p < .001). Focusing education and interventions on these barriers may help pregnant women achieve healthy exercise levels.
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Prioreschi A, Wrottesley S, Draper CE, Tomaz SA, Cook CJ, Watson ED, Van Poppel MNM, Said-Mohamed R, Norris SA, Lambert EV, Micklesfield LK. Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children. Glob Health Action 2017; 10:1301085. [PMID: 28524803 PMCID: PMC5496051 DOI: 10.1080/16549716.2017.1301085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/26/2017] [Indexed: 11/21/2022] Open
Abstract
Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.
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Affiliation(s)
- A. Prioreschi
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S. Wrottesley
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C. E. Draper
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S. A. Tomaz
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C. J. Cook
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - E. D. Watson
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M. N. M. Van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Graz, Austria
| | - R. Said-Mohamed
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S. A. Norris
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - E. V. Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - L. K. Micklesfield
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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