Food-related taboos and misconceptions during pregnancy among rural communities of Illu Aba Bor zone, Southwest Ethiopia. A community based qualitative cross-sectional study

Intrahousehold food allocation social norms and food taboos in rural Ethiopia: The case of adolescent girls

Background

In low-income countries, social norms play a significant role in intrahousehold food allocation practices. These norms can sometimes lead to discrimination against specific groups, posing a public health concern. This study focuses on the social norm surrounding food allocation within households and food taboos affecting adolescent girls in rural Ethiopia.

Method

A qualitative study was conducted using vignettes as prompts for 20 focus group discussions and 32 in-depth interviews. The vignettes were tailored to the local context. Participants were chosen purposefully, and data were collected in a comfortable setting. All sessions were recorded and transcribed verbatim. Data analysis was done using Open Code qualitative analysis software with a thematic framework approach.

Findings

In the community, adolescent girls were expected to eat after serving the male family members. Those who did not follow this expectation faced sanctions such as being labeled as disrespectful and could even be insulted or beaten by their spouses and siblings. However, there were some exceptions to this rule, such as when girls were giving birth, breastfeeding, sick, or when male family members were traveling. Certain foods were also prohibited for adolescent girls, including spicy foods like chili, animal products such as meat and milk, and nuts. These foods were believed to increase girls' sexual desire, potentially leading them to engage in premarital or extramarital sex. Additionally, eating outside of the house was not considered appropriate behavior for adolescent girls in this community.

Conclusion

In many households, social norms dictate that adolescent girls are not given enough food or are denied essential nutrients for their health. It is important to challenge these norms to ensure fair food distribution within households and support the healthy development of adolescent girls.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

Analysis of traditional feeding practices and stunting among children aged 6 to 59 months in Karanganyar District, Central Java Province, Indonesia

BACKGROUND

Traditional feeding practices are widespread in Indonesia. Therefore, using traditional feeding practices commonly used among mothers, this study examined the association between these practices and stunting along with other relevant factors (i.e., sociodemographic factors, feeding practices, vaccination status, and place of residence).

METHODS

This cross-sectional study was conducted in Karanganyar District, Central Java Province. Data from a total of 706 children aged 6 to 59 months (352 children with stunting and 354 children without stunting) were obtained from the medical records of 10 primary health care units (PHCUs) in 9 subdistricts. Descriptive analysis and binary logistic regression (BLR) were performed to explore the association between the dependent (stunting) and independent variables.

RESULTS

The BLR results from children 6 to 59 months indicated that children of mothers with food restrictions during pregnancy (AOR = 5.87, 95% CI: 3.03, 11.38), children with prelacteal feeding (AOR = 4.27, 95% CI: 2.16, 8.41) and children with food restrictions (AOR = 7.74, 95% CI: 1.22, 49.16) were more likely to experience stunting. Those from children 6 to 23 months revealed that food restrictions during pregnancy (AOR = 17.55, 95% CI: 2.86, 107.80) and prelacteal feeding (AOR = 10.58, 95% CI: 2.06, 54.41) were related to stunting. The reasons for traditional feeding practices were related to cultural beliefs. For example, mothers believed that red meat could cause high blood pressure; thus, the consumption of red meat could trigger miscarriage or bleeding during delivery. In addition, this study showed that low sociodemographic status, inappropriate feeding practices, incomplete vaccination, and residence in rural areas were related to stunting.

CONCLUSIONS

The findings reflect the importance of education for mothers to correct misconceptions of traditional feeding practices. The government should strengthen counseling services in PHCUs to improve mothers' knowledge of and attitudes toward appropriate feeding practices. Additionally, public relations practices through the mass media should continue for family members, especially senior members, as they influence mothers' autonomy in decision-making regarding feeding practices in Indonesia.

The misbeliefs and food taboos during pregnancy and early infancy: a pitfall to attaining adequate maternal and child nutrition outcomes among the rural Acholi communities in Northern Uganda

BACKGROUND

In developing countries, the practice of food taboo is pervasive. The types of foods considered as taboos and the reasons attached to taboos vary from society to society. Food taboos have been recognized as one of the factors contributing to maternal undernutrition in pregnancy, especially in rural settings. In the rural Acholi community where malnutrition is prevalent, very little is known about these food taboos and misbeliefs. This study, therefore, aims to explore various misbeliefs and food taboos in the time of pregnancy that can influence maternal and child nutrition outcomes in Acholi.

METHODS

A community-based qualitative cross-sectional study was conducted between April and May 2022 in five districts in the Acholi subregion. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect data. Data transcription was done verbatim, organised into themes, assigned unique color codes, and manually analysed thematically.

RESULTS

Upon scrutiny of the transcripts, three themes were eminent. The first theme focused on foods that are considered taboos in Acholi community and the reasons linked to them. Participants indicated offals, chicken, wild birds, smoked meat and fish, sugarcane, garden egg ('Tula'), groundnut, bush meat, mushrooms, honey, sour fruits, or meals (oranges, mango, passion fruits, lemon, tamarind, 'Malakwang'), goat's meat, 'Lalaa' (the bitter green leafy vegetable), and 'Lamola' (Hyptis spicigera) as the major taboo foods. The second theme was the reasons underlying the adherence to the food taboos and misconceptions. Cultural dictates, individual characteristics, and societal context were the main reasons for the adherence to food taboos. The third theme looked at the misconceptions and other taboos during pregnancy. It was found that pregnant women are not allowed to touch grave soil, shave their hair, walk over an anthill, slaughter chicken or birds, have sex during pregnancy, sit on animal's hide or skin, and/or touch needles.

CONCLUSIONS

Nutritional counseling and education should focus more on addressing food taboos. The mode of delivery of the nutrition message should be inclusive, targeting pregnant women and their spouses, school-going children, adolescent girls, and cultural leaders at their respective points of contact.

Exploring Perceptions and Needs of Mobile Health Interventions for Nutrition, Anemia, and Preeclampsia among Pregnant Women in Underprivileged Indian Communities: A Cross-Sectional Survey

According to the National Family Health Survey of 2021, about 57% of women aged 15-49 in India currently suffer from anemia, marking a significant increase from the 53% recorded in 2016. Similarly, a study conducted in southern India reported a 32.60% prevalence of preeclampsia. Several community-based initiatives have been launched in India to address these public health challenges. However, these interventions have yet to achieve the desired results. Could the challenges faced by traditional healthcare interventions be overcome through a technological leap? This study assesses pregnant mothers' perceptions regarding mobile health interventions for managing anemia and preeclampsia. Additionally, the study captures their health awareness and knowledge. We conducted a survey with 131 pregnant mothers in three underserved villages in Jharkhand, India. Statistical analysis was conducted using the SEMinR package in R (Version 2023.06.0), utilizing the non-parametric partial least squares-structural equation modeling. We found that every household had at least one smartphone, with the respondents being the primary users. The main uses of smartphones were for calling, messaging, and social media. A total of 61% of respondents showed interest in a nutrition and pregnancy app, while 23.66% were uncertain. Regarding nutritional knowledge during pregnancy, 68.7% reported having some knowledge, but only 11.45% claimed comprehensive knowledge. There was a considerable knowledge gap regarding the critical nutrients needed during pregnancy and the foods recommended for a healthy pregnancy diet. Awareness of pregnancy-related conditions such as anemia and preeclampsia was low, with most respondents unsure of these conditions' primary causes, impacts, and symptoms. This study serves as a critical step towards leveraging technology to enhance public health outcomes in low-resource settings. With the accessibility of mobile devices and an apparent willingness to utilize mHealth apps, compounded by the pressing need for improved maternal health, the impetus for action is indisputable. It is incumbent upon us to seize this opportunity, ensuring that the potential of technology is fully realized and not squandered, thus circumventing the risk of a burgeoning digital divide.

Dietary Behaviour and Sociocultural Determinants of Dietary Diversity among Rural Women of Reproductive Age: A Case of Amhara Region, Ethiopia

Women of reproductive age have specific nutritional requirements due to pregnancy and lactation. Little is known about the sociocultural determinants of dietary diversity among women of reproductive age. This study assesses trends of dietary behaviour and associated determinants of dietary diversity of women of reproductive age. A community-based cross-sectional study was conducted in the Amhara region of Ethiopia in 2019. Using multistage systematic random sampling, the dietary diversity of n = 421 women of reproductive age was assessed by a qualitative 24 h dietary recall. Descriptive analysis revealed characteristics of dietary behaviour and a chi-square test enabled the identification of associated determinants of women's dietary diversity. Only about a quarter (26.8%) of the women consumed five or more food groups per day and met the minimum dietary diversity score (MDD-W). Drawing on the socioecological framework, at an intrapersonal/individual level, women's education, age, perception of nutritious diet, and frequency of consumption of animal-sourced foods, vegetables, and fruit were significantly associated with MDD-W. At an interpersonal/household level, the husbands' education, women's decision-making regarding food purchase/consumption, the family's actual eating occasion, and women's engagement in domestic and farming tasks were significantly associated with MDD-W. At a community level, access to clean water and especially cultural beliefs were significant determinants of MDD-W. Amharic proverbs and sayings prioritise men and pose severe restrictions on women regarding food allocation. The majority (76.7%) of women of reproductive age practise frequent religious fasting, relating to the institutional/national level. This undermines efforts to support healthy dietary behaviour of women of reproductive age. Indepth studies on religious and cultural practices are needed, to assess not only their negative effects on the dietary diversity of women of reproductive age but also on women's lives.

Prevalence of cultural malpractice during the perinatal period and its determinants among reproductive age women in southwest Ethiopia: A community-based cross-sectional study

Background

Cultural malpractices are accepted cultural norms and socially shared practices that have a negative impact on health. Cultural malpractices vary in type and number in different communities. This study aimed to determine the prevalence of cultural malpractice during the perinatal period and identify its predictors among reproductive-age women in rural communities of southwestern Ethiopia.

Methods

A community-based cross-sectional study was conducted from May 5 to 31, 2019 in Semen Bench district, southwestern Ethiopia; among reproductive-age women who had experienced at least one prior delivery. A systematic random sampling technique was employed to select 422 women for the interview. After collection, the data were entered into EpiData and exported to STATA-14 for further analysis. Descriptive analyses were performed and presented in texts and tables. Besides, binary and multivariable logistic regressions were computed to identify determinants of cultural malpractice.

Result

A total of 414 women completed the survey, resulting in a response rate of 98%. We found that 26.33% (95% CI: 22.15, 30.85%) had food taboos during pregnancy, 31.88% (95% CI: 27.42, 36.61%) delivered their last child at home, and 33.82% (95% CI: 29.27, 38.6%) practiced pre-lacteal feeding. Lack of formal education (AOR: 11.22, 95% CI: 6.24, 20.15), lack of ANC follow-up (AOR: 10.82, 95% CI: 5.46, 21.42), rural residence (AOR: 6.23, 95% CI: 2.18, 17.78), and avoiding colostrum (AOR: 21.94, 95% CI: 9.73, 49.48) were significantly associated with cultural malpractice during the perinatal period.

Conclusion

The prevalence of cultural malpractice is notably high in the study area. Hence, community-based measures including expansion of education and promotion of maternal health services are important to reduce cultural malpractice during the perinatal period.

Food taboo practices and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

Food taboos have a negative impact on pregnant women and their fetuses by preventing them from consuming vital foods. Previous research found that pregnant women avoided certain foods during their pregnancy for a variety of reasons. This review aimed to determine the pooled prevalence of food taboo practices and associated factors in Ethiopia. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, we searched the literature using PubMed/MEDLINE, AJOL (African Journal Online), HINARI, Science Direct, Google Scholar, and Google electronic databases. The random-effects model was used to estimate the pooled prevalence of food taboo and its determinants at a 95% confidence interval with their respective odds ratios. The pooled food taboo practice among Ethiopian pregnant women was 34.22% (95% CI 25.47-42.96), and after adjustment for publication bias with the trim-and-fill analysis, the pooled food taboo practice of pregnant women was changed to 21.31% (95% CI: 10.85-31.67%). Having less than a secondary education level (OR = 3.57; 95% CI 1.43-8.89), having no ANC follow-up (OR = 4.35; 95% CI 1.12-16.94), and being a rural resident (OR = 3.08; 95% CI 1.14-8.28) were the significant factors. Dairy products, some fruits, green leafy vegetables, meat, and honey are among the taboo foods. The most frequently stated reasons for this taboo practice were: fear of producing a big fetus, which is difficult during delivery; attachment to the fetus's body or head; and fear of fetal abnormality.

The Effect of an eHealth Coaching Program (Smarter Pregnancy) on Attitudes and Practices Toward Periconception Lifestyle Behaviors in Women Attempting Pregnancy: Prospective Study

BACKGROUND

Lifestyle behaviors during the periconception period contribute to achievement of a successful pregnancy. Assessment of attitudes and practices toward these modifiable behaviors can aid in identifying gaps in unhealthy lifestyle behaviors with impact on intervention effectiveness.

OBJECTIVE

This study investigates the effectiveness of coaching by the eHealth program Smarter Pregnancy during the periconception period on improvement of attitudes and practices toward fruit and vegetable intake and smoking in women attempting pregnancy through assisted reproductive technology (ART) or natural conception.

METHODS

Women attempting pregnancy through ART (n=1060) or natural conception (n=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching for 24 weeks, whereas the control group conceived through ART and did not receive coaching. Attitudes and practices at baseline and follow-up periods were obtained from self-administered online questionnaire provided by the program. Attitudes were assessed in women with unhealthy behaviors as their intention to increase their fruit and vegetable intake and to quit smoking using a yes/no question. Outcomes on practices, suggesting effectiveness, included daily fruit (pieces) and vegetable (grams) intake, and if women smoked (yes/no). Changes in attitudes and practices were compared at 12 and 24 weeks with baseline between the ART intervention and ART control groups, and within the intervention groups between ART and natural conception. Changes in practices at 12 and 24 weeks were also compared with baseline between women with negative attitude and positive attitude within the intervention groups: ART and natural conception. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices.

RESULTS

The ART intervention group showed higher vegetable intake and lower odds for negative attitudes toward vegetable intake after 12 weeks (β_adj=25.72 g, P<.001; adjusted odds ratio [OR_adj] 0.24, P<.001) and 24 weeks of coaching (β_adj=23.84 g, P<.001; OR_adj 0.28, P<.001) compared with ART controls. No statistically significant effect was observed on attitudes and practices toward fruit intake (12 weeks: P=.16 and .08, respectively; 24 weeks: P=.16 and .08, respectively) and smoking behavior (12 weeks: P=.87; 24 weeks: P=.92). No difference was observed for the studied attitudes and practices between the ART intervention and natural conception intervention groups. Women with persistent negative attitude toward fruit and vegetable intake at week 12 showed lower fruit and vegetable intake at week 24 compared with women with positive attitude (β_adj=-.49, P<.001; β_adj=-30.07, P<.001, respectively).

CONCLUSIONS

The eHealth Smarter Pregnancy program may improve vegetable intake-related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. Despite small changes, this study demonstrates again that Smarter Pregnancy can be used to improve vegetable intake, which can complemented by blended care that combines face-to-face and online care to also improve fruit intake and smoking behavior.

Cultural malpractices during pregnancy, child-birth and postnatal period among women of child bearing age in Loma Woreda, Southwest Ethiopia

Background

Every day nearly 810 women died from preventable causes related to pregnancy and childbirth. Sub-Saharan Africa shares two-thirds of the world's maternal mortality ratio. World health organization recommends skilled care to save the lives of women and newborns. However, cultural malpractice is a common practice in developing countries like Ethiopia. So this study intends to determine the prevalence of cultural malpractice during pregnancy, childbirth and postnatal period and associated factors.

Method

A community-based cross-sectional study was conducted in Loma district southwest Ethiopia from February to June 2018. A sample of 387 reproductive-age women who gave birth in the last two years was included using a systematic sampling technique. Data were collected using pretested structured interviewer-administered questionnaire. A multivariable logistic regressions model was used to identify independent predictors of cultural malpractice. Significance association was declared by AOR at 95% confidence and p-value <0.05.

Result

A total of 387 participants were involved in the study yielding a response rate of 100%. The prevalence of cultural malpractice during pregnancy, childbirth, and postnatal period was 68%, 37.5%, and 72.6% respectively. The occupational status of women being students (AOR = 3.198, 95% CI: 1.250, 8.184) was an independent predictor of cultural malpractice during pregnancy. Age less than 30 (AOR = 2.075, 95% CI: 1.282, 3.357), rural residence (AOR = 1.892, 95% CI: 1.014, 3.532), occupation housewife (AOR = 2.841, 95% CI: 1.228, 6.575), merchant (AOR = 3.077, 95% CI: 1.134, 8.346) and number of pregnancy less than five (AOR = 2.707, 95% CI: 1.594, 4.597) were independent predictors of cultural malpractice during childbirth. Occupation housewives (AOR = 0.408, 95% CI: 0.226, 0.736) and a number of pregnancies less than five (AOR = 1.832, 95% CI: 1.035, 3.244) were independent predictors of cultural malpractice during the postnatal period.

Conclusion

and recommendation: cultural malpractice among reproductive-age women was high. Therefore, concerned bodies should strengthen the promotion of skilled birth attendance and community sensitization on the cultural malpractice consequences.

Lived experiences of women with low birth weight infants in the Solomon Islands: A descriptive qualitative study

Every year, around 20 million women worldwide give birth to low birth weight (LBW) infants, with majority of these births occurring in low-and middle-income countries, including the Solomon Islands. Few studies have explored the pregnancy lived experience of women who deliver LBW infants. The aim of the study is to understand the lived experience of women in the Solomon Islands who gave birth to LBW infants by exploring their personal (socio-demographic and health), behavioural, social and environmental contexts. We used a qualitative descriptive approach and purposely selected 18 postnatal women with LBW infants in the Solomon Islands for an in-depth interview. All data were analysed using thematic analysis in NVivo. We identified six themes reported as being related to LBW: health issues, diet and nutrition, substance use, domestic violence, environmental conditions and antenatal care. Our findings suggest that women in the Solomon Islands are exposed to various personal, behavioural, social and environmental risk factors during pregnancy that can impact birth outcomes, particularly LBW. We recommend further research should be redirected to look at the factors/themes identified in the interviews.