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Win PP, Hlaing T, Win HH. Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review. PLoS One 2024; 19:e0293197. [PMID: 38758946 PMCID: PMC11101123 DOI: 10.1371/journal.pone.0293197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/08/2023] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries. METHODS This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings. RESULTS Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited. CONCLUSION Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare.
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Affiliation(s)
- Pyae Phyo Win
- Department of Public Health and Social Medicine, University of Medicine, Magwae, Myanmar
| | - Thein Hlaing
- District Public Health Department (Ministry of Health), Pyay District, Bago Region, Myanmar
| | - Hla Hla Win
- Department of Health and Social Sciences, STI Myanmar University, Yangon, Myanmar
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Agustina R, Rianda D, Lasepa W, Birahmatika FS, Stajic V, Mufida R. Nutrient intakes of pregnant and lactating women in Indonesia and Malaysia: Systematic review and meta-analysis. Front Nutr 2023; 10:1030343. [PMID: 37063336 PMCID: PMC10098007 DOI: 10.3389/fnut.2023.1030343] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/02/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionOptimizing dietary intake during pregnancy and lactation is crucial to the growth and development of children and their lifelong health. We performed a systematic review and meta-analysis to describe the nutrient intakes of pregnant and lactating women in Indonesia and Malaysia, countries that are experiencing rapid nutrition transition in Southeast Asia.MethodsWe screened 2,258 studies published between January 1980 and March 2021. The nutrient intakes of pregnant and lactating women were quantitatively analyzed to calculate the percentage of adequacy using national recommended daily allowances or nutrient intakes (RDA/RNI) and estimated average requirements (EAR) for micronutrients. Standardized mean differences (SMD) between dietary intake and RDA/RNI were determined for selected nutrients.ResultsFifty-three studies were included and showed that energy and macronutrient intakes among pregnant and lactating women in both countries were below the RDA/RNI. In addition, most studies reported that women failed to meet the EAR for vitamin D (<70% EAR), vitamin E (<50% EAR), and water-soluble vitamins (<80% EAR) except for vitamin C and A among Malaysians. Moreover, calcium, potassium, and iron intakes of pregnant women were <60% EAR in Indonesia and <80% EAR in Malaysia. Phosphorus intake among pregnant women in both countries and sodium intake among Malaysian pregnant women exceeded 100% EAR. Indonesian lactating women had <60% EAR for calcium and potassium intakes, while Malaysian women had more than 100% EAR. For 21 studies reporting overall protein intakes, the standard mean difference (SMD) was −2.26 (95% CI; −2.98, −1.54) below the RDA/RNI for pregnant women and −0.67 SMD (95% CI −15.7, −11.5) for lactating women. When the four studies from Malaysia were analyzed separately, protein intakes of pregnant women were above the RNI. Moreover, low intakes of vitamin D, vitamin C, calcium, and iron, but sufficient intakes in vitamin A, zinc, and phosphorus were observed in pregnant women in both countries.ConclusionDietary intakes of energy, macronutrients, and micronutrients (vitamin D, vitamin E, water-soluble vitamins, calcium, and iron) of pregnant and lactating women in Indonesia and Malaysia were below the recommendations. Important heterogeneities were observed even between these two countries for specific essential nutrient intakes. Innovative research and targeted programs to address specific deficiencies should be prioritized.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021252204, identifier: CRD42021252204.
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Affiliation(s)
- Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- *Correspondence: Rina Agustina ;
| | - Davrina Rianda
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Wanda Lasepa
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fitya S. Birahmatika
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vladimir Stajic
- Blackmores Institute, Blackmores Limited, Sydney, NSW, Australia
| | - Rachmi Mufida
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Dang VK, Walker LO. Dietary Information to Support a Healthy Pregnancy in Vietnamese Americans. Nurs Womens Health 2021; 25:461-470. [PMID: 34717893 DOI: 10.1016/j.nwh.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/22/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
Because optimal nutrition is vital during pregnancy, there are specific U.S. dietary guidelines and recommendations for pregnant individuals. However, Vietnamese Americans often have insufficient access to dietary recommendations for pregnancy that pertain specifically to their culture and cuisine. Healthful components of the traditional Vietnamese diet include vegetables, herbs, fruits, fish, and some unsaturated fats. Adjustments to the traditional and acculturated Vietnamese diet, such as reduced sodium intake from fermented foods and sauces, less sugar, more diverse carbohydrate consumption, more fiber, and less fat intake, would improve overall health and potentially reduce the common pregnancy complications pregnant Vietnamese women face, including gestational diabetes and certain micronutrient deficiencies. Understanding the traditional Vietnamese diet can help nurses provide culturally competent care to Vietnamese Americans.
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Chong MFF, Bui CT, Jaisamrarn U, Pacquing-Songco D, Shaw SW, Tam CT, Bardosono S. A landscape of micronutrient status in women through the reproductive years: Insights from seven regions in Asia. ACTA ACUST UNITED AC 2021; 16:1745506520973110. [PMID: 33243091 PMCID: PMC7705789 DOI: 10.1177/1745506520973110] [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] [Indexed: 11/15/2022]
Abstract
Optimal micronutrient status is critical to the health of women, particularly during their reproductive years. A woman’s health and nutritional status during the preconception stage thus has significant implications for pregnancy outcomes and her offspring’s health later in life. In this review, we evaluated micronutrient intakes and status (iron, folate, and vitamin B12) of women in their reproductive years and during pregnancy, along with associated health consequences and dietary causes, across seven regions in Asia, namely, Hong Kong, Indonesia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. A structured literature search, targeting peer-reviewed publication databases, as well as data from international and national sources in the public domain, was conducted. Our review of the nutritional landscape demonstrates that micronutrient deficiency–related conditions, especially anemia and its associated health consequences, are common among Asian women of reproductive age, yet the dietary causes are poorly studied. Inadequate or borderline dietary intake of micronutrients and low consumption of micronutrient supplements were evident, despite existing recommendations, food fortification, and supplementation strategies. Evaluation of current programs through nutrition monitoring and improvement of supplementation strategies, such as supplementing with multiple micronutrients, alongside food-based programs, will help better support the health of women through their reproductive years.
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Affiliation(s)
| | - Chi Thuong Bui
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Debby Pacquing-Songco
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Steven W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei.,College of Medicine, Chang Gung University, Taoyuan City
| | - Ching Ting Tam
- Gleneagles Hong Kong Hospital, Wong Chuk Hang, Hong Kong
| | - Saptawati Bardosono
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Cui M, Lu XL, Lyu YY, Wang F, Xie XL, Cheng XY, Zhang T. Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:432. [PMID: 34154557 PMCID: PMC8218380 DOI: 10.1186/s12884-021-03893-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/24/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The prevalence of neural tube defects (NTDs) in China declined during 2000-2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. METHODS All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. RESULTS A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18-2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30-3.04), and highly educated women (OR = 2.37, 95% CI 1.45-3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21-3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01-9.53) were less likely to begin taking FA before pregnancy. CONCLUSIONS Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.
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Affiliation(s)
- Mingming Cui
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
| | - Xiao-Lin Lu
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
| | - Yan-Yu Lyu
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
| | - Fang Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
| | - Xiao-Lu Xie
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
| | - Xi-Yue Cheng
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
| | - Ting Zhang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, #2 YaBao Road, Beijing, 100020 China
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Cheng Q, Gao L. Maternal serum zinc concentration and neural tube defects in offspring: a meta-analysis. J Matern Fetal Neonatal Med 2020; 35:4644-4652. [PMID: 33350875 DOI: 10.1080/14767058.2020.1860930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study was to assess the relationship between maternal serum zinc concentration and NTDs in offspring by conducting a meta-analysis. METHODS We searched Pubmed, Medline and Web of Science for all English studies about the relationship between maternal serum zinc level and NTDs in offspring (published between 1 January 1975 and 1 January 2020). Pooled effect sizes with corresponding 95% CIs were calculated using a random-effect model by Revman 5.3 and Stata 15.1 software. RESULTS Eight articles met our selection criteria and a total of 187 cases and 894 controls were included in this meta-analysis. Our results showed that mothers with NTDs infants had lower serum zinc concentration than those with healthy infants (SMD= -0.77, 95%CI [-1.16, -0.37], p = .0001, I 2 = 73%). CONCLUSIONS Compared with mothers with healthy infants, mothers with NTDs infants have lower serum zinc levels, suggesting that low maternal serum zinc level during pregnancy is probably associated with the risk of NTDs in offspring. But the mechanism of the association remains to be ascertained by large-scale cohort studies.
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Affiliation(s)
- QianHui Cheng
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - LiJie Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Silva-Perez LJ, Gonzalez-Cardenas N, Surani S, Etindele Sosso FA, Surani SR. Socioeconomic Status in Pregnant Women and Sleep Quality During Pregnancy. Cureus 2019; 11:e6183. [PMID: 31890389 PMCID: PMC6913899 DOI: 10.7759/cureus.6183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review focuses on factors contributing to sleep quality among pregnant women with low socioeconomic statuses during the third trimester of their pregnancy. Electronic searches were conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched for published, peer reviewed, English language primary research articles using electronic databases including PubMed, EMBASE, Ovid, MEDLINE and Google Scholar ending June 2019. All references were reviewed manually and independently by authors. After applying the inclusion criteria, 56 articles were selected; 38 of which are full-text and included in this review. All articles related to the analysis of poor sleep quality among uncomplicated pregnant women were included. Pregnant women with a specific pathology were excluded. We found poor sleep quality among pregnant women is correlated with low socioeconomic levels. Pregnant women with lower incomes tend to have inadequate diets, which further complicates the health of the mother and the baby. External factors including low income, poor quality of life and poor diet tend to increase the possibility of future health complications in both mother and child, and can result in complications such as preterm labor, low birth weight, preeclampsia, perinatal death, and spontaneous abortion.
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Affiliation(s)
| | | | - Sara Surani
- Global Health, Harvard University, Cambridge, USA
| | - F A Etindele Sosso
- Center of Advanced Research in Sleep Medicine, Hopital du Sacre-Coeur de Montreal, Montreal, CAN
| | - Salim R Surani
- Internal Medicine, Texas A&M Health Science Center, Temple, USA
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Ha AVV, Zhao Y, Binns CW, Pham NM, Nguyen CL, Nguyen PTH, Chu TK, Lee AH. Low Prevalence of Folic Acid Supplementation during Pregnancy: A Multicenter Study in Vietnam. Nutrients 2019; 11:nu11102347. [PMID: 31581726 PMCID: PMC6835766 DOI: 10.3390/nu11102347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 01/05/2023] Open
Abstract
Periconceptional folic acid (FA) supplementation is recommended to prevent neural tube defects (NTDs), but little information is known about its use in Vietnam. It is important that FA supplements start to be taken when planning a pregnancy and continued through the first trimester to prevent NTDs, as the neural tube closes in the first month of pregnancy. However, FA supplementation in Vietnam is usually recommended to commence from the first antenatal visit, which is usually at 16 weeks, and very few women take FA before their first visit. This multicenter study aimed to determine the prevalence of FA supplement use and associated maternal characteristics in Vietnam. FA supplementation was assessed in 2030 singleton pregnant women between 2015 and 2016. In total, 654 (32.2%) women reported taking either supplements containing FA alone or multivitamins containing FA, and 505 (24.9%) reported correctly taking supplements containing FA alone. Women who were aged 30 years or over, had low education levels, had formal employment, and whose current pregnancy was first or unplanned were less likely to supplement with FA. Education programs are needed to encourage FA supplementation when contemplating pregnancy.
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Affiliation(s)
- Anh Vo Van Ha
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 700000, Vietnam.
| | - Yun Zhao
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam.
| | - Cong Luat Nguyen
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam.
| | - Phung Thi Hoang Nguyen
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
| | - Tan Khac Chu
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 180000, Vietnam.
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
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Dietary Quantity and Diversity among Anemic Pregnant Women in Madura Island, Indonesia. J Nutr Metab 2019; 2019:2647230. [PMID: 31662905 PMCID: PMC6791205 DOI: 10.1155/2019/2647230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/18/2019] [Accepted: 09/11/2019] [Indexed: 12/31/2022] Open
Abstract
Dietary diversity and quantity are important for pregnant women, particularly anemic pregnant women. This study aimed to analyze the association between dietary quantity and diversity among anemic pregnant women. This cross-sectional study was conducted in 2017 at Madura Island, Indonesia, and involved 152 anemic pregnant women. Hemoglobin concentration was analyzed by the cyanmethemoglobin method. Dietary quantity was measured by the 2 × 24 h recall. Dietary diversity was determined by Minimum Dietary Diversity for Women of Reproductive Age (MDD-W). Spearman's rank association was performed to analyze the association between dietary diversity and quantity. The median of hemoglobin concentration was 10.1 g/dL, and 57.2% pregnant women had mild anemia. Most of the pregnant women had low adequacy levels of energy and macro- and micronutrients (except for iron). More than half (57.9%) of anemic pregnant women had reached minimum dietary diversity. Family size (p=0.048) and gestational age (p=0.004) had negative associations with dietary diversity. Dietary diversity had positive associations with energy (p=0.029), protein (p=0.003), vitamin A (p=0.001), vitamin C (p=0.004), and zinc (p=0.015) adequacy levels. Dietary diversity had no significant association with calcium (p=0.078) and iron adequacy level (p=0.206). High prevalence of mild and moderate anemia was found among pregnant women in their third trimester. Anemic pregnant women already consumed food with minimum dietary diversity but did not meet dietary quantity. Increasing dietary quantity is a priority for anemic pregnant women.
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