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Workneh F, Tsegaye S, Amanuel H, Eglovitch M, Shifraw T, Shiferie F, Tadesse AW, Worku A, Isanaka S, Lee ACC, Berhane Y. Dietary Perspectives and Practices during Pregnancy in Rural Amhara Region of Ethiopia: An Exploratory Qualitative Study. Curr Dev Nutr 2023; 7:100079. [PMID: 37250386 PMCID: PMC10209480 DOI: 10.1016/j.cdnut.2023.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Background Nutrition during pregnancy has lifelong impacts on the mother and fetus. In Ethiopia, nearly a third of pregnant women experience undernutrition. When designing nutrition interventions during pregnancy, it is important to understand existing dietary perspectives and practices in local communities. Objectives To explore the processes that shape dietary perspectives and practices during pregnancy in rural West Gojjam and South Gondar Zones of the Amhara region in Ethiopia. Methods From October to November 2018, we conducted 40 in-depth interviews with pregnant women (n = 16), family members (n = 12), and healthcare providers (n = 12) using a semistructured interview guide. Interviews were conducted in Amharic, transcribed in Amharic, and translated into English. We used a thematic analysis approach to organize data per the predefined topic areas and identify emerging themes, as well as barriers and enablers to healthy nutrition during pregnancy. Results Pregnant women and their family members recognized the benefits of a diversified diet to promote the health of the mother and the fetus. However, participants reported low dietary diversity because of limited access to nutritious foods and particular perspectives on food restrictions during pregnancy. The common practice of religious fasting also limited pregnant women's dietary intake. Women reported restricting their food intake in later pregnancy because of loss of appetite, as well as concerns about having a large infant, which might complicate delivery. Intake of locally made alcoholic drinks (Tella) was reported among pregnant women because participants thought it had low levels of alcohol that would not harm the fetus. Conclusions Although participants understood the importance of a healthy and diverse diet in pregnancy, we identified several barriers and perspectives regarding nutrition during pregnancy. Low income and lack of access to diverse foods, particularly in certain seasons, religious fasting, intentional food restrictions to limit the size of the infant, and alcohol use were commonly reported. Locally appropriate counseling and interventions should be developed, with an emphasis on increasing access to and consumption of diverse foods. Curr Dev Nutr 2023;x:xx.
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Affiliation(s)
- Firehiwot Workneh
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sitota Tsegaye
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Amanuel
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Michelle Eglovitch
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Tigest Shifraw
- Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Fisseha Shiferie
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Amare W. Tadesse
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sheila Isanaka
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Anne CC Lee
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Gebregziabher H, Kahsay A, Gebrearegay F, Berhe K, Gebremariam A, Gebretsadik GG. Food taboos and their perceived reasons among pregnant women in Ethiopia: a systematic review, 2022. BMC Pregnancy Childbirth 2023; 23:116. [PMID: 36797675 PMCID: PMC9933406 DOI: 10.1186/s12884-023-05437-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND There are foods considered as taboo across different communities in the world and in Ethiopia in particular. Although food taboos exist across all ages or physiologic states, they are predominant among pregnant women and children. Identifying such foods among pregnant women is crucial in providing focused interventions and prevents their negative consequences. Therefore, the aim of this review was to review the available evidence on food taboos and their perceived reasons among pregnant women in Ethiopia to provide comprehensive and precise evidence for decision making. METHODS Electronic search of the literature was made from Pub-Med, Google Scholar, Google Scopus, and Medline databases using search terms set based on the PICO/PS (Population, Intervention/exposure, Comparison, and Outcome) and PS (Population and Situation) search table. The search was made from December 05, 2020 - December, 29, 2021, and updated on January, 2022. All quantitative and qualitative studies published in English were included in the review. The systematic review protocol was registered at INPLASY (Registration number: INPLASY202310078). The outcome of interest was food taboo for pregnant women and its perceived reasons. The results of the review was narrated. RESULTS After identifying eighty two articles, thirteen were found eligible for the review. Vegetables, fruits, and fatty foods like meat, and dairy products were considered as taboo for pregnant women in different parts of Ethiopia. The reasons stated for the food taboo vary from fear of having a big baby, obstructed labour, and abortion to evil eye and physical and aesthetic deformities in the newborn. CONCLUSIONS Though not uniform across the country, there are foods considered as taboo for pregnant women in Ethiopia due to several perceived reasons, misconceptions, and societal influences. This could increase the risk of malnutrition and could have short and long term consequences on both the mother and her growing foetus. Therefore, context specific nutritional counseling with emphasis during ante-natal care and post-natal service is important.
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Affiliation(s)
- Hadush Gebregziabher
- grid.30820.390000 0001 1539 8988Department of Nutrition and Dietetics School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Amaha Kahsay
- grid.30820.390000 0001 1539 8988Department of Nutrition and Dietetics School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Fereweini Gebrearegay
- grid.30820.390000 0001 1539 8988Department of Nutrition and Dietetics School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Kidanemaryam Berhe
- grid.30820.390000 0001 1539 8988Department of Nutrition and Dietetics School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Alem Gebremariam
- grid.472243.40000 0004 1783 9494Department of Public Health, College of Medicine and Health Science, Adigrat University, Tigray, Ethiopia
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Rasul MG, Hasan M, Hossain D, Haseen F, Das S, Ahmed T. Qualitative assessment of programmatic constraints in delivery of effective interventions for improving maternal nutrition in Bangladesh. BMJ Nutr Prev Health 2023; 6:65-75. [PMID: 37559963 PMCID: PMC10407389 DOI: 10.1136/bmjnph-2021-000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Maternal undernutrition is highly prevalent in most of the developing countries. Prevalence of both extremes of maternal malnutrition (undernutrition and overweight/obesity) are common in those countries. For Bangladesh, the scenario is not different. The Government of Bangladesh recognises maternal nutrition as a public health priority and addresses the issue in its policies and programmes. We identified and analysed the existing maternal nutrition programmes and determined the bottlenecks in implementing the programmes in Bangladesh using qualitative approach. METHODS We followed a qualitative research approach and conducted 25 key informant interviews with the programme managers and policymakers, 10 in-depth interviews with the service providers and six focus group discussions with the pregnant women to identify the constraints of programme implementation. We analysed data using thematic and inductive approaches of qualitative research methods. RESULTS We have found that successful implementation of maternal nutrition intervention was being hampered by both the demand and supply side issues. On the demand side, major constraints were financial inability of the families to avail maternal nutrition-related services, ignorance of the family members and cultural barriers of using maternal nutrition-related services. Lack of priority and heavy workload of the service providers, lack of human resources, poor monitoring system, lack of medicine to supply and incoordination have been identified as major supply-side constraints in providing maternal nutrition-related interventions in Bangladesh. CONCLUSION Both supply side and demand side issues are responsible for the existing bottlenecks in implementing maternal nutrition-related programmes in Bangladesh. Findings of this study will help the policymakers to learn about the programmatic constraints regarding maternal nutrition services in Bangladesh.
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Affiliation(s)
- Md Golam Rasul
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mahamudul Hasan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Daluwar Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Fariha Haseen
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Habtu M, Agena AG, Umugwaneza M, Mochama M, Munyanshongore C. Effect and Challenges of an Integrated Nutrition-Intervention Package Utilization among Pregnant Women and Lactating Mothers in Rwanda: An Exploratory Qualitative Study. Curr Dev Nutr 2023; 7:100018. [PMID: 37181118 PMCID: PMC10100936 DOI: 10.1016/j.cdnut.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background Malnutrition among pregnant women and lactating mothers remains an issue of public health concern in developing countries. The Gikuriro program, an integrated nutrition-specific and nutrition-sensitive intervention, was implemented in 5 districts of Rwanda for 5 y to address this problem. Postprogram quasi-experiments showed significant effect of the intervention on maternal and child undernutrition. Notwithstanding, there was a need for a qualitative study to explore the views of the beneficiaries and implementers regarding its benefits, challenges, and limitations to inform future interventions. Objective This study aimed to explore the effect and challenges of an integrated nutrition-intervention program among pregnant women and lactating mothers. Methods This was a qualitative study involving 25 community health officers and 27 nutritionists as key informants and 80 beneficiaries in 10 focus group discussions. All interviews and group discussions were audio-recorded, transcribed verbatim, translated into English, and double coded. A deductive and inductive content analysis approach was used with the help of ATLAS.ti, version 9.15. Results The study identified several positive effects, such as improved knowledge and skills on nutrition, a positive mindset toward a balanced diet, perceived improved nutrition, and economic independence among pregnant women and lactating mothers. However, some of the main obstacles of the integrated nutrition intervention were lack of awareness of the program, negative beliefs, poverty, lack of spousal support, and time constraints. Moreover, the study identified a main limitation: the lack of inclusiveness for all social categories. Conclusions This study demonstrates that integrated nutrition interventions have perceived positive effect on nutrition; however, such interventions may face some challenges and limitations. These findings suggest that, apart from contributing to the body of evidence for scale up of such interventions in resource-limited settings, economic challenges and misconceptions have to be addressed to maximize the effect of such interventions.
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Affiliation(s)
- Michael Habtu
- School of Public Heatlh, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Maryse Umugwaneza
- School of Public Heatlh, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Monica Mochama
- Department of Public Heatlh, School of Health Sciences, Mount Kenya University, Thika, Kenya
| | - Cyprien Munyanshongore
- School of Public Heatlh, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Quinones S, Palermo T, Gavrilovic M, Vinci V, Otchere F, Mussa EC, Valli E, Waidler J, Tadele G, Adamu S, Abebe T, Tadesse Y, Nega F, Kebede M, Muluye F, Matsentu A, Aklilu D, Serdan AGG, Ouedraogo LM, Kebede GB. Knowledge of and access to frontline workers among poor, rural households in Amhara region, Ethiopia: a mixed-methods study. BMC Public Health 2022; 22:2179. [PMID: 36434573 PMCID: PMC9700966 DOI: 10.1186/s12889-022-14594-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Social protection programmes have effectively reduced poverty and improved food security. However, the effects of poverty require an intersectoral approach to adequately address poor nutrition and health. Identifying gaps in knowledge and access to frontline workers who oversee these integrations is critical for understanding the potential for integrated social protection programming to improve these outcomes. We measured levels of social protection programme participants' knowledge of and interaction with social workers (SWs) and health extension workers (HEWs) in rural Ethiopia. METHODS This mixed-methods study uses cross-sectional data from the baseline survey of a quasi-experimental impact evaluation among a sample of 5,036 households participating in Ethiopia's Productive Safety Net Programme. Qualitative interviews include key informant interviews, in depth interviews and focus group discussions with caregivers, community members, frontline agents, and stakeholders. Using data from household questionnaires administered to household heads, quantitative analyses include univariate and bivariate descriptive statistics as well as mutually-adjusted multivariable logistic regression analyses to estimate adjusted odds ratios and 95% confidence intervals for household sociodemographic characteristics associated with 1) knowledge of SWs and HEWs and 2) interaction with SWs and HEWs in their communities. Qualitative data were analysed using thematic analysis combining both a fluid and more structured coding processes to unpack the important topics within the data supported by illustrative quotes. RESULTS Our results show that knowledge of and interaction with SWs is limited while many knew of and interacted with HEWs quite regularly. Interactions with SWs were negatively associated with increased household size and living in Dewa Chefa. Factors associated with increased knowledge of and interaction with HEWs include having children under the age of 5 years in the household, having health insurance, and having a formal education. Qualitative analyses suggest that SWs are limited by overwhelming caseloads, limited resources to carry out their work, and high staff turnover. However, SWs are considered highly valuable in the communities where they work. CONCLUSIONS While most of the participants reported knowing their HEW, there is room for improvement, especially around household engagement with HEWs. Although SWs support the ISNP in the treatment districts only and not formally incorporated into the structure in the region, our findings highlight a need to provide greater support to SWs to effectively facilitate improvements in health and nutritional outcomes among vulnerable households. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201902876946874) and the Registry for International Development Impact Evaluations (RIDIE-STUDY-ID-5bf27eb0404a0).
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Affiliation(s)
- Sarah Quinones
- grid.273335.30000 0004 1936 9887Department of Epidemiology and Environmental Health, University at Buffalo (State University of New York), 270 Farber Hall, Buffalo, NY 14214-8001 USA
| | - Tia Palermo
- grid.273335.30000 0004 1936 9887Department of Epidemiology and Environmental Health, University at Buffalo (State University of New York), 270 Farber Hall, Buffalo, NY 14214-8001 USA
| | | | - Vincenzo Vinci
- grid.5012.60000 0001 0481 6099Maastricht Graduate School of Governance, Maastricht University/UNU-Merit, Maastricht, Netherlands ,UNICEF, Ho Chi Minh City, Vietnam
| | | | - Essa Chanie Mussa
- Via Degli Alfani 58, 50121 Florence, Italy ,grid.59547.3a0000 0000 8539 4635Department of Agricultural Economics, University of Gondar, Gondar, Ethiopia
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Kwan CK, Lo KC. Issues behind the Utilization of Community Mental Health Services by Ethnic Minorities in Hong Kong. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:631-642. [PMID: 35491859 DOI: 10.1080/19371918.2022.2071371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study collected data on the utilization rates of community mental health services among ethnic minorities and explained the results from the frontline social workers' perspective. Information about users' ethnicity was collected from 11 community mental health service providers from 2015 to 2018. This was followed by two sessions of focus groups conducted with 10 frontline social workers from six community mental health centers in Hong Kong. A hybrid analysis model was employed to analyze the qualitative data. The average utilization rates of community mental health services by ethnic minorities were 0.49%, 0.58%, and 0.68% in the years 2015-16, 2016-17, and 2017-18, respectively, showing that ethnic minorities who comprised 8% of the population were significantly underrepresented. It is worth noting that supply-side and demand-side factors are interrelated, suggesting the low utilization rate may be overcome by implementing a proactive social work service strategy.
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Affiliation(s)
- Chi Kin Kwan
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Kai Chung Lo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Bora K, Barman B, Pala S, Das A, Doke G, Tripura A. Coverage of antenatal iron-folic acid and calcium distribution during pregnancy and their contextual determinants in the northeastern region of India. Front Nutr 2022; 9:894245. [PMID: 35923196 PMCID: PMC9339897 DOI: 10.3389/fnut.2022.894245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Iron-folic acid (IFA) and calcium supplementation are nutritional interventions recommended prophylactically (against maternal anemia and preeclampsia, respectively) to all antenatal mothers in India under basic antenatal care (ANC) services. Using Health Management Information System data (reporting period: 2018–19 to 2020–21), we mapped the coverage of antenatal IFA and calcium distribution across the remote northeastern region of India relative to the number of pregnant women (PW) who registered for ANC, disaggregated by states and districts. Variations in coverage were also investigated by subgroups based on contextual attributes, viz., physiography (hilly/ plateau/ plain), socioeconomic development (“aspirational”/ “non-aspirational”) and proportion of early ANC visits (low/ medium/ high). Full course of antenatal IFA and calcium supplements were received by 79.36 (95% CI: 79.31–79.40) and 61.26 (95% CI: 61.21–61.32) PW per 100 ANC registered women, respectively. There was widespread heterogeneity in outreach, with calcium coverage generally trailing behind IFA coverage. Among states, coverage of the two interventions (per 100 ANC registered women) was highest in Assam (97.06 and 78.11 PW, respectively) and lowest in Nagaland (24.87 and 16.77 PW, respectively). At the district-level, the two interventions failed to reach even 50 PW per 100 ANC registered women in 32 (out of 115) districts. The coverage tended to be inferior in districts that were hilly, “non-aspirational” and had low proportion of early ANC visits. The granular information provided by our findings will facilitate monitoring, root cause analyses, microplanning, informed resource allocation and tailoring of locally appropriate solutions to achieve targeted coverage improvements.
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Affiliation(s)
- Kaustubh Bora
- Hematology Division, ICMR-Regional Medical Research Centre North East Region, Dibrugarh, India
- *Correspondence: Kaustubh Bora
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Ananya Das
- Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Goter Doke
- Department of Obstetrics and Gynecology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, India
| | - Amar Tripura
- Department of Community Medicine, Agartala Government Medical College, Agartala, India
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Eyasu K, Gebremariam LW, Gebrearegay F, Hadush Z, Mulugeta A. Community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia: an explorative qualitative study. BMC Pregnancy Childbirth 2022; 22:256. [PMID: 35346095 PMCID: PMC8958790 DOI: 10.1186/s12884-022-04593-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dietary related misconceptions during pregnancy affect the heath of mothers and their growing babies. Misconceptions vary from place to place and from community to community. Understanding of a given community’s food perceptions during pregnancy helps policy makers able to design cultural appropriate interventions. In Ethiopia, however, evidences on food beliefs and perceptions during pregnancy are limited. Therefore, this study is aimed at qualitatively assessing community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia. Methods We conducted 10 in-depth interviews (n = 10) and four focus group discussions (n = 32) among purposively selected community groups including pregnant mothers, religious leaders, and elders in rural kebeles of Ofla Woreda, Northern Ethiopia. Data were transcribed word-for-word, translated into English, and uploaded into ATLAST ti version 7.5.1.6. Data were analyzed following the principles of thematic analysis. Line-by-line coding was applied to identify codes; identified codes were categorized based on their similarities and differences and themes were developed inductively. Results Three main themes were identified inductively; foods positively and negatively linked with pregnancy; perceived benefits and harms of alcoholic drinks during pregnancy; and religion and fasting. In this study, consumptions of animal source foods such as egg were discouraged because such foods were perceived to increase the risk of having big baby that could delay delivery. However, intakes of locally produced alcoholic drinks during pregnancy were encouraged by the local community. Furthermore, avoidance of animal source foods and meal skipping during religious fasting-periods were also common practices among pregnant mothers in the study area. Conclusions This study explored misconceptions on food intakes during pregnancy. Positive attitude towards intake of “soft” alcoholic drinks might result in alcohol related teratogenic effects. Restriction on the intakes of nutrient rich diets due to religious fasting and other misconceptions would lead to insufficient nutrient intake both to the mothers and their growing fetus. Culturally appropriate intervention to improve awareness on healthy dietary intake during pregnancy is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04593-3.
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Misgina KH, Boezen HM, van der Beek EM, Mulugeta A, Groen H. What factors are associated with pre-pregnancy nutritional status? Baseline analysis of the KITE cohort: a prospective study in northern Ethiopia. BMJ Open 2021; 11:e043484. [PMID: 34183336 PMCID: PMC8240578 DOI: 10.1136/bmjopen-2020-043484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess a broad range of factors associated with pre-pregnancy nutritional status, a key step towards improving maternal and child health outcomes, in Ethiopia. DESIGN A baseline data analysis of a population-based prospective study. SETTING Kilite-Awlaelo Health and Demographic Surveillance Site, eastern zone of Tigray regional state, northern Ethiopia. PARTICIPANTS We used weight measurements of all 17 500 women of reproductive age living in the surveillance site between August 2017 and October 2017 as a baseline. Subsequently, 991 women who became pregnant were included consecutively at an average of 14.8 weeks (SD: 1.9 weeks) of gestation between February 2018 and September 2018. Eligible women were married, aged 18 years or older, with a pre-pregnancy weight measurement performed, and a gestational age ≤20 weeks at inclusion. OUTCOME MEASURES The outcome measure was pre-pregnancy nutritional status assessed by body mass index (BMI) and mid-upper arm circumference (MUAC). Undernutrition was defined as BMI of <18.5 kg/m2 and/or MUAC of <21.0 cm. BMI was calculated using weight measured before pregnancy, and MUAC was measured at inclusion. Linear and spline regressions were used to identify factors associated with pre-pregnancy nutritional status as a continuous and Poisson regression with pre-pregnancy undernutrition as a dichotomous variable. RESULTS The mean pre-pregnancy BMI and MUAC were 19.7 kg/m2 (SD: 2.0 kg/m2) and 22.6 cm (SD: 1.9 cm), respectively. Overall, the prevalence of pre-pregnancy undernutrition was 36.2% based on BMI and/or MUAC. Lower age, not being from a model household, lower values of women empowerment score, food insecurity, lower dietary diversity, regular fasting and low agrobiodiversity showed significant associations with lower BMI and/or MUAC. CONCLUSION The prevalence of pre-pregnancy undernutrition in our study population was very high. The pre-pregnancy nutritional status could be improved by advancing community awareness on dietary practice and gender equality, empowering females, raising agricultural productivity and strengthening health extension. Such changes require the coordinated efforts of concerned governmental bodies and religious leaders in the Ethiopian setting.
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Affiliation(s)
- Kebede Haile Misgina
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
- Department of Public Health, Aksum University, Axum, Ethiopia
| | - H Marike Boezen
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | | | - Afework Mulugeta
- Department of Nutrition, University of Mekelle, Mekelle, Ethiopia
| | - Henk Groen
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
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Beyene SA, Weldegerima L, Tela FG, Seid O, Brown AT, Bezabih AM. Barriers to utilize nutrition interventions among lactating women in rural communities of Tigray, northern Ethiopia: An exploratory study. PLoS One 2021; 16:e0250696. [PMID: 33930036 PMCID: PMC8087028 DOI: 10.1371/journal.pone.0250696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND While lactation is a physiological process requiring high energy demand to fulfill the nutrient requirements of the mother and the breastfeeding child, many factors affecting maternal nutrient intake can lead to nutritional deficits. Previous studies in Ethiopia have reported the prevalence of maternal and child undernutrition and related complications. However, qualitative studies exploring potential barriers to utilizing available nutrition interventions are limited. This study, therefore, sought to qualitatively explore barriers hindering the uptake of nutrition services among lactating mothers from rural communities in Tigray, northern Ethiopia. METHODS We conducted 6 in-depth interviews, 70 key informant interviews, and 13 focus group discussions among purposively selected community groups, experts, and lactating mothers between November- 2017 and January- 2018. Audio records of all interviews and focus group discussions were transcribed verbatim (word-to-word) and translated into English. Then, translated data were analyzed thematically using qualitative data analysis software Atlas ti-version 7.4. RESULTS The participants in this study perceived that lactating mothers in their study area are not properly utilizing available and recommended nutrition interventions, and as a result, their nutrient intake was reported as inadequate. Participants identified inadequate accessibility and availability of foods, feeding practices, cultural and religious influences, focus on agricultural production and productivity, barriers related to health services and poor access to water, sanitation and hygiene as major barriers hindering the uptake of nutrition interventions by lactating women in Tigray, northern Ethiopia. CONCLUSION The uptake of nutrition intervention services was low among lactating mothers and was hindered by multiple socio-cultural and health service related factors requiring problem-specific interventions at community, health facility, and administrative levels to improve the nutritional status of lactating mothers in the study area.
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Affiliation(s)
- Selemawit Asfaw Beyene
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Lemlem Weldegerima
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Freweini Gebrearegay Tela
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Omer Seid
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir Dar, Ethiopia
| | | | - Afework Mulugeta Bezabih
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
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Kahsay A, Gebregziabher H, Hadush Z, Yemane D, Hailemariam A, Mulugeta A. Exploration of Barriers to the Uptake of Nutritional Services Among Adolescent Girls from the Rural Communities of Tigray Region, Northern Ethiopia: A Qualitative Study. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:157-171. [PMID: 33117032 PMCID: PMC7588270 DOI: 10.2147/ahmt.s276459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022]
Abstract
Background Adolescence is a time of tremendous physical growth and mental development, with high nutrient requirements. Ethiopia is among the countries with a high prevalence of nutritional deficiencies among the women of reproductive age group, whilst adolescent girls from rural areas suffered disproportionately. However, there is a dearth of evidence regarding the barriers that hinder adolescent girls to utilize the available nutritional services. Purpose The current study aimed to qualitatively explore the range of barriers for the uptake of nutritional interventions among adolescent girls in rural communities of Tigray, Northern Ethiopia. Methods and Participants We employed an explorative qualitative study among purposively selected adolescent girls and school teachers from rural districts of Tigray region. We conducted 11 focused group discussions with adolescent girls, 17 in-depth interviews (seven with teachers, seven with in-school adolescent girls, and three with out-of-school adolescent girls) using a semi-structured guide. Data was audio-taped, transcribed verbatim in local language, translated into English, and imported into ATLAS.ti version 7.5 qualitative data analysis software for analysis. Results Adolescents perceived that stunting, anemia, and thinness are among the main nutritional problems in their community. Food insecurity, limited nutrition awareness in the community, limited access to a water source, high workload, service provider's little attention for adolescents' nutrition, and food taboo have emerged as barriers for the uptake of adolescent girls' nutritional interventions. Though limited in reach, available nutritional interventions include awareness creation, nutritional supplementation, and disease prevention. Conclusion Food insecurity poses a strong challenge to adolescent girls' nutrition. As access to safe drinking water continues to be a considerable bottleneck for nutritional interventions, a multi-sectoral response to integrate water, sanitation, and hygiene (WASH) services is required. Bounded by food taboo, high burden of workload among the adolescent girls, women empowerment and nutritional status seem to be the unfinished agenda in resource limited settings such as the rural areas of Tigray region.
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Affiliation(s)
- Amaha Kahsay
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hadush Gebregziabher
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Znabu Hadush
- Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Dejen Yemane
- Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Abera SF, Kantelhardt EJ, Bezabih AM, Tsadik M, Lauvai J, Ejeta G, Wienke A, Frank J, Scherbaum V. What factors are associated with maternal undernutrition in eastern zone of Tigray, Ethiopia? Evidence for nutritional well-being of lactating mothers. BMC Public Health 2020; 20:1214. [PMID: 32770979 PMCID: PMC7414570 DOI: 10.1186/s12889-020-09313-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background Maternal undernutrition is a pervasive health problem among Ethiopian mothers. This study aims at identifying the level of maternal undernutrition and its associated factors in Kilte Awaleo-Health and Demographic Surveillance Site (KA-HDSS), Tigray region, Ethiopia. Methods Nutritional status of 2260 lactating mothers was evaluated using the mid-upper-arm circumference (MUAC). Data from the vital events and verbal autopsy databases were linked to the survey and baseline recensus data to investigate the association of adult mortality from chronic causes of death (CoD) on maternal undernutrition. We employed a generalized log-binomial model to estimate the independent effects of the fitted covariates. Results The overall prevalence of maternal undernutrition based on MUAC < 23 cm was 38% (95% CI: 36.1, 40.1%). Recent occurrence of household morbidity (adjusted prevalence ratio (adjPR) = 1.49; 95%CI: 1.22, 1.81) was associated with increased risk of maternal undernutrition. In addition, there was a 28% higher risk (adjPR = 1.28; 95%CI: 0.98, 1.67) of maternal undernutrition for those mothers who lived in households with history of adult mortality from chronic diseases. Especially, its association with severe maternal undernutrition was strong (adjusted OR = 3.27; 95%CI: 1.48, 7.22). In contrast, good maternal health-seeking practice (adjPR = 0.86; 95%CI: 0.77, 0.96) and production of diverse food crops (adjPR = 0.72; 95%CI: 0.64, 0.81) were associated with a lower risk of maternal undernutrition. Relative to mothers with low scores of housing and environmental factors index (HAEFI), those with medium and higher scores of HAEFI had 0.81 (adjPR = 0.81; 95%CI: 0.69, 0.95) and 0.82 (adjPR = 0.82; 95%CI: 0.72, 0.95) times lower risk of maternal undernutrition, respectively. Conclusions Efforts to ameliorate maternal undernutrition need to consider the influence of the rising epidemiology of adult mortality from chronic diseases. Our data clearly indicate the need for channeling the integrated intervention power of nutrition-sensitive development programs with that of nutrition-specific sectoral services.
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Affiliation(s)
- Semaw Ferede Abera
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany. .,Food Security Center, University of Hohenheim, Stuttgart, Germany. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany.,Department of Gynaecology, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mache Tsadik
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Judith Lauvai
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, IN, USA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
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Using Three Delay Model to Understand the Social Factors Responsible for Neonatal Deaths Among Displaced Tribal Communities in India. J Immigr Minor Health 2020; 23:265-277. [PMID: 32107720 DOI: 10.1007/s10903-020-00990-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the tribal region, risk of death among neonates is influenced to a great extent by factors related to the mother such as situation of the mother prior to and post pregnancy, care received before, during and after pregnancy, birth order, and care received by the child during the first few years of his/her life. There is paucity of basic epidemiological data on reproductive health outcomes of displaced people (Hynes et al. in JAMA 288(5):595-603, 2002). Therefore, this study aims to examine the social factors responsible for neonatal deaths among displaced tribal communities in India. Sequential exploratory study design was used to collect data from displaced tribal communities in the state of Odisha and Chhattisgarh during 2016-2017. A purposive sampling method was used to select the sample from the definite population. Results indicate that in total 115 (59.3%) women had experienced at least one child deaths. Analysis of neonatal deaths suggests that about 39.2% women experienced at least one or more neonatal death during the last 5 years. Women who chose to deliver at home experience higher neonatal deaths (47.1%) in comparison to the women who delivered at the health facility (26.0%). The logistic regression analysis indicate that mothers education, place of delivery, utilization of the services, possession of Below Poverty Line (BPL) card and Particularly Vulnerable Tribal Group (PVTG) status are significant predictors of neonatal mortality. The probability of occurrence of neonatal mortality is 60% lower for literate women as compared to the illiterate women. Findings of the study identified three phases of delay that affect displaced tribal women in accessing and receiving health care services. Displaced tribal women are late in recognizing health problems of neonates and delay in seeking medical care due to rooted cultural barriers. Women who participated in this study had low levels of risk perception about delivering children at home and visiting traditional healer for the treatment. This is mainly due to their personal experiences of uneventful deliveries conducted by mothers-in-law or Traditional Birth Attendants (TBA) and sociocultural beliefs. There is need for provision of culturally sensitive instruction to service providers. This would further motivate service providers to sensitize the displaced tribal communities on various free healthcare services available to them.
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