Women's knowledge in Madagascar: A health needs assessment study

Abstract

Nutritional and hygienic practices contribute to high morbidity and mortality rates related to malnutrition in Madagascar. This study, a research effort that brought together charitable organisations, non-governmental organisations (NGOs) and university collaborators, investigates women's health knowledge in the Anosy region of Madagascar. The needs assessment sought to characterise women's knowledge and understanding of nutrition and hygiene. Eight focus groups of 13–60 women each were conducted in the seven most impoverished communes of the Anosy region (n=373). Participants were recruited with the aid of a UK–Malagasy partnered NGO, Azafady. Study findings show that women fully understand the interplay between poor nutrition, hygiene and malnutrition but are unable to change everyday practices because the barriers to better nutrition and hygiene seem beyond their control. These findings may be used to prioritise projects and research seeking to improve nutrition and hygiene, thus reducing malnutrition in the Anosy region.     

Influences on maternal and child nutrition in the highlands of the northern Lao PDR

In two remote northern provinces of the Lao People's Democratic Republic, provincial and district teams were trained and subsequently conducted a qualitative study using a participatory approach to investigate people's knowledge, attitudes, beliefs and practices in relation to women's and children's nutrition. Using focus group discussions, key informant interviews, and structured observation, the teams found that certain nutrition behaviours, including food taboos, may contribute to the high prevalence of child malnutrition and micronutrient deficiencies in these northern provinces. Ethnic groups gave details of nutrition-related beliefs and practices; the teams found that many of these are likely to be amenable to change through relatively low-cost nutrition promotion informed by these findings. In particular, barriers to exclusive breastfeeding, food taboos and hygiene behaviour could be addressed. The study also demonstrated that with appropriate training, supervision and support, local teams are able to plan and conduct a large-scale qualitative study.     

EXPLAINING NUTRITION OUTCOMES OF FOOD-BASED INTERVENTIONS THROUGH AN ANALYSIS OF WOMEN'S DECISION-MAKING POWER

Community-based nutrition program interventions have yielded measurable nutrition results. These interventions engage community members in and throughout the process to ensure that the interventions are acceptable and appropriate. Despite this, hunger and other forms of malnutrition continue to be problematic-- for some individuals, in some communities and in some regions. Current development discourse on agency and capabilities, and power and choices suggests an approach for achieving further improvements. Five community-based intervention research studies that strengthened women's contributions to nutrition by reducing their resource constraints are reviewed in light of this discourse. All five used food-based strategies that yielded improvements in micronutrient dietary intake or status in a timely fashion. Although the studies were guided by standard development practices including participatory approaches and methods, and addressed women's resource needs, they differed significantly in terms of the locus of decision-making power. This retrospective analysis suggests that nutrition programs could enhance their outcomes by investing in women's agency and decision-making power, and contribute to realizing the rights of all to development.     

Determinants of Appropriate Child Health and Nutrition Practices among Women in Rural Gambia

Health education and awareness involves providing knowledge about causes of illness and choices to promote a change in individual behaviour and, thus, improves survival of individuals. Studies have, however, shown that improved knowledge and awareness is not always translated into appropriate actions. This study aimed at exploring the factors determining mothers’ choices of appropriate child health and nutrition practices in the Gambia. Eight focus-group discussions (FGDs) were held with 63 women whose children had been seen at the Keneba MRC Clinic within the 12 months preceding the study. The FGDs were analyzed using a thematic framework. Gender inequality, presence or absence of support networks, alternative explanatory models of malnutrition, and poverty were identified as the main factors that would determine the ability of a mother to practise what she knows about child health and nutrition. The findings highlight the need to consider the broader social, cultural and economic factors, including the value of involving men in childcare, when designing nutritional interventions.Key words: Child health, Child nutrition, Child nutrition disorders, Gender, Health education, Interventions, Knowledge, attitudes, practices, The Gambia     

Nutrition education intervention for college female athletes

OBJECTIVE: To evaluate the efficacy of a nutrition education intervention for college female athletes to improve nutrition knowledge, build self-efficacy with respect to making healthful dietary choices, and improve dietary intake. DESIGN: A pretest-posttest control group design was implemented. PARTICIPANTS: A women's soccer team (n =15) and a women's swim team (n = 15) were randomly assigned to experimental and control groups, respectively. INTERVENTION: The intervention focused on nutrition knowledge, self-efficacy in making healthful dietary choices, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES: Dependent variables were nutrition knowledge, self-efficacy, and dietary practices. Independent variables were group assignment. ANALYSES: The Mann-Whitney U test was used to analyze the results between groups, and the Fisher exact probability test was used to detect differences between groups in the number of positive dietary changes. RESULTS: Treatment participants significantly improved nutrition knowledge, self-efficacy (P <.05), and the overall number of positive dietary changes (P <.03). CONCLUSIONS: This study reduces the paucity of nutrition education intervention research among athletes and demonstrates the ability to increase not only nutrition knowledge, which is typically reported, but also self-efficacy and improvement in overall positive dietary changes during an 8-week intervention.     

Women's douching practices and related attitudes: findings from four focus groups

PURPOSE: Vaginal douching is a common hygiene practice for many U.S. women, but is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. This qualitative study, consisting of four focus groups of 31 southern women, was conducted to gather in-depth information about attitudes and beliefs associated with douching. The focus groups consisted of separate groups of low-income and middle-income Caucasian and African-American women. RESULTS: The African-Americans and low-income Caucasians were more likely to douche than middle-income Caucasians. The participants reported douching after menstruation, after sexual intercourse, and at other times for cleanliness and odor control. Concern about odor and cleanliness was a recurrent theme, and douching was represented as an expected and necessary part of feminine hygiene. Several socioeconomic and racial differences were observed in douching practices and attitudes. CONCLUSIONS: This study provides preliminary information about women's douching practices and attitudes that may inform practitioners' educational efforts and future research.     

Heavy agricultural workloads and low crop diversity are strong barriers to improving child feeding practices in the Bolivian Andes

Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0-36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.     

Relationship of Social Roles and Nutrition Beliefs to Fat Avoidance Practices: Investigation of a US Model Among Danish Women

Objective This study was designed to investigate the associations among women's social roles, their nutrition beliefs, and their dietary fat avoidance practices. Role theory and prior qualitative research among US women provided the theoretical framework.Design/subjects A random-sample mail survey (76% response) was used to gather information on the usual pattern of dietary fat use, nutrition beliefs, and social positions of Danish women aged 30 to 60 years. A fat avoidance score was calculated for each respondent on the basis of 12 fat consumption practices. Sequential multiple linear regression was used to develop an explanatory model for fat avoidance using responses from 594 women.Results Interactions between nutrition attitudes and beliefs and social roles suggested that the roles themselves did not influence fat avoidance practices, but the nutrition beliefs associated with particular roles did have an influence. Among employed women, fat avoidance was lower among those who perceived many barriers to healthful eating. Among women who were not employed, fat avoidance was lower among those who perceived little social support for healthful eating. The association of fat avoidance with caretaking responsibility varied by age group. Caretaking was positively associated with fat avoidance among women in their forties, but not in older or younger age groups.Conclusions Nutrition messages should be tailored to fit women's unique social roles and the beliefs associated with them. Nutrition professionals in Denmark and the United States can adapt these findings to their own cultural context. J Am Diet Assoc. 1996; 96:580-584.     

晚孕妇女营养知识、态度和饮食行为调查分析

目的:了解济宁市晚期妊娠妇女营养知识、态度和饮食行为(Knowledge attitude practice KAP)及其影响因素,为开展孕妇营养教育工作提供理论依据。方法:采用问卷调查方法随机选择226例晚期妊娠妇女,对其一般情况和营养KAP进行调查。结果:济宁市晚期妊娠妇女的营养KAP总体水平一般,及格率为64.93%,营养态度较好,营养知识与态度、营养知识与饮食行为呈正相关,营养KAP得分与孕妇的文化程度和职业有关,文化程度越高,得分越高。结论:济宁市晚期妊娠妇女的营养知识水平和饮食行为有待进一步提高和改善,应根据孕妇的文化程度、职业等采取不同的方式开展孕妇营养健康知识宣教,指导孕妇科学合理的安排饮食,促进孕妇健康,保护胎儿正常生长发育。     

Gendered health policies and a women's movement: the Gypsy case

Health concepts depend on socially constructed hygiene practices. Many accounts of "traditional" Gypsy hygiene make gender differentiation primary, implying that traditional health practices reinforce patriarchy and emphasizing the special needs of Gypsy women. This paper argues, however, that the position of women is contested in Romani society. Although prioritizing the more apparent health needs of women and small children appeals to health professionals, this cannot by itself create an effective critique of the health system's response to Gypsy needs. The emergence of a Gypsy women's movement has led to a new critique, and challenge to the victim image of women.     

Perceptions of the role of maternal nutrition in HIV-positive breast-feeding women in Malawi

A neglected issue in the literature on maternal nutrition and HIV is how HIV-positive women perceive their own bodies, health, and well-being, particularly in light of their infection, and whether these perceptions influence their infant feeding practices and their perceived ability to breast-feed exclusively through 6 mo. We conducted formative research to better understand breast-feeding practices and perceptions, and to inform the Breastfeeding, Antiretroviral, and Nutrition (BAN) Study, a clinical trial to evaluate antiretroviral and nutrition interventions to reduce mother-to-child transmission of HIV during breast-feeding in Lilongwe, Malawi. Twenty-two HIV-positive women living in semi-rural areas on the periphery of Lilongwe participated in in-depth interviews. In an adaptation of the body-silhouette methodology, nine culturally appropriate body silhouettes, representing a continuum of very thin to very large shapes, were used to elicit women's views on their present, previous-year, and preferred body shapes, and on the shape they perceived as healthy. The narrative scenario method was also used to explore women's views on 2 fictional women infected with HIV and their ability to exclusively breast-feed. Women perceived larger body shapes as healthy, because fatness is considered a sign of good health and absence of disease, and many recognized the role of nutrition in achieving a preferred or healthy body shape. Several women believed their nutritional status (body size) was declining because of their illness. Women were concerned that breast-feeding may increase the progression of HIV, suggesting that international guidelines to promote appropriate infant feeding practices for infants whose mothers are infected with HIV should focus on the mother's health and well-being, as well as the infant's.     

Distinguishing the temporal association between women's intravaginal practices and risk of human immunodeficiency virus infection: a prospective study of South African women

Cross-sectional studies have suggested that intravaginal practices, such as douching or "dry sex," may increase women's susceptibility to infection with human immunodeficiency virus (HIV). The authors examined the temporal nature of this association in a cohort of South African women. At enrollment (2001-2002), 4,089 women were tested for HIV infection. Participants reported their intravaginal practices at a 6-month follow-up visit and were followed with repeat HIV testing for up to 24 months. Among the 3,570 women who were HIV-negative at enrollment, 26% reported some type of intravaginal practice, mostly washing inside the vagina with water and/or cloth as part of daily hygiene. During follow-up, 85 incident HIV infections were observed. Intravaginal practices were associated with prevalent HIV at enrollment (adjusted odds ratio = 1.50, 95% confidence interval: 1.22, 1.85), but during follow-up there was no association between intravaginal practices and incident HIV (adjusted hazard ratio = 1.04, 95% confidence interval: 0.65, 1.68). These findings may be explained by a reversal of the causal sequence assumed for this association, since intravaginal practices may be undertaken in response to vaginal infections that occur more commonly among HIV-infected women. Intravaginal practices appear unlikely to be a cofactor in the male-to-female transmission of HIV in this setting.     

"We grandmothers know plenty": breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi

This paper has two purposes: first of all, we examine grandmothers' role and views of child feeding practices in northern Malawi, and their influence on younger women's practices. Secondly, we consider the implications of these findings for health promotion activities and models of health education. Data were collected from semi-structured interviews, focus groups and a participatory workshop. Findings demonstrate that, to address child feeding practices which have an effect on nutrition, attention must be paid to the broader context that influences child nutrition, including extended family relations. Paternal grandmothers have a powerful and multifaceted role within the extended family in northern Malawi, both in terms of childcare and in other arenas such as agricultural practices and marital relations. Grandmothers often differ in their ideas about early child feeding from conventional Western medicine. Some practices have existed in the area at least since colonial times, and have strong cultural significance. Despite the important integrated role, older women have within households and communities in this part of Malawi, hospital personnel often have disparaging and paternalistic attitudes towards 'grannies' and their knowledge. Health education rarely involves grandmothers, and even if they are involved, their perspectives are not taken into consideration. Hospital staff often reject grandmother knowledge as part of a broader modernization paradigm which views 'traditional knowledge' as backward. Grandmothers view current child health conditions within a broader context of changing livelihood conditions and a high prevalence of HIV/AIDS. The paper concludes by discussing the challenges of involving grandmothers in health education, and the difficulties of incorporating local knowledge into a medical system that largely rejects it.     

Nutrition Advice During Pregnancy: Do Women Receive it and Can Health Professionals Provide it?

A healthy diet during pregnancy is essential for normal growth and development of the foetus. Pregnant women may obtain nutrition information from a number of sources but evidence regarding the adequacy and extent of this information is sparse. A systematic literature review was conducted to identify sources of nutrition information accessed by pregnant women, their perceived needs for nutrition education, the perceptions of healthcare providers about nutrition education in pregnancy, and to assess the effectiveness of public health programs that aim to improve nutritional practices. The Scopus data base was searched during January, 2013 and in February 2014 to access both qualitative and quantitative studies published between 2002 and 2014 which focused on healthy pregnant women and their healthcare providers in developed countries. Articles were excluded if they focused on the needs of women with medical conditions, including obesity, gestational diabetes or malnutrition. Of 506 articles identified by the search terms, 25 articles were deemed to be eligible for inclusion. Generally, women were not receiving adequate nutrition education during pregnancy. Although healthcare practitioners perceived nutrition education to be important, barriers to providing education to clients included lack of time, lack of resources and lack of relevant training. Further well designed studies are needed to identify the most effective nutrition education strategies to improve nutrition knowledge and dietary behaviours for women during antenatal care.     

Influence of Sociocultural Practices on Food and Nutrition Security in Karamoja Subregion of Uganda

The study determined the influence of sociocultural practices on food and nutrition security of children and women in Karamoja subregion, located in northeastern Uganda. Sixteen focus group discussions were conducted among 133 participants. Data were analyzed using qualitative content analysis. Findings indicate that cultural norms, myths, and taboos restrict consumption of animal-sourced foods and some green vegetables by women. Sociocultural practices promoted prelacteal feeding, affecting the implementation of World Health Organization’s recommendations for exclusive breast feeding. In conclusion, sociocultural practices influence food and nutrition security, exposing women and children to the risk of malnutrition and associated consequences.     

Self-efficacy and rural women's performance of breast and cervical cancer detection practices

Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women (N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.     

Determinants of nutrition knowledge in young and middle-aged Belgian women and the association with their dietary behaviour

The present study investigated the role of socio-demographic and lifestyle determinants on the nutrition knowledge of Belgian women and the association between their knowledge and dietary behaviour. A total of 803 women, aged 18–39 years, were included in a cross-sectional study and completed a general and nutrition knowledge questionnaire and a 2-day food record. Their height and weight were measured under standardised conditions. Linear regression models showed independent significant associations between the following determinants and the women's nutrition knowledge (in order of importance): educational level, age, kind of occupation, smoking behaviour, and work status. Inconsistent or no associations were found for body mass index, physical activity, living situation, and whether or not they had children. The investigated determinants accounted for 13–14.5% of variance in total nutrition knowledge. A rise in nutrition knowledge was associated with a significant rise in consumption of vegetables and fruit, but no differences were seen for other dietary indicators. Most important determinants of the women's nutrition knowledge were educational level, age and their kind of occupation. Women who had better knowledge of nutrition also exhibited better dietary behaviour, thus underlying the importance of nutrition education for improving dietary behaviour.     

Health care at home setting: social interaction and daily life]

OBJECTIVE: To explore the boundaries and agents which make up women's knowledge about health care. METHODS: A qualitative study was carried out in 4 regions in Mexico. Forty middle-aged women (between 35 and 65 years old) were interviewed and their responses analyzed. RESULTS: The findings of this study point out to the relationship of women and their different social interactions with their health care practice. Among these interactions are: the contact with health services (which shapes the way women take care of their own health and their family); mass media (particularly television); use of medicines; traditional healers; knowledge acquired from their grandparents, mothers, and peers; and women's own experience while taking care of their family. Health care at home setting is a mixture of traditional healing practices and the conventional medical practices disseminated among the population. CONCLUSION: The different social interactions in which women are involved make up the way Mexican women take care of their own health and their family.     

Impact of the participation of women in science: on rethinking the place of women especially in occupational health.

Recently, women have become scientists in increasing numbers. The present article uses a perspective drawn from the sociology of knowledge to examine the impact of this participation on science, especially the study of occupational health and safety. Five evolutionary stages are described: (1) Inclusion of women as scientific workers; (2) Inclusion of women as subjects of scientific research; (3) Inclusion of variables relevant to women, rather than merely applying to women the factors used to explain men's situations; (4) Using new methodologies to reveal the complexity and the specificity of women's life situations, in addition to those tools developed while studying male populations; (5) Questioning the values on which traditional science has been based, and orienting research according to feminist values. Examples from the study of women's occupational health illustrate these five stages. It is suggested that scientific research oriented toward the well-being of women workers will not only yield a better understanding of women's conditions but also lead to a rethinking of standard practices for research on men's conditions.