Coming Full Circle: Addressing Perceptions and Cultural Beliefs of Maternal Dietary Practices, Weight Gain and Breastfeeding for Birth Spacing from Pregnancy to Postpartum in Egypt.

Objectives: To examine women's perceptions and cultural beliefs regarding maternal dietary practices during pregnancy and postpartum, weight gain during pregnancy, and iron folic acid supplementation. Methods: Implementation research was conducted in Upper and Lower Egypt in February-April 2013 among women who were participating in the United States Agency for International Development (USAID)-funded Maternal and Child Health Integrated Program (MCHIP)/ Smart project that focuses on improving the nutritional status of children less than two years of age. A doubling in stunting prevalence in Lower Egypt between the 2005 and 2008 Demographic and Health Surveys in comparison to Upper Egypt, served as the impetus for a research study examining factors associated with stunting in Smart project areas in Lower and Upper Egypt. Qualitative data collection included in-depth interviews with 40 pregnant and 40 postpartum women. Pregnant and postpartum mothers discussed cultural norms regarding foods eaten during their current pregnancy/postpartum and their perceptions of weight gain during current/ previous pregnancy, iron folic acid supplementation and breastfeeding to prevent pregnancy. Results: Mothers' knowledge of healthy foods to eat during pregnancy and postpartum was adequate, however cultural misconceptions reduced food intake. Foods perceived as "light and "easy to digest" limited the quantity and types of foods eaten during pregnancy. Foods thought to increase milk production were consumed postpartum. Sources of advice varied and affected behavior. Provider advice regarding antenatal iron folic acid supplementation was inadequate. Conclusions: Messages should be culturally tailored to dispel misperceptions regarding the appropriateness of foods and target mothers and influential community members.

Improving Iron-Folic Acid and Calcium Supplementation Compliance through Counseling, Reminder Cards and Cell Phone Messages in Kenya.

Objectives: To determine if compliance with daily iron-folic acid (IFA) supplementation to prevent anemia and daily IFA and calcium supplementation to prevent anemia and pre-eclampsia can be improved with counseling and by using reminder cards and cell phone messages to ensure daily intake. Methods: Implementation research conducted in Eastern region and Nyanza region of Kenya over six months with 120 pregnant women. Initial qualitative research determined women's perceptions about anemia and pre-eclampsia and experiences with taking IFA/calcium and was used to develop counseling messages. All women received standard antenatal care (ANC), counseling, and reminder cards. Women were randomized into one of four groups: those receiving only IFA and no text messages; those receiving only IFA with text messages; those receiving IFA and calcium with no text messages; and those receiving IFA and calcium with text messages. Supplement compliance and barriers to compliance was assessed monthly during ANC or home visits and measured by self-reporting by women, reporting by a family member who observed intake, and by counting remaining pills. Husbands, mothers-in-law, health workers and community leaders were interviewed for insights about how they can influence compliance. Results: Initial findings in Kenya suggest that less than 5% of women are taking 90+IFA supplements during pregnancy due to inadequate supplies, lack of counseling or compliance with IFA supplementation. Conclusions: This study will help inform future programming on the existing IFA supplementation policy and as the country introduces calcium supplementation.