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.

Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania.

The study sought to identify determinants of blood loss at childbirth and 24 hours postpartum. The study was nested in a community-based randomized trial of treatments for anaemia during pregnancy in Wete Town, Pemba Island, Zanzibar, United Republic of Tanzania. Status of anaemia during pregnancy, nutritional information, obstetric history, and socioeconomic status were assessed at enrollment during routine antenatal care. Pregnant women presented for spontaneous vaginal delivery, and nurse-midwives collected information on labour and delivery via partograph. Blood-stained sanitary napkins and pads from childbirth and 24 hours postpartum were quantified using the alkaline hematin method. Moderate-to-severe anaemia (Hb <90 g/L) at enrollment was strongly associated with blood loss at delivery and the immediate postpartum period, after adjusting for maternal covariates and variables of biological relevance to blood loss. Greater blood loss was associated (p<0.10) with duration of the first stage of labour, placental weight, receipt of oxytocin, preterm birth, and grand multiparity. The findings provide unique evidence of a previously-suspected link between maternal anaemia and greater blood loss at childbirth and postpartum. Further research is needed to confirm these findings on a larger sample of women to determine whether women with moderate-to-severe anaemia are more likely to experience postpartum haemorrhage and whether appropriate antenatal or peripartum care can affect the relationships described here.