Background In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women. Methods We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables. Results Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group. Conclusions Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting. Trial registration Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).

This article brings the social science concept of ‘deservingness’ to bear on clinical cases of transnational migrant patients. Based on the authors’ medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.

Objective: To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour. Design: We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables. Setting: The study was conducted in twenty villages in rural Malawi. Participants: Data from 257 pregnant women who were enrolled during late first trimester and followed until birth. Results: The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS. Conclusions: Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.

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With wide access to antiretroviral therapy, people living with HIV are living longer. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV to have children and remarry. However, some continue to have limited access to sexual and reproductive health services. The study explores barriers encountered by couples living with HIV in accessing sexual and reproductive health services using the social ecological model. Data were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities in Malawi from July to December 2010. Data were analyzed using framework analysis method. The study findings identify barriers across the five levels of the social ecological model indicating that the use of sexual and reproductive health services is influenced by diverse factors. We suggest three main areas for primary intervention: services must be located closer to their communities and integrated with existing antiretroviral services. In addition, information gatekeepers, both formal and informal, should be empowered with knowledge about sexual and reproductive health, including HIV and AIDS. Finally, there is a need to coordinate the flow of reproductive health, HIV, and AIDS information between Malawi Ministry of Health and formal and informal organizations.

The current issue of Asian Medicine emerges from the presentations made and discussions held during the panel 'Women and Gender in Medicine and Healing Across Asia' at the Asian Medicine: Cultivating Traditions and the Challenges of Globalisation conference in Bhutan, September 2009 (organised by IASTAM, the International Association for Traditional Medicine in collaboration with the Institute for Traditional Medicine Services, Thimphu). The original papers given at that panel spanned topics such as female medical practitioners in the history of Korean medicine, reproduction in late imperial and contemporary China, Islamic embryology, and women and gender in Tibetan medicine. While this issue focuses on the Tibetan medical contributions alone, it draws on insights gained from the wider discussions at the panel. It also includes other articles from scholars whose research is particularly relevant to the topic. The intention of this special issue is to present current research focusing on women and gender within the field of Tibetan medical and cultural practices. It presents articles that explore social, cultural, economic and medical aspects of women's health, as well as historical and contemporary roles and perspectives of female doctors and patients found within the medical landscape of a broadly defined Tibet. These contributions serve as points of reflection for this introductory essay, in which we review past and ongoing activities, explore analytical trajectories and innovative approaches in interdisciplinary research on women, gender and medicine in Tibet. OutlineThis introduction has three parts: the first reviews gendered productions, transmissions and practices of Tibetan medicine; the second part discusses the representation of women in medical literature and illustrations, while the 176 H. Fjeld, T. Hofer / Asian Medicine 6 (2010-11) third and last part addresses Tibetan medicine and reproductive health. So far, in the history of Tibetan medicine, called Sowa Rigpa (the 'science of healing', gso ba rig pa), most of its practitioners and authors have been men. Both the learning and practice of Sowa Rigpa and its associated texts have been closely connected to monastic institutions. This however, is only part of the (his)story. Sowa Rigpa was also learnt outside monasteries, within medical lineages, where knowledge and practice was often transmitted from father to son, uncle to nephew, and, as we shall see, from father to daughter, uncle to niece, and mother to daughter and son. Here we find the concept of the 'house' that derives from anthropological kinship theory a useful and encompassing tool for analysing the transmission and practice of Tibetan medicine outside lay and monastic institutions, for it draws out the relations between what in Tibetan are termed medical lineages (sman gyi rgyud) and medical houses (sman grong). We discuss whether, as has been suggested in earlier work by Janet Gyatso and Hanna Havnevik, Tibetan medicine has posed a relatively open field for women and, if so, how wom...

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