BackgroundSemantic, technical, content, criterion and conceptual equivalence must be examined in order to validate a psychological rating scale in a new cultural setting. Few validation studies have been conducted in sub-Saharan Africa for scales seeking to detect depression in pregnant women. The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression among Afaan Oromo speaking pregnant Ethiopian women.MethodsA random sample of 246 pregnant women were recruited in Seka Chekorsa District, Ethiopia during their first, second or third trimester. One week later, 29 participants were selected to answer the questionnaire for a second time to evaluate test retest reliability. The Mini International Neuropsychiatric Interview (MINI-Plus) scale was used as a gold standard to evaluate validity. PHQ-9 was compared with MINI-Plus and sensitivity, specificity, accuracy, positive likelihood ratio, negative likelihood ratio and Receiver Operating Characteristic Curves (ROC) for PHQ-9 were calculated. Rasch analysis was also carried out using Winsteps version 3.81.0.ResultsThe reliability coefficient, Cronbach's alpha, for the PHQ-9 total score was 0.84. Both the agreement and consistency Intra-class Correlation coefficients (ICC) for the one-week test-retest reliability were 0.98. The cut-off point of a summed score of eight resulted in a sensitivity of 80.8% and a specificity of 79.5%. The calculated area under the curve (AUC) for the PHQ-9 score versus the MINI-Plus was excellent, 0.88 (SE = 0.04; CI = 0.81–0.95). The PHQ-9 meets the criteria established by Linacre for rating scale effectiveness.ConclusionsThe PHQ-9 proved to be a reliable and valid instrument that may be used to screen major depressive disorders among Afaan Oromo speaking Ethiopian pregnant women.

Micronutrient deficiencies and imbalanced dietary intake tend to occur during the reproductive period among women in China. In accordance with traditional Chinese culture, pregnant women are commonly advised to follow a specific set of dietary precautions. The purpose of this study was to assess dietary intake data and identify risk factors for nutritional inadequacy in pregnant women from urban and rural areas of Deyang region, Sichuan province of China. Cross-sectional sampling was applied in two urban hospitals and five rural clinics (randomly selected) in Deyang region. Between July and October 2010, a total of 203 pregnant women in the third trimester, aged 19–42 years, were recruited on the basis of informed consent during antenatal clinic sessions. Semi-structured interviews on background information and 24-h dietary recalls were conducted. On the basis of self-reported height and pre-pregnancy weight, 68.7% of the women had a pre-pregnancy body mass index (BMI) within the normal range (18.5 ≤ BMI < 25), 26.3% were found to be underweight with a BMI <18.5 (20.8% in urban vs. 35.6% in rural areas), while only 5.1% were overweight with a BMI ≥30. In view of acceptable macronutrient distribution ranges (AMDRs) the women’s overall dietary energy originated excessively from fat (39%), was low in carbohydrates (49.6%), and reached the lower limits for protein (12.1%). Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake (RNI) fulfillment levels for energy (106.1% vs. 93.4%), fat (146.6% vs. 119.7%), protein (86.9% vs. 71.6%), vitamin A (94.3% vs. 65.2%), Zn (70.9% vs. 61.8%), Fe (56.3% vs. 48%), Ca (55.1% vs. 41%) and riboflavin (74.7% vs. 60%). The likelihood of pregnant women following traditional food recommendations, such as avoiding rabbit meat, beef and lamb, was higher in rural (80%) than in urban (65.1%) areas. In conclusion, culturally sensitive nutrition education sessions are necessary for both urban and rural women. The prevalence of underweight before conception and an insufficient supply of important micronutrients were more pronounced in rural areas. Therefore, attention must be given to the nutritional status, especially of rural women before, or at the latest, during pregnancy.

In the present study, the effects of various conventional shelling methods (oil-bath roasting, direct steam roasting, drying, and open pan roasting) as well as a novel “Flores” hand-cracking method on the levels of bioactive compounds of cashew nut kernels were investigated. The raw cashew nut kernels were found to possess appreciable levels of certain bioactive compounds such as β-carotene (9.57 μg/100 g of DM), lutein (30.29 μg/100 g of DM), zeaxanthin (0.56 μg/100 g of DM), α-tocopherol (0.29 mg/100 g of DM), γ-tocopherol (1.10 mg/100 g of DM), thiamin (1.08 mg/100 g of DM), stearic acid (4.96 g/100 g of DM), oleic acid (21.87 g/100 g of DM), and linoleic acid (5.55 g/100 g of DM). All of the conventional shelling methods including oil-bath roasting, steam roasting, drying, and open pan roasting revealed a significant reduction, whereas the Flores hand-cracking method exhibited similar levels of carotenoids, thiamin, and unsaturated fatty acids in cashew nuts when compared to raw unprocessed samples.

Breastfeeding has an important role in the prevention of different forms of childhood malnutrition, including wasting, stunting, over- and underweight and micronutrient deficiencies. This chapter reviews research that demonstrates how improved breastfeeding rates have the potential to improve childhood nutrition, with associated impacts on infectious and noninfectious disease prevention. The unique composition of breastmilk, the importance of breastfeeding in infectious disease prevention, the iron status of breastfed infants, and breastfeeding's protective effect on overweight and obesity are discussed based on currently available research. Early and tailored dietary counseling is needed to improve maternal diets, which can affect the nutritional status of breastmilk. Promotion and support of breastfeeding are important to prevent childhood morbidity and mortality. A review of the literature reveals key factors shown to be effective in improving breastfeeding rates, especially including legislation to control the marketing of breastmilk substitutes. In conclusion, breastfeeding is shown to be the best natural resource to improve childhood nutrition throughout the world.

BackgroundDepression during pregnancy has far-reaching adverse consequences on mothers, children and the whole family. The magnitude and determinants of prenatal depressive symptoms in low-resource countries are not well established. This study aims to describe the prevalence of prenatal depressive symptoms and whether it is associated with maternal nutrition, intimate partner violence and social support among pregnant women in rural Ethiopia.MethodsThis study is based on the baseline data from a large prospective, community-based, birth cohort study conducted in the South Western part of Ethiopia from March 2014 to March 2016. A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9) scale and a cut off of ≥8 was taken to define prenatal depressive symptoms. Data collection was conducted electronically on handheld tablets and submitted to a secured server via an internet connection. Bivariate and multivariate logistic regression analyses were computed using IBM SPSS version 20 software.ResultThe community based prevalence of depressive symptoms during pregnancy was 10.8% (95%Confidence Interval (CI): 9.92–11.70). Adjusting for confounding variables, moderate household food insecurity (OR 1.74; 95% CI: 1.31–2.32), severe household food insecurity (OR 7.90; 95% CI: 5.87–10.62), anaemia (OR = 1.30; 95% CI: 1.04–1.61) and intimate partner violence (OR 3.08; 95% CI: 2.23–4.25) were significantly associated with prenatal depressive symptoms. On the other hand, good social support from friends, families and husband reduced the risk of prenatal depressive symptoms by 39% (OR 0.61; 95% CI: 0.50–0.76).ConclusionPrenatal depressive symptomatology is rather common during pregnancy in rural Ethiopia. In this community based study, household food insecurity, anaemia and intimate partner violence were significantly associated with prenatal depressive symptoms. Good maternal social support from friends, families and spouse was rather protective. The study highlights the need for targeted screening for depression and intimate partner violence during pregnancy. Policies aimed at reducing household food insecurity, maternal anaemia and intimate partner violence during pregnancy may possibly reduce depression.

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The objective was to assess the prevalence of anemia and nutritional status of mothers and children under five years among Syrian refugees in Lebanon and to identify nutritional deficiencies among pregnant, lactating, and non-pregnant non-lactating (NPNLM) mothers. A cross-sectional study was conducted among Syrian refugee mothers with children under five years in Greater Beirut, Lebanon (n = 433). Data on socio-economic status, maternal health, lifestyle characteristics, dietary intake, anthropometric measurements, and hemoglobin concentrations were collected. The prevalence of anemia was 21.7% among mothers and 30.5% among children. NPNLM with overweight/obesity and an at-risk waist circumference (WC) had 14.7-times and 10.9-times higher odds of anemia than mothers with normal WC and weight. Children of anemic mothers had 2.7-times and 4.4-times higher odds of total and mild anemia than those of non-anemic. Higher odds of mild anemia were found among children of lactating mothers than of NPNLM. A high percent energy intake of total fat and sugar was found among all mothers. Nutritional inadequacy was identified in higher proportions of lactating and pregnant mothers than NPNLM. Our findings highlighted the co-existence of overnutrition and anemia among Syrian refugee mothers and undernutrition among children from the same household. Culture-specific interventions are needed to support maternal nutrition, to ensure the health and wellbeing of their offspring.

BackgroundThis study investigated the infant feeding practices of participating mothers who were recruited into a research project aimed at improving the nutritional status of mildly wasted children (< -1.0 to ≥ -1.5 Weight-for-Height Z-scores) aged ≥ 6 to < 60 months on Nias Island, Indonesia.MethodsCross-sectional, questionnaire-based interview of mothers of the index children (n = 215) who were admitted to the community program for mildly wasted children in the study area. Four focus groups and twenty in-depth interviews were conducted to explore further information on infant feeding practices in the study area.ResultsRetrospective results indicated that 6% of the mothers never breastfed. Fifty two percent of mothers initiated breastfeeding within six hours of birth, but 17% discarded colostrum. Exclusive breastfeeding until 6 months of age was practiced by 12%. Seventy-four percent of the mothers offered supplementary liquids besides breast milk within the first 7 days of life, and 14% of infants received these supplementary liquids from 7 days onwards until 6 months of age. Moreover, 79% of the infants were given complementary foods (solid, semi-solid, or soft foods) before 6 months of age. About 9% of the children were breastfed at least two years. Less than one in five of the mildly wasted children (19%) were breastfed on admission to the community program. Qualitative assessments found that inappropriate infant feeding practices were strongly influenced by traditional beliefs of the mothers and paternal grandmothers in the study areas.ConclusionGenerally, suboptimal infant feeding was widely practiced among mothers of mildly wasted children in the study area on Nias Island, Indonesia. To promote breastfeeding practices among mothers on Nias Island, appropriate nutrition training for community workers and health-nutrition officers is needed to improve relevant counseling skills. In addition, encouraging public nutrition education that promotes breastfeeding, taking into account social-cultural factors such as the influence of paternal grandmothers on infant feeding practice, is needed.