Nutrition and health-seeking practices during pregnancy and lactation and potential strategies to increase micronutrient intakes among women in northern Lao PDR

Abstract

Access to and utilisation of antenatal care (ANC) is important for optimising health and nutrition during pregnancy. This study aimed to assess adherence to and factors associated with ANC and antenatal supplement use among Laotian women, and consider culturally appropriate strategies to increase micronutrient intakes. Mother–child (aged 21 d to <18 months) dyads (n 699) enrolled in a hospital-based prospective cohort study with the community comparison group in Luang Prabang province were interviewed about their antenatal history, supplement use, household sociodemographic and dietary practices, including postpartum food avoidances. Ninety percent of women (mean age 24⋅7 ± 6⋅3 years) reported receiving ANC during their pregnancy, with the majority reporting four to seven contacts, while 84⋅6 and 17⋅3 % reported supplement use during pregnancy and lactation, respectively. Adequate ANC contacts (≥8) and supplement use was more likely among women with complete primary education and from higher socioeconomic status households, and less likely among women belonging to ethnic minority populations and those who delivered their child at home. All women continued to consume salt while adhering to postpartum food avoidances; however, 58⋅5 and 38⋅7 % of habitual consumers restricted fish and soy sauces, respectively. Eighty-six percent of women reported they would be willing to take supplements when adhering to postpartum dietary restrictions. Overall, women's reported ANC attendance and antenatal supplement use was suboptimal. Understanding predictors of and barriers to ANC and supplement use may help implement effective public health strategies to improve adherence. Alongside targeted supplementation, salt fortification with micronutrients may be a viable population-wide intervention that needs further evaluation.

Risk factors for anaemia among women and their young children hospitalised with suspected thiamine deficiency in northern Lao PDR

“…Thiamine deficiency is not commonly considered a cause of anaemia (WHO, 2017 ), except for megaloblastic anaemia responsive to thiamine, which is a rare autosomal recessive hereditary disease with an extremely low incidence (Green & Datta Mitra, 2021 ). So a more likely explanation for our findings is that anaemia and thiamine deficiency are caused by similar poverty‐related risk factors (Smith, Sitthideth, et al, 2022 ). This same interaction of poverty‐related risk factors may explain our findings that lower BMI and low MUAC among women and stunting among children were significantly associated with anaemia among women and children, respectively.…”

“…A weakness of this secondary study is that the study population is not representative of the Luang Prabang region or the country. Indeed, the Lao Thiamine study also included a frequency‐matched community comparison group, and several socioeconomic characteristics and diet and nutrition practices differed significantly from the hospital cohort (Smith, Sitthideth, et al, 2022 ; Smith, Tan, 2022 ). While the present study included a wide range of risk factors, only limited information was available on primary causes, such as inherited red blood cell anomalies, infections such as soil‐transmitted helminthiasis, schistosomiasis and malaria, gynaecological and obstetric conditions and other chronic diseases that lead to blood loss, decreased erythropoiesis or destruction of erythrocytes (Chaparro & Suchdev, 2019 ; Hess et al, 2023 ; WHO, 2017 ).…”