Herbal medicine use during pregnancy and childbirth: perceptions of women living in Lilongwe rural, Malawi - a qualitative study.

BACKGROUND: Globally, use of herbal medicine during pregnancy and labour is often associated with adverse obstetric outcomes such as uterine rupture and fetal distress. However, in rural Malawi, information on the perceptions of women about the use of herbal medicine during pregnancy and labour is underreported despite the practice. Understanding women's views and perceptions on use of herbal medicine during pregnancy and labour is therefore critical for understanding the basis of their practice and for setting up maternal and neonatal health care interventions to alleviate any possible pregnancy and labour complications. AIMS: To explore the perceptions of women on the use of herbal medicine during pregnancy and labour in rural Malawi. METHODS: We employed a qualitative descriptive (QD) study on the purposively identified participants (women with parity [Formula: see text]), residing in four villages (Kagona, Champsinja, Mthupi and Manja) of Traditional Authority Malili, in Lilongwe rural district, Malawi. Qualitative data was collected through four Focus Groups of 6-8 women in each group that were conducted in each village. Data analysis was performed inductively, using reflexive thematic analysis approach. RESULTS: A total of 28 women of reproductive age 20 and above; 20-24 (32.14%), married (75%), average of 3 deliveries (57.14%), primary school education (75.0%), and Christians (92.86%) were recruited and interviewed. Two main themes emerged from the narratives: (1) perceived benefits of using herbal medicine: (i) hastens labour, (ii) prevents pregnancy complications and (iii) prevents and treats illnesses, and (2) perceived risks of using herbal medicine: (i) perceived maternal risks, (ii) perceived fetal risks. CONCLUSION: In rural Malawi, the practice of using herbal medicine during pregnancy and labour is perceived as both risky and beneficial to women. These perceptions are shaped by the exposure to either personal or other people's experiences, hence the continued practice. Therefore, inclusion of health education topics on maternal complications due to use of herbal medicine among women can help reduce maternal and neonatal mortality rates in rural Malawi. Further research is also warranted to explore accessibility and community pathway systems for herbal medicine use during pregnancy and labour among the pregnant women.

Does Poor Mental Health Impair the Effectiveness of Complementary Food Hygiene Behavior Change Intervention in Rural Malawi?

Mental disorders have the potential to affect an individual's capacity to perform household daily activities such as water, sanitation, and hygiene (food hygiene inclusive) that require effort, time, and strong internal motivation. However, there is limited detailed assessment about the influence of mental health on food hygiene behaviors at household level. We conducted a follow-up study to detect the effects of mental health on food hygiene behaviors after food hygiene intervention delivery to child caregivers in rural Malawi. Face-to-face interviews, based on the Risk, Attitude, Norms, Ability, and Self-regulations (RANAS) model, were conducted with 819 participants (control and intervention group) to assess their handwashing and food hygiene-related behaviors. Mental health was assessed using the validated Self-Reporting Questionnaire. Study results showed a significant negative relationship between mental health and handwashing with soap behavior (r = -0.135) and keeping utensils in an elevated place (r = -0.093). Further, a significant difference was found between people with good versus poor mental health on handwashing with soap behavior (p = 0.050) among the intervention group. The results showed that the influence of the intervention on handwashing with soap behavior was mediated by mental health. Thus, integration of mental health in food hygiene interventions can result in improved outcomes for caregivers with poor mental health.

Provision of small-quantity lipid-based nutrient supplements does not improve intestinal health among rural Malawian children.

Lipid-based nutrient supplements (LNS) have been found to improve child growth and reduce child mortality. However, the mechanistic pathways for these improvements warrant exploration. One potential pathway is linked to improvement in intestinal health. Our study aimed to test a hypothesis that small-quantity LNS (SQ-LNS) could reduce the levels of intestinal inflammation, repair and permeability of children. As intestinal health markers we measured fecal calprotectin, regenerating 1B protein (REG1B) and alpha-1-antitrypsin concentrations at 18 months of age (after 12 months of supplementation) and 1 year later (12 months after cessation of supplementation). In this analysis, we included data of 735 children who participated in a randomised dietary supplementation trial in rural Malawi; 243 children who received 20 g/day SQ-LNS from 6 to 18 months of age were in the SQ-LNS group, while the others who received no dietary supplementation during this period were in the control group. At 18 months of age, the mean concentrations of calprotectin, REG1B and alpha-1-antitrypsin were 241, 105 µg/g and 7.1 mg/dl, respectively, in the SQ-LNS group, and 224, 105 µg/g and 7.4 mg/dl, respectively, in the control group, and did not differ between the SQ-LNS and control groups. We conclude that SQ-LNS provision did not have an impact on children's intestinal health in rural Malawi.