| 1. ObjectiveThe medical perspective of the puerperium refers to a period of time after placental expulsion that is required for the body organs (except for mammary glands) to return to the normal non-pregnant state, a process of about 6 weeks. The traditional Chinese rite of zuo-yue-tzi, which literally means"doing the month", is an integrated set of customs which includes the beliefs and practices during the postpartum period. This custom has been regarded as a pivotal transitional period for woman's recuperation down the ages. Women have many confinements and taboos in their postnatal convalescence. The purpose of this study is to investigate and explore the present condition of the knowledge about postpartum nutrition and health, dietary, hygiene behaviors and their influencing factors, puerperal disorders of women in Wuhan City during the period of doing the month, and to lay the foundation fort the follow-up survey.2. MethodsThe entire investigation process was divided into two parts/steps. In the first part, a total of 648 women who had given birth to live-born infants within 1~7 days in the inpatient department of Hubei Maternal and Child Health Hospital from May, 2009 to January, 2010 were recruited as the participants of the study by cluster random sampling. Questionnaires used in this investigation were designed by our study group. Data regarding postpartum practices and potentially related factors were collected through questionnaires by trained investigators. Six hundred and twenty-five questionnaires were available, and the effective rate attained 96.5%. The second part requires the first part for its foundation. We applied a self-designed questionnaire based on the first part. Six hundred and twenty-five women within one year after their delivery in Hubei Maternal and Child Health Hospital were selected as the participants once again. We investigated them through individual telephone-interview one by one from March to July, 2010. The achieved sample size was 502, the effective rate attained 80.3%. Data were input to create a database with EpiData 3.1 (The EpiData Association, Odense, Denmark). Data analysis was conducted using SPSS18.0 for Windows statistical software package (SPSS Inc, Chicago, IL, USA). The Chi-square test analysis was used to analyze the factors influencing on the knowledge about postpartum nutrition and health, and logistic regression analysis was performed to determine the association of the influencing factors with women's dietary and health behaviors during the postpartum period.3. Results3.1 The survey on present condition of the nutrition and health knowledge of women during the postpartum period. The nutrition and health knowledge of the subjects is lopsided. They had fairly low level of the knowledge about postpartum nutrition and health. The knowledge of related nutrients and food preference is deficient. Only 15.7% and 39.4% of them were aware of the particularly outstanding sources of calcium and iron. Less than 20% knew soybean is one of the good food sources of high-quality protein. Nearly 50% of them considered that they could not eat fruit or vegetables in the period of puerperium. Degree of education (P <0.01) and maternal age (P <0.05) etc were the significant factors which influenced the level of the knowledge about postpartum nutrition and health. 3.2 The survey on present condition of dietary, health behaviors and specific postpartum symptoms of women in the puerperium.3.2.1 The women had an inadequate and unbalanced diet during the postpartum period. They consumed abundant meat, poultry, fish, eggs and other animal products, however, the consumption of fruit and vegetables were not enough. Of all the participants, 38.8% never ate fruit, 28.0% of them seldom ate vegetables or never ate them at all in the puerperium. The intake of milk increased to some extent, 27.1% of them increased the consumption of milk, 41.4% had daily consumption of milk, and meanwhile the consumption of brown sugar decreased. Only 4.8% of them consumed it per day. The women kept the bed an average of (10.26±3.63) hours per day. 55.0% of them didn't have any outdoor activities and 86.9% didn't do any housework during that period. Women who did post-natal exercises everyday only accounted for 9.6%. The unhealthy hygiene behaviors such as never opened the windows, never basked in the sun, never took a bath, washed their hair or brushed teeth and never had any outdoor activities during that period still exist. The results of Logistic regression analysis showed that the obvious factors which influenced the dietary and health behaviors were nutrition education, postpartum examination, traditional concept, the standpoint from books or magazines, educational levels of woman and her husband, mode of delivery, maternal age, annual household income, puerperal disorders etc. The major negative factors included the traditional concepts from parents or parents-in-law (P <0.05), puerperal disorders (P <0.05), cesarean section (P <0.01), maternal age (P <0.01) etc.3.2.2 In terms of puerperium-related diseases, the prevalence of anemia which was the highest prevalence disease of specific postpartum symptoms was 39.2%. 54.2% of他the subjects suffered from at least one symptom. The other common diseases included mammitis, leg cramps, constipation, low-back pain, dizziness, breast swelling and arthralgia etc. Also, 31.7% of the subjects were reported overweight or obesity in the puerperium.4. Conclusions4.1 Most of the postpartum women lack the knowledge about postpartum nutrition and health. The subjects had fairly low level of the knowledge about postpartum nutrition and health. The nutrition and health knowledge of them is uneven and unbalanced. Furthermore, some nutrition concepts were still influenced by Chinese traditional dietary custom.4.2 There are some misconceptions about the pattern of postpartum recuperation and many puerperium-related diseases in postpartum women. The subjects have wide varieties of diet but unbalanced during the puerperium, high-protein and high-fat diets, and lack of fruit and vegetables simultaneously. The poor hygiene behaviors still existed. Furthermore, the specific postpartum symptoms of women in the puerperium frequently happened. So, all of these should deserve special attention.4.3 Effective intervention measures are required. We must take effective nutrition educational measures such as holding special lectures together, giving individual guidance and distributing promotional materials (e.g. pamphlet with illustrations and pictures, VCD etc.) to correct the bad and wrong beliefs and practices, and advocate scientific and rational pattern of postpartum recuperation in the puerperium. |
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