Public Health Commons^™

Analysis Of Fluid Intake During Pregnancy, Irem Dilaver, Busra Parlak Somuncu, Murat Topbas, Kubra Sahin, Medine Gozde Ustundag, Cansu Agrali Gundogmus, Gamze Can, Nazim Ercument Beyhun

Makara Journal of Health Research

Background: Pregnancy is an important process that affects the body’s daily water requirements through various mechanisms. Adequate fluid intake also plays a critical role in pregnancy. This research aimed to determine levels of water/fluid intake and influencing factors among pregnant women presenting to a university hospital in Trabzon, Türkiye.

Methods: A total of 1,082 pregnant women were included in this cross-sectional research. A questionnaire was used during the face-to-face interviews to collect data. SPSS version 23.0 software was employed during data analysis, and logistic regression was applied to identify factors that affect adequate daily fluid intake.

Results: …

Unraveling The Multilevel Dynamics Of Water, Sanitation, And Child Anthropometry In Indonesia, Rifa Kirana, Ahmad Komarulzaman

Makara Journal of Health Research

Background: Anthropometrics, reflecting nutritional status, growth, and development, are crucial elements that can predict a person’s health and well-being. However, low anthropometric measures among children under 5 years remain a significant issue in Indonesia, often influenced by various factors at the household and community levels. Access to clean water and adequate sanitation has been identified as major determinants of these adverse health outcomes. This study analyzes the relationship between anthropometric measures and access to water and sanitation at household and community levels using a multilevel analysis approach.

Methods: The study employs cross-sectional data from the Indonesian Family Life …

The Challenges Of Down Syndrome Screening In Primary Healthcare For Pregnant Women In Iran In 2018, Mona Zeinaloo, Mohammad Shariati, Masoud Younesian, Azita Kheiltash

Makara Journal of Health Research

Background: This study aimed to evaluate the various aspects of the implementation phase, including an economic evaluation, of Iran’s Down syndrome (DS) screening program.

Methods: Data were collected via phone interviews involving three random sample groups, with each group consisting of 1000 mothers who completed their pregnancies in 2018. To analyze the DS screening program from an economic aspect, we compared the costs related to the care of a DS individual in the country with that of finding and aborting a DS fetus based on the current screening program. In addition, to examine the financial expenses, we assessed …

Leveraging The Science Of Early Life Predictability To Inform Policies Promoting Child Health, Laura M. Glynn, Sabrina R. Liu, Candice Taylor Lucas, Elysia Poggi Davis

Psychology Faculty Articles and Research

Addressing the tremendous burden of early-life adversity requires constructive dialogues between scientists and policy makers to improve population health. Whereas dialogues focused on several aspects of early-life adversity have been initiated, discussion of an underrecognized form of adversity that has been observed across multiple contexts and cultures is only now emerging. Here we provide evidence for “why unpredictability?”, including: 1. Evidence that exposures to unpredictability affect child neurodevelopment, with influences that persist into adulthood. 2. The existence of a translational non-human animal model of exposure to early life unpredictability that can be capitalized upon to causally probe neurobiological mechanisms. 3. …

Exploring The Impact Of Maternal Early Life Adversity On Interoceptive Sensibility In Pregnancy: Implications For Prenatal Depression, Paul W. Savoca, Laura M. Glynn, Molly M. Fox, Misty C. Richards, Bridget L. Callaghan

Psychology Faculty Articles and Research

Purpose

Pregnancy is a sensitive period of development in adult life characterized by massive changes in physical, emotional, and cognitive function. Such changes may be adaptive, e.g., facilitating adjustment to physical demands, but they may also reflect or contribute to risks inherent to this stage of life, e.g., prenatal depression. One cognitive ability that may undergo change during pregnancy and contribute to mental wellness is interoception - the ability to perceive, integrate, and model sensory information originating from the body. Strong interoceptive abilities are associated with lower rates of depression in non-pregnant adult populations, and interoception is generally weaker in …

Relationship Between Parental Involvement And Infant Bonding Among Families Of Barangay Tambacan, Tubod, And Santiago, Iligan City, Samantha Colegado Templado, Jezneel C. Cale, Ian C. Abordo Phd, Donna Belle P. Sumugat Rn, Man, Ma. Almira P. Nebres Rn, Man, Phd, Angelica N. Sarsaba

Pacific Journal of Health

Background and Aim: This study explored and assesses the extent of parental involvement and its relationship to infant bonding. It aimed to determine how varying levels of engagement from parents influence the development of a strong bond with their infants.

Design: We employed a descriptive correlational design and utilized questionnaires to collect data from 150 families living in Iligan City. Respondents were specifically from squatter areas of Iligan City.

Results: The findings of this study reveal that fathers tend to show indirect care that happens monthly, which relates to the infant’s soothing level. Mothers generally understand their infants' basic mental …

Strategic Advocacy: Doula Care, Liminality, And Reproductive Justice, Julie Johnson Searcy, Ellen Block, Angela N. Castañeda

Sociology Faculty Publications

No abstract provided.

Addressing The Increased Prevalence Of Gestational Diabetes Among Hispanic/Latino Pregnant Persons In The Central Valley Of California, Kathleen Janise Farrell Wardell

Master's Projects and Capstones

Gestational Diabetes (GDM) is a preventable noncommunicable disease that has been on the rise over the last 60 years. Pregnant persons with gestational diabetes are 10 times higher of acquiring Type 2 Diabetes after pregnancy (Ionannou et al., 2024). There is an urgent need to address this public health threat because of its increase in mortality. To address this complex chronic disease, this literature review explored multi-level interventions using the socioecological model to mitigate GDM in the Central Valley’s, Tulare County. Tulare County is disproportionately affected by chronic diseases like diabetes especially among the Hispanic and Latinx communities. Therefore, it …

Five A Day, The Rainbow Way: A Nutrition Education Toolkit For Elementary School Aged Children, Sasha Menard

Department of Nutrition Student Projects

Learning Outcome: Develop a nutrition educational toolkit based on Social Cognitive Theory (SCT) for obesity prevention among elementary school-aged children by improving determinants of fruit and vegetable intake.

Background: Poor consumption of fruits and vegetables is a major contributing factor to childhood obesity, increasing the risk for chronic diseases later in life. There is a need for multicomponent nutrition educational tools to influence children to improve their eating behavior by increasing their awareness and self-efficacy. The current project describes the development of a 3-component toolkit for improving participants’ knowledge and values related to fruit and vegetable intake among 6-11-year-olds.

Methods: …

Variability And Error In Measurement Of Infant Formula Powder And Water: An Experimental Study, Richard R. Rosenkranz, Ana Gonzalez-Alvarez, Chris Acosta, Andrew Hooyman, Jose R. Hidalgo, Cindyromina Ballasteros-Paniagua, Sara K. Rosenkranz

Physical Therapy Faculty Articles and Research

Introduction: Formula feeding is the only viable nutrition alternative for infants 0–6mos who cannot breastfeed. Among the drawbacks of formula feeding, however, is potential dilution or concentration errors in the formula during preparation that may lead to infant health issues. The present study aimed to investigate the accuracy of caregiver measurements as they prepared infant formula under multiple conditions, compared with manufacturer specifications.

Methods: A diverse sample of caregivers (N = 84) participated in this cross-over experimental study. Participants hand-scooped infant formula powder and poured water to prepare 4oz. and 7oz. feedings, using both a standardized set of …

The Precise-Dyad Neurodevelopmental Substudy Protocol: Neurodevelopmental Risk In Children Of Mothers With Pregnancy Complications, Dorcas Magai, Jaya Chandna, Marie-Laure Volvert, Rachel Craik, Hawanatu Jah, Agnes Msoka, Amina Abubakar, Angela Koech, Grace Mwashigadi, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear—particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories. Open Peer Review Approval Status 1 2 version 2 (revision) 05 Aug 2024 view view version 1 09 Nov 2023 view view Kimford Meador, Stanford University School of Medicine, Palo Alto, CA,, USA 1. Page 1 of 21 Wellcome Open Research 2024, 8:508 Last …

Scaling Up, Sustaining, And Enhancing School-Based Sexuality Education Programs In Resource-Constrained And Conservative Contexts: Replicable Lessons From Positive-Deviant Countries, Chandra Mouli, Michielsen Kristien, Gogoi Aparajita, Nair M, Ziauddin Mohammed, Hadi S, Ijaz A, Rubio Auriolesh, Marleen Temmerman

Centre of Excellence in Women and Child Health

Despite considerable efforts, progress in the implementationof sexuality education (SE) has been uneven. This study identi-fied six “positive-deviant” low- and middle-income countries,i.e., countries that had scaled up, sustained and enhancedtheir SE programs when many others—in similar social, cul-tural and economic circumstances—were not able to do so. Inother words, they were significantly and consistently moresuccessful than the norm. Countries were shortlisted using avalidated framework and were analyzed using three other vali-dated frameworks on political priority setting, scaling up, andstakeholder engagement. The study found that India, Pakistan,Nigeria, Senegal, Mexico, and Uruguay had scaled up (eithernationwide or in some states/provinces), sustained andenhanced their …

Effect Of Male Partners' Involvement And Support On Reproductive, Maternal And Child Health And Well-Being In East Africa: A Scoping Review, Richard Fletcher, Faye Forbes, Abel Fekadu Dadi, Getachew Mullu Kassa, Casey Regan, Anna Galle, Addisu Beyene, Rebecca Liackman, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background and Aims: East African countries have high rates of maternal and childmortality and morbidity. Studies have shown that the involvement of male partners inreproductive health can benefit maternal and child health (MCH). This scoping reviewaims to provide an overview of the evidence across East Africa that describes malepartner involvement and its effect on maternal, reproductive, and child well‐being.

Methods: Ten databases were searched to identify quantitative data on male'sinvolvement in East Africa. Studies reporting qualitative data, “intention to use” dataor only reporting on male partner's education or economic status were excluded.Studies were organized into five a priori categories: antenatal …

Enhancing Vaginal Delivery In Greece Through Educational And Behavioral Interventions Among Maternity Care Providers Regarding Labor Management: The Engage Stepped-Wedge Randomized Prospective Trial Protocol, Nikolaos Vrachnis, Nikolaos Antonakopoulos, Peter Von Dadelszen, Marianne Vidler, Georgios Maroudias, Jeffrey Bone, Ash Sandhu, Nikolaos Loukas, Laura Magee, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: There is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).

Methods: Twenty-two selected maternity units in Greece will participate in …

Preeclampsia In The Context Of Covid-19: Mechanisms, Pathophysiology, And Clinical Outcomes, Guilherme M Nobrega, Brittany R Jones, Indira U Mysorekar, Maria Laura Costa

Center on Aging Staff Publications

The emergence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to the global COVID-19 pandemic, significantly impacting the health of pregnant women. Obstetric populations, already vulnerable, face increased morbidity and mortality related to COVID-19, aggravated by preexisting comorbidities. Recent studies have shed light on the potential correlation between COVID-19 and preeclampsia (PE), a leading cause of maternal and perinatal morbidity worldwide, emphasizing the significance of exploring the relationship between these two conditions. Here, we review the pathophysiological similarities that PE shares with COVID-19, with a particular focus on severe COVID-19 cases and in PE-like syndrome cases related with …

Integration Of Depression And Anxiety Screening Among Uninsured And Underinsured Patients In A Mobile Nurse-Led Clinic, Samantha Hamm

DNP Projects

This quality improvement project sought to increase screening rates and referrals for pregnant and postpartum depression/ anxiety using the Edinburgh Postnatal Depression Scale (EPDS) and increase the rate of mental health referrals as a result of that screening in an underserved population /community health mobile clinic. Maternal mental health is a key public health concern. In the most recent community health needs assessment (2022-2025) in one Midwestern rural community, priority needs were identified with the top priority of building families with access to culturally competent healthcare, including access to mental health services (Central MN Alliance, 2022). Under-reporting anxiety and depression …

Maternal Decision Making And Children’S Nutritional Status: Evidence From Indonesia, Nadia Roswita, Teguh Dartanto

Jurnal Ekonomi Kependudukan dan Keluarga

Indonesia is encountering consecutive health problems caused by malnutrition. The latter poses long-term effects on children’s development. As this issue continue its prominence, using linear regression and binary logistic with time lag to analyze data from Indonesia Family Life Survey (IFLS) in 2007 and 2014 shall support the analysis of issue. Previous results from the models indicated that maternal decision-making in their share of food expenditure has a weak correlation for stunted children's experience. However, this study revealed different results. It suggested that involvement in from men in nutritional knowledge, skills, and financial backing to advance women's roles contributes to …

Breastfeeding As Co-Occupation: Occupational Therapy’S Role In Promoting Health And Well-Being, Lisa Joelle Sutton, Julie D. Kugel, Dragana Krpalek, Arezou Salamat

The Open Journal of Occupational Therapy

Background: Even with efforts to encourage mothers to breastfeed exclusively for the first 6 months, the majority of women are not able to undertake breastfeeding as the sole means of infant nutrition provision for various reasons. The role of occupational therapists working with mothers who breastfeed is complex and not strongly supported in the literature. Therefore, this qualitative study was designed to examine the role that occupational therapists may engage in supporting mothers and infants in the co-occupation of breastfeeding.

Method: A qualitative phenomenological study design was applied and included 11 occupational therapists working with breastfeeding dyads. The …

Transcriptomic Analysis Reveals The Anti-Cancer Effect Of Gestational Mesenchymal Stem Cell Secretome, Salvatore Vaiasicca, Gianmarco Melone, David W James, Marcos Quintela, Jing Xiao, Seydou Yao, Richard H Finnell, Robert S Conlan, Lewis W Francis, Bruna Corradetti

Faculty, Staff and Students Publications

The environment created during embryogenesis contributes to reducing aberrations that drive structural malformations and tumorigenesis. In this study, we investigate the anti-cancer effect of mesenchymal stem cells (MSCs) derived from 2 different gestational tissues, the amniotic fluid (AF) and the chorionic villi (CV), with emphasis on their secretome. Transcriptomic analysis was performed on patient-derived AF- and CV-MSCs collected during prenatal diagnosis and identified both mRNAs and lncRNAs, involved in tissue homeostasis and inhibiting biological processes associated with the etiology of aggressive cancers while regulating immune pathways shown to be important in chronic disorders. Secretome enrichment analysis also identified soluble moieties …

Multicountry Spread Of Influenza A(H1n1)Pdm09 Viruses With Reduced Oseltamivir Inhibition, May 2023-February 2024, Mira C Patel, Ha T Nguyen, Philippe Noriel Q Pascua, Rongyuan Gao, John Steel, Rebecca J Kondor, Larisa V Gubareva

Faculty, Staff and Student Publications

Since May 2023, a novel combination of neuraminidase mutations, I223V + S247N, has been detected in influenza A(H1N1)pdm09 viruses collected in countries spanning 5 continents, mostly in Europe (67/101). The viruses belong to 2 phylogenetically distinct groups and display ≈13-fold reduced inhibition by oseltamivir while retaining normal susceptibility to other antiviral drugs.

A Landscape Evaluation Of Caffeine Citrate Availability And Use In Newborn Care Across Five Low- And Middle-Income Countries, Osayame Ekhaguere, Olufunke Bolaji, Helen Nabwera, Andrew Storey, Nicholas Embleton, Stephen Allen, Zelalem Demeke, Olufunke Fasawe, Betty Wariari, Mansharan Seth

Centre of Excellence in Women and Child Health

Apnoea of prematurity (AOP) is a common complication among preterm infants (< 37 weeks gestation), globally. However, access to caffeine citrate (CC) that is a proven safe and effective treatment in high-income countries is largely unavailable in low- and-middle income countries, where most preterm infants are born. Therefore, the overall aim of this study was to describe the demand, policies, and supply factors affecting the availability and clinical use of CC in LMICs. A mixed methods approach was used to collect data from diverse settings in LMICs including Ethiopia, Kenya, Nigeria, South Africa, and India. Qualitative semi-structured interviews and focus group discussions were conducted with 107 different health care providers, and 21 policymakers and other stakeholders from industry. Additional data was collected using standard questionnaires. A thematic framework approach was used to analyze the qualitative data and descriptive statistics were used to summarize the quantitative data. The findings indicate that there is variation in in-country policies on the use of CC in the prevention and treatment of AOP and its availability across the LMICs. As a result, the knowledge and experience of using CC also varied with clinicians in Ethiopia having no experience of using it while those in India have greater knowledge and experience of using it. This, in turn, influenced the demand, and our findings show that only 29% of eligible preterm infants are receiving CC in these countries. There is an urgent need to address the multilevel barriers to accessing CC for managing AOP in Africa. These include cost, lack of national policies, and, therefore, lack of demand stemming from its clinical equivalency with aminophylline. Practical ways to reduce the cost of CC in LMICs could potentially increase its availability and use.

Parenting Identity And Parental Mental Health In Chinese Parents In Mainland China, Zhenqiao Yang

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

In the modern context of mainland China, parents of young children face unique parenting stressors, making parental mental health during the early stages of parenting a significant public concern. Increasing awareness of the role of self-concepts in mental health underscores the importance of exploring the relationships between parenting identity concepts, parenting stress, parental mental health, and familial factors. This study aims to examine the relationship between parenting identity and parental mental health, specifically depression and anxiety, in the context of early childhood parenting stress. Data were collected from 456 parents at four daycare centers and public spaces in an Eastern …

Social Media And Dermatology During The Covid-19 Pandemic: Analyzing User-Submitted Posts Seeking Dermatologic Advice On Reddit, Vivek V Shukla, Benjamin A Carper, Namasivayam Ambalavanan, Matthew A Rysavy, Edward F Bell, Abhik Das, Ravi M Patel, Carl T D'Angio, Kristi L Watterberg, C Michael Cotten, Stephanie L Merhar, Myra H Wyckoff, Pablo J Sánchez, Neha Kumbhat, Waldemar A Carlo, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Neonatal Research Network

Faculty, Staff and Student Publications

HYPOTHESIS: Increased social distancing was associated with a lower incidence of extremely preterm live births (EPLB) during the initial COVID-19 pandemic period.

STUDY DESIGN: Prospective study at the NICHD Neonatal Research Network sites comparing EPLB (22

RESULTS: EPLB and EPIS percentages did not significantly decrease (1.58-1.45%, p = 0.07, and 0.08-0.06%, p = 0.14, respectively). SDI was not significantly correlated with percent change of EPLB (CC = 0.29, 95% CI = -0.12, 0.71) or EPIS (CC = -0.23, 95% CI = -0.65, 0.18). Percent change in mean gestational age was positively correlated with SDI (CC = 0.49, 95% CI = …

Implementation Of Specific Nutrition Interventions To Prevent Stunting In Pregnant Women In The Oesapa Community Health Center Area East Nusa Tenggara, Septa Katmawanti, Oktavia Sri Wahyuni, Farah Paramita, Agung Kurniawan, Siti Khuzaimah

Preventia: The Indonesian Journal of Public Health

Policies related to stunting prevention have been in place since 2013. However, the prevalence of stunting in East Nusa Tenggara Province is still the highest in Indonesia from 2013 to 2022. One of the areas in the province where the prevalence decreased from 2021 to 2022 is Kupang City. Oesapa Community Health Centre was appointed by the Indonesian Ministry of Health as a pilot health centre representing Kupang City. The purpose of this study is to describe the implementation of specific nutritional interventions for handling stunting based on the variables of communication, bureaucratic structure, resources, and disposition in the target …

Impact Of Infancy Conditions On Physical Growth Of Children Under-Five, Claudia Azhari, Yeni Mahwati, Yeni Suryamah, Arfian Hikmat Ramdan

Preventia: The Indonesian Journal of Public Health

Children under five years old is the age group most vulnerable to several health problems. It is important to evaluate the impact of infancy condition on their physical growth. This research aimed to examine the impact of infancy condition on the physical growth of children under-five years old. The unmatched case-control study was conducted in Puskesmas Griya Antapani areas, Bandung from May to July, 2023. A total of 112 children aged under 5 years were included in this study (56 cases and 56 control). The analysis used multivariate logistic regression to determine adjusted odds ratios (OR). The results showed that …

Determinants Of Utilization Of Covid-19 Vaccination Services For Pregnant Women, Risa Septi Astutik, Ayun Sriatmi, Eka Yunila Fatmasari

Preventia: The Indonesian Journal of Public Health

The COVID-19 pandemic has caused an increase in the death rate of pregnant women. The government is taking preventive action by providing COVID-19 vaccination to pregnant women in accordance with the Circular Letter of the Ministry of Health of the Republic of Indonesia HK.02.01/I/2007/2021. Even though it has been carried out for 2 months, vaccination coverage is still low, especially in Temanggung Regency. This study aims to determine behavioral determinants in the use of COVID-19 vaccination services for pregnant women. This research uses an analytical survey method with a quantitative approach through a cross-sectional study. Taking 200 samples using the …

A Comparison Of Menstrual Health And Well-Being Among Adolescent Girls In Urban And Rural Areas Of The Belegavi District: A Crossectional Study, Arati Mahishale, Nagma Khan

Internet Journal of Allied Health Sciences and Practice

Background: Due to their relationship with several health hazards, menstrual hygiene management (MHM) and awareness are major public health concerns in both urban and rural settings. This study examined the awareness of MHM among adolescent girls in Belagavi and assessed their knowledge and understanding of menstruation and related taboos.

Methods: In the Belagavi District of Karnataka, India, a cross-sectional, community-based observational study was carried out. About 380 (as 8 were excluded) menstruating adolescent girls between the ages of 12 and 18 who attended different convent and government schools were included in the study. IBM SPSS version 20 was used to …

Development Of An Educational Brochure About Treatment Options For Pregnant Women With Opioid Use Disorders, Ruth Jeminiwa, Sohyeon Park, Caroline Popielaski, Meghan Gannon, Ronald Myers, Diane J. Abatemarco

College of Pharmacy Faculty Papers

The goal of this study was to describe the development of an educational brochure for pregnant women with opioid use disorders (OUDs) about treatment options. Based on findings from a preliminary review of the literature, we drafted a brochure that addressed the following questions: (1) What are your options (Medication-Assisted Treatment (MAT) versus no treatment)? (2) What are the benefits of MAT? (3) What are the risks of MAT? (4) Can I take buprenorphine or methadone while breastfeeding? (5) Which medication should I choose? Clinicians and doulas (n = 19) who provide care to pregnant women with OUDs were recruited. …

Cannabis Exposure During Pregnancy And Neural Mechanisms Of Parenting: Assessing Neural Responses To Infant Cues And Parenting Outcomes, Shannon Powers

Electronic Theses and Dissertations

As legalization of cannabis and cannabinoids spreads in the United States, access and use of cannabis during the prenatal period has increased. There is limited knowledge on the effects of prenatal cannabis use on the parental brain. One way to identify potential effects of cannabis on parenting is through studying parenting brain functions and behavior. Cannabis use disorder (CUD) has been shown to be associated with lower positive parenting and lower sensitivity to infants, but it is unclear by what mechanisms. The following two studies address this gap in knowledge by examining the association between cannabis use during the prenatal …

Exploring The Experiences Of Hiv Positive Pregnant Women On Prevention Of Vertical Transmission Of Hiv/Aids In Rural Malawi, Gertrude Finyiza

Electronic Theses and Dissertations

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) continues to be the primary conduct that HIV is transmitted to children worldwide. The problem of HIV/acquired immunodeficiency syndrome (AIDS) is having a great impact on the world's children. The prevalence of HIV/AIDS in Malawi continues to be a serious public health issue, especially for expectant mothers. The health outcomes of mothers and children remain significantly threatened by vertical HIV transmission, even with improvements in preventive and treatment efforts. The purpose of this thesis was to explore the experiences of HIV-positive pregnant women in Malawi. I conducted semi structured interviews with thirteen …