title: Exploring and optimising maternal and infant nutrition in North West Pakistan.
abstract: OBJECTIVE
  the aim of this study was to explore and contextualise meanings, beliefs and practices surrounding maternal and infant nutrition in North West Pakistan and to use the findings to inform the development of a nutritional improvement programme adapted to local needs.
  
  
  METHODS
  the Context-Mechanism-Outcome framework was used to gather contextual data, formulate questions and conduct focus groups to inform the design of a culturally appropriate nutritional health programme with the overall goal of improving practices related to maternal and infant nutrition. Two focus groups were conducted with the team of local lady health workers (n=16), one prior to implementing a nutritional improvement programme and one 6 months after implementation.
  
  
  METHODS
  the study was conducted in communities surrounding and served by the Emergency Satellite Hospital (ESH) in Nahaqi in Khyber Pakhtunkhawa (KP) (formally known as the Northwest Frontier Province), Pakistan.
  
  
  RESULTS
  poverty and specific cultural practices impeded the achievement of optimum maternal and infant nutrition. A nutrition support programme was implemented; it involved cookery demonstration kitchens and free food supplements, coupled with nutrition and health-care information-giving for pregnant and lactating women. Focus group discussions revealed that women had positive perceptions of the impact of the nutritional health improvement programme, feeling that knowledge and practices were enhanced. However, structural and cultural factors continued to have a powerful influence on their practices.
  
  
  CONCLUSIONS
  this study highlights that despite structural, cultural and practical barriers, a culturally sensitive health improvement programme has the potential to enhance maternal and infant nutritional practices. However, we should not underestimate the powerful influence of poverty and culturally embedded norms upon women's decisions and practices.
authors.affiliation: Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston PR1 2HE, UK. fcdykes@uclan.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Dykes
authors.forename: Monique
authors.initials: M
authors.lastname: Lhussier
authors.forename: Sonia
authors.initials: S
authors.lastname: Bangash
authors.forename: Mukhtiar
authors.initials: M
authors.lastname: Zaman
authors.forename: Nicola
authors.initials: N
authors.lastname: Lowe
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D007228:Infant Nutrition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena; D007229:Infant Welfare / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D044342:Malnutrition / Q000453:epidemiology / Q000517:prevention & control*; D008427:Maternal Health Services / Q000379:methods; D039382:Maternal Nutritional Physiological Phenomena; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D009752:Nutritional Status; D010154:Pakistan; D011203:Poverty; D055815:Young Adult