A Community Based Study of Prepregnancy Awareness of Safe Maternity Amongst Rural Tribal Women

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Research Article | DOI: https://doi.org/10.31579/2642-9756/151

A Community Based Study of Prepregnancy Awareness of Safe Maternity Amongst Rural Tribal Women

Chhabra S ^*

Rajani Jatkala ²

Kanchan Bhise ³

1Emeritus Professor, Obstetrics Gynaecology, Ex. Dean, Mahatma Gandhi Institute of Medical Sciences, Sevagram. Chief Executive Officer, Akanksha Shishu Kalyan Kendra, Sevagram. Officer On Special Duty, Dr. Sushila Nayar Hospital, Amravati, Kasturba Health Society, Sewagram, Wardha, Maharashtra, India.
2Senior Resident, Department of Obstetrics and Gynecology,Mahatma Gandhi Institute of Medical Science Sewagram, Wardha Mahashtra , India
3Medical Officer ,Dr. Sushila Nayar Hospital, Utavali, Melghat, Amravati,India

*Corresponding Author: Chhabra S, Emeritus Professor, Obstetrics Gynaecology, Ex. Dean, Mahatma Gandhi Institute of Medical Sciences, Sevagram. Chief Executive Officer, Akanksha Shishu Kalyan Kendra, Sevagram. Officer On Special Duty, Dr. Sushila Nayar Hospital, Amravati, Kastu

Citation: Chhabra S ,Rajani Jatkala, Kanchan Bhise (2023), A Community Based Study of Prepregnancy Awareness of Safe Maternity Amongst Rural Tribal Women, J. Women Health Care and Issues. 6(3); DOI:10.31579/2642-9756/151

Copyright: © 2023, Chhabra S. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 27 April 2023 | Accepted: 12 May 2023 | Published: 24 May 2023

Keywords: prepregnancy awareness disorders; anaemia; micronutrients; hygiene; effects

Abstract

Background
Every pregnant woman faces risk of complications during pregnancy, birth, not only due to pregnancy, birth related problems but preexisting disorders which get exaggerated during pregnancy. Prepregnancy awareness of various prepregnancy, peripregnancy factors for safe maternity is essential.
Objective:
Community based study was to know awareness about prepregnancy issues for safe maternity.
Material methods
Study was conducted in tribal communities of remote forestry hilly region. Randomly from each village 20 married women of 15-40 yr in whom pregnancy was possible, 2400 became study subjects in 100 villages around village with health facility.
Results
Of 2400 study subjects, 1396 (58.2%) had scatchy awareness, 30.3% right age for pregnancy, 34.2% possibility of diseases running in family, 35.5% essentiality of knowing last menstruation date (LMD), 935 (35.10%) necessity of good health, 45.6% stress free life, 24.4% avoidance of heavy work and 30% need of care for good health during pregnancy. Only 1247 (52%) were aware of prepregnancy anaemia, (27% said it was due to lack of food, 73% lack of supplements), 51.7% knew about need of extra micronutrients, (41.7% by blood improving tablets, 58.3% extra energy providing diet), 1039 (43.3%) were aware of need of prepregnancy prevention / treatment, of anaemia for preventing complications, (34.6% giddiness, 29.4% legs swelling, nausea, 36.0% dangers of bleeding), 1164 (48.5%) were aware of genital hygiene, (38.0% said prevented genital infection, 62.0% urinary infection, retention).

Introduction

Every pregnant woman faces risk of complications during pregnancy, and birth which can lead to severe illnesses, even death of the mother and / or the baby. However many women and new-borns also die due to disorders which are present before pregnancy. Such disorders affect pregnancy and also get exaggerated during pregnancy and add risk to a woman’s and her baby’s life. Prepregnancy awareness about safe maternity is essential, for safe pregnancy, safe birth and safe future of the mother as well as the baby. It is opined that it remains unclear whether awareness translates into appropriate actions, but awareness should lead to better outcome. Women need to know about right age for having pregnancy, right interval between too pregnancies and many other issues which need to be taken care preconception and also during pregnancy. For all this prepregnancy care (PPC) is essential so that detection, treatment or counselling of pre-existing disorders and environmental, social conditions that may come in the way of safe maternity. Dangers of exposure to harmful practices, medication during early pregnancy and general health are all essential. It also includes encouraging behavioural change allowing early identification of risk factors and try prevention before pregnancy. So prepregnancy period has been proposed for improving pregnancy outcome. While results from studies have been encouraging, not much is known about women of rural remote regions.
Objective:
Community based study was carried out to know about awareness of prepregnancy issues for safe maternity amongst tribal women in rural remote region.
Study Setting
Community based study was conducted in rural tribal communities of remote forestry hilly region in 100 villages near the village having health facility.
Study design
Descriptive research with predesigned tool.
Study period – one year
Study sample - 2400 sample calculated by descriptive study formula 1
Inclusion exclusion criteria
Women of 15-40 years in whom pregnancy was possible were included. Women age <15years>40years those in whom pregnancy was not possible, cases of hysterectomy, total ligation, menopausal etc and not willing, though there were none, were excluded.

Results

The study revealed that, of 2400 study subjects, only 1396 (58.2%) had some scatchy awareness, [423 (30.3%) said they knew about right age for pregnancy, 477 (34.2%) possibility of diseases running in family and 496 (35.5%) essentiality of knowing the last menstrual date (LMD)]. Relationship of awareness with different variables like age, education, profession, economic status and previous birth is in table I (Table I). There was significant difference in number of women with awareness between illiterate and secondary school educated (p-value <0>(Table II). There was significant difference between number of women knowing the need of prepregnancy good health with age (p-value <0>(Table III). Also there was significant difference in numbers of illiterate and even primary school educated women (p-value <0> Overall of 2400 study subjects, 1240 (51.7%) were aware of need of extra micronutrients during pregnancy, [517 (41.7%) by blood improving tablets and 723 (58.3%) by extra energy providing diet]. Relation of awareness with age, education, profession, economic status, and number of births is in table IV (Table IV). Also there was significant difference with better education in women knowing need of extra micronutrient during pregnancy (p-value <0>
Variables Total Prepregnancy issues
Age In Year Yes % Right age for pregnancy % Diseases running in family % Last menstruation date %
15-19 336 269 80.1 99 36.8 90 33.5 80 29.7
20-29 1564 887 56.7 267 30.1 300 33.8 320 36.1
30-40 500 249 49.8 66 26.5 87 34.9 96 38.6
Total 2400 1396 58.2 423 30.3 477 34.2 496 35.5
Education
Illiterate 953 457 48.0 107 23.4 180 39.4 170 37.2
Primary 850 558 65.6 168 30.1 180 32.3 210 37.6
Secondary / Higher Secondary 597 381 63.8 148 38.8 117 30.7 116 30.4
Total 2400 1396 58.2 423 30.3 477 34.2 496 35.5
Profession
Home Maker 275 140 50.9 24 17.1 60 42.9 56 40.0
Agriculture Labourer 958 499 52.1 169 33.9 170 34.1 160 32.1
Casual Labourer* 468 259 55.3 92 35.5 77 29.7 90 34.7
Shop Keeper 699 498 71.2 138 27.7 170 34.1 190 38.2
Total 2400 1396 58.2 423 30.3 477 34.2 496 35.5
Economic Status
Upper 147 74 50.3 14 18.9 30 40.5 30 40.5
upper middle 183 59 32.2 17 28.8 22 37.3 20 33.9
Middle 544 278 51.1 88 31.7 100 36.0 90 32.4
Upper lower 662 439 66.3 174 39.6 115 26.2 150 34.2
Lower 864 546 63.2 130 23.8 210 38.5 206 37.7
Total 2400 1396 58.2 423 30.3 477 34.2 496 35.5
Parity
P0 105 35 33.3 10 28.6 15 42.9 10 28.6
P1- P2 1063 806 75.8 326 40.4 220 27.3 260 32.3
>P3 1212 555 45.8 87 15.7 242 43.6 226 40.7
Total 2400 1396 58.2 423 30.3 477 34.2 496 35.5
Table I: Prepregnancy Awareness About Needs for Safe Maternity
*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace
Variables Total During Pregnancy
Age In Year Yes % Stress free life during pregnancy % Avoidance of heavy work during pregnancy % Health care during pregnancy %
15-19 336 118 35.1 12 10.2 23 19.5 83 70.3
20-29 1564 549 35.1 340 61.9 87 15.8 122 22.2
30-40 500 268 53.6 74 27.6 118 44.0 76 28.4
Total 2400 935 39.0 426 45.6 228 24.4 281 30.1
Education
Illiterate 953 404 42.4 214 53.0 76 18.8 114 28.2
Primary 850 372 43.8 148 39.8 132 35.5 92 24.7
Secondary / Higher Secondary 597 159 26.6 64 40.3 20 12.6 75 47.2
Total 2400 935 39.0 426 45.6 228 24.4 281 30.1
Profession
Home Maker 275 177 64.4 159 89.8 11 6.2 7 4.0
Agriculture Labourer 958 369 38.5 125 33.9 122 33.1 122 33.1
Casual Labourer* 468 170 36.3 83 48.8 26 15.3 61 35.9
Shop Keeper 699 219 31.3 59 26.9 69 31.5 91 41.6
Total 2400 935 39.0 426 45.6 228 24.4 281 30.1
Economic Status
Upper 147 102 69.4 12 11.8 17 16.7 73 71.6
upper middle 183 35 19.1 16 45.7 12 34.3 7 20.0
Middle 544 275 50.6 187 68.0 38 13.8 50 18.2
Upper lower 662 227 34.3 81 35.7 128 56.4 18 7.9
Lower 864 296 34.3 130 43.9 33 11.1 133 44.9
Total 2400 935 39.0 426 45.6 228 24.4 281 30.1
Parity
P0 105 73 69.5 12 16.4 12 16.4 49 67.1
P1-P2 1083 286 26.4 199 69.6 33 11.5 54 18.9
>P3 1212 576 47.5 215 37.3 183 31.8 178 30.9
Total 2400 935 39.0 426 45.6 228 24.4 281 30.1
*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace
Table II: Prepregnancy Awareness of Essentialities During Pregnancy
Variable Total Awareness of Anaemia and Its Causes
Age In Years Yes % Lack Of Food % Lack Of Iron %
15-19 336 163 48.5 68 41.7 95 58.3
20-29 1564 857 54.8 220 25.7 637 74.3
30-40 500 227 45.4 49 21.6 178 78.4
Total 2400 1247 52.0 337 27.0 910 73.0
Education
Illiterate 953 584 61.3 197 33.7 387 66.3
Primary 850 426 50.1 79 18.5 347 81.5
Secondary / Higher Secondary 597 237 39.7 61 25.7 176 74.3
Total 2400 1247 52.0 337 27.0 910 73.0
Profession
Home Maker 275 72 26.2 41 56.9 31 43.1
Agriculture Labourer 958 556 58.0 172 30.9 384 69.1
Casual Labourer* 468 267 57.1 81 30.3 186 69.7
Shop Keeper 699 352 50.4 43 12.2 309 87.8
Total 2400 1247 52.0 337 27.0 910 73.0
Economic Status
Upper 147 79 53.7 33 41.8 46 58.2
Upper Middle 183 51 27.9 28 54.9 23 45.1
Middle 544 231 42.5 69 29.9 162 70.1
Upper Lower 662 228 34.4 42 18.4 186 81.6
Lower 864 658 76.2 165 25.1 493 74.9
Total 2400 1247 52.0 337 27.0 910 73.0
Parity
P0 105 77 73.3 36 46.8 41 53.2
P1 - P2 1083 465 42.9 169 36.3 296 63.7
>P3 1212 707 58.3 132 18.7 575 81.3
Total 2400 1247 52.0 337 27.0 910 73.0

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace
Table III: Awareness of Prepregnancy Anaemia
Variable Total Yes % Prevented Giddiness % Prevented legs Swelling, Nausea Vomiting % Prevents Dangers Due to Bleeding %
Age In Years
15-19 336 117 34.8 44 37.6 39 33.3 34 29.1
20-29 1564 724 46.3 272 37.6 221 30.5 231 31.9
30-40 500 198 39.6 47 23.7 45 22.7 16 8.1
Total 2400 1039 43.3 360 34.6 305 29.4 374 36.0
Education
Illiterate 953 476 49.9 188 39.5 130 27.3 158 33.2
Primary 850 360 42.4 90 25.0 81 22.5 189 52.5
Secondary / Higher Secondary 597 203 34.0 81 39.9 94 46.3 28 13.8
Total 2400 1039 43.3 360 34.6 305 29.4 374 36.0
Profession
Home Maker 275 73 26.5 29 39.7 16 21.9 28 38.4
Agriculture Labourer 958 403 42.1 109 27.0 106 26.3 188 46.7
Casual Labourer* 468 242 51.7 151 62.4 65 26.9 26 10.7
Shop Keeper 699 321 45.9 71 22.1 118 36.8 132 41.1
Total 2400 1039 43.3 360 34.6 305 29.4 374 36.0
Economic Status
Upper 147 88 59.9 20 22.7 40 45.5 28 31.8
Upper Middle 183 62 33.9 16 25.8 23 37.1 23 37.1
Middle 544 158 29.0 66 41.8 49 31.0 43 27.2
Upper Lower 662 317 47.9 119 37.5 96 30.3 102 32.2
Lower 864 414 47.9 139 33.6 97 23.4 178 43.0
Total 2400 1039 43.3 360 34.6 305 29.4 374 36.0
Patiry
P0 105 63 60.0 20 31.7 17 27.0 26 41.3
P1- P2 1083 557 51.4 259 46.5 113 20.3 185 33.2
>P3 1212 419 34.6 83 19.8 174 41.5 164 39.1
Total 2400 1039 43.3 360 34.6 305 29.4 374 36.0
*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table IV: Advantages of Prevention and Treatment of Anaemia Prepregnancy
Variable Total Modes of Getting Micronutrients
Age In Years Yes % Blood Improving Tablets % Energy Providing Food %
15-19 1069 527 49.3 275 52.2 252 47.8
20-29 1164 605 52.0 223 36.9 382 63.1
30-40 167 108 64.7 19 17.6 89 82.4
Total 2400 1240 51.7 517 41.7 723 58.3
Education
Illiterate 953 529 55.5 319 60.3 210 39.7
Primary 850 397 46.7 124 31.2 273 68.8
Secondary / Higher Secondary 597 314 52.6 74 23.6 240 76.4
Total 2400 1240 51.7 517 41.7 723 58.3
Profession
Home Maker 275 201 73.1 93 46.3 108 53.7
Agriculture Labourer 958 538 56.2 170 31.6 368 68.4
Casual Labourer* 468 270 57.7 112 41.5 158 58.5
Shop Keeper 699 231 33.0 142 61.5 89 38.5
Total 2400 1240 51.7 517 41.7 723 58.3
Economic Status
Upper 147 101 68.7 58 57.4 43 42.6
Upper Middle 183 116 63.4 12 10.3 104 89.7
Middle 544 341 62.7 158 46.3 183 53.7
Upper Lower 662 253 38.2 133 52.6 120 47.4
Lower 864 429 49.7 156 36.4 273 63.6
Total 2400 1240 51.7 517 41.7 723 58.3
Parity
P0 105 63 60.0 29 46.0 34 54.0
P1- P2 1083 499 46.1 294 58.9 205 41.1
>P3 1212 678 55.9 194 28.6 484 71.4
Total 2400 1240 51.7 517 41.7 723 58.3
*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace
Table V: Awareness Of Extra Micronutrients In pregnancy
Variable Total Advantages of good hygiene
Age In Years Yes % Prevention of genital disease % Prevention of urinary infection %
15-19 336 155 46.1 58 37.4 97 62.6
20-29 1564 709 45.3 287 40.5 422 59.5
30-40 500 300 60.0 97 32.3 203 67.7
Total 2400 1164 48.5 442 38.0 722 62.0
Education
Illiterate 953 372 39.0 123 33.1 249 66.9
Primary 850 546 64.2 251 46.0 295 54.0
Secondary / Higher Secondary 597 246 41.2 68 27.6 178 72.4
Total 2400 1164 48.5 442 38.0 722 62.0
Profession
Home Maker 275 128 46.5 63 49.2 65 50.8
Agriculture Labourer 958 405 42.3 167 41.2 238 58.8
Casual Labourer* 468 229 48.9 81 35.4 148 64.6
Shop Keeper 699 402 57.5 131 32.6 271 67.4
Total 2400 1164 48.5 442 38.0 722 62.0
Economic Status
Upper 147 100 68.0 28 28.0 72 72.0
Upper Middle 183 134 73.2 64 47.8 70 52.2
Middle 544 158 29.0 78 49.4 80 50.6
Upper Lower 662 310 46.8 131 42.3 179 57.7
Lower 864 462 53.5 141 30.5 321 69.5
Total 2400 1164 48.5 442 38.0 722 62.0
Parity
P0 105 75 71.4 15 20.0 60 80.0
P1- P2 509 169 33.2 45 26.6 124 73.4
>P3 1212 605 49.9 185 30.6 420 69.4
Total 2400 1164 48.5 442 38.0 722 62.0
*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace
Table VI: Awareness About Hygiene During Pregnancy

Discussion
Preconception care (PCC) refers to things, women could do before and between pregnancies for safe pregnancy, safe birth and safe future of the mother as well as the baby. Unfortunately, millions of women in the world have no access to getting pre-pregnancy information and care and both are essential. Antenatal care is too late to reduce the harmful effects of many preexisting disorders and undesired happenings preconception, periconception and during early pregnancy. Raising awareness of women about right age of pregnancy, right interval between two pregnancies, good health at onset of pregnancy and during pregnancy and clean hygiene, all are essential. Also protection from ill effects of pre-existing disorders and environmental issues is essential. There are modest additional requirements for energy and protein during pregnancy and women need to know. Martine [2] also reported that awareness of anaemia, a public health problem responsible for a big proportion of maternal deaths was very essential. In the present study only 1247 (52%) women were aware of essentiality of treatment of anaemia pre-pregnancy. Mason [3] opined that there was convincing evidence that health problems and nutritional problems, contributed to poor pregnancy outcome and it was essential that women were aware. Stephenson et al [4] from USA reported that despite a high level of pregnancy planning, awareness of preconception health among women and health professionals was low. However, many women were motivated to adopt healthy behaviour preconception. Doke et al [5] also reported that very few countries including India implemented comprehensive packages of PCC. In their study, PCC was rolled out among all women, who desired to be pregnant in a year. Their study in central India revealed that only 50% pregnancies were planned. The decision about first pregnancy was influenced more by the mother-in-law. Women knew that pregnancy should not occur in teen age and inadequate weight had adverse impact on the health of new-born. Women had some knowledge about adverse effects of tobacco and alcohol use in pregnancy. Most of them did not practice behaviour or accessed services of PCC. In the present study, of 2400 study subjects, only 1396 (58.2%) had some scatchy awareness of prepregnancy issues which affected pregnancy. Of them, only 423 (17.7%) women talked about right age for having pregnancy, 477 (19.8%) talked of possibility of diseases running in family, and 496 (20.6%) women said it was essential to know LMD. No one talked of preexisting disorders in the mother, interval between two pregnancies and so many other issues. Only 549 (22.87%) women were aware of necessity of prepregnancy good health, 340 (14.16%) said stress free life was essential and only 87 (3.6%) said for remaining healthy it was essential to avoid heavy work during pregnancy. However women did not talk of protection from environmental issues or medication, specially periconception and in early pregnancy. Umar et al [6] from North-Western, Nigeria reported poor awareness but good perceptions and acceptability of PCC by women, and opined that there was a need to create awareness and it needed to be incorporated into maternal health services. Akinajo et al 7 reported high awareness of PCC (76%) in many, but practice was low (34.2%) before index pregnancy and reported a huge disconnect between awareness and practice in Nigeria. Ojifinni et al [8] reported that in Nigeria participants stated that there were neither defined PCC services in the health system nor guidelines. PCC services were however provided when health workers perceived a need or when clients demanded health information, treatment modification, medical check-up, screening or education and counselling. Alemu et al [9] from Ethiopia reported significantly low knowledge and utilisation of PCC. Educational status and antenatal care were shown to affect PCC knowledge. Age and sound knowledge of PCC had significant association with utilisation of PCC. It has been opined that although it remains unclear how awareness translated into appropriate actions, chances of better outcome are there. Ayelew et al 10 from Ethiopia reported that overall knowledge of PCC was in 27.5% women with secondary school education and more 25 to 34 years, were having knowledge of PCC than their other counterparts. In the present study also, of 850 women with primary school education, 34.4% had some scatchy awareness and of 91 with women who had higher secondary school education, 64.8% were aware, significantly more (p-value 0000.1). Of 105 women who had no birth, 73 (3.04%) were aware about essentiality of prepregnancy good health and only 12 (0.5%) talked of stress free life, 12 (0.5%) avoidance of heavy work and 49 (2.04%) talked about need of regular check up during pregnancy. Of 275 home makers, 201 (73%) were aware of need of micronutrients. Of 147 women from upper economic class, 101 (68.7%) were aware and of 864 from lower economic class, 429 (49.65%) were aware of need of micronutrients, significant difference (p value <0>Summary and Conclusion
Over all it was revealed only some women had scatchy prepregnancy awareness. No one talked of appropriate interval, existing disorders, effects of environment, or medication, although the health care before pregnancy and during pregnancy was talked by some. Only 30.1% women knew disorders needed treatment before pregnancy, and 51.67 % women were aware of the extra micronutrient required in pregnancy, 48.50% women were aware about hygiene during pregnancy. Awareness was directly proportional to variables like age, literacy, economic status and occupation. Overall there seems a real need of creating prepregnancy awareness, provide PCC services for promoting maternal and new-born health and preventing maternal and new-born mortality.
Conflict of Interest – Nil

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Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

Luiz Sellmann

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

Zhao Jia

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

Thomas Urban

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

Cristina Berriozabal

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

Dr Tewodros Kassahun Tarekegn

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

Dr Shweta Tiwari

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

Dr Farooq Wandroo

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

Dr Anyuta Ivanova

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

Dr David Vinyes

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

Gertraud Teuchert-Noodt

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Variables	Total	Prepregnancy issues
Age In Year	Total	Yes	%	Right age for pregnancy	%	Diseases running in family	%	Last menstruation date	%
15-19	336	269	80.1	99	36.8	90	33.5	80	29.7
20-29	1564	887	56.7	267	30.1	300	33.8	320	36.1
30-40	500	249	49.8	66	26.5	87	34.9	96	38.6
Total	2400	1396	58.2	423	30.3	477	34.2	496	35.5
Education
Illiterate	953	457	48.0	107	23.4	180	39.4	170	37.2
Primary	850	558	65.6	168	30.1	180	32.3	210	37.6
Secondary / Higher Secondary	597	381	63.8	148	38.8	117	30.7	116	30.4
Total	2400	1396	58.2	423	30.3	477	34.2	496	35.5
Profession
Home Maker	275	140	50.9	24	17.1	60	42.9	56	40.0
Agriculture Labourer	958	499	52.1	169	33.9	170	34.1	160	32.1
Casual Labourer*	468	259	55.3	92	35.5	77	29.7	90	34.7
Shop Keeper	699	498	71.2	138	27.7	170	34.1	190	38.2
Total	2400	1396	58.2	423	30.3	477	34.2	496	35.5
Economic Status
Upper	147	74	50.3	14	18.9	30	40.5	30	40.5
upper middle	183	59	32.2	17	28.8	22	37.3	20	33.9
Middle	544	278	51.1	88	31.7	100	36.0	90	32.4
Upper lower	662	439	66.3	174	39.6	115	26.2	150	34.2
Lower	864	546	63.2	130	23.8	210	38.5	206	37.7
Total	2400	1396	58.2	423	30.3	477	34.2	496	35.5
Parity
P0	105	35	33.3	10	28.6	15	42.9	10	28.6
P1- P2	1063	806	75.8	326	40.4	220	27.3	260	32.3
>P3	1212	555	45.8	87	15.7	242	43.6	226	40.7
Total	2400	1396	58.2	423	30.3	477	34.2	496	35.5

Variables	Total	During Pregnancy
Age In Year	Total	Yes	%	Stress free life during pregnancy	%	Avoidance of heavy work during pregnancy	%	Health care during pregnancy	%
15-19	336	118	35.1	12	10.2	23	19.5	83	70.3
20-29	1564	549	35.1	340	61.9	87	15.8	122	22.2
30-40	500	268	53.6	74	27.6	118	44.0	76	28.4
Total	2400	935	39.0	426	45.6	228	24.4	281	30.1
Education
Illiterate	953	404	42.4	214	53.0	76	18.8	114	28.2
Primary	850	372	43.8	148	39.8	132	35.5	92	24.7
Secondary / Higher Secondary	597	159	26.6	64	40.3	20	12.6	75	47.2
Total	2400	935	39.0	426	45.6	228	24.4	281	30.1
Profession
Home Maker	275	177	64.4	159	89.8	11	6.2	7	4.0
Agriculture Labourer	958	369	38.5	125	33.9	122	33.1	122	33.1
Casual Labourer*	468	170	36.3	83	48.8	26	15.3	61	35.9
Shop Keeper	699	219	31.3	59	26.9	69	31.5	91	41.6
Total	2400	935	39.0	426	45.6	228	24.4	281	30.1
Economic Status
Upper	147	102	69.4	12	11.8	17	16.7	73	71.6
upper middle	183	35	19.1	16	45.7	12	34.3	7	20.0
Middle	544	275	50.6	187	68.0	38	13.8	50	18.2
Upper lower	662	227	34.3	81	35.7	128	56.4	18	7.9
Lower	864	296	34.3	130	43.9	33	11.1	133	44.9
Total	2400	935	39.0	426	45.6	228	24.4	281	30.1
Parity
P0	105	73	69.5	12	16.4	12	16.4	49	67.1
P1-P2	1083	286	26.4	199	69.6	33	11.5	54	18.9
>P3	1212	576	47.5	215	37.3	183	31.8	178	30.9
Total	2400	935	39.0	426	45.6	228	24.4	281	30.1

Variable	Total	Awareness of Anaemia and Its Causes
Age In Years	Total	Yes	%	Lack Of Food	%	Lack Of Iron	%
15-19	336	163	48.5	68	41.7	95	58.3
20-29	1564	857	54.8	220	25.7	637	74.3
30-40	500	227	45.4	49	21.6	178	78.4
Total	2400	1247	52.0	337	27.0	910	73.0
Education
Illiterate	953	584	61.3	197	33.7	387	66.3
Primary	850	426	50.1	79	18.5	347	81.5
Secondary / Higher Secondary	597	237	39.7	61	25.7	176	74.3
Total	2400	1247	52.0	337	27.0	910	73.0
Profession
Home Maker	275	72	26.2	41	56.9	31	43.1
Agriculture Labourer	958	556	58.0	172	30.9	384	69.1
Casual Labourer*	468	267	57.1	81	30.3	186	69.7
Shop Keeper	699	352	50.4	43	12.2	309	87.8
Total	2400	1247	52.0	337	27.0	910	73.0
Economic Status
Upper	147	79	53.7	33	41.8	46	58.2
Upper Middle	183	51	27.9	28	54.9	23	45.1
Middle	544	231	42.5	69	29.9	162	70.1
Upper Lower	662	228	34.4	42	18.4	186	81.6
Lower	864	658	76.2	165	25.1	493	74.9
Total	2400	1247	52.0	337	27.0	910	73.0
Parity
P0	105	77	73.3	36	46.8	41	53.2
P1 - P2	1083	465	42.9	169	36.3	296	63.7
>P3	1212	707	58.3	132	18.7	575	81.3
Total	2400	1247	52.0	337	27.0	910	73.0

Variable	Total	Modes of Getting Micronutrients
Age In Years	Total	Yes	%	Blood Improving Tablets	%	Energy Providing Food	%
15-19	1069	527	49.3	275	52.2	252	47.8
20-29	1164	605	52.0	223	36.9	382	63.1
30-40	167	108	64.7	19	17.6	89	82.4
Total	2400	1240	51.7	517	41.7	723	58.3
Education
Illiterate	953	529	55.5	319	60.3	210	39.7
Primary	850	397	46.7	124	31.2	273	68.8
Secondary / Higher Secondary	597	314	52.6	74	23.6	240	76.4
Total	2400	1240	51.7	517	41.7	723	58.3
Profession
Home Maker	275	201	73.1	93	46.3	108	53.7
Agriculture Labourer	958	538	56.2	170	31.6	368	68.4
Casual Labourer*	468	270	57.7	112	41.5	158	58.5
Shop Keeper	699	231	33.0	142	61.5	89	38.5
Total	2400	1240	51.7	517	41.7	723	58.3
Economic Status
Upper	147	101	68.7	58	57.4	43	42.6
Upper Middle	183	116	63.4	12	10.3	104	89.7
Middle	544	341	62.7	158	46.3	183	53.7
Upper Lower	662	253	38.2	133	52.6	120	47.4
Lower	864	429	49.7	156	36.4	273	63.6
Total	2400	1240	51.7	517	41.7	723	58.3
Parity
P0	105	63	60.0	29	46.0	34	54.0
P1- P2	1083	499	46.1	294	58.9	205	41.1
>P3	1212	678	55.9	194	28.6	484	71.4
Total	2400	1240	51.7	517	41.7	723	58.3

Variable	Total	Advantages of good hygiene
Age In Years	Total	Yes	%	Prevention of genital disease	%	Prevention of urinary infection	%
15-19	336	155	46.1	58	37.4	97	62.6
20-29	1564	709	45.3	287	40.5	422	59.5
30-40	500	300	60.0	97	32.3	203	67.7
Total	2400	1164	48.5	442	38.0	722	62.0
Education
Illiterate	953	372	39.0	123	33.1	249	66.9
Primary	850	546	64.2	251	46.0	295	54.0
Secondary / Higher Secondary	597	246	41.2	68	27.6	178	72.4
Total	2400	1164	48.5	442	38.0	722	62.0
Profession
Home Maker	275	128	46.5	63	49.2	65	50.8
Agriculture Labourer	958	405	42.3	167	41.2	238	58.8
Casual Labourer*	468	229	48.9	81	35.4	148	64.6
Shop Keeper	699	402	57.5	131	32.6	271	67.4
Total	2400	1164	48.5	442	38.0	722	62.0
Economic Status
Upper	147	100	68.0	28	28.0	72	72.0
Upper Middle	183	134	73.2	64	47.8	70	52.2
Middle	544	158	29.0	78	49.4	80	50.6
Upper Lower	662	310	46.8	131	42.3	179	57.7
Lower	864	462	53.5	141	30.5	321	69.5
Total	2400	1164	48.5	442	38.0	722	62.0
Parity
P0	105	75	71.4	15	20.0	60	80.0
P1- P2	509	169	33.2	45	26.6	124	73.4
>P3	1212	605	49.9	185	30.6	420	69.4
Total	2400	1164	48.5	442	38.0	722	62.0