{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T03:52:16Z","timestamp":1782791536223,"version":"3.54.5"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008309","name":"Johns Hopkins Bloomberg School of Public Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008309","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nutr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Food-related beliefs and practices during pregnancy may contribute to the high prevalence of chronic energy deficiencies (CED) in Eastern Indonesia, particularly in Southeast Maluku regency, where 21.33% of pregnant women experience CED. Currently, little information on these issues is available. This study investigates food beliefs and practices related to pregnancy on Kei Besar Island in the Maluku province of Eastern Indonesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A qualitative study was conducted utilizing in-depth interviews, free lists, and pile sort exercises. Data collection was conducted in January 2023 and involved married pregnant women aged 18 and above (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912), community health volunteers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), and traditional healers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) from 9 villages in Kei Besar District. All participants must be natives of Kei Besar Island, with community health volunteers and traditional healers being respective figures recommended by the local villagers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The need to avoid or minimize consumption of certain foods during pregnancy, such as some kinds of fish, chili and spicy food, soda, pineapples, octopus, squid, and ice was reported by more than one-third of all participants. Consumption of prescribed foods, such as cassava leaves, papaya, coconut water, rice during early pregnancies, moringa leaves, bananas, and\n                      <jats:italic>katok<\/jats:italic>\n                      leaves was reported by five or more participants. These food proscriptions and prescriptions were due to concerns about the risks of miscarriage, adverse effects on the fetus and mother, and complications during labor. Participants also reported other practices, such as eating for two during early pregnancy and reducing food intake in late pregnancy. We found that food beliefs have shaped the dietary patterns of most participants. However, they still consumed food recommended by community health volunteers and midwives.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Food beliefs are present and practiced in the Kei Besar community and may impact the nutritional status of women and their infants. Interventions should target training healthcare providers and community health volunteers to provide culturally appropriate health education that incorporates prescribed local ingredients and provides nutritionally adequate substitutes for the proscribed food items.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40795-024-00905-2","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T05:01:55Z","timestamp":1720674115000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Formative research to understand food beliefs and practices relating to pregnancy on Kei Besar Island, Eastern Indonesia"],"prefix":"10.1186","volume":"10","author":[{"given":"Jessica Gloria","family":"Mogi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Premikha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ona","family":"Nabila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adhi","family":"Sanjaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Prihartono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Gittelsohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"905_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/epirev\/mxq001","volume":"32","author":"K Abu-Saad","year":"2010","unstructured":"Abu-Saad K, Fraser D. Maternal nutrition and birth outcomes. Epidemiol Rev. 2010;32:5\u201325.","journal-title":"Epidemiol Rev"},{"key":"905_CR2","doi-asserted-by":"publisher","first-page":"e22952","DOI":"10.1002\/ajhb.22952","volume":"29","author":"R Martorell","year":"2017","unstructured":"Martorell R. Improved nutrition in the first 1000 days and adult human capital and health. Am J Hum Biol. 2017;29:e22952.","journal-title":"Am J Hum Biol"},{"key":"905_CR3","volume-title":"Standing Committee on Nutrition. Report of the standing committee on nutrition at its thirty-third session","author":"United Nations System","year":"2006","unstructured":"United Nations System. Standing Committee on Nutrition. Report of the standing committee on nutrition at its thirty-third session. Geneva, Switzerland: World Health Organization; 2006."},{"key":"905_CR4","first-page":"128","volume":"32","author":"Sandjaja","year":"2009","unstructured":"Sandjaja. Risiko Kurang energi kronis (KEK) pada Ibu Hamil Di Indonesia. Gizi Indon. 2009;32:128\u201338.","journal-title":"Gizi Indon"},{"issue":"Suppl 1","key":"905_CR5","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1159\/000345165","volume":"61","author":"T Ahmed","year":"2012","unstructured":"Ahmed T, Hossain M, Sanin KI. Global burden of maternal and child undernutrition and micronutrient deficiencies. Ann Nutr Metab. 2012;61(Suppl 1):8\u201317.","journal-title":"Ann Nutr Metab"},{"key":"905_CR6","volume-title":"Laporan kinerja direktorat gizi masyarakat tahun 2018","author":"Direktorat Gizi Masyarakat Kemenkes RI","year":"2019","unstructured":"Direktorat Gizi Masyarakat Kemenkes RI. Laporan kinerja direktorat gizi masyarakat tahun 2018. Jakarta, Indonesia: Kementarian Kesehatan Republik Indonesia; 2019."},{"key":"905_CR7","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/S0140-6736(07)61690-0","volume":"371","author":"RE Black","year":"2008","unstructured":"Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243\u201360.","journal-title":"Lancet"},{"key":"905_CR8","unstructured":"World Health Organization. Stunting in a nutshell. 2015. https:\/\/www.who.int\/news\/item\/19-11-2015-stunting-in-a-nutshell. Accessed 3 Feb 2023."},{"key":"905_CR9","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1016\/S0140-6736(17)32366-8","volume":"390","author":"GBD 2016 Risk Factors Collaborators","year":"2017","unstructured":"GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990\u20132016: a systematic analysis for the global burden of Disease Study 2016. Lancet. 2017;390:1345\u2013422.","journal-title":"Lancet"},{"key":"905_CR10","volume-title":"Laporan akuntabilitas kinerja instansi pemerintah (LAKIP) ditjen kesehatan masyarakat tahun 2021","author":"Direktorat Jenderal Kesehatan Masyarakat, Kementerian Kesehatan","year":"2021","unstructured":"Direktorat Jenderal Kesehatan Masyarakat, Kementerian Kesehatan. Laporan akuntabilitas kinerja instansi pemerintah (LAKIP) ditjen kesehatan masyarakat tahun 2021. Jakarta, Indonesia: Kementerian Kesehatan Republik Indonesia; 2021."},{"key":"905_CR11","volume-title":"The common ground in the Kei Islands: eggs from one fish and one bird","author":"P Laksono","year":"2002","unstructured":"Laksono P. The common ground in the Kei Islands: eggs from one fish and one bird. Yogyakarta, Indonesia: Galang; 2002."},{"key":"905_CR12","volume-title":"Laporan provinsi Maluku Riskesdas 2018","author":"Badan Penelitian dan Pengembangan Kesehatan","year":"2019","unstructured":"Badan Penelitian dan Pengembangan Kesehatan. Laporan provinsi Maluku Riskesdas 2018. Jakarta, Indonesia: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2019."},{"key":"905_CR13","doi-asserted-by":"publisher","first-page":"489","DOI":"10.25026\/jsk.v3i4.432","volume":"3","author":"R Tampubolon","year":"2021","unstructured":"Tampubolon R, Panuntun B, Lasamahu JF. Identifikasi faktor-faktor kejadian anemia pada Ibu Hamil Di Kecamatan Amahai Kabupaten Maluku Tengah. J Sains Kesehat. 2021;3:489\u2013505.","journal-title":"J Sains Kesehat"},{"key":"905_CR14","doi-asserted-by":"publisher","first-page":"251","DOI":"10.20473\/amnt.v5i3.2021.251-259","volume":"5","author":"AD Laksono","year":"2021","unstructured":"Laksono AD, Wulandari RD. Pantangan Makanan pada suku Muyu Di Papua. Amerta Nutr. 2021;5:251\u20139.","journal-title":"Amerta Nutr"},{"key":"905_CR15","unstructured":"Rusman R. Socio-cultural and demographic factors affecting child survival in D.I.Yogyakarta (DIY) and Nusatenggara Barat (NTB) - Indonesia (Doctoral thesis). Canberra, Australia: Australian National University; 1991."},{"key":"905_CR16","volume-title":"Laporan kinerja instansi pemerintah: LKIP kabupaten Maluku Tenggara Tahun 2021","author":"Bagian Organisasi Sekretaris Daerah Kabupaten Maluku Tenggara","year":"2021","unstructured":"Bagian Organisasi Sekretaris Daerah Kabupaten Maluku Tenggara. Laporan kinerja instansi pemerintah: LKIP kabupaten Maluku Tenggara Tahun 2021. Southeast Maluku: Maluku Tenggara; 2021."},{"key":"905_CR17","unstructured":"Leisubun G. Pelayanan e-KTP di pulau Kei Besar dipusatkan pada kantor camat setempat. Maluku Post. 2021. https:\/\/malukupost.com\/2021\/11\/pelayanan-e-ktp-di-pulau-kei-besar-dipusatkan-pada-kantor-camat-setempat\/. Accessed 28 Jan 2023."},{"key":"905_CR18","unstructured":"Sekretariat Wakil Presiden Republik Indonesia. Data provinsi Maluku terkait dengan stunting di 35 kabupaten\/kota prioritas kemiskinan ekstrim. Kementerian Sekretariat Negara Indonesia. 2021. https:\/\/stunting.go.id\/data-provinsi-maluku-terkait-dengan-stunting-di-35-kabupaten-kota-prioritas-kemiskinan-ekstrim\/. Accessed 9Aug 2022."},{"key":"905_CR19","unstructured":"Badan Pusat Statistik Maluku Tenggara. Maluku tenggara regency in Fig.\u00a02021. In: BPS-Statistics of Maluku Tenggara Regency, editor. BPS-statistics of Maluku tenggara regency. Maluku Tenggara, Indonesia: BPS-Statistics of Maluku Tenggara Regency; 2021. pp. 115\u2009\u2013\u200939."},{"key":"905_CR20","doi-asserted-by":"publisher","first-page":"7","DOI":"10.32734\/lingtersa.v2i1.6118","volume":"2","author":"W Akihary","year":"2021","unstructured":"Akihary W, Rahajaan S. The mapping of KEI language teaching materials and presentation at senior high schools in KEI Islands, Southeast Maluku. Linguist Terjem Sastra (LINGTERSA). 2021;2:7\u201310.","journal-title":"Linguist Terjem Sastra (LINGTERSA)"},{"key":"905_CR21","volume-title":"Kementerian Kesehatan Republik Indonesia. Data dasar puskesmas: Kondisi 31 Desember 2019, Provinsi Maluku","author":"Pusat Data dan Informasi (Pusdatin)","year":"2019","unstructured":"Pusat Data dan Informasi (Pusdatin). Kementerian Kesehatan Republik Indonesia. Data dasar puskesmas: Kondisi 31 Desember 2019, Provinsi Maluku. Jakarta, Indonesia: Kementerian Kesehatanre Republik Indonesia; 2019."},{"key":"905_CR22","first-page":"26","volume-title":"Media berbagi doctorSHARE edisi 1\/2019","author":"P Sumirat","year":"2019","unstructured":"Sumirat P. Panti rawat gizi doctorSHARE kembali diaktifkan. In: Sumirat P, editor. Media berbagi doctorSHARE edisi 1\/2019. Jakarta, Indonesia: doctorSHARE; 2019. pp. 26\u20137."},{"key":"905_CR23","volume-title":"Kecamatan Kei Besar dalam angka 2022. Maluku Tenggara","author":"Badan Pusat Statistik Kabupaten Maluku Tenggara","year":"2022","unstructured":"Badan Pusat Statistik Kabupaten Maluku Tenggara. Kecamatan Kei Besar dalam angka 2022. Maluku Tenggara. Indonesia: Badan Pusat Statistik Kabupaten Maluku Tenggara; 2022."},{"key":"905_CR24","volume-title":"Pedoman Umum Pengelolaan Posyandu. Jakarta","author":"Kementerian Kesehatan Republik Indonesia","year":"2011","unstructured":"Kementerian Kesehatan Republik Indonesia. Pedoman Umum Pengelolaan Posyandu. Jakarta. Indonesia: Pusat Promosi Kesehatan, Kementerian Kesehatan Republik Indonesia; 2011."},{"key":"905_CR25","first-page":"1","volume":"8","author":"I Isti\u2019anah","year":"2020","unstructured":"Isti\u2019anah I, Maulana R. Karakterisasi Morfologis Ikan Tongkol Komo (Euthynnus affinis) Yang didaratkan di pasar ikan kabupaten Maluku Tenggara Dan Kota Tual. Pros Semin Nas Biot. 2020;8:1\u20136.","journal-title":"Pros Semin Nas Biot"},{"key":"905_CR26","first-page":"22","volume":"13","author":"S Hadinoto","year":"2017","unstructured":"Hadinoto S, Kolanus JP. Evaluasi Nilai Gizi Dan Mutu Ikan Layang (Decapterus sp.) presto dengan penambahan asap cair dan ragi. Maj BIAM. 2017;13:22\u201330.","journal-title":"Maj BIAM"},{"key":"905_CR27","first-page":"17","volume":"4","author":"DE Kalay","year":"2015","unstructured":"Kalay DE, Marasabessy M. The waves\u2019 dynamic of Moluccas waters in east monsoon. Amanisal. 2015;4:17\u201323.","journal-title":"Amanisal"},{"key":"905_CR28","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.enfcli.2019.10.052","volume":"30","author":"YI Jayadi","year":"2020","unstructured":"Jayadi YI, Dewi NU, Rahmawati, Hermiyanty H, Syahrir S. Food taboo among pregnant women and children in the Kaili tribe Palu City, Indonesia. Enferm Cl\u00edn. 2020;30:109\u201313.","journal-title":"Enferm Cl\u00edn"},{"key":"905_CR29","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1016\/j.enfcli.2019.04.125","volume":"29","author":"VY Tobing","year":"2019","unstructured":"Tobing VY, Afiyanti Y, Rachmawati IN. Following the cultural norms as an effort to protect the mother and the baby during the perinatal period: an ethnographic study of women\u2019s food choices. Enferm Cl\u00edn. 2019;29:831\u20136.","journal-title":"Enferm Cl\u00edn"},{"key":"905_CR30","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s40795-017-0159-x","volume":"3","author":"Z Hadush","year":"2017","unstructured":"Hadush Z, Birhanu Z, Chaka M, Gebreyesus H. Foods tabooed for pregnant women in Abala district of Afar region, Ethiopia: an inductive qualitative study. BMC Nutr. 2017;3:40.","journal-title":"BMC Nutr"},{"key":"905_CR31","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13002-017-0157-8","volume":"13","author":"RM Riang\u2019a","year":"2017","unstructured":"Riang\u2019a RM, Broerse J, Nangulu AK. Food beliefs and practices among the Kalenjin pregnant women in rural Uasin Gishu County, Kenya. J Ethnobiol Ethnomed. 2017;13:29.","journal-title":"J Ethnobiol Ethnomed"},{"key":"905_CR32","doi-asserted-by":"publisher","first-page":"52","DOI":"10.22435\/jek.17.1.140.52-63","volume":"17","author":"BA Chahyanto","year":"2018","unstructured":"Chahyanto BA, Wulansari A. Aspek gizi dan makna simbolis tabu makanan Ibu Hamil Di Indonesia. J Ekol Kesehat. 2018;17:52\u201363.","journal-title":"J Ekol Kesehat"},{"key":"905_CR33","doi-asserted-by":"publisher","first-page":"135","DOI":"10.20473\/mgi.v11i2.135-143","volume":"11","author":"RK Illahi","year":"2018","unstructured":"Illahi RK, Muniroh L. Gambaran Sosio Budaya Gizi Etnik Madura Dan Kejadian stunting balita usia 24\u201359 bulan di Bangkalan. Media Gizi Indones. 2018;11:135\u201343.","journal-title":"Media Gizi Indones"},{"key":"905_CR34","doi-asserted-by":"publisher","first-page":"e0234545","DOI":"10.1371\/journal.pone.0234545","volume":"15","author":"S Bhanbhro","year":"2020","unstructured":"Bhanbhro S, Kamal T, Diyo RW, Lipoeto NI, Soltani H. Factors affecting maternal nutrition and health: a qualitative study in a matrilineal community in Indonesia. PLoS ONE. 2020;15:e0234545.","journal-title":"PLoS ONE"},{"key":"905_CR35","doi-asserted-by":"publisher","first-page":"86","DOI":"10.4103\/jfmpc.jfmpc_53_17","volume":"8","author":"S Chakrabarti","year":"2019","unstructured":"Chakrabarti S, Chakrabarti A. Food taboos in pregnancy and early lactation among women living in a rural area of West Bengal. J Family Med Prim Care. 2019;8:86\u201390.","journal-title":"J Family Med Prim Care"},{"key":"905_CR36","doi-asserted-by":"publisher","first-page":"2933","DOI":"10.3390\/nu5082933","volume":"5","author":"H Gao","year":"2013","unstructured":"Gao H, Stiller CK, Scherbaum V, Biesalski HK, Wang Q, Hormann E, et al. Dietary intake and food habits of pregnant women residing in urban and rural areas of Deyang City, Sichuan Province, China. Nutrients. 2013;5:2933\u201354.","journal-title":"Nutrients"},{"key":"905_CR37","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13002-021-00451-2","volume":"17","author":"M Ramulondi","year":"2021","unstructured":"Ramulondi M, De Wet H, Ntuli NR. Traditional food taboos and practices during pregnancy, postpartum recovery, and infant care of Zulu women in northern KwaZulu-Natal. J Ethnobiol Ethnomed. 2021;17:15.","journal-title":"J Ethnobiol Ethnomed"},{"key":"905_CR38","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1007\/978-1-61779-894-8_25","volume-title":"Nutritional health, strategies for disease prevention","author":"S Young","year":"2012","unstructured":"Young S, Pelto G. Core concepts in nutritional anthropology. In: Temple N, Wilson T, Jacobs D Jr, editors. Nutritional health, strategies for disease prevention. Totowa, NJ: Humana; 2012. pp. 523\u201337."}],"container-title":["BMC Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-024-00905-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40795-024-00905-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-024-00905-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T05:08:15Z","timestamp":1720674495000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcnutr.biomedcentral.com\/articles\/10.1186\/s40795-024-00905-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,11]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["905"],"URL":"https:\/\/doi.org\/10.1186\/s40795-024-00905-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3320182\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-3320182\/v1","asserted-by":"object"}]},"ISSN":["2055-0928"],"issn-type":[{"value":"2055-0928","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,11]]},"assertion":[{"value":"2 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods in the study were performed in accordance with the Declaration of Helsinki. Ethical approval of the research protocol, recruitment materials, and verbal consent scripts was obtained from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB No: 22949) and RSUP Prof. Dr. R. D. Kandou Health Research Ethics Committee (No. 212\/EC\/KEPK-KANDOU\/XI\/2022). Permission to conduct the study on Kei Besar Island was obtained from the Southeast Maluku Agency of National Unity and Politics (Kesbangpol Malra) on behalf of the Regent of Southeast Maluku (No.: 070\/186\/SIP\/BKBP\/2022). Verbal consent for interviewing and recording was obtained from each participant after explaining the objectives of the study in their local language. Each participant was given monetary remuneration in the sum of IDR 50,000.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"JGM is an Indonesian primary care physician who trained in North Sulawesi and practiced in Kei Besar Island for a year, gaining conversational proficiency in Ambonese Malay. PM, a physician who also studied at Hopkins accompanied JGM to Kei Besar Island, providing support by recording pile sort groupings and participating in peer debriefings. Both authors reported the field conditions to JG, an experienced medical anthropologist who served as a content expert and provided guidance remotely during the fieldwork. ON and AS are both experienced public health physicians and researchers from doctorSHARE who provided support on the field and during the manuscript writing process. IP is a research associate from Hopkins who provided substantial input and revision on the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 information"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"97"}}