IMPACT OF ADEQUATE NUTRITION DURING PREGNANCY ON CHILDBEARING MOTHER

ABSTRACT

Introduction:

Malnutrition is still highly prevalent among pregnant women in Nigeria with 12% of them being undernourished 64% of pregnant women and 53% of lactating women being anemic and 18.6% of pregnant women and 17.3% of lactating mothers having Vitamin A deficiency.

Many of the 200 million women who become pregnant each year, most of them in developing countries suffer from ongoing nutritional deficiencies, repeated infections and the long term cumulative consequences of under nutrition during their own childhood.(UNICEF, 2009) General objective:

The study assessed the factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo.

Research methodology:

The study employed a cross-sectional research design to collect data on factors contributing to malnutrition in pregnant mothers. A Convenient sampling method was adopted to recruit 325 mothers into this study. Structured questionnaire was used to collect data and data was analyzed using SPSS16 version.

Results:

The study revealed that, of the 325 pregnant mothers interviewed, 45.38% (147/325) were found to be malnourished. Lack of balanced diet [OR=3.2 (CI=1.54-6.88) P=0.002 ] , Parity more than 4 [OR=2.22 (CI=1.06-4.64) P=0.035 ] , Having food taboos [OR=0.17 (CI=0.05-0.52) P=0.002] , Age more than 30 years [OR=26.4(CI=6.07-114.9) P=0.001] ,Christians [OR=0.29 (CI=0.130.66) P=0.003] and monthly income more than Ush.100,000 [OR=2.72(CI=1.04-7.08)P=0.04] , we found to the contributing factors to malnutrition among pregnant mothers in Uyo.

Conclusion:

The study found out that the prevalence of malnutrition was moderately high. Age more than 30 years, Christian faith religion, monthly income of more than Ush. 100,000, lack of a balanced diet, parity more than 4 and having food taboos were found to be the major independent variables contributing to malnutrition among pregnant women attending ANC in Mityana hospital, Uyo.

Recommendation:

Therefore, Community based nutrition and maternal health programs should be established to tackle the problem of malnutrition and poor knowledge and attitudes on maternal health in the community.

CHAPTER ONE: INTRODUCTION

1.0 Background

More than half a million women die every year due to pregnancy related causes. Almost 4 million neonatal deaths are also registered of the majority of 200 million women who conceive every year, many are living in developing countries, suffer from ongoing nutritional deficiencies, repeated illnesses and long term cumulative consequences of under nutrition during their childhood. UNICEF (2009)

Malnutrition means consuming inadequate nourishing foods or taking in a particular type of food which has little or no nutritive value. It can be mild, moderate or severe malnutrition (Pelleter et al 1994). The extent and distribution of malnutrition in a given population depends on many factors ; the household economic status, knowledge and attitude, level of education and  employment, literacy, child spacing, cultural and religious food customs, existence and effectiveness of nutrition programs and  availability and quality of health services.

About 35%of adult women worldwide are estimated to be overweight (BMI ≥25kg/m²), a third of whom (297 million) are obese (BMI≥ 30kg/m²) WHO 2011’s data. In the European

Region, the Eastern Mediterranean Region and the Region of the Americas this number exceeds 50%. Obesity in pregnancy is connected to maternal complications ranging from effects on fertility to effects on delivery and during the postpartum period, as well as many complications also affecting the unborn and newborn (Arendaset al.2008). According to Pooblan and colleagues (2008), the risk of caesarean delivery is increased by 50% in overweight women and is more than double for obese women compared to women who have a normal BMI. Many socio-demographic and lifestyle factors have been associated with the use of dietary supplements which contribute to obesity. The most typical female supplement user seems to be a well-educated woman whose diet is already close to the nutrition recommendations without supplement use (Paturiet al.2008).

In addition, greater age has also been associated with higher supplement use (Yuet al.2010). However, age and education did not differentiate among supplement users and non-users during pregnancy in a study on Finnish women (Erkkola et al 2008), whereas in Norwegian pregnant women of higher level of education (Nilsen et al.2010) and among British women higher age were associated positively with supplement use during pregnancy (Mathews et

al.2010).

Conversely, low BMI and/ or short stature( height less than 145cm) are found to be common among women in low-social countries, with the highest rates formerly observed in southern and south eastern Asia, followed by sub Saharan Africa with critical rates (≥40%) in Bangladesh and Eritrea, and a serious rate (20-39%) prevalence in Chad, Cambodia, India, Ethiopia, Mali, Nepal, Madagascar and Yemen (WHO 2011), Other countries their prevalence is less (10-19%). In Bangladesh, India, and Nepal, more than 10% of women are shorter than 145cm. One of the factors contributing to short stature is lack of nutritional knowledge, dietary restriction and food taboos. According to Gillett (2009), the major problem with food taboos is preventing a pregnant mother from accessing a well-balanced diet in the belief that transgression of those taboos may harm the mother and baby. Consequently, any miscarriage, complications during childbirth or baby being born with certain abnormalities are often believed to be caused by the mother, who may have eaten certain foods not allowed in pregnancy. Several studies have shown that educational intervention not only increases knowledge about a proper diet in pregnancy (Rao, et al., 2008), but also are positively correlated with good eating habits (Kim, et al., 2009). In addition, Liu, et al. (2009) observed that educational intervention enables women to change unhealthy practices and consequently decreases prevalence of postpartum complications.

Also data from WHO 2011 suggests that almost 468 million women aged between 15 -49

years (30% of all women) are thought to be anemic and at least half of them are as a result of iron deficiency. Majority are Africans (48- 57%) and south eastern Asians are of the greater numbers( 182 million women of reproductive age and 18 million expectant mothers). The prevalence of anemia in teenagers (15–19 years) can be even higher and exceeds 60% in Ghana, Mali and Senegal.

Similarly 12% of the same age category were reported to be thin (BMI less than 18.5kg/m² ), 9% are mildly thin and 3% are moderately or severely thin. About one in every five women (19%)are overweight or obese. 38% of children aged 6 to 59 months and 36% of women aged 15 to 49 years were reported to have vitamin A deficiency (UDHS 2011). Therefore malnutrition which is associated with a lower physical capacity and increased susceptibility to infections, needs to be tackled before women become pregnant in order to reduce the risks of poor maternal health and low birth weight babies.

Though maternal nutrition during pregnancy is so important in reducing maternal and infant mortality which are targeted in achieving the millennium development goal, very few studies have been done on factors contributing to malnutrition among pregnant women in Mityana. As a result, there is lack of comprehensive information regarding nutritional knowledge and factors associated with this condition. Therefore the purpose of this study is to identify factors that contribute to malnutrition among pregnant women in a bid to cover the knowledge and information gap.

1.1 Problem statement

Malnutrition is still highly prevalent with 12% of women being undernourished or thin (BMI less than 18.5), 64% of pregnant women and 53% of lactating women being anemic and 18.6% of pregnant women and 17.3% of lactating mothers having Vitamin A deficiency (demographic and health survey 2008). Poor nutrition amongst women reduces physical development thus leading to miscarriages, low birth weight or worse still, still births, perinatal deaths and irreversible brain damage to the unborn child. As a result this hurts development in terms of education and productivity. Therefore drastic measures need to be taken into account in-order to address this problem. Hence the purpose of this study was to identify factors contributing to malnutrition among pregnant women attending ANC in a bid to address this issue.

WHO guidelines together with MOH recommends at least 4 ANC visits to every pregnant and the 1^st visit should be made within the 1^st trimester. However, only 48% of women in Nigeria make these visits (UDHS 2011). The major objective of ANC visits is to detect anemia, infections and other health problems associated with pregnancy including malnutrition. In addition, the government of Nigeria has tried to combat maternal malnutrition through introduction of the minimum health care package which also supports promotion of ANC, supplementation with iron and folic acid, treatment and control of

helminths infestations, diet diversification in-order to increase dietary iron intake.

In-spite of these efforts, majority of the mothers still don’t have access to these services or even information. This is evidenced by the fact that only 1 in 3 mothers receive postpartum vitamin A supplementation, only 47% of mothers attend 4 or more ANC visits, less than 1% of mothers follow the recommended dose of 90 + IFA (Iron Folic Acid) supplementation and only 60% of pregnant women take their iron supplements (Demographic and health survey 2008).

1.2 General Objective

The study assessed the factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo.

1.3 Specific Objectives

The study was guided by the flowing objectives;

1. To identify the prevalence of malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo.
2. To determine the demographic factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo.

• To identify socio-economic factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo

1. To identify the personal related factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo.

1.4 Research questions

This study answered the following questions;

1. What is the prevalence of malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo?
2. What are the demographic factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo?

• What are the socio-economic factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo?

1. What are the personal related factors contributing to malnutrition among pregnant women attending antenatal clinic in Mityana hospital, Uyo?

Poor pregnancy outcome

The conceptual framework for factors contributing to malnutrition among pregnant women attending Antenatal clinic in Mityana hospital, Uyo

Description of the conceptual framework

In the above conceptual framework, the independent variables included personal-related factors (Knowledge, attitude, child spacing, parity, presence of minor disorders, frequency of ANC attendance, diet, oral contraceptives, breastfeeding, number of family members, gestational age of enrollment at ANC), Socio-economic factors (Employment, literacy/level of education, household), and Demographic factors (Age, marital status, religion and culture) which all affect the dependent variable being malnutrition among pregnant women which all lead to poor pregnancy outcomes.

1.6 Justification of the study

The information gathered may help the authorities create policies for improving maternal malnutrition in Mityana. The information generated may add to the knowledge already on the already existing pool of data on the prevalence of malnutrition among women in Mityana. This may help women have good pregnancy outcomes hence good health and healthy babies. Even though, maternal nutrition during pregnancy is crucial in reducing maternal mortality and infant mortality which are the target areas in achieving millennium development goals, very few studies have been conducted on factors associated with malnutrition among pregnant women. As a result, there is lack of comprehensive information regarding nutritional knowledge and factors associated with this condition.

Therefore the aim of the study was to assess the nutritional status of pregnant women in order to identify women who have nutrient deficiencies during pregnancies indicated by low BMIs, inadequate gestational weight gain and pattern of food intake. This will help to identify the trimester at which pregnant women are nutritionally at risk, so that programs could be geared towards pregnant women found in that particular trimesters and improve maternal health as a whole.

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