ABSTRACT
Maternal nutrition during pregnancy has gained interest over the years due to understanding that there is an increased physiological, metabolic and nutritional demand associated with pregnancy. This has been regarded as an important determinant of foetal growth. The study was undertaken to determine the food habit and dietary practices of adolescent pregnant women in Ikot Ekpene Local Government Area of Akwa-Ibom State. Data for this report was obtained from a cross-sectional survey of 385 adolescent pregnant women. A structured questionnaire was used to elicit information on personal, socio-economic characteristics and food habit. Data obtained from the study were subjected to statistical analysis, using statistical package for social sciences version 23. The results of the different variables collected revealed that many (43.9%) of them are within the age of 13-15years, 50.6% are single. Information on socio-economic showed that 14.8% attained tertiary education, 38.2% are traders and 38.4% had N10, 000 - N19,000 as their monthly income. Information on the food consumption pattern shows that little above half (59.7%) eats three times daily, 37.4% skips meal and meal skipped by many (14.0%) of them were breakfast. The favorite food of 29.6% of them were Garri and soup as 19.2% were fufu and soup. More of the respondents (67.8%) eat snacks as 11.7% do consumed chin-chin and groundnut each respectively. The fruit consumed by many (38.4%) of them were mango. The Dietary Diversity of Respondents According To Age revealed that some of the respondents (31.7%) had a dietary diversity score (DDS) of less than three food groups indicating a low dietary diversity, although those within the age of 10-12years (41.2%) were more when compared to that of those within the age of 13-15years (23.5%) and 16-18years (33.7%). The food frequency consumption of the respondents showed that garri, fufu, Abacha, yam and rice, being the major items consumed by respondents on daily basis. Most of the respondents (67.3%) consumed garri daily whereas very few (23%) consumed it weekly. However, 34.0% and 14.0% eats fufu and Abacha daily respectively.. Among the response of consumption vegetables, bitter leaf (27.5%), pumpkin leaf (52.2%), lettuce (11.9%), watermelon (59.0%), cabbage (16.9%), garden egg (10.4%), cucumber (11.9%), okro (39.2%) and tomatoes (45.2%) were the consumed daily as the same vegetable; bitter leaf (23.1%), pumpkin leaf (6.5%), lettuce (10.6%), watermelon (6.5%), cabbage (15.6%), garden egg (30.9%), cucumber (20.5%), okro (11.2%) and tomatoes (16.6%). The result showed that there was a strong positive significant relationship between the educational level of the adolescent pregnant mothers and meal skipping, educational level and meal skipped, educational level. However there was negative relationship between the educational level and consumption of fruit as well as educational level and fruit and vegetable consumed (P>0.05). There was no relationship between any food habit and occupation of the respondents (P<0.05). There was strong positive relationship between monthly income and meal skipping, monthly income and meal skipped, monthly income and Consumption of fruits (P>0.05).
TABLES OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENTS v
LIST OF TABLES viii
ABSTRACT ix
CHAPTER 1: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problem 5
1.3 Objectives of the Study 8
1.3.1 General Objective of the Study 8
1.3.2 Specific Objective of the Study 8
1.4 Significance of the Study 9
CHAPTER 2: LITERATURE REVIEW
2.1 Adolescence 10
2.2 Nutrition in Pregnancy 10
2.3 Pregnancy during Adolescence 12
2.4 Physiological Changes during Pregnancy 12
2.4.1 Changes in Body Composition and Weight Gain 13
2.4.2 Changes in Blood Composition 13
2.5 Nutrition Requirements during Pregnancy 14
2.6 Nutritional Status Prior to Pregnancy 15
2.6.1 Improving Nutrition during Adolescent Pregnancy 19
2.7 Nutrient Needs during Pregnancy 21
2.7.1 Macronutrients and Micronutrients during Pregnancy 22
2.7.2 Nutrition and Gestational Weight Gain of Pregnant Women 22
2.7 Factors Affecting Food Habits and Nutritional Status of Pregnant Women 36
2.7.1 Trends among Pregnant Women and the Prevalence of Overweight 38 and Obesity
2.7.2 Social and Environmental Factors 38
CHAPTER 3: MATERIALS AND METHODS
3.1 Study Design 39
3.2 Area of Study 42
3.3 Population of the Study 42
3.4 Sampling and Sampling Techniques 43
3.4.1 Sample size 43
3.4.2 Sampling Procedure 43
3.5 Preliminary Activities 44
3.5.1 Informed consent 44
3.5.2 Training of research assistants 44
3.5.3 Preliminary visits 45
3.5.4 Research Assistants 45
3.5.6 Ethical Approval 45
3.6 Data Collection 46
3.7 Statistical Analysis 46
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Personal Characteristics of the Respondents 47
4.2 Socio-Economic Characteristics of the Respondents 48
4.3 Food Consumption Pattern of Respondents 53
4.4 Fruits and Vegetables Consumed 57
4.5 Frequency of Consumption of Food by the Respondents 66
4.6 The Relationship between the Socio-Economic Characteristics 70
and Food Habit of the Respondent
CHAPTER 5 CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 79
5.2 Recommendations 81
REFERENCES 83
APPENDIX
LIST OF TABLES
4.1 Personal characteristics of the respondents 50
4.2 Socio-economic characteristics of the respondents 55
4.3a Food consumption pattern of respondents 59
4.3b Food consumption pattern of respondents 62
4.4 Fruits and Vegetables consumed 68
4.5a Frequency of consumption of some selected food 74
4.5b Frequency of consumption of some selected food 77
4.6 The relationship between the socio-economic characteristics and food habit of the respondent 80
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Nutrition is the science that interprets the relationship of food to the functioning of the living organisms (Carrillo et al., 2011). Adolescence has been described as the period of life between 1 and 19 years of age in which profound and dramatic biological, emotional and cognitive maturity is attained (Buxton, 2014; Brown, 2008). It has been indicated that adolescents are particularly vulnerable to nutrient inadequacies as their bodies undergo various physiological changes, and as they become more socially independent, which often impacts negatively on their dietary intakes (Norton et al., 2003; Jennings et al., 2010).
Adolescent pregnancies are a global problem that occurs in high, middle, and low income countries. Around the world, adolescent pregnancies are more likely to occur in marginalized communities, commonly driven by poverty and lack of education and employment opportunities (UNFPA, 2015). For some adolescents, pregnancy and childbirth are planned and wanted. In some contexts, girls may face social pressure to marry and, once married, to have children. Each year, about 15 million girls are married before the age of 18 years, and 90% of births to girls aged 15 to 19 years occur within marriage (UNFPA, 2015; UNICEF, 2009).
For many adolescents, pregnancy and childbirth are neither planned nor wanted. Twenty-three million girls aged 15 to 19 years in developing regions have an unmet need for modern contraception (Darroch et al., 2016). As a result, half of pregnancies among girls aged 15 to 19 years in developing regions are estimated to be unintended (Darroch et al., 2016).
According to WHO (2011), Adolescents face barriers to accessing contraception including restrictive laws and policies regarding provision of contraceptive based on age or marital status, health worker bias and/or lack of willingness to acknowledge adolescents’ sexual health needs, and adolescents’ own inability to access contraceptives because of knowledge, transportation, and financial constraints. Additionally, adolescents face barriers that prevent use and/or consistent and correct use of contraception, even when adolescents are able to obtain contraceptives: pressure to have children; stigma surrounding non-marital sexual activity and/or contraceptive use; fear of side effects; lack of knowledge on correct use; and factors contributing to discontinuation (for example, hesitation to go back and seek contraceptives because of negative first experiences with health workers and health systems, changing reproductive needs, changing reproductive intentions) (Kozuki et al., 2013).
In some situations, adolescent girls may be unable to refuse unwanted sex or resist coerced sex, which tends to be unprotected. Sexual violence is widespread and particularly affects adolescent girls: about 20% of girls around the world experience sexual abuse as children and adolescents (WHO, 2013). Inequitable gender norms and social norms that condone violence against women put girls at greater risk of unintended pregnancy.
Food habits are an integral part of a person’s lifestyle, and are related to other behavioural patterns. It is a recurrent behaviour, not determined by heredity (Truswell and Darnton, 2009). Food habits are acquired by frequent repetition or physiological exposure, so that they have nearly or completely become involuntary (French and Larson, 2001). According to European Food Information Council Review (2014), food habit comprises of psychological and sociological aspects and factors that guide food habit and includes taste preference, sensory attributes, cost, availability, convenience, cognitive restraint and cultural familiarity in addition to environmental cues. It is a subject of research in nutrition, food science, psychology etc.
These food habits are not only the characteristic and repetitive way to provide oneself with nourishment, but also ways to simultaneously attain social and economic goals. Once formed, they tend to control food-related behavior, and are slow to change (Schwimmer et al., 2003). Healthy eating is important in adolescent pregnancy, not only because of their nutritional needs, but also habits formed early in one’s life, will most likely be carried into adulthood. Cari ‘s Live Science Report (2014) on pregnancy, diet and nutrition recommends that pregnant adolescent should choose a variety of healthy foods and beverages to provide the important nutrients a baby needs for growth and development. The key pregnancy nutrients includes; more calcium, folic acid, iron and protein. Eating healthy during pregnancy is one of the best things a mother can do for her baby, since the food they eat is their baby’s main source of nutrition. Hovdenak and Haram (2012) had shown that vitamin supplementation can improve pregnancy outcomes and reduce nausea, and morning sickness.
Pregnant adolescent should choose the right foods, monitor their weight gain to ensure that they are not gaining too much or too little. As a result, foods to be included in their diets should contain protein, omega 3 fatty acid, vitamin D, zinc, calcium rich food, vitamin B-12, iron-rich foods etc. What to limit (avoid or minimize) includes: alcohol, caffeine, (aim for less than 300mg per day), cured/deli meats, artificial sweeteners, high sugar intake, using cravings to justify poor food habits. Foods to completely avoid includes: raw or undercooked animal foods such as meat, seafood and eggs, mackerel, tobacco etc. (Berardi, 2016).
Pregnancy is a period of anabolism, or building. Pregnant adolescent’s bodies are in building mode, they are building the tissue. To this end, it is critical that adolescents should be getting more calories, more macro nutrients (protein, carbohydrates and fats) and more micronutrient (vitamins and minerals) than they would normally need (Beradi, 2016).
Tanentsapf and Adegboye (2011) reported that improving adolescent’s physical health during pregnancy and after birth has increased in recent years. This may be due to the focus of governments around the world on the issue as a result of increasing maternal obesity rates and a greater understanding of the impact of maternal obesity and gestational weight gain on pregnancy outcomes for mother and baby. Dietary components have been suggested as the most important elements to support antenatal and postnatal adolescents to maintaining a healthy weight. Campaigns to reduce weight in postnatal adolescents and women have been found to be of benefit when combining physical activity with dietary advice than with dietary components alone (Bertz et al., 2012).
1.2 STATEMENT OF THE PROBLEM
Maternal nutrition during pregnancy has gained interest over the years due to understanding that there is an increased physiological, metabolic and nutritional demand that is associated with pregnancy. This has been regarded as an important determinant of foetal growth (Godfrey and Barker, 2000). The problem of malnutrition has ranked the major cause of maternal mortality and it is a major determinant of successful pregnancy and a healthy well-nourished baby. Pregnancy is a critical stage of development during which maternal nutrition can strongly influence obstetric and neonatal outcomes (Kramer, 2003). According to American Dietetic Association (2008), optimal nutrition is necessary to maintain the health of the mother, to help ensure a normal, healthy delivery, and also to reduce the risk of birth defects, sub-optimal foetal development and chronic health problems in childhood. Poor nutritional status and sub-optimal pre- and ante-natal care are common in developing countries, often resulting in pregnancy complications and poor obstetric outcomes (Hampshire et al., 2004). Pregnant adolescents in Sub-Saharan Africa which Nigeria belong to are at particular nutritional risk as a result of poverty, food insecurity, political and economic instabilities, frequent infections, and frequent pregnancies (Lartey, 2008).
Poor nutritional status has been known to have unfavorable effects (Hood, 2015). Research has shown that poor nutritional status during development can also have consequences for the child later in life, increasing his or her risk for cardiovascular hypertension and Type 2 diabetes (Berardi, 2016). An ever increasing number of studies have shown that nutrition of the mother will have an effect on the child throughout life. The risks includes cancer, cardiovascular disease, hypertension and diabetes mellitus. An inadequate or excessive amount of nutrients may cause malformations or medical problems in the fetus. Neurological disorders and handicaps are some of the risk that children who are born by adolescent pregnant women face (Barasi and Moltran, 2002).
World Health Organization (WHO) (2011) revealed that 23.8% of babies worldwide are estimated to be born with lower than optimal weights at birth due to lack of proper nutrition. Personal habits such as smoking, alcohol, caffeine, using certain medications and street drugs in the early stages of pregnancy can negatively and irreversibly affect the development of the baby (Laura, 2006).
The main nutritional issues facing these adolescents include maternal under- and over-nutrition and deficiencies of key micronutrients, such as iron, folate, calcium, vitamin D and vitamin A which are needed by pregnant women. Consequently, poor obstetric outcomes, such as anemia, neural tube defects (NTDs), rickets, low birth weight (LBW) and maternal and neonatal mortality are common in Sub-Saharan Africa. Consequently, it is unknown to what extent the nutritional deficiencies and pregnancy complications are occurring in Nigeria, and other countries of Sub-Saharan Africa (Johnson et al., 2013).
According to United Nation International Children Emergency Fund (UNICEF) (2009) which stated that each year, more than half a million adolescent pregnant women die from causes that are related to pregnancy and childbirth. Nearly 4 million newborns die within 28 days of birth, millions more suffer from disability, diseases, infection and injury. The lifetime risk of maternal death for a woman in a less developed country is more than 300 times greater than for a woman living in an industrialized country.
The unfortunate nutritional situation prevalent in certain under-developed countries affords opportunities for this study on the nutritional status of pregnant adolescent women. These statistics above showed why it is important that the major avoidable causes of maternal mortality and adverse pregnancy outcome are eliminated by looking into the food habits and the dietary practices of adolescent pregnant women in Ikot Ekpene Local Government Area of Akwa Ibom State.
1.3 OBJECTIVES OF THE STUDY
1.3.1 General Objective of the Study
The general objective of the study is to determine the food habits and dietary practices of adolescent pregnant women in Ikot Ekpene Local Government Area of Akwa Ibom State.
1.3.2. Specific Objective of the Study
The specific objectives of this study are to:
i. assess the socio-economic characteristics of the respondents
ii. determine the dietary practices of pregnant adolescent pregnant womenin IkotEkpene Local Government Area of Akwa-Ibom State.
iii. assess the food habits of pregnant adolescent pregnant women in the study area.
iv. determine the relationship between food habits and dietary practices of these adolescent pregnant women.
1.4 SIGNIFICANCE OF THE STUDY
This work is therefore important because:
1. The information obtained from this study will serve as a source of enlightenment to adolescent pregnant women in Ikot Ekpene and beyond so as to make them to be become nutrition-conscious before, during and after pregnancy thereby protecting their health and that of their babies.
2. This study will give preventive measures that will eliminate or reduce the effects of unhealthy food habits.
3. The recommendations from this study can serve as a guideline for maternal and child health workers and nutritionists in creating public health awareness towards dietary practices and food habits of adolescent pregnant women.
4. Data that is gotten from this study will also provide an insight to policy makers/programmers thereby serving as a baseline data for further studies that are related to dietary practices and food habit of adolescent pregnant women.
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