ABSTRACT
Nutritioneducationisoneoftheimportantcomponentsofantenatalcare.Itisawidelyused strategy to improve nutritional knowledge of pregnant women seeking ante natal care more so in government run healthcare facilities. A lot of studies to assess the level of nutritional knowledge on pregnant women attending antenatal care in government health facilities have been done but little data exists on the antenatal care situation at Mbagathi hospital given that it’s one of the key government run level five hospital facility in Nairobi County that serves a population of about 3.1 million urban dwellers. The broad objective of this study was to determine the nutritional knowledge and dietary practices of pregnant women receiving nutrition education while attending antenatal care at Mbagathi hospital Nairobi county.
The study used a descriptive cross-sectional study design for collection and analysis of data and. Total of 195 pregnant women receiving nutrition education while attending antenatal care in Mbagathi hospital Antenatal clinic were recruited into the study through systematic sampling. The study, using a semi structured questionnaire, assessed the level of nutritional knowledge and dietary practices of attendees of ante natal clinic. Anthropometric measurement of the Middle-upper arm Circumference (MUAC) was used to assess the nutrition status of the women. The study used Statistical Package for the Social Sciences (SPSS) version 20 software for data entry and analysis. Descriptive statistics (mean, median, frequency and standard deviation) described the background characteristics of the study sample while inferential statistics, (P-Value of <0.05 at 95% confidence interval), were employed to determine associations and relationships between two or more variables.
Majority (69%) of the participants were within the age category of between 21- 30 years and the mean age was 27 (±=5.38) years. Over three quarters (79%) were married while 21% were not. Slightly below half of the women, 43%, had attained secondary education 17% had primary education while 9% had University education. Slightly over a third (35%) were housewives, 31% self-employed and 12% were salaried workers. The mean household size was 3.18 (±=1.47)
Over 50% of the respondents were in their third trimester of pregnancy, 34% in the second and 7% in the first trimester. Only 39% had made between three and four antenatal visits, with the mean number of visits was 3.7. Nearly all (94%) participants had blood pressure readings taken, 71% had a concurrent illness (colds and flus, urinary tract infections, Malaria), 8% had a diagnosis of High Blood Pressure, 4% had gestational diabetes while 2% had iron deficiency anemia. On assessment of nutritional knowledge, 84% displayed adequate levels of nutrition knowledge with regards to aspects of nutrition during pregnancy like variety of foods; amount of food during pregnancy; energy sources; micronutrient supplement for pregnant women, necessity for supplementation and duration; micronutrients, iron and calcium and consequences of deficiency during pregnancy while 13% had poor knowledge score. The level of nutritional knowledge was strongly associated with the number of antenatal care visits attended (p=0.03), nutrition status (p=0.018) and the mean dietary diversity score (p=0.03) of the participants. Assessment of dietary diversity showed that having consumed at least five food groups, 63% met the minimum dietary diversity score for women. There was a significant association between household size and dietary diversity score (p=0.033). Majority (65%) of pregnant women from household sizes of 1 to 4 members displayed adequate dietary diversity. However, there was no association between dietary diversity with education status, marital status, occupation and level of income. Nutrition status was assessed by taking the reading of the middle upper arm circumference (MUAC) using an adult MUAC tape. The respondents had MUAC measurement of ranging from 22.8cm to over 30cm, with 62% of the pregnant women had normal nutritional status with a MUAC reading of between 22.8-30.7cm, 27% of the women were obese with a MUAC readings of >30cm while 11% with MUAC reading of <22 cm were underweight.
From the research findings, pregnant women who receive nutrition education while attending antenatal care ante natal care at Level 5 hospitals in Kenya have adequate maternal nutrition knowledge and dietary diversity score. The more the number of ante natal visits a pregnant woman makes, the higher the level of nutritional knowledge.
This study recommends that the Government of Kenya, Ministry of Health and partners should continuously and consistently create more awareness of the existence of antenatal care service and its benefits to pregnant women. Health workers at antenatal clinics should also pay particular attention to underweight and overweight pregnant women since they have poor nutrition knowledge the health workers should go an extra mile to find out why they are unable to make the right food choices.
TABLE OF CONTENTS
DECLARATION ii
LIST OF TABLES vi
LIST OFFIGURES vii
ABSTRACT viii
ACRONYMS AND ABBREVIATIONS x
OPERATIONAL DEFINITION xi
CHAPTER ONE: INTRODUCTION
1.1 Background Information 1
1.2 Statement of the Problem 3
1.3 Justification of the study 3
1.4 Aim of the study 3
1.5 Purpose of the study 3
1.6 Objectives of the study 4
1.6.1 Main Objective 4
1.6.2 Specific objectives 4
1.7 Research Questions 4
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction 5
2.1 Overview of Antenatal Care 5
2.2 Nutritional knowledge of pregnant women 7
2.3 Dietary intake of pregnant women 8
2.4 Research Design and methodology 11
2.4 Gaps in knowledge 13
2.6 Conceptual Framework of the study variables 15
CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY
3.1 Study Design 16
3.2 Study site and Population 16
3.2.1 Study site 16
3.2.2 Study population 17
3.3 Sample size 17
3.3.1 Sample size determination 17
3.3.2 Sampling procedure 18
3.3.3 Inclusion criteria 18
3.3.4 Exclusion criteria 19
3.4 Data collection tools and procedure 19
3.4.1 Study Questionnaire 19
3.5 Recruitment and Training of Research Assistants 21
3.6 Pre -Test of the Data Collection Tools 21
3.7 Ethical and Human Rights Consideration 21
3.8 Data analysis and Quality Assurance Procedures 22
CHAPTER: FOUR RESULTS
4.1 Socio-demographic characteristics of the respondents 23
4.2 Gestational age and ANC attendance of pregnant women at Mbagathi hospital 24
4.3 Medical profile for the current pregnancy of pregnant women at Mbagathi hospital 25
4.4 Nutrition education topics taught to pregnant women attending antenatal care at Mbagathi Hospital 26
4.5 Level of nutrition Knowledge of pregnant women attending antenatal care at Mbagathi hospital................... 27
4.6 Dietary Diversity score of pregnant women attending antenatal care at Mbagathi hospital 28
4.7 Nutritional status of the pregnant women attending antenatal care at Mbagathi hospital 32
CHAPTER FIVE: DISCUSSION
5.1 Introduction 34
5.2 Socio-demographic context of the study participants 34
5.3 Level of Nutritional knowledge of the study participants 35
5.4 Dietary practices of the pregnant women attending antenatal care at Mbagathi hospital 36
5.5 Distribution of nutritional knowledge and mean dietary diversity score of pregnant women attending antenatal care at Mbagathi hospital 36
5.6 Nutrition status of the study participants attending antenatal care at Mbagathi hospital 37
5.7 Distribution of nutritional knowledge levels by nutritional status of pregnant women attending antenatal care at Mbagathi hospital 37
5.8 Association between the level of nutritional knowledge and antenatal care attendance 38
CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS
6.1 Conclusion 39
6.2 Recommendations 39
REFERENCE 40
APPENDIX 1: STUDY QUESTIONNAIRE 44
APPENDIX 2: OBSERVATION GUIDE AT THE ANTE NATAL CLINIC 48
APPENDIX 3: GUIDELINES AND RESOURCE MATERIALS AVAILABLE ON MATERNAL NUTRITION 49
APPENDIX 4: CONSENT FORM 50
LIST OF TABLES
Table 1: Demographic characteristics of the respondents attending antenatal care at Mbagathi Hospital 23
Table 2: Gestational age and ANC attendance of pregnant women attending ANC at Mbagathi hospital 25
Table 3: Medical profile of the respondents of pregnant women 25
Table 4: Topics taught during nutrition education sessions at Mbagathi hospital 26
Table 5: Association between the level of nutritional knowledge and nutrition status (MUAC)........................ 28
Table 6: Distribution of socio-demographic characteristics by dietary diversity score 30
Table 7: Association between nutritional knowledge and consumption of the recommended ten food groups and the Mean Dietary Diversity score of pregnant women attending antenatal care at Mbagathi hospital 31
LIST OFFIGURES
Figure 1: Illustration of research study designs Error! Bookmark not defined.
Figure 2: Knowledge-Attitude-Behavior (KAB) model 14
Figure 3: Conceptual framework derived from study objectives 15
Figure 4: Map of Kenya showing Mbagathi Hospital 17
Figure 5: Sampling frame for study site and study population at Mbagathi hospital 18
Figure 6: Level of nutritional knowledge of the study participants at Mbagathi hospital 28
Figure 7: Dietary Diversity Scores of the pregnant women attending antenatal care at Mbagathi hospital 29
Figure 8: Nutritional status of pregnant women attending antenatal care at Mbagathi hospital based on MUAC cut-off points 32
Figure 9: Association between the level of nutritional knowledge and nutritional status of the women attending antenatal care at Mbagathi hospital 33
ACRONYMS AND ABBREVIATIONS
ANC Ante natal care
DDS Dietary Diversity Score
DDS-W Dietary Diversity Score for Women
FAO Food and Agriculture Organization
FGD Focus Group Discussion
IFAS Iron and Folic acid supplements
KAB Knowledge Attitude Behavior model
KDHS Kenya Demographic and Health Survey
KII KeyInformant Interview
MDD Minimum Dietary Diversity
MDDS Mean Dietary Diversity Score
MIYCN Maternal Infant and Young Child Nutrition
MOH Ministry of Health
MUAC Mid-Upper Arm Circumference
WHO World Health Organization
WRA Women of Reproductive Age
OPERATIONAL DEFINITION
Antenatal care-It’s a form of health care where pregnant women learn from skilled health personnel about proper nutrition during pregnancy, they receive micronutrient supplements and treatment in case of an illness and also learn about healthy behavior during pregnancy. The health care personnel also monitor pregnancy and any danger signs during ante natal visits
Dietary practices-Dietary practice is defined as a participant’s preference in food consumption or behavior of dietary habits and can be classified as good dietary practice and poor dietary practices
Nutrition Education-This is education given to pregnant women during antenatal care visits about their nutritional needs and requirements in pregnancy. Nutrition education covers variety of topics on maternal nutrition
Nutrition knowledge–Nutritional knowledge refers a pregnant woman understanding on various aspect of maternal nutrition including energy and protein requirements in pregnancy, micronutrient requirements, serving size of food groups, diversity of diets. The purpose of equipping pregnant women with nutritional knowledge is to help them improve their dietary practices in order to meet her nutritional needs together with the needs of the developing baby Nutritional Status-This is the state of a pregnant woman’s health that is determined by wrapping a tape otherwise known as an adult MUAC on the left Middle Upper Arm and reading the circumference in centimeters. The reading is categorized as either underweight (a reading of less than 22cm, overweight (a reading of over 30cm or normal (a reading of between 22-30cm)
Middle Upper Arm Circumference- This is a reading taken on the upper left arm of a pregnant woman in order to determine her nutrition status. The reading is taken in centimeters and categorized as either underweight, normal or overweight
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