ABSTRACT
This study examines the dietary habit and anthropometric status of adolescent pregnant women in rural community in Igbo Etiti Local Government Area, Enugu State. The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 422 respondents which were all adolescent pregnant women. Data on socio-demographic/economic characteristics, feeding habits, adherence to dietary supplements and anthropometric status of the respondents were collected using structured and validated questionnaire. The IBM SPSS version 23.0 computer programme was used to analyze the data. Significant relationship was judged at p ≤ 0.05. Data obtained were described using frequency, percentage, mean and standard deviation. Chi-square was used to analyze the relationship between dietary habits, dietary practices and anthropometric status of the pregnant women. Result from the study showed that more than half (66.6%) of the adolescent pregnant women were still single while most of them are Christians (67.9%) and earn less than N 19,000 in a month (84.1%). However, majority (80.5%) of the adolescents ate 3 times in a day while few (28.9%) skip their meals. Some (46.4%) of the respondents consume snacks while some (47%) mostly avoid meat. Majority of the respondents consume fruits (98.6%) and vegetables (83.4%) while most of them (61.8%) consume it more than 3 times in a week. Additionally, most (63.9%) of the respondents take dietary supplements and more than half (53.6%) of them mostly take only calcium supplements while few (26.6%) take multivitamin. The mid upper arm circumference of the adolescents indicated that some (36.6%) of them are at risk of low birth weight (LBW) while few (5.2%) are obese. Meanwhile, there is a significant relationship between respondents mid upper are circumference and intake of fruits and vegetables (p=0.00). There is need for a differentiated maternal and prenatal care to pregnant adolescents. Since these group of people pass through two phases of development simultaneously, adequate health measures are needed in order to prevent risks health and life, promote and maintain health and well-being of both mother and child.
TABLE 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 Problem 5
1.3 Objectives of the Study 7
1.3.1 General Objective of the Study 7
1.3.2. Specific Objective of the Study 7
1.4 Significance of the Study 7
CHAPTER 2: LITERATURE REVIEW
2.1 Adolescents and Nutrition 8
2.1.1 Characteristics of Adolescence 9
2.1.2 Pregnancy during Adolescence 10
2.2 Physiological Changes During Pregnancy 10
2.2.1 Changes in Body Composition and Weight Gain 10
2.2.2 Changes in Blood Composition 11
2.3 Nutrition During Pregnancy 12
2.3.1 Nutrient Needs during Pregnancy 12
2.3.1.1 Macronutrients and Micronutrients during Pregnancy 12
2.3.1.2 Micronutrients during Pregnancy 18
2.4 Improving Nutrition During Pregnancy 25
2.4.1 Recommendations to Improve Nutrition during Adolescent
Pregnancy 25
2.4.1.1 Focus on Foods, Not Nutrients 25
2.4.1.2 Individualize and Work within the Pregnant Adolescent's Current
Eating Habits 26
2.4.1.3 Consider the Context of Family and Peer Groups 28
2.5 Factors Affecting Food Habits and Nutritional Status of Pregnant Women 30
2.5.1 Trends among Pregnant Women and the Prevalence of Overweight
and Obesity 30
2.5.2 Social and Environmental Factors 31
CHAPTER 3: MATERIALS AND METHODS
3.1 Study Design 34
3.2 Area of Study 34 3.3 Population of Study 34
3.4 Sampling and Sampling Techniques 35
3.4.1 Sample size 36
3.4.2 Sampling Procedure 36
3.5 Preliminary Activities 36
3.5.1 Preliminary visits 36
3.5.2 Training of research assistants 37
3.5.3 Informed Consent 37 3.5.4 Ethical Approval 37
3.6 Data Collection 38
3.6.1 Questionnaire Design 38
3.6.2 Questionnaire administration 38
3.7 Anthropometric Measurement 38
3.7.1 Mid Upper Arm Circumference (MUAC) measurement 39
3.8 Data Analysis 39
3.9 Statistical Analysis 39
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Socio-Demographic Characteristics of the Pregnant Women 41
4.2 Food Habits of the Respondents 43
4.3 Adherence to Supplementary 48
4.4 Frequency of Consumption of Food by Respondents 51
4.5 Anthropometric Status of the Respondents Using Mid-Upper Arm
Circumference 60
4.6 Relationship Between Dietary Practices and Anthropometric Status of
the Pregnant Women 62
CHAPTER 5: CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 64
5.2 Recommendations 65
References 66
Appendix 76
LIST OF TABLES
Table 4.1: Socio-Demographic Characteristics of the Mothers 42
Table 4.2 Food Habits of the Respondents 46
Table 4.3: Adherence to Supplement Intake 50
Table 4.4a: Frequency of Consumption of starchy roots and tubers and cereals 54
Table 4.4b: Frequency of Consumption of meat and meat alternatives 55
Table 4.4c: Frequency of Consumption of fruits and vegetables 56
Table 4.4d: Frequency of Consumption of milk and milk products 57
Table 4.4e: Frequency of Consumption of fats and oil 58
Table 4.4f: Frequency of Consumption of beverages 59
Table 4.5 Anthropometric Status of the Respondents Using Mid-Upper Arm Circumference 61
Table 4.6: Relationship Between Dietary Practices and Anthropometric Status of the Pregnant Women 63
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Adolescence has been described as the period of life between 10 and 19 years of age in which profound and dramatic biological, emotional and cognitive maturity is attained (Brown, 2008; Buxton, 2014). Adolescence marks a critical period of biological and psychosocial growth and development that is unique among phases in the life cycle. 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 (Jennings et al., 2010). The nutrient needs of adolescents are higher than those of prepubescent children and adults (Bhutta et al., 2017). Given the increasing autonomy in diet and eating habits that adolescents experience as parental control lessens, adolescence can be a key entry point for interventions that will underlie healthy practices in adulthood. The 2013 Lancet series on maternal and child under nutrition highlighted adolescence as a priority on the global health agenda and underscored the need for a life-cycle approach that promotes nutrition-related policies, programming, and interventions for this group specifically (Maternal and Child Nutrition MCN, 2013).
Diet is the sum of food consumed by a person or an organism. It often implies the use of specific intake of nutrition for health or other reasons (Keown, 2004). Dietary habit is defined as observable dietary actions or behavior of individuals and can be classified as having good dietary practices and poor dietary practices. They are food choices preferred by persons in their daily life. They differ from person to person. The incidence of dietary inadequacies as a result of dietary habits and patterns is higher during pregnancy when compared to any other stage of the life cycle. Different scholars discovered that many women in developing countries restrict their food intake during pregnancy for different reasons such as to have smaller infants because smaller infants will carry a lower risk of delivery complications, cultural reason and perceived severity of delivery complications because big babies make delivery difficult (Daba et al., 2013; Kuche et al., 2015). Thus, low intake of essential nutrients such as protein, energy, vitamins C, Vitamin A and iron due to inappropriate nutrition practices together with environmental factors, socioeconomic factors and infections are common causes of maternal mortality, low birth weight and intrauterine growth retardation (Madhavi and Singh, 2011).
Anthropometry refers to the measurement of the human. It involves the systematic measurement of the physical properties of the human body, primarily dimensional descriptors of body size and shape (Mosharraf, 2010). It is the most basic methods of assessing body composition. Anthropometric measurements describe body mass, size, shape, and level of fatness (Gibney et al., 2009). Since the body size changes with weight gain, anthropometry gives the researcher an adequate assessment of the overall adiposity of an individual. For pregnant adolescents, general adequacy is assessed by measuring their mid upper arm circumference. Body fat will be estimated by measuring skinfold thickness and muscle diameter (Gibney et al., 2009).
Pregnancy, also known as gestation, is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus. 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). Pregnancy represents an ideal time for health promotion activities. It is the most crucial nutritionally demanding period of every woman’s life. The high demand of nutrients to deposit energy in the form of new tissue, growth of existing maternal tissues such as breast and uterus and increased energy requirements for tissue synthesis makes pregnant women more vulnerable to malnutrition (Goldberg, 2002). Pregnancy needs attention in term of health, exercise and nutrition (Grieger and Clifton, 2014).
Improving nutritional habits during pregnancy in adolescents may improve birth outcomes and develop positive eating habits in the adolescent. Adolescent mothers have specific requirements for macro- and micronutrients to support fetal development in addition to their own growing needs (Scholl et al., 2004). Many adolescents' diets do not provide the recommended intakes for iron, zinc, calcium and folate and that those with the lowest incomes had significantly lower mean intakes than those from the highest income groups (Scholl et al., 2004). Spending money on healthy food is often a lower priority compared to other fixed financial pressures such as housing, transport and utility bills (Burchett and Seeley, 2003). With many competing priorities, it can be a challenge for health professionals to support women in making positive dietary changes and providing practical advice such as guiding on recipes that are suitable for circumstances with limited budget, cooking skills or facilities.
Rural communities are geographical areas that are located outside towns and cities. They are principally peasant in nature, with subsistence agriculture as the main form of sustenance combined with various levels of dependence on forests, freshwater or wildlife. Many programs to address anemia in pregnant adolescent women have been launched but are confined mostly to developed countries. Before adapting such programs for rural Nigerian setting, it is important to develop appropriate programs to ascertain the dietary habit and anthropometric status of adolescent pregnant women in Nigeria. Thus, the aim of this study is to determine the dietary habit and anthropometric status of adolescent pregnant women in Igbo-Etiti Local Government Area (LGA), Enugu State.
1.2 STATEMENT OF THE PROBLEM
Adolescent pregnancy has been considered a major contributor to maternal and child mortality worldwide and is a major public health concern (WHO, 2014). A healthy diet and lifestyle during pregnancy is essential to ensure fetal growth and development is optimized (Hall et al., 2007). This is of particular importance to young adolescent mothers in whom poor nutrition and adverse outcomes such as stillbirth, preterm birth and low birth weight have been frequently reported (Chen et al., 2007).
In 2010, maternal and child under nutrition was responsible for 1.5 million mortalities in the world (Lim et al., 2012). A serious problem of maternal under nutrition is evident in most country, especially in Nigeria. 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 been 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). 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).
Malnutrition during pregnancy yield both short and long-term effects on the health of an infant by limiting the infant’s development and it is also associated with risk of noncommunicable diseases such as obesity, type 2 diabetes, hypertension and cardiovascular disease in later life (Isolauri, 2011; Koletzko et al., 2012). Malnourished mothers are more vulnerable to diseases, encounter more miscarriages and give birth to underweight children whose survival is at risk (Chasi, 2009).
According to United Nations International Children Education 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 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. These unfortunate nutritional situations are prevalent among adolescents can be eliminated by assessing the food habits and dietary practices of adolescent pregnant women, thus, the purpose of this study.
1.3 OBJECTIVES OF THE STUDY
1.3.1 General Objective of the Study
The general objective of the study is to determine the anthropometric status and dietary habit of adolescent pregnant women in Umunko and Ukehe rural communities in Igbo Etiti Local Government Area, Enugu State.
1.3.2. Specific Objective of the Study
The specific objectives of this study are to:
i. assess the dietary habits of the respondents.
ii. evaluate the anthropometric characteristics of the adolescent women using mid-upper arm circumference.
iii. assess the socio-economic characteristics of the pregnant women.
iv. determine the relationship between dietary habits, dietary practices and anthropometric status of the pregnant women.
1.4 SIGNIFICANCE OF THE STUDY
The information obtained from this study will serve as a source of enlightenment to adolescent pregnant women in Enugu state and beyond so as to make them to be conscious of their nutritional status before, during and after pregnancy thereby protecting their health and that of their babies. Data from this study will also serve as a guideline for maternal and child health workers and nutritionists in creating public health awareness towards dietary practices and feeding habits of adolescent pregnant women.
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