DIETARY PRACTICES AND RESTRICTIONS AMONG PREGNANT WOMEN THAT ATTEND ANTENATAL CLINIC AT FEDERAL MEDICAL CENTER UMUAHIA, ABIA STATE

ABSTRACTS

Improper dietary practices of pregnant women have apparently led to increased rates of stillbirths, premature births, low-birth weight, maternal and prenatal deaths. This study assessed the dietary practice and restriction among pregnant women that attend Federal Medical Center Umuahia, Abia State. A cross sectional descriptive survey design was adopted. The population of the study include only pregnant women that attend antenatal clinic at Federal Medical Center Umuahia, Abia State. A random sampling technique was used to select 200 pregnant women that attend antenatal clinic at Federal Medical Center Umuahia, Abia State for the study. Data collection was done using a closed ended questionnaire. IBM Statistical package for service solution (SPSS version 21), software was used to analyse the data. Descriptive statistics (frequency and percentage, mean and standard deviation) was used. Significant difference was judged at p<0.05.Result showed that half (50%) of the respondents were between the age range of 25-31 years, some (35%) of them between 32-38 years while few (15%) of them were between 18-24 years of age. Majority (85%) of the respondents had tertiary education as their highest completed level of education while few (15%) of them had secondary education as their highest completed level of education. many (65%) of them were civil/public servants, some (25%) of them were traders/business women. Less than half (40%) of the respondents earned a monthly income ranging from N 30, 999 – N 50, 000. More than half (55%) of the respondents do not skip meals while many (45%) of them still did skip meals. Lunch was the major meal skipped by some (40%) of the respondents while dinner and lunch were skipped by few (5%) of the respondents. Formed habit was the reason given by some (25%) of the respondents who skipped meals while lack of time was the reason given by few (20%) of them. Many (60%) of the respondents consumed in-between meals sometimes, some (20%) of them always consume in-between meals while few (5%) of the respondents never consume in-between meals. Majority (85.5%) of the respondents restrict some foods while few (14.5%) of them do not restrict some foods. Less than half (45%) of those who restricted or avoided some foods gave health as reason for avoiding or restricting them while some (20%) of those who restrict or avoid some foods gave culture as the reason for avoiding or restricting them. Among the foods restricted, many (60%) of the respondents restricted uda, 70% of them restricted alcohol, 60% restricted grasscutter, 70% restricted fatty meat while 55% restricted pica. The study concluded that although meal skipping and food avoidance and restrictions were prevalent, majority of those who restrict foods also skipped meals. Further recommended nutrition-related health education interventions.

TABLE OF CONTENTS

TITLE PAGE                                                                                                                                                                                      i

CERTIFICATION                                                                                                                                                                              ii

DEDICATION                                                                                                                                                                                   iii

ACKNOWLEDGEMENTS                                                                                                                                                               iv

TABLE OF CONTENTS                                                                                                                                                                   v

LIST OF TABLES                                                                                                                                                                             vi

LIST OF FIGURES                                                                                                                vii           

ABSTRACT                                                                                                                                                                                       viii

CHAPTER ONE

INTRODUCTION                                                                                                                  1

1.1           Background of the study

1.2           Statement of the problem                                                                                           3

1.3           Objective of the Study                                                                                                5

1.4           Significance of the Study                                                                                           6

CHAPTER TWO

LITERATURE REVIEW                                                                                                       7

2.1 Nutrition in pregnancy                                                                                                      7

2.2 Characteristics of food consumption by pregnant women in Nigeria                                    9

2.3 Cultural practices during pregnancy in Nigeria                                                                       11

2.4 Physiological adjustment of pregnancy                                                                            15

2.5 Energy and nutrient needs during pregnancy                                                                   19

2.6 Food taboos in pregnancy                                                                                                26

CHAPTER THREE

MATERIALS AND METHODS                                                                                           32

3.1 Study Design                                                                                                                    32

3.2 Area of Study                                                                                                                    32

3.3 Population of the Study                                                                                                    32

3.4 Sampling and Sampling Techniques                                                                                33

3.4.1 Sample Size                                                                                                                   33

3.4.2 Sampling procedure                                                                                                       33

3.5 Preliminary Activities                                                                                                      33

3.5.1 Preliminary Visits                                                                                                          33

3.5.2 Training of Research Assistants                                                                                                34

3.5.3 Informed Consent                                                                                                          34

3.6 Data Collection                                                                                                                 34

3.6.1 Questionnaire Administration                                                                                       34

3.7 Statistical Analysis                                                                                                           35

CHAPTER FOUR

RESULTS AND DISCUSSION                                                                                             36

4.1 Socio-economic/demographic characteristic                                                                  36

4.2 Dietary practices of the pregnant women                                                                         39

4.3 Dietary restrictions prevalent among pregnant women                                                    43

4.4 Influence of dietary restrictions on the dietary practices of pregnant women           47

CHAPTER FIVE

CONCLUSION AND RECOMMENDATION                                                                      48

5.1 Conclusion                                                                                                                        48

5.2 Recommendation                                                                                                             49

REFERENCES                                                                                                                       51

LIST OF TABLES

Table 2.1: The dietary allowances for most vitamins and minerals during

pregnancy                                                                                                                               26

Table 4.1: Socio-economic characteristics of the respondents                                              36

Table 4.2: Demographic characteristics of the respondents                                                   38

Table 4.3a:Dietary practices of the respondents                                                                         39

Table 4.3b: Dietary practices of the respondents                                                                  41

Table 4.4a: Dietary restrictions prevalent among pregnant women                                        43

Table 4.4b: Dietary restrictions prevalent among pregnant women                                               45

Table 4.5: Influence of dietary restrictions on the dietary practices of pregnant women         47

CHAPTER ONE

INTRODUCTION

1.0  Background of the study

Pregnancy is a very critical phase in a woman's life when the expecting mother needs optimal nutrition to support the developing fetus naturally. It is a unique and critical stage of life during which extensive anatomical, physiological, biochemical and several other related changes take place (Chandraharan, 2012). The urge to eat more is usually experienced by nearly all pregnant women. Although inadequate intake (food insecurity) and diseases are the predominant cause of malnutrition, traditions and cultural beliefs surrounding dietary practices during pregnancy can impact the nutritional status and pregnancy outcomes. Acknowledging these cultural beliefs and traditions is an important global health consideration when trying to improve maternal and child health outcomes.

A number of studies (Marchant et al., 2002; Wulandari and Whelan, 2011; Arzoaquoi et al., 2015; Adamson, 2015) considered traditional prenatal practices highlighting both diversities and commonalities. Wulandari and Whelan (2011), state that there is a wide range of ‘should and should not be eaten’ lists for pregnancy which are indigenously informed. Food avoidance among Ghanaian pregnant women were found to range from avoiding meat, snails or certain vegetables to avoid a drooling or a ‘spirited’ child (Arzoaquoi et al., 2015). A study conducted in southern Tanzania revealed that 69% of the women avoided fish and farm meats (Marchant et al., 2002). Foregoing of eggs in parts of Tanzania and throughout parts of Africa is to assuage fears related to the animal’s characteristics being transferred to the child or sterility (Adamson, 2015).

Long‐standing local dietary practices can affect food intake during different life stages, including pregnancy. Local dietary taxonomies, referring to the segmentation of food items into categories based on social functions rather than nutritional profiles, can dictate the quantities and types of food women consume during pregnancy. Many of these taxonomies emerge from sociocultural associations of specific foods with poor health outcomes in pregnancy, such as miscarriage and complicated delivery (Mothupi, 2014; Lennox et al., 2017; Riang'a et al., 2017; Wulandari and Whelan, 2011). Across country settings, perceptions of nutrient‐dense foods as harmful to the developing fetus or undervaluing of locally available nutritive food items have been linked to poor maternal and newborn nutrition (Onyesom et al., 2008; Heidkamp et al., 2015). There is some evidence for the contribution of these local dietary taxonomies to suboptimal maternal dietary practices. Studies conducted in South Asia have attributed particular maternal food consumption behaviours, including intentional food intake restrictions (referred to as “eating down” in pregnancy), to both physiological and sociocultural factors, such as food aversions during pregnancy, fears of an oversized fetus resulting from excessive food intake, and perceived pregnancy/childbirth complications associated with unhealthy pregnancy diets (Christian et al., 2006; Harding et al., 2017). Similarly, research in Nigeria has documented the influence of culturally bound food proscriptions on intentional reductions in food consumption during pregnancy (Maduforo, 2010; Ugwa, 2016).

            1.1           Statement of the problem

Malnutrition is ranked as one of the major causes of maternal mortality and it is a major determi-nant of a successful pregnancy and a healthy well-nourished baby (Sholeye, Badejo, and Jeminusi, 2014; Maduforo, 2010). Developing nations account for 99% of all maternal deaths in the world (World Health Organization, 2015). Nigeria has one of the highest maternal death rates in the world with the current rate of 576 deaths per 100,000 live births (National Population Commission, 2013). These staggering statistics show that while it is important that the major avoidable causes of maternal mortality and adverse pregnancy outcome are eliminated by looking into the feeding practices of women due to their traditional beliefs and taboos, and also to determine its effect on their nutritional status.

According to World Health Organization (WHO), 585,000 deaths resulting from pregnancy and childbirth related complications occur globally with about 1,500 deaths recorded daily. However most of these deaths occur in developing countries (Shole, 2015). In Nigeria, there still remains dearth in the number of published studies showing the exact number of deaths recorded. However, an incidence rate of 10–40% has been reported in a rural community in the northern part of Nigeria (Ugwa, 2016). Also 75% of pregnant women from the western part of Nigeria was reported to have had inadequate dietary energy intake (Ojofeitimi et al., 2008). Nevertheless, Poor nutrition in pregnancy negatively affects the woman’s health and that of the unborn child (Ojo and Briggs, 2010). To the woman, it causes weakness and lethargy, anaemia and loss of life for both the mother and the foetus and also reduces the woman’s lactation performance (Abu-Saad and Fraser, 2010).

In Nigeria too, improper dietary practices of pregnant women have apparently led to increased rates of stillbirths, premature births, low birth weight, maternal and prenatal deaths (Ramakrishnan, 2004). Food consumption practices of pregnant women in Nigeria are highly influenced by many socio-cultural factors such as food taboos, family food distribution, food beliefs, and food restriction practices (Ojofeitimi et al., 2008; Ogunjuyigbe et al., 2008; Maduforo, 2010; Sholeye et al., 2014). In a study conducted by Maduforo (2010) in Nwangele Local Government Area (LGA) of Imo State, southeastern Nigeria, it revealed that 15.0% of the respondents mentioned some foods as taboos in the study area and 38.0% of the pregnant women were malnourished. Maduforo (2010) observed that pregnant women held onto the food taboos handed down from generation to generation, including prohibition of grass-cutter meat, cassava meals (fufu), spaghetti (pasta), noodles, cocoa beverages, eggs, and snails. Some of the prohibited or avoided foods are common sources of essential nutrients that are essential for improving maternal and child health (Ojofeitimi et al., 2008).

As a result of the well-entrenched traditional food taboos and socio-cultural beliefs relating to dietary intake during pregnancy, many pregnant women have misinformation about the harmful effects of these taboo foods (Kavle et al., 2014). In some sub-Saharan African countries including Nigeria, it is commonly believed that sexually transmitted diseases or complications during childbirth are the result of the violation of food taboos (Maimbolwa et al., 2003; Maduforo, 2010). An earlier study conducted in Nigeria by Odebiyi (1989) observed that Yoruba traditional healers in Nigeria often interpreted the occurrence or persistence of illness as a punishment for the violation of food taboos. It will therefore not be surprising if some pregnant Yoruba women have inadequate knowledge and misperceptions relating to necessary diets. Issues relating to knowledge and socio-cultural factors influencing dietary intake among pregnant women especially in south-eastern parts of Nigeria have not been well documented. Addressing these issues have the potential of facilitating the design and implementation of interventions and polices that would address the problem of malnutrition among pregnant women. It is as a result of these that this study seeks to assess the dietary practices and restrictions among pregnant women that attend Federal Medical Center, Umuahia, Abia State.

1.2       OBJECTIVE OF THE STUDY

The general objective of the study is to assess the dietary practice and restriction among pregnant women that attend antenatal clinic of the Federal Medical Center Umuahia, Abia State.

1.2.1    Specific objectives of the study

The specific objectives of the study were to:

i.      assess the socio-economic/demographic characteristics of pregnant women that attend antenatal clinic of the Federal Medical Center Umuahia, Abia State.

ii.     determine the dietary practices of the pregnant women;

iii.   identify the dietary restrictions prevalent among them; and

iv.   determine the influence of dietary restrictions on the dietary practices of the respondents.

1.3       Significance of the study

This study will benefit the Government and policy makers as it will provide valuable information on the socio-economic/demographic characteristics, dietary practices and restrictions of pregnant women, this will inform better policy formulation and implementation that will address the problems been faced by this group. This study will also benefit the women as it will highlight the faulty practices and restrictions among this group thereby informing correct practices by showcasing the dangers involved in those restrictions. Findings will also benefit the academia as it will add to the existing body of knowledge and also serve as a reference material for future researches in this area.

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