ABSTRACT
The lactation period is a major source of concern in developing countries because of its positive impact on the health and nutrition of the mothers. Adequate nutrition for the mothers is therefore important for their good health. The objective of this study was to assess nutritional status of breastfeeding mothers in Umuahia South LGA, Nigeria. This cross sectional study was conducted on 232 randomly selected women attending post natal clinics with their infants (0-6 months) in four healths facilitates in Umuahia South Local Government Area (LGA) of Abia State, Nigeria. A structured, validated questionnaire was used to obtain information on socioeconomic characteristics. Body Mass Index (BMI) was used to assess nutritional status by taking height and weight measurements using standard procedures. Dietary intake was assessed using 24 hour recall and a validated food frequency questionnaire. Data was analyzed using descriptive statistics. Majority 52.6% of the women were in the age range of 28-38years, 40.1% had a total family monthly income >N40, 000. The prevalence of overweight and obesity were 51.3% and 17.2%, respectively. Cereals/cereal based dishes and leafy/non leafy vegetables were consumed more frequently while legumes were less frequently consumed on a daily basis. No significant correlation was found between BMI and energy intake. Intake of some essential nutrients (protein, fatty acids, vitamins and minerals) was lower than recommendations. Intervention programs such as nutrition education and dietary diversity should be emphasized during antenatal and lactation period to improve health and nutrition status of the mothers.
TABLE OF CONTENTS
COVER PAGE i
CERTIFICATION PAGE ii
TITLE PAGE iii
DEDICATION iv
ACKNOWLEDGEMENT v
TABLE OF CONTENT vi
LIST OF TABLES viii
ABSTRACTS ix
CHAPTER 1: INTRODUCTION 1
1.1 Statement of Problem 3
1.2 Objective of the study 4
1.2.1 The general objectives of the study 4
1.2.2 The specific objective of the study 4
1.3 Significance of the study 5
CHAPTER 2: LITERATURE REVIEW 6
2.1 Feeding patterns and nutritional status of breastfeeding mothers 6
2.2 Malnutrition 6
2.2.1 Types of Malnutrition 7
2.2.2 Causes of Malnutrition among Lactating Mothers 7
2.2.3 Effects of Malnutrition on Lactating Mothers 9
2.3 Nutritional status of breastfeeding mothers 9
2.4 Work load of breastfeeding mothers 12
2.5 Breastfeeding mother 13
2.6 Nutritional requirements during breastfeeding 15
2.6.1 Energy 15
2.6.2 Protein 17
2.6.3 Carbohydrates 17
2.6.4 Fat 17
2.6.5 Vitamins 19
2.6.5.1 Water-soluble vitamins 19
2.6.5.2 Fat-soluble vitamins 19
2.6.6 Minerals 20
2.7 Energy and nutrient needs of the mother during breastfeeding. 22
CHAPTER 3: MATERIALS AND METHODS 24
3.1 Study design 24
3.2 Area of study 24
3.3 Population of the study 25
3.4 Sampling and sampling techniques 25
3.4.1 Sample Size 25
3.4.2 Sampling Procedure 27
3.5 Preliminary activities 28
3.5.1 Preliminary Visits 28
3.5.2 Training of research assistants 28
3.5.3 Informed consent 28
3.6 Validation of Questionnaire 29
3.6.1 Data collection/questionnaire administration 29
3.6.2 Anthropometric Measurements 30
3.6.2.1 Weight 30
3.6.2.2 Height 31
3.6.2.3 Hip Circumference 31
3.6.2.4 Waist Circumference 31
3.6.2.5 Waist Hip Ratio 32
3.6.3 Dietary Measurement 32
3.7 Data analysis 33
3.8 Statistical Analysis 34
CHAPTER 4: RESULTS AND DISCUSSION 35
4.1 Background information of respondents 35
4.2 Socio-economic status of the respondents 37
4.3 Dietary pattern of the respondents 40
4.3.1 Frequency of consumption of Legumes/Nuts/Seed foods of respondents 42
4.3.2 Frequency of consumption of starchy/root/tubers and cereals foods 44
4.3.3 Consumption pattern of animal-source foods of the respondents 47
4.3.4 Frequency of consumption of fruits of the respondents 50
4.3.5 Frequency of consumption of leafy and non-leafy vegetables 53
4.3.6 Frequency of consumption of fats and oil 56
4.4 Consumption of liquid foods/drugs and dietary lifestyle 59
4.5 Anthropometric status (BMI GRADE AND WAIST HIP RATIO) 61
CHAPTER 5: CONCLUSION AND RECOMMENDATION 64
REFERENCE 65
APPENDIX
CHAPTERONE
INTRODUCTION
The consumption of food items and their combination in dishes and meals give rise to food consumption pattern of individuals. The pattern show large temporal and spatial differences, mainly caused by availability of food commodities, cultural aspects and economic factors (FAO, 2010). Diets evolve over time, and are influenced by many factors such as income, prices, individuals’ preferences and beliefs, cultural traditions. Other factors that affects food consumption pattern are geographical location, environmental, social and economic factors. These under listed factors interact in a complex manner to shape dietary consumption patterns of an individual. Accompanying the changes in food consumption patterns are considerable health-related problems arising from failure to consume adequate diet required to meet the nutritional needs (FAO, 2010).
Mother is the base of any family unit and her health is of great importance (Shotraniforoshani, 2006). Study revealed that the consumption pattern of a mother depends on her income (Yu, 2005).Study has shown that women particularly breastfeeding mothers from low-income settings (Linkage Publication, 2002), experience numerous physiologic, mental and social changes in post-partum period and therefore need more attention during this period (Pilliteri, 2007). Women in low-income settings often consume inadequate amount of micronutrients because of resource limitations and cultural aspects. They have a limited intake of animal food sources, fruits and vegetables. Intake of micronutrients less than the recommended values increases women’s risk of micronutrient deficiencies (Humffman et al., 2006). Adequate nutritional status of women has been shown to be of great importance for good health and increased work capacity of women themselves, as well as for the health of their offspring (Black et al., 2008). Due to the nursing process, mothers are subjected to nutritional stresses, which lead to malnutrition; malnutrition among women is likely to have a major impact on their own health, as well as their children’s health (Rousmans et al., 2008). Culture and environment on the other hand have been shown to affects the nutritional status of the mothers (Reynolds et al., 2008). Also, Socio-cultural traditions and disparities in household work patterns also increase women’s chance of being malnourished (Ransom, 2003). The diet consumed by the mother will not only fulfill her own nutritional needs but will also enable her to produce enough milk for her infant (Sylvia and Mary, 2002; Demissie et al., 2003). It has been reported that lactation has different effects on maternal nutritional status depending on its duration, intensity, as well cultural diversity (Rasmussen and McGuire, 2006).The high-energy cost of lactation as well as the nutritional and health risk it could pose for the women emphasizes the need for continuous monitoring of their nutritional status and dietary intake in poor resource countries (Ukegbu and Uwaegbute, 2012). This study is designed to evaluate the Dietary pattern and nutritional status of breastfeeding mothers in Umuahia South Local Government Area of Abia State
1.2 STATEMENT OF PROBLEM
Food rules based on culture and tradition (eat this, avoid that) can cause harm by reducing the mother’s ability to choose an adequate diet or by discouraging her from breastfeeding. Different cultural ethnicity groups may encourage or frown upon consumption of some types of foods by individuals (particularly the lactating women) (Dindyal, 2003). Religion plays one of the most influential roles in the choices and subsequent selection of foods consumed in certain societies. The occupation of the women affects their food choices, which are directly influenced by their social class. Certain professions such as manual labour, like farming, which are associated with low socio-economic status, make food choice of limited (Dindyal, 2003). All these factors stated above put together on individual affects the nutrition status of a lactating mother negatively. A malnourished mother is likely to give low-birth-weight (LBW) baby susceptible to disease and premature death, which only further undermines the economic development of the family and society and continue the cycle of poverty and malnutrition (WHO, 2003). Some of the causes and effects of the generally poor nutritional status (malnutrition) of women illustrates the interrelationship of nutrition and health in the contex of women’s energy expenditure in agricultural and domestic chores and the nutrient intake. Severally, malnourished mothers have reduced lactation performance contributing to the increased risk of child mortality (Demissie et al., 2003). Malnutrition poses a variety of threats to women. It weakens women’s ability to survive childbirth, makes them more susceptible to infections, and leaves them with fewer reserves to recover from illness. Malnutrition undermines women’s productivity, capacity to generate income, and ability to care for their families. Frequent pregnancies followed by lactation increase the health risk of mothers resulting in a high maternal mortality (Asha, 1998). Women who are severely malnourished have reduced lactation performance (Allen, 2012).
1.2 OBJECTIVE OF THE STUDY
1.2.1 The general objectives of the study
The general objective of the study is to determine the Dietary pattern and nutritional status of breastfeeding mothers in Umuahia South Local Government Area of Abia State.
1.2.2 The specific objective of the study
The specific objectives of the study are to:
i. elicits the personal information of the respondent which include their socio-economic status.
ii. evaluate their dietary intake using a food frequency questionnaire and 24-hour dietary recall.
iii. determine their nutritional status by using their anthropometric measurement.
1.3 SIGNIFICANCE OF THE STUDY
This study will be very important to health and social care professionals, and those working in residential care homes to become aware of the prevalence of malnutrition.
The study would also be of great benefit to Doctors, Nurses, Dietitians, Nutritionists, Health professionals, Health workers, Government policy and Decision makers to know the health effects of malnutrition on the life of the breastfeeding mothers as well as their infants. Nutritionists and dietitians will find the result of this study helpful as it will provide information that will aid them in managing and counseling lactating mothers at risk of malnutrition. The result will help them in counseling the mother towards the feeding habits and its effects on their health status. The study will disclose information on the women nutrients intake and its impact on their nutritional status which may create health problems that can indirectly affects the society.
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