ABSTRACT
Pregnancy is the most crucial nutritionally demanding period of every woman’s life. Micronutrients are essential in sufficient amounts for a healthy pregnancy and childbirth. increasing the consumption of immune system boosting foods is an important health behaviour during pregnancy. This study assessed the knowledge and consumption of immune boosting foods among pregnant mothers attending antenatal centers in Umuahia metropolis. The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 297 pregnant women. Data on socio-demographic/economic characteristics, awareness, knowledge, attitude and consumption of immune system boosting foods were collected using structured and validated questionnaire. The IBM SPSS version 22.0 software 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. Pearson correlation analysis was used to analyse the relationship between the knowledge, attitude and consumption pattern of immune boosting foods among pregnant mothers. The result from this study revealed that majority (86.5%) of the respondents had a good knowledge towards immune boosting foods. More than half (57.2%) of the respondents also had a positive attitude towards immune boosting foods. Most (68.0%) of the pregnant women consume immune boosting foods and majority (78.5%) of them identified cost as one of the factors affecting the consumption of immune boosting foods. Result also revealed that there was a significant relationship between knowledge and attitude of respondents towards immune boosting foods. There was also a significant relationship between respondents attitude towards immune boosting foods and their consumption of immune boosting foods. Nutritional education should be intensified to empower antenatal mothers to understand the importance of nutrition in pregnancy, a vital determinant for optimal maternal and infant health outcomes.
TABLE
OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of content v
Lists of tables vii
List of figures viii
Abstract ix
CHAPTER 1
Introduction 1
1.1
Statement of the problem 5
1.2 Objectives
of the study 7
1.2.1 General objective of the study 7
1.2.2 Specific objectives of the study 7
1.3 Significance
of The Study 8
CHAPTER 2
LITERATURE REVIEW
2.1 Definition and types of immunity 9
2.1.2 Types of immunity 9
2.2 Immunology
of Pregnancy 12
2.2.1 Maternal-fetal interface 12
2.2.2 Humoral immunity 13
2.2.3 Cell-mediated immunity 13
2.2.4 T-Helper Cells and the Th1-Th2 Shift 14
2.2.5 Systemic immune changes 15
2.3 Pregnancy And Conventional Infectious
Disease Threats 15
2.4 Role Of Vitamins And Minerals In Human Immune System 17
2.4.1 Vitamins 17
2.4.2 Minerals 19
2.5 Foods With
Immunity-Boosting Properties 21
CHAPTER 3
MATERIALS AND METHODS
3.1 Study
design 40
3.2 Study
area 40
3.3 Population
of the study 41
3.4 Sampling
and sampling techniques 41
3.4.1 Sample
size 41
3.4.2 Sampling
procedure 42
3.5 Preliminary
activities 42
3.5.1 Preliminary
visit 42
3.5.2 Training
of the research assistant 43
3.5.3 Informed
Consent 43
3.6 Data
Collection 43
3.6.1 Questionnaire
43
3.6.2 Socio-demographic data 44
3.6.3
Nutritional knowledge 44
3.6.4 Attitude 45
3.6.5 Dietary assessment 45
3.6.5.1 Food frequency questionnaire 45
3.7 Statistical Analysis 45
CHAPTER 4
RESULT AND DISCUSSION
4.1 Socio
Demographic/Economic Characteristics Of Pregnant Women 46
4.2 Knowledge Of
Respondents Towards Immune Boosting Foods 49
4.3 Attitude Of
The Respondent Towards The Consumption Of Immune Boosting Foods 54
4.4 Consumption Of
Immune Boosting Foods Among Pregnant Mothers 56
4.5 Consumption
Pattern Of Immune Boosting Foods By The Pregnant Women 59
4.5 Relationship
Between The Knowledge And Consumption Pattern Of Immune
Boosting
Foods Among Pregnant Mothers 62
CHAPTER 5
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 64
5.2 Recommendation 64
REFERENCES
APPENDIX
LIST OF TABLES
Table
4.1: Socio demographic/economic
characteristics of pregnant women. 47
Table
4.2a: Knowledge of respondents towards Immune Boosting Foods 49
Table
4.2b: Knowledge of respondents towards Immune Boosting Foods 52
Table
4.3a: Attitude of the respondent towards immune boosting foods 55
Table
4.4: Consumption of immune boosting foods among pregnant mothers 57
Table
4.5: Food consumption pattern for pregnant mothers 60
Table
4.5: Relationship between the knowledge, attitude and consumption pattern of
immune boosting foods among pregnant mothers 63
LIST OF FIGURES
Fig
1: Knowledge of immune boosting foods 53
Fig
2: Attitude level towards immune boosting foods 56
Fig 3: Factors affecting consumption of immune foods 58
CHAPTER 1
INTRODUCTION
Pregnancy
is also known as gravidity or gestation, and it is the time during which one or
more babies develop inside a woman (Obrowski
et al., 2016).
A Multiple Pregnancy involves more than one child, such as with twins.
Pregnancy can occur by sexual intercourse or assisted reproductive technology.
It usually lasts around 40 weeks from the Last Menstrual Period (LMP) and ends
in childbirth. This is just over nine lunar months, where each month is about
29½ days. When measured from conception it is about 38 weeks (266 days) (Obrowski
et al., 2016).
A typical pregnancy normally lasts from 37 to 42 weeks, counting from the first
day of the last period. The 40 weeks are divided into trimesters, with each one
lasting for three months, or around 12-13 weeks (Wild, 2021). Viral
or bacterial pandemics threaten the general population; however, there are
special populations, such as children and pregnant women, which may be at a
higher risk and more susceptible to or more severely affected by infectious
diseases. Pregnant women are considered to be a special population group due to
their specific susceptibility to some infectious diseases because of the unique
‘immunological’ condition caused by pregnancy. Therefore, pregnancy presents
many challenges for making decisions on how to approach, prevent and treat
infectious diseases (Mparmpakas et al., 2012; Kourtiset
al., 2014).
The
immune system exists to protect the host from noxious environmental agent’s
especially pathogenic organisms, which may be in the form of bacteria, viruses,
fungi or parasites. The immune system is always active, carrying out
surveillance, but its activity is enhanced if an individual becomes infected
(Litmanet al., 2005;Schnarr and Smaill, 2008; Sheffieldand Cunningham,
2009; Kourtis et al., 2014). This
heightened activity is accompanied by an increased rate of metabolism,
requiring energy sources, substrates for biosynthesis and regulatory molecules.
These energy sources, substrates and regulatory molecules are ultimately
derived from the diet(Shapira, 2008; Kourtis et al., 2014). The complexity of the
interaction between nutrition and immunology is vast. An individual’s overall
nutrition status, state of nourishment, and pattern of food intake (comprised
of foods, nutrients and non-nutritive bioactive compounds) impact the
functioning of the immune system, this impact can occur at the level of
physical barriers (e.g., skin, intestinal mucous membranes), the micro biome,
the innate immune system (e.g., macrophage function and polarization) and the
adaptive immune system (e.g., T- and B-cell function)(Shapira,
2008; Kourtis et al., 2014).
The
immune functions in healthy individuals are damaged by several factors and the
deprivation of health is related to disruption of immune functions (Kaminogawa
and Masanobu, 2004). Nutritional deficiencies cause impairments in immune
system development and have a negative effect on immune incompetence that
results in susceptibility to infection, allergies and chronic inflammation
(Rubhana and Cravioto, 2009; Albers, 2013; Cooper and Melissa, 2017). Several
health conditions that are the result of an impaired immune function like
cancer, inflammation processes such as atherosclerosis, rheumatoid arthritis,
bronchial asthma, cystic fibrosis, fibromyalgia have been known to be prevented
and treated by components present in food (Ascensión et al., 2003). Therefore, it has been suggested that components
derived from certain foods included in the diet can improve the immune
functions in healthy people. The consumption of foods that provide such
nutritional components not only stabilizes immune functions but also reduces
the occurrence of pathogenic infection (Kaminogawa and Masanobu, 2004). The
Macronutrients (lipids such as n-3 PUFA) and micronutrients (zinc, vitamin D,
and vitamin E), in addition to phytochemicals and functional foods (probiotics
and green tea), may benefit the immune system when taken in appropriate
amounts. Their immuno-modulating effects include inhibition of pro-inflammatory
mediators, promotion of anti-inflammatory functions, modulation of
cell-mediated immunity, alteration of APC function, and communication between
the innate and adaptive immune systems (Wu, 2019). Also, nutritional factors
modulate metabolic processes which may include the activation or inhibition of
key enzymes or immune-regulatory mediators that can result in altered cellular
immune function, particularly in cells of T lymphocytes lineage (Ibrahim and
El-Sayed, 2016). Several trace elements and vitamins, have an important role in
key metabolic pathways and immune cell functions (Shapira,
2008). Food containing vitamins like C, E and beta-carotene need to be added to
our diet as they show defence mechanism against free radicals (Karacabey and
Ozdemir, 2012).
To
boost up the immunity of individuals, the consumption of proper foods
containing a balanced nutritious diet is crucial. In this regard, the foods
containing more nutrients, such as vitamins, minerals, fatty acids, and a few
polysaccharides and non-nutrient (i.e. polyphenols) which have therapeutic
functions can be very beneficial. These compounds have the potential to either
act against viruses directly or be effective against them by boosting the
immunity of the body. For example, vitamins such as A, D, E, and C are known for
playing a crucial role in body development and repair mechanisms which can
enhance immunity (Galanakis, 2020; Zhang and Liu, 2020). It has been shown that
the consumption of foods like carrots, citrus fruits, fruit juices, germ oils,
nuts, seeds, milk, and dairy products that are rich in those vitamins can be
helpful in boosting immunity. An investigation carried out by Keil et al. (2016) on the effect of
riboflavin against the MERS-CoV (EMC strain), showed a 4.07 log reduction in
viral growth. Wang et al. (2020)
reported that vitamin D played an important role as an immune modulator against
the Hepatitis C virus. Most of the vitamins are potent antioxidants responsible
for scavenging free radicals reducing oxidative stress. The ability of vitamin
C in reducing the severity of respiratory tract infection caused by SARS
coronavirus was reported by Hemil¨a and Chalker (2013). Lipids, particularly
polyunsaturated fatty acids (PUFA) and few medium-chain fatty acids, are potent
antiviral agents (Das, 2020; Galanakis, 2020). Goldson et al. (2011) reported that PUFA’s exhibited antiviral action
against the chronic Hepatitis C virus (HCV) along with participating in normal
physiological function. Regarding the minerals, zinc, selenium, iron, and
chromium are crucial in increasing the immunity because of possessing some
antiviral properties. For instance, Shah et
al. (2019) reported that zinc can be used as supplement to reduce the
intensity of COVID-19 infection and lessen the respiratory tract infection.
Some of the non-nutrient components, particularly phytochemicals such as
polyphenols, flavonoids, alkaloids, thiophenes, terpenoids, tannins, lignins,
etc, have shown some important antiviral properties. Flavonoids are beneficial
due to their antioxidant, antiviral, anticarcinogenic, and anti-inflammatory
activities (Abdelkebir et al., 2019).
The polyphenols such as epigallocatechin gallate, the phytochemical extracted
from green tea showed an important antiviral activity against several viruses
(Li et al., 2020). Furthermore,
fruits and vegetables can also present valuable antiviral properties due to
their high content in phytochemicals and some other minor health-related
compounds (Martín-Acebes et al.,
2012). Regarding proteins, lectin has shown antiviral action against the
coronaviruses (Mani et al., 2020).
Furthermore, the essential oils extracted from plants, known for their
antibacterial, antifungal, antiviral, and antioxidant properties are also
beneficial for the health of individuals.
1.1
STATEMENT
OF THE PROBLEM
The
immune functions in healthy individuals are damaged by several factors and the
deprivation of health is related to disruption of immune functions (Kaminogawa and Masanobu, 2004). Nutritional
deficiencies cause impairments in immune system development and have a negative
effect on immune competence that results in susceptibility to infection,
allergies and chronic inflammation (Raqib and
Alejandro, 2009; Albers, 2013; Cooper and Ma, 2017).Pregnant women are
exposed to many infectious agents that are potentially harmful not only to the
mother but also to the fetus. It is well accepted that in those cases infection
will lead to embryonic and fetal death, induce miscarriage or induce major
congenital anomalies (Srinivas et al.,
2006; Mor and Cardenas, 2010).
Women
living in low-income countries like Nigeria are often unable to meet the
micronutrient demands of pregnancy due to a chronically poor diet (Gernandet al., 2016). At the same time, the
costs of assessing biochemical indicators of individual micronutrients have led
to few population estimates of deficiencies during pregnancy. This situation
has given rise to the term ‘hidden hunger’, referring to a lack of knowledge as
to the extent and consequences of this nutritional burden.Worldwide, the
estimated prevalence of prenatal iron deficiency anaemia is 15–20%, calculated
as half of women with anemia, and defined as haemoglobin <110 g/l (because
half respond to supplementation with iron based on data from population-based
intervention trials). Vitamin A deficiency, classified by a low serum retinol
(<0.70 μmol/l), affects an estimated 15% of pregnant women in low-income
countries. Eight percent of pregnant women have vitamin A deficiency high
enough to lead to night blindness, an ocular consequence the deficiency. Iodine
deficiency ranges from 17% in Oceania to 40% in Africa. These estimates are
based on a median urinary iodine concentration falling below 150 μmol/l in
population assessments of children aged 6–12 years, an age group regarded as ‘sentinel’
in reflecting geographic and population-level risk, although one that might
underestimate iodine deficiency in pregnancy. While global estimates of other
deficiencies are unavailable, population-based studies in South Asia, including
India, Bangladesh and Nepal have reported deficiencies of zinc (15–74%),
vitamin B12 (19–74%), vitamin E (as α-tocopherol, 50–70%), and folate (0–26%)
in pregnant women. In a few instances, where a larger number of nutrients have
been assessed in the same population, multiple deficiencies appear, although
unequal in burden. For example, in Côte d’Ivoire in West Africa, the prevalence
of deficiencies among women of reproductive age varied widely for vitamin A
(1%), iron (17%), vitamin B12 (18%) and folate (86%). In the plains of southern
Nepal, the percentage of pregnant women varied in deficiencies of vitamins A
(7%), D (14%), E (moderate-to-severe, 25%), B12 (28%), B2 (33%) and B6 (40%),
folate (12%), iron (40%) and zinc (61%), and only 4% were normal in status for all
nutrients. Deficiencies in the surveyed area of southern Nepal varied by
season, which is likely to be the result of seasonal shortages in available
food sources and consequent diet, characteristic of rural agrarian
societies. Although not well estimated during pregnancy, vitamin D deficiency
(defined as 25-hydroxyvitamin D <30 nmol/l) is high in many countries
including Turkey (50%), India (60%), and Pakistan (45%), and women and infants
(reflective of maternal status) have lower vitamin D status in the Asia/Pacific
region. In the absence of adequate data on biochemical status, quantitative
dietary data in pregnant women can be used to estimate the prevalence of
inadequate intake, based on the percentage of population intakes below the EAR.
With few exceptions, most estimates of average intake are below the EAR in
low-income and middle-income countries for folate, iron, and zinc; and vitamin
A intake is low particularly in Asia and Africa. However, to the best knowledge
of the researcher no information exist on the knowledge and consumption of
immune boosting foods among pregnant mothers. Thus it is in view of these
identified problems that this study seeks to assess the knowledge and
consumption of immune boosting foods among pregnant mothers attending health
centers in Umuahia metropolis.
1.2 OBJECTIVES OF THE STUDY
1.2.1 General objective of the study
The
general objective of this study is to assess the knowledge and consumption of
immune boosting foods among pregnant mothers attending health centers in
Umuahia metropolis.
1.2.2 Specific objectives of the study
The specific objectives
of the study include to;
·
assess the socio-economic and demographic
characteristics of the pregnant mothers attending health centers in Umuahia
metropolis.
·
assess the knowledge of the pregnant
mothers attending health centers in Umuahia metropolis on immune boosting
foods.
·
assess the attitude of pregnant mothers
towards consuming immune boosting foods.
·
determine the consumption pattern of
immune boosting foods among pregnant mothers attending health centers in
Umuahia metropolis.
·
evaluate the relationship between the
knowledge and consumption pattern of immune boosting foods among pregnant
mothers attending health centers in Umuahia metropolis.
1.3 SIGNIFICANCE
OF THE STUDY
Findings
will be useful to the women of reproductive age, nursing mothers, both
government and non-governmental organizations, policy makers, the general
public, nutrition educators, health professionals and future researchers. The
findings will provide useful information about the knowledge, attitude and
practice of consuming immune boosting foods which will enable stakeholders and
the general public take appropriate actions. It will also contribute the
existing body of knowledge and serve as a reference material.
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