ABSTRACT
Folic acid (FA) given before and during pregnancy reduces the risk of several birth defects, including neurologic, cardiac, urinary and other congenital anomalies in the new-born This study assessed the knowledge and practice of periconceptional folic acid supplementation among women of child bearing age (18-45 years) in Ikwuano Local Government Area, Abia State. The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 440 women of child bearing age (18-45 years). Data on socio-demographic/economic characteristics, awareness, knowledge and use of folic acid supplementation were collected using structured and validated questionnaire. Anthropometry was carried out using standard methods. The IBM SPSS version 22.0 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. Pearson correlation analysis was used to analyse the relationship between socio-demographic/economic characteristics, knowledge and use of peri-conceptional folic acid supplementation. Result revealed that majority (80.2%) of the women were married and more than half (56.4%) have given birth to 3-5 children. Majority (84.8%) of the women attained a tertiary education. However, majority (95.5%) of the respondents were aware of peri-conceptional folic acid supplementation. Most (71.6%) of them got to know about folic acid supplementation from antenatal clinic while others got their awareness from school (6.1%), church (1.4%), seminar/workshop (6.4%), from friends and relatives (8.6%). However, more than half (51.6%) of the respondents had a good knowledge about periconceptional folic acid supplementation, 23.4% had an average knowledge while some (25.0%) had a poor knowledge about peri-conceptional folic acid supplementation. Meanwhile, majority (92.0%) had used folic acid supplements. Some (43.9%) used it before getting pregnant; some (44.5%) used it during pregnancy while few (3.0%) used it after giving birth. The prevalence of underweight, overweight and obesity among the women were 7.5%, 23.9% and 31.1% respectively. However, 17% of the respondents had obesity grade I, 8% had obesity grade II while 6.1% had obesity grade III. According to the waist hip ratio of the respondents, majority (74.3%) of the respondents were normal while 25.7% were at risk of cardiovascular diseases. There was a significant relationship between marital status, knowledge and use of folic acid supplements. This study underscores the need for better health education and greater involvement of health professionals in promoting essential information among women, especially in their preconception period. Promoting folic acid supplementation before pregnancy and during the childbearing ages is essential.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENT v
LISTS OF TABLES viii
ABSTRACT x
CHAPTER 1
INTRODUCTION
1.1 Statement of problem 1
1.2 General objective of the study 3
1.2.1 Specific Objective of the Study 4
1.3 Significance of the study 5
CHAPTER 2
LITERATURE REVIEW
2.1
Physiology of pregnancy in women 6
2.2 Nutrition before and during pregnancy 7
2.2.1 Antenatal Care during Pregnancy 8
2.3 Folic acid supplementation and pregnancy 8
2.3.1 Folic Acid Metabolism 9
2.3.2 Folic Acid and the Prevention of Neural tube defects 9
2.3.3 Folic Acid and the Prevention of Anemia 10
2.3.4 Folic Acid and the Prevention of Preterm Birth 11
2.3.5 Additional Benefits of Folic Acid Supplementation 12
2.4 Neural tube defects (NTDS) 14
2.4.1 Clinical Features of Neural Tube Defects 14
2.4.1.1 Open NTDs and Associated
Conditions 15
2.4.2 Diagnosis of Neual tube defects 16
2.5 Causes of Neural tube defects 16
2.5.1 Environment Factors 17
2.5.2 Nutritional factors and folate 18
2.6 Primary prevention of Neural tube defects 18
2.6.1 Folic Acid Supplementation and Fortification 19
2.7 Folate-resistant Neural tube defects 19
2.8 Prevalence and use of folic acid
supplementation 20`
CHAPTER 3
MATERIALS AND METHODS
3.1 Study design 22
3.2 Area of study 22
3.3 Population of the study 22
3.4 Sampling and sampling technique 23
3.4.1 Sample size determination 23
3.4.2 Sample procedure 24
3.5 Preliminary activities 24
3.5.1 Preliminary visits 24
3.5.2 Training of research assistants 24
3.5.3 Informed Consent 24
3.6 Data collection 25
3.6.1 Questionnaire Design 25
3.6.2 Questionnaire administration 25
3.6.3 Anthropometric measurement 25
3.6.3.1 Weight Measurement 25
3.6.3.2 Height measurement 26
3.6.3.3 Hip Circumference
Measurement 26
3.6.3.4 Waist circumference
measurement 26
3.6.3.5 Waist hip ratio (WHR) 27
3.7 Data analysis 27
3.8 Statistical analysis 28
CHATPER 4
RESULTS AND DISCUSSION
4.1 Socio-demographic/economic characteristics of the respondents 29
4.2 Awareness of folic acid supplementation 33
4.3 Knowledge of the respondents towards peri conceptional
folic acid supplementation 34
4.4 Consumption and utilization of folic acid supplements 38
4.5 Anthropometric status of the respondents 40
4.6 Relationship between respondent’s socio economic
characteristics,
knowledge and
use of folic acid supplements 42
CHAPTER 5
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 44
5.2 Recommendation 44
References 46
LIST OF TABLES
Table Page
4.1: Socio demographic/economic characteristics of the respondents 32
4.2: Awareness
of the respondents towards folic acid
supplementation 34
4.3a: Knowledge of the respondents towards folic acid 35
4.3b: Knowledge level of the respondents 37
4.4: Utilization of folic acid supplements 39
4.5: Anthropometric status of the respondents 40
4.6: Relationship between respondent’s socio economic
characteristics,
knowledge and
use of folic acid supplements 43
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The nutritional status of women
during pregnancy is very important, not just for the quality of their own
lives, but also for the wellbeing of their children. Vitamins and minerals
support maternal, placental, and fetal metabolic needs and enable healthy gestation
(Mudambi, 2012). Pregnancy represents a period full of both physical and
emotional changes and, as such, the health and wellbeing of expectant mothers
require extra attention (Mudambi, 2012). Adequate maternal nutrition is
indispensable before and during pregnancy to ensure both maternal and fetal
health (Rusescu, 2015). This is because the fetus is nurtured directly through
the placenta and their nutritional status is entirely dependent upon that of
the mother (Mudambi, 2012).
The
neural tube is an embryonic structure that develops into the brain and spinal
cord. A flat sheet of cells fuses to form a closed tube by the 28th day after
conception. Neural tube defects (NTDs) occur when the neural tube fails to
close completely, which causes malformations in the brain and spine, with the
most common associated conditions being spina bifida and anencephaly
(Wallingford et al., 2013).
Folic acid (FA) is an important
substance which is grouped under essential vitamin B which plays a crucial role
in various vital functions including DNA synthesis, methylation and repair, and
also serves as a cofactor in numerous biological reactions (Weinstein et al., 2013). Supplementing folic acid
before pregnancy is the provision of folate for reproductive age group women who
have a plan to be pregnant, so that the health of women before pregnancy can be
promoted and pregnancy-related outcomes can be improved (Moore and Moumdle,
2015). Moore and Moumdle (2015) noted that
the pathway of folic acid plays a critical role in cellular function and human
development. Folic acid supplementation before
pregnancy is known to significantly reduce the risk of having a baby with NTDs
(Park et al., 2011). It also
prevents congenital heart defects, growth retardation (e.g., low birth weight,
smaller head and chest circumferences), preterm births, and cleft palates
(Rehan et al., 2015). The World Health Organization recommends that all
women take a folic acid supplement from the moment they begin trying to
conceive or from 4 to 12 weeks before pregnancy until 12 weeks of pregnancy
(Gomes et al., 2016; WHO, 2016). The Centers for Disease Control
and Prevention (CDC) (2012) also recommend at least 400 µg of FA per day periconceptionally
and in the first trimester (12 weeks). Wilson et al. (2007) pointed that maternal consumption of FA before and
during the first trimester of pregnancy reduces the risk of NTDs by 50 – 80%. Hursthouse
et al. (2011) also noted that periconceptional
consumption and during first trimester of pregnancy significantly decreases the
possibility of neural tube defects (NTDs), which lead to congenital
malformations including spinal bifida and anencephaly
According to different
interventional studies done in different countries, administering of 0.4 mg of
folic acid for the reproductive age group three months before pregnancy, during
pregnancy period, and up to one month after pregnancy has been associated with
up to 80% reduction in specific congenital anomalies including neural tube
defects (NTDs) with associated hydrocephalus, oral facial clefts with or
without cleft palate, congenital heart disease, urinary tract anomalies, and
limb defects, as well as some pediatric cancers (Teckie et al.,
2013; Viswanathan et al., 2017).
Hodgetts et al. (2014) revealed that
preconception folic acid supplementation is associated with increased fetal
growth resulting in higher placental and birth weight, and decreased risks of
low birth weight and small for gestational age. Greenberg et al., 2011) also revealed that the consumption of folic acid
before conception can decrease the risk of developing anemia and peripheral
neuropathy. Despite wide availability of its natural food sources (green leafy
vegetables, bananas, and legumes), folic acid deficiency among women of
reproductive age is common worldwide, usually as a result of low dietary intake
(Haidar et al., 2012).
Since
appropriate folic acid use before and during early pregnancy has been shown to
protect against neural tube defects and other congenital anomalies De-Regil et al. (2014) and since lack of
knowledge about common preconception risk factors seems to be one of the
critical factors affecting the use of folic acid supplementation, this study
was therefore aimed to assess the knowledge and practice of periconceptional
folic acid supplementation among women of child bearing age (18-45 years) in
Ikwuano Local Government Area, Abia State.
1.2 STATEMENT OF PROBLEM
Birth defects have so far been the leading cause
of infant mortality for the past 25 years, causing 22% of all infant
deaths in the world (World
Health Organization, 2015). Worldwide, neural
tube defects account for 10% of all neonatal mortality, 10% of the burden of
all congenital conditions and these defects are responsible annually for 41,000
deaths and 2.3 million disability-adjusted life years (Nelson, 2011; Safi et al., 2012). Neural Tube Defects
are affecting 0.5–2 per 1000 pregnancies and occurring in about 2–3% live
births worldwide (Rofail et al.,
2011; Anzaku et al., 2013). The incidence
of neural tube defects in developing countries have been reported to be up to
fourfold higher than in developed ones (Lawal and Adeleye, 2014). In Nigeria,
the neonatal mortality rate of neural tube defects is 37 deaths per 1,000 live
births and the perinatal mortality rate is 41 per 1,000 pregnancies (National
Population Commission, 2013). Neural tube defect contributes to the increase in
neonatal and perinatal mortality. Lores et
al. (2014) estimated that approximately 12, 000 births are affected each
year in Nigeria.
Adverse
pregnancy outcomes are significant health challenges for women in the
periconceptional period as well as infants. These include pregnancy bleeding,
hypertensive disorders and sepsis, which lead to more than half of the maternal
deaths (Victora et al., 2016). Neural tube defect rates differ from one population to
another and have been found to vary according to geography, time and selected
maternal demographic characteristics (Behrooz, 2017). Lawal
et al. (2015) suggested that the
lifelong medical and socioeconomic consequences of neural tube defects in affected children are well known to be
worse in low-resource settings. Studies conducted by Temel et al. (2015) and Rehan et
al. (2015) also showed that women’s awareness and knowledge on
periconceptional folic acid supplementation is affected by socio-demographic
characteristics (such as age, gender, educational status, ethnicity, income,
and marital status) and women’s reproductive history (history of pregnancy,
history of family planning use, health condition, history of antenatal care
visit, parity, and gravidity). A study
conducted by Anzaku (2013) showed a significant decline in the knowledge and
use of folic acid among pregnant women visiting antenatal care. However, there
are no studies on the knowledge and use of folic acid among women of
childbearing age who are not pregnant in South East. To address this gap, we
therefore conducted this study to assess the knowledge and practice of periconceptional folic acid supplementation
among women of child bearing age (18-45 years) in Ikwuano Local Government
Area, Abia State.
1.3 OBJECTIVE OF THE STUDY
1.3.1 General Objective of the study
The general objective of this
study was to assess the knowledge and practice
of periconceptional folic acid supplementation among women of child bearing age
(18-45 years) in Ikwuano Local Government Area, Abia State.
1.3.2 Specific Objective of the Study
The specific
objective of the study was to:
1.
determine the socio-demographic and socio-economic
characteristics of the respondents
2.
assess the knowledge of the respondents towards
periconceptional folic acid supplementation
3.
ascertain the practice and use of folic acid
supplements.
4.
ascertain the anthropometric status of the respondents
5.
determine the relationship between respondent’s socio
economic characteristics, knowledge and use of folic acid supplements.
1.4 SIGNIFICANCE OF THE STUDY
Findings from
this study will provide information on the knowledge and practice of
periconceptional folic acid supplementation among women of child bearing age.
Information gotten from this study will also be helpful for policy makers to
allocate resources for improving of maternal and child health. It will also help
pregnant women improve their folic acid intake before and during pregnancy by
promoting adequate diet. It can also provide insight to policy
makers/programmers, nutritionists, dieticians and other health care thereby
serving as a baseline data for further studies that are related to nutrition in
pregnancy.
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