EFFECT OF MATERNAL NUTRITION KNOWLEDGE AND NUTRITIONAL STATUS ON PREGNANCY OUTCOME IN RURAL AND URBAN AREAS OF EBONYI STATE, NIGERIA

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ABSTRACT

The main purpose of this study was to assess the effect of maternal nutrition knowledge and nutritional status on pregnancy outcome in Ebonyi State, Nigeria. Specifically, the study sought to describe the general characteristics of pregnant women in rural and urban areas of Ebonyi State, to assess the nutrition knowledge of the respondents; assess their dietary practices and their perception of the effect of poor nutrition on pregnancy outcome in rural and urban areas of Ebonyi state; determine the mortality rate of neonates in the study area; determine the nutritional status of the respondents and anthropometric indices of their neonates; determine the effect of mother’s nutrition knowledge and nutritional status on pregnancy outcome in Ebonyi State. The population for this study was made up of all the pregnant women attending antenatal clinics in hospitals and maternity homes in Ebonyi State. Ebonyi state was stratified into three strata. Simple random sampling was used to draw four hundred pregnant women who participated in the study. A structured questionnaire was used for data collection. Information from focus group discussion was used to produce the questionnaire. A three day weighed food intake was conducted on a sub-sample of 60 respondents. Their height and weight were also taken and compared with standards. Anthropometric indices of neonates and haemoglobin status of the respondents were collected from their hospital folders (records). Data collected were analysed using mean, standard deviation, correlation and regression analyses. Findings revealed that 70.4% of the respondents were from rural community, while 29.6% were from urban; 22.5% were adolescents, 76.2% were middle aged, while 1.3% were older women. All the respondents were Christians. Majority (90.6%) were married while 9.4% were single. About 86.6% of the respondents were fairly educated. More than half of the respondents (66.5%) were farmers, traders and artisans, while 14.5% were government workers. About 64.5% earned between N30,000 – N100,000; 26.8% and 26.3% earned high and low income, respectively. Twenty percent (20%), 32.9% and 47.1% had poor, fair and good knowledge respectively of the foods that make up an adequate diet; 90.4% and 9.6% had poor and fair knowledge of nutrient sources and deficiencies. More rural respondents skipped their meals because they were not hungry; 98.5% of the respondents ate snacks, while 52.2%, 66.3% and 50.8% ate more in the first, second and third trimesters of their pregnancies. Weight gain was normal for 32.7% while 61.5% of the respondents gained above normal weight. About 86.1% and 13.9% had normal and poor haemoglobin status, respectively. LBW rate was 4.8% (urban 8.5% and rural 3.2%); 95.2%, 63.5%, 79%, 99.1%, 89.9% and 89.9% of the neonates had normal birth weight, birth length, head circumference, chest circumference, abdominal circumference, and placental weight. There was a significant (p= <0 .05="" abdominal="" adaptations="" affect="" also="" an="" and="" antenatal="" associated="" be="" between="" birth="" calcium="" care="" carefully="" checkups="" child="" circumference="" conclusion="" considered="" contributed="" did="" early="" ebonyi="" effectiveness="" expansion="" findings="" free="" further="" gain="" haemoglobin="" have="" hb="" health="" in="" indication="" intake="" intakes="" investigation.="" iron="" is="" knowledge="" lbw="" levels.="" low="" maternal="" mother="" must="" need="" needs="" negative="" neonatal="" normal="" not="" nutrition="" of="" placental="" positive="" pragramme="" pregnancy="" prevalence="" programme="" protein="" reactivation="" recorded="" registration="" regular="" relationship="" respectively.="" riboflavin="" size="" some="" span="" state.="" status="" study="" supplements="" support="" the="" this="" to="" use="" weight.="" weight="" were="" while="" with="">

TABLE OF CONTENTS

Title page
List of tables
ABSTRACT

CHAPTER ONE: INTRODUCTION
1.1       Background of the Study
1.2       Statement of the Problem
1.3       Objectives of the Study
1.4       Significance of the Study
1.5       Research Questions
1.6       Research Hypotheses

CHAPTER TWO: LITERATURE REVIEW
2.1       Maternal nutrient requirements
2.2       Maternal nutritional status and associated factors
2.3       Factors affecting maternal nutrient intake
2.4       Variables for assessing pregnancy outcome
2.5       Effects of maternal nutritional and health status on pregnancy outcome
2.6       Long term consequences of poor maternal nutrition
2.7       Review of Related Empirical Studies
2.8       Summary of Literature Reviewed

CHAPTER THREE: MATERIALS AND METHOD
3.1       Area of the Study
3.2       Design of the Study
3.3       Population of the Study
3.4       Sample Size Determination
3.5       Preliminary Visit and Informed Consent
3.6       Sampling Technique
3.7       Method of Data Collection
3.6.1    Focus Group Discussion
3.6.2    Questionnaire
3.6.3    Validation of the Instrument
3.6.4    Reliability of the Instrument
3.6.5    Training of Research Assistants
3.6.6    Maternal Anthropometric Measurement
3.6.7    Maternal Dietary Intake Measurement
3.6.8    Maternal Biochemical Measurements
3.6.9    Neonatal Anthropometric Measurements
3.7       Method of Data Analyses

CHAPTER FOUR: RESULTS
4.0       Quantitative Data Presentation: Report of Focus group discussion (FGD)
4.0.1    Nutrition Knowledge
4.0.2    Effect of Poor Nutrition on Pregnancy Outcome
4.0.3 Food Production
4.0.4    Dietary Practices/Food Intake
4.0.5    Addition of Vegetables to Food During Cooking
4.0.6    Mode of Feeding During Pregnancy
4.0.7    Food Liked and Disliked During Pregnancy
4.0.8    Pica Habit
4.0.9    Type of Care Needed by Pregnant Women

CHAPTER FIVE: DISCUSSION
5.1       Nutrition Knowledge of The Respondents
5.2       Food Habit and Dietary Practices of Respondents
5.3       24 Hour Food Recall and Food Production of Pregnant Women in Ebonyi State
5.4       Perception of the Effect of Poor Nutrition on Pregnancy Outcome in Ebonyi State
5.5       Nutritional Status of Pregnant Women in Ebonyi State, Using their Haemoglobin
            Status, Nutrient Intake and Weight Gain During Pregnancy
5.6       Mortality Rates of Neonates in Ebonyi State
5.7       Birth Weight and Anthropometric Indices of Neonates in Ebonyi State
5.8       Effect of Maternal Nutrition Knowledge, Nutrient Intake and Nutritional Status on
            Anthropometric Indices of Their Neonates
5.9       Conclusion
5.10     Recommendations
REFERENCES
APPENDICES

CHAPTER ONE

INTRODUCTION
1.1 Background to the study
Nutrition is a major intrauterine environmental factor that alters expression of the foetal genome and may have life long consequences (Guoyao, Fuller, Timothy, Cynthia

&    Thomas, 2005). Alterations in foetal nutritional status may result in developmental adaptations that permanently change the structure, physiology and metabolism of the offspring, thereby predisposing individuals to metabolic, endocrine, and cardiovascular diseases in adult life (Guoyao et al., 2005). Maternal nutrition comprises of anthropometric factors such as pre-pregnancy weight for height (body mass index (BMI) and gestational weight gain which partly reflects the balance between energy intake and energy expenditure, but also includes increases in body water, as well as intake of protein and micronutrients (Tannys, Pat, Francesca & Leah, 2006). Of the pregnancy outcomes that might be affected by maternal nutrition, the one encountered most often in research literature is low birth weight. Other outcomes are deformities, morbidity and mortality rate (Kramer, 1998).


Low birthweight is defined as a body weight at birth of less than 2500g . There are two main causes of low birth weight: prematurity and intrauterine growth retardation (IUGR). Infants born with low birth weight suffer from extremely high rates of morbidity and mortality from infectious disease, and are underweight, stunted and wasted beginning in the neonatal period through childhood (ACC/SCN, 2000). The causes and effects of low birth weight are complex and best considered withins the lifecycle conceptual framework. Poor nutrition often begins in the intrauterine environment and extends throughout the lifecycle. Low birthweight is an intergenerational problem where low birthweight infants grow up to be undernourished and stunted children and adolescents and, ultimately undernourished women of child bearing age, and undernourished pregnant women who deliver low birthweight infants. This amplifies risk to the individual’s and perpetuates the cycle of poverty, undernutrition and disease. This is especially so when adolescents become pregnant before their own growth is completed, leaving little to fulfil their own or their infant’s nutritional requirement (ACC/SCN, 2000).

Any successful pregnancy requires the net deposition of tissue within the mother, the placenta and the foetus. Thus, there is a fundamental relationship between the nutritional status of the mother and her ability to transfer nutrients to the foetus at the appropriate time during pregnancy. The mother’s ability to achieve effective and timely transfer may however be constrained by factors other than her immediate dietary intake or overall nutritional status. The mother may have her own demands for nutrients that compete with the needs of the foetus. In a younger woman, the needs to complete her own growth and development have to be satisfied (Alan, Zulfiqar & Pisake, 2003).

Sub-optimal foetal growth is associated with higher foetal mortality, neonatal morbidity and mortality. Small size at birth is associated with greater susceptibility to infection and both altered postnatal growth and neuro cognitive development (Alan et al., 2003). Nutrition, acting either directly, or through specific endocrine mechanism is a major determinant of the pace and balance of foetal growth, with effects that have adverse consequence later in infancy and childhood. Modest changes in maternal diet, from very early in pregnancy, or even in the preconception period, can have marked effect on the ability of the foetus and newborn to withstand other infective or physical environmental stresses (Alan et al., 2003).

High rates of pregnancy-related mortality and morbidity persist in the poorer countries of the world (including Nigeria) with maternal mortality rates reaching over 1000 per 100,000 live births in some countries, and millions of infants are born too early, too small or with serious infections (ACC/SCN, 1993). Poor maternal nutritional status leads to many other complications for the mother and baby in both the short and long term. From nutritional status stems maternal weight gain, which strongly influences birth weight (Tannys et al., 2006).

Maternal under nutrition during gestation reduces placental and foetal growth of both domestic animals and humans. Available evidence suggests that foetal growth is most vulnerable to maternal dietary deficiencies of nutrients (such as protein and micronutrients) during the peri-implantation period and the period of rapid placental development (Wu et al., 2005). Under nutrition in pregnant women may result from low intake of dietary nutrients owing to either a limited supply of food or severe nausea and vomiting as hyperemesis gravidarum. This life threatening disorder occurs in 1-2% of pregnancies and generally extends beyond the 16th week of gestation. Pregnant women may also be at increased risk of under nutrition because of early or closely spaced pregnancies (Vause, Martz, Richard, & Gramlich, 2006).

When the mother has little control over family fund, dietary arrangement may become difficult. A woman’s access to and control over income and assets would be a major determinant of her nutrient intake (Mulokozi, 1999). Women’s occupation is such that they control fewer productive assets at every socio-economic level. In spite of the fact that they are responsible for meeting the family needs, they earn less income. This makes them resort to labour intensive jobs which add to their nutritional risk particularly for the pregnant women. Heavy workload for women might lead to poorer diets not only for their children and other members of the family but also for the women themselves (Mulokozi, 1991). The risk of improper nutrient intake and nutritional inadequacy during the periods of heavy physical work is high (Mozie, 2000).....

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