DIETARY PATTERN, ANTENATAL CARE ATTENDANCE AND BIRTH OUTCOME AMONG PREGNANT WOMEN AT MAIGANA WARD, SOBA LOCAL GOVERNMENT AREA KADUNA STATE, NIGERIA

ABSTRACT
Infant weight at birth is an important indicator of maternal health and nutrition, during pregnancy and a predictor of infant growth and survival. The effect of dietary intake, antenatal care attendance on birth outcome among randomly selected pregnant women in their third trimester in Maigana Ward of Soba Local Government Area, of Kaduna state was evaluated. Socio-economic/information, nutritional status, dietary intake, micronutrient status, antenatal care attendance score and baby‟s birth weight at delivery were determined using standard methods. The socioeconomic characteristics of the pregnant women evaluated included; age, marital status, highest educational attainment, occupation and monthly income, 10% of the pregnant women were between age 11-15years, while 73% were between age 16-30years, 68% had no formal education and (53%) were poor, earning less than #350 per day. Their nutritional status revealed that 9.7% were under weight (MUAC ˂ 23.3cm), 31.1% were normal (MUAC 23.3 – 25.0 cm) and 59.2% were overweight (MUAC ˃ 25cm). Strong significant correlation was found between MUAC and maternal weight with birth weight of neonates (r = 0.816, p = 0.000 and r = 0.648, p = 0.000) respectively. The dietary pattern of the pregnant women reveals cereal, vegetable soup and sauces were frequently consumed more at 22.1 and 21%, 2-3 times/day while meat, fish and poultry, fruits and other plants were consumed less at 3 and 4.9%, once a day respectively. The antenatal care attendance and compliance status indicated that 76.7% were below compliance, 16.5% had minimal compliance and 6.8% had desired compliance. The mean micronutrient serum concentration (µmol) were 4.02, 2.52 and 0.45 for iron(Fe),zinc(Zn) and vitamin A respectively, leaving 73.1%, 96.2% and all (100%) deficient of the micronutrients. The incidence of low birth weights was 16.5%. Factors that have significant association with low birth weight are Age (χ2=58.609, p = 0.000), occupation (χ2=13.019, p=0.011) monthly income (χ2=15.484, p=0.008) Iron level (χ2=7.344, p=0.007) and maternal nutritional status(χ2=40.713, p=0.000) .This study establish that nutritional status, socioeconomic status (age, occupation, monthly income), and antenatal compliance score of the pregnant women were determinants of their birth outcome in Maigana ward of Soba LGA


CHAPTER ONE
1.0 INTRODUCTION
1.1       Background of Study
Good maternal nutrition is important for the health and reproductive performance of women, the health, survival, and development of their children (Mora and Nestel, 2000).Maternal nutrition has been identified as the mostimportant determinant of adverse pregnancy outcomes in Nigeria. It‟s also a major determinant of the baby‟s size at birth; it has a direct causal impact on the incidence of small size at birth (Ogunjuyigbeet al.,2008).

Birth weight is the first weight of a baby, taken immediately after birth (WHO 2004). Low birth weight is one of the poor outcomes of pregnancy that has caught the attention of the World Health Organization. Low birth weight (LBW) is defined as“weight of a live born infant of less than 2500g regardless of gestational age” (WHO, 2006). A child‟s birth weight or size at birth is “an important indicator of the child‟s vulnerability to the risk of childhood illnesses and the child‟s chances of survival” (NDHS, 2013). However, children‟s weight is to great extent determined by factors that operate in the uterus wall before they are born (Wilcox and Skaeven, 1992). An infant weight at birth is an important indicator of maternal health and nutrition prior to, during pregnancy and a predictor of infant growth and survival (WHO, 2006). At birth, foetus weight is accepted as a single parameter of the health and nutrition of the mother (Wilcox and Skaeven, 1992).

Dietary intake during pregnancy influences maternal health, as poor dietary practices during pregnancy have been linked to maternal complications (Grashamet.al.,2014). During pregnancy most especially second and third trimester, nutrient needs increase, energy requirements also increase by about 300 calories per day (Blount, 2005). During pregnancy the daily requirement of calcium is about 1000 mg, 75 to 100g of protein, the combination of sodium, potassium, water and iron is about 27 mg , at least 85 mg of vitamin C and 6-8mg per day of folic acid. Other practices such as alcohol consumption, use of drugs and tobacco smoking are considered harmful practices (Blount, 2005).

Undernourishment of foetus in the womb can lead to diminished potential andpredisposes infant to early death (UNICEF, 2014). Those who survive tend to have impaired immune function and increased risk of disease and are likely to remain undernourished, with reduced muscle strength, cognitive abilities and intelligent quotient throughout their lives. As adults, they are likely to suffer a higher incidence of diabetes and heart disease (UNICEF, 2014). Components leading to healthy pregnancy outcome include healthy pre pregnancy weight, appropriate weight gain and physical activity during pregnancy, consumption of a wide variety of foods, appropriate vitamin and mineral supplementation, avoidance of alcohol and other harmful substances, and safe food handling (Sandra, 2014).

Evidence shows that high maternal, prenatal, neonatal and child mortality rates are associated with inadequate and poor quality health services, these evidence also suggests that explicit, evidence-based, cost effective packages of interventions can improve the processes and outcomes of health care when appropriately implemented (UNICEF, 2000, CSLAC, 2001)

Antenatal care which is the care received from health professionals during pregnancy (Blount, 2005), contributes to the identification of pregnancy complications. The early initiation of regular care has been shown to directly reduce the incidence of low birth weight (Carey and Hamer, 1991).

Antenatal care is globally accepted and commonly understood to have a beneficial impact on pregnancy outcome, either through detecting and treatment of complications or by contributing to the reduction of modifiable maternal risk of delivering a preterm or growth retarded infant. (Magadiet al.,2000). It also provides an array of available medical nutritional and educational interventions intended to reducethe risk of low birth weight and other adverse pregnancy outcomes (Blooms and Wupis, 1999).Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth and 99% of these maternal deaths occur in developing countries (UNICEF, 2014).

Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known (Moss et al., 2002). All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. Maternal health and newborn health are closely linked. Approximately 2.7 million newborn babies die every year, and an additional 2.6 million are stillborn. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for both the mother and the baby (UNICEF, 2014).

A woman‟s nutritional status has important implications for her health as well as for the health of her children. Malnutrition results in reduced productivity, increased susceptibility to infections, slow recovery from illness, and a heightened risk of adverse pregnancy outcomes (NDHS, 2013).

1.2.    Statement of Research Problem
“Accordingto Sandra (2014), pregnancy is a critical period during which maternal nutrition and lifestyle choices are major influences on mother andchild health”. Inadequate levels of key nutrients during crucial periods of fetal development may lead to reprogramming within fetal tissues, predisposing the infant to chronic conditions in later life (Sandra, 2014).

Pregnant women in sub-Sahara Africa are at high risk of malnutrition as a result of poverty, food insecurity, political and economical instabilities, frequent infections and pregnancies (Lartey 2008).

Maternal mortality remains a major challenge to health systems worldwide (NDHS, 2008). Globally, there were an estimated 289 000 maternal deaths in 2013, due to pregnancy related complications and childbirth due to lack of access to skilled routine and emergency care, a declineof 45% from1990 (NDHS, 2013). The sub-Saharan Africa region alone accounted for 62% (179 000) of global deaths followed by Southern Asia at 24% (69 000). At the country level, the two countries that accounted for one third of all global maternal deaths are India at 17% (50 000) and Nigeria at 14% (40 000) (WHO, 2015). The lifetime risk of maternal death indicates that 1 in 30 womenwill have a death related to pregnancy or childbearing, when compared withthat of the developed countries of 1 in 3300 women(WHO, 2015).

“In Nigeria the neonatal mortality rate is 528/day, one of the highest in the world, second to India. Infant and under-5 mortality rates in the past five years are 69 and 128deaths per 1,000 live births, respectively. At these mortality levels, one in every 15 Nigerian children die before reaching age one. One in every eight do not survive to their fifth birthday. Infant mortality has declined by 26 percent over the last 15 years,”(WHO, 2015).

Therefore an acceleration of the pace of progress is urgently required to achieve the Sustainable Development Goal (SDG) targets on maternal and child survival, particularly in high mortality countries in sub-Saharan Africa like Nigeria (WHO, 2015).Childhood mortality rates are higher in rural areas than in urban areas (WHO, 2015).In Nigeria, childhood mortality is highest in the North –West region of the country. There is also variation in the incidence of low birth weight across the region of Nigeria, North-West has the highest incidence, with (27.2%), followed by North-East (13.6 %),South-South (11.6 %), North- Central is (7.5%), South-East (4.3%),while South –West has the lowest, (3.4%)(NDHS, 2013).

1.3 Significances of the Findings
To establish for the first time;

1. The nutritional Status of pregnant women in Maigana ward, Soba LGA.

2. The incidence of low birth weight in Maigana, Soba LGA.

3. Antenatal attendance score among pregnant women in Maigana, Soba LGA.

1.4       Justification
Increasing numbers of women are now seeking care during childbirth in health facilities. Therefore, it is important to ensure a adequate care provision for both the mother and neonate.

Reliable information about the rates and trends in maternal mortality and pregnancy outcome is essential for resource mobilization, planning and as assessment of progress towards achieving Sustainable Development Goal (SDGs) 1, 2 and 3, (no poverty, zero hunger, good health and wellbeing respectively) (WHO, 2015).

This study was motivated by the high incidence of low birth weights in North-west of Nigeria and the attendant negative consequences such as chronic disease and other health complications in between life. Hence at the end of the study, information derived will be good input to improving maternal dietary intake and pregnancy outcome,create awareness on the relationship between dietary intake and pregnancy outcome and also for policy makers (Government, Non GovernmentalOrganisation (NGO)) to formulate policies aimed at improving the maternal and child‟s health in the affected area in particular and Nigeria in general.

1.5       Aim and Objectives
1.5.1    Aim
The aim of this research is to assess the dietary pattern, antenatal care attendance, and birth outcome of pregnant women at Maigana ward, Soba Local Government Area (LGA) of Kaduna State.

1.5.2    Specific objectives
The specific objectives of the research were to:

1. Determine the social-economic and nutritional status of pregnant women at Maigana ward, Soba LGA.

2. Assess dietary intake of the pregnant women in the study area

3. Evaluate the antenatal care utilization of the pregnant women inMaigana ward Soba local LGA

4. Determine micronutrient status of the pregnant women in the study area at third trimester

5. Determine the incidences and contributing factors of low birth weight in Maigana ward, Soba LGA.

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Item Type: Project Material  |  Attribute: 79 pages  |  Chapters: 1-5
Format: MS Word  |  Price: N3,000  |  Delivery: Within 30Mins.
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