Undernutrition and its associated factors among pregnant mothers in Gondar town, Northwest Ethiopia

Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University teaching hospitals in northern Uganda

BACKGROUND

Undernutrition has deleterious consequences to both the mother and the unborn child, significantly contributing to maternal and neonatal morbidity and mortality. We assessed dietary diversity, the prevalence, and predictors of undernutrition among pregnant adolescents and young women (PAYW) attending antenatal clinic (ANC) at two large teaching hospitals in northern Uganda.

METHODS

Between 12th June 2023 to 27th October 2023, we conducted a facility-based, cross-sectional study at Gulu Regional Referral Hospital (GRRH) and St Mary's Hospital Lacor (SMHL), both in Gulu district, Uganda. We recruited PAYW aged 15-24 years attending ANCs. Sociodemographic and clinical characteristics of the study participants were collected using a pre-tested, semi-structured questionnaire. Undernutrition was defined as a mid-upper arm circumference (MUAC) of < 23 cm. Modified Poisson regression analysis was performed to determine factors independently associated with undernutrition. Data analyses was performed using STATA version 17.0. A p<0.05 was considered statistically significant.

RESULTS

A total of 324 participants, with a mean age of 21.2±2.2 years were enrolled. About 62.0% (n = 201) of the participants dewormed during pregnancy. The prevalence of undernutrition was 12.7% [n = 41]. Prevalence was higher among participants who maintained pre-pregnancy diet (adjusted prevalence ratio [aPR] = 2.27, 95% Confidence Interval [CI]: 1.26-4.05, p = 0.006), those who did not receive nutritional education (aPR = 2.25, 95% CI: 1.21-4.20, p = 0.011) and consumption of non-green leafy vegetables (aPR = 4.62 95% CI: 1.64-13.01, p = 0.004). The prevalence of undernutrition was lower among participants who consumed milk and milk products (aPR = 0.44 95% CI: 0.24-0.81, p = 0.009) and among those who consumed fish and seafood compared to those who did not (aPR = 0.45 95% CI: 0.20-1.00, p = 0.050).

CONCLUSIONS

About 1 in 8 of PAYW attending GRRH or SMHL had undernutrition, particularly those who lacked education about feeding habits during pregnancy and limited access to milk and milk products, fish and seafoods. We recommend health workers to offer timely education of pregnant adolescent and young women mothers about good feeding habits during pregnancy, appropriate monitoring of weight gain and physiological changes during pregnancy.

Undernutrition and associated factors among pregnant women in Ethiopia. A systematic review and meta-analysis

Background

Maternal undernutrition is a major public health concern due to its association with mortality and overall disease burden for mothers and their children. Maternal nutrition determines pregnancy outcomes since reduced intake of nutrients influences gestational age length, placental function, and fetal growth during pregnancy. The complexity of the intergenerational aspects of maternal nutrition may also confound the design of interventions. Therefore, this research aimed to assess the prevalence of undernutrition and associated factors among pregnant women in Ethiopia.

Methods

We identified the literature from PubMed, EMBASE, Scopus, and CINAHL databases. Data were entered into Microsoft Excel and then exported to Stata version 17 statistical software for analysis. The I2 and Q-statistic values detect the level of heterogeneity, and meta regression was performed to investigate between-study heterogeneity using more than one moderator. JBI quality assessment tools were used to include relevant articles. Evidence of publication bias was indicated using the funnel plot and Egger's linear regression test. The effect size was expressed in the form of point estimates and an odds ratio of 95% CI in the fixed-effect model.

Result

In total, 19 studies fulfill the inclusion criteria. The pooled prevalence of undernutrition among pregnant women was 32% (95% CI 31.3-33.2 I2 = 97.5%, P < 0.0). Illiteracy (AOR = 3.6 95% CI; 2.3-5.6), rural residence (AOR = 2.6 95% CI; 1.2-3.5), a lack of prenatal dietary advice (AOR = 2.6 95% CI; 1.8-3.7), household food insecurity (AOR = 2.5 95% CI; 1.9-3.2), and low dietary diversity score (AOR = 3.7 95% CI; 2.2-5.9) appear to be significantly associated with undernutrition among pregnant women.

Conclusion

The review showed that the prevalence of undernutrition is still high among pregnant women. Illiteracy, rural residence, a lack of prenatal dietary advice, household food insecurity, and low dietary diversity score were significantly associated with undernutrition during pregnancy. Interventions should focus on educating the public and helping families access food or supplements they need through local markets, health systems, and community-based support, as undernutrition is caused by numerous interconnected causes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42023417028.

The effect of nutrition and health behavior change communication through community-level actors on the nutritional status of pregnant women in the Ambo district, Ethiopia: A randomized controlled trial

Pregnant women in Ethiopia often had trouble understanding the normal nutrition and health information given by health professionals and found it inconsistent. Undernutrition is still a significant public health problem as a result. Hence, this trial aimed to assess the effect of nutrition and health behavior change communication using the community-level actors on the nutritional status of pregnant women. Cluster-randomized controlled community trial with baseline and endline measurements were used. Endpoint data from 744 pregnant women (372 intervention and 372 control groups) were gathered, respectively. In the intervention group, the community-level actors delivered the behavior change communication main message based on intervention protocol. The control group got nutrition information during their ANC visits but did not receive the behavior change communication intervention. Binary generalized estimating equations regression analyses adjusted for baseline covariates were used to test effects of the intervention on nutritional status. Following the trial's implementation, the prevalence of undernutrition in the intervention arm fell by 10% from the baseline (23.7% vs. 13.7%) and was 13.7% lower than in the control arm (13.7% vs. 27.4%, p = <.001). Pregnant women in the intervention group showed significantly lower risk of undernutrition than the control group (ARR = 0.21; 95% CI 0.14-0.30). This study showed that engaging community actors to communicate about nutrition and health behavior change was successful in enhancing pregnant women's nutritional status. Therefore, nutrition and health behavior change communication through the community-level actors is recommended to improve the nutritional status of pregnant women.

Dietary diversity, undernutrition and associated factors among pregnant women in Gindeberet district, Oromia, Ethiopia: a cross-sectional study

BACKGROUND

Appropriate levels of dietary diversity are essential for proper physiology of human being and it is crucial to consume healthy foods at every phase of life, especially during pregnancy. Inadequate dietary diversity and malnutrition are risk factors for low birth weight, intrauterine growth reduction and small for gestational age. This study was aimed to assess dietary diversity, undernutrition and associated factors among pregnant women in Gindeberet district, Oromia, Ethiopia, 2020.

METHOD

A community based cross-sectional study was conducted among 627 pregnant women in Gindeberet district selected by systematic random sampling from October 10/2020- November 10/2020. Data were collected through interviewer administered questionnaires. The collected data were coded and entered to Epi-info version 7.2.2.6 and analyzed by SPSS version 23. Logistic regression analysis was carried out to identify factor associated with undernutrition and dietary diversity. Level of statistical significance was declared at p-value < 0.05.

RESULTS

overall prevalence of inadequate dietary diversity and undernutrition were 276 (44.4%) and 110 (17.7%) respectively. Pregnant women who did not receive antenatal care (AOR = 2.32, [95% CI: 1.38, 3.90]), family size ≥ 5 (AOR: 2.93; [95%CI: 1.10, 7.79]), unprotected sources of water (AOR: 4.14; [95% CI: 1.63, 10.52]) were significantly associated with undernutrition. Rural residence (AOR = 2.59, [95% CI: 1.66-4.04]), pregnant women who did not received ANC (AOR = 2.52, [95% CI: 1.58-4.03]) and nutrition information (AOR = 1.43; [95% CI: 1.10, 2.10]) were significantly associated with dietary diversity among pregnant women.

CONCLUSION

undernutrition and inadequate dietary diversity among pregnant women were high in study area. Source of drinking water, ANC visit and family size were significantly associated with pregnant women undernutrition. Place of residence, ANC visit and nutrition information were significantly associated with inadequate dietary diversity. Therefore, pregnant women, government, non-governmental organization and stakeholders should focus on importance of ANC visit, clean source of drinking water and adequate dietary diversity to improve nutritional status of pregnant women.

Association between malaria and undernutrition among pregnant women at presentation for antenatal care in health facilities in the Mount Cameroon region

In resource limited settings, malaria and undernutrition are major public health problems in pregnancy. Therefore, this study assessed the association between malaria infection and undernutrition among pregnant women in the Mount Cameroon area. This cross-sectional study enrolled 1,014 pregnant women consecutively over a year. A structured questionnaire was used to collect socio-demographic information and clinical data. Maternal nutrition was assessed using dietary diversity (DD). Peripheral blood samples collected were used for the diagnosis of malaria parasitaemia by microscopy whereas haemoglobin (Hb) levels were determined using an Hb meter. Logistic regression was used to determine factors associated with malaria and dietary diversity. The prevalence of malaria infection and undernutrition was 17.8% and 89.6% respectively. In addition, of those infected with malaria, geometric mean parasite density was 301/μL of blood (range: 40-9280) while mean DD score was 3.57±0.82 (range: 1-7). The odds of being infected with malaria parasitaemia was highest among women enrolled in the rainy season (OR = 1.58, P = 0.043), who were farmers (OR = 2.3, P = 0.030), had a household size of < 4 individuals (OR = 1.48, P = 0.026) and who were febrile (OR = 1.87, P < 0.001). Also, attending clinic visits in Mutengene Medical Centre (OR = 2.0, P = 0.012) or Buea Integrated Health Centre (OR = 2.9, P = < 0.001), being < 25 years (OR = 2.4, P = 0.002) and a farmer (OR = 10.6, P = 0.024) as well as < 4 clinic visits (OR = 1.62, P = 0.039) were identified as predictors of undernutrition. Furthermore, the association between malaria and DD was statistically significant (P = 0.015). In this study, undernutrition was highly frequent than malaria infection. Thus, there is an urgent need to improve maternal awareness through nutritional counselling and health campaigns on the benefits of consuming at least five food groups. Besides, improved maternal dietary nutrient intake is likely to have impact on the burden of malaria parasite infection.

Effects of intensive nutrition education and counseling on nutritional status of pregnant women in East Shoa Zone, Ethiopia

Background

Nutritional status is defined as an individual's health condition as it is influenced by the intake and utilization of nutrients. Maternal malnutrition is widespread throughout the world, with Sub-Saharan Africa and Asia bearing the brunt of the burden. The objective of this study was to evaluate the effect of intensive nutrition education and counseling on nutritional status during pregnancy.

Methods and materials

The study was a one-year, two-arm parallel design cluster randomized controlled trial conducted in the East Shoa zone, Ethiopia, from January 1, 2021, to February 30, 2022. A total of 374 participants were enrolled in the intervention (n = 185) and control (n = 189) groups. End-line data were collected from 163 women, from each group. The intervention package provided three counseling sessions by trained midwives, three-page take-home brochures prepared in local languages, and the delivery of 18 weekly serial short text messages. The women in the control group received routine nutrition education from the health facilities. After adjusting for potential confounders, a linear mixed-effects model was employed to assess the intervention effect.

Results

After the intervention, the mean mid-upper arm circumference in the intervention group increased by 1.8% (23.08 vs. 23.44, p < 0.01). Similarly, the proportion of undernutrition in the intervention group was 11% (25 vs. 36%, p = 0.02) lower compared to the control arm. At the end of the trial, women in the intervention arm had significantly better nutritional status than women in the control group (β = 0.47, p < 0.01).

Conclusion

The findings showed that intensive nutrition education and counseling using the health belief model was effective in improving nutritional status and reducing undernutrition among pregnant women. As a result, nutrition education and counseling using HBM constructs, as well as regular reminder messages, should be provided to pregnant women as part of the routine antenatal care service.

The prevalence of undernutrition among students attending traditional Ethiopian orthodox Tewahedo church schools in northwest Ethiopia

Background

Undernutrition is a major public health concern affecting the health, growth, development, and academic performance of adolescents studying in school. During this crucial period, dietary patterns have a vital impact on lifetime nutritional status and health. The problem of undernutrition among particular groups of adolescents attending traditional schools has not previously been studied. Therefore, this study aimed to assess the prevalence of undernutrition and associated factors among adolescents aged 10-19 years attending Orthodox Church schools in northwest Ethiopia.

Methods

An institution-based, cross-sectional study design was employed, with data collected from March 1 to 30, 2021. A simple random sampling technique was used to recruit a total of 848 male attendees of traditional schools. Data were collected via an interviewer-administered semi-structured questionnaire. The nutritional status of participants was assessed using anthropometric measurements. The WHO Anthroplus software was used for analysis. Both bivariable and multivariable logistic regression analyses were conducted to identify the factors associated with nutritional status. The degree of association between the independent variables and the dependent variable was assessed using odds ratios, reported with 95% confidence intervals, and a threshold of p ≤ 0.05.

Results

The prevalence of undernutrition was found to be 61.3% [95% CI: 58.1, 64.6]. The likelihood of developing undernutrition was elevated among those adolescents who were following the traditional school levels of dikuna (AOR = 4.3, 95% CI = 1.3, 13.6), kinne (AOR = 4.5, 95% CI = 1.4, 14.6), aquaquame (AOR = 9.9, 95% CI = 2.5, 39.88), tirguame (AOR = 6.4, 95% CI = 1.6, 25.6), and among those whose mothers had no formal education [AOR = 3.7, 95% CI: 1.2, 12.8]. In contrast, those adolescents who always washed their hands after a toilet visit had lower odds of undernutrition than their counterparts [AOR = 0.7, 95%CI: 0.5, 0.98].

Conclusion

More than three out of five participating male adolescents were undernourished. Thus, to improve the nutritional status of adolescents studying in traditional church schools, extensive health education for these adolescents is essential. Moreover, the establishment of well-resourced traditional religious school, equipped for the provision of an adequate, diversified diet, is important. Developing the habit of handwashing after visiting the toilet and before and after food preparation is also recommended for adolescent students.

Prevalence of undernutrition among pregnant women and its differences across relevant subgroups in rural Ethiopia: a community-based cross-sectional study

BACKGROUND

Maternal undernutrition is one of the commonest public health problems in many low- and middle-income countries where generally more than 20% of women are undernourished. It is more common in rural areas due to unclear factors. Therefore, the aim of this study was to investigate the prevalence of undernutrition in general and in subgroups and determine risk factors among pregnant women in rural Ethiopia.

METHODS

A community-based cross-sectional survey was conducted from April 30 to May 30, 2019 on 550 pregnant women who were randomly selected from six districts in southern Ethiopia. Trained and experienced nurses measured undernutrition using mid-upper arm circumference and collected other data. We used multilevel mixed-effect logistic regression to identify factors associated with undernutrition among pregnant women.

RESULTS

The prevalence of undernutrition among pregnant women was 38% (95% CI: (34.2-42.3). The odds of undernutrition was higher among women who got pregnant previously (adjusted odds ratio [AOR]: 1.66; 95% CI: 1.02-2.71), who had a history of miscarriage (AOR: 3.18; 95% CI: 1.77-5.70), who practiced food taboos (AOR: 2.23; 95% CI: 1.47-3.39), and who did not get any nutritional counseling during pregnancy (AOR: 2.97; 95% CI: 1.79- 4.95). The prevalence of undernutrition was higher among pregnant women who had multiple risk factors and the difference was statistically significant (p < 0.001).

CONCLUSION

Undernutrition is a highly prevalent problem among rural Ethiopian pregnant women, especially with those who avoid food, do not get counseled, and had two or more pregnancies and a history of miscarriage. Improving the integration of nutrition programs with routine healthcare services and encouraging a multi-sectorial intervention strategy would help to reduce maternal undernutrition in the country.

Dietary Diversity and Haemoglobin Level Associated With Under Nutrition Among Pregnant Women at Sidama Hawassa, Ethiopia: Facility Based Cross-Sectional Study

Background

Under nutrition among pregnant women is common public health problem in developing countries including Ethiopia. It leads to poor maternal and neonatal outcomes. Despite its consequences there is shortage of research evidence to support intervention in this regard in the southern part of the country. Therefore, the aim of the study was to assess the determinates of under nutrition among pregnant women visiting antenatal care clinics at selected health facilities in Hawassa town.

Methods

Health facility based cross-sectional study was employed among 454 systematically selected study participants. Data were collected by using structured and pre-tested questionnaires with face to face interview. Data were entered into Epi info and then exported to SPSS version 26 statistical software for analysis. Data were analyzed with descriptive statistics; bivariate and multivariate binary logistic regression.

Result

The over all of prevalence of under nutrition among pregnant women was 27.6% [95% CI (22.6, 30.8)]. In multivariate logistic regression model, lowest wealth quintile [AOR = 3.3, 95% CI (1.7, 7.0)], women with dietary diversity [AOR = 2.0, 95% CI (1.3, 4.0)], presence of anemia [AOR = 10.7, 95% CI (5.8,19.8)], lower pregnant women education level [AOR = 3.3, 95% CI (1.4, 7.9)], lower partner education level [AOR = 3.1, 95% CI (1.1, 8.5)], not ate flush/meat food [AOR = 2.8, 95% CI (1.7, 4.8)], and not ate other fruits [AOR = 1.8, 95% CI (1.1, 2.8)] had significant association with under nutrition.

Conclusion

In this health facility based study, the burden of under nutrition was high. Lowest wealth quintiles, low dietary diversity scores, being anemic and low education of the pregnant women and her partner were associated with under nutrition. Therefore, counseling for dietary diversity during antenatal care, health promotion and education for pregnant women and empowering women on income generation activities are a key intervention to tackle under nutrition.

Undernutrition and associated factors among pregnant women in East Borena Zone, Liban District, Oromia regional state, Ethiopia

Background

Undernutrition is cellular imbalance between supply of nutrients, energy and body's demand to ensure growth, maintenance, and specific function. However, there was no study conducted earlier on this topic in East Borena Zone.

Objective

To assess the prevalence of undernutrition and associated factors among pregnant women in East Borena Zone, Liban District.

Method

A community-based cross-sectional study was conducted on 420 study participants from November 20 to December 2021. The systematic sampling technique and simple random sampling methods were used to select study participants. Data were double entered into Epi-info software version 7 and SPSS version 21 software for analysis. Descriptive statistics were used to describe the characteristics of study participants. Bivariate and multivariable logistic regressions were carried out to identify the association between independent and dependent variables by measuring the adjusted odds ratio and 95% confidence interval. P-values less than 0.05 were considered statistically significant.

Results

Prevalence of undernutrition among pregnant women was about (44.9%) of family monthly income [AOR = 8.72 (4.80, 15.83)], women's decision-making autonomy [AOR = 0.40 (0.19, 0.82)], skipping meal [AOR = 2.62 (1.41, 4.89)], substance use [AOR = 2.01 (1.07, 3.77)], household food insecurity [AOR = 2.01 (1.06, 3.80)], lack of prenatal dietary advice [AOR = 2.73 (1.53, 4.89)], absence of household latrine [AOR = 9.23 (3.48, 24.46)], not participating health development army's meeting at village level [AOR = 3.01 (1.57, 5.72)] and hand washing habit [AOR = 6.55 (3.02, 14.20)] had shown statistically significant association with undernutrition.

Conclusion

The prevalence of undernutrition among pregnant women was high income. Women's decision-making autonomy, skipping meals, substances use, household food insecurity, lack of prenatal dietary advice, poor hand washing habit, lack household of latrine, and not participation in health development army's meeting were found to be predictors of the undernutrition.

Determinants of nutritional status among pregnant women in East Shoa zone, Central Ethiopia

Background

Undernutrition is an insufficient intake of energy and nutrients to meet an individual's needs to maintain good health. Undernutrition during pregnancy severely affects the health of mothers and her baby. Globally it contributes directly or indirectly to 3.5 million maternal deaths annually. This study aimed to determine the level of undernutrition and identify factors associated with undernutrition among pregnant women attending public health facilities in the East Shoa Zone, Central Ethiopia.

Methods

Institution-based cross-sectional study was conducted among 472 randomly selected pregnant women from June to August 2021. Sociodemographic, obstetrics, and knowledge related data were collected using a structured interviewer-administered questionnaire, and maternal nutritional status was measured using the Mid Upper Arm Circumference (MUAC). The collected data were entered to EPI-info version 3.5.4 and then exported to SPSS for windows version 26.0 software for analysis. Multivariable regression analysis was fitted to identify determinants of undernutrition. An adjusted odds ratio with 95% confidence intervals and a p-value < 0.05 was considered a statistically significant.

Results

The prevalence of undernutrition among pregnant women was 13.9% [95% CI: 11.0-17.4]. On multivariable logistic regression model after adjusting background variables, wealth (AOR: 4.9, 95% CI 1.34-18.20), women's decision making power (AOR: 3.31, 95% CI 1.18-7.79), and nutritional counseling (AOR: 3.53, 95% CI 1.29-9.60) were independently associated with nutritional status of pregnant women.

Conclusion

Findings indicated that significant number of pregnant women in the study were undernourished. Higher wealth index, nutritional counseling, and women's decision-making power were inversely associated with undernutrition. The findings imply the need for economic empowerment of women, enhancing decision-making ability of women and routine and consistent nutritional counseling to decrease undernutrition among pregnant women.

Magnitude and effects of food cravings on nutritional status of pregnant women in Southern Ethiopia: A community-based cross sectional study

BACKGROUND

Food cravings is a strong and intense urge to consume a specific food and reported as being associated with overweight and overall caloric intake in pregnant women. However, the nutritional and anthropometric consequences are not well recognized. Therefore, this study aimed to assess magnitude and effects of food cravings on nutritional status of pregnant women in Southern Ethiopia.

METHODS

A community-based cross-sectional study conducted among 586 randomly selected pregnant mothers at Sidama Regional State from June 1-20, 2019. Pre-tested and semistructured face-to-face interview questionnaires used to collect the data. The data were cleaned, coded, and entered into Epi Data version 3.1 and analysed using SPSS IBM version 20. The bi-variable and multivariable logistic regression used to identify the possible factors of food cravings. Principal component analysis used to determine the wealth status of the study participants. Adjusted Odds Ratio (AOR) together with 95% Confidence Intervals (CIs) used to declare statistical significance.

RESULTS

The study found that nearly three in five, 309 (58.3%) [95%, CI: 54.2%-62.8%] of the study participants reported food cravings. Meat (71.5%) and Fruits (41.7%) were the most frequently craved. About one-third, 194 (36.6%) of the study participants were undernourished (MUAC < 23 cm). Age of women (20-34 years), government employed, Antenatal Care (ANC), Pica practice, lowest wealth quintile, and skipping meals were statistically associated with food cravings. Whereas, wealth quintile and ability to consume craved food were factors associated with the nutritional status of pregnant women. Moreover, our study result found that maternal undernutrition and food cravings were statistically associated (p<0.001).

CONCLUSION

The prevalence of food cravings in this study is comparable to the global level. However, the magnitude of undernutrition found to be higher. Thus, health care providers need to take every opportunity to encourage women to adopt healthful dietary practices during pregnancy.

Multilevel analysis of undernutrition and associated factors among adolescent girls and young women in Ethiopia

Background

The consequences of undernutrition have serious implication for the health and future reproductive periods of adolescent girls and young women aged 15–24 years. Inspite of this, they are neglected age groups and there is limited information about the nutritional status of this age group in Ethiopia. Therefore, estimating the extent and associated factors of undernutrition among adolescent girls and young women in a national context using multilevel analysis is essential.

Methods

Secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016. A total sample weight of 5362 adolescent girls and young women was included in this study. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was fitted to determine the associated factors of undernutrition among adolescent girls and young women in Ethiopia. Finally, the odds ratios along with the 95% confidence interval was generated to determine the individual and community level factors of undernutrition. A p-value less than 0.05 was declared as the level of statistical significance.

Results

Overall, 25.6% (95%CI: 24.5–26.9) of adolescent girls and young women were undernourished. Statistically significant individual level factors includes adolescent girls and young women aged 15–19 years (AOR: 1.53, 95%CI: 1.32–1.77), individual media exposure (AOR: 0.82, 95%CI: 0.69–0.97), and unprotected drinking water source (AOR: 1.24, 95%CI: 1.04–1.48). Whereas, Southern Nations, Nationalities, and Peoples' Region (AOR: 0.33, 95%CI: 0.13–0.83) and rural residence (AOR: 1.69, 95%CI: 1.24–2.32), were community level factors for adolescent girls and young women undernutrition.

Conclusion

One quarter of the Ethiopian adolescent girls and young women were undernourished. Therefore, the Ethiopian government should better engage this age group in different aspects of the food system. To improve nutritional status, public health interventions such as increased media exposure for rural residents and interventions that improve access to protected water sources will be critical.

Undernutrition and associated factors among rural pregnant women in Eastern Ethiopia

Objectives:

Maternal undernutrition is a burning issue in Ethiopia. However, updated evidence is limited in the eastern part of the country; particularly the mental health-related factors of undernutrition. The study, hence, aimed at assessing the prevalence and predictors of undernutrition among rural pregnant women in eastern Ethiopia.

Methods:

A cross-sectional research was carried out at a community level among 1015 randomly selected pregnant women. A structured questionnaire was used to collect the data through face-to-face interviews. The characteristics of participants were described and summarized by frequencies, percentages, and summary measures. Logistic regression was performed to find out factors related to undernutrition.

Results:

The prevalence of undernutrition was 43.8% (95% confidence interval: 40.8, 47.0). Early marriage (adjusted odds ratio = 2.63, confidence interval: 2.00, 3.47), no antenatal care follow-up (adjusted odds ratio = 1.73, 95% confidence interval: 1.31, 2.29), inadequately diversified diet (adjusted odds ratio = 2.48, 95% confidence interval: 1.77, 3.48), current substance use (adjusted odds ratio = 1.50, 95% confidence interval: 1.02, 2.19), history of mental illness (adjusted odds ratio = 2.44, 95% confidence interval: 1.02, 5.82), and common mental disorders (adjusted odds ratio = 1.81, 95% confidence interval: 1.34, 2.43) were the significant predictors of undernutrition among pregnant women.

Conclusions:

Undernutrition was a significant public health issue among rural pregnant women. Age at first marriage, antenatal care follow-up, dietary diversity, current substance use, history of mental illness, and common mental disorder were the independent predictors of undernutrition. Therefore, the health offices of Kersa and Haramaya districts should invest their efforts to prevent undernutrition among pregnant women through nutrition counselling and education, and mental health and psychosocial support.

Undernutrition and its associated factors among pregnant women at the Public Hospitals of Bench-Sheko and Kaffa zone, Southwest Ethiopia

Background

Undernutrition in pregnant women, expressed as low mid-upper arm circumference, is responsible for maternal mortality and morbidity, adverse birth outcomes, subsequent childhood malnutrition, and mortality. As a result, the purpose of this study was to determine the prevalence of maternal undernutrition and associated factors during pregnancy in public hospitals in the Bench-Sheko and Kaffa zones of southwest Ethiopia.

Methods

A facility-based cross-sectional study design was employed among 566 women who received antenatal care from March–May 2021 at the public hospitals of the Bench-Sheko and Kaffa zones, Southwest Ethiopia. A systematic random sampling technique was used to select the research unit. Undernutrition was measured by mid-upper arm circumference. The data were entered into Epi- Data version 3.1 and then exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Multivariate logistic regression models were constructed using variables with a P-value <0.25 in bivariate logistic regression analysis. Finally, in multivariate logistic regression analysis, the variable with a (P-value < 0.05) is considered statistically significant.

Results

A total of 566 pregnant women participated in our study with a response rate of 98.3%. The overall prevalence of undernutrition among pregnant women was 42.4% (95% CI: 38.3, 46.5). In multivariate logistic regression, the age of mothers between 16-24 years old (AOR = 3.9, 95% CI: 1.60, 9.70), household food insecurity (AOR = 1.81, 95% CI: 1.04, 3.15), and poor dietary knowledge (AOR = 3.25, 95% CI: 1.94, 5.47) were the factors significantly associated with undernutrition among pregnant women.

Conclusion

According to this study finding, the prevalence of undernutrition was very much high in the study area, which was significantly associated with the age groups of 16–24 years older women, poor dietary knowledge, and household food insecurity. Therefore, the strategies and programs targeted towards reducing and preventing undernutrition among pregnant mothers should be made at all levels to improve their nutritional status, and also health information, nutrition counseling, and food assistant should be provided.

Under-nutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, southern Ethiopia: A cross-sectional study

Background

Balanced and adequate nutritious food during pregnancy helps to improve maternal weight and for the healthy growth of the fetus. There has been little progress in reducing pregnant undernutrition in Ethiopia; it has been too slow.

Objective

The objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, Southern Ethiopia.

Method

A cross-sectional study design was used in public hospitals of Gedeo Zone, Southern Ethiopia from February 01 to March 01, 2019. Pretested structure questionnaire was used to collect data on the socio-economic and demographic characteristics of the study participants. Epi-data was used to code and enter the data and SPSS-25 was used to analyse and interpret the data. To assess the relationship between the dependent and the independent variables, bi-variable and multivariable logistic regression analysis was done.

Results

In this study, the prevalence of undernutrition among pregnant women was 21% (95% CI: 20.8-21.2). After controlling other co-variables, the multivariable logistic regression model revealed that average monthly income, women's educational status, nutrition education and counseling, and parity were found to have a significant association with pregnant women's nutritional status. The odds of under-nutrition among pregnant women whose monthly income is <800 ETB were 2.8 times higher than those whose monthly incomes were >1500 (AOR: 2.89; 95%CI: 1.49-5.6).

Conclusion

In this study the magnitude of undernutrition among pregnant women was found to be higher than the previously reported findings. Average household monthly income, family size, mother's educational status, nutrition education and counseling, current health condition of the mother, and parity were factors significantly associated with undernutrition of pregnant mothers. Therefore, Interventions should be initiated in earlier stages of pregnancy to prevent the high level of undernutrition during the second and third trimester in this study area.

Prenatal Education Intervention for Increasing Knowledge and Changing Attitude Toward Offspring Obesity Risk Factors

This pre- and post-test quasi-experimental design study pilot tested an educational intervention designed to increase knowledge of and change attitudes toward prenatal factors that increase risk of childhood offspring obesity in 36 pregnant women. Educational intervention content included monitoring blood glucose, gestational weight gain in pregnancy, healthy lifestyle choices, and breastfeeding. Education intervention delivery method included: Verbal, written, and video. Participants’ knowledge improved after the intervention for most topics (p = .03–.000). Their attitude score also differed before and after intervention (p = .002). Video delivery mode was the most useful, attractive, and most helpful method. This study showed an education intervention could potentially increase pregnant women’s knowledge and attitudes toward offspring obesity risk factors.

Scoping Review of Intervention Strategies for Improving Coverage and Uptake of Maternal Nutrition Services in Southeast Asia

Maternal undernutrition can lead to protein-energy malnutrition, micronutrient deficiencies, or anemia during pregnancy or after birth. It remains a major problem, despite evidence-based maternal-nutrition interventions happening on ground. We conducted a scoping review to understand different strategies and delivery mechanisms to improve maternal nutrition, as well as how interventions have improved coverage and uptake of services. An electronic search was conducted in PubMed and Google Scholar for published studies reporting on the effectiveness of maternal-nutrition interventions in terms of access or coverage, health outcomes, compliance, and barriers to intervention utilization. The search was limited to studies published within ten years before the initial search date, 8 November 2019; later, it was updated to 17 February 2021. Of 31 studies identified following screening and data extraction, 22 studies were included for narrative synthesis. Twelve studies were reported from India and eleven from Bangladesh, three from Nepal, two from both Pakistan and Thailand (Myanmar), and one from Indonesia. Nutrition education and counselling, home visits, directly observed supplement intake, community mobilization, food, and conditional cash transfer by community health workers were found to be effective. There is a need to incorporate diverse strategies, including various health education approaches, supplementation, as well as strengthening of community participation and the response of the health system in order to achieve impactful maternal nutrition programs.

The effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia: a prospective cohort study

BACKGROUND

The teratogenic effect of fetal alcohol exposure may lead to actual and potential problems, instantly after birth, at infancy; or even later, and mental impairment in life. This study aimed to investigate the effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes at Gondar town public health facilities, Northwest Ethiopia.

METHODS

A facility-based prospective cohort study was performed among 1778 pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include participants in the cohort. Data were collected using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) standardized and pre-tested questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and interested adverse birth outcomes using log-binomial regression modeling. The burden of outcomes was reported using the adjusted risk ratio and population-attributable risk (PAR).

RESULTS

A total of 1686 pregnant women were included in the analysis, which revealed that the incidences of low birth weight, preterm, and stillbirth were 12.63% (95% CI: 11.12, 14.31), 6.05% (95% CI: 5.00, 7.29) and 4.27% (95% CI: 3.4, 5.35), respectively. Non-hazardous and hazardous alcohol consumption during pregnancy was significantly associated with low birth weight (ARR = 1.50; 95% CI: 1.31, 1.98) and (ARR = 2.34; 95% CI: 1.66, 3.30), respectively. Hazardous alcohol consumption during pregnancy was also significantly associated with preterm birth (ARR = 2.06; 95% CI: 1.21, 3.52). The adjusted PAR of low birth weight related to non-hazardous and hazardous alcohol drinking during pregnancy was 11.72 and 8.44%, respectively. The adjusted PAR of hazardous alcohol consumption was 6.80% for preterm.

CONCLUSIONS

Our findings suggest that there is an increasing risk of adverse birth outcomes, particularly preterm delivery and low birth weight, with increasing levels of alcohol intake. This result showed that the prevention of maternal alcohol use during pregnancy has the potential to reduce low birth weight and preterm birth. Hence, screening women for alcohol use during antenatal care visits and providing advice with rigorous follow-up of women who used alcohol may save the fetus from the potential risks of adverse birth outcomes.

Prevalence and associated factors of undernutrition among pregnant Sudanese women

BACKGROUND

Maternal undernutrition is a global health challenge, and it is associated with significant maternal and perinatal morbidity and mortality. This study aimed to assess the prevalence and the factors associated with undernutrition among pregnant women in Sudan.

METHODS

A cross-sectional study was carried out in Saad Abuelela Hospital in Khartoum, Sudan, from June to December 2019. Sociodemographic and obstetric characteristics were collected through a questionnaire. Mid-upper arm circumference was measured. Undernutrition was defined as a mid-upper arm circumference of <23 cm. Multiple logistic regression was used to assess the factors associated with maternal undernutrition.

RESULTS

Of 1801 pregnant women, 226 (12.5%) were undernourished. Multivariable analysis revealed that ≤2 antenatal care clinic visits (adjusted OR [AOR]=3.06, 95% CI 1.68 to 5.58) was associated with undernutrition. Age (AOR=0.90, 95% CI 0.87 to 0.94) and haemoglobin levels (AOR=0.81, 95% CI 0.67 to 0.97) were negatively associated with undernutrition. There was no association between parity, education, interpregnancy interval, occupation and maternal undernutrition.

CONCLUSIONS

Our findings indicated that 12.5% of the pregnant women in Khartoum were undernourished. More effort and action are need to improve the counselling and future inclusion of a supplemental food supply for undernourished pregnant women.

Prevalence of undernutrition and its associated factors among pregnant women in Konso district, southern Ethiopia: a community-based cross-sectional study

Background

Undernutrition during pregnancy is an important public health problem. It is highly prevalent in Ethiopia but not sufficiently addressed yet. Hence, this study aimed to assess the prevalence of undernutrition and its associated factors among pregnant mothers in Konso district, Ethiopia.

Methods

Community-based cross-sectional study was conducted with a qualitative inquiry from December 2018 to January 2019. A multistage stratified sampling technique was used to select 527 subjects and quantitative data were collected from these subjects using a structured interviewer-administered questionnaire and additionally qualitative data were generated through two focus group discussions among purposely selected discussants. Mid upper arm circumference (MUAC) was measured by standard non-stretchable MUAC tape. Data were entered into Epi-data version3.1 and analyzed by SPSS version 21. In multivariable binary logistic regression, a statistically significant association was declared at p-value < 0.05 while thematic framework analysis was employed for the qualitative data.

Results

Among 501 participants, the overall prevalence of undernutrition (MUAC < 23 cm) was 43.1% (95% CI 38.7–47.5%). Household food security (AOR = 3.1; 95% CI: 2.1–4.6), low dietary diversity score (AOR = 4.9; 95% CI: 2.6–9.2), medium dietary diversity score (AOR = 2.3; 95% CI: 1.2–4.7), absence of latrine (AOR = 1.8; 95% CI: 1.2–2.6) and having family resource decision making by husband only (AOR = 1.7; 95% CI: 1.1–2.6) were significantly associated factors. Traditional believes to restrict food such as egg, milk, and milk products, avocado for women, weak nutrition education and malnutrition screening program, daily consumption of locally prepared alcoholic drink called “Cheka”, drought-prone nature of this setting, traditional way of farming practices and low socio-economic status were found to be barriers for women’s undernutrition.

Conclusions

The prevalence of undernutrition was found to be higher than previously reported findings. Household food security, dietary diversity, latrine availability, family resource decision making, food restrictions, weak maternal nutrition education, and malnutrition screening program, the practice of depending on a local alcoholic drink called “Cheka”, drought, traditional way of farming and low socio-economic status were identified factors. Hence, interventions targeting maternal nutrition education, hygiene, and sanitation promotion, household food insecurity improvement strategies should be implemented to improve the nutritional status of pregnant women.

Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review

AIM

Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors.

METHODS

PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar.

RESULTS

Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control.

CONCLUSION

In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.

Stunting at birth and associated factors among newborns delivered at the University of Gondar Comprehensive Specialized Referral Hospital

Background

Stunting at birth is a chronic form of undernutrition majorly attributable to poor prenatal nutrition, which could persist in children’s later life and impact their physical and cognitive health. Although multiple studies have been conducted in Ethiopia to show the magnitude of stunting and factors, all are concentrated on children aged between 6 to 59 months. Therefore, this study was done to determine the prevalence and associated factors of stunting at birth among newborns delivered at the University of Gondar Comprehensive Specialized Referral Hospital, Northwest, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from February 26^th to April 25^th/2020. A systematic random sampling technique was used, to select a total of 422 newborn-mother pairs. The binary logistic regression was employed to identify factors associated with stunting and all independent variables were entered into the multivariable logistic regression model to adjust for confounders. Variables that had significant association were identified based on p-value < 0.05 and the adjusted odds ratio with its respective 95% confidence interval was applied to determine the strength as well as the direction of the association.

Results

About 30.5% (95% CI: 26.3%, 35.1%) of newborns were stunted at birth. Being male [Adjusted odds ratio (AOR) = 2.9(1.62, 5.21)], newborns conceived in Kiremt(rainy season) [AOR = 2.7(1.49, 4.97)], being low birth weight [AOR = 3.1(1.64, 6.06)] were factors associated with stunting at birth. Likewise, newborns born to short stature mothers [AOR = 2.8(1.21, 6.62)] and chronically malnourished mothers [AOR = 15.3(8.12, 29.1)] were at greater risk of being stunted.

Conclusion

Just under a third of newborns are stunted at birth, implying a pressing public health problem. Newborns born to chronically malnourished and short stature mothers were more stunted. Besides, stunting was prevalently observed among male neonates, newborns conceived in Kiremet, and being low birth weight. Thus, policymakers and nutrition programmers should work on preventing maternal undernutrition through nutrition education to reduce the burden of low birth weight and stunting. Further, paying due attention to newborns conceived in Kiremet season to improve nutritional status is recommended.

Undernutrition among Pregnant Women in Rural Communities in Southern Ethiopia

Background

Maternal undernutrition rates in Ethiopia are among the highest in the world. In addition, a huge inequity exists within the country, with pregnant women in rural communities being at increased risk. This study assessed the prevalence of undernutrition and its associated factors among pregnant women in a rural community in southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 376 randomly selected pregnant women. Data were collected through face-to-face interview followed by mid–upper arm circumference measurement. Household food insecurity and minimum dietary diversity for women were assessed. Data were entered into EpiData 3.1 and exported to SPSS 20 for analysis. Logistic regression models were fitted to check associations between independent variables and undernutrition. Statistical significance was set at p<0.05.

Results

The prevalence of undernutrition was 41.2% (95% CI 36.3%–46.3%). Unintended pregnancy (AOR 2.06, 95% CI 1.27–3.36) and not participating in Wome's Health Development Army meetings (AOR 3.64, 95% CI 1.51–8.77) were independent predictors of undernutrition. However, minimum dietary diversity for women of five or more food groups (AOR 0.24, 95% CI 0.07–0.82), having at least one antenatal care visit (AOR 0.46, 95% CI 0.27–0.78), age at first pregnancy ≥20 years (AOR 0.39, 95% CI 0.21–0.76), and being from food-secure households (AOR 0.26, 95% CI 0.16–0.43) were independent protective factors against undernutrition.

Conclusion

Undernutrition among pregnant women was highly prevalent in the study area. Interventions aiming to reduce undernutrition should focus on discouraging teenage and unintended pregnancy, reducing household food insecurity, and promoting antenatal care visits and encouraging consumption of diversified diets by women. Strengthening the existing network of the Women’s Health Development Army seems to be very important.

Prevalence and associated factors of undernutrition among pregnant women visiting ANC clinics in Silte zone, Southern Ethiopia

BACKGROUND

Maternal undernutrition is highly prevalent in underdeveloped countries. Hence, this study was intended to determine the prevalence and associated factors of undernutrition among pregnant women visiting ANC clinics in Silte Zone.

METHOD

Facility-based cross-sectional study was conducted from July to January 2019. Systematic random sampling technique was used to select 422 study participants from 11 randomly selected health facilities. Data was collected by using a structured-interviewer administered questionnaire. Mid upper arm circumference (MUAC) was measured by standard non stretchable MUAC tape. Data was entered into a computer using Epi data 3.1 and edited, cleaned, and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were employed to identify factors associated with maternal undernutrition.

RESULT

In this study, the overall prevalence of undernutrition among study subjects was 21.8%. Age greater than 31 years of women (AOR = 0.15; 95% CI: 0.03, 0.93), Birth intervals > 2 years (AOR = 0.18; 95% CI: 0.04, 0.76), good nutritional knowledge (AOR = 0.34; 95% CI: 0.17, 0.67), and having no dietary change as a result of current pregnancy AOR = 6.02; 95% CI: 2.99, 12.14) were significantly associated with undernutrition.

CONCLUSIONS

The prevalence of undernutrition among pregnant women was 21.8%. Current estimate is lower than previously reported in the study area but higher than reported in developed country. Age of women, Birth intervals, and Dietary change as a result of current pregnancy and Nutrition knowledge were important risk factors/ predictors of undernutrition (MUAC < 23 cm). Interventions targeting maternal nutrition education and child spacing with giving special emphasis to adolescent pregnant women are recommended.

Effect of guided counseling on nutritional status of pregnant women in West Gojjam zone, Ethiopia: a cluster-randomized controlled trial

BACKGROUND

Undernutrition during pregnancy affects birth outcomes adversely. In Ethiopia, despite nutrition counseling on the maternal diet being given by the health workers during pregnancy, maternal undernutrition is still high in the country. Hence, this study aimed to assess the effect of guided counseling using the health belief model and the theory of planned behavior on the nutritional status of pregnant women.

METHODS

A two-arm parallel cluster randomized controlled community trial was conducted in West Gojjam Zone, Ethiopia, from May 1, 2018, to April 30, 2019. The nutritional status of the women was assessed using mid-upper arm circumference. A total of 694 pregnant women were recruited from the intervention (n=346 ) and control (n=348) clusters. Of which endline data were collected from 313 and 332 pregnant women in the intervention and control clusters, respectively. The intervention was started before 16 weeks of gestation and pregnant women in the intervention group attended 4 counseling sessions. Counseling was given at the participants' homes using a counseling guide with the core contents of the intervention. Leaflets with appropriate pictures and the core messages were given for women in the intervention arm. Women in the control group got the routine nutrition education given by the health care system. Data were collected using interviewer administered structured questionnaires and mid-upper arm circumference was measured using an adult MUAC tape. Descriptive statistics  and linear mixed-effects model were used to assess the intervention effect after adjusting for potential confounders.

RESULTS

After the intervention, the prevalence of undernutrition was 16.7% lower in the intervention group compared with the control arm (30.6% Vs 47.3%, P = < 0.001). Women in the intervention group showed significant improvement in nutritional status at the end of the trial than the control group (β = 0.615, p = < 0.001).

CONCLUSION

This study demonstrated that guided counseling using the health belief model and the theory of planned behavior was effective in improving the nutritional status of pregnant women. The results imply the need for the design of model and theory based nutrition counseling guidelines. The trial was registered in Clinical Trials.gov (NCT03627156).