Nutritional Knowledge And Practices Among Expectant Mothers

NUTRITIONAL KNOWLEDGE AND PRACTICES AMONG EXPECTANT MOTHERS IN ONITSHA NORTH AND SOUTH LOCAL GOVERNMENT AREAS OF ANAMBRA STATE

ABSTRACT

The interaction between a pregnant mother and her developing baby are numerous and varied ranging from the food she eats to the kicks of the baby that she feels. What the developing baby feeds on goes a long way in determining its state of health at birth. For a pregnant mother to eat healthfully, she needs to have adequate knowledge of the different component of food. But if the knowledge is not put in practice, it becomes meaningless.

The major objective of this study therefore was to examine the nutritional knowledge and practice of the pregnant women in Onitsha North and South Local Government Areas of Anambra State. Because of the large number involved, and the fact that most of the hospital had no maternity, only two hundred and fifty expectant mothers were used. Eight specific objectives and corresponding research questions and six hypotheses were stated and used for the study.

The instrument for data collection was a questionnaire which had three sections. The personal data of the respondents, fourteen questions each on nutritional knowledge and practice respectively. The questionnaire responses on knowledge were two-point scale of Yes and No while that of practices were in three-point scale of “Practice Always”. “Do not practice” and “Practice Rarely”. Data were analyzed using correlation analysis, percentage, ANOVA and multiple t-test of paired comparison. The results showed that all the hypothesis of the study were rejected. The mean (x) percentage of the subjects who indicated knowledge of what constituted good nutrition was greater than those who indicated regular practice. Some correlation existed between the subject’s knowledge of nutrition and their nutritional practice. Education, age and parity influenced their knowledge and practices of nutrition. Based on these results some recommendations were made such as:- (a) Health educators and nutritionists should be invited to give health talks to pregnant women during antenatal clinic. (b) The age, educational level and parity levels of these expectant mothers should be considered during the lessons.

TABLE OF CONTENTS

Title page

i

Approval Page

ii

Certification

iii

Dedication

iv

Acknowledgement

v

Abstract

vi

Table of content

vii

CHAPTER ONE

Introduction

Background of the Study

1

Statement of the Problem

8

Purpose of the Study

10

Significance of the Study

11

Scope of the Study

12

Research Questions

13

Research Hypothesis

14

CHAPTER TWO

Review of Related Literature

16

Concept of Nutrition

16

Concept of Pregnancy (Expectant)

24

Nutritional Needs and Knowledge in pregnancy

26

Nutritional practices in pregnancy

36

Empirical Studies on the Relationship Between and Pregnancy

39

Empirical Studies on the Role of Nutrition

Supplements in pregnancy

42

Effects of weight gain in pregnancy

45

Consideration in Determining Nutritional Needs in Pregnancy

51

Summary of the Literature Review

61

CHAPTER THREE

Methodology

64

Research Design

64

Design of the Study

64

Area of Study

65

Population of the Study

66

Sample and Sampling Techniques

66

Instrument for Data collection

68

Validity of the instrument

69

Reliability

70

Method of Data collection

70

Method of Data Analysis

71

CHAPTER FOUR

Presentation and Analysis of Data

73

Summary of Major Findings

107

CHAPTER FIVE

Discussion , Conclusion , Recommendation

Discussion

110

Conclusion

128

Recommendation

129

Implication of the Study

132

Limitations of the Study

133

Suggestions for Further Studies

134

References

135

Questionnaire

Appendix

CHAPTER ONE

INTRODUCTION

Background of Study

Eating is one activity most of us take for granted (Donatelle & Davis 1989). At times, according to Donatelle and Davis we are concerned about eating sufficient food that would get us through the day and less attention is given on their nutritional contents. The trend towards a healthful lifestyle calls for healthy eating yet in the effort to eat nutritionally, many people, wonder if they are actually eating a balanced diet or if they have been duped by fed while for some others, any food can go.

Although our choices of food are determined by many factors such as the availability of food in the locality, the money available to purchase these foods, the food supplies including the ways the foods are being processed or prepared and the knowledge and appreciation the individual feels about certain food values (Okafor, 2002), it is important that we realize that we are what we eat and that nutrition has become very important in both preventive and curative healthcare system (United Nations Children Fund, UNICEF 1995). According to UNICEF, dietary factors have been implicated in the etiology of many diseases such as diabetes, heart diseases, cancer and several diseases of children, UNICEF (1995) also pointed the out that Nutrition has shifted from its previous focus on the minimum amount needed to prevent or cure acute deficiency diseases, for example scurvy, and beriberi, to the need to promote health, longevity and resistance to chronic disorders like cardiovascular diseases, cancer, hypertension, diabetes and even acquired immune deficiency syndrome (AIDS). In pregnancy, the importance of nutrition is being emphasized in the newspapers, magazines and health journals and even in many health related television shows to mention but a few.

Nutrition can be defined as the science of food, its use within the body, and its relationship to good health. It includes the study of the major food components – proteins, carbohydrates, fats, vitamins and minerals including water and more than 50 various nutrients of which they are composed (Levy, Digman & Shirref, 1984). It is therefore clear that for somebody to eat healthfully he or she must have adequate knowledge of the different components of food we eat.

Nutrition also can be defined as the science that investigates the relationship between physiological functions and the essential elements of the food we eat (Donatelle & Davis 1998). The world book encyclopedia on health (1996) simply puts nutrition as the process by which living things take in foods and use it. It is therefore the study of food and the process of receiving nourishment from the food we eat after digestion and metabolism. Brien (2010) defines it as the study of food and nourishments, examining the nutritional contents of foods, the amount of nutrients required for healthy growth and function and varies for different people.

The extent of practices of nutrition is dependent among other things on the level of knowledge one has about nutrition. According to Ayo (2003) Nutritional knowledge refers to that aspect of education that prepares one for meaningful nutritional practices. Ayo emphasized that every living thing has the right to have access and the right to affordability of nutritious food and at when due. However, Donatelle et. al. (1998) were of the view that many were accessible to vast number of choices of food or to almost every nutrient by implications should have fewer nutritional problems than their counterparts who do not have such affluence but unfortunately, nutritionists according to them, believe that “diet of affluence” were responsible for many of their diseases and disabilities such as heart diseases, certain types of cancer, hypertension, cirrhosis of the liver, tooth decay and chronic obesity.

Nutritional knowledge without practice is not meaningful. Nutritional practice is outward demonstration of nutritional knowledge in our homes, outside our homes and even in social gatherings. Knowledge about nutrition prepares one for meaningful nutritional practices and it is acquired through formal and non-formal education and it is as old as culture itself since the knowledge is passed on from generation to generation and from parents to their offspring. As such every locality has different kinds of foods available to them and are being prepared differently.

Nutritional knowledge and practices are being emphasized upon according to Williams (2007), because of their role in determining the pregnancy outcome as well as the state of health of the mother after childbirth. In support of this, Karger and Basel (2010) emphasized that nutrition is important to expectant mothers because it can spell the difference between a healthy newborn and a sickly child. Karger and Basel advised the expectant mother to follow scientifically – proven – practices to make sure that the baby is healthy and strong when it is bor. This according to them will be achieved by eating food rich in vitamins and nutrients.

An expectant mother according to Crowder (1995) is a woman that is pregnant. According to him, pregnancy is the fertilization of an Ovum and its implementation in a woman’s uterus. He noted further, that for approximately nine months the mother carries the developing child within her and that the pregnancy terminates with delivery of the child, Nash (2002) observed that the relationship that exists between the mother and her unborn child is much. According to her, “even while the child is still in the womb, its genes engage the environment of the womb in an elaborate conversation, which is a two-way dialogue that involves not only the air the mother breathes and the water she drinks but also what drugs she takes, what diseases she contacts and what hardship she suffers” pg24. According to Nash (2003;19) once the beginning embryo is able to obtain good nutrition directly from the mother, development can proceed more rapidly. But if what is obtained from the mother is not nutritional healthy or balanced, so many complications are bound to arise in pregnancy. Williams (1981) noted that hazards increase with age, the number of pregnancies and the intervals between pregnancies influence the nutritional needs of the mother and the outcome of pregnancy. Furthermore, Zhn et al (1999) observed that pregnant women that are underweight or overweight and those advanced or young maternal age need nutritional support and counseling programmes that will improve birth weight, decrease infant mortality and improve participant’s diet. Also, White head, (1994) maintained that those women delivering first child at over 30 years old were not nutritionally prepared. This is because at that age upwards, many women had been on some type of weight reduction diet which makes their nutritional status not better than that of many teenagers.

More so, an expectant mother who lacks good education and exposure may be easily deceived by smooth talks of nutritional quacks who advocate fad diets. Not only that, the habits and practices of those who lack good education would be affected by taboos, superstitions and prejudices as Mankinde (1980) noted.

Pre-study investigation from some hospitals within the Local Government Areas revealed that, majority of the women of study start antennal care very late and as such do not start their nutritional supplements early enough. The expectant mothers of these local Government Areas still at these century have children with birth defects of the brain and spinal cord (Neural tube), and other malformation of the bone, have very low birth weight while some are over weight most of the expectant mothers themselves have low resistance, diabetes and many are anemic. All these problems may be associated to poor eating habits. It becomes necessary therefore that an expectant mother should have adequate knowledge of nutrition and should be able to eat nutritionally. The writer therefore, is of the view that if the level of knowledge and practices of nutrition among expectant mothers in Onitsha North and South Local Government Areas are identified and adequate information about what constitutes good nutrition is given to them, their nutritional behaviour will improve with motivation.

It is against this background that this topic has been chosen to survey the nutritional knowledge and practices of expectant mothers in Onitsha North and South Local Government Area of Anambra State.

Statement of the Problem

Ayo (2003:20) mentioned that in the World Health organization (WHO) sponsored conference of delegates on 134 countries and 67 United Nations members in 1978, adequate nutrition was classified as “a fundamental human rights” the aim being in pursuance of an acceptable level of nutrition for the people of the world. The women of Onitsha North and south Local Government Area lack the knowledge of good nutrition and this will expose them to diseases associated with malnutrition for example, chronic obesity, tooth decay, overweight & low birth weight and associated problems.

Williams (1981) pointed out that optimal nutrition is a fundamental aspect of therapy for many complication of pregnancy like iron deficiency anemia, Hemorrhagic anemia, megaloblastic anemia and toxemia. These health problems have a high morbidity and mortality consequences. Poor nutrition according to Ramakrishna (2008) is a known cause of low birth weight which remains the significant public health problem in many development countries. Nash (2002) clearly stated that although there may be long-term health threat to the fetus, maternal undernourishment which stunts growth even when they are born full-term, may top such lists.

Onitsha is a business city and experience revealed that it has the biggest market in West Africa. Quite a great number of pregnant women in Onitsha are traders. They also travel a lot to various parts of the country, especially to the northern parts to buy goods for sale. The result is that most times a good number of them sleep many days on the road. Some of the expectant mothers are busy bankers in several banks located in the city. There are nurses, teachers and others, some prefer dining out because they are very busy. A very close look at the expectant mothers revealed that they were lean and not well fed. This is exactly what prompted this study. Also from experience and observation many maternity homes or antenatal clinics in Onitsha rarely give nutritional-talks to expectant mothers and some that give nutritional-talks to expectant mothers do so with inadequate emphasis on its importance to pregnancy outcome. This is far from right and is unlike what is obtainable from some other parts of Nigeria and abroad (overseas) where pregnant women are being educated about what constitutes good nutrition before, during and after childbirth. Pregnant women should be thought what constitutes a healthy diet especially from the local rich foods obtainable for such locality.

To the best knowledge of the researcher no work has been done on these women in the two LAGs to determine how much they knew and practice nutrition. It is against his background that this study that this study has been designed to find out the following purpose of the study.

Purpose of the Study

The main purpose of this study was to: determine the nutritional knowledge and practices among expectant mothers in Onitsha north and south local Government Area of Anambra State. The specific purposes were:-

  1. Ascertain the level of nutritional knowledge possessed by the expectant mothers in Onitsha North and South Local Government of Anambra State.
  2. Determine the level of nutritional practices, of those expectant mothers of study.
  3. Ascertain the relationship between the nutritional knowledge of these expectant mothers’ and those of their practices.
  4. Ascertain the nutritional knowledge of the subjects of study based on their level of education, age and parity.
  5. Determine the nutritional practice of the subjects of study based on their level of education, age and parity.
  6. Determine the relationship between the nutritional knowledge and practices of the subjects of study in relation to their education.
  7. Determine the relationship between the nutritional knowledge and practices of the subjects of study in relation to age.
  8. Determine the relationship between the nutritional knowledge and practices of the subjects of study in relation to parity.

Significance of the Study

This study is expected to access the levels of knowledge and the practices of nutrition among the expectant mothers in Onitsha North and South. The anticipated results of the study will help in the overall improvement of the health status of the community since the pregnant mothers who prepare meals for the family will get an insight to what constitutes adequate nutrition. This information will be useful to other health professionals who are seeking ways of improving health care. To the government ministries of health and education, this study will help the planners to know the state of knowledge of these women and make preparation for enlightening them. It will help the curriculum planners to incorporate nutrition in school curriculum as well as findings ways of making the students appreciate the need for good nutrition and practice them. Fellow researchers reviewing literature and who wish to learn from the experience of previous researchers on a similar subject will also find the work both useful and stimulating. For future researchers, it will form a baseline for those interested in such areas of study.

Scope of the Study

This study would not cover every aspect of nutrition. It will be limited to five essential food nutrients including water and fiber as they play important roles in the body. The six essential nutrients to be studied are proteins, vitamins and minerals, simple carbohydrates and fats. Although there are many categories of pregnant women, this study will consider only those that are not vegetarians and those without degenerative health problems that require specific nutrition or dieting like in diabetic, heart and liver cases.

Research Questions

This study is on the nutritional knowledge and practices of the expectant mothers in Onitsha North and South Local Government Areas of Anambra State. To achieve this, the following specific research questions were asked.

  • What are the levels of nutritional knowledge of the sources of food substances possessed by the expectant mothers in Onitsha North and South Local Government Areas.
  • What are the levels of nutritional practice of those expectant mothers of the study?
  • What is the strength of relationship between the nutritional knowledge and practices of the expectant mother of the study?
  • What is the level of nutritional knowledge of he expectant mothers of the study based on their levels of education, age and parity?
  • What is the level of nutritional practices of these expectant mothers of study in relation to their level of education, age and parity?
  • What is the relationship between the nutritional knowledge and practices of the subjects of study based on their levels of education?
  • What is the relationship between nutritional knowledge and practices of the subjects in relation to their ages?
  • What is the relationship between nutritional knowledge and practices of the subjects of study based on their levels of parity?

Research Hypotheses

The major hypothesis of this study was that there was no significant difference between the nutritional knowledge and practices of the expectant mothers of Onitsha North and South Local Government Areas of Anambra State.

From this major hypothesis, the following sub-hypotheses have been formulated for the study.

  1. There was no significant difference in the nutritional knowledge and practices of mothers of the study.
  2. There was not significant difference in the level of knowledge of nutrition based on their level of education, age groups and parity.
  3. There was no significant difference in the nutritional practices of expectant mothers of this study in relations education, age groups and parity.
  4. There was no significant in the relationship between the nutritional knowledge and practices of the subjects of study based on their level of education.
  5. There was no significant difference in the relationship between the nutritional knowledge and practices of the subjects of the study in relation to their ages.
  6. There will be no significant difference in the relationship between the nutritional knowledge and practices of the subjects of study based on their parity levels.

References

Allen, L. H. (1986, June 18). Nutrition in Pregnancy: be a role model. Nutrition Today Magazine, pp. 21:6-10

Ayo, O.B. (2003, September 22). Adequate nutrition: fulfilling our rights to a happy and healthy life. Business Times, pp.24-26.

Berendes, H.W., & Forman, M. R. (1991). Delayed childbearing:Trends and consequences. In M. keily (Ed.), Reproduction and Prenatal epidemiology. Bocakaton: CRC Press.

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Ceesay, P. & Cole, S. (1997). Effects on birth weight and Prenatal mortality of maternal dietary supplements in rural Gambia: 5 year randomized control trial. Assessed September 24, 2004 on 315: 786-90 Bm J & resid = 315/7111/786>.

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Cogswell,  P. & Ickes, B. (2008). Iron supplementation during pregnancy, anemic and birth weight, a randomized controlled trial. American Journal of Clinical Nutrition,Achieved September 20, 2008 at Link type = ABST & journalCode = ajcn & resid = 78 / 417737.

Crowder, J. (ed) (1995). Oxford Advanced Learner’s Dictionary, New Introductional Edition. New York: Oxford University Press.