ABSTRACT
Pre-conception nutrition is a key determinant of the pregnancy outcome and the health of a newborn. Since women are likely to conceive at some point in their lives, there is need to attain appropriate nutrition status in order to prepare them to meet the future needs of pregnancy for both the mother and the unborn child. Several factors including demographic and economic characteristics, nutrition knowledge and attitude are known to influence dietary practices. Several researches have focused on pregnancy. However, information about pre-conception and its determinants, especially in Kenya, is scanty and there is concern that women rarely consider their pre-conception dietary practices and nutrition status to be important. This study aimed to establish the determinants of pre-conception dietary practices among female undergraduate students at Kenyatta University, Kenya. The study adopted a cross- sectional analytical design. A sample of 422 female undergraduate students was randomly selected from Kenyatta University. A semi-structured questionnaire and focus group discussion guide were used to collect participants’ information. Body mass index (BMI) was used to assess the participants’ nutrition status. Knowledge on pre-conception dietary practices was determined based on nutrition knowledge scores (correct response: 1, incorrect: 0). Overall knowledge level was percentages of total correct responses categorized as low, moderate and high. Attitudes were measured using a five point likert scale. Dietary practices were determined using a minimum dietary diversity for women (MDDS-W) and food frequency questionnaire (FFQ). Quantitative data was analyzed using SPSS version 20. Chi-square test was used to establish relationship between categorical variables. Regression analysis was used to determine factors influencing pre-conception dietary practices. Qualitative data from focus group discussions (FGDs) was organized and analyzed thematically. Descriptive statistics such as percentages and mean was used to describe data. All analyses were considered significant at p<0.05. Close to half (45.9%) of the participants had low knowledge on pre-conception dietary practices while majority exhibited a positive attitude towards pre-conception dietary practices (99%). The results showed that 31.7% of the participants were not fit to conceive based on their BMI while 36% had MDDS-W below the recommended of ≥ 5 food groups per day. Fruits and vegetables were consumed everyday by only 38.5% and 47.1% of the students, respectively. Chi-square test showed that MDDS was significantly associated with course of study (p=0.034), amount of money used on food (p=0.023) and Knowledge on pre-conception dietary practices (p=0.015). MDDS-W was significantly associated with nutrition status (p=0.044). Logistical regression analysis revealed that level of knowledge on preconception dietary practices (AOR=2.74, CI (1.21-6.17), P= 0.015), nutrition status (AOR=1.26, CI (0.17-9.01), p = 0.040) and
amount of money spent daily on food (AOR=240.25, CI (13.47-4284.87), p < 0.001) were significant predictors of pre-conception dietary practices. Knowledge on pre- conception dietary practices is therefore vital in improving pre-conception dietary practices and subsequently improves nutrition status. Universities should come up with workshops and seminars for undergraduates especially where nutrition is not taught directly or indirectly. Additionally, policy makers should develop sustainable ways of ensuring that women of reproductive age are aware of ways to optimize nutrition before conception.
CHAPTER ONE: INTRODUCTION
Background to the Study
A woman’s pre-conception dietary practice is an important determinant of pregnancy outcome and health of the new born (Bhutta, Makrides & Prentice, 2015). Adolescent girls and women need to be in their optimal nutrition status so as to prepare themselves to meet the future needs of pregnancy (Xie, Madkour, & Harville, 2015). However, Kenya has been undergoing rapid urbanization which has resulted in changes in lifestyle and dietary habits affecting the health and nutrition status of the citizens (Steyn et al., 2012; Steyn et al., 2011). Currently, women of childbearing age do not typically receive information about proper nutrition until they are already pregnant, during the pre-natal period and after delivery. However, the effects of inadequate maternal nutrition start even before conception, continues through pregnancy to delivery and finally lactation where the cycle may resume (Park, 2011; Kenya National Bureau of Statistics (KNBS) & ICF Macro, 2010).
The rapid changes in eating habits and lifestyles in Kenya have resulted to the overweight/obesity transition. Three hundred million women in the world are estimated to be obese making obesity a global health problem (WHO, 2014). The prevalence is even higher in urban areas where the level of obesity in Kenya is now approaching 50% among women in urban areas, aged between 19 and 49 years (Haddad et al., 2015). A study by Kinyua (2013) among undergraduate students in Nairobi showed that 22.9% of the students were overweight and obese while 5.5% were underweight. The minimum BMI was 15.4 kg/m2 and the maximum BMI being 37.3 kg/m2. Research demonstrate
that women who get into pregnancy while overweight and obese are at increased risk of pre-term delivery, pre-eclampsia, gestational diabetes, neonatal death, macrosomia and foetal death (McDonald et al., 2010). Women who get into pregnancy while underweight have an increased risk for low birth weight babies, pre-term births and intrauterine growth retardation (IUD) (Han et al., 2011). Under nutrition reduces the chances of a woman to survive childbirth and give birth to a healthy baby, translating to increased maternal and infant morbidity and mortality (UNICEF, 2014).
Micronutrient deficiencies are a concern among women of reproductive age in Kenya (Republic of Kenya, 2011). Folic acid is especially an important nutrient before conception as it has been proved to reduce the risk of neural tube defects (NTD) such as spina bifida (Hambidge et al., 2014). About 47.9% of non-pregnant women in Kenya experience iron deficiency anaemia (Ministry of Public Health and Sanitation (MOPHS & Save the Children UK (SCUK), 2011). A woman will benefit from boosting her iron stores before becoming pregnant as this helps to prepare her body for the needs of the fetus. Low levels of hemoglobin and ferritin during the pre-conception period increase the risk of poor fetal growth and giving birth to low birth weight babies (Ronnenberg et al., 2004).
While adverse pregnancy outcomes are a world concern, inadequate health care, poverty and inadequate knowledge on health are among the factors that influence morbidity and mortality in developing countries (Harelick, Viola & Tahara, 2011). Johnson et al. (2006) argue that one of the reasons there is little progress in improving pregnancy outcomes is
that there is failure to come up with interventions that inform, screen, manage and modify pre-conception health conditions and risk factors that contribute to adverse maternal and infant outcomes. A study conducted among university undergraduate students in Nairobi showed that more students have lower knowledge in the area of micro-nutrients compared to knowledge in macro-nutrients (Kinyua, 2013). Nutrition knowledge is believed to be important in promoting healthier eating habits but may not be sufficient to change dietary habits on its own hence it is crucial to improve attitude towards healthy feeding habits (Harelick, Viola, & Tahara, 2011).
Non marital cohabitation among university students in Kenya have been on the increase. This has been as a result of the transition of the marriage institution due to the infiltration of the Western culture. A study by Muriithi (2006) in Kenyatta University showed that one third of the students were cohabiting. This exposes the students to pre-marital sexual activity and unintended pregnancies. According to KDHS (2014), close to 2 million women in Kenya experiences unplanned pregnancies annually. In Nairobi, 11.5% of women with secondary education and above had begun childbearing between 15-19 years of age while the median age at first birth for women (25-29 years) in Nairobi with at least secondary level education is 22.9 years. This is the age when most of the women are in college and exposed to unhealthy dietary practices which consequently increase their risk of poor maternal health (Bhutta, Makrides, & Prentice, 2015).
In order to overcome the health risks associated with inadequate nutrition before pregnancy, women in the reproductive age need to be empowered to make healthy food
choices. This can be achieved by providing them with Knowledge on pre-conception dietary practices and improving their attitudes towards healthy eating (Bhutta, Makrides & Prentice, 2015). In Kenya, there is limited literature on what determines women’s pre- conception dietary practices. This study aimed to fill this gap.
Problem Statement
Pre-conception nutrition is very critical since several exposures and risk behaviours affect the foetus development and subsequent outcomes (Hambidge et al., 2014; Grieger, Grzeskowiak & Clifton, 2014). The greatest effects occur early during the pregnancy, most often before the woman realizes she is pregnant (Xie, Madkour & Harville, 2015). Poor dietary practices are a concern among college students in Kenya. A study among first year undergraduate students at Kenyatta University showed that 96.33% of the students exhibited sub-standard feeding habits (Wangeri & Mutweleli, 2012). These are our immediate future mothers and poor feeding habits are likely to predispose them to macro and micro-nutrients deficiencies.
Attainment of the 3rd Sustainable Development Goal (SDG) of achieving good health and wellbeing of all ages may not be achieved considering that pre-pregnancy nutrition status contributes a great deal to birth of healthy children and subsequently a healthy nation. In addition, many studies that have been done before on pre-conception nutrition focus on the effects of pre-conception dietary practices on pregnancy outcomes (Hammiche, 2012; Park, 2011; Cuco et al., 2006). However, there is scanty information with regard to what
determines pre-conception dietary practices among women of reproductive age especially in the developing countries (Harelick, Viola & Tahara, 2011).
Nutrition education has been recommended for women of reproductive age as a way of combating malnutrition (Popa et al., 2013). However, many women may not be aware of the importance of pre-conception nutrition and supplementation, nor even have access to nutrition information (Moos et al., 2008). Most women are also unaware of the extent to which their nutrition status can impact their pregnancy outcome and therefore, improving their weight related behaviours and nutrition should begin during their earlier reproductive years (Dean et al., 2014). There is little research in this area in spite of the growing body of evidence that many of the most significant determinants of birth outcomes may be present before conception takes place. The absence of adequate data is also a limiting factor to developing preventive and intervention strategies. To address this gap, this study aimed to establish the determinants of pre-conception dietary practices among female undergraduate students at Kenyatta University.
Purpose of the Study
The purpose of this study was to establish the determinants of pre-conception dietary practices among female students at Kenyatta University.
