ABSTRACT
Adolescent’s pregnancy is on the increase. This consequently has led to high morbidity, mortality among the born child. Appropriate mother’s nutrition status during pregnancy is essential for both the mother and the fetus. Dietary intake among pregnant adolescents is a key factor that influences their nutrition status and the birth outcome. Nutrition knowledge of the mothers has been shown to affect the dietary practices of the children. However, nutrition knowledge among pregnant adolescents is normally ignored. More research has focused on pregnant mothers in general with a little focus on those who are adolescents. In addition, there is inadequate information on nutrition status and dietary intake among pregnant adolescents. Thus, the study aimed to assess nutrition knowledge, dietary practices and nutrition status of pregnant adolescents. A cross sectional analytical design was used, to carry out the study in Mandera East Sub- County, Mandera County which is one of the ASAL areas in Kenya. A sample size of 258 pregnant adolescents visiting the various Health Facilities in Mandera East Sub- County was selected using a systematic sampling technique from hospital records. A researcher administered questionnaire was used for collecting data. Additional data was collected using focus group discussions guides and key informants interviews. Nutri- survey software was used to analyze dietary data for amount of nutrients consumed. Data was collected, entered and analyzed using SPSS. Pearson’s correlation coefficient was used assess the relationships between non-categorical variables while chi-square was used for categorical variables. Logistical regression analysis was used to assess prediction among variables. A probability value <0.05 was taken as significant. Qualitative data was analyzed to indicate the emerging themes. Results show that the proportion of the pregnant adolescents (22.1%) were unmarried and with up to primary level education (68.4%). They were mainly casual workers or pastoralists earning an average monthly income of 6,934± 625 KES. The mean nutrition knowledge score was
46.4 ± 6.8 was low with majority (47.5%) having moderate nutrition knowledge. The mean number of meals was 2.95 ± 0.6. The mean energy intake was 1850.5 ±33. Intake of energy and other micronutrients were below the recommended daily allowance apart from fat. The mean individual dietary diversity score was 5.64 ± 2.32 food groups. Cereals and oils/fats, flesh meat and milk and milk products were the common foods consumed by most mothers. The nutrition status was poor 31.1% were underweight. About 36.1% of the mothers had been sick in the previous two weeks. The main illness were malaria and cough experienced by (33) 37.5% and (25) 28.4% of respondents, respectively. The nutrition knowledge score was shown to have a significant positive relationship with nutrition status (r=0.069; P<0.001) and morbidity status (χ2 =121 df= 6, P= <0.001). There was a significant relationship (r=0.069; P<0.033) between the dietary diversity score and the nutrition status as well as with morbidity status (r = 0.526; p= 0.005). This study concludes that the nutrition knowledge of these mothers was low and led to poor nutrition status. The poor nutrition status was associated with inadequate dietary intake and frequent illness. The poor dietary practices were as a result of by low education level as well as low nutrition knowledge level which was in combination with lack of adequate income to procure food. The low education level and low income led to poor health seeking behavior and as such led to a higher morbidly status among the pregnant adolescents.This study recommends a policy on utilisation of the training package among health workers so as to help the mothers improve their care practices.
CHAPTER ONE: INTRODUCTION
Background to the study
A third of women in developing countries deliver below the age of 18 years (Langille, 2007). Most of the teenage births are in developing countries (Imamura, Tucker, Hannaford et al., 2007). Research shows that adolescent birth rate is still increasing (Sukrat, 2014). A study in forty-three developing countries in sub-Saharan Africa, show that childbearing among adolescents is high (Singh, 2008). In the majority of these countries, it is due to the fact that girls marry in their teens (Adebowale, Fagbamigbe & Okareh, 2012). In Kenya, based on the Kenya Demographic Health Survey (KDHS, 2014), 18% of young girls aged fifteen to nineteen years are already in child bearing age, 15% are mothers and an additional three percent are pregnant with their first child.
Teenage pregnancy occurs due to minimal protection to teenage girls (Symonds & Ramsay, 2010). Poverty triggers early marriage, where children are regarded as a strategy for economic survival. A girl may be given to an older man in marriage as a means of survival (Adebowale, Fagbamigbe & Okareh, 2012). According to Stewart et al. (2007), traditional attitudes lead to family heads making marital choices for their children without thinking of the implication on the health and welfare of the girl child (Kramer, 2008). Young girls with no education are more than three times likely to have started childbearing by the age of nineteen than those who have acquired secondary and higher education (Were, 2007).
Pregnancy among underage and adolescents girls puts them at the risk of nutrition challenges (Aguilar de Díaz Escobar, 2013). Teenage pregnancy is labeled as a major public health problem due to the associated birth outcomes like premature births, low
birth weight and maternal deaths (Imamura, Tucker & Hannaford et al., 2007). The main reason is that their bodies have low nutrition reserves due to poor dietary practices (Özünlü & Cetinkaya, 2013). Adolescent pregnancies affect the growth and health of mothers and the infant especially stunting which are never achieved later in life. An underweight mother transfers the effect to the infant (Singh, 2008). In Kenya, the main causes of underweight are due to food insecurity and low nutrition knowledge (Obare et al., 2012).
Many girls drop out of school as a result of pregnancy which affects their lives negatively (Rah, Christian & Shamim, 2008). Complications related to teenage pregnancies are the leading cause of death among girls in developing countries (Were, 2007). About 70,000 adolescents die each year (Stapleton & Keenan, 2009). Nutrition throughout pregnancy affects fetal growth and may also have far-reaching effects whereby the born child’s mortality and morbidity are increased. Though no particular study has been conducted in North Eastern Kenya, high cases of mortality among infants born of adolescent’s mothers have been reported in other parts of Kenya (Nderitu et al., 2015).
The nutrition knowledge of women prior to pregnancy is also of importance in increasing the maternal awareness. Studies have shown that nutrition knowledge relates to the quality of food consumed (O’Brien & Davies, 2007). It is important for women to have adequate nutrition knowledge on dietary practices.
This is important to guide on sources of nutritious foods. Appropriate dietary practices characterized by good nutrition practices during pregnancy is important for the pregnancy performance (Bawadia et al., 2010). The dietary behaviors are influenced by
various socio-demographic characteristics and nutrition knowledge is significantly associated with healthier choice.
The nutrition status of women of reproductive age is a determinant of pregnancy outcomes, including birth weight of the new born. A study by Ramachandran (2002), highlights that poor maternal nutrition is a major contributing factor to maternal mortality, infant mortality and low birth weight of infants. Nutrition status at conception is a determinant of status later in life, thus, a vital determinant of reproductive efficiency (Brown & Isaacs, 2011). Early pregnancies related complications are the leading causes of death to girls. A study has shown that it is important to have optimal nutrition status before and during pregnancy (Black et al., 2008).
ASAL regions are characterized by low rainfall and famine (Venton et al., 2012) with pastoralism being the main livelihood. Populations in these regions live in low socio- economic status (Venton et al., 2012). Mandera County is one of the counties in arid and semi-arid lands (ASAL) areas of Kenya. The areas are characterized by food insecurity. Early marriage seems more prevalent in the Northern part of Kenya than the other parts due to the effect of Muslim religion (Omwancha, 2012). This is risky especially in ASAL regions which has >15% of under nutrition among adolescents (Keino, 2014).
Problem Statement
Pregnant adolescents are more vulnerable to malnutrition because of their physiological requirements. There has been an increase in adolescent pregnancies (Sukrat, 2014). Pregnant adolescents are more vulnerable to malnutrition and infections. This causes a risk to the health of mother and child. As such, malnutrition is passed from one
generation to the next leading to vicious cycle. To break this viscous cycle, information specific to pregnant adolescents is needed. Most studies shows information about all pregnant mothers with minimal information on pregnant adolescents. Most of these studies have been conducted in developed countries with only a few in developing countries. In addition, information on prevalence of under nutrition has not been associated with the causative factors like nutrition knowledge. Pregnant adolescents are characterized with poor dietary practices and nutrition status. Studies have associated nutrition knowledge with pregnancy performance (Bookari, Yeatman & Williamson, 2013).
Studies focusing on pregnant adolescents have been scarce in Kenya. Thus, minimal information on how to design programs to intervene on this vulnerable group. This is more so in Mandera County which is an ASAL area. The population in this county is vulnerable due to food insecurity (Waithaka, 2015). This study thus assessed nutrition knowledge, dietary practices and nutrition status among pregnant adolescents in Mandera East Constituency, Mandera County.
Purpose of the Study
The study focused to assess nutrition knowledge, dietary practices and nutrition status among pregnant adolescents in Mandera County. This is with an aim to improving the dietary practices and thus the birth outcome.
