TABLE OF CONTENTS
Title page – – – – – – – – i
Table of contents – – – – – – – ii
List of tables – – – – – – iv
ABSTRACT – – – – – – – – viii
CHAPTER ONE
1.0 INTRODUCTION – — – – – – 1
1.1 Background
of the study – – – – 1
1.2 Statement
of problem – – – – 2
1.3 Objectives
of the study – – – – 3
1.4 Significance – – – – – – 3
CHAPTER TWO
2.0 LITERATURE
REVIEW – – – – – 4
2.1 Maternal
nutritional and physiological adjustment in pregnancy 5
2.2 Micronutrient status in pregnancy – – 6
2.3 Nutritional requirements of pregnant women – 7
2.4 Energy expenditure and its implication on the pregnant woman 8
2.5 Socio-economic
and nutritional status – – 9
2.6 Nutritional status: it’s implication for pregnancy – 10
2.7 Maternal nutrition and infant development – – 10
2.8 Maternal malnutrition and organ development – 10
2.9 Methods of nutritional assessment – – 11
2.9.1 Historical
information – – – – 11
2.9.1.1 Diet history — – – – – – 12
2.9.1.2 24-Hour recall – – – – – 12
2.9.1.3 Usual food intake – – – – – 12
2.9.1.4 Food record – – – – – – 13
2.9.1.5 Food frequency checklist – – – – 13
2.9.2 Anthropometric data – – – – 13
2.9.3 Physical examination (clinical assessment) – 14
2.9.4 Biochemical analysis (laboratory tests) – – 15
2.10 Methods of assessing iron status – – – 16
CHAPTER THREE
3.0 MATERIALS AND METHODS – – – 18
3.1 Study
area – – – – – – 18
3.2 Study
population – – – – – 18
3.3 Study
design – – – – – 18
3.4 Sample
size – – – – – – 18
3.5 Sampling
technique – – – – – 18
3.6 Methods of data collections – – 19
3.6.1 Questionnaire – – – – 19
3.6.2 Clinical
assessment of pregnant women – – 19
3.6.3 Anthropometric
measurements – – – 19
3.6.3.1 Weight – – – – – – 19
3.6.3.2 Height – – – – – – – 19
3.6.4 Biochemical analysis of iron – — – 20
3.6.5 Dietary assessment of pregnant women using 24-hr dietary recall-20
3.6.6 Food consumption pattern of pregnant women using food frequency check list 20
3.6.7 Ethical clearance and consent forms – – 21
3.7 Data analysis – – – – – 21
CHAPTER FOUR
4.0 RESULTS – – – – – – 22
4.1 Basic
characteristics of mothers – – – 22
4.1.1 Socio-economic characteristics of mothers – 23
4.1.2 Ante
natal history of mothers – – – 25
4.1.3 Medical conditions influencing nutritional status 26
4.2 Nutritional
status – – – – – 27
4.2.3.1 24-Hr dietary recall – – – – – 29
4.2.3.2 Responses to diet history questions – – 30
4.2.3.3 Mothers’ food craving/taboos by trimesters – 31
4.2.3.4 a Food taboos based on mothers’ religion/culture – 32
4.2.3.4b Reasons
for food taboos by mothers’ religion/culture 33
4.2.4 Frequency of food consumption by the mothers 34
4.2.5 Mothers’ frequency of consumption of various food types by trimester – 35
4.2.6 Frequency of consumption of specific foods from various food types – – – – – 36
4.2.6 Frequency of consumption of starchy roots/tubers according to their specific types – – – 36
4.2.6.1 Frequency of consumption of cereal/cereal products according to their specific types – – – 37
4.2.6.2 Frequency of consumption of meat/milk by specific type 38
4.2.6.3 Frequency of consumption of iron rich foods by specific types – -39
4.2.6.4 Frequency of consumption of legume/legume products by specific types – – – – – 40
4.3.0 Biochemical
assessments – – – – 42
4.3.1 Mothers’ haemoglobin levels and packed cell volume values – – 42
4.3.2 Haemoglobin levels of mothers in different trimesters 43
4.3.3 Medical conditions associated with low haemoglobin levels – – 44
4.3.4 Basic characteristics of mothers and their haemoglobin levels – 45
CHAPTER FIVE
5.0 DISCUSSION – – – – 47
5.1 Background information of pregnant mothers 47
5.2 Assessment
of nutritional status – – – 48
5.2.1 Anthropometric assessment of pregnant mothers- – – 48
5.2.2 Anthropometric weight gain in pregnancy – 49
5.2.3 Clinical/physical assessment – – – 49
5.2.4 Dietary
studies – – – – – 50
5.3.0 Iron
status of pregnant mothers – – – 52
5.3.1 Biochemical measurements – – – – 52
5.4.0 Factors that may influence iron status of pregnant mothers 53
5.5.0 Conclusion – – – – – – 53
5.6.0 Recommendation – – – – – 55
REFERENCES – – – – – 56
ABSTRACT
Pregnant and lactating women are nutritionally, the
most vulnerable group especially in developing regions of the world. This is
because of repeated pregnancies and lactation which are aggravated by food
taboos and poor maternal stress. The poor nutrition experienced by these women
results to “maternal depletion syndrome”, the most common of which is
protein-energy malnutrition (PEM). This study therefore had the following key
objectives: (i) to assess the nutritional status of pregnant mothers attending
antenatal clinic at the University of Nigeria Teaching Hospital, Ituku, Ozalla,
Enugu (ii) to assess the iron status of the mothers and (iii) determine factors that are associated
with iron deficiency in pregnant mothers. A retrospective and prospective
review of pregnant mothers in the University of Nigeria Teaching Hospital,
Ituku/Ozalla, Enugu was carried out to assess their nutritional status using
anthropometry, dietary, clinical/physical and biochemical methods. The mothers
were enrolled as they came within a period of six months. A total of 405
mothers were enrolled, only those who met the inclusion criteria were selected.
Those who were included were in their first or second trimesters, consistent in
their visits and were able to do prescribed tests. A total of 263 mothers were qualified
to be selected. The results of the study
showed that of the 263 pregnant mothers that participated, about 7.6% delivered
their babies in a peripheral hospital. The majority (92.4%) of the mothers were
married. About 38.4% were within the age
range of 27 – 31 years and almost the same number (38.3%) were multiparous.
More than a half of the mothers (68.8%)
were in their second trimester and 34.2%
were in their first trimester. Only 9.1%
had no formal education and 18.6% stopped at primary school level. Paleness of
the eyes and swollen legs in 61.2% and 29.3% of the subjects were the clinical
signs of malnutrition observed . The biochemical analysis showed that 39.5% of
the mothers had mild anaemia, 37.3% had moderate anaemia and 10.3% had severe
anaemia in their second trimester. Only
12.9% of the mothers had normal haemoglobin. Mothers’ parity, trimester, hours
of work and marital status affected their haemoglobin levels. Th mean height of
of the mothers was 1.64 ± 0.6m, weight 79.9 ± 10.9kg and age 30.8 ± 3.7 years. Malaria (19.8%) was
the main cause of low haemoglobin in the mothers. The 24-hr food recall and
food frequency analysis showed that on daily basis, the bulk of the mothers
food consisted mainly of starchy roots\tubers, about 19.0% and 28.1% in the first and second trimesters
and consumed less of meat\milk products
( 8.0% and 14.4%) in the respective trimesters. About 9.0% and 7.0% of
mothers in the first trimester consumed fruits and vegetables and nearly 17.0%
and 19.0% of mothers in the second trimester consumed fruits and vegetables.
The mothers on weekly basis consumed diets containing adequate foods. The overall
nutritional status of the pregnant mothers was poor. Mothers’ occupations,
parity and literacy levels significantly (P < 0.05) affected their consumption
of vegetables, fruits, legumes and
starchy roots/tubers at various levels. The inadequate consumption of these
foods may result to micronutrient deficiency (hidden hunger). Women’s under
nutrition translates into loss of economic productivity and of lives.
Appropriate interventions in addressing maternal nutritional status depend on
the factors affecting their status in a particular household and community. A
common cause in Nigeria, Enugu in particular is one in which women are underfed
and over worked.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the study
Pregnant and lactating women are
nutritionally, the most vulnerable group especially in developing regions of
the world because comparatively little is known of their nutritional needs(World
Health Organization (WHO), 2001). The pregnant woman may find herself being
alien to her most favourite dish or going for a particular type of diet that
she previously hated, while some crave for non-food substances that have no
nutritional value. All these are due to physiological changes occurring in
pregnancy as a result of hormonal changes. This change in food or eating
pattern predisposes the woman to a state of malnutrition and low iron reserve,
an important cause of morbidity and when severe, could lead to mortality in
pregnant women.
Malnutrition is intrinsically a
problem affecting individuals and nations which the pregnant women are part of
(UN/SCN, 2002). Large numbers are at risk of specific nutrient deficiencies
like iron. This is because majority are either too poor to acquire foods
containing essential nutrients or are ignorant of the proper cooking technique
and combination of food classes and others have many children and large family
size (ACC/SCN, 2003).
Women in some areas are in a state of
nutritional stress always. The whole of their adult life may be continuously
reproductive as pregnancies and lactation follow one another without pause
(Ojo/Briggs, 2008). Their nutritional needs are high and this is more in some
cultures where women may be responsible for such heavy work carried out with
inefficient and clumsy tools (ACC/SCN, 2002) even during pregnancy. Such strenuous work includes
farming, carrying heavy things to market, cooking, collecting water and wood
and pounding foofoo. The already poor
nutritional state is further aggravated by food taboos applying to women.
Cultural beliefs and food taboos such as women labour, early marriage, female
genital mutilations and superstitions prohibiting women from eating certain
foods like chicken, eggs, mutton, snails, certain types of fish, cereals and
vegetables which are the main sources of animal protein, vitamins and iron etc
also influence the health and nutrition of the pregnant women.
The poor nutrition experienced by
these women results to “maternal depletion syndrome”, the most common of which
is protein-energy malnutrition (PEM). Others are iron deficiency, megaloblastic
anaemia and iodine deficiency (East Wood, 2007) in women of child bearing age
which can lead to low birth weight babies, failure to gain weight in pregnancy,
decrease in subcutaneous fat and muscle tissue. All these undoubtedly
contribute to premature ageing and early death seen in women in the developing
countries.
Nutritional assessment is an
indispensable component of nutritional care of pregnant mothers in antenatal
clinics because the failure to identify and treat malnourished pregnant mothers
poses a threat to the mothers and their fetus in utero.
1.2 Statement of the problem
Food consumption and state of nutrition are
dependent on a whole complex of socio-economic factors which are inter-related
(Ngwu, 1992). Meeting nutrient needs depends on what foods and combinations
consumed. This is particularly important for pregnant women whose nutritional
state is very important; the cost of iron balance on the mother is more in
pregnancy than the non pregnant state. More iron and other nutrients are needed
in pregnancy for the expansion of the maternal red cell mass though most of the
iron is returned to stores after delivery (INACG, 2006).
A lot of women enter into pregnancy
with poor or low iron reserve and general malnutrition and pass through the
clinics unnoticed resulting to lots of complications during pregnancy, labour
and puerperium (INACG, 2006). The low reserve of iron and general malnutrition
could be due to low iron and other essential nutrients like protein, minerals,
vitamins, carbohydrates content in food probably from ignorance, cultural
practices, poverty, type of occupation and environment or due to
bioavailability of iron and other nutrients from gastric enzyme alterations.
The pregnant women are also given
nutrition education in the clinics by unqualified personnel. The nutrition
education given is not meaningful with the result that they remain in the dark
about the benefits and adverse effects of low or non consumption of these food
components. The pregnant women are also in a more nutritional and health
dilemma because of the severe economic situation in the country affecting the
poor and the rich, young and old. It is therefore necessary to identify the
pregnant women with poor nutritional and iron status with a view to monitoring
and helping them pass through child birth with no complications to them and their
babies.
It is
improper to correct nutrition inadequacies of the pregnant women without
understanding their food consumption pattern and socioeconomic background
(DeMaeyer, 2008). This study was therefore undertaken to assess the nutritional
and iron status of pregnant mothers attending antenatal clinic at the
University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu.
1.3 Objectives of the study
The general objective of this study
was to assess the nutritional and iron status of pregnant women attending
antenatal clinic at the University of Nigeria Teaching Hospital, Ituku/Ozalla,
Enugu.
The study has the following specific objectives:
- to
assess the nutritional status of pregnant mothers attending ante natal clinic
at University of Nigeria Teaching Hospital using anthropometric, biochemical,
dietary and clinical methods.
- to
assess the iron status of the pregnant mothers using their haemoglobin and
haematocrit counts.
- to
determine factors that are associated with iron deficiency in the mothers.
1.4 Significance
of the study:
(1) The study will
provide basic information on the nutritional status of pregnant mothers
attending antenatal clinic at the University of Nigeria Teaching Hospital in
particular and Enugu State in general and will be of great importance to
nurses, doctors, nutritionists and policy makers on the best way to care for
women before, during and after pregnancy.
(2) Women as a
whole should have their own health and nutritiona
