MATERNAL DIETARY PRACTICE, NUTRITIONAL STATUS, AND RELATED BIRTH WEIGHT IN HARAMAYA DISTRICT, EASTERN ETHIOPIA

Abstract

Background: Annually, maternal undernutrition and low birth weight contributes to 800, 000 neonatal deaths and 1.1 million neonatal mortality worldwide,respectively. Iron deficiency is one of the leading risk factors for disability and death worldwide, affecting an estimated 2 billion people, of whom 42% were pregnant women. Evidence is scarce on the underlying causes and insufficient to uncover the burden of the problem. This mainly due to the majority of the existing studies are facility based, a proxy measures like hemoglobin is used to assess iron deficiency as part of routine care, as many deliveries occur in homes data on LBW remain limited and research that assess nutritional status using biochemical tests has been generally given less emphasis. Therefore, this thesis carried out to fill the existing gap in Ethiopia, particularly in study setup. Objective: This thesis aimed to assess maternal dietary practice, nutritional status and related birth weight in Haramaya District, Eastern Ethiopia, 2021. Methods: A community-based prospective study design was conducted among 448 pregnant women. The study was embedded into the HDS-HRC. After constructing a sampling frame from the HDS-HRC database, simple random sampling was applied to the eight randomly selected kebeles and then the eligible women were selected using computer generated lottery method. Data were collected on the dietary practice, nutritional status, and biochemical (ferritin, hemoglobin, retinol, and folate) and measured birth weights within 72 hours of birth. Blood was aseptically collected from venous blood, transported and analyzed at the EPHI, while hemoglobin was measured onsite using HemoCue 301. A modified Poisson regression model with robust variance estimation analysis was used to identify variables associated with appropriate dietary practices, acceptable FCS, undernutrition and LBW. A logistic regression and log-binomial regression analyses were used to identify variables associated with consumption of ASFs and ID respectively. Finally, p-<0.05 was used as a cut-off point for declaring significant association. Results: We found that the prevalence of appropriate dietary practice was 15.2% (95% CI=12%- 18%). Appropriate dietary practice was more likely among women who were merchant (aPR=2.07; 95% CI=1.07–4.02) and whose husbands were educated (aPR=1.96; 95% CI=1.06–3.46), whereas it was less likely among those who reported chewing khat (aPR=0.58; 95% CI=0.37–0.90) and restriction of intake of some foods (aPR=0.36; 95% CI=0.20–0.65). In addition, only quarters (24.78%; 95% CI 21%-29%) of the women were found to consume high ASFs. Consumption of high ASFs was more likely among literate women (AOR=1.80; 95% xii CI=1.05-3.10) and those who owned milk cows (AOR=1.70; 95% CI=1.00-2.86). However, those who reported chewing khat were 44% (AOR=0.56; 95%CI=0.35-0.90) less likely to consume ASFs. Moreover, level of acceptable FCS was found to be 54.46% (95% CI 49%-59%). We found that acceptable FCS was higher among respondents who were in the richest quintile (aPR=1.31; 95% CI=1.04-1.66), had ANC follow-up (aPR=1.78;95% CI=1.40-2.27), had a favorable attitude toward dietary practice (aPR=1.30; 95% CI= 1.12-1.52) and consumed high ASFs (aPR=1.28; 95% CI=1.01-1.51). Nutritionally, 47.9% (95% CI: 43%-53%), 53.15% (95% CI=48-58) and 28.03% (95% CI: 21.27- 32.44) of the pregnant women had undernutrition, ID and IDA, respectively. The prevalence of folate and vitamin A deficiencies were 50, and 48%, respectively. Undernutrition was more likely among women who had large family (aPR=1.19;95% CI=1.02-1.40), low DDS (aPR=1.58; 95% CI=1.13-2.21), and anemic (aPR=4.27; 95%CI=3.17-5.76). Similarly, the risk of ID was more likely among women who had low DDS (aRR=1.36; 95% CI=1.07-1.72), those who skip meals (aRR=1.29; 95% CI=1.05-1.57), and who did not have ANC (aRR=1.37 (95%CI=1.14-1.65). This study revealed that 20% (95% CI:16-24%) of mothers gave LBW. The prevalence of LBW was higher among neonates born from undernourished women (aPR=1.92;95%CI=1.33-2.27), born from stunted mothers (aPR=1.54; 95% CI=1.04-2.27) and female babies (aPR=3.7;95% CI=2.28-6.00) but lower among neonates born from mothers who had IFAS (aPR=0.55; 95% CI=0.36-0.84). The prevalence of LBW was 5.04 (95% CI=2.78-9.14) times higher among women who were iron deficient. Conclusions: We found that poor diet practices (inappropriate dietary practice, low consumption of ASFs, and unacceptable FCS), undernutrition, ID and multiple micronutrient deficiency are frequent. In addition, LBW was observed to be prevalent. The factors like education, occupation, wealth, restriction of intake of some foods, skipping meals, DD, and consumption of ASFs and khat chewing were identified as significant predictors of maternal dietary practices. Social and behavioral change communication intervention on maternal nutrition should include strategies that promote lifestyle modification, shifts in social norms on food habit and enable desirable dietary behavior. Future studies on the effect of dietary practice and maternal undernutrition on pregnancy outcomes are indicated