ABSTRACT
Infant weight at birth is an important indicator of maternal
health and nutrition, during pregnancy and a predictor of infant growth and
survival. The effect of dietary intake, antenatal care attendance on birth
outcome among randomly selected pregnant women in their third trimester in
Maigana Ward of Soba Local Government Area, of Kaduna state was evaluated.
Socio-economic/information, nutritional status, dietary intake, micronutrient
status, antenatal care attendance score and baby‟s birth weight at delivery
were determined using standard methods. The socioeconomic characteristics of the
pregnant women evaluated included; age, marital status, highest educational
attainment, occupation and monthly income, 10% of the pregnant women were
between age 11-15years, while 73% were between age 16-30years, 68% had no
formal education and (53%) were poor, earning less than #350 per day. Their
nutritional status revealed that 9.7% were under weight (MUAC ˂ 23.3cm), 31.1%
were normal (MUAC 23.3 – 25.0 cm) and 59.2% were overweight (MUAC ˃ 25cm).
Strong significant correlation was found between MUAC and maternal weight with
birth weight of neonates (r = 0.816, p = 0.000 and r = 0.648, p = 0.000) respectively.
The dietary pattern of the pregnant women reveals cereal, vegetable soup and
sauces were frequently consumed more at 22.1 and 21%, 2-3 times/day while meat,
fish and poultry, fruits and other plants were consumed less at 3 and 4.9%,
once a day respectively. The antenatal care attendance and compliance status
indicated that 76.7% were below compliance, 16.5% had minimal compliance and
6.8% had desired compliance. The mean micronutrient serum concentration (µmol)
were 4.02, 2.52 and 0.45 for iron(Fe),zinc(Zn) and vitamin A respectively,
leaving 73.1%, 96.2% and all (100%) deficient of the micronutrients. The
incidence of low birth weights was 16.5%. Factors that have significant
association with low birth weight are Age (χ2=58.609, p = 0.000), occupation
(χ2=13.019, p=0.011) monthly income (χ2=15.484, p=0.008) Iron level (χ2=7.344,
p=0.007) and maternal nutritional status(χ2=40.713, p=0.000) .This
study establish that nutritional status, socioeconomic status (age, occupation,
monthly income), and antenatal compliance score of the pregnant women were
determinants of their birth outcome in Maigana ward of Soba LGA
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of
Study
Good maternal nutrition is important for the health and
reproductive performance of women, the health, survival, and development of
their children (Mora and Nestel, 2000).Maternal nutrition has been identified
as the mostimportant determinant of adverse pregnancy outcomes in Nigeria. It‟s
also a major determinant of the baby‟s size at birth; it has a direct causal
impact on the incidence of small size at birth (Ogunjuyigbeet al.,2008).
Birth weight is the first weight of a baby, taken immediately
after birth (WHO 2004). Low birth weight is one of the poor outcomes of
pregnancy that has caught the attention of the World Health Organization. Low
birth weight (LBW) is defined as“weight of a live born infant of less than
2500g regardless of gestational age” (WHO, 2006). A child‟s birth weight or
size at birth is “an important indicator of the child‟s vulnerability to the
risk of childhood illnesses and the child‟s chances of survival” (NDHS, 2013).
However, children‟s weight is to great extent determined by factors that
operate in the uterus wall before they are born (Wilcox and Skaeven, 1992). An
infant weight at birth is an important indicator of maternal health and
nutrition prior to, during pregnancy and a predictor of infant growth and
survival (WHO, 2006). At birth, foetus weight is accepted as a single parameter
of the health and nutrition of the mother (Wilcox and Skaeven, 1992).
Dietary intake during pregnancy influences maternal health,
as poor dietary practices during pregnancy have been linked to maternal
complications (Grashamet.al.,2014). During pregnancy most especially second and
third trimester, nutrient needs increase, energy requirements also increase by
about 300 calories per day (Blount, 2005). During pregnancy the daily
requirement of calcium is about 1000 mg, 75 to 100g of protein, the combination
of sodium, potassium, water and iron is about 27 mg , at least 85 mg of vitamin
C and 6-8mg per day of folic acid. Other practices such as alcohol
consumption, use of drugs and tobacco smoking are considered harmful
practices (Blount, 2005).
Undernourishment of foetus in the womb can lead to diminished
potential andpredisposes infant to early death (UNICEF, 2014). Those who
survive tend to have impaired immune function and increased risk of disease and
are likely to remain undernourished, with reduced muscle strength, cognitive
abilities and intelligent quotient throughout their lives. As adults, they are
likely to suffer a higher incidence of diabetes and heart disease (UNICEF,
2014). Components leading to healthy pregnancy outcome include healthy pre
pregnancy weight, appropriate weight gain and physical activity during
pregnancy, consumption of a wide variety of foods, appropriate vitamin and
mineral supplementation, avoidance of alcohol and other harmful substances, and
safe food handling (Sandra, 2014).
Evidence shows that high maternal, prenatal, neonatal and
child mortality rates are associated with inadequate and poor quality health
services, these evidence also suggests that explicit, evidence-based, cost effective
packages of interventions can improve the processes and outcomes of health care
when appropriately implemented (UNICEF, 2000, CSLAC, 2001)
Antenatal care which is the care received from health
professionals during pregnancy (Blount, 2005), contributes to the
identification of pregnancy complications. The early initiation of regular care
has been shown to directly reduce the incidence of low birth weight (Carey and
Hamer, 1991).
Antenatal care is globally accepted and commonly understood
to have a beneficial impact on pregnancy outcome, either through detecting and
treatment of complications or by contributing to the reduction of modifiable
maternal risk of delivering a preterm or growth retarded infant. (Magadiet al.,2000).
It also provides an array of available medical nutritional and educational
interventions intended to reducethe risk of low birth weight and other adverse
pregnancy outcomes (Blooms and Wupis, 1999).Every day, approximately 830 women
die from preventable causes related to pregnancy and childbirth and 99% of
these maternal deaths occur in developing countries (UNICEF, 2014).
Most maternal deaths are preventable, as the health-care
solutions to prevent or manage complications are well known (Moss et al.,
2002). All women need access to antenatal care in pregnancy, skilled care
during childbirth, and care and support in the weeks after childbirth. Maternal health and newborn health are closely
linked. Approximately 2.7 million newborn babies die every year, and an
additional 2.6 million are stillborn. It is particularly important that all
births are attended by skilled health professionals, as timely management and
treatment can make the difference between life and death for both the mother and
the baby (UNICEF, 2014).
A woman‟s nutritional status has important implications for
her health as well as for the health of her children. Malnutrition results in
reduced productivity, increased susceptibility to infections, slow recovery
from illness, and a heightened risk of adverse pregnancy outcomes (NDHS, 2013).
1.2. Statement of
Research Problem
“Accordingto Sandra (2014), pregnancy is a critical period
during which maternal nutrition and lifestyle choices are major influences on
mother andchild health”. Inadequate levels of key nutrients during crucial
periods of fetal development may lead to reprogramming within fetal tissues,
predisposing the infant to chronic conditions in later life (Sandra, 2014).
Pregnant women in sub-Sahara Africa are at high risk of
malnutrition as a result of poverty, food insecurity, political and economical
instabilities, frequent infections and pregnancies (Lartey 2008).
Maternal mortality remains a major challenge to health
systems worldwide (NDHS, 2008). Globally, there were an estimated 289 000
maternal deaths in 2013, due to pregnancy related complications and childbirth
due to lack of access to skilled routine and emergency care, a declineof 45%
from1990 (NDHS, 2013). The sub-Saharan Africa region alone accounted for 62%
(179 000) of global deaths followed by Southern Asia at 24% (69 000). At the
country level, the two countries that accounted for one third of all global
maternal deaths are India at 17% (50 000) and Nigeria at 14% (40 000) (WHO,
2015). The lifetime risk of maternal death indicates that 1 in 30 womenwill
have a death related to pregnancy or childbearing, when compared withthat of
the developed countries of 1 in 3300 women(WHO, 2015).
“In Nigeria the neonatal mortality rate is 528/day, one of
the highest in the world, second to India. Infant and under-5 mortality rates
in the past five years are 69 and 128deaths per 1,000 live births,
respectively. At these mortality levels, one in every 15 Nigerian children die
before reaching age one. One in every eight do not survive to their fifth
birthday. Infant mortality has declined by 26 percent over the last 15
years,”(WHO, 2015).
Therefore an acceleration of the pace of progress is urgently
required to achieve the Sustainable Development Goal (SDG) targets on maternal
and child survival, particularly in high mortality countries in sub-Saharan
Africa like Nigeria (WHO, 2015).Childhood mortality rates are higher in rural
areas than in urban areas (WHO, 2015).In Nigeria, childhood mortality is
highest in the North –West region of the country. There is also variation in the incidence of low birth weight across the
region of Nigeria, North-West has the highest incidence, with (27.2%), followed
by North-East (13.6 %),South-South (11.6 %), North- Central is (7.5%),
South-East (4.3%),while South –West has the lowest, (3.4%)(NDHS, 2013).
1.3 Significances of the Findings
To establish for the first time;
1. The nutritional Status of pregnant women in Maigana ward,
Soba LGA.
2. The incidence of low birth weight in Maigana, Soba LGA.
3. Antenatal attendance score among pregnant women in Maigana,
Soba LGA.
1.4 Justification
Increasing numbers of women are now seeking care during
childbirth in health facilities. Therefore, it is important to ensure a
adequate care provision for both the mother and neonate.
Reliable information about the rates and trends in maternal
mortality and pregnancy outcome is essential for resource mobilization,
planning and as assessment of progress towards achieving Sustainable
Development Goal (SDGs) 1, 2 and 3, (no poverty, zero hunger, good health and
wellbeing respectively) (WHO, 2015).
This study was motivated by the high incidence of low birth
weights in North-west of Nigeria and the attendant negative consequences such as
chronic disease and other health complications in between life. Hence at the
end of the study, information derived will be good input to improving maternal
dietary intake and pregnancy outcome,create awareness on the relationship
between dietary intake and pregnancy outcome and also for policy makers
(Government, Non GovernmentalOrganisation (NGO)) to formulate policies aimed at
improving the maternal and child‟s health in the affected area in particular
and Nigeria in general.
1.5 Aim and
Objectives
1.5.1 Aim
The aim of this research is to assess the dietary pattern,
antenatal care attendance, and birth outcome of pregnant women at Maigana ward,
Soba Local Government Area (LGA) of Kaduna State.
1.5.2 Specific
objectives
The specific objectives of the research were to:
1. Determine the social-economic and nutritional status of
pregnant women at Maigana ward, Soba LGA.
2. Assess dietary intake of the pregnant women in the study area
3. Evaluate the antenatal care utilization of the pregnant women
inMaigana ward Soba local LGA
5. Determine the incidences and contributing factors of low
birth weight in Maigana ward, Soba LGA.
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