Article Type : Research Article
Authors : Animasaun OP, Animasaun OS, Akomolafe BK, Iyevhobu KO, Olurinde OJ, Adepoju OT, Akanmu MO, Omolumen BA, Airhomwanbor KO, Ade-Balogun TD, Courage O, Alonge AS, Ayodele FL, Amoo, ED, Oladunni O, Ogundokun O , Bello LA, Ameh DA and James DB
Keywords : Pregnancy; Dietary pattern; supplements; Medical history; Antenatal care
Background: Pregnancy is associated with
irregular appetite and food intake. This research was aimed at evaluating the
social demographic, pregnancy-related variables, medical history, and dietary
patterns of pregnant women attending primary healthcare centres (PHCs) in
Oluyole local government area (LGA), Ibadan, Oyo state.
Methodology: A cross-sectional survey was
conducted on eighty-nine (89) randomly selected pregnant women, ages 20-35
years, in three PHCs; their socio-demographic characteristics, pregnancy-related
variables, medical history and dietary information were obtained using
pretested semi-structured questionnaires and the data were analysed.
Results: Majority (65.9%) of the pregnant
women were above 25 years, and 94.1 % were married; 82.4% of them have had at
least one child before their present pregnancy. Sixty-seven percent (67%) of
the respondents are self-employed; and 94.1% have formal education.
Pregnancy-related variables showed that majority (41.2%) of them were in their
second trimester. Assessment of the use of supplements and micronutrients
showed that 68.2% and 57.6% have used iron and folic acid supplements
respectively; while over 75% have never taken zinc, magnesium, and vitamin A
supplements. Majority (96.5%) reported having no family history of any disease;
while only few (27.1%) have health insurance cover. Malaria was diagnosed as
the most common illness in 76.5% of the pregnant women. Food mostly consumed
once daily were fruits and vegetables (98.8%), cereals and its products
(54.1%); fish and fish products (36.5%) were consumed 1-3 times weekly while
90.7% of the respondents do consume milk and milk products at least once a
week.
Conclusion: There is
fair report of intake of micronutrient supplement and good dietary lifestyles
as well as abstinence from alcohol and herbal concoctions, however, the
pregnant women had poor early registration for antenatal care since most of
them either resume at the second or third trimester
Pregnancy is a period between conception and birth
during which women encounter a wide range of physical and physiological
changes, as a result of rapid growth and cell differentiation, both of the
mother and the developing foetus. During pregnancy, both the foetus and the
mother are susceptible to alterations in dietary supply, especially of
nutrients which are marginal under normal circumstances [1,2]. In pregnancy,
the period of intrauterine nourishment, growth and development is the most
vulnerable periods which affect nutrition status of foetus [3]. During this
time, inadequate stores or intake of micronutrients can have adverse effects on
the mother, such as anaemia, hypertension, complications of labour, or even
death. Furthermore, the foetus can be affected, resulting in a stillbirth,
preterm delivery, intrauterine growth retardation, congenital malformations,
reduced immune-competence, and abnormal organ developments [4]. It is common
for pregnant women to experience fluctuations in appetite and food intake due
to hormonal changes and changes in the gastrointestinal tract as the fetus
develops [5]. Nutritional status in early pregnancy may be an important
predictor of nutritional risk in late pregnancy [6].
Among the Millennium Development Goals (MDGs) of the
United Nations is the elimination of extreme poverty and hunger [7]. Like
poverty, under nutrition and micronutrient deficiencies often occur as part of
an intergenerational cycle [8]. Pregnant mothers without optimal nutritional
intakes have children with suboptimal nutritional status including impaired
physical and mental development, setting the infant on a deleterious course of
stunting, increased likelihood for infection, and developmental delays [9].
Later in life these children themselves enter their reproductive years at a
nutritional disadvantage and the cycle continues [10]. Furthermore, adults with
nutritional disadvantages often have a lower work capacity due to the early
developmental delays mediated through a lack of education in tackling the
disadvantages. Thus, both malnutrition and poverty often track together and
operate synergistically. Maintaining a healthy intake of some micronutrients
throughout pregnancy has been shown to lower the risk of preterm birth.
Nutritional status in early pregnancy may be an important predictor of
nutritional risk in late pregnancy. There is paucity of established data on
relationship evaluation of social demographic, pregnancy-related variables,
medical history and dietary pattern: focus on pregnant women under primary
healthcare centres in Oluyole LGA, Ibadan, and Oyo state.
Study Design
This was a cross-sectional study carried out in three
primary health care facilities namely Odo Ona Elewe, Adaramagbo and Ajofeebo in
Oluyole local government area of Oyo State. A convenience sampling method was
used to select the sample size. An
interviewer – administered questionnaire was employed for the study
design and blood samples were collected.
Study Area
Oluyole local government area is a local government
under Ibadan in Oyo State. Ibadan is located in south-western Nigeria and lies
on the geographical coordinate of 10? 23? 0? N, 12? 5’ 0” E. It is the capital
of Oyo State, and is reputed to be the largest indigenous city in Africa, south
of the Sahara. Its population is estimated to be about 3,800,000 according to
2006 estimates. The principal inhabitants of the city are the Yoruba. There are
eleven (11) Local Governments in Ibadan Metropolitan
area consisting of five urban local governments in the city and six semi-urban
local governments in the less developed city. Ibadan North, Ibadan North East,
Ibadan North West, Ibadan South East, Ibadan South West constitute the urban
Local Government Areas while Akinyele, Egbeda, Ido, Lagelu, Ona Ara, and
Oluyole LGAs are the semi-urban LGAs in Ibadan land.
Study Population
The study population comprised of 89 pregnant women
(20-35 years) attending three primary healthcare centres in Oluyole local
government area of Oyo State. Pregnant women between the ages of 20-35, in
their first, second and third trimesters without any medical history of chronic
disease, were included in the study while those with medical history of chronic
diseases and above the age of 35 were excluded from this study
Sample Size
The sample size was drawn from three primary healthcare centres in Oluyole LGA, of pregnant women (20-35 years). Considering the prevalence of micronutrient deficiency and allowable error (Precision) of 5%, Dobson formula (n=t2 ((pXq))/d^2) was used for sample size determination [11]. n = Sample size; t =Error risk where t=1.96 at 95% confidence interval; p = Expected prevalence using 21.4% corresponding to p=0; d =absolute desired precision of 5%
Sampling Procedure
A combination of multistage and convenience sampling
methods were used in the survey. First, the list and names of the primary
healthcare centres were obtained from Oluyole LGA Secretariat. From each of the
primary healthcare centres eligible respondents were selected from each
trimester. All pregnant women who met the inclusion criteria and were willing,
were given an equal chance to participate in the study.
Ethical
Approval (MofH/OyS/HREC/DPRSD/09/2016) was obtained
from the ethical committee, Ministry of Health, Oyo State; informed consent of
the respondents was obtained prior to administration of questionnaire.
Data
Collection
Pretested semi-structured questionnaire allowing the
pregnant women to self-report their socioeconomic characteristics, pregnancy
related variables, medical history and dietary lifestyle was administered to
the respondents. The questionnaire was translated into Yoruba language for
those who cannot read English language and two support staff were also
recruited for the study.
Statistical
Analysis
Data entry was done using Microsoft Excel, followed by
export to Statistical Package for Social Sciences (SPSS) version 23 (Chicago,
IL, USA) for analysis using both Inferential (One Way ANOVA) and descriptive
statistics.
Socio Economic
Characteristics of Pregnant Women under Primary Healthcare Centres in Oluyole
LGA, Ibadan
Table 1 describes the socioeconomic characteristics of
pregnant women under Primary Healthcare Centres in Oluyole LGA, Ibadan. Most of
the respondents were married, 3.5% are single parents, while 1.2% were divorced
or separated. About 29.4% of them were aged between 20 - 25 years, 36.5% were
aged 26-30 years, and 29.4% were aged between 20 - 25 years. In the survey, 51 (60.0%) respondents
identified as Christians, and 34 (40.0%) as Muslims. According to their parity
information, 82.4% had given birth to a child before their present pregnancy,
with 42.4% having one child, 29.4% having two children, and 10.6% having three
children or more, while 17.6% did not have any prior birth experience. Also, their spouses were engaged in different
occupations: 55 (64.7%) were self-employed, 19 (22.4%) were Civil servants,
while only 11 (13%) were engaged in other activities that were not outlined in
the questionnaire (Banker, Miner, Clergy and Okada rider). Fifty-seven (67%)
among the respondents are self-employed, 10 (11.8%) are full housewives, while
11 (13%) are engaged in activities not captured in the questionnaire (e.g pepper
grinder and students). Majority (67.1%) of the respondents’ spouses earned
above the country’s minimum wage (? 18,000); 41.2% earned above ?35,000 and
25.9% earned between ?26,000 - ?35,000, while only 5.9% earned between ?5,000 -
?10, 000. Assessment of the level of education shows that 80 (94.1%)
respondents had a kind of formal education; 41 (48.2% had) tertiary education,
31 (36.5%) had secondary education, 8 (9.4%) primary education, while 4 (4.7%)
had informal education (adult education), and 1 (1.2%) had no form of education
at all (Table 1) (Figure 1).
Figure 1: Percentage Distribution of Educational status of the Pregnant Women in
the Study Area
Pregnancy Related
Variables of Pregnant Women Attending Primary Healthcare Centres in Oluyole
Local Government Area of Ibadan.
Table 2 presents the pregnancy-related variables of
pregnant women attending Primary Healthcare Centres in Oluyole Local Government
Area of Ibadan: 35 (41.2%) of the pregnant women were in their second
trimester, 27 (31.8%) in their third trimester, while 23 (27.1%) were in their
first trimester. All the respondents have attended antenatal services at one
time or the other, with 29 (34.1%) respondents attending once, 23 (27.1%)
attending twice, 18 (21.2%) attending thrice and only 1 (1.2%) attending more
than four (4) times. With respect to the respondent taking their antenatal
drugs, 58 (68.2%) took iron supplement, 49 (57.6%) took folic acid, while 82
(96.5%), 83 (97.6%) and 66 (77.6%) have never taken zinc, magnesium, and vitamin
A as at the time of data collection. Majority 70 (82.4%) of the study
participants have taken in at one time or the other before their present
pregnancy, with 36 (42.4%), 25 (29.4%), 9 (10.6%) have had one, two and 3 and
above pregnancies respectively, while 15 (17.6%) have never taken in before now
(Table 2).
Medical History of
Pregnant Women under Primary Healthcare Centres in Oluyole Local Government
Area of Ibadan
Table 3 presents respondent’s medical history. A vast
majority, 82 (96.5%) of the respondents, reported that they have no family
history of any disease and only 3 (3.5%) attest to having a family history of a
disease.
Table 1: Socio-Economic Variables of Pregnant Women under Primary Healthcare Centres in Oluyole Local Government Area of Ibadan.
CHARACTERISTICS |
FREQUENCY |
PERCENT (%) |
||
Religion |
||||
Christian Islam |
51 34 |
60 40.0 |
||
Marital status |
|
|
||
Married |
80 |
94.1 |
||
Single |
3 |
3.5 |
||
Divorced |
1 |
1.2 |
||
Separated |
1 |
1.2 |
||
Ages (years) |
|
|
||
20 – 25 |
25 |
29.4 |
||
26 – 30 |
31 |
36.5 |
||
31 – 35 |
29 |
34.1 |
||
Parity
(Number of Children) |
||||
Nil |
15 |
17.6 |
||
One |
36 |
42.4 |
||
Two |
25 |
29.4 |
||
Three/Four |
9 |
10.6 |
||
Husband occupation |
||||
Civil servant |
19 |
22.4 |
||
Self-employed |
55 |
64.7 |
||
Others |
11 |
13.0 |
||
Respondent occupation |
||||
Civil servant |
7 |
8.2 |
||
Self-employed |
57 |
67.0 |
||
Full housewife |
10 |
11.8 |
||
Others (Unemployed) |
11 |
13 |
||
Respondent monthly earning |
||||
Less than ?5, 000 |
6 |
7.1 |
||
?5, 000 - ?10, 000 |
5 |
5.9 |
||
?11, 000 - ?25, 000 |
17 |
20.0 |
||
?26,000 - ?35, 000 |
22 |
25.9 |
||
More than ?35, 000 |
35 |
41.2 |
||
Total |
85 |
100 |
Table 2: Pregnancy Related Variables of Pregnant Women under Primary Healthcare Centres in Oluyole Local Government Area of Ibadan.
CHARACTERISTICS |
FREQUENCY |
PERCENT (%) |
Trimester |
||
First |
23 |
27.1 |
Second |
35 |
41.2 |
Third |
27 |
31.8 |
Number of antenatal visits |
||
Once |
29 |
34.1 |
Twice |
23 |
27.1 |
Thrice |
18 |
21.2 |
Four times |
14 |
16.5 |
> 4 times |
1 |
1.2 |
Intake of Iron supplement |
||
Yes |
58 |
68.2 |
No |
27 |
31.8 |
Intake of Zinc supplement |
||
Yes |
3 |
3.5 |
No |
82 |
96.5 |
Intake of Folic Acid supplement |
||
Yes |
49 |
57.6 |
No |
36 |
42.4 |
Intake of Vitamin C supplement |
||
Yes |
19 |
22.4 |
No |
66 |
77.6 |
Number of previous pregnancies |
||
Nil |
15 |
17.6 |
One |
36 |
42.4 |
Two |
25 |
29.4 |
3 and above |
9 |
10.6 |
Table 3: Medical History of Pregnant Women Attending Primary Healthcare Centres in Oluyole Local Government Area of Ibadan.
CHARACTERISTICS |
FREQUENCY |
PERCENT (%) |
Family history of any disease |
||
Yes |
3 |
3.5 |
No |
82 |
96.5 |
Intake herbal supplements/concoction |
||
Yes |
18 |
21.2 |
No |
67 |
78.8 |
Under any Health insurance scheme |
||
Yes |
23 |
27.1 |
No |
62 |
72.9 |
Falling sick during pregnancy |
||
Frequently |
52 |
61.2 |
Always |
6 |
7.1 |
Never |
27 |
31.8 |
Diagnosed of Malaria during pregnancy |
||
Yes |
65 |
76.5 |
No |
20 |
23.5 |
Diagnosed of Typhoid during pregnancy |
||
Yes |
2 |
2.4 |
No |
83 |
97.6 |
Diagnosed of running stool during pregnancy |
||
Yes |
3 |
3.5 |
No |
82 |
96.5 |
Diagnosed of gestational diabetes during pregnancy |
||
Yes |
2 |
2.4 |
No |
83 |
97.6 |
Diagnosed of pregnancy-induced hypertension during pregnancy |
||
Yes |
2 |
2.4 |
No |
83 |
97.6 |
Occurrence of convulsion or seizure during pregnancy |
||
Yes |
8 |
9.4 |
No |
77 |
90.6 |
Intake alcohol |
||
Yes |
2 |
2.4 |
No |
83 |
97.6 |
Total |
85 |
100 |
Table 4: Dietary Pattern of Pregnant Women Attending Primary Healthcare Centres in Oluyole Local Government Area of Ibadan.
|
Frequency (%) of
Consumption |
|||||
Diet |
Once
daily |
Twice
daily |
1–3
times weekly |
4-6
times weekly |
Never |
Total |
Fruits
& Vegetables |
40
(47.1) |
17
(20.0) |
20
(23.5) |
7
(8.2) |
1
(1.2) |
85
(100) |
Fruits |
26
(30.6) |
21
(24.7) |
30
(35.3) |
8
(9.4) |
0
(0) |
85 (100) |
Cereals
& Products |
46
(54.1) |
19
(22.4) |
12
(14.1) |
8
(9.4) |
0
(0) |
85 (100) |
Roots
& Tubers |
25
(29.4) |
10
(11.8) |
47
(55.3) |
3
(3.5) |
0
(0) |
85 (100) |
Meat
& Meat products |
36
(42.4) |
28
(32.9) |
17
(20.0) |
4
(4.7) |
0
(0) |
85 (100) |
Fish
& Fish products |
26
(30.6) |
24
(28.2) |
31
(36.5) |
4
(4.7) |
0
(0) |
85 (100) |
Milk
& Milks products |
31
(36.5) |
5
(5.9) |
35
(41.2) |
6
(7.1) |
8
(9.4) |
85 (100) |
Only 18 (21.2%) take herbal supplements/concoction
while 67 (78.8%) do not; .23 (27.1%) have health insurance cover, while 62
(72.9) do not have any health insurance cover. When it comes to the frequency
of falling sick during pregnancy, only six respondents (7.1%) reported to
always fall sick, 52 (61.2%) reported to fall sick frequently, while 27 (31.8%)
had never fallen sick until the time of the survey. Some of the common
illnesses that were diagnosed among the pregnant women are malaria, 65 (76.5%),
which has the highest occurrence among the pregnant women; typhoid, 2 (2.4%);
body pain, 24 (28.2%); diarrhoea (running stool), 3 (3.5%); gestational
diabetes, 2 (2.4%); and pregnancy induced hypertension, 2 (2.4%). Most of these women have never experienced
any of these illnesses. Eight (9.4%) among the pregnant women reported that
they had convulsion or seizure in the course of their pregnancy, while 77
(90.6%) had no such occurrence. Majority (97.6%) of the study participants do
not consume alcohol (Table 3).
Dietary Pattern of Pregnant Women
Attending Primary Healthcare Centres in Oluyole Local Government Area of Ibadan
Table 4 presents respondents’ dietary pattern
(frequency of consumption) of some selected food groups of interest. As
presented in the table, 84 (98.8%) of the respondents do consume fruits and
vegetables every day with 40 (47.1%), 20 (23.5%), 17 (20.0%) and 7 (8.2%)
consuming the food group once daily, 1-3 times weekly, twice daily and 4-6
times weekly respectively. As for the frequency of consumption of fruits alone,
all the respondents do consume fruits at least once every week; 30 (35.3%), 26
(30.6%), 21 (24.7%) and 8 (9.4%) do consume fruits 1-3 times weekly, once
daily, twice daily and 4-6 times weekly respectively. All the respondent do
also eat fish and fish products with the frequency of consumption as follow; 31
(36.5%), 26 (30.6%), 24 (28.2%) and 4 (4.7%) eating fish and fish products 1-3
times weekly, once daily, twice daily and 4-6 times weekly. The final food
group is the milk and milk products, 77 (90.7%) of the respondents do consume
this food group at least once a week with 35 (41.2%), 31 (36.5%), 6 (7.1%) and
5 (5.9%) consuming it 1-3 times weekly, once daily, 4-6 times weekly and twice
daily. However, 8 (9.4%) of the participants do not consume milk and milk
products at all i.e. they never consume the food group for one reason or the
other (Table 4).
Good nutrition is the most powerful factor that can be
used to reduce the burden of diseases and death across the life span around the
world. This study evaluated the social demographic, pregnancy-related
variables, medical history and dietary pattern of pregnant women under Primary
Healthcare Centres in Oluyole LGA, Ibadan, and Oyo state. The mean age (28
years) of the respondents in this study is similar to that of a previous study
(26 years) conducted among pregnant women visiting PHCs for antenatal care in
Ile-Ife in which nearly all the respondents were also married [12]. This might
be due to the fact that the Nigerian culture frowns at pregnancy out of wedlock
[13]. A higher percentage of the pregnant women in this study has at least a
primary education, and ares within the age range of 26-35 years, which is
similar to a previous study by where they recorded a higher percentage of
participants who were between 20-40 years [14]. The result of this study showed
that many of the respondents were self-employed, which is in contrast to the
study by where most of the respondents were civil servants. Our study was
conducted in a semi urban area populated with most people having a lot of
personal businesses. Starting a small-scale business usually do not require
huge amount of capital and resources, this may be one of the reasons why many
of the respondents were self-employed. The percentage of the pregnant women
that were unemployed (11%) is a real reflection of the high rate of unemployment
in the country. Majority of our respondents also earn above the country’s
minimum wage (N18, 000), which is about $ 41.36 USD. Studies have shown that
income plays a huge role in the quality of feeding of pregnant women [15]. Most
(41.2%) of the respondents earned above N35, 000 (about $97) or less monthly.
This is expected because remuneration of workers is generally poor in Nigeria
and also because of the recession in the country as of the time of the study.
Poor remuneration could seriously affect the standard of living of women, as
well as access their necessary foods that could support healthy dietary
practices. Antenatal attendance was highest in the second trimester as 41.2% of
the respondents were in their second trimester. This compares well with a study
carried out by that showed a higher percentage of antenatal attendance in the
second trimester, with the first trimester being the lowest [16]. Timely and
adequate antenatal care is said to be a cornerstone for preventing
complications during pregnancy. Similarly, late first ANC attendance has been
reported in Zambia [17]. The use of herbal medicine has increased over the
years, and studies have shown that between 65 and 80% of the world's population
use herbal medicines as their primary form of health care [18]. This study
recorded 21.2% prevalence of herbal medicine consumption among the respondents
which also agrees with the study carried out by where they recorded 23.3%-82.3%
prevalence of herbal medicine consumption during pregnancy, a higher percentage
of our participant having above a secondary education could be responsible for
a lower prevalence recorded in this study [19]. Malaria during pregnancy has
been reported to reduce birth weight and low birth weight is a major
determinant of infant mortality [20]. According to this study, most (76.5%) of
respondents had been diagnosed with malaria during pregnancy. This malaria
prevalence (76.5%) among these pregnant women was higher than the prevalence of
7.7% reported by Agomo et al. (2009) among pregnant women in Lagos, South-West
Nigeria. This study has also shown that a larger percentage of the respondents
consume fruits and vegetables (47.1%), cereals and products (54.1%) and meat
and meats product (42%) at least once daily; a higher percentage of them
consume roots and tubers, fish and fish products and milk and milk products at
least one to three times daily. Although on the average, the respondents claim
to feed well on consumption of these food groups. The fact that most of them
claim to consume most of these food groups per day suggests that they are aware
of the importance of adequate and well-balanced diet during pregnancy. This
could be a reflection of the health education activities carried out by the
health workers during the antenatal clinic. Most (60%) of the respondents often
eat more than three times in a day; eating small amounts of food more
frequently (in the appropriate combinations and containing the needed
nutrients) contributes to the well-being of pregnant women and development of
their foetus as well as, has the benefits of helping with some of the
uncomfortable side effects of pregnancy including nausea and heartburn. Herbal
medicine usage is becoming popular in developing and industrialized countries
and studies have showed that 65-80% of the world's population use herbal
medicines as their primary form of health care [21]. Unlike for conventional
western/allopathic medicines, most developing countries do not subject herbal
medicine to rigorous scrutiny in regulation of production, sales, importation,
and sometimes safety and efficacy information is lacking [22]. Despite the fact
that knowledge of potential side effects of many herbal medicines in pregnancy
is limited and that some herbal products may be teratogenic in human and animal
models [23]. Data on the extent of women's use of herbal medicines during
pregnancy is scanty especially in sub-Sahara Africa; the legislation for
distribution and purchase of herbal medicines is not as stringent as it is for
conventional medicines [24]. In conclusion, the pregnant women have a good
intake of micronutrient supplements, a good dietary lifestyle, and a high level
of abstinence from alcohol and herbal concoctions. However, they did not
register for antenatal care early, as most of them either resumed during their
second or third trimester. We recommend that early antenatal care resumption
will help in early detection of abnormalities which can be corrected on time;
and that the pregnant women and their family should also consider obtaining
health insurance cover [25].
Conflicts of
Interest
In compliance with the ICMJE uniform disclosure form,
all authors declare the following:
Payment/services
info: All authors have declared that no
financial support was received from any organization for the submitted work.
All authors have declared that they have no financial relationships at present
or within the previous three years with any organizations that might have an
interest in the submitted work.
Other
relationships
All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted
work.
Acknowledgements
The authors would like to thank all the technical
staffs of St Kenny Research Consult, Ekpoma, and Edo for their excellent assistance
and for providing medical writing support/editorial support in accordance with
Good Publication Practice (GPP3) guidelines.