Dietary Practices during Pregnancy and Newborn Nutritional Status at Birth in Arba Minch Health and Demographic Surveillance Site, Gamo Zone, Southern Ethiopia

Abstract

Maternal and child undernutrition is considered a critical public health problem, with a global burden of 22.3% stunting, 6.8% wasting, and 5.7% overweight among children under the age of five in 2022. Additionally, 29.9% of women of reproductive age are anemic. Most children with malnutrition live in low- and middle-income countries. Maternal and child undernutrition contributes to 800,000 neonatal deaths and 3.1 million deaths among children under the age of 5 years annually, respectively Pregnant women are recommended to consume diets rich in adequate energy, protein, vitamins, and minerals from a variety of foods, maintain a healthy lifestyle, monitor weight gain during pregnancy, engage in regular exercise, and avoid smoking and alcohol. However, many pregnant women consume inadeqaute amounts of fruits, vegetables, meat, and dairy products due to a lack of dietary diversity, which can lead to undernutrition. Recent studies in Ethiopia indicate that 51.20% to 81.50% of pregnant women have an acceptable Food Consumption Score (FCS). However, only 24.78% of the pregnant women consumed animal source foods (ASFs), and 44.6% to 78.4% of them have inadequate dietary diversity. As a result, 17.7% to 47.9% of pregnant women experience undernutrition. These findings suggest that dietary practices during pregnancy are suboptimal, with a notable percentage of pregnant women facing undernutrition. Although many epidemiological studies have been conducted on the nutritional status and dietary practices among pregnant women in Ethiopia, there is limited evidence on dietary patterns, breakfast skipping, and the FCS during pregnancy. To our knowledge, no documented study has been carried out the association between adequate dietary practices during pregnancy and newborn nutritional status. Therefore, this study aims to evaluate the role of adequate dietary practices during pregnancy on newborn nutritional status. Chapter 1 provides a general overview of maternal and child malnutrition, including both the long- and short-term consequences of malnutrition during pregnancy on the health of women and children, as well as on future generations, from both global and local perspectives. Additionally, it presents an overview of global studies on undernutrition at birth. xii Chapter 2 outlines the study setting, sampling methods, measurement of variables, and the methodological approaches applied throughout the study. Chapter 3 summarizes the review of evidence on the magnitude and predictors of stunting at birth. We collected studies from major databases, appraised them, analyzed the data, and presented the best available evidence. In total, eleven studies were included in the review, with 10,181 participants. The meta-analysis revealed that the pooled magnitude of stunting at birth was 24.41% (95% CI: 19.33–29.49%). Predictors of stunting at birth included small for gestational age (AOR = 6.21; 95% CI: 1.19–32.33), low birth weight (AOR = 12.97; 95% CI: 8.02–21.00), preterm birth (AOR = 1.99; 95% CI: 1.41–2.82), maternal short stature (AOR = 2.83; 95% CI: 1.67–5.33), primiparous mothers (AOR = 1.59; 95% CI: 1.09–2.32), and undernourished mothers (AOR = 4.33; 95% CI: 3.18–5.33). Chapter 4 presents the findings on the factors associated with dietary patterns, food consumption scores, and their nexus to the nutritional status of pregnant women in the study area. It was found that 76.96% pregnant women had acceptable food consumption scores, while 31.97% were undernourished in Arma Minch HDSS. The ―Cereals-pulses and dairy,‖ ―leafy local food,‖ and ―nutrient-dense‖ dietary patterns were identified. Place of residence (AOR= 2.18; 95% CI: 1.33, 3.59), socio-economic status (AOR= 2.43; 95% CI: 1.68, 3.51), and gravidity (AOR= 1.72; 95% CI: 1.07, 2.78) were predictors of the ―cereals-pulses and dairy‖ dietary pattern. Maternal educational status (AOR= 1.60; 95% CI: 1.02, 2.51), socioeconomic status (AOR= 1.56; 95% CI: 1.02, 2.38), food aversion (AOR= 1.98; 95% CI: 1.16, 3.39), and dietary knowledge (AOR= 2.16; 95% CI: 1.08, 4.32) were predictors of the ―Nutrient-dense‖ dietary pattern. Maternal educational status (AOR= 2.22; 95% CI: 1.48, 3.36), maternal decision-making autonomy (AOR= 1.91; 95% CI: 1.26, 2.90), and dietary knowledge (AOR= 1.86; 95% CI: 1.13, 3.08) were predictors of ―leafy local food‖ dietary pattern. The ―nutrient-dense‖ dietary pattern (AOR = 1.63; 95% CI: 1.07, 2.47) and the ―leafy local food‖ dietary pattern (AOR = 2.32; 95% CI: 1.54, 3.51) were determinants of undernutrition during pregnancy. xiii Place of residence (APR = 1.09; 95% CI: 1.02, 1.20), socioeconomic status (APR = 1.05; 95% CI: 1.01, 1.16), pregnancy status (APR = 1.13; 95% CI: 1.02, 1.25), mass media exposure (APR = 1.19; 95% CI: 1.07, 1.31), vegetable garden (APR = 1.14; 95% CI: 1.04, 1.25), antenatal care visits (APR = 1.13; 95% CI: 1.02, 1.26), meal frequency (APR = 1.23; 95% CI: 1.11, 1.36), BMI (APR = 1.02; 95% CI: 1.01, 1.04), MUAC in cm (APR = 1.03; 95% CI: 1.01, 1.05), and gestational age (APR = 1.04; 95% CI: 1.01, 1.07) were determinants of acceptable food consumption scores. Chapter 5 presents the findings on determinants of breakfast skipping during pregnancy. The odds of non-formal education (AOR = 3.92; 95% CI: 1.75, 8.78), low socioeconomic status (AOR = 2.93; 95% CI: 1.12, 7.68), poor dietary knowledge (AOR = 2.89; 95% CI: 1.29, 6.47), and experiencing morning sickness (AOR = 2.57; 95% CI: 1.13, 5.84) were higher among cases than controls. The odds of breakfast skipping were higher among cases than controls with every increase in family size (AOR = 1.65; 95% CI: 1.25, 2.18), but decrease with every unit increase in mid-upper arm circumference (AOR = 0.58; 95% CI: 0.46, 0.72) and weekly frequency of drinking coffee leaf tea (AOR = 0.84; 95% CI: 0.78, 0.89). Chapter 6 illustrates that 25.30% of newborns were stunted, 10.32% were wasted, and 1.82% experienced concurrent undernutrition (both stunting and wasting). These conditions were significantly higher among newborns whose mothers had inadequate dietary practices during pregnancy. Path analysis identified the following independent predictors of the LAZ-score: inadequate dietary practice (β = 0.48; 95% CI: 0.12, 0.84), maternal nutritional status (β = 0.10; 95% CI: 0.03, 0.17), maternal decision-making autonomy (β = 0.61; 95% CI: 0.18, 1.05), dietary information (β = 1.12; 95% CI: 0.64, 1.60), meal frequency (β = 0.11; 95% CI: 0.02, 0.20), household socio-economic status (β = 0.32; 95% CI: 0.09, 0.54), maternal short stature (β = 0.01; 95% CI: 0.01, 0.02), a ―nutrient-dense‖ dietary pattern (β = 0.10; 95% CI: 0.02, 0.18), and consumption of ―leafy local foods‖ (β = 0.07; 95% CI: 0.01, 0.12). In addition, inadequate dietary practice (β = 0.71; 95% CI: 0.34, 1.08), household socio-economic status (β = 0.08; 95% CI: 0.02, 0.13), and dietary information (β = 0.67; 95% CI: 0.18, 1.16) were found to be independent predictors of the WHZ-score. In conclusion, the findings of this Ph.D. research showed a high prevalence of undernutrition at birth. Three distinct dietary patterns during pregnancy were identified, and these patterns xiv were associated with maternal nutritional status. A low FCS during pregnancy was directly linked to the nutritional status of the mother. Newborn undernutrition at birth was significantly associated with maternal dietary practices during pregnancy. Chapter 7 presents a general discussion of the findings on undernutrition at birth, along with their implications, conclusions, and recommendations for further research.