Utilization of Antenatal Care Services, Nutrition status and Dietary diversity in pregnancy: a case study of Pumwani Maternity Hospital

Abstract

A woman’s nutritional status has a major bearing on whether her pregnancy has a healthy course and outcome. Nutrient adequacy and better health outcomes in pregnant women are determined by their dietary diversity which is the inclusion of different types of foods or food groups in one’s daily dietary intake. Antenatal care provides the opportunity to learn about health and nutritious diets along with other clinical advice associated with pregnancy. This study evaluated the dietary nutrient intake of pregnant women in relationship to their general nutrition status. The validity and effectiveness of nutrition education as a component of the antenatal care service was also evaluated. The availability of water, sanitation and hygiene practices was also assessed. The study used a cross-sectional design that involved random sampling 133 women attending antenatal clinic at Pumwani Hospital. Dietary intake was assessed using a food frequency table and a dietary diversity score. The height and mid- upper-arm circumference were assessed to determine the nutrition status of the women. Descriptive statistics together with graphical analysis were used to describe the basic features of the data and provide simple summaries about the sample. General linear and logit modelling and chi-square analysis methods were used to clarify and explain relationships between different variables that may be associated with the study data. The study found that the women had much access to water and hygiene services however over a third (36.8%) of them still utilized untreated drinking water. Handwashing techniques among these women was also sub-optimal as a quarter (28%) of these women used water only. Awareness on micronutrient deficiencies among the women was low with over 50% of the women lacking awareness. The mean nutrition knowledge of the women was found to be 44.79±18.82% with the least knowledge scores of 29.17±22.49% and 37.89±24.37% recorded in micronutrients and nutritional deficiencies, respectively. The study also found that the DDS scores were 9.02±1.31. Perception on health and nutrition problems and occupation of the women significantly (p<0.05) influenced the DDS scores. The most food groups were the fats, fruits, starchy cereals, vegetables and milk as they were consumed 5-6 times a week by 97%, 82.7%, 57.1%, 56.4% and 56.4% of the women respectively. Perception of the women on nutritional problems significantly (p<0.05) influences food frequency. The study also found that with a MUAC cut-off of <210mm, only 3.8% of these women were malnourished. The women had an average initial and current BMI of 27.34±4.30 and 27.74±4.57 kg M2, respectively, which were significantly (p<0.05) influenced by the education level. Majority (80.0%) of the women were able to be attended to at the ANC under two hours. The waiting time significantly influenced (p<0.05) frequency of attendance in the ANC among the women. A large proportion of the women had not been trained on various health and nutrition issues including nutrition in pregnancy (70.7%), pregnancy related complications (79.7%), labour and delivery (94.0%), breastfeeding (84.2%) and care of the new born (94.0%) during the ANC visits. The clients observed that greater improvements were needed in customer care services, availability of gynaecologists and customer handling etiquette. In conclusion, accessibility to nutrition services through the ANC services seem to serve a limited role for it is among the least utilized services. In as much as the women had a good nutrition status, gaps in terms of dietary and health practices require improvement. Outreach with nutrition and health education components of the ANC services need improvement that will improve their effectiveness.