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Background: A nutritious and healthy diet during pregnancy is essential for the health of both mother and baby. Inadequate dietary intake during pregnancy contributes to maternal malnutrition and can have lifelong effects on the health of the child. Maternal malnutrition is common in many low-income countries, including the Democratic Republic of Congo (DRC). Kwango province, DRC, has a high prevalence of malnutrition among all population groups, including macro and micronutrient deficiencies among pregnant women. The study aimed to explore the dietary knowledge and practices of a pregnant woman in this area. Methods: This study adopted a qualitative approach using in-depth interviews (IDIs) with pregnant women and key informants, and focus group discussions (FGDs) with fathers and grandmothers in the community, to explore women’s knowledge and practice about diet during pregnancy. Data were collected between January and April 2018. IDIs were conducted with pregnant women who were recruited at antenatal clinics during their second and third trimesters. IDIs were undertaken with selected key informants, who were health workers providing care to pregnant women, and included doctors, nurses, nutritionists, and community health workers. All IDIs and FGDs were audio-recorded, transcribed verbatim, and translated to English. The triangulation method and thematic analyses were used. Results: Overall, women showed good general knowledge about nutrition and the need for increased and varied foods during pregnancy, but little technical knowledge about nutrients and sources of nutrition. Healthcare facilities, media, NGOs, and family members were the main sources of nutritional information. However, women were unable to put this knowledge into practice, primarily due to poverty and poor access to a variety of foods. The Popokabaka community accessed food from farming, fishing, and the market, although purchasing food was frequently unaffordable. Cassava flour was the most common daily food. Food taboos, traditional practices, and late ANC attendance were identified as factors that influenced dietary practices. Conclusions: Various social, economic, and environmental factors within the local community influenced dietary practices among pregnant women in rural DRC. A comprehensive approach is required to improve nutrition, and address food insecurity, cultural practices and improve the health outcomes of both mother and child.
The study was conducted in Popokabaka Heath Zone (HZ), one of the 516 HZs in the DRC. It is located in Kwango Province, which has many rivers and a tropical climate throughout the year. The population of Popokabaka is approximately 202 000 people. Popokabaka is isolated and highly inaccessible from developed areas, the closest urban area is over 10 h’s drive away, mainly on sand roads. The climate permits the cultivation of a wide variety of crops, as well as keeping livestock and fishing. Agriculture and farming are the most common activities in communities in the Kwango province. Women play an essential role in the cultivation of crops and food production. This is an area with high levels of poverty and unemployment, and malnutrition among pregnant women is prevalent. The most commonly spoken local language in Popokabaka is Yaka. The study was conducted in two health areas of Popokabaka (Popo City and Ingasi village: 12 km apart from each other). The areas were purposively chosen to include both a peri-urban and a rural area in Popokabaka HZ. A qualitative study was conducted in two health areas of Popokabaka HZ. The study population consisted of pregnant women, community members, and key informants. Key informants were health professionals involved in providing care to pregnant women and included facility health workers (Doctor, nurses, and nutritionist who provide antenatal care) and community health workers (CHW). All participants were purposely chosen based on their willingness to participate. To be eligible, all participants have resided in the health area for at least 2 years. All pregnant women aged 18 years or above attending for antenatal care (ANC) were eligible to participate were approached to participate. Pregnant women were recruited in the ANC at the hospital and two health centers during the ANC. In the beginning, 12 pregnant women are targeted. Only nine consented, and completed to participate in the study. Older women were purposively selected based on having at least one grandchild, and husbands were selected based on being the father of at least one child, and were eligible to participate in focus group discussions (FGDs). Older women and husbands were not the family members of participating pregnant women. Assisted by a community health worker (CHW), older women and husbands were recruited into the community and invited to participate in FGDs in the community one week before the interview. All participants approached consented and completed. All facility-based health workers and CHWs providing care for pregnant women were identified and invited to participate. Facility-based health workers were approached at health centers and CHWs were identified in the community. Data were collected using in-depth interview (IDI) with pregnant women and health professionals, and FGDs with grandmothers and fathers. Qualitative data collection methods were chosen to explore in-depth information about the topic. FGDs were conducted separately among groups of grandmothers and fathers, this allowed for a dynamic interaction between the participants. All IDIs and FGD were conducted using discussion guides and in the local language Lingala (Yaka) or French according to the preference of the participants. The guides covered topics including food recommendations during pregnancy, advantages of good nutrition during pregnancy, food habits, and food beliefs during pregnancy. To ensure privacy, interviews were conducted at the residence and the office with pregnant women and health professionals respectively. FGDs were conducted in each village at the nearby health centers. Data collection was stopped when saturation was reached. An experienced qualitative researcher assisted by a trained field worker, who was able to speak three local languages, collected all data. All interviews and FGDs were audio recorded using digital audio recorders and notes were taken by the field worker. The audios were transcribed verbatim by the team of three assistants by the investigator, and transcripts were translated into French and English. Transcripts were quality controlled by re-listening to the audio recordings and comparing with transcripts. Data were analyzed according to the inductive thematic approach. To increase coding validity, independent codes were created from a few interviews by two researchers and compared until a coding framework was agreed on. Finally, triangulation of IDI and FGDs was used to validate the data. The proposal received ethical approval from the ethics committees of the Kinshasa School of Public Health. Participation was voluntary. All participants provided written informed consent after a full explanation of the nature, purpose, and procedures used in the study. The participants were informed that responses will be anonymous and that they were free to withdraw from the interview or discussion at any time.
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