Determinants of dietary diversity practice among pregnant women attending antenatal clinic at Wachemo University Nigist Eleni Mohammed memorial referral hospital, Southern Ethiopia

PLoS ONE, Volume 16, No. 4 April, Year 2021

Interpretation

Background Dietary diversity has continued to receive a global attention among pregnant women as they have been considered susceptible to malnutrition because of their increased nutrient demands. Thus, a variety of foodstuffs in their diet are necessary for ensuring the appropriateness of their nutrient consumptions. This study, therefore assessed the dietary diversity practice and its determinants among pregnant women attending antenatal clinic at Wachemo University Nigist Eleni Mohammed memorial referral hospital, Southern Ethiopia. Methods A hospital-based cross-sectional study was carried out on 303 participants from May 1 to June 15, 2019 using a systematic random sampling technique. Data were entered and analyzed using SPSS (version24.0). Both bivariate and multivariable logistic regression analyses were used to decide the association of each explanatory variable with the outcome variable. Odds ratio with their 95% confidence intervals was calculated to identify the presence and strength of association, and statistical significance was declared at p < 0.05. Results The overall prevalence of adequate dietary diversity practices was observed to be 42.6%. The determinants of dietary diversity practice included earning of a monthly income ≥2000 Ethiopian birr (AOR = 1.62; 95%CI:1.19–2.85), maternal educational level (AOR = 2.50; 95% CI: 1.05–6.12), educational status of partner (AOR = 2.45; 95% CI:1.20, 9.57), having a partner who was a government employee (AOR = 4; 95% CI:2.18–7.21), and the receiving of nutritional information (AOR = 1.35; 95% CI: 3.39–6.94). Conclusions The study indicated that the overall consumption of adequate dietary diversity practice was found to be low. Therefore, increasing household income, enhancing nutritional related information, advancing the academic level of both wife and her partner is essential to improve women’s dietary diversity practice. A hospital-based cross-sectional study was carried out from May 1 to June 15, 2019 among pregnant women attending the ANC clinic at Wachemo University Nigist Eleni Mohammed Memorial referral hospital (WUNEMMRH), in Hossana town, Hadiya Zone, Southern Nation’s Nationalities and Peoples Region at 232 kilometers south of Addis Ababa, the capital city of Ethiopia. WUNEMMRH gives preventive, curative and rehabilitative clinical services structured in four case teams in outpatient, inpatient, emergency and critical care, maternal, child health and obstetrics, and the operation theatre. The hospital was chosen due to its highest patient and client attendance. It is the biggest hospital in Hadiya Zone serving the Zonal population and bordering Zones and special woredas including Silte, Gurage, Halaba and Kambata-Tembaro. The source population comprised all pregnant women attending the ANC clinic at WUNEMMRH during the study period, while the study population encompassed randomly selected pregnant women attending the ANC clinic at WUNEMMRH during the study period. Pregnant women who were critically ill or unable to communicate were excluded from the study. The sample size of 306 was calculated using a single population proportion formula with the following considerations: the prevalence of dietary diversity practices is 25.4%, which was taken from the research conducted in Shashemane [19], with a 95% confidence interval, a margin error of 5%, and 5% non-response rate. A systematic random sampling technique was used to recruit the study participants. Since sampling interval was computed to be three, every third interval was used to enroll the participants. The questionnaire was first prepared in English, translated into Amharic, and then translated back to English to ensure the consistency. Two different experts ensured consistency by translating it back to English. Data was collected in Amharic (which is the local language). Data was collected through a structured and pretested questionnaire used in face to face interviews. Dietary intake information was measured by asking participants to list all food items they consumed in the last 24 hours preceding the survey day. Midwives, four with diplomas and two with a bachelor’s degree, were recruited for the data collection and supervision. The data collectors and supervisors were given training on the content of the tool, the purpose of the study, and how to collect the data. The questionnaire was adapted from Food and Agriculture Organization (FAO) dietary diversity guidelines [20]. The validity of the questionnaire was approved through the proper application of validity criteria (content validity). Reliability was assured through stability (the instrument was given to the same respondents more than once under similar situations and it was found consistent). Data were collected on socio-demographic data; obstetric related history, food groups and dietary diversity practice. The validity and reliability of the instrument was ensured in scientific manner. The questionnaire were pretested on 15 pregnant women in Hossana health center which is out of the study area before the actual data collection period. After the pretest, understand ability, clearness, and organization of the instrument was also checked. The supervisors and the investigators strictly monitored the data collection process every day over course of the pretest and the actual data collection period. Further, the filled tool was collected and signed by the supervisor after being observed for any lacking items and certainty. For this study, a total of ten food groups was used and participants who consumed ≥5 food groups were categorized as having an adequate dietary diversity practice while those participants who consumed < 5 food groups was categorized as having an inadequate dietary diversity practice [20]. Data were entered and analyzed using SPSS (version 24.0). Descriptive statistics, frequency, and proportions were calculated to summarize the data. Logistic regression analyses were conducted to identify determinants of diversity dietary practice. Firstly, bivariate logistic regression analysis was conducted on all explanatory variables. Then, multivariable logistic regression was undertaken on variables that had a p-value ≤ 0.25 in the bivariate logistic regression analysis. The degree of association between explanatory variables, and outcome were evaluated using odds ratio with 95% confidence intervals. P<0.05 was stated as statistically significant. The Hosmer-Lemeshow statistic had a significance of 0.86 showing that the model was a good fit. Multi-collinearity was tested for interaction between explanatory variables through variance inflation factor which displayed a value of < 5. Ethical clearance was obtained from the Institutional Review Board of Hossana College of Health Science. Formal letter was attained from the Hossana town health bureau. Then, permission was obtained from WUNEMMRH before starting the data collection. The participants were informed about purpose, procedures, potential risks and benefits of the study. Informed written consent was sought from selected participant to confirm their willingness to participate in the study before the interview. Parental or legal guardian consent was taken for respondents who were under 18 years of age. To keep confidentiality, name was not included in the written questionnaire. Additionally, the participants were ensured that refusal to consent or withdrawal from the study would not alter or put at risk their access to care.

AI Digest

Study Justification:

– The study addresses the importance of dietary diversity among pregnant women, who are susceptible to malnutrition due to increased nutrient demands.
– It provides insights into the dietary diversity practices of pregnant women attending antenatal clinics at Wachemo University Nigist Eleni Mohammed Memorial Referral Hospital in Southern Ethiopia.
– The findings can contribute to the development of interventions and policies aimed at improving women’s dietary diversity practices and overall health during pregnancy.

Highlights:

– The overall prevalence of adequate dietary diversity practices among pregnant women was found to be 42.6%.
– The study identified several determinants of dietary diversity practice, including monthly income, maternal educational level, educational status of the partner, partner’s occupation, and receiving nutritional information.
– Increasing household income, enhancing nutritional-related information, and advancing the academic level of both the wife and her partner are essential for improving women’s dietary diversity practice.

Recommendations:

– Increase household income through income-generating activities and economic empowerment programs targeting pregnant women and their families.
– Enhance nutritional-related information by providing comprehensive and accessible education on the importance of dietary diversity during pregnancy.
– Promote education for both women and their partners to improve their understanding of nutrition and its impact on maternal and child health.
– Collaborate with government agencies and organizations to develop policies and programs that support and encourage dietary diversity practices among pregnant women.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies related to maternal and child health, including nutrition.
– Wachemo University Nigist Eleni Mohammed Memorial Referral Hospital: Provides healthcare services and can play a role in implementing interventions to improve dietary diversity practices.
– Non-governmental organizations (NGOs): Can support educational programs and initiatives aimed at improving dietary diversity practices among pregnant women.
– Community health workers: Can play a role in delivering nutritional information and supporting pregnant women in adopting dietary diversity practices.

Cost Items for Planning Recommendations:

– Development and printing of educational materials on dietary diversity: Includes the cost of designing, printing, and distributing educational materials such as brochures, posters, and pamphlets.
– Training programs for healthcare providers and community health workers: Includes the cost of organizing training sessions, hiring trainers, and providing materials for training.
– Income-generating activities: Includes the cost of implementing programs that support pregnant women and their families in generating additional income, such as vocational training or small business support.
– Monitoring and evaluation: Includes the cost of monitoring the implementation of interventions and evaluating their effectiveness in improving dietary diversity practices among pregnant women.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, sample size calculation, data collection methods, and statistical analysis. However, it lacks information on the validity and reliability of the questionnaire, and the specific results of the logistic regression analysis. To improve the evidence, the abstract could include details on the validity and reliability testing of the questionnaire, as well as the specific odds ratios and confidence intervals for each determinant of dietary diversity practice.

Abstract

A hospital-based cross-sectional study was carried out from May 1 to June 15, 2019 among pregnant women attending the ANC clinic at Wachemo University Nigist Eleni Mohammed Memorial referral hospital (WUNEMMRH), in Hossana town, Hadiya Zone, Southern Nation’s Nationalities and Peoples Region at 232 kilometers south of Addis Ababa, the capital city of Ethiopia. WUNEMMRH gives preventive, curative and rehabilitative clinical services structured in four case teams in outpatient, inpatient, emergency and critical care, maternal, child health and obstetrics, and the operation theatre. The hospital was chosen due to its highest patient and client attendance. It is the biggest hospital in Hadiya Zone serving the Zonal population and bordering Zones and special woredas including Silte, Gurage, Halaba and Kambata-Tembaro. The source population comprised all pregnant women attending the ANC clinic at WUNEMMRH during the study period, while the study population encompassed randomly selected pregnant women attending the ANC clinic at WUNEMMRH during the study period. Pregnant women who were critically ill or unable to communicate were excluded from the study. The sample size of 306 was calculated using a single population proportion formula with the following considerations: the prevalence of dietary diversity practices is 25.4%, which was taken from the research conducted in Shashemane [19], with a 95% confidence interval, a margin error of 5%, and 5% non-response rate. A systematic random sampling technique was used to recruit the study participants. Since sampling interval was computed to be three, every third interval was used to enroll the participants. The questionnaire was first prepared in English, translated into Amharic, and then translated back to English to ensure the consistency. Two different experts ensured consistency by translating it back to English. Data was collected in Amharic (which is the local language). Data was collected through a structured and pretested questionnaire used in face to face interviews. Dietary intake information was measured by asking participants to list all food items they consumed in the last 24 hours preceding the survey day. Midwives, four with diplomas and two with a bachelor’s degree, were recruited for the data collection and supervision. The data collectors and supervisors were given training on the content of the tool, the purpose of the study, and how to collect the data. The questionnaire was adapted from Food and Agriculture Organization (FAO) dietary diversity guidelines [20]. The validity of the questionnaire was approved through the proper application of validity criteria (content validity). Reliability was assured through stability (the instrument was given to the same respondents more than once under similar situations and it was found consistent). Data were collected on socio-demographic data; obstetric related history, food groups and dietary diversity practice. The validity and reliability of the instrument was ensured in scientific manner. The questionnaire were pretested on 15 pregnant women in Hossana health center which is out of the study area before the actual data collection period. After the pretest, understand ability, clearness, and organization of the instrument was also checked. The supervisors and the investigators strictly monitored the data collection process every day over course of the pretest and the actual data collection period. Further, the filled tool was collected and signed by the supervisor after being observed for any lacking items and certainty. For this study, a total of ten food groups was used and participants who consumed ≥5 food groups were categorized as having an adequate dietary diversity practice while those participants who consumed < 5 food groups was categorized as having an inadequate dietary diversity practice [20]. Data were entered and analyzed using SPSS (version 24.0). Descriptive statistics, frequency, and proportions were calculated to summarize the data. Logistic regression analyses were conducted to identify determinants of diversity dietary practice. Firstly, bivariate logistic regression analysis was conducted on all explanatory variables. Then, multivariable logistic regression was undertaken on variables that had a p-value ≤ 0.25 in the bivariate logistic regression analysis. The degree of association between explanatory variables, and outcome were evaluated using odds ratio with 95% confidence intervals. P<0.05 was stated as statistically significant. The Hosmer-Lemeshow statistic had a significance of 0.86 showing that the model was a good fit. Multi-collinearity was tested for interaction between explanatory variables through variance inflation factor which displayed a value of < 5. Ethical clearance was obtained from the Institutional Review Board of Hossana College of Health Science. Formal letter was attained from the Hossana town health bureau. Then, permission was obtained from WUNEMMRH before starting the data collection. The participants were informed about purpose, procedures, potential risks and benefits of the study. Informed written consent was sought from selected participant to confirm their willingness to participate in the study before the interview. Parental or legal guardian consent was taken for respondents who were under 18 years of age. To keep confidentiality, name was not included in the written questionnaire. Additionally, the participants were ensured that refusal to consent or withdrawal from the study would not alter or put at risk their access to care.

Materials

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide pregnant women with access to information and resources related to dietary diversity practices. These apps can provide personalized recommendations, track dietary intake, and send reminders for important health practices.

2. Telemedicine Services: Establish telemedicine services that allow pregnant women to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide access to expert advice on dietary diversity and other maternal health concerns.

3. Community Health Workers: Train and deploy community health workers who can educate pregnant women about the importance of dietary diversity and provide guidance on healthy eating practices. These workers can also conduct regular home visits to monitor progress and provide ongoing support.

4. Nutritional Counseling: Offer specialized nutritional counseling services for pregnant women, either in-person or through telehealth platforms. These sessions can provide personalized guidance on dietary diversity, address specific concerns, and promote healthy eating habits.

5. Public Awareness Campaigns: Launch public awareness campaigns to educate the general population about the importance of maternal health and dietary diversity. These campaigns can use various media channels to reach a wide audience and promote behavior change.

6. Collaboration with Local Food Suppliers: Partner with local food suppliers and markets to ensure the availability and affordability of diverse and nutritious food options for pregnant women. This can include initiatives such as subsidized food vouchers or discounts on healthy food items.

7. Maternal Health Support Groups: Establish support groups for pregnant women where they can share experiences, receive emotional support, and learn from each other about dietary diversity practices. These groups can be facilitated by healthcare professionals or community leaders.

8. Integration of Maternal Health Services: Integrate maternal health services with existing healthcare facilities and programs, such as antenatal clinics and primary healthcare centers. This can ensure that pregnant women have easy access to comprehensive care, including dietary counseling and support.

9. Partnerships with Non-Governmental Organizations (NGOs): Collaborate with NGOs working in the field of maternal health to leverage their expertise, resources, and networks. This can help expand access to innovative interventions and reach underserved populations.

10. Continuous Monitoring and Evaluation: Implement a robust monitoring and evaluation system to assess the effectiveness of interventions aimed at improving access to maternal health. This can help identify areas for improvement and ensure that resources are allocated effectively.

AI Innovations Description

The study titled “Determinants of dietary diversity practice among pregnant women attending antenatal clinic at Wachemo University Nigist Eleni Mohammed memorial referral hospital, Southern Ethiopia” aimed to assess the dietary diversity practice and its determinants among pregnant women attending the antenatal clinic at Wachemo University Nigist Eleni Mohammed memorial referral hospital in Southern Ethiopia.

The study found that the overall prevalence of adequate dietary diversity practices among pregnant women was 42.6%. Several determinants were identified, including earning a monthly income of ≥2000 Ethiopian birr, maternal educational level, educational status of the partner, having a partner who was a government employee, and receiving nutritional information.

Based on these findings, the following recommendations can be made to develop innovations and improve access to maternal health:

1. Increase household income: Since earning a monthly income of ≥2000 Ethiopian birr was associated with better dietary diversity practices, interventions should focus on improving economic opportunities for pregnant women and their families. This can be done through income-generating programs, vocational training, and job creation initiatives.

2. Enhance nutritional-related information: Providing pregnant women with accurate and comprehensive information about the importance of dietary diversity during pregnancy can help improve their dietary practices. This can be achieved through health education programs, antenatal care services, and community-based interventions.

3. Advance the academic level of both the wife and her partner: Maternal educational level and the educational status of the partner were found to be determinants of dietary diversity practices. Promoting access to quality education for women and their partners can empower them to make informed decisions regarding their health and nutrition.

4. Collaborate with government agencies: Having a partner who was a government employee was associated with better dietary diversity practices. Collaborating with government agencies and policymakers can help create supportive environments and policies that promote maternal health and nutrition.

By implementing these recommendations, innovative interventions can be developed to improve access to maternal health and enhance dietary diversity practices among pregnant women.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase household income: Since the study found that earning a monthly income of ≥2000 Ethiopian birr was associated with better dietary diversity practices among pregnant women, implementing interventions to improve household income can help improve access to nutritious food and overall maternal health.

2. Enhance nutritional education: The study identified that receiving nutritional information was associated with better dietary diversity practices. Therefore, implementing educational programs that provide pregnant women with information on the importance of a diverse diet and how to achieve it can improve their access to maternal health.

3. Improve maternal and partner education: The study found that the educational level of both the mother and her partner was associated with dietary diversity practices. Investing in education for women and their partners can empower them to make informed decisions about their health and improve access to maternal health.

4. Collaborate with government employees: Having a partner who is a government employee was associated with better dietary diversity practices. Collaborating with government agencies and providing support to government employees can help improve access to maternal health.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of pregnant women receiving adequate prenatal care or the percentage of pregnant women with improved dietary diversity practices.

2. Collect baseline data: Gather data on the current status of the indicators before implementing the recommendations. This can be done through surveys, interviews, or existing data sources.

3. Implement interventions: Implement the recommended interventions, such as income generation programs, nutritional education campaigns, and educational initiatives for women and their partners.

4. Monitor and evaluate: Continuously monitor the progress of the interventions and collect data on the indicators. This can be done through regular surveys, interviews, or monitoring systems.

5. Analyze the data: Use statistical analysis techniques to analyze the data collected and assess the impact of the interventions on the indicators. This can include comparing pre- and post-intervention data, conducting regression analyses, or using other appropriate statistical methods.

6. Draw conclusions: Based on the analysis, draw conclusions about the impact of the recommendations on improving access to maternal health. Identify any significant changes in the indicators and assess the effectiveness of the interventions.

7. Adjust and refine: Use the findings from the analysis to make any necessary adjustments or refinements to the interventions. This could involve scaling up successful interventions, modifying strategies that were less effective, or identifying new areas for improvement.

8. Repeat the process: Continuously repeat the monitoring, evaluation, and adjustment process to ensure ongoing improvement in access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions.

Author

Dima Health

Statistics:

Citations: 5

Identifiers:

DOI: 10.1371/journal.pone.0250037

Research Areas:

Disparities, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female