Dietary Practice and Associated Factors Among Pregnant Women at Public Health Institution in Mizan-Aman Town, Southwest Ethiopia

Background: A poor dietary intake of key macronutrients and micronutrients adversely affects pregnancy outcomes and neonatal health. The occurrence of dietary inadequacy during pregnancy is higher compared to any other stage of the life cycle. Therefore, this study aimed to assess dietary practice and associated factors among pregnant women. Methods: A facility-based cross-sectional study design was conducted among 378 pregnant women from March to May 2021 at the public health institution of Mizan-Aman town, southwest Ethiopia. A systematic random sampling technique was used to reach the study participants. The short food-frequency questionnaires and nutrition-behaviors checklist measurement were used to assess the dietary practice. Nine questions were applied to assess the dietary attitudes of the respondents. After the summation of the score, the respondent was categorized as favorable attitude if their score was > the median and unfavorable attitude if their score was ⩽ to the median of the score. The data were entered into Epi Data 3.1 and exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Variables of P-value <.25 during bivariate logistic regression analysis were considered for multivariate analysis. Finally variables with an adjusted odds ratio of P-value <.05 along with a 95% Confidence interval (CI) were declared statistically significant. Results: The overall magnitude of good dietary practice among pregnant women was 25.1% (95% CI: 20.9, 29.71%). In multivariate logistic regression analysis, the variables having television/radio (AOR = 4.2, 95% CI: 1.8, 10.2), household food security (AOR = 3.1, 95% CI: 1.0, 9.9), good dietary knowledge(AOR = 4.1, 95% CI: 1.98, 8.6), favorable dietary attitude (AOR = 4.34, 95% CI: 1.2, 8.7), monthly income of 1000 to 2000 Ethiopian birr (AOR = 3.7, 95% CI: 1.3,11.2) and >2000 Ethiopian birr (AOR = 7.0;95% CI: 3.3,15.4) were significantly associated with good dietary practice. Conclusion: The dietary practice among pregnant women was very low. The factors like having television/radio, good dietary knowledge, household food security, favorable dietary attitude, and monthly income of 1000 to 200 and greater than 2000 Ethiopian birr were significantly associated with the good dietary practice of pregnant women. Mizan-Aman town is the capital of Bench- Sheko zone of SNNPR. The town is located 582 km far from the capital city of Addis Ababa. According to Zonal annual reports of 2020, the town has a total population of 62 689 (33 364 are men and 29 325 women). Maize and taro are the main staple foods, and while coffee and spices are the main cash crops in the area, the town has one teaching hospital and one public health center. A facility-based cross-sectional study design was employed from March to May 2021. All pregnant women attended ANC at public health institutions in Mizan-Aman town, southwest Ethiopia. The sample size was determined using a single population proportion formula, considering the following assumption: the prevalence of good dietary practice among pregnant women 33.9%, 25 5% marginal error, 95% Confidence Interval (CI), and none response rate of 10%. Based on this, the actual calculated sample size was: n=(zα/2)2p(1−p)/d2 , n = 344. After adding a 10% none response rate was considered, the final sample size required for this study was 378. A systematic random sampling technique was used to select the study units using the client’s registration books for 3-months before the data collection period. Then every Kth person, as they registered, was included in the study until the desired sample size was attained. The data were collected through the structured and semi-structured interviewer-administered questionnaire by Midwifery and Nursing health professionals. The data on socio-demographic and socio-economic, obstetric and pregnancy-related factors, household food security status, dietary knowledge, dietary attitude, and dietary practices of pregnant women were assessed. The tool used to assess dietary practices of pregnant women was adapted from FAO 25 and other different kinds of literature.10,23,26,27 Dietary practices of pregnant women were assessed using the retrospective dietary assessment methods of short-frequency questioners and nutrition-behaviors checklists measurements. 25 The score of dietary practices was obtained by summation of responses to each question. Each question was given 1 mark if the answer was correct, favorable, or healthy for dietary practices. Zero scores were given if the responses were wrong, unfavorable, or unhealthy for dietary practices.10,23,24,26 The study participants were classified as poor dietary practices if they correctly answered <75% of dietary practice questions and while good dietary practices if they correctly answered ⩾75%.27,28 The dietary knowledge was assessed using 10 open-ended questions adapted from the previous different kinds of literature.10,27,29,30,31 Nutrition knowledge questions aimed to assess pregnant women’s nutrition knowledge on the aspects of nutrition required during pregnancy. 29 Partially categorized questions were open-ended questions that require respondents to provide short answers in their own words, accompanied by a list of correct answers plus the options “Other” and “Do not know.” Predefined options make analysis easier by listing expected responses. After the surveyor has asked the question, he/she should write down the response provided and then categorize it according to the predefined response options. The pregnant women were considered to be knowledgeable if they correctly answered greater than or equal to 70% of the total knowledge assessing questions and not knowledgeable if respondents score <70% (out of 100%) on the knowledge questions.29,31 The attitude of pregnant women on their dietary practice during pregnancy was assessed by adapting the questioners from different literature and conceptualized it to local situations.31,32 Nine questions were applied in this study to assess maternal dietary attitudes that had 3 response options questions 1 positive; a middle option that captures the attitude that was uncertain and 1 negative. The pregnant women were given 1 mark if the answers were favorable for good dietary practices during pregnancy, and 0 scores were given if the responses were unfavorable for dietary practices.27,31 After the summation of the score, the respondent was categorized as favorable attitude if the respondent’s attitude score was > median and unfavorable attitude if the respondents ‘attitude score was ⩽ to the median of the score. 31 The household food insecurity level was measured with Household Food Insecurity Access Scale (HFIAS).33,34 The scale has been a valid tool in measuring household food insecurity among rural and urban areas of Ethiopia. 35 The tool consists of 9 questions representing a generally increasing severity of food insecurity (access). Based on the answer given to the 9 questions and frequency of occurrence over the past 30 days, participants are assigned a score that ranges from 0 to 27. A higher HFIAS score indicates more inadequate access to food and greater household food insecurity, while a score of 0 indicates secure access to food. 33 To ensure the quality of data, a pretest was done among 5% of the study sample. The final version of the questionnaire prepared in English was translated into the local language of the respondents and again translated back to English. Two days of training were given for collectors and supervisors on the instruments, data collection method, ethical issues, and the purpose of the study. Supervisors have checked the collected data for its completeness, accuracy, and consistency throughout the data collection period, and the principal investigator did the overall supervision. Data double entry was used to make comparisons of 2 data cells. After all the data were checked for completeness and internal consistency, the data were coded and entered into Epi Data 3.1 computer software package and exported to Statistical package for social science (SPSS) version 21 software for further analysis. Bivariate logistic regression analyses were conducted to examine the association between dependent and independent variables. Variables with a P-value <.25 during bivariate logistic regression analysis were considered for multivariate logistic regression models to control all possible confounders and identify factors independently associated with the dietary practice of pregnant women. Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) with 95% Confidence interval (CI) were calculated to measure the strength and direction of association between dependent and independent variables. Finally, the variable with (P-value <.05) in the multivariate logistic regression analysis were considered statistically significant. Multicollinearity between independent variables was checked Hosmer tested the model fitness—Lemeshow for the goodness of fit, and model fitted was considered at Hosmer-Lemeshow P-value >.05.