Community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia: an explorative qualitative study

  • BMC Pregnancy and Childbirth, Volume 22, No. 1, Year 2022

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Study Justification:
– Dietary misconceptions during pregnancy can negatively impact the health of mothers and their babies.
– Understanding the food beliefs and perceptions of a community during pregnancy is important for designing culturally appropriate interventions.
– Limited evidence exists on food beliefs and perceptions during pregnancy in Ethiopia.
– This study aims to qualitatively assess community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia.
Highlights:
– Conducted 10 in-depth interviews and four focus group discussions among pregnant mothers, religious leaders, and elders.
– Identified three main themes: foods linked with pregnancy, alcoholic drinks during pregnancy, and religion and fasting.
– Discouraged consumption of animal source foods due to perceived risks.
– Encouraged consumption of locally produced alcoholic drinks during pregnancy.
– Common practices of avoiding animal source foods and meal skipping during religious fasting-periods.
– Concluded that misconceptions on food intake during pregnancy exist and can have negative effects on nutrient intake.
Recommendations:
– Culturally appropriate interventions are needed to improve awareness of healthy dietary intake during pregnancy.
Key Role Players:
– Policy makers
– Health extension workers
– Religious leaders
– Elders
– Pregnant women
Cost Items for Planning Recommendations:
– Development and implementation of educational materials and programs
– Training and capacity building for health extension workers, religious leaders, and elders
– Community engagement and awareness campaigns
– Monitoring and evaluation of intervention effectiveness
Please note that the cost items provided are examples and not actual costs. The actual budget for implementing the recommendations would depend on various factors and would need to be determined through a detailed planning process.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on qualitative research methods, including in-depth interviews and focus group discussions. The study provides detailed information on the community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia. However, the sample size is relatively small, with only 10 in-depth interviews and 4 focus group discussions. To improve the strength of the evidence, a larger sample size could be used to ensure more representative findings. Additionally, the study could benefit from including a wider range of participants, such as healthcare professionals and community leaders, to gain a more comprehensive understanding of the food beliefs and perceptions during pregnancy in the study area.

Background: Dietary related misconceptions during pregnancy affect the heath of mothers and their growing babies. Misconceptions vary from place to place and from community to community. Understanding of a given community’s food perceptions during pregnancy helps policy makers able to design cultural appropriate interventions. In Ethiopia, however, evidences on food beliefs and perceptions during pregnancy are limited. Therefore, this study is aimed at qualitatively assessing community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia. Methods: We conducted 10 in-depth interviews (n = 10) and four focus group discussions (n = 32) among purposively selected community groups including pregnant mothers, religious leaders, and elders in rural kebeles of Ofla Woreda, Northern Ethiopia. Data were transcribed word-for-word, translated into English, and uploaded into ATLAST ti version 7.5.1.6. Data were analyzed following the principles of thematic analysis. Line-by-line coding was applied to identify codes; identified codes were categorized based on their similarities and differences and themes were developed inductively. Results: Three main themes were identified inductively; foods positively and negatively linked with pregnancy; perceived benefits and harms of alcoholic drinks during pregnancy; and religion and fasting. In this study, consumptions of animal source foods such as egg were discouraged because such foods were perceived to increase the risk of having big baby that could delay delivery. However, intakes of locally produced alcoholic drinks during pregnancy were encouraged by the local community. Furthermore, avoidance of animal source foods and meal skipping during religious fasting-periods were also common practices among pregnant mothers in the study area. Conclusions: This study explored misconceptions on food intakes during pregnancy. Positive attitude towards intake of “soft” alcoholic drinks might result in alcohol related teratogenic effects. Restriction on the intakes of nutrient rich diets due to religious fasting and other misconceptions would lead to insufficient nutrient intake both to the mothers and their growing fetus. Culturally appropriate intervention to improve awareness on healthy dietary intake during pregnancy is needed.

This research was conducted in Ofla, a rural woreda, in the southern part of Tigray region, Ethiopia between April and May 2019. The woreda had twenty-one rural kebeles (lowest administrative unit in Ethiopia with a total population of 5,000). Based on the 2007 national census projection, about 144,217 population resided in the woreda of whom 73,550 (51%) were women. Using conversion factor of 3.1% for pregnant women, an estimated 4, 470 pregnant women were residing in the woreda. There were 6 health centers (where curative and preventive health care services were provided) and 22 health posts (lowest health care facilities staffed with two clinical nurses who provided community based prevention services including maternal and child health care services). Regarding the educational status of the target community, only 9.1% (less than the provincial average that is 15.7%) were literate. Two Kebeles, Hayalo and Zata, were selected purposively for this study after consulting the woreda health office officials. While Zata located far away, about 40 km from a town called Korem, Hayalo is located near by the town. These two kebeles which had different degrees of access to the town that could affect peoples’ perception towards the study subject were selected to explore the different dietary perceptions from different geographic locations and different socio-cultural contexts. The findings help policy makers to understand dietary perceptions from different community groups and design socially and culturally appropriate interventional strategies. A community based explorative qualitative study was employed. Taking into consideration the principles of maximum variation, pregnant mothers who ever gave birth, male and female elders, and religious leaders from Orthodox and Muslim followers were purposively selected for this study. Elders and religious leaders are the ones who guide, advice, and also lead the community. Moreover, they have better understanding about the community beliefs and practices including women’s dietary perception during pregnancy. During participant selection, participants’ socio-economic status, educational status, age, and pregnancy status that could enable us to explore their diverse perception towards the purpose of the study were considered. Health extension workers who were working in the target kebeles assisted us in the selection of study participants. Participants were approached on face-to-face base and all contacted participants were willing to participate in the study. Qualitative data for this study were collected from focused group discussions (FGDs) and in- depth interviews (IDIs). A total of ten in-depth interviews (n = 10) among pregnant women and four focused group discussions (n = 32); one among male elders, one among religious leaders; and two among female elders were conducted. The number of discussants in each group was eight. To facilitate the IDIs and FDGs, topic guides were developed by the authors based on the findings of previously conducted scientific researches (Table S1). Participants’ socio-demographic characteristics were also collected during the data collection period. The guides were developed first in English and then translated into Tigrigna, the participants’ language, and then back translated into English to check for their consistency. The first author, KE, together with ZH who were native speakers of the community’s language and had previous experiences on qualitative research facilitated the IDIs and FGDs using pre-tested topic guides. ZH is an MSc holder academic staff in a University located in the study province and KE is a graduate student in the University. Interviewers provided through explanation on the purpose of the study to the study participants and followed probing techniques to minimize social desirable bias during the interview and discussion. Facilitators were open to accept and consider any opinion that came from the study participants and they did not have predetermined assumptions on the study topic. Before the actual data collection was carried out, topic guides were pre-tested in a different area and comments were incorporated into the final version of the guides. Data collection and analysis were conducted simultaneously. New information from the preceding IDI or FGD were incorporated into the guides and utilized for the next IDI and FGD. Conducting in-depth interview and focus group discussion continued until no new information was found. While all IDIs were facilitated in the participants’ home, FGDs were conducted in Churches, meeting spot, and under a tree where participants could explain their perception freely in natural settings. The average durations of IDIs and FGDs were 45 min and 90 min, respectively. All FGDs and IDIs were audio recorded and field notes were also taken during the data collection period. The first author repeatedly listened the audio recordings and read the field notes to familiarize him-self with the data. After familiarization, audio recordings were transcribed word-for-word and then translated into English. Translated data were imported into ATLAST ti version 7.5.1.6, a qualitative data analysis software. After uploading the data into the software, data were analyzed qualitatively following the principles of thematic analysis. First, an initial line-by-line coding was conducted by the first author. Identified codes were discussed among the other authors. Once the identified codes were agreed among the authors, labels were given to each meaningful codes. After that, codes were categorized based on their similarities and differences. Finally, identified categories were grouped to form meaningful themes. The validity and rigor of the study was assured through different means. First, semi-structured data collection tools were developed by experienced researchers who had diversified areas of expertise including health education and behavioral sciences and public health nutrition both at MSc and PhD level who were academic staffs of Mekelle University. The tools were developed in a way that enable participants speak freely about the subject matter. Second, the importance of maximum variation principles were taken into consideration when participants were purposively selected to make sure findings of the study are coming from different community groups who were considered as potential source of information to the study subject. Furthermore, data collection and analysis were carried out parallel and data collection continued till no new information was generated. Third, data analysis was carried out following the principles of inductive analysis and transcriptions were also done word-to-word (verbatim transcription). Fourth, findings of this stud were triangulate from FGDs and In-depth interviews. Ethical approval was obtained from the Institutional Review Board (IRB) of Mekelle University. A written informed consent was obtained from each study participant after thoroughly explaining the purpose of the study. Participants were assured that they can leave or stop participating in the study at any time. To ensure confidentiality, all personal identifiers were redacted before data analysis. Participants were assured that the data will be used only for the purpose of this study and will not be used for other study without their approval. All the involvement of humans in this study was carried out following the principles of the Helsinki Declaration.

Based on the provided research description, here are some potential innovations that could be used to improve access to maternal health:

1. Mobile Health (mHealth) Interventions: Develop and implement mobile phone applications or text messaging services to provide pregnant women with accurate information about nutrition during pregnancy. This can help address misconceptions and provide guidance on healthy dietary choices.

2. Community Health Workers: Train and deploy community health workers to educate pregnant women and their families about proper nutrition during pregnancy. These workers can provide culturally appropriate information and support, addressing community-specific food beliefs and perceptions.

3. Peer Support Groups: Establish peer support groups for pregnant women, where they can share experiences, discuss nutrition, and receive guidance from each other. These groups can help dispel misconceptions and provide a supportive environment for healthy eating practices.

4. Culturally Appropriate Education Materials: Develop educational materials, such as brochures or videos, that are tailored to the specific cultural beliefs and practices of the community. These materials should provide clear and accurate information about nutrition during pregnancy, addressing common misconceptions.

5. Collaboration with Religious Leaders: Engage religious leaders in promoting healthy nutrition during pregnancy. Work with them to develop messages that align with religious teachings and encourage healthy eating practices. This can help overcome misconceptions related to religious fasting and dietary restrictions.

6. Integration with Existing Health Services: Integrate nutrition education and support into existing maternal health services, such as antenatal care visits. This ensures that pregnant women receive consistent and accurate information throughout their pregnancy journey.

7. Community-Based Nutrition Programs: Implement community-based nutrition programs that provide pregnant women with access to nutrient-rich foods, such as fortified foods or supplements. These programs can be tailored to address specific food beliefs and perceptions in the community.

It is important to note that the specific recommendations for improving access to maternal health should be based on a thorough understanding of the local context and community needs.
AI Innovations Description
The research conducted in Ofla Woreda, Northern Ethiopia aimed to explore community food beliefs during pregnancy in rural areas and identify misconceptions that could affect maternal health. The study used qualitative methods, including in-depth interviews and focus group discussions, to gather data from pregnant mothers, religious leaders, and elders in the community.

Three main themes emerged from the analysis of the data: foods positively and negatively linked with pregnancy, perceived benefits and harms of alcoholic drinks during pregnancy, and religion and fasting. The study found that certain animal source foods, such as eggs, were discouraged during pregnancy due to the belief that they could increase the risk of having a big baby and delay delivery. On the other hand, the consumption of locally produced alcoholic drinks during pregnancy was encouraged by the local community. Additionally, pregnant mothers in the study area commonly avoided animal source foods and skipped meals during religious fasting periods.

The findings of this study highlight the presence of misconceptions regarding food intake during pregnancy, which can have negative effects on both the mothers and their growing fetus. Restricting nutrient-rich diets due to religious fasting and other misconceptions can lead to insufficient nutrient intake. Therefore, there is a need for culturally appropriate interventions to improve awareness and promote healthy dietary practices during pregnancy.

The study was conducted in Ofla Woreda, which is a rural area in the southern part of the Tigray region, Ethiopia. The woreda has a total population of 144,217, with an estimated 4,470 pregnant women. There are 6 health centers and 22 health posts in the area, providing curative and preventive health care services, including maternal and child health care.

The research selected two kebeles, Hayalo and Zata, purposively to explore different dietary perceptions from different geographic locations and socio-cultural contexts. Hayalo is located near a town called Korem, while Zata is located farther away, about 40 km from Korem. The selection of these kebeles aimed to capture diverse perceptions towards the study subject.

The study employed a community-based explorative qualitative approach, involving pregnant women who had given birth, male and female elders, and religious leaders from Orthodox and Muslim backgrounds. The selection of participants considered factors such as socio-economic status, educational status, age, and pregnancy status to ensure diverse perspectives.

Data collection involved in-depth interviews and focus group discussions, facilitated by native speakers of the community’s language who had previous experience in qualitative research. Topic guides were developed based on previous research findings and were pre-tested before the actual data collection. The interviews and discussions were conducted in participants’ homes, churches, meeting spots, and natural settings to allow for open and free expression of perceptions.

The data were analyzed using thematic analysis, following the principles of inductive analysis. Line-by-line coding was applied to identify codes, which were then categorized based on similarities and differences. The categories were grouped to form meaningful themes.

To ensure the validity and rigor of the study, several measures were taken. The data collection tools were developed by experienced researchers with expertise in health education, behavioral sciences, and public health nutrition. Maximum variation principles were considered when selecting participants to ensure diverse perspectives. Data collection and analysis were conducted simultaneously, and data collection continued until no new information was generated. Triangulation of findings from focus group discussions and in-depth interviews was also performed.

Ethical approval was obtained from the Institutional Review Board of Mekelle University, and written informed consent was obtained from each study participant. Confidentiality was ensured by redacting personal identifiers before data analysis, and participants were assured that their data would only be used for the purpose of the study.

Overall, this research provides valuable insights into community food beliefs during pregnancy in rural areas of Northern Ethiopia. The findings can inform the development of culturally appropriate interventions to improve access to maternal health and promote healthy dietary practices during pregnancy.
AI Innovations Methodology
The research conducted in Ofla Woreda, Northern Ethiopia aimed to qualitatively assess community food beliefs during pregnancy in rural kebeles. The study used a methodology that included 10 in-depth interviews and four focus group discussions among purposively selected community groups, including pregnant mothers, religious leaders, and elders. The data collected were transcribed, translated into English, and analyzed using thematic analysis.

The study identified three main themes: foods positively and negatively linked with pregnancy, perceived benefits and harms of alcoholic drinks during pregnancy, and religion and fasting. It found that the consumption of certain animal source foods, such as eggs, was discouraged due to the perception that they could increase the risk of having a big baby that could delay delivery. However, the intake of locally produced alcoholic drinks during pregnancy was encouraged by the local community. Additionally, the study found that pregnant mothers in the study area commonly avoided animal source foods and skipped meals during religious fasting periods.

The findings of this study have important implications for policy makers and highlight the need for culturally appropriate interventions to improve awareness of healthy dietary intake during pregnancy. The study provides insights into the dietary perceptions of different community groups and can help inform the design of intervention strategies that are socially and culturally appropriate.

The research was conducted in two purposively selected kebeles, Hayalo and Zata, which had different degrees of access to a nearby town called Korem. This selection was made to explore different dietary perceptions from different geographic locations and socio-cultural contexts. The study employed a community-based explorative qualitative study design, taking into consideration the principles of maximum variation. Participants were selected based on their socio-economic status, educational status, age, and pregnancy status to ensure diverse perspectives.

Data were collected through focused group discussions and in-depth interviews. A total of ten in-depth interviews were conducted among pregnant women, and four focused group discussions were conducted among male and female elders and religious leaders. The topic guides used for the interviews and discussions were developed by the authors based on previous scientific research findings. The interviews and discussions were facilitated by the first author and another native speaker of the community’s language who had previous experience in qualitative research.

The data collection process involved approaching participants face-to-face, providing explanations about the purpose of the study, and using probing techniques to minimize social desirability bias. The interviews were conducted in the participants’ homes, while the discussions took place in churches, meeting spots, and under a tree to create a natural setting for participants to freely express their perceptions. All discussions and interviews were audio recorded, and field notes were taken. The audio recordings were transcribed verbatim and translated into English. The data were then analyzed using thematic analysis in ATLAS.ti software.

To ensure the validity and rigor of the study, several measures were taken. The data collection tools were developed by experienced researchers with expertise in health education, behavioral sciences, and public health nutrition. The principles of maximum variation were considered when selecting participants to ensure diverse perspectives. Data collection and analysis were carried out simultaneously, and data collection continued until no new information was generated. The findings were triangulated from both focus group discussions and in-depth interviews.

Ethical approval was obtained from the Institutional Review Board of Mekelle University, and written informed consent was obtained from each study participant. Confidentiality was ensured by redacting personal identifiers before data analysis, and participants were assured that their data would only be used for the purpose of the study.

Overall, this research provides valuable insights into community food beliefs during pregnancy in rural kebeles of Ofla Woreda, Northern Ethiopia, and highlights the need for culturally appropriate interventions to improve awareness of healthy dietary intake during pregnancy.


Identifiers:
DOI: 10.1186/s12884-022-04593-3
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Substance Abuse
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Exploratory Study, Grounded Theory, randomised-control-trial
Study Approach:
Qualitative
Participants Gender:
Male & Female
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