Undernutrition and its associated factors among pregnant mothers in Gondar town, Northwest Ethiopia

Background Regardless of significant gains and signs of progress in the last decades, maternal undernutrition remains a major public health concern in Ethiopia. Supporting the progress of interventions being taken in the country with evidence might be important to keep the sustainability of the government effort. We aimed at determining the extent of undernutrition and its associated factors among pregnant mothers in Gondar town, Northwest Ethiopia. Method A community-based cross-sectional study was conducted by including 940 selected pregnant mothers through a cluster sampling. A face-to-face interview was administered to pregnant mothers at a household level. We collected data using an Online Data collection kit (ODK) and the collected data was directly downloaded from the Google Cloud platform and finally imported to Stata 14 for further analysis. A multivariable logistic regression model was fitted to identify factors associated with undernutrition. A crude and adjusted odds ratio with their 95% confidence interval was calculated to declare the association and its significance. Model fitness was assured through the Hosmer and Lemeshow goodness of fit test and model classification accuracy. Result 14.4% (95%CI: 12.3-16.7) of pregnant mothers were undernourished. After adjusting for the main covariates; as the age of the pregnant mothers increases the odds of being undernourished decreases by 10% (AOR: 0.90; 95%CI: 0.87-0.95) and having a poor marital condition (AOR: 2.18; 95%CI: 1.03-4.59) increased the odds of undernutrition. The risk of undernutrition was also decreased by 43% among those pregnant mothers who consumed coffee sometimes (AOR: 0.57; 95%CI: 0.36-0.89) as compared to daily consumers. Conclusion A significant proportion of pregnant mother were undernourished. Integration of nutritional interventions with maternity health services would be highly important to improve the nutritional status of the mothers. It is also important to counsel pregnant mothers about a consequence of frequent coffee drinking during their pregnancy. We conducted a cross-sectional study from June 15 to July 30, 2018, on pregnant mothers in their second and third trimester of pregnancy who are living in Gondar Town. Gondar town is located in the Northern part of Amhara regional state at a distance of 747 km away from Addis Ababa and 170 km from Bahir Dar (the regional capital city). Gondar town has a total population of 333,103 and an expected number of pregnant women in the town is estimated to be 11,225 in which at least 8,913 of them are living in urban kebeles (clusters) in 2017/2018. Pregnant women who were living in a randomly selected urban kebeles were considered as the study population. A cluster sampling was used to reach the study participants. On the first stage, five urban clusters from 12 urban clusters were selected by lottery method and on the second stage, a house to house census of pregnant mothers found in the six selected clusters was conducted. The required sample size was determined in Epi Info 7 by using a single and double population proportion formula. A parity variable from a study conducted to determine undernutrition in Gondar referral hospital [8] was used to determine a sample size for our study assuming 80% power, 95% confidence level, an odds ratio of 2.25, proportion of undernutrition in those women’s with no previous birth as 11.62%, proportion of undernutrition among pregnant mothers with >4 births as 22.8%, cluster effect of 2, and a 10% non-response rate. Our double population proportion formula yielded the higher sample size of 858. However, because of the nature of the cluster sampling, 940 pregnant mothers were actually found and included in the study. An interviewer-administered Amharic version of the questionnaire was used to collect the required information from the study participants. The online data collection kit (ODK) application was used to collect and manage data to improve its quality. The prepared questionnaire was designed on the excel spreadsheet, converted to XLSForm online, and checked for its validity using Enketo. The validated form was downloaded and uploaded on a Lenovo tab 7 ODK application. The data storage place for the project was created on the Google cloud platform. The data collectors sent the collected data to the online created data storage system and the principal investigator directly downloaded the data from the system. Maternal nutrition was assessed using a Mid Upper Arm Circumference (MUAC) and categorized as undernutrition (MUAC < 22) and normal (MUAC > = 22) [8, 16]. Maternal depression and anxiety were measured by using an Edinburgh Postnatal Depression Scale (EPDS) revised for Ethiopian context [17]. A mother was considered as depressed if she had a total measurement scale of > = 12. Anxiety was measured by using the third, fourth, and fifth scale on EPDS and a mother with a total scale of > = 6 was classified as having anxiety symptoms [18]. Social support was assessed by using the Oslo Social Support Scale (OSSS-3) and pregnant mothers who scored nine and above were labeled as having “Good” social support and those scored below nine were labeled as having “Poor” social support [19]. Husband support was assessed by a question “My husband helps me a lot” with the options: “Always (5)”, “Most of the time (4), “Some of the time (3)”, “Rarely (2)”, and “Never (1)”. Coffee consumption was assessed based on the number of days the mother consumed coffee in a week. Those who have been consuming coffee one to three days per week were considered as consuming coffee sometimes, those reported consuming coffee every day as daily drinkers, and those have not been drunk before as non-drinkers. A marital condition was also assessed based on mother’s perspective regarding their marital situation in a day to day life and if the marital situation is loving and easy going without conflict and disagreement was considered as “Bad” and if not it was considered as “Good”. Physical activity of the mother was assessed by a question “Have you practice physical activity such as brisk walking, dancing, gardening, and usual housework for at least three hours/week” and their answer was documented as “Yes” and “No” [20]. Food access for the last three months was assessed by a single question: “In the last three months, have you ever worried that your household would not have enough food?” a standard question which has been used for assessing the level of food inaccessibility in a household. The data collection tool was first prepared in English, translated into Amharic and back-translated to English to check for its consistency before administration. Nine trained BSc. nurses were recruited, trained, and collected the data through a house to house survey. The principal investigator and one additional recruited field supervisor supervised the overall data collection activity. A data that was collected online was downloaded from the Google Cloud Platform and imported to the Stata 14 for further analysis. Data were checked and re-checked for completeness before importing and further cleaning was done by running frequencies. Mean, median, proportion/percentage, interquartile range, standard deviations, and exploratory analysis were conducted to understand the nature of the data. Preliminary findings were presented using tables. A bi-variable and multivariable logistic regression model was fitted to identify factors associated with undernutrition. Adjusted odds ratio with its 95% confidence interval was computed to test for statistical significance. Model adequacy was checked using the Hosmer and Lemeshow goodness of fit test (p-value = 0.59) and a classification accuracy (85.6%). The University of Gondar Institutional Review Board ethics committee approved this study. A support letter was obtained from the University of Gondar Research and Community Service to the Gondar town health office and respective districts. Participants of the study were informed about the purpose, objectives and their right to participate or not participate in the study. Privacy and confidentiality of the study participant were ensured by not using a personal identifier. Written informed consent was obtained from the study participants in order to be part of the study. Pregnant mothers who were seriously ill during a house to house data collection time were referred to Gondar University Specialized Hospital and those found severely malnourished were also counseled about proper nutrition.