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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.
