WALLAGA UNIVERSITY

INISTITUTE OF HEALTH SCIENCE

SCHOOL OF NURSING AND MID-WIFERY

DEPARTEMENT OF MIDWIFERY

KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING MATERNAL NUTRITION

AMONG PREGNANT WOMEN ATTENDIG ANTENATAL CARE SERVICE IN BEDELLE
GENERAL HOSPITAL, BUNNO BEDELLE ZONE, BEDELLE TOWN, OROMIA
REGIONAL STATE, SOUTH WEST ETHIOPIA, 2022

BY PRINCIPAL INVESTIGATORS

1. BELAY ZELEKE (BSC CANDIDATE)

2. BINIYAM TESFAYE (BSC CANDIDATE)

3. DESALEGN BIRATU (BSC CANDIDATE)

4. IYASU TSEGAYE (BSC CANDIDATE)

ADVISOR; MRS; ASMARA TULU (MSC IN CLINICAL MIDWIFERY)

PROPOSAL SUBMITTED TO WALLAGA UNIVERSITY, INISTITUTE OF HEALTH SCIENCE,

SCHOOL OF NURSING AND MID-WIFERY, DEPARTMENT OF MIDWIFERY FOR PARTIAL
FULFILLMENT OF THE REQUIRMENTS OF BSC IN MID-WIFERY

JULY,2022

NEKEMTE, ETHOPIA

i|Page
ACKNOWLEDGEMENT
Above all, we would like to give thanks to the almighty God, who allowed us to prepare this
research proposal. Next our gratitude is also to wallaga university, institute of health science,
school of nursing and midwifery, department of midwifery for giving us this chance to prepare
this research proposal.

We would like to express our great appreciation to Mrs. Asmera Tulu (Msc in clinical
midwifery) for her valuable and constructive suggestions during the planning, development and
performing of this research proposal. Then we would like to express our deepest gratitude to
antenatal care ward staff of Bedelle General hospital and Bedelle General hospital medical
directors for their co-operation and provide necessary information. Our acknowledgement also
goes to institute of health science for their co-operation, during searching of some of the
literature documents and books that we used as reference.

ii | P a g e
SUMMARY

Background: Nutrition is a fundamental pillar of human life, health and development

throughout the entire life span. Especially Pregnancy is a time of increased energy and nutrient
needs for woman in order to meet the needs of the growing fetus and of maternal tissues
associated with pregnancy. Worldwide each year, more than half amillion women die from
causes related to pregnancy and child birth .Malnutrition is now a problem in poor and rich
countries .In Ethiopia nutrional disorders are among the cause of morbidity and mortality.
However, a little has been explored about nutrional knowledge and practices among pregnant
women attending antenatal care in Bedelle General hospital.

Objectives: The main objective is to assess knowledge,attitude and practice on maternal

nutrition among pregnant women during pregnancy who come for antenatal care in Bedelle
General Hospital, Ethiopia in 2022.

Methods: an institutional based cross-sectional study will be conducted from, August 1,2022
to September 1,2022 to assess knowledge, attitude and practice of maternal nutrition among
pregnant women during pregnancy. aconvenience sampling method will be used to select study
participants. The data will be collected by 4(3 data collectors and 1supervisor) of wallaga
university Bsc candidates of other groups. Data will be collected by using a face to face
interview structured questionnaire from August 1,2022 to September 1,2022. the collected data
will be tallied, analyised and association will be done by scientific calculator the result will be
presented by tables and graphs.

Work plan and budget breakdown: the total budget required to conduct this research
will be 6177 ETB.

iii | P a g e
 Table of content

Acknowledgement………………………………………….…………………………..……..II

Table content…………………………………………………………………………………..IV,V

Summary……………………………………………….……………………………….…...…III

List of tables……………………………………………………………………………………VI

Acronym and abbreviation……………………………………………………………………...VII

1. INTRODUCTION………………….……………………………………………………….1

1.1 Background of the problem………………………………………………………………...…1

1.2 Statement of the problem …………………………………………………….……...………..3
1.3 Significance of the study…………………………………………………………….…..…….5

2. LITERATURE REVIEW…………………….………………………………………….…...6

3. OBJECTIVES OF THE STUDY…………………………..……….....…...………12

3.1 General objective………………………………………………………….…………………12

3.2 Specific objective ………………………………………………………..………………….12

4. METHODS AND MATERIALS………………….…………..….…….…………13

4.1 Study area and study period ………………………………..………….…………………….13

4.1.1 Study area ………………………………………………...………………….….…………13

4.1.2 study period…………………………………………...……………………….…………...13

4.2 study design ………………………………………...……………………………………….13

4.3 population……………………………………...…………………………………………….13

iv | P a g e
4.3.1 source population……………………………….………………………………………….13

4.3.2 Study population ………………………………………………….……………………….13

4.3.3 Sample population………………………………………………………..………………..13

4.4 Inclusion and exclusion criteria…………………..…………………………………………13

4.4.1. Inclusion criteria………………………………………..…………………………………13

4.4.2 Exclusion criteria…………………………………………………………………………..14

4.5 Sample size determination……………………………………………….…………………..14

4.6 Sampling procedure……………………………………………………………….…………17

4.7 Data collection procedure…………………………………………………………………....18

4.8 Variables of the study ……………………………………………………………………….18

4.8.1 Independent variables…………………………………………………………………...…18

4.8.2 Dependent variables…………………………………………………..................................19

4.9 Operational definition ……………………………………………….....................................19

4.10 Data quality control …………………………………………………………….………….19

4.11 Data collection process and analysis ………………………………………….…..……….19

4.12 Ethical consideration …………………………………………………………………….…20

4.13 dissemination of the study …………………………………………………………………20

5.WORK PLAN ………………………….………………………………..………21

6.BUDGET BREAK DOWN ……………….……………………………………...22

v|Page
7.Reference………………………………………………………….………………..
……...248.Annexes……………………………………….

…………………………………………….30

List of table
Table 1: Work plan for Assessment of attitude, knowledge and practices regarding maternal nutrition
among pregnant women attending ANC BGH, Ethiopia, 2022………………… 15

Table 2: Budget breakdown for personal cost and stationary cost for assessment of attitude,
knowledge and practice regarding maternal nutrition among pregnant mother attending ANC,
BGH ,2022………………………16

vi | P a g e
 ACRONYMS AND ABBREVIATION

ANC: Antenatal care

BGH : Bedele General Hospital

WHO World Health Organization

LBW: Low birth weight

OPD: Out patient Department

UNICEF: United nations children’s fund

EDHS: Ethiopian demographic health survey

HIV: human immune virus

IUGR: intra uterine growth restriction

LBW: Low birth weight

SGA: Small for gestational age

ETB: Ethiopia Birr

GA: Gestational age

PI: principal investigator

TM : Trimester

L: littre

vii | P a g e
Kg: kilogram

viii | P a g e
CHAPTER ONE

Introduction
1.1Back ground of problem
All human beings need a balanced amount of nutrients for proper functioning of the body
system. Nutrition is a fundamental pillar of human life, health and development throughout the
entire life span (1). In pregnancy mothers need a balanced diet to support the growth and
development of the fetus(2).Malnutrition is among the most severe health problems afecting
children and their mothers in Ethiopia. Mal nourished mothers face higher risks during
pregnancy and birth [3]. Poor maternal nutrition during pregnancy were associated with higher
risk of having a preterm labor, low birth-weight, Intrauterine growth restrictions and facing with
multiple threats to their own wellbeing and survival [4]. It also decreases the productivity of a
woman, affecting herself, her family, community and society in general.

Although the level of dietary diversity vary across the world, food security, household/individual
income and income generating activity, Agro biodiversity, educational level of head of
household, knowledge about nutrition and nutrient content of foods where the major factors
influencing children and women nutritional status(5).

‘Maternal over nutrition during pregnancy has long-lasting and detrimental effects on the health
of both the offspring and mother such as, preeclampsia and gestational diabetes, macrosomia,
distocia and higher prevalence of cesarean section (6).Adequate and balanced nutrition during
gestation has been accredited as a prerequisite for a healthy pregnancy and birth outcomes (7). It
is well documented that deficiency of particular nutrients during antenatal period may contribute
to suboptimal embryonic and fetal nutrition, impaired intrauterine growth and development,
congenital malformations, severe pregnancy complications, and preterm deliveries. Maternal
inadequate nutritional intake may also make fetus more prone to cardiovascular, metabolic, or
endocrine program ‘

1|Page
A woman who has been well nourished before conception begins her pregnancy with reserves of
several nutrients so that the recurrent needs of the growing fetus can be met without adversely
affecting her health. Infants, who have been well nourished in the womb, have an improved
chance of entering life in very good health (9). There is growing recognition of the significance
of maternal nutrition interventions as part of ANC to improve maternal and infant health
outcomes (10). Antenatal care (ANC) is a critical strategy in reducing maternal mortality as it
facilitates the identification and mitigation of risk factors early in pregnancy [11].

2|Page
1.2 STATEMENT OF PROBLEM

According to UNICEF ,each year more than half a million women die from causes related to
pregnancy and child birth(12).nearly 4 million die within 28 days of birth(13).many of 200
million women who become pregnant each year, most of them in developing countries suffer
from ongoing nutritional deficiencies(14).7%of the global disease burden and at least one fifth of
maternal mortality are a result of maternal malnutrition along with increased probability of poor
pregnancy outcomes(15).In sub Saharan Africa iron and folate deficiency are the most common
cause of anemia in pregnant women.20% of maternal death in Africa have been attributed to
anemia(16).In 2011,27% of Ethiopian women were malnourished(17).

Maternal malnutrition is influenced not only by lack of adequate utilization but also influenced
by factor like demographic factors ,nutritional knowledge and perception of mothers during
pregnancy(18).maternal malnutrition is also influenced by social factors ,psychological factors
and biological factor(19).lack of knowledge of sufficient nutrition is stated as an instant cause of
malnutrition(20).as evidence a large body of research ,educational status ,occupations and parity
is a factor that influence nutrition knowledge and practice(21,22).

Poor maternal nutrition during pregnancy is associated higher risk of having preterm labor ,low
birth weight ,intra uterine growth restriction and facing with multiple threat to their own
wellbeing and survival(23).it also decreases the productivity of a women ,affecting herself ,her
family ,community and society in general.

World health organization (WHO) endorsed antenatal nutrition education for women to reduce
the birth of underweight infant and prevent maternal complication. the recommendation was
context specific and focused on population affected by malnutrition, especially in low and
middle income countries(24).Ethiopian ministry of health(MoH) has used different strategies
such as nutrition ,education via social media, likewise, the health extension worker, have also
been striving mitigate the deficiency in nutrition knowledge and attitude among women
especially in the rural community(25)

All pregnant women should have knowledge of nutrition during pregnancy and should use

3|Page
it. However about 47% of women lacked cognizance of balanced and diversity diets during
antenatal period (26). few studies on nutrition knowledge ,attitudes and practice have been
conducted in Ethiopia .particularly in Bedelle town ,BGH .so the purpose of this study is to
assess pregnant women nutrition knowledge and practice.

4|Page
 1.2Significance of the Study

Malnutrition in pregnancy is associated with a host of adverse maternal and infant outcomes,
including gestational diabetes, pre-eclampsia, and preterm birth with over nutrition; small for
Gestational age (SGA), low birth weight (LBW), and neonatal death with under nutrition
(11).But no more study has been conducted to assess nutritional knowledge and practices of
pregnant mothers in the study area.
Therefore the finding of this study will contribute in filling the gap in understanding the
knowledge, attitude and practices regarding maternal nutrition among pregnant women attending
ANC clinics in the study area.
The results of the study will inform design of the maternal nutrition education intervention
strategies
targeting pregnant women‟ due to their importance in reproductive and productive roles in the
society.
The finding of this study is important to provide baseline information related to maternal
nutrition for other researchers.
Besides the health providers and Ethiopian Ministry of Health, others who are interested in the
field of maternal health in general will benefit from this research.the result of study will be used
by BGH antenatal care staffs to give services and education about maternal nutrition during
pregnancy when the women visit ANC.

5|Page
CHAPTER TWO
LITERATURE REVIEW

2.1 knowledge of pregnant women towards maternal nutrition

A study done in USA shows that 124 pregnant mothers attending the outpatient clinics of
obstetrics and genecology revealed that 78.2% of women had a good knowledge about the
importance of milk and milk products for pregnant women and also they knew that maternal
malnutrition can endanger the new born health, 45.9% and 49.2% knew correctly neither the
meaning nor the constituents of the balanced diet for the pregnant women,61.3% had good
knowledge about the sources of iron , 71.8% knew the sources of calcium and 62.9% knew the
source of vitamins. It also revealed that women aged 25-35 years had higher mean of nutritional
knowledge among respondents ( 27).Similarly In the United States, Sharp, et al reported that
women of childbearing age who were from low socioeconomic backgrounds knew little about
the importance of the recommended daily intake of folic acid and only 63 (25%) of the total
number of women surveyed (N=250) reported consuming folic acid supplements daily( 28).
Similarly, a New Zealand study identified that knowledge and understanding about
recommended folic acid intake among women of child bearing age was relatively poor, with only
64% of the 1000 women surveyed being aware that pregnant women needed to take
recommended doses of folic acid (29).
A study on 400 pregnant women admitted to the Cuza -Vodă Obstetrics and Gynecology Clinical
Hospital in Iasi, Romania, 2019 showed that 45.3% of participants had used iron supplements
during pregnancy. Women with a higher level of nutritional knowledge used folic acid, iron and
multivitamin supplements more frequently. In another Findings from cross-sectional analysis of
data collected from 836 participants at Porto, Portugal, 2018, reported that Prevalence of use of
supplements during pregnancy was 55.4% for folic acid, 81.9% for iron, and 76.2% for
multivitamins ( 30). Similar study at rural area of India on 50 antenatal mothers showed that iron
6folate tablet was adequately consumed by 62% mothers among the study population ( 31).

 A study in Pakistan shows 84% of mothers had knowledge that diet should be changed
by increasing, adding or avoiding some special food items in the diet during pregnancy,
but
6|Page
  only 65.5% practiced them. The reasons for this deficient knowledge and practice of
dietary intake are lack of nutritional knowledge and poor economy (32).In similar study
which was conducted at Military Hospital and Combined Hospital Rawalpindi, Pakistan,
among 400 married reproductive age women in 2017 revealed that 53.25% of them knew
folic acid intake is important, 40.25% thought that folic acid deficiency among pregnant
women results in abnormality in new born. Regarding the rich source of folic acid
60.25% of women had idea and from the total 23.25% were regularly having green
vegetables and fruits. 51.25% of respondents had received folic acid supplementation
during pregnancy (33).

A study in Malaysia show that, Food and nutritional knowledge has been demonstrated to have
positive effect on the quality of dietary intake as well as healthy food purchasing behavior
among pregnant mother (34). Improvements of nutrition knowledge, by exposing an individual
to new information possibly arouse changes in practice and consequently resulting in
improvements in dietary behavior (35). However, another study reported that higher level of
knowledge among pregnant women was not an indicator to motivate them to alter their dietary
habits (36)

A study at Addis Ababa public hospitals shows that among 322 pregnant women only 87(27%)
of pregnant women had knowledge of nutrition during pregnancy. This study also showed that
75(23.3%), 207(64.3%), 218(67.7%), 147(45.7%) and 114(35.4%) of the respondents had a
complete correct answer to what is balanced diet, pregnant mothers’ diet differ than others,
component of balanced diet, danger of malnutrition for pregnant mother and the fetus
respectively. On the other way, 140(43.5%), 146(45.3%), 300(93.2%), 146(45.3%) and
129(40.1) did not know the importance of protein, milk and its products, folic acid, iron and the
benefit of birth spacing for pregnant woman respectively. (37), Ethiopia in 2019 revealed that
64.4% of women had nutrition knowledge during pregnancy. In these study only 42.2% of the
mother knew the meaning of foods. Regarding to the main food group or balance diet 74.0% of
the mother did not knew the main food groups or the balanced diet and 70-88% had no
knowledge about common food sources of protein, carbohydrate, iron, vitamin A and iodine. In
this study 28-49% of the mother have no the knowledge that food during pregnancy is important

7|Page
for bodies energy and heat, proper functioning of the body, growth and development of the fetus
and infection fighting (38).

2.2 Practice of pregnant women towards maternal nutrition

A research on 124 pregnant females Tanta city, USA, showed that 42.7% of them had practiced
daily servings of milk, milk products and animal protein. 61.3% of pregnant women practiced
badly the habit of eating much starchy food between meals. About two thirds of women had a
good practice of eating vegetables and fruits between meals. About 60 % practiced daily eating
of enough servings of vegetables and fruits. (39).Other similar study was conducted among
pregnant women who attended Obstetrics and Gynecology clinic during their antenatal care
visits. Practice on food and nutrition questionnaire was utilized. The mean (SD) score of
practices for pregnant women was 3.7(0.8) which presented 74% correct response rate . This
study showed no significant mean difference was found in healthy/unhealthy practices on
frequency of taking breakfast, types of snack usually eaten, first selection of food for breakfast,
frequency of fish/other sea food, meat, beef, mutton, egg, beans and products, vegetables, fruits,
and milk intake (40).

A cross sectional study conducted on pregnant adolescents in turkey shows that 87.8% of the
pregnant women took preparations that contain iron, calcium or folic acid and 12.2% of them
didn’t take such preparations. It is found that while 91.8% of pregnant women consumed milk,
yoghurt and the sort during their pregnancy, 8.2% of them never consumed milk, yoghurt and the
sort. The answers given to the question of “Which one makes blood” by pregnant adolescents
that are included in the study are as follows 65.3% of them said from animal product ,8.2% of
them said vegetable and fruit, 26.1% of them said from both animal product, and vegetable and
fruit [41].

Dietary assessment in southeastern India showed that the mother had deficit in micro nutrient
intake especially iron and other micro nutrient. So it is essential to counsel them to increase their
intake in order to meet the demands of the both mother and fetus. Even mothers included all the
food groups like cereals, pulses, fruits and vegetables, milk and milk products, fats and sugars in

their diet are not aware of the number of servings to be taken. They must be counseled about the
number of servings [42]

8|Page
A study conducted in Malaysia shows that (22%)pregnant women attending for their antenatal
follow up had good practices on food and nutrition. In this study it was shown that participants
with healthy practices on: selection of foods for lunch, dinner and drink, consumption of snacks

two or three times/day, and eating fast foods 2-3 times per month. (43). A study at Addis Ababa
public hospitals shows that among 322 pregnant women only 111(34.5%) of pregnant women
had good practices of nutrition during pregnancy. In these study, only 26(8.1%) of women
follow specific dietary regimen, greater than three quarter, 238(73.9%) of women used iodized
salt to prepare their daily main meals, less than one fourth of women, 77(23.9%) had the habit of
eating fresh citrus fruits/juice, most of women, 303(94.1%) of women had the habit of taking
protein daily and less than one third, 101(31.4%), 57(17.7%) of women practiced daily
servings of milk and milk products respectively. As regards fresh vegetable, only 87(27%) of
respondents practiced daily servings. But 84(26.1%), 245(76.1%), 235(73%), 19(5.9%),
222(68.9%) and 266(82.5%) of women had poor practices of daily servings of fresh fruits,
vegetables, protein, milk and milk products respectively.[44]

A study conducted in Jimma zone shows that the diet frequency of meal per day: most of the
respondents (66.1%) had diet frequency of meal 1-2 per day during their pregnancy. The rest
(20.3%) (13.6%) and (29.1%) had diet frequency of meals 3-4,>5 per day and eat more
carbohydrate respectively during their pregnancy (45).

A study at Mekelle town, Ethiopia, shows that among 632 pregnant women in2014 revealed that
Injera and wet was the staple diet for 67.5% of pregnant women. Around halfof the pregnant
women ate three times per day. 57.8%, 33.4%, 45.7% pregnant women took meatonce, milk
twice and egg twice per week respectively. Similarly around half of pregnant women are fruits
once a week. 73% of pregnant women took vegetables twice per week (46).

9|Page
2.3: Attitude of pregnant women towards maternal nutrition

According to study conducted to public hospitals of keffa zone, southern Ethiopia ,10 august to
10 September 2021,two hundred twenty five (59.5%) participant’s had favourable attitude and
the remaining 157(40.5%) had unfavourable attitude (47).regarding food intake during
pregnancy ,about 188(49.7%) of participants think that its good to eat more food (48). In terms
of protein intake during pregnancy,178(47.1%) of mothers were not sure (49).

According to research conducted on maternal nutrition during pregnancy in Addis Ababa 29.8%
eat more food during pregency,6% eat more carbohydrate,65.2% eat more protein or beans
during pregnancy,12.1% have more milk and its products during pregnancy,87% prepare meals
with iron reach foods ,89.1% taste meat and other iron reach food items ,82.5% taste omega 3
reach foods; olive oils, fish with iodized salts. (50)

In the study conducted in the rural Ethiopia on the assessment of knowledge, attitude and
practice of pregnant mother on maternal nutrition, cognizant to awareness levels, mother who
reported to have diversified diet, frequency, mentioned vegetables (53% vs 34.4%) and fish (20.4
vs 9%) as major food sources of vitamin A ( p<0.05). (51) conversely, mothers who had less
diversified diet more frequently mentioned wheat (8.3% vs 1.5%) and egg (19.3% vs 9.8%)
where more frequently mentioned food sources of iron by pregnant mother who had diversified
diet (p<0.05). (51) other wise ,no statistically significant difference was observed in all other
food sources mentioned as sources of either vitamin A or iron. (52)

10 | P a g e
 VILLAGE –LEVEL VARIABLES
Availblity of dietary diversification
Mass media

LOWER LEVEL VARIABLES

Household demographic characteristics
Maternal characteristics

Nutrition and Health

knowledge,Attitude and practice
Antenatal care utilization

knowledge

Attitude Practice

Figure 1 conceptual frame work

Perumal et al.BMC pregnancy and child birth 2013,13:146 http://wwwbiomedcenteral.com/1471-

2393/13/146

11 | P a g e
CHAPTER THREE

OBJECTIVES OF THE STUDY

3.1General objective
The general objective of this research is to assess the knowledge ,attitude and practice regarding
maternal nutrition among pregnant women attending ANC clinics BGH, bunno bedelle zone,
bedelle town Oromia region, south west Ethiopia, 2022

3.2Specific objectives
 To determine the knowledge of pregnant women regarding maternal nutrition during
pregnancy.
 To describe the attitude of pregnant women regarding maternal nutrition during
pregnancy.
 To identify dietary practice of pregnant women with regard to maternal nutrition during
pregnancy.

12 | P a g e
CHAPTER FOUR
METHODS AND MATERIALS

4.1 Study area &Study period

4.1.1 Study area

The study will be conducted in BGH. BGH was established in 2011(2003 E.C) by Oromia health
bureau and its located in Bedele town, Bunno Bedele zone, Oromia region, 483Km from the
capital city Addis Ababa. The hospital is one of the general hospital which provide services for
both outpatient and inpatient services and give service for 2 primary hospitals and 32 health
centers. The hospital has a different department and wards like outpatient department (OPD),
medical wards, gynecology and obstetrics ward, pediatrics ward and surgical ward mother and
child health (MCH), laboratory, radiology, pharmacy, physiotherapy and follow up of chronic
disease. It has a total healthworkers of 165 among them 2 specialist, 2 IESO, 1 general
practitioners, 1 dental surgeon, 58 nurses, 17 midwifes, 4 anesthesiologist, 8 pharmacologist, 13
medical lab technician, 3 radiologist, 2 psychiatry, 2 environmental professionals. The BGH has
more than 100 beds and gives diagnostic and treatment services for more than 900,000
populations per year and about 4,000 pregnant women per year.

4.1.2 Study period

Study will be conducted august 1,2022 to September 1,2022

4.2 Study design

An inistitutional based cross sectional study will be conducted.

4.3Population
4.3.1 Source population: all pregnant women attending ANC services at BGH, bedelle
town in a year 2022.
4.3.2 Study population: all pregnant women attending ANC services from August 1, 2022
to September 1,2022 at BGH, bedelle town.

13 | P a g e
 4.3.3 Sample population: all pregnant women who will be selected by systematic random
sampling method

4.4 Inclusion and Exclusion Criteria

Inclusive criteria

All pregnant mothers those had come to BGH for ANC follow up were included in the study

Exclusive criteria

Seriously ill pregnant mothers and have hearing abnormality.

Pregnant mothers who are mentally ill

Sample size determination

The sample size is determined by using the study conducted in previous research, in Addis
Abeba public hospitals in 2020 the knowledge of pregnant mother was 27% (52) on maternal
nutrition during pregnancy with 5% marginal error and 95% Cl and 10% of nonresponse rate,
The practice with of pregnant mother was 22%(52) on maternal nutrition during pregnancy with
5% marginal error and 95% C1 and 10% nonresponse rate, the attitude with pregnant mother was
20%(52) on maternal nutrition during pregnancy with 5% marginal error and 95% CI and 10% of
nonType equation here .response rate Based on those the actual sample size is determined using
the formula for single population proportion (53)

n of knowledge= )
(
2
z p×q
a
2

d2

Where n= the desirable sample size

a=5% a/2=5%/2=2.5%=0.025

Z(a/2) =Z 0.025

14 | P a g e
 Confidence level =95%

Z (a/2) =the critical value at 95% level of significance (1.96)

p= 27 %

d=acceptable marginal error=0.05

q=1-p=0.73

d=0.05

n= (1.96)2x (0.27) x (0.73)

(0.05)2

n=303

n of attitude = )
(
2
z p×q
a
2
2
d

Where n= the desirable sample size

a=5% a/2=5%/2=2.5%=0.025

Z(a/2) =Z 0.025

Confidence level=95%

Z (a/2) =the critical value at 95% level of significance (1.96)

P=20%

q=1-p=80%

n attitude =(1.96)2x (0.20) x (0.80)

15 | P a g e
 (0.05)2

n=246

n of practice= ( )
za 2 p×q
2

d2

Where n= the desirable sample size

a=5% a/2=5%/2=2.5%=0.025

Z(a/2) =Z 0.025

Confidence level=95%

Z (a/2) =the critical value at 95% level of significance (1.96)

P=22%

q= 1-p=78%

d=0.05

n of practice = n= (1.96)2x (0.22) x (0.78)

(0.05)2

n of attitude =264

 So we have sample size of knowledge is 303, attitude is 246 and practice is

264 for single population proportion. Form those sample size we should
take the largest sample size which is 303
 Since the source population (4,000 according to BGH health management
and information system office) is less than 10,000 the final sample size will
be calculated by population correction formula.
16 | P a g e
  nf=n/1+n/N where nf= final sample size
n= previous sample size=303
N=source population=4,000
= 303/1+303/4,000
=303/1+0.07575
=303/1.07575

=281.7 ~ 282

 also we have 10% of nonresponse rate to get the required final sample size
we add 10% of required sample size (282) to final sample size (282) done
by population correction formula
 i.e 10%x282

=10x282/100

=2820/100
=28.2=28 nonresponse
 So by adding nonresponse rate with sample size acquired by population
correction formula
28+282=310. So the final sample size will be 310.

4.5 Sampling procedures

A convenience sampling technique will be used to select study participants until sample size will
be met .the previous months clients flow of the hospital for anc service was reviewed from
registration book to estimate the number of pregnant women those will visit the anc service in
the next one month period. Accordingly, the number of pregnant women who visit anc in the
previous month was 330.but,our sample size is 310.so,to get the required study participants we
wil use a convenience sampling technique. We will interview starting from starter respondents
each study participants in the order of their coming for follow up starting from and the starter of
the respondent is the 1st pregnant women who will come for follow up

4.6Data collection procedure

17 | P a g e
The data is basically structured interview administered questioners .but since there are people
who are not able to write and read interview administered questionary is prepared and translated
onto Afaan oromo prior to the start of data collection.The data collection tool was pretested with
data collector. The data will be collected by 4 wallaga university Bsc candidates (3 data collector
and 1supervisor) . The interview will be conducted after clients got the ANC service and each
client will be interviewed privately and assure on the confidentiality of the interview using
written consent.

4.7 Variables of the study

4.7.1 Independent variable
A. Socio-demographic factor

 Educational status
 Religion
 Marital status
 Age
 Income level
 Ethnic
 Family size
 Availability of media
 Nutrition

18 | P a g e
4.8.2 Dependent Variable
 Knowledge of pregnant mother on maternal nutrition during pregenacy.
 Practice of pregnant mother on maternal nutrition during pregnancy.
 Attitude of pregnant mother on maternal nutrition during pregenacy.
4.8 Operational definition
Practices: The actions of pregnant women that could afect her meal frequency per day.

Good dietary practices: pregnant women, those who scored > or = 75% (answered 12
questions yes or correctly) of the dietary practice question which is 16 in number. (54)

Poor Dietary practices: pregnant women, those who scored<75% (unanswered 12 question
yes or correctly) of dietary practice question which is 16 in number (54).

Knowledge: refers to an individuals knowledge of nutrition including the ability to remember

and recall food and nutrition related terminology.

Good dietary knowledge: Pregnant women those who scored greater than or equal to 75%
(answered 9 question yes or correctly) dietary practice question which is 11 in number. (55)

Poor dietary knowledge: pregnant women those who score <75% (unanswered 9 question yes
or correctly) dietary practice question which is 11 in number (55).

Attitude: pregnant women’s feelings or eating behaviors which is influenced by her emotions
motivations, perception and thought

Good dietary attitude: pregnant mother those who scored greater than or equal to 75%
( answered 7 question yes or correctly) dietary attitude question which is 9 in number. (56)

Poor dietary attitude: pregnant mother those who score less than 75% (unanswered 7
question yes or correctly) dietary practice question which is 9 in number. (56)

4.9Data quality control

Quality of data is assured through developing standardized questioner. three Data collectors (bsc
candidate) and one supervisor ( bsc candidate) will be trained before data collection on data
collection procedure. The procedure manual for the data collection will be prepared and
distributed for data collectors and supervisor. This will facilitated the communication between
data collectors and investigator. After data collection the principal investigator and supervisor
will review the filled questionnaire on daily basis. each questioner will be checked for
completeness, missed value and inconsistency of responses.

19 | P a g e
4.10 Data collection tool
The data collection tool is adapted structured interview administered questioners. The
questioner is to collect information on sociodemographic, knowledge, attitude and practice
regarding maternal nutrition among pregnant women attending ANC service in BGH, 2022.
The questioners will be translated first in to local language Afan oromoo and then back to
English version for data analysis by language experts.
4.11 Data collection process and analysis
The collected data will be compiled, summarized and processed by using tables and graphs.it
will be calculated by using scientific calculator. Frequency distribution and percentage of the
various parameter will be determined. any error identified during data entry will be corrected by
reviewing the original completed questionary. Descriptive statistics such as mean/median with
standard deviation/interquartile range will be used to describe and summarize the data.

4.12 Ethical consideration

Before the start of study, the approval and permission letter will be sent from ethical clearance
committe of midwifery department of wollega university to chief excutive officer of BGH to
obtain their consent. necessary explanation about the study and procedure will be done. Oral
consent will be obtained from the respondents and confidentiality will be maintained at all levels
of the study and assured for any information provided. unwilling participants in the study will
not be encountered.

4.13 Dissemenation of study

The outcome of this study will be disseminated to Wollega university, institute of health science
department of midwifery, wollega university library, Bedele town health bureau and BGH .
Further attempt will be made to present on national and international conference and to publish
it on medical jornals.

20 | P a g e
CHAPTER FIVE

WORK PLAN
Table 1: Work plan for Assessment Of knowledge, attitude and practices regarding maternal
nutrition among pregnant women attending ANC service at BGH , Bedele town, Oromia region,
Ethiopia, 2022 from August 1,2022 to September 1,2022.

N0 Activities Responsibl April, May, June, July, August, September,

e 2022 2022 2022 2022 2022 2022
Body
1 Topic selection Advisor

2 Searching PI
Literature
3 Proposal PI
Development
4 Obtaining ethical College
Clearance
5 Data collection PI
6 Data entry, PI
analysis and
interpretation
7 Submission of PI
Final work

21 | P a g e
CHAPTER SIX

BUDGET BREAK DOWN

6.1 Personal cost and stationary cost

Table 2: Budget breakdown for personal cost and stationary cost for assessment of knowledge,
attitude and practice regarding maternal nutrition among pregnant mother attending ANC BGH
from August1,2022 to September 1,2022

Description no of unit Duration Quantity Payment/person/day Total

person in day or payment/unit Birr in
ETB

Data 5 - 15 - 50 3750
collectors

Data 1 - 3 - 100 300

supervisor

Secretary 1 - 15 - 70 1050

Duplicating - Data - 300 1 300

paper abstraction
format

Pen - Individual - 3 12 36

Pencil - Individual - 2 5 10

Ruler - Pieces - 2 15 30

Eraser - Pieces - 2 3 6

Sharper - Pieces - 2 15 30

Stapler - Pieces - 1 100 100

Note book - Pieces - 4 25 100

Printing - Pad - 2 80 160

cost

Calculator - Pieces - 1 150 150

Stop watch - Pieces - 1 80 80

22 | P a g e
Binder - Pieces - 2 15 30

Photocopy - Pack - 1 45 45

Subtotals 6177

References
1. World Bank Repositioning Nutrition as central to development: A strategy for large scale
action, The International Bank for Reconstruction and Development, World Bank, Washington
DC, USA, 2017
2. Desalegn K, Pragya S, Debebe M. J Pharm Sci Innovation. Guideline for measuring household
and individual dietary diversity.FAO;2013.
3. Infant and Young Child Nutrition project literature review prepared for the Message and
materials development workshop produced through support provided by the United States
Agency for International Development (USAID), Addis Ababa, Ethiopia; 2019.
4. Riang’a RM, Broerse J, Nangulu AK. Food beliefs and practices among the Kalenjin pregnant
women in rural UasinGishu County, Kenya. J Ethno Biol Ethno Med. 2017;13(1):29.
5. Development Initiatives. Global nutrition report: shining a light to spur action on nutrition.
2018;1–112.
6.Rocco PL, Orbitello B, Perini L, Pera V, Ciano RP, et al. (2005) Effects of pregnancy on eating
attitudes and disorders: a prospective study. J Psychosom Res 59: 175-179
7.H.A. Bawadia, O. Al-Kuranb, L.A. Al-Bastonia, R.F. Tayyemc, A. Jaradatd, G. Tuurie, S. N.
Al- Beitawif, L. M. Al-Mehaisenb. Gestational nutrition improves outcomes of vaginal deliveries
in Jordan: an Epidemiologic screening. Journal of Nutrition Research, 2010, 30 (2):110–117.

8. M. Roudbari, M. Yaghmaei, M. Soheili Prevalence and risk factors of low-birth-weight

infants in Zahedan, Islamic Republic of Iran. East Mediterranean Health Journal, 2017, 13 (4):
838-45.

9. FAO, IFAD, UNICEF W and W. The state of food security and nutrition in the
world.safeguarding against economic slowdowns and downturns. Rome, FAO. 2019;1–239
23 | P a g e
10. Bhutta ZA, Das JK, Rizvi A, Gaff MF, Walker N, Horton S, et al. Maternal and child
nutrition evidence-based interventions for improvement of maternal and child nutrition.
2018;2:1–22

11.Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, Bustreo F, Cavagnero E,

Cometto G, Daelmans B, De Francisco A, Fogstad H, Gupta N, Laski L, Lawn J, Maliqi B,
Mason E, Pitt C, Requejo J, Starrs A, Victora CG, Wardlaw T: Countdown to 2015 decade report
(2016–20): taking stock of maternal, newborn, and child survival. Lancet 2018, 375(9730):2032–
2044

12 . UNICEF (2019) Maternal and Newborn Health in Nigeria: Developing Strategies to

Accelerate Progress. The State of World’s Children 19-22.

13. UNICEF (2019) Maternal and Newborn Health in Nigeria: Developing Strategies to
Accelerate Progress. The State of World’s Children 19-22.

14. Mora JO, Nestel PS (2000) Improving prenatal nutrition in developing countries: strategies,
prospects, and challenges. Am J ClinNutr 71: 1353S-63S.

15. McGuire S, World Health Organization. Comprehensive implementation plan on maternal,

infant, and young child nutrition Geneva, Switzerland, 2020.AdvNutr. 2019;6(1):134–5.

16. Central Statistics Agency International. Ethiopia demographic and health survey 2018. Addis
Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF
International. 2012; 430

17.Awareness Regarding Maternal And Infant Feeding Practices Among Mothers Of Medical
UndergraduatesNGoel, M Kalia, A Galhotra, R Pathak, H Swam

18 knop berg c, TorgersenL,vonHollen,HamerRM,BulikCM, et al.(2019) factors associated with

binge eating is disorderin pregnant

19 TemesgenDH,DeselagnW, HabtamuFG, Dunkana NK, Nutrional status and associated

factors among lactating,mothers in NekemteReferal Hospital and health centers,Ethiopian.

24 | P a g e
20 multisectoral nutrition strategic guidancebrief:maternal nutrition for grilswomen.weshington,
DC:USAID,2020,pp 1-4

21. Guggino A, Barbero S, Ponzo V, et al. Myths about nutrition in pregnancy. J ObstetGynaecol
2016; 36; 964–965, http:// www.tandfonline.com/loi/ijog20

22. FekaduBeyene GD. Assessment of knowledge of pregnant mothers on maternal nutrition and
associated factors in GutoGidaWorde, East Wollega Zone, Ethiopia. J Nutr Food Sci 2013; 3(6):
235.

23. Riang’a RM, Broerse J, Nangulu AK. Food beliefs and practices among the Kalenjin
pregnant women in rural UasinGishu County, Kenya. J Ethno Biol Ethno Med. 2017;13(1):29.

24. World Health Organization. WHO recommendations on antenatal care for a positive
pregnancy experience. Geneva: World Health Organization, 2018.

25. Swanson V, Hart J, Byrne-Davis L, et al. Enhancing behavior change skills in health
extension workers in Ethiopia: evaluation of an intervention to improve maternal and infant
nutrition. Nutrients 2021; 13(6): 1995.

26. Zerfu TA and Biadgilign S. Pregnant mothers have limited knowledge and poor dietary
diversity practices, but favorable attitude towards nutritional recommendations in rural Ethiopia:
evidence from community-based study. BMC Nutr 2018; 4: 43.

27.Latifa M. Fouda, Manal H. Ahmed, Shehab NS. Nutritional Awareness of Women during
Pregnancy Journal of American Science 2019;8(7):494-502.

28.A Comparative Study of Nutritional Awareness among Urban-Rural Pregnant Mothers in

USA2016.

29.Lunet N, Rodrigues T, Correia S, Barros H. Adequacy of prenatal care as a major determinant

of folic acid, iron, and vitamin intake during pregnancy. Cad SaúdePública, Rio de
Janeiro.2020;24 (5):1151-7.

25 | P a g e
30. Lunet N, Rodrigues T, Correia S, Barros H. Adequacy of prenatal care as a major
determinant of folic acid, iron, and vitamin intake during pregnancy. Cad SaúdePública, Rio de
Janeiro.2008;24 (5):1151-7.

31. Pratim P, Sharma S, Sarkar TK, Mitra P. Iron and Folic Acid Consumption by the Ante-natal

Mothers in a Rural Area of India.Int J Prev Med. Oct 2013;4(10):1213-6.

32.Assessment of nutritional beliefs and practices in pregnant and lactating mothers in an urban
and rural area of Pakistan.

33.Hisam A, Rahman MU, Mashhadi SF. Knowledge, attitude and practice regarding folic acid
deficiency; A hidden hunger. Pak J Med Sci. 2017;30(3):583-8.

34.Mitra Mirsanjari1+, Wan Abdul Manan Wan Muda1, Affizal Ahmad1, MohdShukri Othman2
and Maryam Mosavat2 does nutritional knowledge have relationship with dietary attitude and
practice during pregnancy in Malaysia

35.Gittelsohn, J.A. Anliker, S. Sharma, A.E. Vastine, B. Caballero, B. Ethelbah. Psychosocial

determinants of food purchasing and preparation in American Indian households. Journal of
Nutrition Education and Behavior. 2018, 38 (3): 163–168.

36.W. Verbeke, I. De Bourdeaudhuij. Dietary behavior of pregnant versus non-pregnant women.

Appetite.2017, 48 (1): 78–86.

37.Assessment of knowledge, attitude and practice regarding maternal nutrition during

pregnancy in AdisAbeba public hospitals, Ethiopia

38 .Daba G, Beyene F, Garoma W, Fekadu H. Assessment of nutritional practices of Pregnant

Mothers on Maternal Nutrition and Associated Factors in Bedele Woreda Bunno Bedele Zone,
Ethiopia. Star journal. 2020;2(3):105-13.

39. R.E. Patterson, A.R. Kristal, E. White. Do beliefs, knowledge, and perceived norms about
diet and cancer predict dietary change? American Journal of Public Health. 1996, 86 (10): 1394–
400.

26 | P a g e
40.Assessment of Nutritional Knowledge Regarding Maternal and Infant Feeding Practices
Among pregnant mothers visiting private hospital in Chennai

41 .The relation between pregnant adolescents’ attitude about nutrition and weight gain during
pregnancy and hemoglobin level.

42.Assessment of Nutritional Knowledge Regarding Maternal and Infant Feeding Practices

Among pregnant mothers visiting private hospital in Chennai

43. Y. Ozdoğa. 3n, and A. OzferOzcelik. Evaluation of the nutrition knowledge of sports
department students of universities.Journal of the International Society of Sports Nutrition. 2021,
8:118

44.Assessment of knowledge, attitude and practice regarding maternal nutrition during

pregnancy in AdisAbeba public hospitals, Ethiopia

45. Daba G, Beyene F, Garoma W, Fekadu H. Assessment of nutritional practices of Pregnant

Mothers on Maternal Nutrition and Associated Factors in bedele Woreda, Bunno Bedele Zone,
Ethiopia. Star journal. 2018;2(3):105-13

46.Abriha A, Yesuf ME, Wassie MM. Prevalence and associated factors of anemia among
pregnant women of Mekelle town: a cross sectional study. BMC Research Notes.

47. Meija L and Rezeberga D. Guidelines: proper maternal nutrition during pregnancy planning
and pregnancy: a healthy start in life. Recommendations for health care specialists. WHOOMS
WHO, 2017, pp. 1–31, http://www.euro.who.int/__data/ assets/pdf_file/0003/337566/Maternal-
nutrition-Eng.pdf

48. Cetin I, Laoreti A, Fanos Cagliari V, et al. The importance of maternal nutrition for health. J
Pediatr Neonatal Individ Med 2015; 4(2): e040220, www.jpnim.com

49. Multi-sectoral nutrition strategy technical guidance brief: maternal nutrition for girls women.
Washington, DC: USAID, 2014, pp. 1–10.

50. figure 2 attitude of mothers toward nutrition during pregnancy in Addis Ababa, 2015

51. Bloomfield FH, Spiroski AM, Harding JE. Fetal growth factors and fetal

27 | P a g e
nutrition. Semin Fetal Neonatal Med. 2013;18:118–23.

52. Nabarro D. Global child and maternal nutrition - the SUN rises. Lancet.

2013;382:666–7.

53. Pem D. Factors Affecting Early Childhood Growth and Development:

Golden 1000 Days. Adv Practice Nurs. 2015;1:101. https://doi.org/10.4172/

2573-0347.1000101.

54. Perumal N, Cole DC, Ouédraogo HZ, Sindi K, Loechl C, Low J, et al. Health and nutrition
knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics

in Western Kenya: a cross-sectional analysis. BMC Pregnancy and Childbirth. 2017;13:146

55.Daba G, Beyene F, Garoma W, Fekadu H. Assessment of nutritional practices of pregnant

mothers on maternal nutrition and associated factors in Bedele Woreda, Bunno Bedele Zone,
Ethiopia. SciTechnol Arts Res J. 2019;2(3):105–13

56. Nana A, Zema T. Dietary practices and associated factors during pregnancy in northwestern
Ethiopia. BMC Pregnancy Childbirth. 2018;18(1):183.

57.Hanretty KP. obstetrics illustrated. London: Churchill livingstone; 2003.

28 | P a g e
 ANNEX I (ENGLISH VERSION OF THE QUESTIONER)
Information sheet
This questionnaire has four parts which is aimed to address background information and
information on knowledge ,attitude and practice of maternal nutrition during pregnancy
among pregnant women.
Consent Form
My name is _______________ I. came from Wollega University, college of health science,
department of midwifery. I am a student who is caring out this research proposal on
assessment of knowledge, attitude and practice towards maternal nutrition during pregnancy
in BGH
I am going to ask you several questions that are not difficult to answer. Your name is not
necessary to write and will never be used in connection with any of the information you will
tell us and you can stop the interview at any time you want .
However, your honest answer to those questions will help me in identifying the knowledge &
practice towards maternal nutrition during pregnancy. I would like to appreciate you help and
participation in responding to those questions the interview will take about 20 minutes.
Are you willing to participate in this study?
a. Yes b. No

Name of interviewer ____________________ Date ____________________Sign

____________________
29 | P a g e
Instruction: - Please circle the letter that you choice made by the respondents.

Part I: Information on socio- demographic characteristics

NO Characteristics Response
1 Age ……….
2 Address Zone
Woreda
Kebele
3 Ethnicity A. Oromo
B. Amhara
C. Gurage
D. Sidama
E. Other

4 Religion A. Orthodox
B. protestant
C. Muslim
D. catholic
E. other
5 Occupation A. Housewife

30 | P a g e
 B. merchant
C. government employce
D. other..
6 Educational status A. illiterate
B. Elementary school
C. secondary school
D.12+
7 Martial status A. Married
B. single
C. Divorced
D. Widowed
8 Incomes per month A. <775ETB
B. 775-1500ETB
C. >1500ETB
9 Family size A.1-2
B.3-5
C.6-7
D.8-9
E. >10

Part two: information on knowledge

10 Do you know GA A. 1st TM
B. 2nd TM
C. 3rd TM
D. doesn’t know
11 Do you know your A. Yes
weight B. NO
12 If yes to question 11 ___________

31 | P a g e
 how many Kg
13 Do you every heard A.YES
about nutrition B.NO
14 If yes question 13 A. massmedian
where you get
B. health facility’s
information
C. friend
D.other specify
15 Do know nutrients A. YES
B. NO
16 Do you know about A. YES
proper nutrition during B. NO
pregnancy
17 If yes question 16 A. Balanced
what does a proper B. doesn’t know
nutrition during
pregnancy contains
18 Do you now source of A. YES
vitamin B. NO
19 How should a A. Eat more frequently
pergenant women eat
B. eat more protein reach food
in comparison with
non pregenant women C. Eat more Iron reach food
to provide good D. other specify
nutirition to her and
her baby to help him
grow?
20 Take supplements or A. Iron supplement
tablets during
B. Folic acid supplement
pregency?
C. other specify
D. doesn’t know
21 Dangers of A. Increase infection
malnutrition for
B. Anemia
pregenant women?
C. Decrease immune function
D. Labor
E. other specify
22 Source of foods reach A. Organ meat
in Iron ?
B. fesh and sea food
C. Teff
D. Eggs

32 | P a g e
23 Dangers of A. Increased fetal and neonatal death
malnutrition for fetus
B. IUGR
C. LBW,per term delivery
D. birth defect
E. doesn’t know
Part three: Information on practice

24.Do you follow specific 1.yes

dietary regimen during 2.No
pregnancy 3.Don't know
25.Did you use salt to cook 1.yes If yes: what kind of salt did
the main meal eaten by 2.No you use?
members of your family last 3.Don't know 1. Iodized
night? 2.Not iodized
3.Don't know
26. you eat fresh citrus fruit, 1.yes If Yes: how many times?
1. Once a day
such as; orange, lemon, 2.No
2. Twice a week
mango, or drink juice made 3.Don't know 3. Three times
4. Other specify_____
from them?
5. Don’t know
27. If yes for question No.4, 1. 2 hours Before a meal
When do you usually eat 2. During the mealor just
fresh citrus fruits? after a meal
3. 2 hours After a meal
4. Other (specify) ____
5. Don’t know
28. Do you drink coffee or 1. Yes If yes, When do you usually
2. No drink coffee or tea?
tea?
3. Don’t know 1. Two hours or more before
or after a meal
2. Right before a meal
3. During the meal
4. Right after a meal
6. Other (specify)_____
7. Don’t know/no answer
29. Do you have iron 1. Yes, I have If yes, do you take it daily?
2. No, I have not 1. Yes

33 | P a g e
supplement? 3. Don’t know 2. No
3. Don’t know
30. Do you have folic acid 1. Yes, I have If yes, when did you start
supplement? 2. No, I have not taking this supplement?
3. Don’t know 1. Before pregnancy
2. Within the first
trimester
3. Later
4. Don’t know
31. How many times do you 1. Once
have meal daily? 2. Twice
3. Three times
4. Four and above
32. Do you have the habits of 1. Yes, I have
eating snacks between 2. No, I have not
meals? 3. Don’t know
33. Do you the habits of 1. Yes, I have
eating more carbohydrates 2. No, I have not
between meals? 3. Don’t know
34. Do you eat protein (plant 1. Yes If yes, how many times?
source) daily? 2. No 1. Once a day
3. Don’t know 2. Twice a week
3. 3 times a week
4. Other specify _____
5. Don’t know
35.Do you eat fresh 1. Yes If yes, how many times?
vegetables? 2. No, 1. Once a day
3. Don’t know 2. Twice a week
3. 3 times a week
4. Other specify ____
5. Don’t know
36.Do you drink milk? 1. Yes, I have If yes, how many times?
2. No, I have not 1. Once a day
3. Don’t know 2. Twice a week
3. 3 times a week
4. Other specify ____
5. Don’t know
37.Do you eat milk products? 1. Yes If yes, how many times?
2. No 1. Once a day
3. Don’t know 2. Twice a week
3. 3 times a week
4. Other specify_____

34 | P a g e
 5. Don’t know
38. Do you eat meat? 1. Yes If yes, how many times?
2. No 1. Once a day
3. Don’t know 2. Twice a week
3. 3 times a week
4. Other specify_____
5. Don’t know
39.Do follow your weight 1. Yes
during pregnancy? 2. No
3. Don’t know

Part four: information on attitude

40 What do you think to take extra food A. fair

during pregnancy? B. good
C. not good
41 What do you tink to have different types A. Fair
of food during pregency? B. good
C .not good
42 Do you think it’s good to have green A. Yes
leafy vegetable daily in meal? B. no
43 Do you think it’s good to have iron and A. YES
folic acid supplementation? B. no

44 What do you think prepare food using A. Fair

idolized salt? B. good
C. Not good
45 How many litters of water are A. <1L
recommended to drink during pregnancy B. 1L-2L
you think? C.3L-5L
46 Do you think it’s good to drink tea and A. Yes
coffee during pregnancy? B. NO
47 Do you agree drinking alcohol is A. Yes

35 | P a g e
 recommended during pregnancy? B. NO
48 Do you think taking a Tabaco during A. Yes
pregnancy is good? B. NO

THANK YOU FOR YOUR PARTICIPATION

Assurance of principal investigator

This research proposal is our original document and presented for partial fulfillment of
requirements of Bsc in midwifery. Before anywhere in this as well as another university it hasn’t
discussed. The main title is assessment of knowledge , attitude and practice regarding maternal
nutrition among pregnant women attending antenatal care clinics in BGH

Name of investigator :1.Desalegn Biratu

2.Biniyam Tesfaye

3. Belay Zeleka

4. Eyasu Tsegaye

36 | P a g e
Date__________________ Signature___________

Advisor:Asmera Tulu.(msc in clinical midwifery)

Date Signature_____________________

ANNEX II (AFAN OROMO VERSION OF THE QUESTIONER)

ODEEFFANNOO GAAFFIILEE

Gaaffileen kun kutaa 4 kan of keessaa qabu yoo ta’u isaaniis waa’ee odeeffannoo as-dhufaatii
fi odeeffannoo waa’ee beekumsa, ilaalchaa fi gochaa nyaata haadholii yeeroo ulfaa ittin
qorachuuf kan qophaa’edha.

UNKA WALIIGALTEE

Ani maqaankoo ________________________________n jedhama. Kanani dhufe yuunivarsiitii

wolleggaa muummee saayinsii fayyaa mana barnoota nursiingii fi midwifery diipaartimentii
midwifery irraati. Nuti baraattota ebbifamoo baraa kanaa yoo tanuu ebbaa kenyafi qorannoo
waa’ee bekumsaa, ilalchaa fi gochaa nyataa hadholii yeroo ulfaa kan hospitala waliigalaa
bedellle iraatti geggessaa jirra.

Amma gaafilleen qophefadhen sigafadha. Gaafillen kunis deebisudhaf kan si hin rakkisnefii
daqiiqaa 20 kan hin caallee kessatti kan xumuramanidha. kunis yoo fedhii keessan ta’eedha.
Odeeffannoo isin nuf kennitani rakkoo nyataa hadholii yeroo ulfaanii dhufuu furuuf nu
barbachisaa odeeffannoon isin nuf kennitan kunis gutumattii iccitin isaa kan egamefi maqaan
kessanis asirratti kan hin eramnedha. Jalqabne giddutti wan isinif hin galle yoo jiratte gafachu
dandessuu; akkasumas yoo sinitti hin tollelle addan kutuu dandessuu. Kanf yeroo xiqqoo nuf
kenitanii gafille kan akka hirmaattani kabajaan isin gaafanna.

Irratti hirmachuuf fedhii qabduu ? 1. Eyyee 2. Lakki

37 | P a g e
Hundaafuu galatoomaa!

Kallattii

Namoonni odeffannoo funantanii filannoo dhaaf deebii isaa itti maraa, bakkaa duwwadhaf
immoo iddoo kennamefittii guutaa.

Guyyaa odeffannoon itti funanamee ___________

Maqaa nama odeffannoo funannee ____________

Mallattoo ________________________________

Kutaa.1 odeffannoo amalota hawas-dinagdee irratti

Tartiiba lakkofsa Amaloota Deebii

1 Umurii __________
2 Teessoo A. Godina
B. Aanaa
C. Ganda
3 Saba A. Oromo
B. Amaaraa
C. Guraagee
D. Sidaamaa
E. Tigree
F. Kan biro ibsi___
4 Amantii A. Ortodoksii

38 | P a g e
 B. Prootestaanti
C. Muslim
D. Kaatolikii
E. Kan biro ibsi___
5 Hojii A. Haadha warraa
B. Daldaltuu
C. Qacaramtuu hojii
mootummaa
D. Kan biro ibsi___
6 Sadarkaa barnootaa A. Kan hin baranne
B. Barnoota sadarkaa
1ffaa
C. Barnoota sadarkaa
2ffaa
D. Kutaa 12 ol
7 Gaa’ila yeroo amma A. Heerumtee jirti
B. Hin heerumne
C. Hiikteetti
D. Irraa du’eera

8 Galii ji’aa A. <775 birrii

B. 775-1500 birrii
C. >1500 birri
9 Baa’ina maatii A. 1-2
B. 3-5
C. 6-7
D. 8-9
E. >10

39 | P a g e
Kutaa 2 odeffannoo bekumsa hadholii waa’ee nyataa hadholii yeroo ulfaa
irratii

Tartiiba lakkofsaa Odeeffannoo beekumsaa Deebii

10 Umurii ulfakee beektaa? A. Torbee 14 jalqabaa
B. Torbee 14 itti aanan
C. Torbeewwan 29 fi
isaa ol
D. Hin beeku
11 Ulfaatinakee beektaa? A. Eyyee
B. Lakki
12 Yoo gaaffii 11ffaa eyyee jette _________
kg meeqa?
13 Waa’ee nyaataa yeroo ulfaa A. Eyyee
dhageessee beektaa? B. Lakki
14 Yoo gaaffii 13 eyyee jettee A. Midiyaa irraa
eessaa dhageesse? B. Dhaabbata fayyaa
C. Hiriyaa
D. Kan biraa
15 Elemeentota nyaata keessatti A. Eyyee
argaman beektaa? B. Lakki
16 Waa’ee nyaata madaalawaa A. eyyee
yeroo ulfaa beektaa? B. lakki
17 Yoo gaaffii 16ffaa eyyee A. madaalamaa
jettee,nyaatni madaalawaan B. hin beeku
yeroo ulfaa elementoota kam
of keesaa qaba?
18 Madda nyaata vitaaminootaa A. Eyyee
beektaa? B. Lakki
19 Dubartoonni ulfaa akkamin A. Ammaa amma
soorachuu qabu warra ulfa soorachuun

40 | P a g e
 hin taanen yeroo madaalaman B. Nyaata pirootiiniin
nyaata madaalamaa ofiifi badhaadhan hedduu
mucaa isaaniif argamsiisuuf? soorachuun
C. Nyaata ayiraniin
badhaadhan hedduu
soorachuun
D. Kan biro ibsi___
20 Bifa dawaatiin yeroo ulfaa A. Dawaa ayiranii
nyaata ni fudhattaa? B. Dawaa foolik asiidii
C. Kan biro ibsi___
D. Hin beeku
21 Rakkoo hanqina nyaataa A. Baayachuu
haadholii fi yeroo ulfaa ni dhukkuboota jarmiin
beektaa? dhufanii
B. Hir’ina nyaataa
C. Hir’ina farra qama
alagaa
D. Ciniinsuu cufamaa
E. Kan biro ibsi___
22 Maddi nyaata ayiraniin A. Foon qama keessaa
badhaadhanii maali? B. Kuduraaleefi nyaata
galaanaa
C. Xaafii
D. Hanqaaquu
23 Rakkoo hanqina nyaataa A. Dabaluu du’aatii
yeroo ulfaa daa’ima irratti daa’immanii
dhufu beektaa? B. Hir’achuu guddina
daa’immanii garaa
keesatti
C. Ulfaatinni
daa’immanii garaa

41 | P a g e
 keesatti hir’achuufi
daa’imman yeroon hin
geenye dhalachuu
D. Daa’ima qama
miidhamaa dhalachuu
E. Hin beeku_____
Kutaa 3 odeeffannoo gochaa nyataa hadholiin yeroo ulfaa irratti godhanii

Tartibba Odeffannoo gochaa deebii

lakkofsa
24 Safaraa nyataa murtaawoo ta’anii A. Eyyee
yeroo ulfaa ni hordoftaa? B. Lakki
C. Hin beeku
25 Galgala darbe nyaata miseensonni A. Eyyee Yoo eyyee jettee
maatii nyaataniif ashaboo B. Lakki ashaboo akkamiin
fayyadamtee? C. Hin beeku fayyadamte
A. Ayoodinii
B. Ayoodinii
malessaa
C. Hin beeku

26 Fuduraalee haaraa kanneen asiidii A. Eyyee Yoo eyyee jettee

of keessaa qaban kan akka B. Lakki hammam
burtukaana,loomii,maangoo C. Hin beeku hammaminii
nyaattee yookin cuunfaa isaanii A. Guyyatti
dhugdeettaa? tokkoo
B. Torbetti lama
C. Torbettii
sadii
D. Kan biro
ibsaan __

42 | P a g e
27 Yoo gaaffii 26 eyyee jettee yeroo A. Sa’a 2 nyaata
baayee yom fuduraalee asiidawoo dura
fayyadamta? B. Yeroo
nyaataa
yookin
nyaata booda
C. Sa’a 2 nyaata
booda
D. Kan biro
ibsi___
28 Shaayii yookin buna ni dhugdaa? A. Eyyee Yoo eyyee jettee
B. Lakki yoom dhugdaa yeroo
C. Hin beeku baay’ee ?
A. Sa’aa lama
yookiin isaa
ol nyaata
duraa
yookaan
booda
B. Nyaataa
duraa
C. Nyaata
boodaa
D. Kan biro

29 Dawaa ayiranii fudhatteettaa? A. Eyyee qaba Yoo eyyee jettee

B. Lakki hin guyyaa guyyaan
qabbu fudhachaa jirtaa
C. Hin beeku A. Eyyee
B. Lakki
C. Hin beeku

43 | P a g e
30 Dawaa foolik asiidii fudhatteettaa? A. Eyyee nan Yoo eyyee jettee
qaba yoom fudhachuu
B. Lakk hin egaltee
qabu A. Ulfaa dura
C. Hin beeku B. Torbee 14
duraa
C. Garaa booda
D. Hin beeku
31 Guyyaatti nyaata al meeqa A. Al tokko
sooratta? B. Al lama
C. Al sadii
D. Al afuriifi
isaa ol
32 Amala nyaataa tursiistuu nyaachuu A. Eyyee qaba
qabdaa? B. Lakki hin
qabu
C. Hin beeku
33 Amala nyaata kaarbohaaydireetii A. Eyyee qaba
hedduu nyaata gidduu B. Lakki hin
gidduudhaan fudhachuu qabdaa? qabu
C. Hin beeku
34 Nyaata pirootiinii ni soorattaa A. Eyyee Yoo eyyee jeette si’a
warra maddi isaanii biqilootaa B. Lakki meeqaa?
guyyaa guyyaan? C. Hin beeku A. Guyyaatti 1
B. Torbetti 2
C. Torbetti 3
D. Kan biro
E. Hin beeku
35 Kuduraalee haaraa ni soorattaa? A. Eyyee Yoo eyyee jettee
B. Lakki si’aa meeqa?
C. Hin beeku A. Guyyaatti 1

44 | P a g e
 B. Torbetti 2
C. Torbetti 3
D. Kan biroo
E. Hin beeku
36 Aannan ni dugdaa? A. Eyyee Yoo eyyee jettee
B. Lakki si’aa meeqa?
C. Hin beeku A. Guyyaatti 1
B. Torbetti 2
C. Torbetti 3
D. Kan biroo
E. Hin beeku

37 Bu’aawwan aannanii ni soorattaa? A. Eyyee Yoo eyyee jettee

B. Lakki si’aa meeqa?
C. Hin beeku A. Guyyaatti 1
B.Torbetti 2
C.Torbetti 3
D.Kan biroo
E.Hin beeku

38 Foon ni soorattaa? A. Eyyee Yoo eyyee jettee

B. Lakki si’aa meeqa?
C. Hinbeeku A.Guyyaatti 1
B.Torbetti 2
C.Torbetti 3
D.Kan biroo
E.Hin beeku

39 Ulfaatina kee yeroo ulfaa ni A. Eyyee Yoo eyyee jettee

hordoftaa? B. Lakki si’aa meeqa?
C. Hin beeku A.Guyyaatti 1

45 | P a g e
 B.Torbetti 2
C.Torbetti 3
D. Kan biroo
E. Hin beeku

Kutaa 4 odeffannoo ilalchaa nyataa hadholii yeroo ulfaa irratti

Tartibba lakkofasa Odeffannoo ilalchaa deebii

40 Akkamin ilaalta yeroo ulfaa A. Sirrumaa
nyataa dabalata nyachuu ? B. Garridhaa
C. Garrii mitii
41 Nyataa gosaa garagaraa yeroo A. sirrummaa
ulfaa nyachu akamin ilalta? B. garridha
C. garii mitii
42 Nyataa balaa magarisaa A. Eyyee
guyyaa guyyan nayatatii B. Lakki
dabalamuun garii dha jette
yaddaa?
43 Dawwaa ayiranifii foliki A. Eyyee
asidiii fudhachuun garidhaa B. Lakki
jettee yaddaa?
44 Ashaboo ayodiniin nyataa A. Sirummaa
qophessun akamitti ilaalta? B. Garidhaa
C. Garii mitii
45 Yeroo ulfaa guyaatii bishaan A. littiraa <1
litiraa meqatuu dhugudhaf B. littiraa 1-2
eyyemamaa jettee yadaa ? C. litirraa 3-5

46 | P a g e
46 Shayii fi bunnaa yeroo ulfaa A. Eyyee
dhuguun gariii dha jetee B. lakki
yaddaa?
47 Alcholii yeroo ulfaa dhugun A. Eyyee
eyyemamaa dha jette itti B. Lakki
wallii galtaa?
48 Tamboo yeroo ulfaa A. Eyyee
fudhachuun garii dha jette ni B. Lakki
yadda ?

Hiramanaa kessaanif hedduu galatoomaa!

47 | P a g e