DEDICATION

To my sister Anyi Julie and twin brother Atabong Desmond

CERTIFICATION
 BIAKA UNIVERSITY INSTITUTE OF BUEA

SCHOOL OF HEALTH SCIENCES DEPARTMENT OF NURSING

The Research Project of NGENYI CHIARITTA (HS22BN252) entitled: “NUTRITIONAL

KNOWLEDGE AND DIETARY PRACTICES OF PREGNANT WOMEN ATTENDING
ANTENATAL CLINIC AT THE REGIONAL HOSPITAL OF BUEA”, summited to the
Department of Nursing, School of Health Sciences of the Biaka University Institute of Buea in
partial fulfillment of the requirements for the award of the Bachelor’s Degree in Nursing was
done under supervision.

SUPERVISOR

Sign ——————— Date ———————

Mr. NJOPIN CHRISTOPHER
(MSC)

HEAD OF DEPARTMENT

Sign ——————— Date ———————

Mme NAMONDO MARY LUMA

(MSE)

ACKNOWLEDGEMENTS
I will like to express my sincere gratitude to my supervisor, Mr. Njopin Christopher, for his
continuous guidance and endless support. Big thanks to my Head of Department for giving me
the opportunity and motivation to carry out this research.

I am grateful to the Director of Regional Hospital Buea for accepting me to carry out this
research work in his Hospital and also the pregnant women who went out of their busy schedule
to help answer my questionnaires. And to my classmates, I say thanks to you all for your
supports and encourage even though it wasn’t an easy journey.

Special gratitude to my family for their endless love, encouragement, moral and financial
supports. And also to my friends who stood by me from the beginning till the end I say thank
you.

To GOD ALMIGHTY who makes everything possible and oversees all. Daddy I have nothing to
offer but to say THANK YOU father because if not for you I won’t have been where I am today.

ABSTRACT

Background: Nutrition is a fundamental stronghold of human life and its requirement varies
with respect to age, gender and during physiological changes such as pregnancy. Nutritional
requirement increase during pregnancy can influence the growth, development and health of the
mother and new born. Understanding the antenatal mothers nutritional knowledge is essential to
developing effective strategies to combat malnutrition and encouraging healthier dietary
behaviors. The purpose of this study was to investigate the nutritional knowledge and dietary
practices of pregnant women attending Antenatal Care at the Regional Hospital of Buea. The
objectives were; to assess knowledge of pregnant women with regards to their nutritional needs,
to determine pregnant women dietary practices, and to identify the determinants of the nutritional
knowledge and dietary practices of pregnant women in Regional Hospital Buea. Methods: This
study adopted a quantitative hospital based cross sectional descriptive design to investigate the
nutritional knowledge and dietary practices of pregnant women. Data was collected from 100
pregnant women using a structured questionnaire with open ended and closed ended questions.
Data was analyzed using Excel and exported to the Statistical Package for Social Science (SPSS)
software. Results: Sixty eight percent of participants were married, fifty seven percent had
secondary level of education, 45% were unemployed and 51% of their husbands were self-
employed. 38% of respondents belonged to families with monthly income of 60.000-
150.000FCFA. Seventy Eight percent of mothers cited the correct components of the fact that
important of nutrition in pregnancy. However, 68% had aversion towards food and other
important nutrients, 38% of mothers knew that they should eat three to four main meals a day.
Occupation and Religion were apparently positively associated with nutrition knowledge but
there was no significant difference (>0.05) and marital status, level of education and religion
were significantly associated with the dietary practice of pregnant women. Conclusion: pregnant
women in Regional Hospital Buea have adequate knowledge on nutrition in pregnancy (57%),
but there are still gaps and challenges in putting that information into practice. It is challenging
for pregnant women to follow the nutritional advice they are given because of the significant
influence of hormonal changes during pregnancy, socioeconomic level and cultural beliefs have
on their eating habits. Inorder to promote nutrition in pregnancy, health policies that address
cultural taboos should be implemented.

KEY WORDS: Nutritional Knowledge, Dietary Practices, Pregnant Women, antenatal Care.
TABLE OF CONTENTS
LISTS OF TABLES
 LISTS ABBREVIATIONS AND ACRONYMS

A.N.C Antenatal Care

IUGR Intrauterine growth retardation

IQ Intelligence Quotient

R.H.B Regional Hospital of Buea

SDG Sustainable Development Goal

SGA Small for Gestational Age

UN United Nation

UNCF United Nations Children’s Fund

USDA United States Department Of Agriculture

W.H.O World Health Organization

 CHAPTER ONE

INTRODUCTION

1.1 Background

Nutrition is a critical part of health and development, and almost all nutrients play crucial role in

maintaining an optimal immune response. Nutrition is about eating a healthy and balanced diet

so the body gets the nutrients that it needs. Nutrition issues in pregnancy are becoming more and

more important as it has been demonstrated that poor nutrition and improper weight gain during

pregnancy causes morbidity in both mother and the unborn child. Increased nutritional needs

during pregnancy have an impact on the mother and fetus’ growth ⸴ development and health (Lim

et al.⸴ 2018). The United Nations (UN) has proposed good health and wellbeing for all as one of

17 sustainable development goals (SDG) to facilitate global achievement by 2030, despite the

formulation of this goal, maternal and child health outcomes remains a major issue worldwide

(WHO, 2019).

According, Zelalem et al., (2018), nutrition education during pregnancy has a substantial impact

on pregnant women’s eating habits as well as the maternal and fetal outcome of pregnancy.

Women who eat well and avoid known risks tend to have fewer complications during pregnancy

and child birth. On the contrary, women who are malnourished before and during pregnancy are

most likely to experienced adverse pregnancy outcomes.

Globally, about 9.1% of women are underweight and thrice as many, 32.5% are overweight. The

prevalence of malnutrition in the Sub-Saharan and South Asia is still high. About 13% of

pregnant women are estimated to be malnourished and 38% suffer from anemia (WHO, 2009).

Also Nasah and Drouin (2001) stated that pregnancy and delivery exposes pregnant women in
Cameroon to about 2% risk of death during their reproductive life, with about 43% resulting

from hemorrhage, 8.3% from preeclampsia, and 4.2% from placenta abruption all of which are

nutrition related.

Evidence suggests that, women in many countries report inadequate knowledge and dietary

practice during pregnancy. This was the case among 616 pregnant women in Ethiopia where

38.6% of pregnant women had poor nutritional knowledge and 60.7% reported poor dietary

practices (Nana and Zema, 2018). In agreement, it was also reported among Syrian refugee

women in Lebanon that they had insufficient dietary knowledge and poor dietary practices

during pregnancy, 56% and 47% respectively (Harb et al., 2018). In contrast, a study in Nigeria

reported excellent knowledge among 62% of 244 pregnant women, yet this knowledge did not

improve dietary practices in 50% of the participants (Fasola et al., 2018). Another study

conducted by Kever et al., (2019), in Yerwa clinic Nigeria revealed that women had high

knowledge of dietary practices (65.3%), and 63.3% of respondents have positive attitudes

towards the practices. Among the factors that impede good dietary knowledge and practice in the

population were cultural belief and good socioeconomic background while regular attendance of

antenatal clinic and good socioeconomic background enhance good dietary among the

population. This implies that though other women seemed well informed about dietary practices,

more emphasis is needed to achieve good nutritional knowledge and dietary practices to all

pregnant women.

The nutrition knowledge and dietary practices of pregnant women is of great importance in

increasing the maternal awareness. This will enable them to know the type of nutrient to take as

well as identify and eat those foods that will assist the fetus to be healthy. Studies have shown

that nutritional knowledge relates to the quality of food consumed (O’Brien et al., 2007).
1.2 Problem Statement

Pregnant women are more vulnerable to malnutrition and infections because of obvious

physiological changes. Studies have shown that, every year, more them half a million women die

from causes related to pregnancy and childbirth and nearly 4 million newborns die within 28

days of birth worldwide. Many women suffer from a combination of chronic energy deficiency,

poor weight gain, anemia and other micronutrient deficiencies, as well as infections, and the

availability and supply of nutrients to the developing fetus will depend on the maternal nutrients

stored, dietary intake, and her obligatory needs (Ramarishnan et al., 2012).

Nutritional deficiency is a fatal health problem in the World, Africa and Cameroon, and when

there is nutritional deficiency, the mothers immune system weakens thereby exposing her to

illnesses, still birth, intrauterine death, pregnancy may be threatened, fetal restriction and the

woman may lose her life. Also, nutritional deficiencies cause fetal abnormalities, brain damage

and low birth weight. These along with inadequate obstetric care will contribute to high rates of

maternal mortality and poor birth outcomes (Mora et al., 2000).

Although projects focused on maternal health are common, researches and projects on maternal

nutrition specifically related to nutrition knowledge and dietary practices are rare in the study

area. Even though, maternal nutrition during pregnancy is crucial in reducing maternal and infant

mortality which are the target area in achieving the millennium development goal 5 and 6, no

study was traceable in the Regional Hospital Buea (RHB) that was conducted on the assessment

of nutritional knowledge and dietary practices of pregnant women.

1.3 Rationale

Pregnancy is one of the most important events in life of every woman, and brings about

physiological and emotional changes, as well as poses extra demands in the body. Maternal

nutrition and lifestyle choices have major influences on mother and child health. The availability

of nutrients supply to the developing foetus depends on the maternal nutritional status (Shankar

et al., 2019). Adequate knowledge and understanding of nutritional intake and dietary

recommendation can help women achieve a healthy weight gain during pregnancy.

Although numerous researchers have made theoretical and empirical contributions to the study of

maternal nutrition, the area of pregnant women’s knowledge and dietary practice is inadequately

researched. This study will go a long way to provide adequate knowledge to pregnant women on

maternal nutrition and dietary practices in pregnancy and will benefits every pregnant woman as

it serves as a means of curtailing the effects of malnutrition on their health.

1.4 Research Questions

 Are the pregnant women attending Antenatal clinic at the Regional Hospital Buea

knowledgeable (RHB) on their dietary/nutritional needs during pregnancy?

 What are the dietary practices of pregnant women attending ANC at the RHB?

 What are the determinants of the nutritional knowledge and dietary practices of pregnant

women attending ANC in RHB?

1.5 Objectives

1.5.1 General Objectives

The main objective of the study is to assess the Nutritional knowledge and Dietary Practices of

Pregnant Women attending Antenatal Clinic at the Regional Hospital Buea.

1.5.2 Specific objectives

 To assess knowledge of pregnant women with regards to their nutritional needs in the

Regional Hospital Buea.

 To determine pregnant women dietary practices in Regional Hospital Buea.

 To identify the determinants of the nutritional knowledge and dietary practices of

pregnant women in RHB.

1.6 Definition of Terms

Nutrition: it is defined as the process of obtaining food rich in nutrients and are have a balanced

diet necessary for health and growth of the body (Breslin et al., 2016).in this study; it is food

which is necessary or needed for health and growth by pregnant women and their babies.

Knowledge: it is defined as any information and understanding acquired through education. In

this study, it refers to pregnant women’s understanding of nutrition, as well as intellectual ability

to remember and recall food and nutrition related terms, specific pieces of information and facts

(Macias et al., 2014).

Dietary Practice: according to Glasauer et al., 2014, practice is the actual application or the use

of an idea, belief or method, as opposed to theories relating to it. In view to this study, dietary

practice is defined as the preference in food consumption such as eating habits and ways of

feeding.it is classified into two: good dietary practices and poor dietary practices.

Pregnancy: it is referred to as a product of conception which last for about 280 days.
 CHAPTER TWO

LITERATURE REVIEW

2.1 OVERVIEW OF NUTRITION IN PREGNANCY

Nutrition refers to how food promotes various bodily functions including growth and

development (Healingwell, 2009). Nutrition as a concept has been associated with proper use of

food for optimal health outcomes, and all living entities access nutrients, metabolize them to

sustain life’s processes. According to Lagua and Claudio (2008), nutrition is “the science of

food, the nutrients and other substances therein, their action, interaction and balance in relation

to health and diseases as well as the processes by which the organism ingests, absorbs,

transports, utilize and excrete food substances.”

Nutrient requirement may vary at various stages of growth of an individual. In situations where

the nutrient needs are not met, negative health outcomes may occur. Therefore nutrition plays a

very crucial role in growth and development throughout life. Nutrients are molecules found in

food which all organisms needs for energy, growth, development and reproduction. Nutrients are

classified into macro and micronutrients. Macronutrients consist of carbohydrate, fats and

proteins and are important because they provide vast majority of metabolic energy. Carbohydrate

and proteins are estimated to contain 4 kcal of energy/gram while each gram of fats contains 9

kcal (Dunford, 2006). The amount of energy that can be obtained from each of the substances

depends on their rate of absorption and assimilation. Micronutrients are made up of vitamins and

minerals. Therefore, pregnant women should consume a healthy/ balanced diet rich in sufficient

energy, proteins, vitamins, and minerals obtained from deserve food sources necessary for

growth and development of the fetus (WHO, 2019).

2.2 NUTRITIONAL REQUIREMENTS IN PREGNANCY

Nutritional requirements are considerably elevated during pregnancy than in other stage of a

woman’s reproductive life. Women who are pregnant should increase their energy and nutrients

intakes to levels above those of non-pregnant women. To maintain a healthy pregnancy, about

300 extra calories are needed each day and should come from a balanced diet of protein, fruits,

vegetables and whole grains. The foods that are consumed bring different basic substance and

nutrients necessary for the functioning of a pregnant mother. Micronutrient deficiencies

especially vitamin A, Iodine and Iron affects pregnant women with adverse effects like, poor

health, premature birth, blindness, stunting, reduce cognitive development, low IQ, and low

productive capacity (WHO, 2009).

The following nutrients are recommended during pregnancy:

2.2.1 Proteins

Proteins contain molecules of amino acids linked together in chains of peptide bonds. Amino

acids are the building units of proteins and all proteins are a combination of about 20 amino

acids where these amino acids are manufactured in the body when adequate amounts of protein-

rich foods are eaten. During pregnancy, there is an increased amount of proteins needed by

pregnant women to provide amino acids for the development of the fetus, blood volume

expansion and the growth of fetal and maternal tissues, such as the breast and uterus, contribute

to the overall body’s energy metabolism. Protein also function in the manufacture of important

enzymes, hormones, antibodies, serves as a potential source of energy if the diet does not furnish

sufficient kilocalories from carbohydrate or fat (Institute of medicine, Food and Nutrition board,

2005). About 71 grams/day of proteins is recommended during the second trimester of

pregnancy. High quality source of proteins can be obtained from animal sources like meat, egg

yolks, poultry, fish, milk, cheese, yogurt and some variety of plants (Brown, 2010).

2.2.2 Carbohydrate

Carbohydrates are the body’s, and the brain’s main source of energy. Pregnant women needs the

energy provided by carbohydrates for the growth of a healthy baby, as glucose derived from

carbohydrate is the main tool used for intrauterine growth (Clapp, 2002). An increase need of

carbohydrate is usually during the second and third trimester and requires about 175gams/day.

Adequate amount of Carbohydrate intake promotes weight gain, growth of the fetus, placenta

and other maternal tissues. It is important that pregnant women chose high quality carbohydrates

with a low glycemic index found in whole foods such as whole grains, non-starchy vegetables,

fruits, peas, lentils and low fat dairy (USDA, 2010).

2.2.3 Lipids and Fats

Fats provide energy and fat soluble vitamins. Fats intake for pregnant women is 20-30%of total

calories, and pregnant women are recommended to lower the intake of saturated fats and

cholesterol. Essential fatty acid such as alpha-linolenic acid and linoleic acid, helps in fetal

neurologic and visual development. These fatty acids are found in canola, soyabean, walnut oils,

and salmon (Murray and Mckinney, 2014).

2.2.4 Fiber

Fiber is an important component of the prenatal or maternal diet. The development of the fetus is

not dependent on the supply of fiber but adequate and high fiber intake increases the comfort of

pregnant women by helping reduce constipation, abdominal obstruction, hemorrhoids, and

diverticulitis. Fruits, vegetables, beans, seeds, nuts and whole grains are all good source of

dietary fiber. The required quantity of fiber can be absorbed in a balanced diet.

2.2.5 Vitamins

Adequate intake of all vitamins is essential during pregnancy and are required in larger than

normal amounts to fulfill specific needs.

2.2.5.1 Vitamin A (Retinol)

Vitamin A is a crucial micronutrient for pregnant women and their fetuses, required for vision,

immune system function, embryonic development and maintenance of epithelia tissues. Extra

vitamin A in pregnancy is required for growth and maintenance of the fetal ocular health and

maternal night vision. During the third trimester, the requirement increases especially when fetal

growth is most rapid (WHO, 2009). Vitamin A from animal foods such as dairy products, liver,

and eggs is performed and the most bio-available dietary source, but that from plants, such as

carrot, oranges and green leafy vegetables, are in the form of pro-vitamins and have to be

converted before absorption (Faber, 2007).

2.2.5.2 Vitamin B1 (Thiamin)

Vitamin B1 is essential during pregnancy because it supports fetal brain development. It is

needed for energy release in the body’s cells by converting carbohydrate into energy during

pregnancy; about 1.4mg of vitamin A is needed per day. Sources from: fortified breads, cereals,

whole grain, dried beans, peas, fruits.

2.2.5.3 Vitamin B2 (Riboflavin)

Vitamin B2 is an essential vitamin that helps the body produce energy. During pregnancy, it
supports fetal growth, good vision and healthy skin. It is also essential for bones, muscles and

nerves development. 0.3mg/day is needed during pregnancy and deficiency will cause

preeclampsia (Kester, 2000).

2.2.5.4 Folic Acid (folate)

According to WHO (2012), folic acid is an essential vitamin B9 required during the first 28 days

of pregnancy for proper development of the fetal spinal cord, maternal erythropoiesis,

deoxyribonucleic acid (DNA) synthesis and growth of the placenta. Folate requirements increase

during pregnancy as a result of rapidly dividing cells related to fetal growth and requires about

400-800 micrograms daily to reduce the risk for neural tube defects in the fetus (Pitkin, 2007).

The main dietary sources of folic acid are gotten from green leafy vegetables (cabbage, salad

leaves, spinach, and broccoli), bovine liver, beetroot, oranges, tomatoes, banana and legumes

(lentils, beans, peas).

2.2.5.5 Vitamin C (Ascorbic Acid)

Vitamin C is an essential water soluble vitamin and needed to make collagen. It also aid in the

formation of liver bile which helps in detoxify alcohol and other substances. Vitamin C is require

in large quantities of about 75-85milligrams/day in pregnancy and aids in the formation and

development of connective tissues and vascular system. Deficiency will cause Scurvy and

delayed wound healing. Sources of vitamin C include citrus fruits, peppers, strawberries, green

leafy vegetables, tomatoes.

2.2.6 Minerals

2.2.6.1 Calcium
Calcium’s role in the body is to assist with blood clotting, muscle contraction, nerve transmission

and the formation of bone and teeth. In pregnancy, calcium has a beneficial effect in reducing the

risk of pregnancy-induced hypertension. Calcium requirements increases during pregnancy

however the body naturally absorbs increasing amounts by physiological processes and the

recommended amount during pregnancy is about 1000mg. the fetus accumulates 30g of calcium

during pregnancy, and approximately 25g stored in the skeletal system. During pregnancy,

alterations in metabolism, absorption and excretion appears to help preserve maternal calcium

stores. Sources from milk, yogurt, green vegetable, cheese, fortified or enrich grain products and

bones (Institute of medicine, Food and Nutrition board, 2005).

2.2.6.2 Iron supplement

Iron is needed for psychomotor development, maintenance of physical activity and resistance to

infection. Its deficiency develops when the intake of bio-available iron does not meet

requirements or when excessive physiological or pathological losses of iron occur (Gubson,

2005). Iron requirements increases during pregnancy especially during the second trimester when

the volume of blood and erythrocytes increases, thereby allowing the growth of the fetus and

placenta. The absorption of iron during pregnancy increases considerably as there is no loss of

blood through menstruation and it is important to ensure that the intake of iron from food should

be sufficient during pregnancy. Iron supplements can be used if iron reserves are insufficient,

which may result in decreased hemoglobin production (anemia), lower immunity, high risk of

infectious diseases, maternal mortality, premature delivery, placenta abruption. Daily

requirements of iron is 27milligrams and sources from meat, dark green leafy vegetables, dried

fruits, nuts, enriched bread and cereal (WHO, 2006).

2.2.6.3 Sodium

Sodium is a mineral needed to maintain the water balance in the body, regulate blood volume

and ensure proper functioning of cell membranes and other body tissues. During pregnancy,

maternal blood volume increase resulting in a higher filtration rate of the glomerulus, whereby

water and electrolyte balance are maintained by proper metabolism. The recommended amount

of sodium is 1.5-2.3g/day equivalent to 4-5g of cooking salt. Iodize salt is recommended during

pregnancy than cooking salt. Adequate salt in diet and volume of liquids ensures sufficient blood

volume for preventing dehydration and premature contractions.

2.3 IMPORTANCE OF PROPER NUTRITION TO MOTHER AND NEW BORN

In pregnancy, extra nutrients and energy are used for foetal growth as well as changes in the

mother’s body to accommodate the fetus. More than 2500 years ago, Hippocrates said “let food

be thy medicine and medicine be thy food.” Healthy diet help keep the immune system healthy

thereby protecting against many non-communicable diseases likes heart diseases and diabetes.

In the first trimester (involves the first three months of pregnancy), nutritional deficiencies at this

stage can alter the progressing phase of development.

A. To the Mother

1. There is a saying that, “you are what you eat and your diet will impact your health.”

Comprehensive improvement in nutrition and health status of women before and during

pregnancy will contribute to optimal fetal growth, favorable obstetrical outcomes,

improved perinatal survival and the potential for long-term health for both mother and

fetus.
 2. Adequate diets during preconception help protect health and establish sufficient nutrient

reserves to support pregnancy

3. According to Michelle Tierra, “diet is an essential key to all successful healing, without a

proper balanced diet, the effectiveness of treatment is very limited.” So, the consumption

of a balanced diet before and during pregnancy is associated with a reduce risk of

disorders of pregnancy including gestational diabetes mellitus, preterm birth, obesity-

related complications, preeclampsia and gestational hypertension.

4. A balanced macronutrient intake provides healthy pregnancy and optimal perinatal

outcomes. Chesterton said “tell me what you eat, and I will tell you what you are.”

Nutritious diets including ample quantities of vegetables, fruits, whole grains, nuts,

legumes, fish, and fiber provides proper nutrition to support a healthy lifestyle.

B. To the Newborn

1. To eat is necessary but to eat intelligently is an art. Poor maternal nutritional status is

associated with abnormal fetal growth patterns, including low birth weight (LBW

<2500g), small for gestational age (SGA <10% birth weight), fetal growth restriction,

microsomal, and large for gestational age (LGA >90% of birth weight), each of which is

associated with increased risks of developing childhood and adult chronic diseases.

2. Adequate nutrition is important to ensure health, growth and development of the newborn

to full potential. Poor maternal diet will impaired the growth of the brain cells causing

impaired mental growth in the newborn such as low IQ, reduction in social and verbal

abilities (Moehji, 2013).

2.4 EPIDEMIOLOGY OF MALNUTRITION IN PREGNANCY

Malnutrition is a physiological abnormal state brought on by imbalances, excesses or

deficiencies in energy, protein and/or other nutrients. It affects individuals of all ages but

happens to have a long term effects on pregnant women when occur during pregnancy (DFID,

2009). The principal causes of malnutrition in pregnancy are poor nutritional intake and dietary

practice as well as severe repeated infectious diseases (Kramer et al., 2001).

Globally, approximately 170 million pregnant women (9.1%) are underweight with BMI

<18.5kg/m² and 610 million (32.5%) are overweight, BMI ≥25kg/m² (UNCF, 2021). Maternal

malnutrition remains unacceptably high across African regions with a prevalence rate of

estimated to be 27%-51% (WHO, 2017). In Ethiopia, maternal undernutrition is approximately

16.5% and 11% in Nigeria (Adinma et al., 2017). According to Engle-Stone et al., (2018), the

prevalence rate of maternal malnutrition in Cameroon occurs in 24%-35%; in Far North region,

under nutrition is 15% with the highest prevalence, in Douala, the prevalence of maternal

overnutrition was 53% with gestational weight gain been the most frequent, and 13.7% in Buea

(Mbida, 2012).

Malnutrition can be of two forms; undernourishment (undernutrition) or overnourishment

(overnutrition). Under nutrition occur when there is insufficient intake of energy and

micronutrients like vitamins and trace minerals to meet individual’s needs so as to maintain good

health. Consequences of under nutrition in pregnancy include, nutritional anemia, underweight,

still birth, placenta abruption, intrauterine growth retardation, preterm, stunting (WHO, 2017).

While, overnutrition is an imbalanced nutrition due to excessive intake of nutrients leading to

accumulation of body fats resulting to overweight and obesity. Excessive weight gain is
associated to high risks of maternal and fetal complications; cesarean birth, gestational diabetes

mellitus, preeclampsia, gestational hypertension, difficult/obstructive labor, obesity, microsomal

baby, large for gestational age (Birdsong et al., 2014).

Maternal undernutrition in low and middle-income countries is an underlining cause of

3.5million maternal deaths and disabilities due to physical and mental effects of poor dietary

intake in the early months of life. High levels of undernutrition will cause over 40% occurrence

of stunting in children (Loudyi et al., 2016). Malnutrition including underweight, short stature,

anemia and overweight affects millions of women around the world, during the nutritionally

demanding periods of pregnancy.

2.5 FACTORS ASSOCIATED WITH MALNUTRITION IN PREGNANCY

Pregnancy is a time of social, psychological, behavioral and biological changes in a woman’s

life, she become more aware about health and nutrition and their impact to the body. Poor

nutritional knowledge and, dietary practices and marital status are discovered as risk factors of

under nutrition in pregnant women.

2.5.1 Educational status

Education is recognized as one of the social determinants of health and may influence

undernutrition in women and children (Jacobs and Roberts, 2004). Less education is directly

associated with poorer food choices due to lack of the necessary knowledge. Women who

receive a minimal education are generally more aware than those who have no education on the

utilization of available resources for the improvement of their nutritional status. As a result of

low education particularly among pregnant women who are charged with responsibility of food

choice and preparation, there is less dietary diversity (Mazur et al., 2003). A study done among
Japanese women by Murakami et al., (2009) found that women with higher education tended to

have changes in diet and are aware of foods that will help the fetus grow. On the other hand,

higher education was found to be associated with favorable dietary intake patterns such as a

higher intake in proteins and other micronutrients.

2.5.2 Age and Parity

According to Mosby (n.d), pregnancies at either extreme of the reproductive cycle have special

problems. Women’s age and parity are important factors that affect maternal depletion. The

adolescent pregnancy has many social and nutritional risks as its social change and physical

demands/needs are imposed. On the other hand, older pregnant women over 35 years of age

having her first child may require special nutritional attention. Also, pregnant woman with high

parity rate who have had several pregnancies within a limited number of years is at greater risk

since there is a drain in nutritional resources and an increasing physical and economic pressure

of child care. Studies have shown that pregnant women in youngest age group (15-19) and oldest

women (45-49) are mostly affected by undernutrition (Teller and Yimar, 2000).

2.5.3 Marital status and social support

Marital status of women is associated with household headship and socioeconomic status of the

woman that affects her nutritional status. Malnutrition is higher among unmarried and

divorced/separated women compared to married women. A systematic review and metal analysis

conducted by Shah et al., (2011). concluded that single women had increased risks of adverse

pregnancy outcome including preterm delivery, low birthrate and small gestational age.

2.5.4 Morbidity
Morbidity directly affects diet and have been found to be an immediate cause of malnutrition.

When a pregnant woman dietary intake is poor, it affects the woman’s morbidity status as there

is reduced immunity and increased chances of developing infections. On the other hand,

morbidity status in pregnancy affects dietary preferences and choices either due to poor appetite

which leads to only likable foods being selected, or practices such as pica which affects nutrition

(Agan, 2010).

2.5.5 Income and Employment

Women’s employment is going to increase household income and the nutritional status in

particular. Low income is commonly associated with unhealthy eating due to limited financial

resources to provide healthy nutritional diets throughout pregnancy. Economic limitation is

going to affect pregnant women in acquiring the necessary knowledge needed and will enact

different behaviors towards healthy diets.

2.5.6 Psychological factor

Psychological stress can modify behaviors that affect health such as physical activity, alcohol or

food choices. The influence of stress on food choice and intake depends on the individual, the

stressor and circumstances. Some women eat more or less when experiencing stress and if

prolonged or frequent, then adverse dietary changes could occur resulting to possibility of weight

gain and cardiovascular risks. Also, food has influence on mood related to attitudes towards a

particular food, and the wanting to enjoy food but conscious of weight gain.

2.5.7 Cultural Factor

Culture which is the acceptable way of life of a community of individuals has been found to be
very diverse across the world. There have been long term changes in terms of norms, values, and

even behavior by individuals and include, changes in diet and lifestyle (Lopez, 2008). Pregnant

women from various parts of the world are forced to abstain from nutritious foods due to

traditional food habits even if the foods are available in abundance.

2.6 KNOWLEGDE OF PREGNANT WOMEN ON NUTRITION

Nutrition knowledge have been shown to play an important role in influencing a healthy food

choices which ensures nutrient needs in enhancing health and wellness by preventing excess or

less intake of nutrients. During pregnancy, a woman’s micronutrient and macronutrient

requirements increases and is important she consumes food rich in both energy and

micronutrients which is essential in maintaining her health and the baby’s health (WHO et al

2003). Also, the developing fetus obtains all its nutrients from through placental, so dietary

intake has to meet the needs of the mother and enable her to lay down stored nutrients required

for the development of the fetus. When pregnant mothers have knowledge about nutrition during

pregnancy, they are likely to make better believes and taboos about food. Adequate knowledge

and understanding will help a pregnant woman achieve a healthy weight gain during pregnancy

(Wyness, (2014) and Lucas et al., (2014)).

A recent meta-analysis stated that nutritional education during pregnancy is not the only

effective intervention to improve pregnant women’s knowledge but also maternal and fetal

complications (Girard and Olude, 2012). More specifically, nutritional counseling is found to

improve gestational weight gain by 1.8kg during the first trimester and 0.5kg per week during

the second and third trimesters, increase birth weight in small for gestational age newborns and

lower risks of maternal anemia by 30% (Darnton-Hill, 2013).

Evidence shows that women in many countries show inadequate nutritional knowledge during

pregnancy. The case in Guto Gida Woreda, Ethiopia, Daba et al., (2013), conducted a research

on ‘Assessment of knowledge of pregnant mothers on maternal nutrition and associated factors’.

The researchers were geared on ascertaining the knowledge pregnant women have on maternal

nutrition. The sample population comprises of 419 participants and semi-structured

questionnaires were used to administer data. On the data analyzed, they concluded that about

74.0% did not know the main food of a well-balanced diet and 57.8% did not even know the

meaning of food. Another research carried out by Maloba (2022), on the ‘Nutritional Knowledge

and Dietary Practice of Pregnant Women receiving Nutritional Education while attending

Antennal Care at Mbagathi Hospital Nairobi, Kenya’. Study population comprised of 195

participants. Data was collected through questionnaires and analyzed using the SPSS version 20

software. From data analyzed they concluded that the knowledge of pregnant women was low

and inadequate with 56%.

Also, the results reported from America at El-Menshawy Hospital showed that about half of the

women did not have enough knowledge regarding the meaning, importance and constituents of

well-balanced diet (Latifa et al., 2012).

2.7 DIETARY PRACTICES AMONG PREGNANT WOMEN

Women gain awareness of the importance of nutrition when pregnant but face barriers in making

positive changes and lacks reliable source of information. Dietary habits of pregnant women are

important for the proper progression of pregnancy and the development and health of the fetus

(Bianchi et al., 2016). Despite the availability of pregnancy-specific healthy eating guidelines,

dietary behaviors and intakes of pregnant women do not appear to meet the recommendations
(Wallner et al., 2007).

According to the dietary guidelines of Federal Nutrition Policy and Nutrition Education, which

recommended that individual’s healthy eating pattern should include a variety of fruits,

vegetables, fat-free or low fat diary, whole grains, a variety of proteins and healthy oils. It also

recommended limiting calories from added sugars and saturated fat, and reducing sodium intake

as these cause diverse effects. Generally, poor dietary practices and under nutrition of women

arises from complex biological, physiological, psychological, socioeconomic, cultural beliefs,

food taboo and environmental factors (Nchangmugyia et al., 2016). On the other hand, food

insecurity, poverty, illiteracy, heavy workload, diseases, inadequate access to health care, poor

sanitation and hygiene are the major factors influencing maternal nutrition (Westenberg et al.,

2002).

A study conducted by Yassin et al., (2004), in Alexandria, Egypt where 61.7% of the

respondents were found to have poor knowledge of dietary practices in pregnancy. Another study

conducted by Kever et al., (2019), in the study of Knowledge and attitudes of pregnant women

towards dietary practices in Yerwa clinic. Borno state Nigeria. A cross sectional design was

used, data collected through questionnaires and analysed using the SPPS version2013. It was

discovered that 65.31% of respondents showed a high level of knowledge about dietary practices

during pregnancy despite high level of illiteracy among the correspondents.

Also, in a study carried out by Nchangmugyia et al., (2016), on knowledge and attitudes of

pregnant mothers towards dietary practices during pregnancy at Etoug-Ebe Baptist Hospital

Yaounde. The dietary practices as well as craving, pica and aversion were commonly used and

showed that 84% of the pregnant mothers had knowledge that women needs to better their
nutrition during pregnancy but avoided foods like beefs, eggs, fish and citrus fruits, as these are

considered culturally. In view with the finding, that maternal dietary practice was greatly

influenced by physiologic changes, socioeconomic status, food taboos and cultural values.

2.8 DETERMINANTS OF NUTRITIONAL KNOWLEDGE AND DIETARY

PRACTICES OF PREGNANT WOMEN

Several studies conducted indicate that the significant association of variables with nutritional

knowledge and dietary practices vary among pregnant women. A cross sectional study conducted

among 423 selected pregnant women in Ghana between October and November 2019, indicated

that educational level, occupation, ethnicity and number of pregnancies are associated with good

nutritional habit of pregnant women (Appiah et al., 2019). Also, a cross sectional descriptive

survey done in Cameroon, among pregnant mothers who have increased maternal age, increased

educational level, increased number of parity and increased monthly family income are possibly

associated with nutritional knowledge (Nchangmugyia et al., 2016).

Another study done in Manzini Region, Swaziland in 2014 among pregnant mothers, with high

income level, religion and normal BMI are significantly associated to healthy dietary practices

(Masuku and Lan, 2014). In view with a community base cross sectional study conducted at

JilleTumuga District, showed that dietary diversity practice of pregnant women is associated

with maternal education, income, and nutritional information (Aliwo et al., 2019). Furthermore,

a community based cross sectional study conducted among 403 randomly selected pregnant

women in Southwest Ethiopia showed that having four or more family size, monthly income

status and birth interval and having information about nutrition are has positive significant

relation with nutritional practices of mothers (Supplements et al., 2020).

CHAPTER THREE
 MATERIALS AND METHODS

3.1 Research Design

A cross sectional descriptive design was used for this study with a quantitative approach to

investigate the nutritional knowledge and dietary practice among pregnant women.

3.2 Study Area

This research was carried out in the Regional Hospital of Buea (RHB), Southwest Region

Cameroon. The Regional Hospital Buea is situated between the Delegations of Education and the

Army Barracks, along the highway to Bokwango neighborhood and Longstreet. It is one of the

main health care services in Buea which serves as the main referral hospital in the region and

receives patients of all district hospitals and integrated health Centers, and has a bed capacity of

about 200 beds. The hospital is made up of many different specialist unit/department including

the ANC and it’s headed by a Medical Director assisted by a General Supervisor who supervises

all the activities of the staffs.

Buea also shares boundaries with other major towns like that of Tiko municipality to the South

East, limbe to the south west, Muyuka municipality to the East. Buea has moderate economy

with agricultural, administrative, business, tourism and financial sector taking the central stage of

the town.

3.3 Study Population

The study population involved all pregnant women who are attending antenatal at the Regional

Hospital of Buea.

3.4 Sample Size

The total number of women attending ANC at the BRH was about 130 pregnant women.

Sample size was calculated using the Slovin’s formula.

n= Where;

n= sample size

N= Total number of population= 130

e= Margin of errors = 5%

= = 98

Therefore, the study sample would be approximately 100 pregnant women.

3.5 Sampling Techniques

A simple random sampling technique was used to select participants for the study.

3.5.1 Inclusion Criteria

Pregnant women attending antenatal clinic at the Buea Regional Hospital who voluntarily agreed

and gave their consent to participate in the study.

3.5.2 Exclusion Criteria

Pregnant women who were ill, had complications, or in labor were excluded from the study.

3.6 Enrolment of Study Participants/ Data Collection Tools and Methods

Data was collected using a structured questionnaire base on the objectives of this study. The

questionnaire was divided into four sections; according to the objectives set for this study.
3.7 Data Collection and Processing

Data was collected using self-administered structured questionnaire.

3.9 Data Management and Analysis

After the survey, data was keyed into an Excel Data sheet. The computer was secured with a

password known only by the principal investigator. Data was analyzed using Microsoft Excel

2013 and exported to the Statistical Package for Social Science (SPSS) Software (version 21.0).

All information entered into the laptop was stored in a USB flash drive for backup. Results were

presented in frequency tables and charts.

3.10 Ethical Considerations

Before data collection, an authorization letter was obtained from Biaka University Institute of

Buea (BUIB) Department of Nursing, authorization from Southwest Regional Delegation of

Public Health and also authorization from the Regional Hospital of Buea (RHB). Participants

consent was obtained first before handing the questionnaire. Participant’s information was kept

secret at all-time using a personal password on the computer to keep all the information related

to the research. Also, the correspondent could find some questions too private and do not wish to

make the answer public so they had the opportunity to skip the question if it was judged sensitive

and the willingness to answer the questionnaire. After taking these into consideration and fully

living up to the requirements, this study could then be classified as ethical.

CHAPTER FOUR

RESULTS
4.1 Demographic Characteristics

A total of 100 participants were included in this study. Majority of the participants, 59(59.00%)

were between the age 17 to 19years, majority 68(68.00%) were married, 86(75.00%) were

Christians, 57(57.00%) of the participants had attended secondary level of education. Table 2

below illustrates the Socio-demographic characteristics of participants.

Table 2: Demographic characteristics of participants

Variable Category Frequency Percentage (%)

Age 17-19 59 14.00%
30-39 35 35.00%
40-49 6 6.00%
Marital status Married 68 68.00%
Single 32 32.00%
Level of Education Primary 8 8.00%
Secondary 57 57.00%
Tertiary 35 35.00%
Religion Christians 86 86.00%
Muslims 14 14.00%
Occupation civil servant 13 13.00%
private sector 2 2.00%
self employed 28 28.00%
Student 12 12.00%
Unemployed 45 45.00%
Husbands occupation civil servant 29 29.00%
private sector 9 9.00%
self employed 51 51.00%
Student 2 2.00%
Unemployed 9 9.00%
Average monthly <50,000 18 18.00%
income (FCFA) 60,000-150,000 38 38.00%
160,000-200,000 27 27.00%
>200.000 19 10.00%
4.2 Nutritional Knowledge of Pregnant Women.

Table 2: Performance of Participants Nutritional knowledge in Pregnancy.

Variables Frequency Percentage (%)

Knowledge on the importance of adequate nutrition during
pregnancy:
A .To support the growth and development of the foetus and 78 78
maintenance of the woman’s own health 21 21
B .To support growth and development of the fetus 1 1
C .I don’t know
Knowledge in Dietary requirements in pregnancy:
A .Eat more fats 4 4
B .Maintain a normal serving size of food as a non-pregnant 15 15
woman
C .Eat only what she craves 21 21
D .Eat a variety of foods from different food groups / Balanced 59 59
diet
Knowledge on balanced diet:
A .Eating everything that looks healthy 43 43
B .Eating proper nutrients for good heath 30 30
C .Eating fruits and vegetables 26 26
D .I don’t know 1 1
What potential problem can arise when a pregnant woman
is under weight? 51 51
A .Miscarriage 22 22
B .Risk of giving birth to a low weight baby 36 36
C .Risk of baby being born prematurely
What complication(s) can arise when a pregnant woman
gains too much weight? 28 28
A .Chances of giving birth via caesarian section 53 53
B .Difficult labor 19 19
C .I don’t know
What two supplements or tablets do pregnant women
benefits from?
A .Proteins and calcium 54 54
B .Iron and folic acid 42 42
C .Fancider 4 4
D .I don’t know 0 0
Why is it important to take the above supplements during
pregnancy? 21 21
A .To increase appetite 28 28
B .To control heart burn 51 51
C .To prevent anemia and birth defects

4.2.1 Performance of Participants Nutritional Knowledge in Pregnancy.

Majority of the participants, 78(78.00%) accepted to the fact that nutrition in pregnancy is
important in supporting the growth and development of the foetus and maintenance of the

woman’s own health. Table 1 below illustrates the Nutritional Knowledge of participants during

pregnancy. And to a majority; 43(43.00%) opted for balanced diet as eating everything that looks

healthy, while 30(30.00%) opted for eating proper nutrients for good health. Interestingly,

42(42.00%) said Iron and Follic acid are the two supplements pregnant women benefits from,

with 51(51.00 %) said the importance of the supplements to prevent anaemia and birth defects.

4.3 Dietary Practices of Participants.

28(28%) of the respondents said they had specific food type they consume/ate during pregnancy.

of these, 12(43%) had preference for Fufu & Eru during pregnancy. Also, 47% of the

participants consume dairy products (such as, milk, cheese, and yogurt) every day. Notably 68%

of the study participants, admitted to avoiding certain foods and diet during pregnancy, which the

reason for avoidance were culture 30(44%), vomiting 5(7%) and making delivery difficult

10(14%). Table 3 below illustrates the dietary practices of our study participants during

pregnancy.

Table 3: Performance of participants on dietary practices characteristics of pregnant

women.

Variables Frequency Percentages (%)

Do you have any specific food type you consume/eat during
pregnancy?
A .Yes 28 28
B .No 72 72
If yes, which food type_________________?
Fufu & Eru 12 43
Fufu corn & kati kati 6 21
Rice & Fish 4 14
Ndole & plantain 6 21
Do you eat fresh vegetables and fruits such as mango,
lemons, orange, bananas etc.? 81 81
A .Yes 19 19
B .No
Do you have the habits of taking snacks between meals
during pregnancy?
A .Yes 46 46
B .No 54 54
Do you consume dairy products (such as, milk, cheese, and
yogurt) every day? 47 47
A .Yes 53 53
B .No
What is your diet frequency of meal per day during
pregnancy? 27 27
A .1-2 37 37
B .3-4 36 36
C .≥5
How often do you take Iron-Folic acid supplements?
A .Always 36 36
B .Sometimes 55 55
C .Never 9 9
Are you on any other supplement?
A .Yes 71 71
B .No 29 29
If yes, which supplement?

Do you avoid any food or diet during pregnancy?

A .Yes 68 68
B .No 32 32
If yes, reason of avoidance of any food/diet during
pregnancy? 5 7
A Vomiting 30 44
B .Culture 22 32
C .Make the baby big 10 14
D .Makes delivery difficult 1 1
E. Heartburn
4.4 Determinants of Participants Nutritional Knowledge and Dietary practices.

4.4.1 Determinants of Participants Knowledge on Nutrition in Pregnancy

In this study, pregnant women age, marital status, level of education, husband’s occupation and

average monthly income had no statistical significant association with their level of knowledge

on nutrition. While occupation and religion were significantly associated with pregnant women

knowledge on nutrition. In the analysis, women occupational status chi-square test statistic was

calculated as 14.605. The associated p-value (Sig.) is 0.006, which suggests a significant

association between occupation and level of knowledge on nutritional knowledge. Also, the

associated p-value (Sig.) is 0.030, which suggests a significant association between religion and

level of knowledge. Table 4 below illustrates the Determinants of Participants Nutritional

Knowledge.

Table 4: Determinants of Participants Nutritional knowledge.

Variable Category Adequate Inadequate Level of

knowledge knowledge significance
(n(%)) ((%))
Age 17-19 45(45%) 14(14%)
30-39 27(27%) 8(8%) P value=0.926
40-49 5(5%) 5(5%)
Marital status Married 59(59%) 9(9%)
Single 27(27%) 5(5%) P value= 0.748
Level of Education Primary 5(5%) 3(3%)
Secondary 48(48%) 9(9%)
Tertiary 33(33%) 2(2%) P value= 0.116
Religion Christians 75(75%) 11(11%)
Muslims 9(9%) 5(5%) P value= 0.030
Occupation civil servant 10(10%) 3(3%)
private sector 0(0%) 2(2%)
self employed 26(26%) 2(2%) P value= 0.035
Student 11(11%) 1(1%)
Unemployed 39(39%) 6(6%)
Husbands occupation civil servant 10(10%) 3(1%)
private sector 1(1%) 1(1%)
self employed 25(25%) 3(3%) P-value =0.411
Student 8(8%) 4(4%)
Unemployed 37(37%) 8(8%)
Average monthly <50,000 15(15%) 4(4%)
income >200,000 24(24%) 5(5%)
P-value 0.989
160,000- 33(33%) 8(8%)
150,000
60,000- 9(9%) 2(2%)
200,000

4.3.1 Determinants of Dietary Practices among study participants.

In this study, pregnant women’s age, occupation, husband’s occupation and average monthly

income had no statistical significant association with the dietary practices of pregnant women.

While marital status, level of education and religion were significantly associated with the

dietary practice of pregnant women. From the results gotten, chi-square test statistic is calculated

as 3.438, The associated p-value (Sig.) is 0.064, which suggests a marginally significant

association between marital status and level of practice. Table 5 below illustrate the

Determinants of Dietary practices among study participants.

Table 5 Determinants of Dietary Practices among study participants.

Variable Category Adequate Inadequate Level of significance
Practices Practices
(n(%)) (n(%))
Age 17-19 39(39%) 20(20%)
30-39 23(23%) 12(12%) P value= 0.223
40-49 6(6%) 0(0%)
Marital status Married 56(56%) 12(12%)
Single 21(21%) 11(11%) P value= 0.064
Level of Education
Primary 5(5%) 3(3%)
Secondary 48(48%) 9(9%) P value= 0.055
Tertiary 33(33%) 2(2%)
Religion Christians 77(77%) 9(9%)
Muslims 10(10%) 4(4%) P value = 0.062
Occupation civil servant 11(11%) 2(2%)
private sector 1(1%) 1(1%)
self-employed 26(26%) 2(2%) P value= 0.287
Student 9(9%) 3(3%)
Unemployed 40(40%) 5(5%)
Husbands civil servant 11(11%) 2(2%)
occupation private sector 1(1%) 1(1%)
self-employed 26(26%) 2(2%) P value=0.287
student 9(9%) 3(3%)
Unemployed 40(40%) 5(5%)
Average monthly <50,000 16(16%) 3(3%)
income 60,000- 25(25%) 4(4%)
150,000 P value= 0.935
160,000- 33(33%) 8(8%)
200,000
>200,000 9(9%) 2(2%)

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 Discussion
5.1.1 Pregnant Women Knowledge on Nutrition

From the results obtained, majority 78(78%) of the participants had knowledge on the

importance of adequate nutrition during pregnancy as they said it was important because it

supports the growth and development of the foetus and maintenance of the woman’s own health.

30(30%) of the participants opted for balanced diet as Eating proper nutrients for good heath

while 43(43%) opted for balance diet as Eating everything that looks healthy. Also 59(59%) of

the respondents were knowledgeable that a pregnant woman should eat a variety of foods from

different food groups and balanced diet. This is because consuming a wide range of foods

ensures that the mother and her growing baby receive a broad spectrum of essential nutrients.

Each food group provides different vitamins, minerals, and other beneficial compounds

necessary for optimal development and health. Furthermore 51% of the respondents were

knowledgeable that the supplement they took during pregnancy was to prevent anemia and birth

defects. The findings of this study goes contrary to a study by Daba et al., (2013) in Ethiopia

who reported that about 74.0% of their participants did not know the main food of a well-

balanced diet and 57.8% did not even know the meaning of food. And also a study results

reported from America at El-Menshawy Hospital showed that about half of the pregnant women

did not have enough knowledge regarding the meaning, importance and constituents of well-

balanced diet (Latifa et al., 2012). This high level of knowledge on pregnant women knowledge

on Nutrition could be accounted for in Cameroon due to the high advancement in technology and

communication e.g. use of social media, internet etc. All these are means by which information

about pregnancy, nutrition, infant weaning, exclusive breastfeeding etc could be transferred

from the ministry of health to the citizens or person to persons within minutes, thus for the high

level of Knowledge on infant weaning. On the flip side, since most information about pregnancy
and nutrition are currently gotten from electrical gadgets (social media, television, internet etc)

wrong/ inaccurate information is inevitable, this could have accounted for the respondents 4(4%)

who wrongly stated that they took fancider as a supplement during pregnancy.

5.1.2 Dietary Practice characteristics of pregnant women

From the findings of the study above, based on the dietary practices of pregnant women, 28% of

the respondents said they had specific food type they consumed/ate during pregnancy.

Specifically, 12 of the respondents ate Fufu &Eru, while 6 and 4 of the respondents ate Fufu &

Kati Kati and Rice & fish respectively. This could be so because pregnancy often brings about

changes in taste preferences and cravings. Pregnant women may consume specific foods to

satisfy cravings, which can vary widely from person to person. Conversely, some women

experience food aversions and may prefer or tolerate certain types of food over others. Also,

47% of the participants consume dairy products (such as, milk, cheese, and yogurt) every day.

Notably 68% of the study participants, admitted to avoiding certain foods and diet during

pregnancy, which the reason for avoidance were culture 44%, vomiting 7% and making delivery

difficult 14%. This could be so because cultural beliefs and traditions play a significant role in

shaping dietary choices during pregnancy. Certain cultures have specific food taboos or

restrictions believed to protect the health and well-being of both the mother and the baby. These

cultural beliefs may vary widely, and pregnant women may avoid certain foods based on the

traditions passed down through generations. Also some cultural beliefs suggest that consuming

certain foods during pregnancy may make delivery more difficult or labor more prolonged.

These beliefs may be rooted in traditional practices or anecdotal experiences. As a result,

pregnant women may avoid certain foods to ensure a smoother and easier delivery. Furthermore,

Morning sickness, characterized by nausea and vomiting, is a common symptom experienced by

many pregnant women. Certain foods can trigger or worsen these symptoms, leading women to

avoid them to alleviate discomfort. This is in line with a study conducted in Borno State Nigeria

by Kever et al., (2019), it was discovered that 65.31% of respondents showed a high level of

knowledge about dietary practices during pregnancy despite high level of illiteracy among the

correspondents.

5.1.3 Determinants of participants Nutritional Knowledge in pregnancy

In this study, pregnant mother’s average monthly income 0.989 was negatively associated with

maternal knowledge on Nutrition. This might be because Lower income levels can restrict access

to quality healthcare, including prenatal care and nutrition education. Pregnant mothers with

lower incomes may not have the financial means to access specialized healthcare services or

afford nutritious foods, limiting their exposure to information about proper nutrition during

pregnancy. Women occupational status in this study, the associated p-value (Sig.) is 0.006,

which suggests a significant association between occupation and level of knowledge on

knowledge on nutrition. This could because occupations with higher status often involve greater

social interactions and networking opportunities. Women in such positions may have access to

social networks that provide information, support, and discussions on various topics, including

nutrition during pregnancy. Interacting with knowledgeable peers or mentors can contribute to

their level of knowledge in this area. This is similar to a study by (Appiah et al., 2019), in Ghana,

who reported that the significant association of variables and indicated, occupation, ethnicity and

number of pregnancies are associated with good nutritional habit of pregnant women.

5.1.4 Determinants of Dietary Practices among study participants

Based on the result, marital status, level of education and religion were significantly associated
with the dietary practice of pregnant women. This could be because Religious teachings and

practices often include guidelines or restrictions related to food choices. Religious beliefs may

emphasize certain types of foods as being permissible or beneficial, while others may be

discouraged or prohibited during pregnancy. Pregnant women who adhere to specific religious

dietary guidelines are likely to follow those recommendations, which can influence their dietary

practices. Higher levels of education often coincide with better access to educational resources,

healthcare providers, and nutrition-related information. Educated pregnant women may have

more opportunities to attend educational programs, access reliable sources of information, and

consult with healthcare professionals, all of which contribute to better dietary practices. This is in

line with a study by (Masuku and Lan, 2014) in Manzini Region, Swaziland who reported that

high income level, religion and normal BMI are significantly associated to healthy dietary

practices.

5.2 Conclusion

The findings of the study indicate that the majority of participants had knowledge of the

importance of adequate nutrition during pregnancy. They recognized that proper nutrition

supports the growth and development of the fetus and the maintenance of the mother's health.

Additionally, there was a good understanding that a pregnant woman should consume a variety

of foods from different food groups to ensure a broad spectrum of essential nutrients. The dietary

practices of the pregnant women in this study showed that some had specific food preferences

during pregnancy, which is often influenced by changes in taste preferences and cravings. Dairy

products were consumed daily by a significant portion of participants, which is beneficial for

obtaining essential nutrients.

5.3 Recommendations

Education and Counseling: Healthcare providers should prioritize providing comprehensive

and evidence-based nutrition education to pregnant women during antenatal care visits. This

should include information about the importance of a well-balanced diet, specific nutrient

requirements during pregnancy, and the benefits of consuming a variety of foods from different

food groups. Counseling sessions can help address misconceptions, cultural beliefs, and concerns

related to diet during pregnancy.

Improved Access to Information: Efforts should be made to ensure pregnant women have easy

access to accurate and reliable information on nutrition during pregnancy. This can be done

through the use of information materials, such as brochures, posters, or websites, specifically

tailored for pregnant women. Utilizing social media platforms and mobile health applications can

also be effective in disseminating evidence-based information.

REFERENCES

1. Adinma, J.I.B., Umeononihu, O.S., Umeh M.N. (2017). ‘Maternal nutrition in Nigeria.’
 Trop J Obstet Gynaecol, vol. 34, no.2, pp.79-84. doi: 10.4103/TJOG_25_17

2. Agan, T.U. (2010). Prevalence of anemia in women with asymptomatic malaria parasite

at first antenatal care visit at the University of Calaba Teaching Hospital. International

Jornal of Women’s Health, 22(9), P.14. doi:10.2147/IJWH.S11887

3. Aliwo, S., Fentie, M., Awoke, T., Gizaw, Z. (2019). ‘Dietary diversity practice and

associated factors among pregnant women in North East.’ BMC Research Notes, pp.1-6.

https://doi.org/10.1186/s13104-019-4159-6.

4. Appiah, P.K., Rhoda, A., Korklu, N., Bonchel. D.a., Fenu, G.A., Yankey, F.W. (2019).

‘Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents

Attending Antenatal Clinics in Urban Community in Ghana.’

5. Birdsong, A., Byrd, M., Holcomb, H., Ticer, T., Weatherspoon, D. (2014). ‘Excessive

gestational weight gain: long-term health risks.’ International Journal of Childbearing

Education, vol.292, pp51-57.doi:

6. Breslin, G., McKeown, C., Groves, R. (2016). ‘Collins Dictionary.’ Glasgow:

HapperCollins.

7. Brown, L.S. (2010). Nutrition Requirements during Pregnancy. Essentials for Life Cycle

Nutrition United States of America. Jones and Bartlett Publishers.

8. Clapp, J.F. (2002). 3rd Maternal carbohydrate intake and pregnancy outcome. Proc Nutr

Soc, 61(2), pp. 45-50. [PubMed] [Google Scholar]

9. Daba, G., Beyene, F., Fekadu, H., Garoma, W. (2013). Assessment of Nutritional

‘Practices of Pregnant Mothers on Maternal Nutrition and associated Factors in Guto

Gida Woreda, East Wollega Zone, Ethopia.’ J Nutr Food Sci, vol.2, no.3, pp105-

113.doi:10.4314/jnfs.v2i3.98748
10. Darnton-Hill, I. (2013). Nutrition counseling during pregnancy. World Health

Organization. Available at: www.who.int/elena/bbc/nutrition_counseling_pregnancy/en/.

11. Department for International Development (DFID). 2009. The neglected crisis of

undernutrition: evidence for action, DFID, London, UK.

12. Dunford, M. (2006). Sport Nutrition: A Practice Manual for Professionals. American

Dietetic Association. Vol.4

13. Engle-Stone, R., Nankap, M., Ndjebayi, A.O., Friedman, A., Brown, K.H. (2018).

‘Prevalence and predictors of overweight and obesity among Cameroonian women in a

natural survey and relationships with waist circumference and inflammation in Yaounde

and Douala.’ Maternal and Child Nutrition Journal, vol.14, no.4, pp23-48.

14. Faber, M. and Wenhold, F. (2007). Nutrition in contemporary south Africa Water SA.

33(3), pp.393-400. Available at: http://www.wre.org.za/publications.watersa.him.

15. Fasola, O., Abosede, O., Fasola, F.A. (2018). ‘Knowledge, attitude and practices of good

nutrition among women of childbearing age in Somolu Local Government, Lagos state.’

J Public Health Afri, vol.9, no.1, p.793. doi:10.8\4081/jphia.2018.793.

16. Girard, A., and Olude, O. (2012). Nutrition Education and Counseling provided during

pregnancy; effects on maternal, neonatal and child health outcomes. Paediatric and

Perinatal Epidemiology, 26(1), pp.191-204. http://dx.doi.org/10.1111/j.1365-

3016.2012.01278.x.

17. Gubson, R.S. (2005). Principles of Nutritional Assessment, Oxford University Press Inc.,

New York. Journal of Food and Nutrition Sciences. 5(20).

18. Harb, D., AbouHaidar, M.Y., BouYazbeck, E. (2018). ‘Knowledge, attitude and practice

toward nutrition and diet during pregnancy among recently delivered women of Syrian
 refugees.’ Journal Refuge Global Health, Vol.1, no.2, pp.32-37.

doi:10.18297/rgh/voll/iss2/6.

19. Healingwell, (2009). Nutrition in Science and know what nutrition is. Reference from

dictionary.

20. Institute of Medicine, Food and Nutrition Board, (2005). Dietary Reference intakes for

energy, carbohydrate, fiber, fat, fatty acids, cholesterol, proteins, vitamin A, K, Arsenic,

Boron, Iron. Prepublication edition, Washington, DC. National Academic Press.

Available Online at http://www.iom.edu/en/Report/2009/Weight-Gain-during-Pregnancy-

Rexamining-the-Guidelines.aspx.

21. Jacobs, B., and Roberts, E. (2004). Baseline assessment for addressing acute malnutrition

by public-health staff in Cambodia. J Health Popul Nutr. 22(2), pp. 212-219.

22. Kramer, M.S., Chalmers, B., Hodnett, E.D., Sevkovskaya, Z., Dzikovch, I., Shapiro, S.,

Collet, J.P., Vanilovich, I., Ducruet, T., Shishko, G., Bogdanovich, N. (2001). ‘Promotion

of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of

Belarus.’ JAMA vol.285, pp.413-420.

23. Kever, R.T., Martins, S.D., Lola, N., Hubu, H., Fatima, A.A., Sambo, B. (2019).

‘Knowledge and attitude of pregnant women towards dietary practices in Yerwa Clinic,

Maiduguni Metropolitan Council, Borne State.’ J.F Research in Nursing and Midwifery,

vol.4, no.1, pp.12-19.

24. Lagua, R.T., and Claudio, V. (2008). Nutrition and Diet Therapy Reference Dictionary.

25. Latifa, M.F., Manal, H.A., Nihal, S.S. (2012). ‘Nutritional Awareness of Women during

Pregnancy.’ J American Sci. vol.8, no.3,p.35.

26. Lim, Z.X., Wong, J.L., Lim, P.Y., Soon, L.K. (2018). ‘Knowledge of nutrition during
 pregnancy and associated factors among antenatal mothers.’ International Journal Public

Health Clinical Science. Vol.5, no.1, pp. 117-128.

27. Lopez, C.M. (2008). Cultural diversity and the renal diet: the Hispanic population.

Nephrology Nursing Journal. 35(1), pp.69-72.

28. Loudyi, F.M., Kassouati, J., Kabiri, M., Chahid, N., Kharbach, A., Aguenaou, H. (2016).

‘Vitamin D status in Moroccan pregnant women and newborns: reports of 102 cases.’

Pan African Med J. vol.24, p.170. doi:10.11604/pamj.2016.24.170.47682.

29. Lucas, C., Charlton, K., and Yeatman, H. (2014). ‘Nutrition advice during pregnancy.’

Maternal and Child health Journal, Vol.18, pp.2465-2478.

30. Macias, Y.P., and Glasauer, P. (2014). Guidelines for assessing nutrition-related

Knowledge, Attitude and Practices, Rome. Food and Agriculture Organization, 33(6),

pp.1-188 Available at: https://www.cabdirect.org/abstracts/20143306666.html

31. Maloba, M.N. (2022). Nutritional Knowledge and Dietary Practice of Pregnant Women

receiving nutrition education while attending ANC in Magathi hospital Nairobi Kenya.

Food Science Nutrition and Technology.

32. Masuku, S.K.S., and Lan, S.J. (2014). Nutritional Knowledge, Attitude and Practices

among Pregnant and Lactating Women living With HIV in the Manzini Region of

Swaziland. 32(2), pp.261-269.

33. Mazur, R.E., Marquis, G.S., Jensen, H.H. (2003). ‘Diet and food insufficiency among

Hispanic youths: acculturation and socioeconomic factors in the third National Health

and Nutrition Examination survey.’ American Journal of Clinical Nutrition, vol.78, no.6,

pp.1120-1127.

34. Mbida, M.S.D. (2012). Prevalence and Associated Risk Factors of Low Birth Weight in
 Buea Health District. MD thesis. Unplublished: University of Buea.

35. Mora, J.O., and Nestel, P.S. (2000). Improving prenatal nutrition in developing countries:

strategies, prospects, and challengers. American Journal of Clinical Nutrition, 71(5),

pp.1353S-1363S. doi:10.1093/ajcn/71.5.1353s

36. Mosby .(n.d).

37. Murakami, K., Miyake, Y., Sasaki, S., Tanaka, K., Ohya, Y., Hirota, Y. (2009).

‘Education, but not occupation or household income, is positively related to favorable

dietary intake patterns in pregnancy Japanese women: the Osaka Maternal and Child

Health Study.’ Nutrition Research, vol.29, no.3, pp.164-172.

doi:10.1016/j.nutres.2009.02.002

38. Murray, H. and Mckinney, E. (2014). Foundations of maternal newborn and women’s

Health Nursing. 978(1), pp.557-3306-4.

39. Nana, A.,and Zema, T. (2018). Dietary practices and associated factors during pregnancy

in northwestern Ethiopia. BMC Pregnancy Childbirth, 18(5), p.183. doi:10.1186/s12884-

018-1822-1

40. Nasah, T.B., and Drouin, P. (2001). Major factors affecting maternal and child health;

Care of the mother in the tropics, CEPER. Pp.9-15

41. Nchangmugyia, A.S., Nguti, A., Tanya, K., Njotang, P.N., Ndombo, P.K. (2016).

‘Knowledge and Attitudes of Pregnant Mothers towards Maternal Dietary Practices

during Pregnancy at Etoug-Ebe Baptist Hospital Yaounde.’ Health Sciences and

Diseases, vol.17, no.2, pp.24-29. Available at: http://www.hsd-fmsb.org/.

42. O’Brien, G., and Davies, M. (2007). Nutritional Knowledge and boby mass index. Health

Educ Res, 22, pp.571-575.

43. Pitkin, R.M. (2007). Folate and neural tube defects. Am J Clin Nutr, 85(1), pp.285S-

288S.

44. Shah, S., Sharma, G., Shris, L., Shah, S.K., Sapkota, N.K. (2017). ‘Knowledge on dietary

patterns among pregnant attending Antenatal Care checkup in Narayani Hospital, Nepal.’

International Journal of Community Medicine and Public Health, vol.4, no.5, p.1466.

https://doi.org/10.18203/2394-6040.ijcmph20171756.

45. Ramakrishnan, U., Grant, F., Goldenberg, T., Zongrone, A., Martorell, R. (2012). ‘Effect

of women’s nutrition before and during early pregnancy on maternal and infant

outcomes: a systematic review.’ Paediatr Perinat Epidemiol Journal, vol.47, no.7,

pp.724-31.

46. Shankar, H., Kumar, N., Sandhir. R., Singh, M.P., Mittal, S., Adhikari, T., Tarique, M.

(2019). ‘Association of dietary intake below recommendations and micronutrient

deficiencies during pregnancy and Low Birth Weight.’ Journal of Perinatal Medicine,

vol.47, no.7, pp.724-31.

47. Supplements, D. (2020). Dietary Practices and their Determinants among pregnant

women in Gedeo Zone, Southern Ethiopia. A community based cross sectional study.

48. Teller, H., and Yimar, G. (2000). Levels and determinants of malnutrition in adolescent

and adult women in southern Ethiopia. Ethiopian Journal of Health Development, 14(1),

pp.57-66.

49. Wallner, S., Kendall, P., Hillers,V., Bradshaw, E., Medeiros, L.C. (2007). ‘Course

Enhances Nutrition And Health Professionals’ Knowledge of Food Safety Issues of High-

Risk Populations.’ J Am Diet Assoc, vol.24, no.1016, P.1. Available at:

http://dio.org/10.10196/j.jada.2007.05.014
50. Westenberg, L., Klis, K.A., Chan, A., Dekker, G., Keane, R.J. (2002). ‘Aboriginal

teenage pregnancies compared with non-aboriginal in South Australia.’ J Obstet Gynecol,

vol.42, pp.187-192.

51. United Nations Children’s Fund. (2021). Global Nutrition Database. UNICEF: New

York.

52. World Health Organization,(2006).

53. WHO, (2009). Global Prevalence of Vitamin A deficiency in Population at risk 1995-

2005. WHO Global Database on vitamin A deficiency. World Health Organization;

Geneva, Switzerland: [(accessed on 2 nd march 2023)]. Available online:

http://apps.who.int/iris/bitstream/handle/10665/44110/978921598019_eng.pdf?

Sequence=1.

54. World Health Organization,(2012). Daily Iron and Folic Acid supplementation in

pregnancy. Geneva. WHO.

55. World Health Organization,(2019). Assessment for nutrition-related disorders in women

during pregnancy. Available from: http://www.who.int/elena/titles/assessment-methods-

pregnancy/en/. Accessed; February 22nd, 2023.

56. WHO, UNICEF, USAID,(2003). ‘Indicators for assessing infant and young child feeding

practices.’ Geneva: World Health Organization.

57. Wyness, L.(2014). Nutritional issues of vulnerable groups around pregnancy. British

Journal of midwifery, 22(2), pp. 94-104.

58. Yassin, S.A., Sobhy, S.I., Ebrahim, W. (2004). ‘Factors Affecting Dietary Practice

among Adolescent Pregnant Women in Alexandria.’ J. Egypt Public Health Assoc,

vol.34, pp.179-196.
 59. Zelalem, A., Endeshaw, M., Ayenew, M., Shiferaw, S., Yirqu, R.(2017). ‘Effects of

Nutrition Education on Pregnancy-specific Nutrition Knowledge and Healthy Dietary

Practice among pregnant women in Addis Ahaba.’ Clinics in Mother and Child Health,

vol.14, no.3. Available at: http://doi.org/10.4172/2090-7214.1000265.

INFORMED CONSENT FORM

Research Title; NUTRITIONAL KNOWLEDGE AND DIETARY PRACTICES OF

PREGNANT WOMEN ATTENDING ANTENATAL CLINIC INTHE REGIONAL
HOSPITAL OF BUEA.
Investigator: NGENYI CHIARITTA, Biaka University Institute of Buea (BUIB), Department
of Nursing.
Introduction and Purpose of the study; you are being invited to take part in a research study.
This consent form provides you with information to make an informed choice. But before you
accept to participate, we would help you understand the research and what participation you will
be involved in. The purpose of this study is to examine the nutritional knowledge and dietary
practices of pregnant women. Please read through this document carefully and feel free to let us
know if you need any clarifications.
Description of the Research; when you get into this program you’ll be asked to complete some
questions and this will take approximately 5 to 10 minutes of your time.
Potential Risks and Discomfort; There are no known risks involved in this study.
Potential Benefits; People who participate in this study may have a better understanding of
additional treatment methods that enable individuals to experience and increase their overall
sense of wellbeing.
Confidentiality; your identity will be kept confidential and all information taken will be coded
to protect each subject’s name. No names or other identifying information used when discussing
or reporting data. The investigator will safely keep all data collected in a secured locked cabinet
and once the data has been fully analyzed, it will be destroyed.
Authorization; by signing this form, you authorize the use and disclosure of the following in
formation for this research.
Voluntary participation; your decision to participate in this study is completely voluntary. If
you decide not to take part, it will not affect the care or benefits to which you are entitled and if
you decide to participate in this study, you may withdraw from the study at any time without
penalty or consequence.
□Yes, I voluntarily agree to participate in this research.
Participants Name —————————————————— Date: ——————
Participant’s Signature: ———————— Date: ——————
APPENDIX 2

QUESTIONNAIRE

Please do a mark off with a tick (√)

SECTION A: Socio-demographic Profile

 1. Age (in years) —————

2. Marital status: □ Single □Married

3. Religion: □Christian □ Muslim □Other —————

4. Level of Education: □ Primary □Secondary □Tertiary

5. Occupation: □Unemployed/Applicant □Self-employed/Business □Civil Servant

□Employed in a private sector □Student

6. Husband’s occupation: □Unemployed/Applicant □Self-employed/Business □Civil servant

□Employed in a private sector □Student

7. Average monthly income of household : □Less than CFA 50,000 □CFA 60,000 –

150,000 □CFA 160,000—200,000 □ above 200,000CFA

SECTION B: Nutrition Knowledge of Pregnant Women

1. What do you think is the importance of adequate nutrition during pregnancy?

a) To support the growth and development of the foetus and maintenance of the

woman’s own health

b) To support growth and development of the fetus c)I don’t know

2. How should a pregnant woman eat in comparison with a non-pregnant woman?

a) Eat more fats b)Maintain a normal serving size of food as a non-pregnant woman

c) Eat only what she craves d)Eat a variety of foods from different food groups /

Balanced diet

3. What is a balanced diet?

a) Eating everything that looks healthy b)Eating proper nutrients for good heath

c)Eating fruits and vegetables d)I don’t know

 4. What potential problem can arise when a pregnant woman is under weight?

a) Miscarriage b)Risk of giving birth to a low weight baby c)Risk of baby being

born prematurely

5. What complication(s) can arise when a pregnant woman gains too much weight?

a) Chances of giving birth via caesarian section b) Difficult labour c) I don’t know

6. What two supplements or tablets do pregnant women benefits from?

a) Proteins and calcium b) Iron and folic acid c) Fancider d) I don’t know

7. Why is it important to take the above supplements during pregnancy?

a) To increase appetite b) To control heart burn c) To prevent anemia and birth defects

SECTION C: Dietary Practices characteristics of Pregnant Women

1. Do you have any specific food type you consume/eat during pregnancy? a)Yes b) No

1b. If yes, which food type? ———————————————

2. Do you eat fresh vegetables and fruits such as mango, lemons, orange, bananas etc.?

a) Yes b) No

3. Do you have the habits of taking snacks between meals during pregnancy? a) Yes b) No

4. Do you consume dairy products (such as, milk, cheese, and yogurt) every day? a) Yes b)

No

5. What is your diet frequency of meal per day during pregnancy?

a) 1-2 b) 3-4 c) ≥5

6. How often do you take Iron-Folic acid supplements? a) Always b) Sometimes c) Never

7. Are you on any other supplement? a) Yes b) No

If yes, which supplement? ———————————————

8. Do you avoid any food or diet during pregnancy? a) Yes b) No

8b. If yes, reason of avoidance of any food/diet during pregnancy?

a) Religion b) Culture c) Make the baby big d) Makes delivery difficult

e)Other(specify)——————————

Thank you‼