KNOWLEDGE AND PRACTICE OF MATERNAL NUTRITION DURING PREGNANCY: A CASE STUDY OF UNIVERSITY OF UYO TEACHING HOSPITAL (UUTH), UYO

Adequate maternal nutrition during pregnancy is fundamental to foetal development, maternal health outcomes, and the prevention of low birth weight, preterm birth, and micronutrient-deficiency disorders. In Nigeria, nutritional deficiencies including iron-deficiency anaemia, folate deficiency, iodine deficiency, and protein-energy malnutrition remain highly prevalent among pregnant women and continue to contribute significantly to adverse perinatal outcomes. This study examined the knowledge and practice of maternal nutrition during pregnancy among women attending the antenatal clinic of the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria.

Methodology: A descriptive cross-sectional survey design was adopted. A total of 350 pregnant women were recruited through systematic random sampling from the UUTH antenatal clinic between February and July 2024. Data were collected using a researcher-designed, pre-tested, structured questionnaire covering sociodemographic characteristics, nutritional knowledge (macronutrients, micronutrients, dietary diversity, food safety), and nutritional practices (dietary frequency, supplementation adherence, food taboos, meal frequency). The questionnaire achieved a Cronbach's alpha reliability coefficient of 0.81. Data were analysed using SPSS version 27; chi-square tests and binary logistic regression were used to determine associations between variables at a significance level of p ≤ 0.05.

Findings: The mean knowledge score was 15.3 ± 4.6 out of a possible 30 points, with only 41.7% of participants demonstrating good nutritional knowledge. Nutritional practice was rated adequate in 39.1% of participants. Knowledge was significantly associated with educational level (p = 0.001), gestational age (p = 0.014), and number of ANC visits (p = 0.003). The most common nutritional misconception was the belief that eating certain protein-rich foods (eggs, fish) during pregnancy could cause the child to develop undesirable behavioural traits, reported by 53.2% of respondents. Iron-folic acid supplementation adherence was reported by 68.4% of participants, though sustained daily adherence was confirmed in only 47.1%. Dietary diversity scores were generally low, with fewer than one-third of participants consuming five or more food groups per day.

Conclusions: Knowledge and practice of maternal nutrition at UUTH were suboptimal, with pervasive food taboos and low dietary diversity posing significant nutritional risks. Targeted nutritional counselling integrating cultural sensitivity, supplementation adherence support, and dietary diversity promotion must be integrated into antenatal care protocols at UUTH and similar tertiary facilities in Nigeria.

Keywords: Maternal nutrition, dietary practices, pregnancy, food taboos, micronutrient supplementation, antenatal care, UUTH, Nigeria.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

The nutritional status of a woman during pregnancy profoundly influences not only her own health but also the short- and long-term health, growth, and cognitive development of her offspring. The Barker hypothesis and the concept of the Developmental Origins of Health and Disease (DOHaD) have firmly established that foetal undernutrition during critical windows of intrauterine development programmes the foetus for increased susceptibility to non-communicable diseases including type 2 diabetes mellitus, hypertension, and cardiovascular disease in adult life (Godfrey & Barker, 2022). Maternal malnutrition also directly contributes to the leading causes of preventable maternal death, including severe anaemia, pre-eclampsia, and postpartum haemorrhage.

Nigeria has one of the highest burdens of malnutrition in sub-Saharan Africa. The 2023 Nigeria Demographic and Health Survey estimated the prevalence of anaemia among pregnant Nigerian women at 67.3%, with iron deficiency implicated in approximately 55% of cases. Folate deficiency, which is critically associated with neural tube defects, affects an estimated 30–40% of pregnant women in Southern Nigeria, where dietary diversity is limited by economic constraints, cultural food taboos, and inadequate nutritional knowledge (NDHS, 2023; Okafor et al., 2022). These statistics underscore the urgency of evidence-based interventions targeting maternal nutritional knowledge and practice.

Antenatal care represents the most consistent and scalable touchpoint for delivering maternal nutrition education and supplementation. WHO's 2022 recommendations on antenatal care endorse a minimum of eight ANC contacts per pregnancy, each of which should incorporate nutritional assessment, dietary counselling, and micronutrient supplementation monitoring. In practice, however, the quality of nutritional counselling at antenatal clinics in Nigerian public hospitals is frequently constrained by high patient volumes, inadequate staff training, and the absence of standardised nutritional assessment protocols (Eze et al., 2023; Adeleke & Salako, 2024).

The University of Uyo Teaching Hospital provides antenatal services to a geographically and socioeconomically diverse population in the Niger Delta. Previous studies in Akwa Ibom State have documented high rates of food taboos during pregnancy particularly restrictions against protein-rich foods such as eggs, bushmeat, and certain species of fish which substantially reduce dietary quality and increase the risk of protein-energy malnutrition and micronutrient deficiency (Udoh & Archibong, 2022; Ekanem et al., 2023). Despite this background, no comprehensive facility-based study has simultaneously assessed both nutritional knowledge and dietary practices among pregnant women at UUTH, leaving a critical evidence gap that this study sought to fill.

1.2 Statement of the Problem

Suboptimal maternal nutrition during pregnancy remains a leading, yet largely preventable, contributor to adverse maternal and perinatal outcomes in Nigeria. While national surveys have documented the high prevalence of micronutrient deficiencies and malnutrition among pregnant women, facility-specific data on the knowledge and dietary practices of women attending antenatal care at UUTH including the extent of food-taboo adherence, dietary diversity, and supplementation compliance are lacking. Without such localised evidence, nutritional counselling at UUTH cannot be effectively tailored, evaluated, or scaled. This study therefore provided the baseline evidence necessary to design targeted, context-specific nutritional interventions for pregnant women at UUTH.

1.3 Objectives of the Study

The broad objective was to assess the knowledge and practice of maternal nutrition during pregnancy among women attending UUTH antenatal clinic. Specifically, the study aimed to:

i. Determine the level of nutritional knowledge among pregnant women at UUTH regarding macronutrients, micronutrients, dietary diversity, and food safety in pregnancy.

ii. Assess the dietary practices of pregnant women at UUTH, including meal frequency, food-group diversity, supplementation adherence, and food-taboo behaviour.

iii. Identify the sources of nutritional information utilised by pregnant women at UUTH.

iv. Determine the association between sociodemographic characteristics and nutritional knowledge and practice among the study participants.

v. Examine the association between nutritional knowledge and dietary practice among pregnant women at UUTH.

1.4 Research Questions

i. What is the level of nutritional knowledge among pregnant women attending the UUTH antenatal clinic?

ii. What dietary practices do pregnant women at UUTH exhibit regarding meal frequency, food-group diversity, supplementation adherence, and food taboos?

iii. What are the primary sources of nutritional information for pregnant women at UUTH?

iv. Is there a significant association between sociodemographic characteristics and nutritional knowledge and practice among pregnant women at UUTH?

v. Is there a significant association between nutritional knowledge and dietary practice among pregnant women at UUTH?

1.5 Hypotheses

H01: There is no statistically significant association between educational level and nutritional knowledge among pregnant women at UUTH.

H02: There is no statistically significant association between nutritional knowledge and dietary practice among pregnant women at UUTH.

H03: There is no statistically significant association between parity and the prevalence of food-taboo adherence among pregnant women at UUTH.

1.6 Significance of the Study

This study generates actionable facility-specific evidence on maternal nutrition knowledge and practice gaps at UUTH. For midwives and dietitians providing antenatal care, the findings highlight specific knowledge deficits and harmful food-taboo practices that should be prioritised in nutritional counselling sessions. For the UUTH hospital management, the study provides justification for the employment of dedicated antenatal dietitians and the development of standardised, context-specific nutritional counselling protocols. For policy makers at the Akwa Ibom State Ministry of Health, the data support the integration of food-taboo sensitisation into community health programmes targeting pregnant women and their families. The study also contributes to the evidence base supporting Sustainable Development Goal 2 (Zero Hunger) and SDG 3 (Good Health and Well-being) by demonstrating the linkages between nutritional knowledge, dietary practice, and maternal-neonatal health outcomes in a Nigerian tertiary-hospital context.

1.7 Scope of the Study

The study was conducted at the antenatal clinic of the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, between February and July 2024. Participants included all consenting pregnant women in any trimester who attended the UUTH antenatal clinic during the study period and met the inclusion criteria. Women with pre-existing non-gestational medical conditions affecting nutritional status (e.g., HIV/AIDS, chronic kidney disease, coeliac disease) were excluded. The study assessed nutritional knowledge and self-reported dietary practices; biochemical nutritional assessments (e.g., haemoglobin, serum ferritin, folate levels) and anthropometric measurements were not within the study's scope.

1.8 Definition of Terms

Maternal Nutrition: The dietary intake and nutritional status of a woman during pregnancy, encompassing the adequacy of macronutrient (carbohydrate, protein, fat) and micronutrient (vitamins and minerals) consumption relative to the increased physiological demands of pregnancy (WHO, 2022).

Dietary Diversity: A measure of the number of distinct food groups consumed by an individual over a reference period (typically 24 hours or 7 days). Higher dietary diversity is a proxy indicator of micronutrient adequacy and overall dietary quality (FAO/WHO, 2022).

Food Taboo: A culturally or religiously motivated prohibition or restriction on the consumption of specific foods during pregnancy, which may limit dietary diversity and increase the risk of nutrient deficiency (Eze et al., 2023).

Micronutrient Supplementation: The provision of vitamins and minerals including iron, folic acid, calcium, iodine, and vitamin D in pharmaceutical form to pregnant women who may not meet their increased nutritional requirements through diet alone (WHO, 2022).

Iron-Deficiency Anaemia (IDA): A condition characterised by a reduction in haemoglobin concentration below 11 g/dL in pregnancy, resulting primarily from inadequate dietary iron intake or absorption relative to the heightened demands of gestation (Okafor et al., 2022).

Dietary Knowledge: The factual understanding an individual possesses regarding the nutritional value of foods, the dietary requirements during pregnancy, the consequences of nutritional deficiency, and the recommendations for healthy eating during gestation (Adeleke & Salako, 2024).

Dietary Practice: Observable, self-reported behaviour related to food selection, preparation, and consumption, including meal frequency, food-group variety, supplementation adherence, and compliance with nutritional guidance received during antenatal care (Eze et al., 2023).

Antenatal Nutritional Counselling: A structured, evidence-based dialogue between a healthcare provider and a pregnant woman, aimed at assessing dietary intake, providing personalised nutritional guidance, promoting supplementation adherence, and addressing harmful food beliefs or taboos (WHO, 2022).

REFERENCES

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