This was a cross-sectional descriptive study that collected quantitative data.
Study area and population.
This study was carried out in four health centres in Lamwo district in the Acholi sub-region, Northern Uganda. These health centres were purposively selected due to availability of antenatal care services and an adequate number of pregnant women. The study included pregnant women who came for antenatal care services in selected health facilities in Lamwo District and consented to participate in the study. Pregnant women who were critically ill and required urgent referral were excluded from the study. The study was conducted from January, 3rd 2019 to February, 2nd 2019.
Sample Size And Participant Selection
The sample size was determined using the Leslie Kish survey sampling formula ; Z (the value from standard normal distribution) with a 95% Confidence Interval (CI) of 1.96. P, the proportion of undernutrition among pregnant women was 19.06% ; e (the margin of error) was 5% (0.05) to arrive at N (the actual sample size) of 522 pregnant women. Each health centre under the study was allocated a sample proportionate to the available study population. The sample size was distributed across study health centres as follows; Madi-Opei (190), Padibe (143), Lokung (95) and Palabek (94). At each health centre, mothers were consecutively recruited into the study as they came to the antenatal clinic for antenatal care.
Data was collected using an interviewer-administered structured questionnaire formulated purposely for this study. Questions on nutritional status, socio-economic status, house hold food security, maternal health status, and socio-demographic characteristics were asked. Maternal nutrition status was assessed by taking the woman’s Mid Upper Arm Circumference (MUAC) using the MUAC tape. Mid Upper Circumference was measured at the non-dominant arm at the mid-point between the tip of shoulder and elbow. Pregnant women with MUAC reading less or equal to 23cm were considered to be undernourished or wasted. Socio-economic status or wealth index was ascertained using presence or absence of homestead assets and categorized into low, middle or high; Education level was organized in three levels that is to say no formal education, primary, and secondary/tertiary; A mother was considered married if she stayed with the husband and single if she separated from the husband and was staying a lone; A household was categorized as food secure if the woman reported that she possessed food in a store or granary and food insecure if she possessed no food in the food store at the time of interview; and a mother was considered as having adequate nutrition knowledge if she was able to mention nutritional components of a balanced diet.
Data were analysed using STATA version 14.2 (Stata Corp; College Station, TX, USA). Categorical variables were summarized as proportions and continuous variables as means (SD) or medians (IQR) as appropriate. We used Logistic regression to determine the factors associated with undernutrition in our study. Based on scientific literature and biological plausibility, we included the following factors in our final multivariable model: mothers’ education, maternal age, inter-pregnancy interval, physical activity, malaria in pregnancy, nutritional knowledge, meal frequency, gestation, husband’s education, house hold food security, and wealth index. All the variables in the model were assessed for collinearity, which was considered present if the variables had a variance inflation factor (VIF) of > 10. There was no substantial collinearity among the variables included in our model. Statistical significance was determined at p ≤ 0.05. Wealth index was calculated to represent wealth status of the participants’ households. Wealth quintiles were calculated from an asset-based index, using principal component analysis. The following assets were considered: Bicycle, Car, Land, Animals, and Business Granary. The wealth index was later collapsed into tertiles three groups; lowest third, middle third and top third.