DOI: https://doi.org/10.21203/rs.3.rs-1796669/v1
Undernutrition is “cellular imbalance b/n supply of nutrients, energy and body’s demand to ensure growth, maintenance, and specific function. However, there was no study conducted earlier on this topic in East Borena Zone.
To assess the prevalence of undernutrition and associated factors among pregnant women in East Borena Zone, Liban district.
A community-based cross-sectional study was conducted on 500 study participants from November 20 to December 2021. The systematic sampling technique and simple random sampling methods were used to select study participants. Data were double entered into Epi-info software version 7 and SPSS version 21 software for analysis. Descriptive statistics were used to describe the characteristics of study participants. Bivariate and multivariable logistic regressions were carried out to identify the association between independent and dependent variables measuring the adjusted odds ratio and 95% confidence interval. P-values less than 0.05 were considered statistically significant.
Prevalence of undernutrition among pregnant women was about (44.9%) family monthly income [AOR = 8.72 (4.80, 15.83)], women decision making autonomy [AOR = 0.40 (0.19, 0.82)], skipping meal [AOR = 2.62 (1.41, 4.89)], substance use [AOR = 2.01 (1.07, 3.77)], household food insecurity [AOR = 2.01 (1.06, 3.80)], lack of prenatal dietary advices [AOR = 2.73 (1.53, 4.89)], absence of household latrine [AOR = 9.23 (3.48, 24.46)], not participating health development army’s meeting at village level [AOR = 3.01 (1.57, 5.72)] and hand washing habit [AOR = 6.55 (3.02, 14.20)] had shown statistically significant association with undernutrition.
The prevalence of undernutrition among pregnant women was high income, women's decision making autonomy, skipping meals, substances use, household food insecurity, lack of prenatal dietary advice, poor hand washing habit, lack of latrine, and not a participation in health development army’s meeting were found to be predictors of the undernutrition.
Globally, undernutrition is an important health concern, predominantly in under-five children and pregnant women. The World Health Organization (WHO) classifies undernutrition as the greatest threat to public health (1) and every country is facing a serious challenge from undernutrition (2,3). In spite of extensive global economic growth in recent decades, maternal undernutrition is highly prevalent in most countries in south-central and southeastern Asia and Sub-Saharan Africa (3–6).
Ethiopia is one of the countries with a high burden of maternal and child undernutrition. Though maternal undernutrition has declined over the past 16 years, from 30% in 2000 to 22% in 2016, Ethiopia is still among countries with a high burden of maternal undernutrition (7). Specifically, two institution-based cross-sectional studies conducted in the Amhara region reported a prevalence rate of undernutrition ranging from 16–29.8% (3, 8).
Maternal undernutrition in the low and middle-income countries is an underlining cause of 3.5 million mother’s deaths and disabilities due to physical and mental effects of poor dietary intake in the earliest months of life (7, 9, 10). Previous studies have established that undernourished pregnant women suffer from a combination of chronic energy deficiency that leads them to have a low birth weight (LBW), and preterm and unsuccessful birth outcomes (11–13).
Regardless of significant gains and signs of progress in the last decade, maternal undernutrition still remains a major public health problem in Ethiopia (3,14). The government of Ethiopia has developed a revised national nutrition program in 2016 to address the double burden of undernutrition in pregnant and lactating women (1, 10, 15). Even though the progress of this program implementation needs to be supported with a piece of continuous evidence through research, a limited institution-based studies that lack an important variable crucial for prioritizing, designing and initiating intervention programs have been conducted (8). The objective of this study was, therefore, to assess the magnitude of undernutrition at the community level by including an important variable among pregnant women living in East Borena Zone.
A community-based cross-sectional study among pregnant mothers was conducted on 500 study participants from September 11 to February 2020. The target population was all pregnant women in East Borena Zone. The source populations for the study were all pregnant mothers in Liban District whereas the accessible population was all pregnant women within reproductive age groups living in 5 randomly selected rural and 1 urban Kebeles. In addition to this, all pregnant women who lived in the district for more than six months were included if she was volunteer to participate, and no problem to do so.
The sample size was estimated using single population proportion formula, considering the 46.5% of prevalence of under-nutrition among pregnant women from a study done in Jimma Town(28)Other parameters considered are a 5% margin of error, 95% CI, 10%
= X 0.465(1- 0.535) = 382
Where n = Sample size Z α ⁄2 = Z value corresponding to a 95% level of significance = 1.96
p = expected proportion of practices of mothers on nutrition during pregnancy = 50% =0.5
d = absolute precision (5%).
Therefore, from the above sample size is: 382
n = 384 and none response rate = 10% which is 38, n = 382 + 38 = 420
Sample size determination for specific objective two
Insert Table 1
| Variables | Magnitude | Power CI level | AOR | Sample size | Reference | |
|---|---|---|---|---|---|---|
| Exposed | Non exposed | |||||
| Average monthly income of HH | 15.83% | 4.8% | 80%, 95% | 8.72 | 73 | (12) |
| Decision making autonomy of pregnant women | 11.09% | 1.81% | 80%, 95% | 2.7 | 160 | (26) |
| Work load on women | 28.8% | 6.3% | 80%, 95% | 13.6 | 46 | (26) |
| Practice frequent hand washing habits | 14.20% | 3.02% | 80%, 95% | 6.55 | 68 | (12) |
| Educational status | 2.91 | 0.77 | 80%, 95% | 1.50 | 131 | (11,59) |
Sampling Procedures:
First, kebeles in the district were stratified into urban and rural areas (kebele is the lowest governmental administrative structure in Ethiopia). The sample size was proportionally allocated for each stratum and then, representative pregnant women were randomly selected..A random sampling technique was utilized to select 10 Kebeles out of 35 total Kebeles. Finally, 420 samples were allocated proportionally to each selected Kebeles based on their total number of pregnant mothers. The calculated sample size of 500 were proportionally allocated to randomly select 5 health post out of 20 in the Liban district and two health center out of five based on the number of clients attending antenatal care (4) at health post and health center. Then every seven pregnant women, as registered, were included in the study at each antenatal care unit till the desired sample size is achieved (14).
Insert Fig. 2.
The dependent variable of this study was the nutritional status of pregnant women. Independent variables were Socio-demographic characteristics of the pregnant women like age, marital status, education, religion, ethnicity, residence area, family size, income, women's decision-making autonomy, Intra-house holds violence and polygamy. Reproductive, medical, and behavioral characteristics of the study participants like age at first marriage/ pregnancy, trimester of pregnancy, pregnancy intention, gravidity, parity, abortion, inter-pregnancy interval, and recent illness in the past 15 days and substances abuses are independent variables considered in this study. Others are health care and environmental characteristics such as accessibility to health care, prenatal dietary advice, antenatal care follow-up, drinking water source, and latrine possession. Dietary characteristics of the study participants such as Minimum Dietary Diversity of Women, household food insecurity, improved dietary feeding, skipping meals/snack,s and eating an additional meal are also independent variables included in the study.
Data collection tools and procedure:
During data collection, face-to-face-interview, observation, anthropometric measurements, and standard checklists were used to collect data from pregnant women after the interviewers explained the purpose of the study and obtained the participant’s verbal consent to participate in the study. In this study, MDDW was measured by the FAO-2016 standard checklist developed for this purpose which is recommended for 24 h dietary recalls. Household food insecurity was measured by the FANTA-2007 standard tool that has nine questions with each comprising 3 responses; 27-score-based HFIAS scale. Undernutrition was measured by MUAC (in cm) on their left arms at the midpoint between tip of the shoulder (olecranon process) and tip of the elbow (acromion process) and insertion type of MUAC tape was Benonelastic and non-stretchable to take the value with correct tension (not too loose/tight) with nearest 0.1 cm reading. Age, age at pregnancy, and inter-birth time were approximated to local memorable events. The participants were nutritionally accessed via 24-hour recall. Additionally, anthropometric assessment MUAC measurement was involved. A structured questionnaire was developed and adopted from Mini-EDHS 2019, the food frequency questionnaire, and WHO standard.That all the variables to be assessed were incorporated(8).
Data quality control all study instruments were translated into local languages ( by native speakers and then back-translated to English by two other competent persons. Six interviewers and two supervisors were recruited for the survey and were trained on the overall data collection process. All the six data collectors are BSC midwives and the supervisors are senior public health experts with master of public health degrees who are competent in local languages. Completeness and consistency of data were assured through direct and daily supervision by the supervisors and principal investigators. Interviewers re-administered the questionnaire to the respondent under supervision by the supervisor.
To ensure the quality of data, training of data collectors and supervisors was undertaken questionnaires will also be translated into the local language to facilitate understanding of the respondents. In addition to written documentation of responses from study participants, tape recordings were done after obtaining verbal consent to ensure that all feedback are captured for analysis.
Data collectors and supervisors were selected based on their educational background (particularly those who have received training on essential nutrition actions), work position, and experience of data collection. Supervisors and data collectors were trained on the objective and methodologies and data collection techniques of the study. Daily discussions and check-ups of data completeness were made with supervisors and the principal investigator. The data cleaning and entry were conducted exclusively by the principal investigator. The questionnaire was pre-tested among 5% of the total sample size to assess its clarity, length, completeness, and consistency. After the pre-test was conducted adjustments were done according to enhance the reliability and validity of the tool. The structured questionnaire was then rephrased in light of the responses. Test-retest reliability was established by examining the consistency of pre-test responses using and the three main components of the test-retest method are as follows Test-retest reliability of the research instrument was established during pretesting. Pretesting was done on two occasions but on the same respondents, on Monday and Friday: assume there is no change in the underlying condition (or trait you were trying to measure) between test 1 and test 2. And finally, compute the correlation between the two separate measurements and if test 1 and test 2 have become consistent, the questionnaire was considered reliable
The collected data were checked for incompleteness and inconsistency. Data were entered into Epi-Info version 7.2 software and then, exported to SPSS version-21 for analysis. Prior to running for analysis, data were cleaned, composite indexes were computed and recorded aver missing values, and extreme values were identified and trimmed. Descriptive statistics were used to describe the sample accordingly. Bivariate logistic regression was carried out to see the association of each independent variable with acute under-nutrition and those with p- values below 0.25 remained in the final models (multivariate logistic regressions). Odds Ratios (OR) were generated for each variable and the independence of any association was controlled by entering all variables into the model using the backward step-wise method. The magnitude of the association between the independent variables in relation to acute under-nutrition was measured using adjusted odds ratios (AOR) and 95% confidence interval (CI) and P-values below 0.05 were considered statistically significant. Descriptive statistics were used to show Socio-demographic characteristics and the prevalence of nutritional practices.
Logistic regression analysis was used to identify the association between factors and the nutritional status of pregnant mothers and multivariate logistic regression were performed to determine independent predictors of the nutritional status of pregnant mothers. A p-value < 0.05 was considered statistically significant. VIF and tolerance tastes were checked for the presence of multidisciplinary among the independent variables. Step-wise model building strategy with p-value = 0.05 was applied to identify independent predictors of nutritional practice and the Hosmer-Lemeshow Test of Goodness-of-Fit was used to test how well the model explains the data. Adjusted Odds Ratios and their 95% Confidence Intervals were reported. Additionally; tables and figures were used to present the findings.
A total number of 392 pregnant women were interviewed making a response rate of 97.3%. Median (± SD) ages of the mothers were18.0 (± 1.2) years. The majority of the respondents were married (96.2%), housewives (75.5%), and residents of rural (78.8%).
Insert Table 2.
| Characteristics | Categories | Frequency | Percentage (%) |
|---|---|---|---|
| Residence area | Rural | 309 | 78.8 |
| Urban | 83 | 21.2 | |
| Age category in years | <= 25 | 109 | 27.8 |
| 26–29 | 96 | 24.5 | |
| 30–33 | 102 | 26.0 | |
| >= 34 | 85 | 21.7 | |
| Current marital status | Single | 3 | 0.8 |
| Married | 377 | 96.2 | |
| Widowed | 10 | 2.6 | |
| Other | 2 | 0.5 | |
| Educational Level | No formal education | 110 | 28.1 |
| Primary education | 144 | 36.7 | |
| Secondary education | 91 | 23.2 | |
| Diploma and above | 47 | 12.0 | |
| Occupation | Employee | 11 | 2.8 |
| Private business | 15 | 3.8 | |
| Daily labourer | 70 | 17.9 | |
| Housewife | 296 | 75.5 | |
| Family size | <= 3 | 127 | 32.4 |
| 4–6 | 189 | 48.2 | |
| >= 7 | 76 | 19.4 | |
| Household Average monthly income | <=2000 | 126 | 32.1 |
| 2001–2300 | 78 | 19.9 | |
| 2301–3000 | 117 | 29.8 | |
| >= 3001 | 71 | 18.1 | |
| Decision making autonomy | Low | 19 | 4.8 |
| Medium | 166 | 42.3 | |
| High | 207 | 52.8 | |
| Media | 392 | 100.0 | |
| Intra households violence practice | No | 342 | 87.2 |
| Yes | 50 | 12.8 |
About 90% of pregnancies of women were planned and wanted. Around 85% of women didn’t have a history of illness, 93% history of abortion, 79% Worked all household jobs alone and 94.1%) had substance abuse. Insert Table 3 here.
| Characteristics | Categories | Frequency | Percentage (%) |
|---|---|---|---|
| Age at first pregnancy (in year) | <= 18 | 98 | 25.0 |
| 19–20 | 155 | 39.5 | |
| >=21 | 139 | 35.5 | |
| Intention Pregnancy | Not Planned and wanted | 40 | 10.2 |
| Planned and wanted | 352 | 89.8 | |
| Parity | <= 2 | 214 | 54.6 |
| 3–4 | 124 | 31.6 | |
| >= 5 | 54 | 13.8 | |
| Any illness during current pregnancy | Yes | 59 | 15.1 |
| No | 333 | 84.9 | |
| History abortion any type | No | 365 | 93.1 |
| Yes | 27 | 6.9 | |
| Inter pregnancy interval | <=18 | 119 | 30.4 |
| 19–24 | 125 | 31.9 | |
| 25–28 | 60 | 15.3 | |
| >= 29 | 88 | 22.4 | |
| ANC follow-up for current pregnancy | No | 127 | 32.4 |
| Yes | 265 | 67.6 | |
| Months of pregnancy at start ANC | <= 4 | 239 | 61.0 |
| >= 5 | 153 | 39.0 | |
| Work all household jobs alone | No | 310 | 79.1 |
| Yes | 58 | 14.8 | |
| Substance abuse | Substance abused | 22 | 5.6 |
| No substance abuse | 369 | 94.1 |
Prevalence of under-nutrition among pregnant women was 7.7% and the rest were normal nutritional status. The household food security score indicates 103(26.5%) households were food insecure and 288(73.5%) were food insecure.
Out of 391 respondents, 272(69.4%) take a Minimum of six and above diet in the past 24 hours so that they had good minimum dietary diversification. More than three fourth 312(79.6%) pregnant women had a habit of taking additional meals, and 298 (76%) don’t skip meals regularly taken meals.
Insert Table 4
| Characteristics | Categories | Frequency | Percentage (%) |
|---|---|---|---|
| Nutritional status | Under-nourished | 30 | 7.7 |
| Normal | 361 | 92.3 | |
| HFIAS score | Food insecure(< 5) | 103 | 26.5 |
| Food secure( > = 5) | 288 | 73.5 | |
| Prenatal dietary feeding habits | Unimproved | 283 | 72.2 |
| Improved | 109 | 27.8 | |
| Habit taking additional meals | Yes | 312 | 79.6 |
| No | 79 | 20.2 | |
| Do you ever skip meals during this pregnancy | No | 298 | 76.0 |
| Yes | 94 | 24.0 | |
| Avoid any food | No | 256 | 65.3 |
| Yes | 111 | 28.3 | |
| Habit Eating snack between meal | No | 320 | 81.6 |
| Yes | 33 | 8.4 | |
| Minimum datary diversification for women | >= 6 | 272 | 69.4 |
| < 6 | 120 | 30.6 |
A total of 98.2 percent, (n = 372) of the study population had consumed cereals in the previous 24 hours which is predominant. The main cereal consumed was teff in the form of injera which is a made of teff and certain barley and maze in the area. Vegetables form an integral part of the main meal for the majority of the population generally. Over 43% (n = 171) consume vegetables; with 84.8% (n = 123) consuming dark green leafy vegetables and 32.7% (n = 124) consuming other vegetables. Oils and fats consumption was reported by 76.5% (n = 300) of the population. White tubers and roots were consumed by 14.8% (n = 58) (Table 4.8). During the women affirmed that: “Most people consume cereal. This is what is easily available but those who have money may eat some meat but it depends on an individual’s economic ability.”
Health care and Environmental Characteristics of respondents:
Around 375(95.7%) of pregnant women have access to health care services within travel on foot for less than one hour. 143(79%) were supplied with Iron folic acid tablets during second and third-trimester pregnancy. 270(70.7%) history of using modern Contraceptives for at least one year. 287 (71.7%) possession latrines. Hand washing habit/pattern frequently 219(55.9%).
Insert Table 5 here
| Characteristics | Categories | Frequency | Percentage (%) |
|---|---|---|---|
| Access to health care | No | 17 | 4.3 |
| Yes | 375 | 95.7 | |
| Prenatal dietary advice | No | 356 | 90.8 |
| Yes | 36 | 9.2 | |
| Iron folic acid tablet supplementation | No | 38 | 21 |
| Yes | 143 | 79 | |
| Modern Contraceptive | No | 121 | 25.8 |
| Yes | 270 | 70.7 | |
| Latrine possession | No | 105 | 25.5 |
| Yes | 287 | 71.7 | |
| Hand washing habit/pattern | Not frequently | 173 | 44.1 |
| Frequently | 219 | 55.9 | |
| Type of drinking water source | Unprotected | 85 | 21.7 |
| Protected | 303 | 77.3 |
Nutritional status and Factors associated:
Binary logistic regression analysis was used for each variable included in the conceptual framework and accordingly, average monthly income, decision making autonomy, Intrahousehold violence practice, history of any type of abortion, ANC follow up, current pregnancy intention, any illness during the current pregnancy, substance use (≥ 1 of these substances), household food security status and types of latrine possessed were associated with nutritional status. After Binary logistic regression analysis, those predictors which showed statistical significance and a p-value less than 0.25 were used to run multiple logistic regression analyses. In a multiple logistic regression analysis, those who had a gestational age between 25 to 28 months were 5.51 times more likely to be normal nutritional status compared to those who had gestational age above 33 months (AOR = 5.51, 95% CI: 1.27–23.96) and also those respondents who had follow ANC were 6 times more likely to be in normal nutritional status compared to those not following ANC (AOR = 5.95, 95% CI: (1.49 to 23.82).
Insert Table 6 here
| Characteristics | Nutritional Status | P-Value | Odds Ratio (95%Cl ) | ||
|---|---|---|---|---|---|
| Under-Nutrition (MUAC < 23 cm) | Normal (MUAC > = 23 cm) | COR | AOR | ||
| Household average monthly income in ETB | |||||
| <=2000 | 18(14.3%) | 108(85.7%) | 0.00 | 1 | 1 |
| 2001–2300 | 2 (2.6%) | 76 (97.4%) | 0.02 | 0.17(0.04 to 0.77) * | 0.30(0.06 to 1.62) |
| 2301–3000 | 8(6.8% | 109(93.2% | 0.92 | 1.10 (0.15 to 8.03) | 2.96(0.31 to 28.18) |
| >= 3001 | 2(2.8% | 69(97.2%) | 0.25 | 0.39 (0.08 to 1.91 ) | 0.26(0.05 to 1.55) |
| Intra household violence practice | |||||
| Yes | 17(34.0% ) | 33 (66.0% ) | 0.00 | 1 | 1 |
| No | 13(3.8% ) | 329 (96.2%) | 0.001 | 13.4 (5.82 to 29.19)** | 18.81(6.34 to55.8)** |
| Decision making autonomy | |||||
| Low | 4(21.1%) | 15 (78.9%) | 0.04 | 1 | 1 |
| Medium | 13 (7.8%) | 153 (92.2% ) | 0.03 | 0.25 (0.07 to 0.87) * | 0.29 (0.05 to 1.82) |
| High | 13 (6.3% ) | 194 (93.7% ) | 0.56 | 0.79 (0.36 to 1.75) | 1.92 (0.62 to 5.95) |
| Ant type of Abortion | |||||
| Yes | 5(18.5%) | 22(81.5%) | 0.003 | 1 | 1 |
| No | 25(6.8%) | 340(93.2%) | 0.036 | 3.09 (1.08 to 8.86)* | 4.30(1.08 to 17.17)* |
| This pregnancy intention | |||||
| Planned | 9(22.5%) | 31 (77.5%) | 0.001 | 0.22 (0.09 to 0.52)** | 0.29(0.10 to 0.90)* |
| Unplanned | 21(6.0%) | 331 (94%) | 0.000 | 1 | 1 |
| Any illness during current pregnancy | |||||
| Yes | 9(15.3%) | 50(84.7%) | 0.000 | 1 | 1 |
| No | 21(6.3%) | 312(93.7%) | 0.021 | 0.37 (0.16 to 0.86)* | 0.34(0.10 to 1.09) |
| Substance use (≥ 1 of these substances) | |||||
| Yes | 7(31.8%) | 15(68.2%) | 0.000 | 1 | 1 |
| No | 22(6.0%) | 347(94%) | 0.001 | 0.14 (0.05 to 0.37)** | 0.16(0.04 to 0.64)* |
| Household food security status (HFIAS score) | |||||
| Food Secure | 17(5.9%) | 271(94.1%) | 0.034 | 0.44 (0.21 to 0.94)* | 0.65(0.22 to 1.91) |
| Food Insecure | 13(12.5%) | 91(87.5%) | 0.000 | 1 | 1 |
| ANC follow up | |||||
| Yes | 26(9.8%) | 239(90.2%) | 0.012 | 3.35(1.14 to 9.80)* | 5.95(1.49 to 23.82)* |
| No | 4(3.1%) | 123(96.9%) | 0.0 | 1 | 1 |
| Type of latrine possessed | |||||
| Improved | 3(2.8%) | 105(97.2%) | 0.04 | 0.27 (0.08 to 0.92)* | 0.22(0.05 to 0.90)* |
| Unimproved | 26(9.5%) | 246(90.5%) | 0.00 | 1 | 1 |
| Gestational age | |||||
| <=24 Months | 4(4.0%) | 96(96.0%) | 0.53 | 1 | 1 |
| 25–28 Mo | 9(14.0%) | 55(56.0%) | 0.02 | 1.92(0.60 to 6.13) | 5.51(1.27 to 23.96)* |
| 29–32 Mo | 5(7.60%) | 61(92.4%) | 0.82 | 0.49(0.20 to 1.22) | 1.16(0.32 to 4.41) |
| >= 33 Mo | 12(7.4%) | 150(92.6%) | 0.13 | 0.98(0.33 to 2.88) | 2.96(0.74 to 11.78) |
Note: * Statistically significant at P value < 0.05
** Statistically significant at P value < 0.01
COR= Crude Odds Ratio, AOR= Adjusted Odds Ratio
The study showed that 92.3% of the women had normal nutrition status, while only 7.7% were undernourished. Average monthly income, decision-making autonomy, Intrahousehold violence practice, history of any type of abortion, ANC follow up, current pregnancy intention, any illness during the current pregnancy, substance use, food security and types of latrine possessed were factors associated with nutritional status. Reasons for normal and under-nutrition might be due to study setup and MUAC cut-off point to categorize as normal or undernourished for their nutritional status. This finding is almost consistent with studies conducted in Wondo Genet District in Southern Ethiopia which is 9.2%(24) and in Rwanda 8.2%(60) of pregnant women are undernourished.
Prevalence of undernutrition is lower than finding from a cross-sectional study conducted in Gonder town 14.4%(29), and an institutional-based study in the Gonder district16.2%(30), Gambella 28.6%(27), and rural eastern Ethiopia(61). Prevalence of undernutrition is higher than finding in Sudan at 4.4%(31) and Uganda at 6.4%(62). The probable reason for variation in rate could be due to difference in study design (institutional-based cross-sectional study design may overestimate the magnitude of undernutrition compared to community-based), the difference in Socio-demographic factors is another factor for the inconsistency of result. Socio-demographic and economic status, household average monthly income, women's decision-making autonomy, and Intrahousehold violence practice during current pregnancy were factors associated with nutritional status. Pregnant women whose household average monthly income of 2001–2300 ETB per month were less likely to be normal in their nutritional status compared to > = 3001 ETB (AOR = 0.17, 95%CI: 0.04 to 0.77). This finding is in agreement with studies conducted in eastern Ethiopia (25), Gumay District, Jimma Zone, South West Ethiopia(12), and rural Bangladesh(14). Pregnant women having medium decision-making autonomy were less likely to be normal in their nutritional status than those with high Decision-making autonomy (AOR = 0.25, 95%CI: 0.07 to 0.87). This finding is consistent with studies conducted in Gumay District, Jimma Zone, South West Ethiopia(12) eastern Ethiopia (25), and the University of Gondar Hospital, Northwest Ethiopia (30). In addition, this finding was also consistent with findings of cross-sectional household studies done in rural India which showed a statistically significant association of maternal autonomy with stunting(63). The above-indicated finding is also in agreement with other studies conducted in India that show a statistically significant association between maternal undernutrition and their autonomy at the household level. Pregnant women with no Intrahousehold violence practice at home compared to with is 13.04 times more likely to be normal in their nutritional status (AOR = 13.04, 95%CI: 5.82 to 29.19).
History of any type of abortion, Gestational age, pregnancy intention, of any illness during the current pregnancy, and substance use were among reproductive, medical, and behavioral characteristics of women that were associated with nutritional status. Pregnant women with no history of any type of abortion compared to those with abortion were 3.42 times more likely to be normal in their nutritional status (AOR = 3.42, 95%CI: 0.97 to 11.98). Pregnant women with Gestational age of 25–28 weeks were an increased likely hood of to be normal nutritional status by a factor of 5.5 than those who were > = 33 weeks GA (AOR = 5.51, 95%CI: 1.27 to 23.96). Concerning pregnant women, current pregnancy intention, those pregnant women who were not planned for pregnancy were less likely to be normal in their nutritional status than those with planned (AOR = 0.22, 95%CI: 0.09 to 0.52).Concerning pregnant women history of any illness during current pregnancy, those pregnant woman who were ill were less likely to be normal in their nutritional status than those who were not ill (AOR = 0.37, 95%CI: 0.16 to 0.86). Our study also showed that pregnant women who used above one type of Substance were less likely to be normal in their nutritional status than those who didn’t use substance at all (AOR = 0.14, 95%CI: 0.05 to 0.37). This finding is consistent with findings of studies conducted in Gumay District, Jimma Zone, South West Ethiopia(12), Eastern Ethiopia (61), data from a systematic review and dose-response metanalysis(64), and another study done on Cigarette smoking, alcohol use and adverse pregnancy outcomes(65). In this study, Household food security status was also another variable that showed a statistically significant association with pregnant women's nutritional status. Pregnant women with household food security status (HFIAS score), food-insecure pregnant women were less likely to be normal in their nutritional status than those who were food secure (AOR = 0.44, 95%CI: 0.21 to 0.94). This finding is consistent with findings of studies conducted in the Tigray region(15), Jima Ethiopia(12) Gambella (27), and Nepal(19).
Finally, pregnant women ANC attendants and households possessing improved type latrine were health care and environmental factors of respondents that were associated with nutritional status, those pregnant women who were attending FANC at health facilities were increased likely hood of to be normal nutritional status by a factor of 6 than those who don’t attendance FANC (AOR = 5.95, 95%CI: 1.49 to 23.82).Pregnant women of households possessing improved type latrine less likely to have been normal nutritional status in comparison to those having unimproved latrine (AOR = 0.22, 95%CI: 0.05 to 0.90).
In this study, magnitude of acute under nutrition among pregnant women was 7.7% and it is interpreted as low magnitude. Average family income of households of the respondents, decision making autonomy of pregnant women at household level, Using Substance, household food insecurity, household average monthly income, women decision making autonomy, intrahousehold violence practice during the current pregnancy, history of any type of abortion, gestational age, pregnancy intention, of any illness during current pregnancy and substance use, household food security status, pregnant women FANC attendant and household possessing improved type latrine were found to be independent predictors of pregnant mother nutritional status.
AHMC Adama hospital medical collage
AOR Adjusted Odds Ratio;
COR Crude Odds Ratio;
CI Confidence Interval
CED Chronic energy deficiency
DHS Demographic and Health Survey;
EDHS Demographic and Health Survey;
FANTA Food and Nutrition Technical Assistance;
FANC Focused antenatal care
GDP Gross domestic product
GA Gestational age
HFIAS Household Food Insecurity Access Scale;
IFA Iron folic acid
IUGR Intra-Uterine Growth Restriction;
LBW Low birth Weight;
MDD Minimum Dietary Diversity;
MDDW Minimum Dietary Diversity-Women;
MUAC Mid Upper Arm Circumference;
NCD Non-communicable disease
SD Standard deviation
WDDS: Women Dietary Diversity Score;
WRA: Women in Reproductive Age
Ethical Consideration:
Consent was obtained from the Institutional Review Board Adama Hospital Medical College, Department of Medical College. Written permission was obtained from Liban District health department. The study objective participant was explained to the study participants and the benefit of the study along with their right to refuse was discussed. Furthermore, the study participants were reassured of attainment of confidentiality for the information obtained from them and written consent was taken before passing to interview.
Consent for publication: “Not applicable”
Availability of data and materials: The datasets used and/or analyzed during the current study is at the hand of PI.
Competing interests: NA
Funding: NA
Authors' contributions: I did plan, develop a research proposal, collected data, and took the overall activities of the paper from the planning phase to write up results.
Acknowledgment:
I would like to acknowledge Oromia Health Bureau, East Borena Zone, Liban district health office, and study participants for their support.