A descriptive cross-sectional study was conducted to assess the range of food taboos and related misconceptions during pregnancy.
Study area and period
The study was carried out from April to May 2017 in five private clinics found in Mekelle city, capital of Tigray region which is located in the northern part of Ethiopia, at a distance of 783 Kilometers from Addis Ababa, the capital of Ethiopia. By the year 2016/17, the total population of Mekelle city was estimated to be 358,529 and the estimated number of pregnant mothers were 12,333. It has 1 comprehensive specialized hospital, 2 general hospitals, 9 health centers, and 12 known private clinics providing ANC services.
Sources and study population
All of the pregnant women attending their antenatal care (ANC) follow-up from the private clinics found in Mekelle city are considered as the target population, and those with ANC follow-up from the randomly selected clinics were the study population.
All pregnant mothers who are permanent residents of Mekelle city, and who are over the age of 20 years were included whereas, mothers with hearing and speaking difficulty, and who were critically ill during the data collection period were excluded from this study.
Sample size calculation
The sample size was calculated using a single population proportion formula with the assumption of 95% CI and 0.05 margin of error. Looking at the cross-sectional study done in Hadiya Zone, Northern Ethiopia, 27% of the pregnant women practiced food taboos (11). Considering P=27% from that study, the total sample size became 302. We added 10% non-response rate, and the final sample size became 332.
Five clinics were selected randomly from the institutions with a better flow of pregnant women for ANC services. The number of study respondents was proportionally allocated to each clinic by considering the flow of pregnant women who had been served in the selected clinics in similar months of the previous year as a baseline. All pregnant women who came to these clinics for ANC service during the data collection period were taken consecutively until the sample size (332) was attained.
The variables included in this study were: socio-demographic variables such as maternal age, religion, educational status, marital status, and occupational status; and nutrition-related factors such as food taboos and related misconceptions, meal frequency when non-pregnant, meal frequency when pregnant, Women Dietary Diversity Score (WDDS), nutrition counseling, and fasting during pregnancy.
Data collection methods and tools
A series of closed and open-ended questions were prepared by critically reviewing relevant literatures. The open-ended questions were prepared in the way that they can address the reasons why pregnant women avoid food items during their pregnancy. The questionnaire broadly incorporated information regarding socio-demographic characteristics, pregnancy-related characteristics, and behavioral factors. Data were collected by trained midwives who work in the selected clinics.
Women Dietary Diversity Score (WDDS) was calculated from a single 24-hour dietary recall data. All foods and drinks that were consumed a day before the data collection were categorized into 10 food groups. A score of one was assigned for those who consumed a food item from any of the groups; if not, a score of zero was given. Then, a score out of 10 was computed by summing up the values of all the groups, and it was classified as achieved minimum diet diversity (MDD) (≥ 5) and didn’t achieve MDD (< 5) (3).
Data quality assurance
To ensure the quality of data, a carefully designed data collection tool was prepared. Data collectors and supervisors were also trained for two days to have a common understanding of the overall purpose and methodology of the study. The questionnaire was pre-tested before the actual data collection, and modification was made thoroughly based on the pretest results. The questionnaire was translated into Tigrigna (local language), and then back-translated to English for ensuring the consistency of concepts. Supervisors were strictly following the data collection process for completeness of the questionnaires and any related support to boost the quality of the data. The data were checked and cleaned at the time of the data collection process and after data entry.
Data management and analysis
Data were entered into SPSS version 21 for analysis. The results were described using frequency and percentage. Finally results were presented using texts and table. Cross-tabulation (x2- test) was used to analyze the association between the assessed socio-demographic variables and food taboo practice. Statistical significance was declared at P-value < 0.05 and 95% confidence interval (CI).
Ethical approval was obtained from the institutional review board (IRB) of the College of Health Sciences of Mekelle University, and permission was given by the private clinics to proceed the study. Informed verbal consent was taken from the study participants, and confidentiality was maintained throughout the study. The participants were well informed and guaranteed that they have the right to participate, refuse or stop at any time during the data collection process. The procedures of this study constituted a minimal risk to participants, and this was explained to them before the beginning of the data collection.