Mothers' sub optimal dietary practice during pregnancy negatively affects the growth of the fetus [3] and therefore predisposes to low birth weight, premature birth and prenatal mortality. It also adversely affects the health of the pregnant women [31].
This study showed that only 14.97% of the pregnant women had good dietary practice during pregnancy, which was lower than the results from Guto Gida district(33.9%)[18], Bahir Dar city(39.3%)[2], Gondar town(40.1%)[15], Addis Ababa city(34.5%)[19] and Ambo district(26.9%) [17], Ethiopia. Also, it is lower than the results from different African and world countries: Nigeria(56.6%)[3], Kenya(25.9%)[20], Malaysia(74%)[32] and Swaziland(51%)[33]. The possible reason for this disparity may be low coverage of knowledge about maternal nutrition in the study area relative to that of from the above listed studies(for example, those studies in Gondar town[15], Bahir Dar[2], Malaysia[32] and Swaziland[33] have relatively high coverage of knowledge about maternal nutrition than that of the study area), variation in the residence and study setting (for example studies conducted in Addis Ababa[19], Kenya[20], Swaziland[33] and Nigeria[3]), while this study was conducted in rural setting and was community based) and dissimilarity in the sample size will also be an important determinant for the difference. Furthermore, the difference may also be due to the fact that the study area is chronically food insecure, while the above listed study areas are food secured.
This study also revealed the proportion of good dietary practice among pregnant mothers in PSNP user and non PSNP user households. Accordingly, 11.17% and 16.23% of the pregnant women residing in PSNP and non PSNP user households had good dietary practice respectively. Even though the study indicated that the proportion of good dietary practice among pregnant women residing in non PSNP user households was higher, the difference was not statistically significant (p = 0.1). The probable reason for the absence of statistically significant difference in the two groups may be due to subjectivity in inclusion of the HHs to the program so that those who should be included in the program may be left out. Moreover, the staple diet of the comparative groups was cereal based monotonous diet, resulting in low consumption of other food items on daily basis, rain dependent production of food items in all the selected kebeles and vulnerability to drought at the time of climate change can also be listed as factors that affect the presence of difference in the two groups. Furthermore, provision of targeted supplementary feeding (TSF) for pregnant mothers from the two groups whose MUAC is less than 23 cm at the stage of third trimester, not having big difference in the knowledge of the pregnant mothers about diet during pregnancy among the two groups and the small sample size from PSNP user households may mask the difference in the proportion of dietary practice in the two groups.
Concerning the determinant factors of dietary practice among the pregnant women, husband occupation was identified as a significant factor for the dietary practice of the pregnant mothers, which states that pregnant mothers whose husbands were employed had good dietary practice than those whose husbands were daily laborer, which is supported by evidences from Addis Ababa [19] and Ambo district[17]. It may be because of those employed husbands have relatively better educational status and knowledge level than the daily laborers, which may contribute a lot in giving information about the importance of having good dietary practice during pregnancy and increase a tendency to practice it. Also, those employed husbands have good income status so that able to purchase different kinds of food for the household and also may have relatively better support to their pregnant wives to have a healthy dietary practices than daily laborers.
In addition, nutrition information during pregnancy showed significant statistical association with the dietary practice among pregnant mothers, explaining that mothers having nutrition information had better dietary practice than those who had no exposure to nutrition information during their current pregnancy. Similar findings had also been reported from a study in Ogun state, Nigeria [34]Gondar [15] Guto gida[18]and Ambo district [17], Dessie[14] and Addis Ababa[35], elucidating strong statistical association between nutrition information and dietary practice. This might be due to the fact that, exposure to nutrition information can bring improvement in the level of knowledge and understanding, which in turn influences the dietary practice of the pregnant mothers positively. Moreover, the study participants' knowledge about diet during pregnancy showed significant association with their dietary practice. Pregnant mothers having good knowledge about diet during pregnancy had good dietary practice than those who had poor knowledge. This finding is similar with that of from Swaziland [33], Malaysia [32], Gondar [15], Bahir Dar [2] and Addis Ababa [19]. This may be due to the fact that improvement in the level of knowledge about diet during pregnancy positively influences the dietary attitude then the dietary practice of the mother indirectly [33] and the dietary practice directly[36]. Also, those mothers who have good knowledge about maternal nutrition during pregnancy have high probability to be employed so that they have good income to purchase different kind of food items for the household.
Strength and limitation of the study
This study tried to compare the proportion of good dietary practice among pregnant women in PSNP user and non PSNP user households by using comparative cross-sectional study design, which can be considered as the strength of the study. However, some of the limitations ought to be taken into account while interpreting the results. The study is not free from social desirability bias while measuring the dietary practice of the pregnant women. Factors like: presence of chronic illnesses were not investigated by the study. Finally, only quantitative type of data was explored by the study.