Assessment of dietary diversity, antenatal care, food taboos, meal frequency, and nutritional status of pregnant adolescents in rural Malawi: A cross-sectional study

Abstract

High rates of pregnancy during adolescence in Malawi compromise the nutritional status of adolescent mothers and their infants. When a pregnant adolescent is malnourished, she is at risk for health complications. Research focusing on the nutritional status of pregnant adolescents in Malawi is minimal. The purpose of this study was to assess dietary diversity, antenatal care, food taboos, meal frequency, and nutritional status of pregnant adolescents in rural Malawi. The study included sixty-two pregnant adolescents between 15-19 years old. Data collection included the use of a pre-tested questionnaire, standardized dietary diversity survey and measurements of mid-upper arm circumference (MUAC), height, and hemoglobin. Statistical analysis included descriptive analysis, linear and logistic regression. Mean (SD) age was 17.7 (1.2) years. Mean MUAC was 25.9 (2.0) cm; 31% had MUAC <25 cm. The occurrence of stunting was 19% and 21% were ≤150 cm tall. The mean hemoglobin was 10.37 (1.93) g/dL and 66% were anemic. The mean dietary diversity score was 4.06 (1.18) and 69% did not achieve minimum dietary diversity (score ≥ five.) No participants consumed dairy and only 7% consumed eggs. Eating meat and poultry or dark green leafy vegetables predicted a 1.31g/dL (pvalue = 0.0306) or 1.08 g/dL (p-value =0.0331) increase in hemoglobin levels, respectively (R 2 =0.15). Food taboos during pregnancy were common (35%). Compared to the Malawi National Nutrition Guidelines, 87% were not eating daily from each of the six food groups and 74% were not meeting the recommended meal frequency during pregnancy (three meals and at least one snack/day). Less than 50% consumed foods from legumes/nuts and animal food groups. The majority (63%) did not take antenatal supplements and only 37% consumed ferrous sulfate. Only 52% received advice about nutrition during pregnancy and few (8%) received advice about infant and young child feeding. Girls who received nutrition advice were more likely to take an iron supplement [OR=4.19 (1.82-9.68), p=0.0008] compared to those who did not. As the number of antenatal visits increased, the participants were more likely to take a supplement [OR=11.88 (3.40-41.49) p=0.001]. Interventions for pregnant adolescents in rural Malawi should occur early in pregnancy and include education on dietary diversity, increasing hemoglobin levels, meal frequency, food taboos, antenatal supplements and infant and young child feeding.

Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial

“…Utilisation of ANC among pregnant women in rural Malawi is at 80% [ 2 ], and of these nearly 90% receive nutrition counselling as part of this care according to the Malawian Demographic Health Survey (2015–2016) [ 33 ]. The nutrition education offered is based on the National Nutrition Guidelines [ 33 ], which note that during pregnancy, women should eat meals containing ingredients from each of the SFG and eat two extra meals per day.…”

“…Reportedly, there was no difference in nutrition knowledge between pregnant women attending ANC and those who did not [ 11 ]. Moreover, residing in low-resource settings women often under-utilise ANC so that those who make fewer antenatal visits are more likely to miss nutrition counselling [ 2 , 37 ]. Although ANC services remain the most accessible source for nutrition education, they may not permit the roll-out of a comprehensive nutrition education.…”

“…ANC is often decentralised and hence a locally accessible platform for the delivery of maternal nutrition interventions in low-resource settings, such as sub-Saharan Africa [ 1 ]. In Malawi in 2016, 80% of pregnant women reported that their main source of nutrition information was ANC services [ 2 ]. World Health Organisation (WHO)-revised guidelines for undernourished populations emphasise the relevance of nutrition education and counselling services for ANC, aiming to increase daily energy and protein intake to reduce the risk of low birth weight (LBW, birth weight < 2,500 g) infants [ 3 ].…”

“…In line with this, studies have found that care providers often have insufficient time to facilitate group- and individual education sessions, attributing this to high client/provider ratios during the ANC visits [ 16 – 18 ]. Furthermore, attendance to antenatal visits remains low among women in poor Malawian communities, which implies that many pregnant women miss out on substantial education components offered through ANC services [ 2 ]. These factors raise uncertainties about the effect that nutrition education counselling through routine ANC have on developing the required levels of nutrition- and food literacy.…”

Dietary diversity and its correlates among pregnant adolescent girls in Ghana

“…Adolescent pregnancy in Ghana has been linked to socio-economic status, ignorance, and their inability to access information and services related to reproductive health [ 28 ], but dietary diversity and factors associated with it among pregnant adolescents in Ghana have not been studied. Studies conducted in Bangladesh [ 29 ] and Malawi [ 30 ] reported 5.2 and 4.0 as the MDD of pregnant adolescents respectively. Whilst 70% of Malawian pregnant adolescents did not meet the MDD, only 33.3% of Bangladesh pregnant adolescents did not consume from more than five food groups.…”