Factors influencing the state of maternal nutrition in Jinja district, South-Eastern Uganda

Abstract

Context: Due to the existence of variations and complexity of determinants of maternal malnutrition across the globe (Black et al, 2013; Newcombe el al, 2015), research need not to only concentrate on magnitude of this problem but also immensely consider the factors that influence it. Since what is works in one region may not necessarily be significant in another. More so, Black et al (2008) highlighted that the nutritional status of an individual is a complex interaction of several factors while Ruel et al (2013) insinuated that scaling up of nutrition requires addressing its underlying factors. Today in Uganda, evidence shows that it is still difficult to determine region specific causes of maternal malnutrition (FANTA II, 2010). This study assessed the factors influencing the state of maternal nutrition in Jinja district in order to increase understanding of the context in which maternal malnutrition occurs and be able to guide development of intervention plans. Specifically, the study determined the proportion of pregnant and lactating mothers with good nutritional status; described their feeding habits and then assessed the geo-economic and socio-cultural factors influencing the state of maternal nutrition in Jinja district. METHODS: A cross-sectional study using mixed methods (quantitative and qualitative) was utilized to collect data from a sample size of 124 participants. The study applied a multi-stage study design; stratified random sampling method to select 10 government health facilities out of 15 offering antennal and postnatal services in Jinja district; census method to sample participants who passed the selection criteria at every individual health facility and purposive random sampling method to choose in-charges from antenatal or postnatal clinics to respond in-depth interviews. The nutritional statuses of mothers were assessed using anthropometry (MUAC), clinical (presence of night blindness) and biochemical analysis (Hb level) obtained from the current medical records of the sampled mothers whereas their feeding habits were assessed by using both xvii Women’s Dietary Diversity Scores (WDDS) followed by Food Frequency Questionnaires (FFQ). Interviews documenting geo-economic and socio-cultural factors influencing the state of maternal nutrition in Jinja district were also examined. Data was analyzed using SPSS windows version 20.0. Descriptive statistics were then performed into frequency tables, charts and graphs while a multivariate analysis was computed using Multiple Linear Regression Model to determine the associations between: nutritional status and socio-demographic; geo-economic and socio-cultural factors. FINDINGS: The results indicated that there was a poor state of maternal nutrition in Jinja district with 25% of pregnant women wasted, 49.2% of them anemic while 15.3 % had VAD compared to 30.2% wasting, 27.8% anemic and 12.8% with VAD among the lactating mothers. This was explained by poor feeding habits of participants caused high consumption of starchy staples (97.3%) coupled with low consumption of micronutrient rich foods especially of iron (36%) and vitamin A (65%). However, the Multiple Linear Regression model analysis showed nutritional status of participants to greatly depend location (urban or rural), marital status and sex of household head with significant P values (0.028, 0.001 and 0.009 respectively) while geo-economic factors like annual income of participants, main use of food crops grown in their households and geographical distribution of foods (lack of food in the area but plenty in other areas) significantly determined low consumption of micronutrient rich foods (Vitamin A) whereas reduction on household workload during pregnancy or lactation was revealed to be the only significant socio cultural factor influencing the low consumption of micronutrient rich foods (Vitamin A rich foods). CONCLUSION: Geo-economic factors such as annual income of participants, geographical distribution of foods and main use of food crops grown; Socio-cultural factor of workload xviii reduction during pregnancy and lactation as well as Socio-demographic characteristics of location, sex of household head and marital status of participants were specifically responsible for the poor state of maternal nutrition in Jinja district.