Abstract

Malnutrition during pregnancy remains a significant public health challenge, particularly in low- and middle-income countries, where it contributes to adverse maternal and fetal outcomes. This study aimed to assess the knowledge of malnutrition complications, associated factors, and preventive strategies among pregnant women attending antenatal care (ANC) at the Muea Sub-Divisional Hospital in Buea, Cameroon. A descriptive cross-sectional design was employed, with data collected from 100 pregnant women using a semi-structured questionnaire.

The study focused on three specific objectives: evaluating knowledge of malnutrition complications, identifying associated factors, and exploring preventive strategies. The findings revealed that participants had varying levels of knowledge about malnutrition complications. While awareness of anemia (73%) and weakened immune systems (84%) was high, understanding of gestational diabetes (59%) and postpartum hemorrhage (62%) was comparatively lower.

Fetal complications, such as low birth weight (80%) and developmental delays (88%), were more widely recognized. Key factors associated with malnutrition included loss of appetite (60%), religious fasting (65%), and financial constraints (53%). Preventive strategies like iron supplementation (88%) and hydration (91%) were well-known, but practical challenges, such as limited access to nutritious foods (58%), hindered implementation.

The study underscores the need for enhanced nutrition education during ANC visits, addressing socioeconomic barriers, and promoting culturally sensitive interventions. Recommendations include regular ANC attendance, diversified diets, and community-based programs to improve food security. These measures can help reduce malnutrition-related complications and improve pregnancy outcomes in the region.

CHAPTER ONE

INTRODUCTION

1.1 Background

Malnutrition is defined as lack of balance in energy use and consumption of nutrients and can be discussed in the two dimensions of under nutrition and over nutrition. The scope and distribution of both types of malnutrition must be understood so that public health resources can be channeled appropriately. The estimated global prevalence of obesity as 400 million in 2005 and the predicted figure for 2015 was 700 million; however, only 462 million individuals are underweight (WHO, 2017).

These statistics show that in recent years malnutrition has shifted from undernutrition toward overnutrition. The third Sustainable Development Goal (SDG) outlines the international commitment to promote healthy lives and ensure well-being for all, with targets 3.1.1 and 3.2.1 emphasizing the reduction of maternal deaths to less than 70 per 100 000 live births and neonatal deaths to 12 deaths per 1000 live births respectively (UN-SDG, 2015).

These targets can be achieved not only by improving the access and quality of maternal and neonatal care, but also by optimizing the quality of nutrition during pregnancy (Bhutta et al., 2013; Manfredini, 2020; Black et al., 2008). Antenatal care (ANC) is a critical strategy in ensuring healthy pregnancy outcomes for the mothers and their newborns (Ghosh-jerath et al., 2015; Lee et al., 2018). Timely and frequent use of ANC enables delivery of essential health promotion and prevention services, including effective nutrition counseling amongst others (World Health Organization, 2003).

Despite the availability of nutrition guidelines for pregnant women, ignorance and non-adherence to these recommendations has the potential to negatively impact on the mothers’ and babies’ health, leading to poor maternal and fetal outcomes (Marías and Glasauer, 2014). The quality of nutrition during pregnancy has been shown to influence pregnancy outcomes. Diets deficient in certain nutrients are associated with preventable congenital defects and impaired growth and milestones (Affizal and Mohd, 2012). For example, folate deficiency and neural tube defects or cleft lip/palate; iron deficiency and low birth weight; iodine deficiency and cretinism and impaired brain development. Also, Poor nutrition during pregnancy has also been associated with prematurity, Intra-uterine Growth Retardation (IUGR), macrosomal, and pregnancy loss.

Furthermore, adequate nutrition during pregnancy has also shown to play a role in reducing the risk of preeclampsia, cardiovascular disease, impaired glucose metabolism, obesity, and dyslipidemia in the mother (Perumal et al., 2016). Due to these potential risks, health policies have been established to supplement pregnant women with these important nutrients in the form of drugs taking throughout the pregnancy (Marías and Glasauer, 2014).

However, many factors can reduce the consumption of these supplements such as; low level of education, low income, inaccessibility, change in dietary habits during pregnancy and culture. All these factors demonstrate the importance of adequate nutrition to meet the required dietary needs during pregnancy due to its accessibility, acceptability, affordability, safety and sustainability (Marangoni et al., 2016; Kominiareket al., 2016). According to Zerfu and Biadgilign (2018), the dietary patterns during pregnancy can be influenced by many factors, but pregnancy nutrition knowledge has been associated with a significant overall diet quality in recent times. Measures such as improving the nutrition knowledge of pregnant women could be a cost-effective approach to achieve safe, healthy and balanced diets during pregnancy hence lowering the risk of adverse health outcomes for the mother and her unborn baby.

1.2. Problem Statement

More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone (Tebeu et al., 2015). In Cameroon, poor nutrition habits during pregnancy have been associated with adverse health outcomes for the mother and her newborn.

Nutrition knowledge of pregnant women may be influential on the practices towards adequate dietary intakes during this period (Tebeu et al., 2015). The maternal mortality ratio in Cameroon is estimated at 529 per 100,000 live births as of 2017 with the common causes of death being post-partum haemorrhage and hypertensive disorders in pregnancy (Agborndip et al., 2020).

The neonatal mortality rate in Cameroon was estimated at 2,600 per 100,000 births in 2019, with the predominant etiologies in the Buea health district being birth asphyxia (66%), complications of prematurity (14%), and neonatal sepsis (10%) (Agborndip et al., 2020). These causes are directly or indirectly related to the mother’s diet during pregnancy. Due to these potential risks, and the fact that drug supplementation policies for pregnant women may not be effective for all, there is an urgent need and relevance of adequate nutrition to meet the required dietary needs for pregnancy due to its accessibility, acceptability, affordability, safety and sustainability.

Although studies have been carried out to assess the knowledge on diet in pregnancy, studies on this topic in the Southwest Region of Cameroon are limited. Hence, the need for this study which seeks to asses malnutrition and complications during pregnancy and its associated factors among pregnant women attending ANC at the Muea Sun Divisional Hospital, Buea.

1.3. Rationale

Maternal malnutrition has some effects on the pregnant woman, her unborn baby, her family, her community, and the health care system. Maternal malnutrition secondary to poor nutrition habits is influenced not only by lack of adequate nutrition but also influenced by factors like socio demographic factors, nutritional knowledge of mothers and local practices (Agborndip et al., 2020).

Despite the abundant published literature on strategies to curb the high maternal and neonatal mortality rates in low-and middle-income countries, emphasis on maternal nutrition is underrated.

Despite the highlighted importance of maternal nutrition during pregnancy being crucial in reducing the burden of maternal and neonatal death which are the targets in achieving SDGs 3 and 5, limited studies has been conducted to assess the knowledge of pregnant women in the Buea municipality on nutrition and associated factors during pregnancy (Agborndip et al., 2020). As a result, there is lack of comprehensive information regarding this topic in this study area.

The results of this study can be used to advocate for effective nutrition programs and campaigns, and to ensure a healthy start to life, and to promote better nutrition counseling at the antenatal care unit of the study area. This study therefore, aims at assessing malnutrition and complications during pregnancy and its associated factors among pregnant women attending ANC at the Muea Sub Divisional Hospital Buea, Cameroon.

1.4.      Research Questions

1. What knowledge do pregnant women attending ANC at the Muea sub divisional Hospital have on the complications of malnutrition during pregnancy?
2. What are the associated factors of malnutrition amongst these pregnant women attending ANC at the Muea sub divisional Hospital?
3. What are the strategies used in the prevention of malnutrition by pregnant women attending ANC at the Muea sub divisional Hospital?

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