Dietary diversity and nutritional status of pregnant women attending an ante-natal clinic in KZN

Abstract

Aim: This research aimed to establish the socio-demographic background, nutritional status, as well as food intake patterns of pregnant women in the first trimester of pregnancy attending an antenatal clinic in Cato Manor, Durban. This study formed part of the first phase of the MRC approved study “A multi-staged multi-disciplinary healthcare approach in reducing maternal morbidity and mortality rates in a selected district in KwaZulu-Natal”, aimed at pregnant women and planned by the Faculty of Health Sciences at the Durban University of Technology.

The research was conducted in South Africa in the province of KwaZulu-Natal. This study was conducted in a primary health care clinic (PHC) in Cato Manor which falls under the auspices of the eThekwini municipality. The total sample (n=300) as predetermined by the MRC approved study included all pregnant women presenting at the PHC for their first antenatal visit over a designated period until the total sample size has been reached. These women were allocated into 3 groups: Group 1 compromised of the antenatal intervention group (n=100). A total of 139 pregnant women in the first trimester of pregnancy were eligible to be accepted to be a part of the study; however, due to a low return rate and incomplete questionnaires, a final sample of 100 women were included in the study and their data was used.

Methods:

A valid and relevant socio-demographic questionnaire was completed in a one-on-one interview situation wherein participants would be asked to tick relevant answers pertaining to the question at hand. Information regarding income, education level, religious influences and any other questions relating to the socio demographic background of the participants were included in the questionnaire.

A valid and reliable food frequency questionnaire was also completed in a one-on-one interview situation whereby participants would be asked to tick relevant answers pertaining to the question at hand, in order to determine the food variety and food diversity intake of the participants. Participants’ dietary intake was determined through the completion of two x 24- hour recall questionnaires which were conducted in an interview situation. The two x 24-hour

recall questionnaires were completed pertaining to the participant’s dietary intake during the week as well as to the participants’ dietary intake on a weekend day.

Finally, participants’ anthropometric measurements were obtained through the use of a scale and stadiometer in order to measure the weight and height, respectively, of each participant and calculate the BMI (body Mass Index) of each participant. All measurements were conducted twice and the average of the two figures was used in order to ensure accuracy.

Results:

The majority of the participants’ role in the family was that of a daughter (72%) and they lived in a squatter camp (48%). In addition, 57% of participants shared a house with between two and five other people and the majority lived in a brick house (51%) with more than two rooms (63%). Most of the women were unemployed at the time of research (65%) and received a total monthly income of <R1500 a month (67%; n=43) with only one other person contributing to the monthly income (60%; n=59). Food insecurity was prevalent among some participants as 25% (n=24) reported sometimes not having enough money in the month to buy food and 40% of the participants spent <R500 a month on food. Furthermore, standard 10 (matric) was the highest level of education completed by most participants (48%) and Zulu was the most spoken language among the group (49%). The majority of the participants had a normal BMI (40%) whereas 28% were considered overweight and 20% fell within obese class I. In addition, according to blood pressure measuring instruments, most participants had a normal systolic (82%) and diastolic (65%) blood pressure with a low prevalence of both low and high blood pressure. The total range of individual food items consumed by an individual during the seven-day data collection period measured by the (FFQ) was between six and 62 foods. Fifty-two percent of participants consumed all nine food groups and a summary of the food variety within the food groups of the pregnant women was a mean of 31.02 (SD11.029) different foods within the nine food groups in a seven-day period which indicates a medium food variety score (FVS). Furthermore, the cereal group reported the highest individual mean FVS (±SD) of 6.60 (±3.000), followed by the vegetable group 4.56 (±2.217) and the meat group with a mean of 4.51 (±2.011).

The nutrient analysis indicated a deficient intake of all nutrients with the exception of phosphorous, vitamin A, niacin, vitamin B6 and vitamin K. The mean (SD) for carbohydrates was 191.82g (SD±68.718) which indicated that all participants met the EAR of 135g per day; however, the energy contribution indicated that 95% of participants consumed <100 percent of the EER for energy.

Furthermore, the findings from the Top 20 food items measured by the 24-hour recall questionnaires indicated that pregnant women in the Cato Manor community consumed a largely carbohydrate-based diet as starchy food were the top three consumed. Protein-based foods, dairy, as well and fruit and vegetables had a very low consumption rate with the per capita intake of fruit and vegetables of 165.73g per day being significantly lower than the WHO goal of ≥400g, and the mean intake of 12.55g of dietary fibre was less than half of the recommended amount of 25g per day. However, the energy distribution of the macronutrients from the average of both 24-Hour Recalls indicated that the pregnant women were in the range of 15-30 percent of the total fat intake, 10-15 percent of the total protein intake and 55- 75 percent of the total carbohydrate intake.