THIKA SCHOOL OF MEDICAL AND HEALTH SCIENCES

DEPARTMENT OF HUMAN NUTRITION

FACTORS CONTRIBUTING TO POOR NUTRITIONAL

STATUS AMONG PREGNANT WOMEN IN KIAMBA VILLAGE

MURANGA COUNTY

BY:

RESEARCH PROJECT SUBMITTED IN PARTIAL

FULLFIMENT OF THE REQUIREMENT FOR THE AWARD OF

DIPLOMA IN COMMUNITY HEALTH AND DEVELOPMENT

AT THIKA SCHOOL OF MEDICAL AND HEALTH SCIENCES

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DECLARATION

This thesis is my original work and not a duplicate

Name:

Signature……………………………………………

date…………………………………………………

Supervisor: this thesis has been submitted for review with my approval

Signature…………………………………………..

Date……………………………………………….

Department of human nutrition

Thika School of medical and health sciences

DEDICATION

This thesis is dedicated to my mother Mercy Mburu for her continued encouragement and

unending support.

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ACKNOWLEDGEMENT

I would like to express my heartfelt appreciation to all whose contribution made completion of

this study possible .This study is a product of effort by several people whom i may not mention

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by name .First I am grateful to God for enabling me to complete this work through the help of

several other people who deserve special recognition.

I wish to thank Madam Mary for her keen and tireless supervision.

TABLE OF CONTENTS
Declaration........................................................................................................................................i

Dedication........................................................................................................................................ii

iii
Acknowledgement..........................................................................................................................iii

Definition Of Terms.....................................................................................................................viii

Abstract...........................................................................................................................................ix

CHAPTER ONE............................................................................................................................1

Introduction......................................................................................................................................1

Background Information..................................................................................................................1

Problem Statement...........................................................................................................................2

Significance Of The Study...............................................................................................................2

Objectives........................................................................................................................................2

Hypothesis.......................................................................................................................................3

Conceptual Framework....................................................................................................................4

CHAPTER TWO...........................................................................................................................5

Literature Review............................................................................................................................5

2.1 Introduction................................................................................................................................5

2.2 Assessment Of POOR NUTRITIONAL...................................................................................5

2.3 Nutrition Status Of Pregnant Women........................................................................................5

2.4 Consequences Of Poor POOR NUTRITIONAL On Maternal Nutrition Status.......................6

2.5 Factors Affecting Individual POOR NUTRITIONAL..............................................................7

2.5.1 Socio-Economic Factors And Their Effects On POOR NUTRITIONAL.............................7

2.5.2 Maternal Factors And Their Effects On POOR NUTRITIONAL..........................................7

2.5.3 Cultural Factors And Their Effect On POOR NUTRITIONAL............................................7

2.5.4 Household Food Security Status.............................................................................................8

2.5.5 Summary Of Literature Review..............................................................................................8

CHAPTER THREE.......................................................................................................................9

Research Methodology....................................................................................................................9

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3.1 Research Design........................................................................................................................9

3.2 Study Variables..........................................................................................................................9

3.3 Location Of The Study..............................................................................................................9

3.4 Target Population.......................................................................................................................9

3.5 Sample Size Determination.......................................................................................................9

3.6 Sampling Techniques...............................................................................................................10

3.7 Research Instruments And Equipment....................................................................................10

3.7.1 Questionnaire, Focus Group Discussion Guides..................................................................10

3.8 Data Collection Techniques.....................................................................................................11

3.9 Data Analysis And Presentation..............................................................................................11

4.0 Ethical Consideration...............................................................................................................12

CHAPTER FOUR.......................................................................................................................13

Results............................................................................................................................................13

4.1 Introduction..............................................................................................................................13

4.2 Demographic Characteristics Of The Respondents.................................................................13

4.2.1 Age Groups Of The Respondents.........................................................................................13

4.2.2 Gestation In Weeks Of The Respondents.............................................................................14

4.2.4 Marital Status Of The Respondents......................................................................................15

4.2.6 Anc Attendance....................................................................................................................15

4.3 Socio- Economic Characteristics Of The Respondents...........................................................16

4.3.1 Level Of Education Of The Respondents.............................................................................16

4.3.2 Occupation Of The Respondents And Their Husbands/Partners.........................................17

4.3.3 Housing Type Of The Respondents......................................................................................18

4.3.4 Main Source Of Cooking And Lighting Fuel Of The Respondents.....................................20

4.3.6 Asset Ownership Of The Respondents.................................................................................21

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4.4 POOR NUTRITIONAL And POOR Intake Of The Respondents..........................................22

4.4.1 Consumption Of Foods Based On Food Groups..................................................................22

4.4.2 Individual POOR NUTRITIONAL Score Based On 24 Hour Recall..................................24

4.4.3 Intake Of Selected Nutrients By The Respondents..............................................................25

4.4.3.1 POOR Intake And Gestation Age Of The Respondents....................................................26

4.4.3.2 POOR Intake And Level Of Education.............................................................................27

4.4.3.3 POOR Intake And Mean Dds Of The Respondents..........................................................28

4.5 Nutritional Status Of The Respondents...................................................................................28

4.5.2 Nutrition Status By Haemoglobin Levels.............................................................................29

4.6 Factors Affecting POOR NUTRITIONAL And Nutritional Status........................................31

4.6.1 Socio Economic Factors.......................................................................................................31

4.6.2 Maternal Demographic Factors............................................................................................32

4.6.3. Morbidity Patterns Of The Respondents.............................................................................32

4.6.4 Food Security Status Of The Respondents...........................................................................33

4.6.5 Cultural Factors....................................................................................................................34

4.7 Relationship Between POOR NUTRITIONAL, Nutrition Status And Influencing Factors...35

4.7.1 Relationship Between POOR NUTRITIONAL, Nutrition Status And Demographic Factors
.......................................................................................................................................................35

4.7.2 Relationship Between POOR NUTRITIONAL, Nutrition Status, And Socio Economic
Factors............................................................................................................................................37

4.7.2.1 Ownership Of Assets.........................................................................................................37

4.7.5 Relationship Between Nutrition Status And Morbidity Patterns..........................................38

CHAPTER FIVE.........................................................................................................................39

Discussion......................................................................................................................................39

5.1 Socio-Demographic And Socio Economic Characteristics.....................................................39

5.2 POOR NUTRITIONAL And POOR Intake............................................................................41

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5.3 Nutritional Status And Haemoglobin Status............................................................................44

5.4 Factors Affecting POOR NUTRITIONAL And Nutritional Status........................................45

5.5 Hypotheses Testing..................................................................................................................48

CHAPTER SIX............................................................................................................................49

Summary, Conclusions And Recommendations...........................................................................49

6.1 Introduction..............................................................................................................................49

6.2 Summary..................................................................................................................................49

6.3 Implications Of The Findings..................................................................................................51

6.4 Conclusions..............................................................................................................................52

6.5 Recommendations For Policy..................................................................................................52

6.6 Recommendations For Practice...............................................................................................53

6.6 Recommendations For Further Research.................................................................................53

Reference.......................................................................................................................................54

Section 1 : Socio- Demographic Information................................................................................59

Section 2: POOR NUTRITIONAL...............................................................................................61

Section 3: Micronutrient Supplementation....................................................................................63

Section 4: Anc Attendance And Morbidity...................................................................................64

Socio-Economic Characteristics Of The Households....................................................................65

Appendices....................................................................................................................................67

Time Schedule...............................................................................................................................67

Budget............................................................................................................................................68

DEFINITION OF TERMS

Acculturation- it is a long-term process during which people simultaneously learn and modify

certain aspects of their values, norms and behavior including diet.

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Anaemia +’n pregnancy is a hemoglobin (Hb) concentration of <vigil of blood

Culture is a set of values, beliefs, attitudes and practices accepted by a community of

individuals.

POOR NUTRITIONAL is defined as the number of different foods or food groups consumed

over a given period.

Food security-is the situation when all people at all times have physical and economical access

to sufficient, safe and nutritious food for a health life.

Malnutrition is the state when the body does not have enough of the required nutrients.

Nutritional status- is a measurement of the extent in which individuals physiological need for

nutrients are met and measured using MUAC.

Cultural factors refers to beliefs and norms about foods and POOR NUTRITIONAL practices.

Maternal factors – in the study includes age, education, occupation, ANC attendance.

Were defined by occupation and ownership assets

ABSTRACT

POOR is an aspect of POOR quality that indicates general nutritional adequacy. Lack of

diversified diet is a severe problem in the developing world where diets are predominantly

starchy staples with a few animal products seasonal fruits and vegetables. The nutritional status

viii
woman during pregnancy is important as a sub optional diet impacts negatively on the health of a

mother, the foetus and the newborn. There is limited knowledge in POOR NUTRITIONAL and

factors affecting it among pregnant women despite evidence showing that maternal nutrition has

important direct and indirect consequences. It is recommended that guidelines for nutrition and

diets for pregnant women be developed and disseminated and promotion of POOR

NUTRITIONAL and modification of diets to be carried out through practical demonstration in

the community and health facilities. The findings of the study may be used by the ministry of

public health and sanitation (MOPHS) and other organization to promote and implement

programs aimed at improving POOR NUTRITIONAL and nutrition status among pregnant

women in the country and other counties with similar characteristics.

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CHAPTER ONE

INTRODUCTION

BACKGROUND INFORMATION

POOR NUTRITIONAL refers to the consumption of an adequate variety of food groups.

The high nutrient demand of pregnancy put women of reproductive age in developing

countries at high risk because consumption of low quality monotonous diets is common in

these countries thus pregnant women risk a variety and nutritional adequacy with regard to

the vitamins and minerals , distribution of food within the households has been found to

affect nutritional status of individuals. In addition preparation of food and feeding practices

have effect on nutrition and in turn the health of an individual (conceicao et al, 2011)

Lack of NUTRITIONAL has been identified by other studies to be a particularly severe

problem among poor populations in the developing in the developing world whose diets are

predominantly starchy staples and the consumption of animal products , seasonal fruits and

vegetables is generally absent or minimal (becquency, capon and martin ,2010) those most

likely to suffer from deficiencies include infants and young children, adolescent girls and

women of reproductive age (WRA )(arimond et al, 2010)

Maternal undernutrition ranges from 10 to 19 percent in most countries across the world with

severity in sub-Saharan Africa, Asia and Yemen where more than twenty percent of women

of reproductive age are underwing (conceiao et al 2011).

In Kenya, nationality twelve percent of women are wasted (thin). The proportion of thin

women is higher in north eastern with twenty six percent and lowest in Nairobi with three

percent wasting (KNBS 2010)

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PROBLEM STATEMENT

For a healthy pregnancy outcome, it is important for the nutritional status off a woman before

and during pregnancy to be good. Most women enter pregnancy with a poor nutrition status

that makes it difficult to achieve the fifth millennium development goal(MDA) on

improving maternal nutrition thus reducing maternal ,mortality information with regard of

POOR NUTRITIONAL and its association with maternal nutrition status in Kenya as well

as in Muranga county. This study therefore aimed at determining POOR NUTRITIONAL,

the nutritional status and factors influencing the two among –pregnant women so as to

increase knowledge in the area and thus improve the practice.

SIGNIFICANCE OF THE STUDY

The finding of the study may be used by ministry of public health and sanitation (MOPHS)

and other organization working in the promotion of maternal health to implement

programmes aimed at improving POOR NUTRITIONAL among pregnant women as a way

to improve maternal nutritional status in Muranga County. It has also contributed to

knowledge on POOR NUTRITIONAL.

OBJECTIVES

General objectives

To assess POOR NUTRITIONAL and nutritional status among pregnant women attending

antenatal clinic at kirwarwa district COUNTY, Kenya

Specific objectives

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  To assess the various food groups of pregnant women aged 15-45 years.

 To determine the nutrition status of pregnant women attending ANC at kirwarwa district

COUNTY

 To establish NUTRITIONAL and nutrition status.

 To assess socio-economic and cultural factors affecting POOR NUTRITIONAL and

nutritional status.

HYPOTHESIS

Alternative hypothesis

There is significant relationship between socio economic factors, POOR NUTRITIONAL and

nutritional status of pregnant women age 15-45 years.

Limitations

The data collected did not show variation in POOR practices by season of the year.

The research was expensive to collect data

Delimitations

The research can only be applied to areas with similar characteristics.

Data collection was not hindered by language because the locality is familiar

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 CONCEPTUAL FRAMEWORK

Maternal nutrition status

(undernutrition)

Dietary diversity morbidity

Maternal factors
(demographic)
Socio-economic Cultural factors House food
 Age factors (income) security status
Norms and beliefs on
 Parity occupation diet
 Education

Figure 1.1 conceptual framework on factors affecting POOR NUTRITIONAL (UNICEF 2011)

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CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

The nutrition status of a woman has been found to be very important and critical as it determines

and allows for a healthy pregnancy outcome (Khoushabi and Saraswati, 2010). Maternal intake

of carbohydrates and protein, fatty acids and micronutrients such as zinc, iron, magnesium,

calcium, riboflarin and vitamin C have important effects on growth of the foetus and perinatal

outcomes. For maternal stores not to get depleted, the mothers diet should provide adequate

nutrient ( Khoushabi and Saraswathi, 2010) However, developing countries e.g. Sudan, and in

developed countries e.g. U. S. A have reported inadequacy of macronutrient and micronutrient

intake among pregnant women (Succhan ey al 2010)

2.2 Assessment of POOR NUTRITIONAL

A number of studies have been able to link POOR NUTRITIONAL to the intake of nutrient

specifically among adults in the developing countries like Kenya. Diet NUTRITIONAL score

has remained a significant protective factors against health risks where women with a higher diet

NUTRITIONAL score were more likely to have greater health risks (Mohamadpour, sharif and

keysami, 2012) However as there is limited information on POOR NUTRITIONAL among

pregnant women, this study aimed to determine on POOR NUTRITIONAL and its relation to

nutritional status.

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2.3 Nutrition status of pregnant women

A pregnant woman’s nutritional status has important implications for her health and that of her

children. Sufficient nutrition before and during pregnancy has the potential for the promotion of

a long term health of the mother and her child (Khoushabi and Saraswathi, 2010). Malnutrition

in women result in reduced productivity, an increased susceptibility to infections, slow recovery

from illness and heightened risks of adverse pregnancy outcomes (KNBS & ICF Mcro, 2010)

Inadequate nutrient intake can lead to maternal anemia, increasing the risks for other maternal

morbidities and mortality, foetal growth retardation and low foetal birth weight (Sukchan et al,

2010)

Anaemia is the most common micronutrient deficiency that affects about one third of the global

population with over 2 billion. It is estimated that 52 percent of pregnant women in developing

countries are anemic. The prevalence of anemia in developed countries among pregnant women

is 14 percent in developed and is highest in India ranging between 65-75 percent (Karaogiu Et al

2010). Maternal anaemia has been proposed as an indicator for monitoring Malaria control in

sub-Saharan Africa (Coffianan et al 2012)

2.4 Consequences of poor POOR NUTRITIONAL on maternal nutrition status

Lack of access to adequate and diversified diet has been identified as one of the severe problems

among poor populations especially in countries where resources are limited and this results to

various forms of nutrition problems (Ekesa, Blomme and Graming, 2011) Low micronutrient

intake has been found to be a problem even in countries undergoing transition in terms of

development and has been a dominant problem in many of the poorest regions across the world

(Arimond et al 2010)

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There is an increased risk of giving birth to low birth weight babies, a risk factor for neonatal and

infant mortality, increased morbidity, impaired mental development and risk of chronic adult

disease. The study seeks to give information on the pregnant women in Murang’a County who

were consuming a non-diversified diet, being the population at risk.

2.5 Factors affecting individual POOR NUTRITIONAL

2.5.1 socio-economic factors and their effects on POOR NUTRITIONAL.

Low socio-economic status is associated with consumption of poor and monotous diets, food

insufficiencies and the risk of a variety of micronutrient deficiencies is high. POOR intakes and

food insufficiency are highly determined by the availability or the lack of resources (Arimond et

al 2010) Women from a low socio economic background are generally likely to be underweight

(Corsi, Kyu and Subramanian 2011). The study used ownership of assets to assess socio

economic status and its relation to POOR NUTRITIONAL among pregnant women.

2.5.2 Maternal factors and their effects on POOR NUTRITIONAL

Maternal factors such as a age, marital status, education level, parity and gestation ag have been

shown to influence the POOR NUTRITIONAL. A low education level and unemployment are

associated with an unhealthier diet. POOR pattern have been shown to vary according to

demographic profiles including gender and marital status (Mejean et al 2010) the study focused

on maternal factors above and how they affect POOR NUTRITIONAL.

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2.5.3 Cultural factors and their effect on POOR NUTRITIONAL.

Cultures, the acceptable way of life of a community of individuals is very diverse across the

world. Pregnant women in various parts of the world are forced to abstain from nutritious foods

due to traditional food habit even if the foods are available abundantly. This study explored the

cultural beliefs among pregnant women in Murang’a and how it affected their diets.

2.5.4 Household food security status

Household food insecurity is one of the underlying factors affecting nutrition status. Food

security requires nutritional adequacy, therefore when a person is undernourished or has a

micronutrient deficiency, may be said to be food insecure (Ivers and Cullen, 2011). Food

insecurity is related to lower macro and micro-nutrient intakes, lower intake of fruits and

vegetables and lack of diet NUTRITIONAL. This study examined food security status with

regards to POOR among pregnant women.

2.5.5 Summary of literature review

In summary, the importance of POOR NUTRITIONAL cannot be overlooked considering the

fact that it significantly influences both the nutritional status of the mother and the foetal

outcome. Socio – economic factors low level of education and food insecurity have been shown

to be strongly related to low consumption of certain food groups such as age, parity, education

levels of the mother and unemployment status affect POOR NUTRITIONAL. Though the

importance of POOR NUTRITIONAL as an indicator of nutrient adequacy has been shown,

there is limited knowledge especially on its association with the nutrient status of pregnant

8
women. This study therefore determined the POOR NUTRITIONAL, factors affecting it and the

nutritional status of pregnant women aged 15-45 years in Murang’a county.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Research design

This study used cross-sectional analytical design as I would show the POOR NUTRITIONAL

status, factors affecting it and also nutritional status of the pregnant women.

3.2 Study variables

The dependent variable was maternal nutritional status and POOR NUTRITIONAL. Independent

variables include: socio economic status- occupation and ownership of assets: maternal factors

such as age, education level, parity; morbidity pattern; socio cultural factors (belief and customs

and household food security status.

3.3 location of the study

Murang’a County is one of the counties in central Kenya. The major livelihood activity is mixed

forming. The area of study is situated in Gatanga sub-county.

3.4 Target population

The study targeted pregnant women aged 15-45 years attending Antenatal clinic (ANC) at

KIAMBA district COUNTY.

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3.5 Sample size determination

The fisher’s at formula will be used to calculate the size of the sample

N = (Z2 X PQ)

D2

N = desired sample

Z = standard normal deviation sample (1.65)

P = prevalence rate population (10%)

D = degree of accuracy (0.1)

Q = 1-P (1-0.1 =0.9)

N = (1.65 X 1.65 X 0.1 X 0.9)

0.01

N=24 Subjects

A sample size of 24 pregnant women was calculated for the study

3.6 Sampling Techniques

Simple random sampling was used to collect data as it is cheap and takes a short time in data

collection

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3.7 Research instruments and equipment

3.7.1 Questionnaire, focus group discussion Guides

An individual POOR NUTRITIONAL questionnaire was adopted and modified to collect data on

POOR NUTRITIONAL, socio demographic and other factors influencing POOR

NUTRITIONAL and nutritional status. The socio demographic data required were; age, parity,

gestation in weeks, marital status, level of education and main occupation of the respondent and

the husband if married.

The 24 hours recall was used as it minimizes recall bias and it conforms to recall time period. It

involved asking the respondents to recall all the all the drinks and food eaten the previous day

starting with food eaten in the morning through the day up to the time the respondents went to

sleep. A focus group discussion guide was used to collect information on attitudes and beliefs

affected food choices and POOR NUTRITIONAL practices so as to give an in-depth

understanding on the status of POOR NUTRITIONAL.

3.8 Data collection techniques

Data was collected on a daily basis during the five working days i.e. Monday to Friday. The

respondents were interviewed after they had received their routine clinic services in a private

room. Anthropometry measurement of MUAC were taken using a standard MUAC tape to

determine the nutrition status. MJAC of the left arm was taken to the nearest 0.1 CM with no

clothing on the arm. The left arm was used as it shows malnutrition while the right arm is

frequently used and would show lean muscle mass as a result of work.

A qualified laboratory technician did the hemoglobin test in the same room where the interview

was done. Whole blood was drawn up from a finger prick.

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3.9 Data analysis and presentation

Completed questionnaires were checked on a daily basis for accuracy and completeness in

recording of responses. Editing and coding was done before data entry. Data were entered and

analyzed using SPPS version 16, while POOR intake data from 24 hours recall was entered and

analyzed using nutria-survey software.

MUAC and hemoglobin levels were used to assess the nutrition status of the respondents. Based

on the MUAC measurements, under nutrition among the pregnant women was defined as MUAC

of less than 21.0cm while MUAC equal to or more than 21.0cm considered normal.

Data for 24 hour recall was entered into a modified version of nutria-survey nutrition assessment

programme arranged in general categories identified in the discussion guideline then coded.

4.0 Ethical consideration

Permission was sought from Thika School of medical and health sciences and approval to carry

out research was granted.

Consent was also sought from the medical superintendent at KIAMBA COUNTY and from the

respondents where confidentiality was assured

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CHAPTER FOUR

RESULTS

4.1 Introduction

Presented in this chapter are the study findings as per the objectives as follows: Demographic

and socio economic characteristics of the study population comprising pregnant women

attending ANC at KIAMBA District COUNTY- Muranga County; POOR NUTRITIONAL of

the study population; Nutritional status of the study population; Factors influencing POOR

NUTRITIONAL and nutritional status and relationships between POOR NUTRITIONAL and

nutrition status and factors influencing the two. Data was presented in bar charts and tables.

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4.2 Demographic Characteristics of the Respondents

4.2.1 Age Groups of the Respondents

Age was collected in terms of completed years. Though the definition of women of reproductive

age includes women in the age category of 15-45 years, data collected had women aged 19-45

years and therefore analysis was restricted to this category. The mean age of the study

population was 25 years ± 5 with a range of 19 to 44 years. Of the respondents, 49 percent

(n=12) were aged between 15-24 years while those aged 25-34 years and above 35 years were

15(n=3) and 36 percent(n=9) respectively (Table 4.1).

Table 4.1: Demographic characteristics of the respondents

Age in years Frequency(n) Percentage

15-24 12 49
25-34 3 15
Above 35 9 36

Total 24 100

4.2.2 Gestation in Weeks of the Respondents

A woman is considered to be in the first, second or third trimester when they are 0-12 weeks, 13-

28 weeks and 29-40 weeks pregnant respectively. Data on the gestation in weeks were collected

from the ANC book. In this study, more than half of the respondents (63 percent, n=15) were in

their third trimester, more than a third (36 percent, n=8) in the second trimester and about one

percent (n=1) of the respondents were in their first trimester (Figure 4.1). Of those in the third

14
trimester, more than half were already at the 36th week or above. Discharge to maternity is done

at this time and therefore some of the pregnant women may not get an opportunity for continued

Antenatal care.

Pregnancy Trimester

70
63

60

50
Percentage

40 36

30

20

10
1
0
1st trimester 2nd trimester 3rd trimester

4.2.4 Marital Status of the Respondents

Majority of the respondents were married (83 percent, n=20) and 14 percent (n=3) were single.

The respondents that were separated and those that are widowed were 3 percent (n=1) (Table

4.2). Marital status of a person may affect the economic status as it directly affects issues of

access to resources and thus in turn will affect the POOR NUTRITIONAL and the nutritional

status.

Table 4.2: Marital status of the respondents

Marital status Frequency(n) Percentage

Married 20 83
Single 3 14

15
Separated/widowed 1 3

Total 24 100

4.2.6 ANC Attendance

Those attending the clinic for the first or second time were 40(n=10) and 31 percent (n=7)

respectively. About 19 percent (n=4) were attending the clinic for the third time and only 10

percent (n=3) were in their fourth visit (Table 4.3).

Table 4.3: ANC attendance of the respondents

Attendance Frequency Percentage

Once 10 40.0
Twice 7 31.0
Three times 4 18.6
Four Times 3 10.3
Total 24 100.0

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Ante natal care clinic (ANC) attendance is of great importance for early detection and treatment

of anaemia and infections. It is a recommendation that pregnant women should attend ANC at

least four times during each pregnancy and the visits should be started when the women are in

their second trimester as it will allow time to consume the iron and follic supplements (KNBS &

ICF Macro, 2010). In this study, it was found that majority of the respondents came to the clinic

in their third trimester and thus micronutrient supplementation is interfered with or was not

feasible at all.

4.3 Socio- economic Characteristics of the Respondents

4.3.1 Level of Education of the Respondents

The respondents were asked the level of education acquired as it may affect their economic

status, the food choices and the food security status. Majority of the pregnant women had

acquired some primary education (44 percent, n=11), however, of these only 19 percent had

completed primary education. About 33 percent (n=7) had acquired some secondary education

Of those with post secondary education, 12 percent (n=3) had a certificate training and about

eleven percent had acquired a diploma (n=2) (Figure 4.3).

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 Education levels
44

40
33
35
30
Percentage

25
20
15 12
10 11
5
0
Completed Secondary Certificate Diploma
primary education training

Figure 4.3: Education levels of respondents

4.3.2 Occupation of the Respondents and their Husbands/Partners

The respondents that reported as being housewives were 43 percent (n=11); those who were

involved in petty trade were 7.3 percent (n=1), those in salaried employment were 10 percent

(n=3) Those who reported as engaging in casual work were 1.4 percent (n=2) (Table 4.4).

The occupation of the father is important as it may improve the socio- economic status of the

household. Slightly more than a quarter (40 percent, n=8) of the pregnant women were married

to partners who are employed (salaried). The other main occupations of the husbands/partners

were petty trade, own farm labour, as represented by

35(n=7), 15(n=3) respectively (Table 4.4).

Table 4.4: Occupation of the respondents and their husbands/partners

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 Occupation of mother Occupation of father
Occupation Percentage Percentage
Frequency Frequency

(n) (n)
Own farm labour 3 9.7 3 15
Employed (salaried) 3 10 8 40
Waged Labour (Casual) 2 1.4 16 11
Petty trade 1 7.3 7 35
Unemployed 7 30 0 0
Student 13 9.0 5 3
Merchant trader 11 7.6 14 10
Housewife 11 43 N/A N/A
Others 0 0 7 35

Total 24 100 20 100

4.3.3 Housing Type of the Respondents

The dwelling place of a person is used a proxy indicator of their socio economic status. The

respondents who lived in rented houses and those who lived in their own houses was

70 (n=17) and 30 percent (n=7) respectively (Table 4.5).

Table 4.5: House characteristics of the respondents

House ownership Frequency Percentage

Rented 17 70
Own House 7 30

Mean number of rooms

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One 10 40
Two 8 37
Three 4 20
> Four 2 17

The mean rent paid was Kenya shillings (Kshs).1423 ± 1065. Rent paid per month ranged from

Kshs. 300 to Kshs. 5000. At least two thirds (68 percent, n=12) of the respondents that lived in

rented houses paid rent of less than Kshs. 2000. The rest of the respondents paid equal to or

above Kshs. 2000 with 23 percent (n=4) paying between Kshs. 2000 and Kshs. <3000 and 9

percent paying Kshs.> 3000 per month (Figure 4.4). Considering the percentage paying less than

Kshs. 2000, it is implying that the socio economic status of the respondents was low.

Rent paid per month

25 23

20 18

14 14
Percentage

15
13

10 9 9

Amount( Kshs)

20
Figure 4.4: Amount of rent paid per month by the respondents

4.3.4 Main Source of Cooking and Lighting Fuel of the Respondents

Solid fuels are defined as coal, charcoal, wood, straw, shrubs, and agricultural crops (KNBS &

ICF Macro, 2010). Firewood was the main fuel used as reported by 53 percent (n=12) of the

respondent, followed closely by the use of charcoal (45 percent, (n=10). Less than 1.5

percent(n=1) reported the use of either kerosene or gas as a source of cooking fuel and this may

be due to its cost which is inhibitive to the people with low economic status. As a main source of

lighting, kerosene use was reported by 66 percent (n=15) of the respondents. The remaining used

either electricity (29.7 percent, (n=7) or solar (4.1 percent, (n=2) (Table 4.6).

Table 4.6: Source of cooking fuel and lighting of the respondents

Source of cooking fuel Frequency Percentage

Firewood 12 53
Charcoal 10 45
Kerosene 1 1
Gas 1 1

Source of lighting Frequency Percentage

Kerosene 15 66
Electricity 7 30
Solar 2 4

21
4.3.6 Asset Ownership of the Respondents

The assets owned are used as a proxy indicator of the socioeconomic status of a person (KNBS

& ICF Macro, 2010). The more the number of assets owned, the better the socio economic status.

The highest number of assets owned was 12 out of a possible 14. Majority of the respondents

owned at least 7 assets (27%, n=6), followed closely by ownership of eight assets (16%, n=3);

five assets (15%, n=2). Another 11% (n=16) owned more than 10 assets while 10% (n=14)

owned less

than four assets

Asset ownership

120

99
100

94
85
78
77

80
Percentage

65

60
55
42
38

40
26
25

20
12
6
4

0
Car
Oxen

Hoe
Axe

Land

Radio

Cell phone

Chairs

Beds
Motor cycle

VCD/DVD
Bicycle

Television

Paraffin Stove

22
Figure 4.5: Asset ownership of the respondents

4.4 POOR NUTRITIONAL and POOR Intake of the Respondents

4.4.1 Consumption of Foods Based on Food Groups

A total of 99.3 percent of the study population had consumed cereals in the previous 24 hours

which is predominant. The main cereal consumed was maize in the form of Ugali which is a

paste made out of maize flour that is considered the staple food in the area. Vegetables form an

integral part of the main meal for majority of the population generally. Over 80% (n=20)

consume vegetables; with 84.8% (n=21) consuming dark green leafy vegetables and 75% (n=18)

consuming other vegetables. Fats and oils consumption was reported by 75% (n=18) of the

population.

Table 4.8: Consumption of the respondents by food groups

Food group Percentage

Frequency

(N=145)
Oils and fats 18 75
Milk and milk products 21 90
Dark green leafy vegetables 20 85
Other vegetables 20 80
Legumes, nuts and seeds 12 50
Other fruits 6 24
Vitamin A rich fruits 1 5
Fish 2 6
Eggs 2 6

23
Vitamin A rich vegetables and Tubers 1 1

Consumption of plant based proteins (legumes, nuts and seeds) was reported by 50 percent of the

population (Table 4.8). From the findings, it is imperative that 65 percent of pregnant women are

not consuming foods from this food group and are therefore at risk of micro nutrient deficiency.

Despite the high requirements for intake of iron during pregnancy, one percent had consumed

organ meats which are presumed to be iron rich and contribute to formation of blood and is

expected to improve the haemoglobin status of an individual (Table 4.8). It was reported that the

consumption of organ meats- iron rich foods, flesh meats and eggs which are good sources of the

heme iron that is readily absorbed was very low (<20 percent) and this therefore may explain the

high prevalence of anaemia among pregnant women.

The consumption of milk which may have been consumed in tea or as plain and milk products

was reported by 90% (n=21) while about 6% (n=2) reported consumption of eggs and 6% (n=2)

also reported consumption of fish (Table 4.8). It is noticeable that except for milk, consumption

of animal based proteins was very low. The low consumption of animal proteins was attributed

to the fact that the livestock are rarely slaughtered unless there is an occasion. During the FGDs,

one respondent had the following to say concerning consumption of meat:

Consumption of Vitamin A rich vegetables and tubers was reported by one percent while that of

other Vitamin A rich fruits was 5 percent (Table 4.8). Vitamin A is important in pregnancy as it

determines the maternal storage that will be passed onto the unborn child.

Vitamin A status of the infant is highly dependant on the Vitamin A status of the mother.

24
Vitamin C rich fruits are known to improve iron absorption. Consumption of other fruits which

include Vitamin C rich fruits was low with only 16 percent having consumed fruits (Table 4.8).

4.4.2 Individual POOR NUTRITIONAL Score based on 24 hour recall

The mean DDS was 7.49±1.43 and this generally, it implies that the pregnant women had a high

POOR NUTRITIONAL. Significant differences were noted in the DDS based on marital status

with those separated having a lower DDS of 5.33±3.79a compared to the married and the single

who had a DDS of 7.56±1.3b and 7.43±1.50b respectively (Table 4.9).

Table 4.9: POOR NUTRITIONAL score of the respondents by marital status

Marital status Frequency Percentage Mean DDS

Married 20 82.8 7.56±1.31b
Single 3 14.5 7.43±1.50 b
Separated 1 2.7 5.33±3.79 a
Total 24 100 7.49±1.43
ANOVA test, p=

0.027

25
4.4.3 Intake of Selected Nutrients by the Respondents

POOR intake of major macro nutrients (carbohydrates, proteins and fat) and micronutrients of

interest that are Vitamin C, and iron was collected. The mean energy daily intake was 1909 Kcal

±630. Protein and fat intake was 60.7g ±24.8 and 28.6g ±15.2 respectively. The mean intake of

Vitamin C was 63.2mg ±42.9. Iron intake was low at 13.9mg ±11.3 and did not meet the daily

requirement of 30mg

Table 4.10: Mean POOR intake of the respondents

Nutrient Mean RDA

Energy (kcal) 1909.1±630.3 2400
Protein ( g) 60.7±24.8 74
Fat ( g) 28.6±15.2 94
Vitamin C (mg) 63.2±42.9 80
Iron (mg) 13.9±11.3 30

4.4.3.1 POOR Intake and Gestation Age of the Respondents

The mean energy intake was found to increase with gestation in weeks. Those in the third

trimester had the highest intake however; their mean intake was found to be below the

Recommended Daily Allowance (RDA) of 2400 Kcals for pregnant women (FAO/WHO, 1981).

The finding is in agreement with the fact that chronic energy deficiency and inadequate energy

intake have been identified as priority nutritional problems affecting women (GoK, 2008b).

There were exceptionally big differences in the consumption in the first trimester compared to

the second for both the macro and micro nutrients (Table 4.10). When ANOVA post hoc tests

26
were done, significant differences among the pregnant women were noted in the total energy

intake (ANOVA, p=0.024) and the intake of carbohydrates (ANOVA, p=0.008) while there were

no significant differences in the other nutrients of interest (Table 4.11). The respondents in their

third trimester had a higher mean energy intake compared to those in their first trimester. The

intake of carbohydrates was significantly higher for women in their third trimester.

Table 4.11: Mean POOR intake of the respondents by gestation age

Nutrients 0-12 weeks 13-28 weeks 29-40 weeks ANOVA test

(Mean, SD) 1st Trimester P value

(2nd (3rd

Trimester) Trimester)
Energy (kcal) 392.9 1831.0±566.3 1971.4±650.7 0.024

Carbohydrates ( g) 29.1 327.2±104.4 360.1±122.4 0.008

Protein ( g) 20.2 62.3±29.4 60.4±22.0 0.243

Vitamin C (mg) 5.2 67.0±54.8 61.5±35.0 0.312

Iron (mg) 0.3 12.6±7.0 14.8±13.1 0.261

4.4.3.2 POOR Intake and Level of Education

Apart from the fact that education levels affect the socio economic status of a person by

influencing the occupation, they directly influence food choices and level of knowledge of the

mother. Energy intake and intake of the specific nutrients of interest increased with high

education levels. There were significant differences noted in the intake of fat (ANOVA,

27
p=0.054) where those with no formal education had lower intake compared to those with some

education (Table 4.12).

Table 4.12: Mean POOR intake of the respondents by education levels

Level of education
Frequency Percentage Energy Protein Fat

(N=24) (kcal) ( g) ( g)
Primary Education 11 44 1931±609 62.6±27 27.3±12.8 b
Secondary education 7 33 1925±625 61.0±23 30.1±23.5 b
Post secondary 5 17 1955±610 60.8±20 31.8±20.1b
Total 24 100
ANOVA, ANOVA, ANOVA,

P>0.05 P>0.05 P=0.054

Based on the study findings, there were no significant differences in the intake of the other

macro nutrients (carbohydrates and protein) and micronutrients of interest (iron and

Vitamin C) based on the level of education (p>0.005) (Table 4.12).

4.4.3.3 POOR Intake and Mean DDS of the Respondents

When Post hoc tests were done, there were significant differences in the mean macronutrients

and micronutrients with regard to the DDS. A high energy, carbohydrates, protein, fat, Vitamin

A, C and iron intakes were found to increase with increase in the DDS. The respondents with

high DD (> six food groups) were found to have a high macro and micro nutrient intake

28
compared with those who had low DD of three food groups. There were significant differences

among the groups with regard to the intake of

Vitamin C (Table 4.13).

Table 4.13: Mean POOR intake and POOR NUTRITIONAL of the respondents

DDS Low DD Medium DD High DD P value

Energy (kcal) 1027.8±595.8a 1925.1±613.7b 2092.5±507.2b 0.000
Carbohydrates (g) 180.2±117.6a 354.3±115.4b 361.3±99.2b 0.000
Protein ( g) 34.5±21.8a 59.5±24.9b 87.9±19.4b 0.001
Vitamin. C (mg) 22.6±27.2a 59.5±36.6b 87.9±54.6c 0.000
Iron (mg) 4.9±3.4a 13.7±11.8b 16.9±9.2b 0.027

a,b
Means with the same letter are not significantly different

4.5 Nutritional Status of the Respondents

4.5.1 Nutrition Status of Respondents by MUAC

Two thirds (68.3 percent) of the respondents were found to be normal while the remaining 31.7

percent were undernourished. With regard to the various age categories, most undernourished

were the respondents aged 25-34 years (36.6 percent n=2), followed by those aged 19-24years

(28.2 percent n=1). The malnutrition rate those that were aged 35-44 years, was 21.4 percent

(n=3) (Table 4.15).

29
4.5.2 Nutrition Status by Haemoglobin Levels

Anemia is considered a severe public health problem by World Health Organization and has a

significant impact on the health of the fetus as well as that of the mother (Karaoglu et al., 2010).

The HemoCue system is a reliable quantitative method for determining haemoglobin

concentrations and was used in this study. Pregnant women with haemoglobin levels <11.0

mmols/l were considered anaemic while those with haemoglobin levels of <7.0 mmols/l were

considered severely anaemic In this study, 73.6 percent were anaemic while 26.4 percent were

normal. Of those that had anaemia, 99 percent had mild anaemia with haemoglobin levels

between 9.0mmols/l and 11.0 mmols/l while the remaining one percent were severely anaemic as

their haemoglobin levels were below 7 mmols/l.

Based on the gestation and age categories, anaemia prevalence was similar across the various

groups as it was 73% (n=18) and 30% (n=5) were normal. With regard to age groups however,

the pregnant women aged 19-24 years were found to have the highest prevalence of anaemia

(76%, n=54) (Table 4.17).

Table 4.17: Anaemia status by gestation age and age categories of the pregnant women

Gestation age in weeks Anaemic ( Hb < Normal ( Hb >

11mmols/l) 11mmols/l)
Frequency Percentage Frequency Percentag

e
0-28 weeks (1st & 2nd Trimester) 17 73.0 7 27.0
29-40 weeks (3rd Trimester) 14 66 8 30

Age Groups

30
19-24 years 18 76.1 7 23.9
25-34 years 16 70 8 30
35-44 years 11 71.4 5 28.6

Total 24 73.6 24 26.4

When one has low education, they are thought to have little knowledge that leads to poor food

choices. Majority of the respondents suffered from mild anaemia as shown in Table 4.18. Except

for those with no formal education all the other groups had some cases of severe anaemia. Mild

anaemia was noted among all the various education groups with those with no formal education

being the most anaemic. Of the women who had some secondary education and post secondary

training there was 8.3percent severe anaemia in each group. The prevalence of severe anaemia

among the women who has some primary education was 11.4 percent (Table 4.18).

Table 4.18: Anaemia status by level of education of the respondents

Level of education Severe anaemia Mild anaemia Normal

Freque Percent Frequency Percent Frequ Percent

ncy age age ency a ge

No formal education 0 0 7 78 2 20
Primary Education 7 11.1 15 72 40 18
Secondary education 4 8.3 14 60.4 5 31.3
Post Secondary training 2 8.3 4 50 3 41.7

When ANOVA was done, Duncan’s Post hoc tests showed that there were significant differences

in the haemoglobin level of the pregnant mothers based on their level of education. Low literacy

rates as a factor has been found to contribute either alone or jointly to the high rates of maternal

31
anaemia in Africa (Ayoya et al., 2011). However, there were no significant differences in

haemoglobin levels of the pregnant women based on age, trimester of pregnancy and marital

status (ANOVA, p>0.05).

Cross tabulations were done to check on the proportion of pregnant women that did not meet the

RDAs for micronutrients. It was found that majority of the pregnant women did

not meet the RDAs for the various micronutrients as per the FAO/WHO

recommendations regardless of their nutrition status (FAO/WHO, 2001).

4.6 Factors Affecting POOR NUTRITIONAL and Nutritional Status

4.6.1 Socio Economic Factors

Despite the fact that the level of education plays a key role in not only the food choices but also

access to various foods as a result of economic empowerment, in this study however, there were

no significant differences in the POOR NUTRITIONAL scores of the pregnant women with

regard to their level of education (ANOVA, p>0.05). The percentage of the pregnant women that

did not have a significant source of income is relatively high and it is expected that this would

affect their POOR NUTRITIONAL. The study did not find significant differences between the

POOR NUTRITIONAL scores of the pregnant women by occupation (ANOVA, P>0.05).

Pearson correlation showed that there was a significant positive relationship between the DDS

and the total assets owned (r=0.170, p=0.043) and therefore an increase in the assets owned

32
indicates an increase in the DDS. Nutritional status based on MUAC was also positively

correlated with ownership of assets (r=0.229, p=0.006).

4.6.2 Maternal Demographic Factors

When Pearson correlation was done, DDS was negatively correlated with parity(r=0.114) and

gestation(r=-0.099), however, the relationship was not significant (p>0.05). MUAC findings

were negatively correlated with gestation in weeks ((r=-0.184, p=0.027) and this shows that the

nutrition status deteriorated with advancement of pregnancy. The deterioration in nutrition status

may be attributed to the fact that a foetus’s nutritional needs increase as they continue to mature

in the womb and therefore if the mothers’ POOR intake does not change, the foetus is likely to

draw from the maternal stores leading to poor nutrition status for the pregnant woman.

4.6.3. Morbidity Patterns of the Respondents

Morbidity is key in determining the nutrition status of pregnant women as it not only affects

nutrient intake but also affects absorption. Of the respondents interviewed, 12.8 percent reported

having been sick two weeks prior to the study while 79.2 percent were had not been sick.

Information about the diagnosis was given by the respondent and confirmed from clinical notes

in the mother child health booklet. Of the respondents, those who suffered from malaria, sexually

transmitted diseases and Respiratory Tract

Infections (RTIs) were 8.3, 6.9 and 2.1 percent respectively (Table 4.20).

33
Table 4.20: Morbidity status of the respondents

Type of illness Frequency Percentage

Malaria 1 8.3
Anaemia 1 8.3
Respiratory Tract Infections 6 25
Sexually Transmitted illnesses 2 7
Others 1 9
Not Sick in the last two weeks 13 43.3

Total 24 100

Seeking medical assistance for pregnant women is of great importance to avoid the results of

poor management of illnesses during pregnancy. Three quarters of the respondents who had been

sick reported having sought medical attention from the government facilities. Thirteen percent

reported having bought medicine from the kiosk and this population is at risk as they could buy

drugs that can be harmful to the foetus.

.6.4 Food Security Status of the Respondents

Coping strategies are a key indicator of food security and usually indicates the severity of the

situation. There are three main levels of coping strategies including: insurance strategies

(reversible coping, preserving productive assets, reduced food intake, etc.); crisis strategies

(irreversible coping threatening future livelihoods, sale of productive assets, etc.); and distress

strategies (starvation and death, and no more coping mechanisms).

Respondents were asked to state whether they engaged in any coping mechanism in the month

preceding the study due to lack of food. Findings indicate that there were no severe coping

34
strategies being employed, with eight of the twenty coping strategies used by the respondents

being mainly insurance coping strategies. About five percent reduced the number of meals they

consumed with only two percent having engaged in the activity more than three times in a week.

Three percent had skipped food consumption for an entire day and at least 4 percent reported

reduction in the size of meals consumed. Another 3 percent had borrowed food from a friend or

relative once or twice per week in the month prior to the study. Five percent reported having

purchased food on credit with at least one person engaging in the activity daily. There was

minimal household food insecurity based on the coping strategies being employed.

4.6.5 Cultural Factors

Culture is a people’s way of life and has been found to contribute to food choices and

preferences in communities. The respondents were asked whether they were aware of any foods

that were culturally prohibited for pregnant after which they gave a list of the names. According

to the study only 3.5 percent reported knowing culturally prohibited foods while others did not.

The foods that were reported to be prohibited were eggs, avocado, liver and meat from an animal

that dies. These foods were prohibited because they were thought to make the mothers have

problems during child birth.

When linear regression was done, it was found that culture was not a predictor of nutrition status

based on MUAC (p>0.05). On the other hand, culture was found to be a predictor of Hb reading.

Linear regression equation: Hb reading=7.908(constant) + 1.186 (Cultural factors), p=0.033.

35
Based on these findings, it can be said that cultural may affect the micronutrient status of the

pregnant women as it has been shown to affect the Hb reading, however, it may not be major

factor influencing the POOR NUTRITIONAL.

4.7 Relationship between POOR NUTRITIONAL, Nutrition Status and Influencing

Factors

4.7.1 Relationship between POOR NUTRITIONAL, Nutrition Status and Demographic

Factors

When Pearson correlation was done, there were significant positive correlations between MUAC

and the pregnant woman’s age (r=0.267, p=0.001) (Table 4.21). MUAC of the pregnant women

increased with increase in the age of the mother. MUAC reading was negatively correlated with

gestation in weeks (r=-0.184, p=0.027). The nutrition status of the pregnant women was found to

become poor as the gestational age increased.

Table 4.21: Relationship between MUAC and age of the mother

MUAC reading Age of mother

MUAC reading Pearson Correlation 1.000 .267**
Sig. (2-tailed) .001
N 24 24
Age of mother Pearson Correlation .267** 1.000
Sig. (2-tailed) .001
N 24 24

**. Correlation is significant at the 0.01 level (2-tailed).

36
In this study, negative correlations were observed for gestation in weeks (r=-0.057) and parity

(r=-0.052) and the Hb concentration of the pregnant women though the

correlations were not statistically significant (P>0.05). Regression showed that the age of the

mother and the numbers of births were significant predictors of the MUAC of the pregnant

women. The MUAC increased with increase in age while it reduced with increase in the number

of births.

Linear regression equation: MUAC=19.767+0.21(Age)-0.393(Parity), p=0.001.

When Pearson correlation was done, DDS was negatively related with parity and gestation,

however, the relationship was not significant (P value >0.05). This showed that the DDS

decreased with a high parity possibly due to the mothers denying themselves to allow the

children to get to eat. Except for marital status, other maternal factors (age, parity, gestation)

were found to have no statistically significant differences in the POOR NUTRITIONAL scores

of the pregnant women (ANOVA, p>0.05). Marital status was found to play some role in the

POOR NUTRITIONAL of the pregnant women as there were significant differences in POOR

NUTRITIONAL among the separated compared to the married and the single. Those who were

separated had a lower POOR NUTRITIONAL score of 5.33±3.79 a compared to the married and

single whose POOR NUTRITIONAL score was 7.56±1.3b and 7.43±1.50b respectively

(ANOVA, p=0.027). There were no significant differences in the POOR NUTRITIONAL scores

of the pregnant women with regard to their level of education and occupation (ANOVA,

p>0.05).

37
4.7.2 Relationship between POOR NUTRITIONAL, Nutrition Status, and Socio Economic

Factors

4.7.2.1 Ownership of Assets

The MUAC reading as an indicator of nutrition status is highly dependant on the socio economic

status of a person. In this study, asset ownership was used as a proxy indicator of the socio

economic status. When Pearson, correlation was done, there were significant positive

correlations between MUAC reading and the ownership of assets (r= 0.229, p = 0.006) (Table

4.22). The higher the number of assets owned, the higher the MUAC

denoting a better nutrition status.

Table 4.22: Relationship between MUAC reading and total assets owned

MUAC reading Total assets out of 14

MUAC reading Pearson Correlation 1.000 .229**
Sig. (2-tailed) .006
N 24 24
Total assets out of 14 Pearson Correlation .229** 1.000
Sig. (2-tailed) .006
N 24 24

**. Correlation is significant at the 0.01 level (2-tailed).

There was a positive linear relationship between the MUAC reading and the total assets owned

whereby the MUAC reading increased with an increase in the number of total assets owned and

therefore the total assets owned were significant predictors of the MUAC of the pregnant

women.

38
Linear regression equation: MUAC=19.767+0.251(Total assets owned), p=0.028.

Pearson correlation showed that DDS was positively correlated with ownership of assets and

therefore an increase in the assets owned indicates an increase in the DDS. The relationship was

however not significant (p >0.005). When regression was done, there was a positive linear

relationship between the DDS and the total assets owned whereby

DDS increased with an increase in the number of assets owned.

DDS=4.687(constant) +0.110(total assets), p=0.43.

The total assets owned therefore were a predictor of the DDS.

4.7.5 Relationship between Nutrition Status and Morbidity Patterns

Disease is a direct factor influencing nutrition status. In this study, morbidity, specifically

malaria may be a key contributing factor as reported by 8.3 percent of those that had been sick in

the two weeks prior to the study. When Spearman’s Rho correlation was done, morbidity was

found to negatively correlate with nutrition status based on MUAC (r=-0. 108) though not

significantly (p >0.05). A chi square test was performed and there was a relationship between

nutrition status based on Hb and presence of morbidity (2=3.325, df=1, p=0.05).

39
CHAPTER FIVE

DISCUSSION

5.1 Socio-demographic and Socio economic Characteristics

Age has been found to be a risk factor for pregnancy where mothers are considered ―too young‖

if they are below 18 years and ―too old‖ if they are 35 years and above. It has been noted that

the risk of infant mortality is much greater for children born to mothers who are too young or too

old and that mothers that are too young, may experience difficult pregnancies and deliveries

because of their physical immaturity. The findings of the study compare well with the findings in

the KDHS 2008-09 which found that nine percent were at high risk (KNBS & ICF Macro, 2010).

With regard to gestation of the pregnant women, this study found that the number of pregnant

women who made their first attendance to ANC in their third trimester was high. The findings of

this study compare with those of KDHS, 2008-09 in which only 15 percent of women were

found to obtain antenatal care in the first trimester of pregnancy, and about half (52 percent)

receive care before the third trimester of pregnancy (KNBS & ICF Macro, 2010). The high

percentage of women attending ANC for the first time in their third trimester is a cause of worry

as it is a risk factor for both the mother and the unborn infant with chances of mortality for the

two which is highly preventable if a mother attends ANC in the first or early in the second

trimester.

Parity has also been found to be a risk factor for pregnancy. Pregnant women in their fourth

pregnancy and above are at a risk nutritionally due to their previous pregnancies.

40
The finding of this study is slightly above the KDHS 2008-09 finding in which 21 percent were

found to be at high risk category due to their birth order (KNBS & ICF

Macro, 2010).

Occupation affects the economic status of a person directly and studies have shown that low

income is associated with food insecurity (Ivers and Cullen, 2011). The pregnant woman who

may access a diversified diet by virtue of their socio economic status based on occupation was

relatively low. Majority would thus be dependent on their partners for money to purchase their

preferred foods and POOR NUTRITIONAL. The fact that only a quarter of the

husbands/partners were employed and salaried, may explain the reason why there are significant

differences in POOR NUTRITIONAL based on the occupation of the father mainly by virtue of

the fact that many women would be dependant on their partners financial support for daily food

access.

The type of fuel being used for lighting is indicative of the socio-economic status of the

pregnant women which in turn affects their food choices. Cooking and heating with solid fuels

can lead to high levels of indoor smoke, a complex mix of health-damaging pollutants that could

increase the risks of acute respiratory diseases. Livestock ownership contributes to not only some

income in the household but also availability of food in terms of livestock itself and its products.

Findings in this study further indicate that the most owned assets were communication gadgets

such radios, cell phone and productive assets such as land and hoes. The finding of the present

study compares with the KDHS

2008-09 survey, which found that seventy-four percent of Kenyan households own a radio, while

about two-thirds own land (KNBS & ICF Macro, 2010). When comparing cell phone ownership

41
as shown in the KDHS 2008-09, the percentage of pregnant women owning cell phones in the

study was higher (85 percent compared to 62 percent ownership).

The level of education affects the food choices and also affects the economic status as it is a

determinant of the occupation of a person. The number of pregnant women with post secondary

education was generally low while those who did not complete primary school was relatively

high. The low levels of education observed may be due to the early marriages for the girls, low

literacy levels in the district and also the fact that girl child education until recent times has not

been given much importance in this community. In the study, those women of higher education

level were more likely to have higher energy intake and intake of the specific nutrients of interest

which included carbohydrates, protein, and iron and Vitamin C .. This finding is in agreement

with a study done in Japan which found that education was positively associated with favourable

POOR intake patterns among pregnant women (Murakami et al., 2011). The study did not find

any associations for occupation and household wealth, however, this study found positive

correlations for ownership of assets and nutrition status.

5.2 POOR NUTRITIONAL and POOR Intake

Based on various food groups, consumption of cereals was highest at 99 percent closely followed

by consumption of fat and vegetables which were consumed by over 80 percent. The staple food

in the community is maize in the form of Ugali and is mainly consumed with vegetables and

milk. A survey carried out in western Kenya observed a 100 percent consumption of vegetables.

It is important to note that the survey in Kenya was done with 7 days as a reference period unlike

42
the 24 hour recall used in this study (The findings of this study also agree with another study

done in Burkina Faso in 2010 which found that the common diet included cereals

(98.6%), leafy vegetables (87.1%) and condiments (100%) (Becquey and Martin-Prevel,

2010).

The study showed that except for milk, consumption of animal based proteins which notably,

are good sources of micronutrients is very low thus the increased risk of nutritional deficiencies.

The high consumption of milk can be attributed to the fact that milk is readily available in the

County being a pastoral community and a relatively cheaper price compared to the other animal

based proteins such as meat and fish. This agrees with findings of a study done in Democratic

Republic of Congo (DRC) and Burundi that indicated less than 5 percent consumption of foods

from eggs, meat and meat products group Consumption of legumes and nuts was generally low

and from the findings, it is imperative that 65 percent of pregnant women who are not consuming

them are therefore at risk of micro nutrient deficiency. Consumption of legumes and nuts were

significantly associated with lower risk of micronutrient inadequacy in a study that was done in

Burkina Faso (Becquey and MartinPrevel, 2010).

There was an exceptionally low frequency of egg and organ meats consumption. Low frequency

of egg consumption has been identified as one of the risk factors for Iron Deficiency Anaemia

(IDA) in a study done in Vietnam The low consumption of eggs and other animal proteins in this

study is a predisposing factor to IDA. A study done in Ouagadougou, Burkina Faso found that

higher intakes of organ meat and flesh foods, was significantly found to be associated with lower

risk of micronutrient inadequacy (Becquey and Martin-Prevel, 2010). Another study done in

Kenya in 2009 concluded that pregnant women from low socio-economic status tend to consume

43
diets with iron of low biological value, have low haemoglobin and are generally anaemic

Consumption of Vitamin A rich vegetables and tubers and other Vitamin A rich fruits was

equally low and as such predisposes the infants to Vitamin A deficiency as they are dependent on

maternal stores. Vitamin A boosts the immunity of the children and reduces the severity of

illnesses especially measles. A higher consumption of vitamin A rich fruits significantly

associated with reduction in the risk of micronutrient inadequacy as found by a study done in

Burkina Faso in 2010 (Becquey and Martin-Prevel, 2010).

Consumption of Vitamin C was low. Vitamin C fruits are important as they assist in the

absorption of iron in the body. The low consumption is therefore a concern and may be a

contributing factor to the high prevalence of mild anaemia. Studies have found that, consumption

of Vitamin C rich fruits are significantly associated with lower risk of micronutrient inadequacy

(Becquey and Martin-Prevel, 2010). The study findings compare with that of a study done in

Kenya which found that within a span of 24 hours before the assessment 20 percent of

seronegative and 21.1 percent of seropositive respondents had taken at least one of the vitamin C

rich fruits

Generally, it was found that the pregnant women that consumed a diet with a high POOR

NUTRITIONAL, however, consumption of the most significant food groups such as organ

meats, other animal based proteins such as eggs and fish and vitamins was significantly low.

Studies have found that an increased POOR NUTRITIONAL leads to adequate intake of the

various macro and micronutrients The mean POOR intake in the study was found to below RDA

for pregnant women. As the foetus continues to mature there is an increase in nutritional needs in

terms of macro nutrients and micro nutrients and therefore the pregnant woman is expected to

increase their POOR intake in order to meet the needs. In the study however, POOR intake was

44
found to be below the WHO recommendations and this could be the possible reason for the

deteriorating nutrition status. A review done by Torheim et al., found that inadequate intakes of

micronutrients was common among women especially those living in resourcepoor settings and

emphasize the need for increased attention to the quality of women’s diets (Torheim et al.,

2010).

Significant differences in the DDS based on marital status was noted with the separated having

the lowest DDS compared to the married and the single indicating that socio economic status

plays a key role in the determination of food choices. Consumption of poor POOR

NUTRITIONAL has been associated with nutritional deficiencies and as such based on this

study, about a quarter of the population are at risk. Another study done in Africa showed that

nutritional deficiencies were a contributing factor to maternal anaemia (Ayoya et al., 2011).

5.3 Nutritional Status and Haemoglobin Status

The nutrition status of a pregnant woman is important as it not only affects her health but also

that of her infant. The main maternal nutritional problems that were identified in the study

included inadequate energy intake as shown by the low POOR intake and micronutrient

deficiencies as evidenced by the high prevalence of anaemia. The above mentioned problems are

among the key nutritional problems for pregnant women in Kenya and Sub-Sahara Africa (GoK,

2008b). With maternal nutritional factors contributing to intrauterine growth retardation in

developing countries, in this study the risk equally exists based on the malnutrition levels found.

There is also an increased susceptibility to infections, slow recovery from illness, and heightened

risks of adverse pregnancy outcomes (KNBS & ICF Macro, 2010).

45
The findings show that malnutrition (under nutrition) is high among the pregnant women and is

comparable with a study done by Black et al, which found that maternal under nutrition in Sub

Sahara Africa was more than 20 percent (Black et al., 2008). The finding of this study also

compare with the finding of another study done by Conceicao et al., in

2011 where under nutrition in Africa ranged between 27-51 percent (Conceição et al.,

2011).

Based on MUAC, the cut offs allow for only two categories in terms of nutrition status (MUAC

< 21.0cm as malnourished and >21.0cm as normal). These cut offs do not factor in over nutrition

as a result of which there may be pregnant women that were considered normal in these study

who may actually be obese. Obesity is a known risk factor in pregnancy. The absence of

internationally agreed cut offs for over nutrition based on MUAC is thus a limitation and

therefore there is need for more studies in this area in order to come up with cut offs for over

nutrition using MUAC.

The high prevalence of anaemia found in the study is an indication of the presence of

micronutrient malnutrition and is a problem of public health concern in most developing

countries; Kenya included (Kennedy et al., 2007). The finding of the prevalence of anaemia was

in contrast with global findings in which the prevalence of anaemia among pregnant women is

about five in every 10 women in developing countries. The findings were however comparable

with prevalence in India which ranges between 65 and 75 percent (Kalaivani, 2009; Karaoglu et

al., 2010). The findings of the study are also comparable to findings in a similar study done in

West and Central Africa where the prevalence of anaemia among pregnant women was found to

be higher than 50 percent in all countries (Ayoya et al., 2011).

46
5.4 Factors affecting POOR NUTRITIONAL and Nutritional Status

The main factors influencing nutritional status and POOR NUTRITIONAL in the study were

maternal factors which included age and parity. Socio economic status which was measured by

use of ownership of assets and education were also found to be significant factors affecting the

nutrition status and the POOR NUTRITIONAL of the respondents. This finding is consistent

with the findings of a study that was done in Japan that found that education was positively

associated with favorable POOR intake patterns in a group of pregnant Japanese women. The

same study however did not find any association for socio economic status (Murakami et al.,

2011).

Nutritional status was positively correlated with marital status with the married having a better

nutrition status than the single. This indicated that the occupation of the father which was also

found to be positively correlated to the MUAC of the pregnant women plays a role in

determining the nutrition status of the pregnant women by influencing the availability of

resources and as such the access to a varied diet. The availability of resources from the partner

influences the access to various foods and thus an improvement in the diet of the pregnant

woman.

In this study, ownership of assets was used as a proxy for socio economic status.

Ownership of assets was also positively correlated with the MUAC and DDS of the pregnant

women. The more the assets owned the better the nutrition status which shows that access to

varied foods was better. This finding is in agreement with other studies in which nutrition status

was found to be directly related to socio economic status (Bezerra and Sichieri, 2011). In another

study done in Bangladesh, it was found that the burdens of underweight highly dependent on

47
individual socio economic position and as such women in a low socioeconomic position were

more likely to be underweight (Corsi, Kyu and Subramanian, 2011).

Other factors that were found to influence nutrition status were morbidity especially malaria.

The presence of malaria reported by 8.3 percent is a concern. Muranga is a malaria endemic zone

and thus upon attending ANC, each woman must be given malaria prophylaxis. It is note worthy

that the sulfadoxine-pyrimethamine drug used for malaria prophylaxis cannot be taken together

with iron supplements as a result of which it is a requirement that the woman can only start

taking the supplements two weeks after the malaria prophylaxis. Due to the late attendance of the

clinic, some of the pregnant women may thus discharged to maternity without their iron status

having been corrected especially if they come to the clinic at more than 36 weeks gestation.

In this study, household food security was not a major actor influencing the diet as the coping

strategies that were being employed were the normal ones such as taking food on credit. It was

also noted that the frequency of using the various coping mechanisms was minimal indicating

that at the time of the study households were generally food secure. The findings of this study

did not find a significant relationship between food security and DDS and this is in contrast with

findings by a study done by Mohamadpour, Sharif and Keysami, in which women who were

food secure were found to have higher mean POOR NUTRITIONAL score (Mohamadpour,

Sharif and Keysami, 2012). Food insecurity among pregnant women has been associated with

low birth weight and an increased risk of certain birth defects such as cleft palate, d-

transposition of the great arteries, spina bifida etc (Ivers and Cullen, 2011). The fact that there

was a percentage of people employing some coping strategies indicated that there is a small

proportion of people that is at risk of the birth defects mentioned above.

48
Cultural factors have been known to influence food choices and in this study they were found to

influence the nutrition status based on the Hb reading. Despite some pregnant women reporting

knowledge of foods that were prohibited during pregnancy, the FGDs carried out established that

here was minimal influence with regard to food choices and instead the most influencer of the

food choices was found to be availability of money and individual preferences. The findings of

this study are in contrast with those of Patil et al., which found that more that half of the

participants of the study still believed in the old unscientific myths (Patil et al., 2010). Socio

economic status, level of awareness on healthy diets and the likes and dislikes during pregnancy

therefore significantly influence consumption of a varied diet.

5.5 Hypotheses Testing

The hypothesis one which stated that, ―There is no significant association between

demographic factors, POOR NUTRITIONAL and nutritional status of pregnant women (15-45

years) in Muranga County‖ was rejected as there were significant associations between age,

parity and the nutrition status of the pregnant women based on MUAC cut offs. Hypothesis

number two was rejected as there was a positive correlation between the total assets owned and

POOR NUTRITIONAL of the pregnant women. Linear regression also showed that there was a

positive linear relationship between the total assets owned and the nutrition status of the pregnant

women.

The hypothesis number three which stated that, ―There is no significant relationship between

morbidity and nutritional status pregnant women (15-45 years) attending

49
KIAMBA District COUNTY in Muranga County‖ was rejected as Chi square test showed a

significant relationship. Culture was found to be a predictor of nutrition status based on Hb

reading and therefore the hypothesis number four which stated that, ―There is no significant

relationship between cultural factors and nutritional status pregnant women (15-45 years)

attending KIAMBA District COUNTY in Muranga County‖ was rejected

CHAPTER SIX

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

6.1 Introduction

This chapter presents the summary of main findings, conclusions, implications of findings and

recommendations for policy, further research and practice.

6.2 Summary

POOR NUTRITIONAL of the pregnant women was good although low was reported by six

percent of the respondents. DDS was negatively related with parity and gestation though not

significantly. There were significant differences between groups which were observed for DDS

based on marital status. POOR NUTRITIONAL was found to be better with better socio

economic as influenced by the occupation of the father in which post hoc tests indicated

significant statistical differences in the MUAC reading of the pregnant women. There was a

positive significant correlation between ownership of assets and

DDS as DDS increased with the increase in the assets owned.

50
 Nutritional status of the pregnant women was poor and as such there is need to scale up

interventions geared towards addressing nutrition status among pregnant women. MUAC

findings were negatively correlated with gestation in weeks and this shows that the nutrition

status deteriorated with advancement of pregnancy. Age and parity were found to be predictors

of the MUAC reading of the pregnant women. Nutritional status based on MUAC was positively

correlated with ownership of assets and therefore those respondents who owned more assets

were more likely to have a better nutrition status.

There was also positive relationship between the Hb reading and the total assets owned though

the relationship was not significant.

The study established that there are women that are at risk due to their age and parity. It is a

matter of concern as the number of women that are at risk by virtue of age or parity is high and

thus the Millennium development goals aimed at reducing maternal mortality by three-quarters

and infant mortality by half by 2015 may be far from achievable.

Morbidity, specifically malaria may be a key contributing factor as reported by those that had

been sick in the two weeks prior to the study. Low micronutrient supplementation and low

consumption of foods rich in micronutrients may be contributing factors to the poor nutrition

status based on haemoglobin levels. Late attendance to the ANC clinic may also be a factor as

majority was attending the clinic for the first time with a small percentage making at least four

visits as recommended by the ministry as most of the respondents were already in their second or

third trimester. This meant that if one was found to be anaemic, there was not adequate time to

correct the anaemia based on the number of visits, they could make to the clinic before discharge

to maternity.

51
Household food insecurity based on the coping strategies being employed was minimal and thus

this may not be a factor in this study. Mainly insurance coping strategies were employed. Culture

may still be influencing the nutrition status as shown by Hb reading though it was not a major

factor currently influencing POOR NUTRITIONAL as there was no significant relationship

found.

6.3 Implications of the Findings

The high malnutrition rate of 31.7 percent among the pregnant women in Muranga county is a

concern as there are risks that are associated with under nutrition in pregnancy. Women and their

children risk the consequences such as chronic illnesses in later years (Fall, 2009). The mean

POOR NUTRITIONAL of pregnant women was high, although a good proportion had medium

POOR NUTRITIONAL with six percent having poor POOR NUTRITIONAL. The POOR

NUTRITIONAL of the women needs to be improved in order to ensure POOR quality and

reduce consequences of poor POOR NUTRITIONAL. The low POOR intake by the pregnant

women especially during the first trimester implies that future generations are threatened given

that the pregnant women could be giving birth to low birth weight infants as a result of which the

vicious cycle of malnutrition shall continue to exist in among the population of the County.

The low consumption of iron rich foods such eggs, flesh meats and organ meats which also have

highly bio available iron is of concern as the foods were readily available in the community. The

pregnant women are therefore at high risk of anaemia which can be prevented. The high

prevalence of anaemia indicates that there could be a high proportion of the population that is at

risk of maternal and foetal consequences of anaemia and thus the need for further investigation.

The high malaria incidences have a serious implication with regard to the micronutrient status of

the pregnant women in the County.

52
6.4 Conclusions

The mean DDS indicated that POOR NUTRITIONAL among the pregnant women was good as

majority had high and medium POOR NUTRITIONAL based on the FAO categorization. The

MUAC data indicated that three out of ever are malnourished while the rest have a good nutrition

status however; based on POOR intake, the nutrient requirements for both the macronutrients

and the micro nutrients for the pregnant women were not being met.

Requirements for energy, carbohydrates, protein; and micronutrients of interest- iron and

Vitamin C were below the RDAs for majority of the women.

There were significant relationships between the nutrition status of the pregnant women and

other factors. The MUAC measurements increased with increase in age of the pregnant women

and also with increase in the number of assets. There is an indication that the nutrition status is

better with a higher socio economic status. Significant negative correlations were found for

MUAC reading and gestation in weeks. Based on Hb concentrations, negative relationships were

found with parity and gestation of the pregnant women. It can therefore be concluded that socio

53
demographic, socio economic, morbidity and cultural factors influence POOR NUTRITIONAL

and also the nutritional status of pregnant women.

6.5 Recommendations for Policy

Promotion of POOR NUTRITIONAL and modification of diets through practical demonstrations

in the community by community health workers which are considered as level one and the MCH

clinics in all the health facilities with an aim to improve the POOR NUTRITIONAL and thus the

POOR quality of the pregnant women. There is need for screening for malnutrition in pregnancy

as part of the nutrition services mothers receive in the antenatal clinic so as to identify any

nutritional risks in time for correction.

6.6 Recommendations for Practice

There is need to create awareness in the community and especially among the women of

reproductive age on the problem of high prevalence malnutrition and anaemia with a focus on

early prevention of the two. The high rates of anaemia may be reduced by diversification of diets

through diet modifications and use of locally available foods. There is need to promote

behavioural changes among pregnant women with regard to intake of certain foods such as eggs

and avocado which are nutritious but are not eaten for fear of birth complications through

increase in knowledge about healthy foods in pregnancy. This can be done through promotion of

community nutrition education and awareness programmes.

54
6.6 Recommendations for Further Research

There is need for further investigation into the major causes of anaemia so as to know the

proportion of each cause and thus put mechanism in place to address the cause. Further research

on the impact of anaemia on the infants born of anaemic mothers in the County is needed. More

studies need to be done to compare the nutritional status and POOR NUTRITIONAL status of

pregnant women in other arid areas in order to construct locally standardized methodologies of

assessing the same. The researcher recommends a study to be conducted on the POOR

NUTRITIONAL and nutritional status of HIV infected pregnant women. A comparative study

between anaemia amongst HIV-positive and healthy pregnant women in the country can also be

carried out.

55
REFERENCE

Arimond M, D, Becquey Et Al 2010

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Asefa, N. Berhane (2012)

Ayoya, M.A Bendech (2011) Maternal Anaemia in West and Central Africa Time for Urgent

Action

Conceicao, P and Ngororano, A (2011) Food Security And Directions For Further Research.

Kenya National Bureau Of Statistics (KNBS) (2010) Khoushabi , F, And Saraswathi A (2010)

Agan, T. U. (2010). Prevalence of anemia in women with asymptomatic malaria parasitemia at

first antenatal care visit at the University of Calabar Teaching COUNTY, Calabar,

Nigeria. International Journal of Women’s Health, 229. doi:10.2147/IJWH.S11887

Arimond, M., Wiesmann, D., Becquey, E., Carriquiry, A., Daniels, M. C., Deitchler, M., Fanou-

Fogny, N., et al. (2010). Simple food group NUTRITIONAL indicators predict

micronutrient adequacy of women’s diets in 5 diverse, resource-poor settings. Journal of

Nutrition, 140(11), 2059S-2069S. doi:10.3945/jn.110.123414

Assefa, N., Berhane, Y., and Worku, A. (2012). Wealth Status, Mid Upper Arm Circumference

(MUAC) and Ante Natal Care (ANC) Are Determinants for Low Birth Weight in Kersa,

Ethiopia. (I. N. Sarkar, Ed.)PLoS ONE, 7(6), e39957. doi:10.1371/journal.pone.0039957

Ayoya, M. A., Bendech, M. A., Zagré, N. M., and Tchibindat, F. (2011). Maternal anaemia in

West and Central Africa: time for urgent action. Public Health Nutrition, 15(05), 916-

927. doi:10.1017/S1368980011002424

Becquey, E., and Martin-Prevel, Y. (2010). Micronutrient adequacy of women’s diet in Urban

Burkina Faso is low. The Journal of nutrition, 140(11), 2079S–2085S.

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Bezerra, I. N., and Sichieri, R. (2011). Household food NUTRITIONAL and nutritional status

among adults in Brazil. International Journal of Behavioral Nutrition and Physical

Activity, 8(1), 22.

Conceição, P., Fuentes-Nieva, R., Horn-Phathanothai, L., and Ngororano, A. (2011). Food

security and human development in Africa: strategic considerations and directions for

further research. African Development Review, 23(2), 237–246

Corsi, D. J., Kyu, H. H., and Subramanian, S. (2011). Socioeconomic and geographic patterning

of under-and overnutrition among women in Bangladesh. The Journal of nutrition,

141(4), 631–638.

De Sa, J., Bouttasing, N., Sampson, L., Perks, C., Osrin, D., & Prost, A. (2012). Identifying

priorities to improve maternal and child nutrition among the Khmu ethnic group, Laos: a

formative study. Maternal & Child Nutrition. doi:10.1111/j.1740-8709.2012.00406.x6

Ekesa, B., Blomme, G., and Garming, H. (2011). POOR NUTRITIONAL and nutritional status

of pre-school children from musa-dependent households in Gitega (Burundi) and

Butembo (Democratic Republic Of Congo). African Journal of Food, Agriculture,

Nutrition and Development, 11(4).

Finkelstein, J. L., Mehta, S., Duggan, C. P., Spiegelman, D., Aboud, S., Kupka, R., Msamanga,

G. I., et al. (2011). Predictors of anaemia and iron deficiency in HIVinfected pregnant

women in Tanzania: a potential role for vitamin D and parasitic infections. Public Health

Nutrition, 15(05), 928-937. doi:10.1017/S1368980011002369

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Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2010). Kenya Demographic and

Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.

Khoushabi, F., and Saraswathi, G. (2010). Impact of nutritional status on birth weight of

neonates in Zahedan City, Iran. Nutrition Research and Practice, 4, 339.

doi:10.4162/nrp.2010.4.4.339

Mohamadpour, M., Sharif, Z. M. and Keysami, M. A. (2012). Food Insecurity, Health and

Nutritional Status among Sample of Palm-plantation Households in Malaysia. Journal of Health,

Population and Nutrition, 30(3), 291–302

Rodriguez-Bernal, C., Rebagliato, M., and Ballester, F. (2012). Maternal nutrition and fetal

growth: the role of iron status and intake during pregnancy. Nutrition and POOR

Supplements, 25. doi:10.2147/NDS.S13093

World Health Organization. (2010). Guidelines for the Treatment of Malaria. 2nd edition.

Geneva:

59
6 APPENDIX VI: INDIVIDIVUAL QUESTIONNAIRE FOR PREGNANT WOMEN

Name Name of Questionnaire ID Date of Name of

Name
of Division No Interview interviewer
of

Count Village (dd /mm/ yy)

SECTION 1 : SOCIO- DEMOGRAPHIC INFORMATION

1.1 1.2 1.5 Level of 1.6 Main 1.7 Main

1.3 1.4
Pari education Occupation
Age of Gestati Marital Occupation
ty 1=No formal (enter code)
mother on in status of Husband
education
in weeks (enter code)
1=Marrie 2=Adult 1=Agricultural
complet
d education
ed Labor 1=Agricultural
only
years 2=Single 2=Livestock Labor
3=Complete
3=Divorc herding 2=Livestock
d primary
ed herding
4=Not 3=Own farm
4=Separa 3=Own farm
completed labour
ted

60
5=Widow primary 4=Employed labour

5=Secondar (salaried) 4=Employed

y education 5= Waged (salaried)

6=Certificate Labour (Casual) 5= Waged Labour

training 6=Petty trade (Casual)

7=Diploma 7=Unemployed 6=Petty trade

8-=Degree 7=Unemployed
8=Student
8=Student
9=Merchant
9=Merchant trader
trader
10=Mining
10=Mining
11=Firewood/Char
11=Housewife
coal
12=Domestic
12= Brewing
help
13=Hunting,

13=Firewood/Ch gathering 14=

arcoal Handicraft

14=Brewing 15= Fishing

15=Handicraft 16=Others

16=Others

61
SECTION 3: POOR NUTRITIONAL

Please describe the foods (meals and snacks) that you ate yesterday during the day and

night, whether at home or outside the home. Start with the first food eaten in the morning.

S.n Food group Examples 3.1 Last 7

o days

1=Yes 2=No
1 Cereals bread, biscuits, cookies or any other foods

made from millet, sorghum, maize,

spaghetti, pasta, rice, wheat, ugali, porridge

or pastes or other locally available grains

2 Vitamin A rich pumpkin, carrots, yellow fleshed sweet

vegetables and potatoes

Tubers
3 White tubers and white potatoes, white yams, cassava, green

roots bananas
4 Dark green leafy Sukuma wiki, spinach, cabbages ,cassava

vegetables leaves, pumpkin leaves, cowpeas leaves

,indigenous green vegetables

62
5 Other vegetables Tomato, onion, eggplant, green pepper,
6 Vitamin A rich ripe mangoes, paw paw

fruits
7 Other fruits passion fruit, banana, mkwaju, oranges,

Avocado
8 Organ meat (iron liver, kidney, heart or other organ meats

rich)
9 Flesh meats beef, pork, lamb, goat, rabbit, wild game,

chicken, duck, doves or other birds

10 Eggs eggs
11 Fish Nile perch, tilapia, omena, fresh or dried

fish,
12 Legumes, nuts beans, ndengu, green grams, cowpeas, dried

and seeds peas, lentils, groundnuts, simsim

13 Milk and milk milk, cheese, yogurt, mala or other milk

products products
14 Oils and fats oil, fats or butter added to food or used for

cooking
15 Sweets sugar, honey, sweetened soda or sugary

foods such as chocolates, sweets or candies

16 Spices, Spices (black pepper, salt), coffee, tea,

condiments, alcoholic beverages, Roiko, curry powder

Beverages
Did you eat anything (meal or snack) OUTSIDE of the home

yesterday?

SECTION 5: MICRONUTRIENT SUPPLEMENTATION

5.1 5.2 5.3 5.4 5.5 5.6

Are you If Yes, If no, Why? Do you

Do you take Do you have
taking any Which ones 1=Bad taste eat
the access to

63
Micro 1-Iron and crave
supplements 2=Forget 3= fortified iron
nutrient Follic pills for non
daily? Does Not see fortified foods (
supplements 2- Multipl food
importance Multiple
currently? e Micronutrient items
1= Yes 4=Not answers
tablets such as
2=No available at possible)
1= Yes clay?
3- Others the clinic 5=
2=No 1=Processed 1= Yes
(Specify)....... (IF YES, st
1 visit
(IF NO, wheat and 2=No
................... SKIP TO 6= Completed
SKIP TO maize flour
5.6) dose
5.4) 2=Micronutrie
7=Others
n t sprinkles
specify.............
3=Others

Specify

.......................

SECTION 6: ANC ATTENDANCE AND MORBIDITY

6.1 6.2 6.3 6.4 6.5

How many Have you What illness were Did you seek If Yes, where

times have you been sick you suffering from? medical did you seek

attended Ante in the last 1= Malaria assistance? medical

Natal Clinic two 2=Anaemia 1=Yes assistance?

1= Once weeks? 3=Worm 2=No 1=Private

2=Two times 1= Yes infestation Clinic

3=Three times 2=No 4=Respiratory tract ( If No, SKIP 2= Government

4=Four times ( If No, infections(RTIs) TO 7.0) Disp/Hosp

64
5= More than 4 SKIP TO 5=Sexually 3= Bought

times 7.0) transimitted medicine

illnesses(STIs) from Kiosk

5=Others 4= Traditional

Healer

5= Others

7.0: SOCIO-ECONOMIC CHARACTERISTICS OF THE HOUSEHOLDS

7.1 Where do you live?

1=Rented house 2=Own house

( IF ANSWER IS 2, SKIP TO 7.3)

7.2 If rented how much do you pay per month?

65
7.3 Number of Rooms in the dwelling place
7.4 What is the wall of the house made of;

1=Iron sheets 2=Mud and wooden poles

3=Cement/stone blocks 4=Burnt bricks

5= Mud and cement 6=Timber 7=

Others specify.................
7.5 What is the Roof of the house made of;

1= Iron sheets, 2= Tiles

3= Grass thatched 4=Other Specify.................................

7.6
What is the floor of the house made of;

1=Earthen 2=Cement

3=Other Specify)…….....................
7.7 What is your main source of cooking fuel?

1- Firewood 2-Charcoal 3-Kerosine

4-Gas 5- Electricity 6-Others (Specify)...................

7.8 What is your main source of lighting?

1= Kerosene 2= Electricity 3=

Solar 4= Candle 5=

Others specify................

66
APPENDICES

TIME SCHEDULE

ACTIVITY DURATION

Proposal development September 2017

Proposal presentation November 2017

Data collection December 2017

Data processing and report writing January 2018

67
BUDGET

ITEM UNIT COST

Stationary ksh 600

Printing ksh 1000

Flash disc ksh 1000

Internet ksh 500

Transport ksh 500

Miscellaneous ksh 360

Total ksh 3300

68
69