Cagayan State University College of Allied Health Sciences

PREVALENCE AND ASSOCIATED RISK FACTORS OF UNDERNUTRITION

AMONG PREGNANT WOMEN OF RIZAL, KALINGA: INPUT FOR A
MATERNAL NUTRITION PROGRAM

An Undergraduate Thesis Proposal

Presented to the Faculty
of the College of Allied Health
Sciences Cagayan State University
Tuguegarao City

In Partial Fulfillment
of the Requirements for the Degree
Bachelor of Science in Public Health

By:

ATIBO PRINCESS
BAYED ANGEL MAE
CABADIDO FILMA
PANGDAO JENNY ROSE

APRIL, 2023
 Cagayan State University College of Allied Health Sciences

CHAPTER 1

INTRODUCTION

Background of the Study

The nutritional needs of women vary throughout their lifetime, particularly

during pregnancy and breastfeeding when their vulnerability to malnutrition is greatest.

It is crucial to ensure that women have access to adequate care and nutritious diets for

their own and their children's survival and well-being. Malnutrition among pregnant

women can cause numerous issues, such as disease, miscarriage, low birth weight,

poor fetal growth, infant morbidity, and mortality. It may also lead to long-term

cognitive, motor, and health impairment that is difficult to reverse. Undernutrition

during pregnancy is a significant public health concern and has been a serious problem

in the Philippines.

Undernutrition among pregnant women is prevalent in the Philippines,

affecting 20% of expectant mothers and leading to economic losses and the

preservation of poverty. In addition, infants aged six to 11 months experience under-

nutrition at a rate of 38%, while 26% of children aged 12 to 23 months are also

affected. The World Health Organization aims to reduce anemia and low birth weight

by 50% and 30%, respectively, by the year 2025. The achievement of these targets

requires current knowledge of the nutritional profiles of pregnant women and effective

intervention strategies to prevent maternal and child under-nutrition.

 Cagayan State University College of Allied Health Sciences

Therefore, understanding the prevalence and associated factors of malnutrition

among pregnant women in Rizal, Kalinga, is essential for developing appropriate and

effective interventions.
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STATEMENT OF THE PROBLEM

The aim of this study is to determine the prevalence and associated risk factors

of malnutrition among pregnant women in Rizal, Kalinga, in order to provide input for

the development of a maternal nutrition program. Specifically, the study seeks to

answer the following questions:

 What is the prevalence of malnutrition among pregnant women in Rizal, Kalinga?

 What are the associated risk factors for malnutrition among pregnant women in

Rizal, Kalinga?

 What are the current practices and interventions related to maternal nutrition in

Rizal, Kalinga?

 What are the perceptions of pregnant women and healthcare providers regarding

the importance of maternal nutrition and the barriers to accessing adequate

nutrition in Rizal, Kalinga?

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STATEMENT OF THE HYPOTHESIS

H1: There is a significant association between the prevalence of malnutrition

among pregnant women in Rizal, Kalinga, and their socio-demographic characteristics,

health status, dietary intake, and access to healthcare.

This hypothesis implies that various factors such as age, education, income,

nutritional knowledge, health status, dietary intake, and access to healthcare could have

an impact on the prevalence of malnutrition among pregnant women in Rizal, Kalinga.

The research study could aim to test this hypothesis through data analysis and

statistical tests to determine the extent of the association between these factors and the

prevalence of malnutrition among pregnant women in the area.

 Cagayan State University College of Allied Health Sciences

CONCEPTUAL FRAMEWORK

The conceptual framework for this research is based on the assumption that

various factors contribute to the prevalence of malnutrition among pregnant women in

Rizal, Kalinga. These factors can be categorized into three broad categories: individual

factors, household factors, and community-level factors.

Individual factors include the woman's age, education, occupation, and health

status. Pregnant women who are younger, have lower levels of education, have poor

health, and are engaged in labor-intensive activities are more likely to be

malnourished.

Household factors refer to the household's socioeconomic status, access to

health care, and food security. A low socioeconomic status, lack of access to health

care, and food insecurity can contribute to malnutrition among pregnant women.

Community-level factors include the availability of health care facilities,

infrastructure, and community support. Lack of access to health care facilities, poor

infrastructure, and lack of community support can affect the nutritional status of

pregnant women.

The conceptual framework assumes that these factors interact with each other

and can impact the nutritional status of pregnant women in Rizal, Kalinga. The

framework also suggests that identifying and addressing these factors can help reduce

the prevalence of malnutrition among pregnant women in the area.

 Cagayan State University College of Allied Health Sciences

RESEARCH PARADIGM

INPUT PROCESS OUTPUT

 Demographic  Data collection  Prevalence rate
data of through survey of malnutrition
pregnant questionnaires among pregnant
and interviews women in Rizal,
women (age, Kalinga
education,  Analysis of data
 Identification of
income, etc.) using statistical the associated
 Nutritional software risk factors for
 Identification of malnutrition
knowledge and
risk factors  Development of
practices of associated with a maternal
pregnant malnutrition nutrition
women among pregnant program tailored
 Access to women to the needs of
healthcare  Development of a pregnant women
in Rizal, Kalinga
services maternal nutrition
 Recommendatio
 Availability of program based on
ns for policy
nutritious food the identified risk changes and
options factors interventions to
address
malnutrition
among pregnant
women in the
community.
 Cagayan State University College of Allied Health Sciences

SCOPE AND DELIMITATIONS

The scope of the study "Prevalence and Associated Risk factors of malnutrition

among pregnant women of Rizal, Kalinga: Input for a maternal Nutrition Program" is

limited to pregnant women residing in Rizal, Kalinga, and does not include non-

pregnant women or pregnant women residing in other areas.

The study aims to determine the prevalence of malnutrition among pregnant

women in Rizal, Kalinga, and identify the risk factors associated with malnutrition. It

also aims to provide input for a maternal nutrition program that can address the

identified risk factors and improve the nutritional status of pregnant women in the area.

The study will use a cross-sectional research design and will collect data

through a survey questionnaire and anthropometric measurements. The study will

focus on the following variables: age, education, income, parity, gestational age, pre-

pregnancy weight, weight gain during pregnancy, and dietary intake. The survey will

be conducted on October- December in the year 2023.

The study has several limitations, including the small sample size, which may

not be representative of the entire population of pregnant women in Rizal, Kalinga.

 Cagayan State University College of Allied Health Sciences

SIGNIFICANCE OF THE STUDY

The significance of the study on the prevalence and associated risk factors of

malnutrition among pregnant women in Rizal, Kalinga, is manifold. Firstly, the

findings of the study can contribute to the current knowledge on the nutritional

status of pregnant women in the Philippines, particularly in Rizal, Kalinga. This

can be useful in the development of policies and programs aimed at reducing the

incidence of malnutrition among pregnant women, as well as in addressing the health

and developmental issues that result from malnutrition.

Secondly, the study can help identify the risk factors associated with

malnutrition among pregnant women in Rizal, Kalinga. This can be useful in

developing appropriate and effective interventions that target these risk factors, with

the aim of preventing or reducing malnutrition among pregnant women in the area.

Thirdly, the study can provide input for the development of a maternal

nutrition program specifically tailored to the needs of pregnant women in Rizal,

Kalinga. This can help ensure that pregnant women in the area have access to adequate

care and nutritious diets, which can contribute to their own and their children's survival

and well-being.

Finally, the study can also have implications for the wider field of maternal

and child health, as the findings can contribute to the development of strategies and
 Cagayan State University College of Allied Health Sciences

interventions that can be implemented in other areas facing similar challenges with

regards to malnutrition among pregnant women.

Health intervention: The study can provide valuable information for health

policymakers, stakeholders, and health workers in designing and implementing

interventions to address malnutrition among pregnant women in Rizal, Kalinga. The

findings of the study can be used to develop targeted interventions that address the

specific risk factors for malnutrition in the area.

Improved maternal health: Malnutrition during pregnancy can lead to various

adverse health outcomes, including low birth weight, preterm birth, and maternal

morbidity and mortality. By addressing the risk factors for malnutrition among

pregnant women in Rizal, Kalinga, the study can contribute to improving the overall

maternal health outcomes in the area.

Cost-effective approach: Addressing malnutrition in pregnant women can be a cost-

effective approach to improving maternal and child health outcomes. Preventing

malnutrition during pregnancy can reduce the need for costly medical interventions and

can have long-term benefits for the health and well-being of both the mother and the

child.

Fill the knowledge gap: There is currently a lack of data on the prevalence and

associated risk factors of malnutrition among pregnant women in Rizal, Kalinga. This
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study can help fill this knowledge gap and provide insights into the unique risk factors

and challenges that pregnant women in the area face.

Research contribution: The study can contribute to the existing literature on

malnutrition among pregnant women, particularly in resource-limited settings. The

findings of the study can also serve as a basis for further research on the topic.
 Cagayan State University College of Allied Health Sciences

DEFINITION OF TERMS

Prevalence: The proportion of individuals in a population who have a particular

condition or disease at a specific point in time. In this study, prevalence refers to the

proportion of pregnant women in Rizal, Kalinga, who are experiencing malnutrition.

Malnutrition: A condition that occurs when the body does not receive adequate

nutrients, which can result in stunted growth, underweight, micronutrient deficiencies,

and other health problems. In this study, malnutrition refers to a lack of adequate

nutrients among pregnant women in Rizal, Kalinga.

Associated risk factors: Factors that are known or suspected to increase the likelihood

of a particular condition or disease. In this study, associated risk factors refer to the

factors that contribute to the development of malnutrition among pregnant women in

Rizal, Kalinga.

Maternal nutrition program: A program designed to improve the nutritional status of

pregnant women, which can help prevent malnutrition and other health problems. In

this study, a maternal nutrition program refers to a program that is designed to address

the nutritional needs of pregnant women in Rizal, Kalinga, and improve their health

outcomes.
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Pregnancy: The state of carrying a developing embryo or fetus within the female

reproductive system. In this study, pregnancy refers to the state of being pregnant

among women in Rizal, Kalinga.

Healthcare professionals: Individuals who are trained and licensed to provide

medical care, such as doctors, nurses, and midwives. In this study, healthcare

professionals refer to individuals who are responsible for providing medical care and

nutritional advice to pregnant women in Rizal, Kalinga

 Cagayan State University College of Allied Health Sciences

CHAPTER 2

REVIEW OF RELATED LITERATURE

Malnutrition is a global public health issue and is particularly concerning for

pregnant women, as it can have serious implications for both maternal and fetal health.

In this RRL, we will explore the prevalence of malnutrition among pregnant women

and associated risk factors. This information will be used to develop an effective

maternal nutrition program.

Prevalence of malnutrition among pregnant women: Malnutrition is a

significant public health concern globally, particularly among pregnant women.

According to the World Health Organization (WHO), about 795 million people

worldwide suffer from malnutrition, and it is estimated that about 2 billion people

suffer from micronutrient deficiencies, including pregnant women (WHO, 2021).

Malnutrition during pregnancy is associated with adverse maternal and fetal outcomes,

including poor birth outcomes, an increased risk of maternal morbidity and mortality,

and impaired cognitive development in the child (Daru et al., 2018).

The prevalence of malnutrition among pregnant women varies widely across

different regions and countries. According to a study conducted in Bangladesh, the

prevalence of undernutrition among pregnant women was found to be 29.3% (Mridha

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et al., 2018). In another study conducted in Nepal, the prevalence of undernutrition was

found to be 20.3% (Shrestha et al., 2017). In India, the prevalence of undernutrition

among pregnant women ranges from 15% to 38%, depending on the region

(Ramachandran, 2018). A study conducted in sub-Saharan Africa found that the

prevalence of undernutrition among pregnant women was as high as 46% (Fall et al.,

2017).

Associated Risk Factors:Several risk factors are associated with malnutrition

among pregnant women. These include poverty, lack of education, food insecurity, and

poor dietary intake (Daru et al., 2018). Inadequate dietary intake during pregnancy,

particularly of key nutrients such as iron, folic acid, and vitamin A, can lead to

malnutrition (Daru et al., 2018). Other risk factors include teenage pregnancy, multiple

pregnancies, and chronic medical conditions such as HIV/AIDS, tuberculosis, and

malaria (Daru et al., 2018).Gastrointestinal infections, such as diarrhea and vomiting,

can also contribute to malnutrition among pregnant women by disrupting nutrient

absorption and increasing nutrient losses. (Arndt, M. B., et al. (2010). Chronic illnesses,

such as HIV/AIDS and tuberculosis, can also lead to malnutrition among pregnant

women by reducing appetite, increasing nutrient requirements, and interfering with

nutrient absorption.( Kasonka, L., et al. (2006).

In additiom In low-income countries, malnutrition is often caused by poverty,

limited access to healthcare, and poor maternal education. De-Regil, L. M., Harding, K.
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B., Roche, M. L., & Peña-Rosas, J. P. (2016). Addressing malnutrition in pregnancy: A

review of the evidence and implications for strengthening maternal nutrition

interventions.

Food insecurity and lack of access to safe drinking water can also contribute to

malnutrition among pregnant women. (Frongillo, E. A., & de Onis, M. (2013). Food

insecurity and maternal-child nutrition in Haiti: a longitudinal study and Malnutrition

is one of the major problems in which the physical function of an individual is

impaired to the point that it can no longer maintain adequate body processes such as

growth, physical work, and resistance to or recovery from disease. Malnutrition is

associated with a low economic situation, and poor personal and environmental

hygiene. Recent studies found that the center of the problem is the backward

socioeconomic development of the country. The level of the healthcare services in

Ethiopia is low, even when compared to sub-Sahara African countries. The objective

of this study was to assess the magnitude of malnutrition and associated factors among

pregnant women and lactating mothers.

The World Health Organization (WHO) defines malnutrition as ‘the cellular

imbalance between the supply of nutrients and energy and the body’s demand for them

to ensure growth, maintenance, and specific functions’. Contrary to the common use,

the term malnutrition refers not only to deficiency states but also to excess and

imbalance in the intake of calories, proteins and/or other nutrients.

 Cagayan State University College of Allied Health Sciences

A balanced amount of nutrients is necessary for the proper functioning of the

body system. Nutrition is a fundamental pillar of human life, health and development

throughout the entire life span. Proper food and good nutrition are essential for survival,

physical growth, mental development, performance and productivity, health, and

wellbeing. However, nutrition requirements vary with age, and during physiological

changes such as pregnancy. Pregnancy is such a critical phase in a woman's life when

the expecting mother needs optimal nutrients of superior quality to support the

developing fetus.

Malnutrition manifests itself as a function of many and complex factors that

affect the national child status. It is directly linked to inadequacy in diet and diseases

under living conditions factors that include crisis in household food supply,

inappropriate childcare and feeding practices, unhealthy place of residence and

insufficient basic health services for those in poor socioeconomic situations, cultural

beliefs, and lack of parents’ education, especially that of mothers.

Families with many members is also an important factor related to the

nutritional status of pregnant women and lactating mothers. The reason is that there is

probably not enough time for proper care and enough food for them, increasing the risk

of malnutrition. The effect of large family size with overcrowding and inadequate

spacing has been implicated as a risk factor for the prevalence of malnutrition.
 Cagayan State University College of Allied Health Sciences

Maternal undernutrition is highly prevalent in underdeveloped countries.

Undernutrition and poor health from avoidable causes excessively affect the health of

millions of people in developing countries . Women and young children are the most

affected. Child and maternal undernutrition is responsible for approximately 3.5

million deaths of under-five age children. Undernutrition during pregnancy

physiologically demanding period would result in adverse pregnancy outcomes

Undernutrition makes the women more susceptible to diseases, more risk of having

miscarriages, and give birth to low weight baby whose survival is at risk.

Nutritional status during pregnancy is directly linked to intrauterine growth

retardation (IUGR) and birth weight. Babies with fetal growth restriction are at

increased risk of death throughout infancy. Globally, about 23.8% of newborns

affected by IUGR were born every year. Overall, about 75% of all affected newborns

are born in developing countries.

Nutrition knowledge of pregnant women was significantly associated with

maternal undernutrition. It was negatively associated with maternal undernutrition. The

odds of undernutrition among pregnant women with poor nutritional knowledge were

higher than their counterparts. This finding is similar to a previous study. This could be

possibly due to that poor nutritional knowledge about nutrition usually results in poor

dietary intake leading to undernutrition.

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Malnutrition during pregnancy is a significant public health issue that requires

urgent attention. The prevalence of malnutrition among pregnant women varies across

different regions and countries, but poverty, lack of education, food insecurity, and

poor dietary intake are common risk factors. An effective maternal nutrition program

should be developed to address these risk factors and provide pregnant women with the

necessary nutrients to ensure optimal maternal and fetal health. This program should

focus on education and awareness, access to nutritious foods, and improving the

quality of antenatal care.

 Cagayan State University College of Allied Health Sciences

CHAPTER 3

METHODOLOGY

RESEARCH DESIGN:

This study will use a mixed method specifically, descriptive-correlational

research design will be employed in this study as it determined the association between

the prevalence and the associated factors malnutrition. The researcher will be using

survey questionnaire to determine the prevalence and associated factors among

pregnant women of Rizal Kalinga.

In addition to the survey questionnaire, the study will also use focus group

discussions (FGDs) and in-depth interviews (IDIs) to gather qualitative data. The

FGDs and IDIs will be conducted with pregnant women, their partners or family

members, healthcare providers, and other stakeholders involved in maternal nutrition

programs in Rizal, Kalinga.

By using mixed methods, the study will be able to provide a more holistic

understanding of the issue and inform the development of a maternal nutrition program

that is tailored to the specific needs of the population.

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LOCALE OF THE STUDY

The study will focus on pregnant women in Rizal, Kalinga, who are at risk of

malnutrition due to factors such as poverty, lack of access to healthcare, and cultural

practices. The study aims to provide insights into the prevalence and risk factors of

malnutrition among pregnant women in Rizal, Kalinga, to inform the development of a

maternal nutrition program that can address the specific needs of this population.

SAMPLING DESIGN:

The sampling design for this study will be a multistage random sampling technique.

Stage 1: Selection of Barangays

A list of all the barangays in Rizal, Kalinga will be obtained.

The barangays will be classified based on their proximity to the town center (e.g. near

or far).

Stage 2: Selection of Participants

The researcher will obtain a list of pregnant women from the health center of each

selected barangay.

The list will be used as the sampling frame for the study.

The sample size will be calculated using the following formula: n = Z²pq / E²
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where n = sample size, Z = confidence level (set at 95%), p = estimated prevalence of

malnutrition (50%), q = 1-p, and E = margin of error (5%).

The calculated sample size will be divided equally among the selected

barangays.Participants will be selected through simple random sampling from the list

of pregnant women in each barangay until the required sample size is achieved.

Stage 3: Selection of FGD and IDI Participants

Participants for the FGD and IDI sessions will be selected through purposive

sampling.The researcher will select pregnant women who have experienced

malnutrition or those who are at high risk of malnutrition. The selected participants

will be invited to participate in the FGD or IDI session.

The sample size for this study will be determined by the formula mentioned in Stage 2,

and the number of participants for the FGD and IDI sessions will depend on data

saturation, which means that data collection will continue until no new information or

themes emerge from the data.

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RESEARCH INSTRUMENT:

The survey questionnaire for the research entitled "Prevalence and Associated

Risk Factors of Malnutrition Among Pregnant Women of Rizal, Kalinga: Input for a

Maternal Nutrition Program" will be designed to collect quantitative data on the

prevalence and associated risk factors of malnutrition among pregnant women in the

study area. The questionnaire will consist of the following sections:

Section 1: Demographic Information

This section will collect information on the demographic characteristics of the

participants, such as age, education, occupation, income, and household size.

Section 2: Maternal Health and Nutrition

This section will collect information on the participants' maternal health and nutrition

practices, such as pre-pregnancy weight, current weight, height, and Body Mass Index

(BMI), nutritional knowledge, dietary practices, and use of supplements.

Section 3: Associated Risk Factors

This section will collect information on the potential risk factors associated with

malnutrition among pregnant women, such as poverty, lack of access to healthcare

services, cultural practices, and other socio-economic factors.

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Section 4: Malnutrition Assessment

This section will assess the prevalence of malnutrition among pregnant women using

validated tools such as the Mid-Upper Arm Circumference (MUAC) measurement and

the World Health Organization (WHO) criteria for BMI.

Section 5: Feedback and Recommendations

This section will allow participants to provide feedback on the study and to offer

suggestions for improving maternal nutrition programs in the study area.

The survey questionnaire will be administered in the local language by trained research

assistants to ensure accurate data collection. The questionnaire will be pre-tested with a

small group of pregnant women to ensure clarity and validity of the questions. The data

collected from the survey questionnaire will be analyzed using statistical software to

determine the prevalence and associated risk factors of malnutrition among pregnant

women in Rizal, Kalinga.

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DATA GATHERING PROCEDURE

Identification of Study Participants

The first step in the data gathering procedure is to identify and recruit study

participants. Pregnant women residing in the study area of Rizal, Kalinga will be

identified with the help of local health officials and community leaders. Participants

will be invited to participate in the study and provided with information on the purpose

and procedures of the study.

Informed Consent and Confidentiality

Prior to participation, the study participants will be asked to provide informed

consent. The informed consent process will explain the study objectives, expected

duration of participation, potential risks and benefits, and the right to withdraw from

the study at any time. Participants will also be informed about the confidentiality of

their information and that the data collected will be used only for research purposes.

Data Collection

The data collection will be conducted using survey questionnaires. The survey

questionnaire will be administered in-person by trained research assistants, who will

explain the purpose and instructions for filling out the questionnaire. The survey

questionnaire will be conducted in the local language to ensure that the participants

understand the questions.

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Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs)

In addition to the survey questionnaire, FGDs and IDIs will be conducted with

selected participants to gain a deeper understanding of their experiences and

perceptions related to maternal nutrition. FGDs will be conducted with groups of 6-8

participants, while IDIs will be conducted with individual participants who may have

unique or sensitive experiences related to maternal nutrition.

Data Analysis

The data collected from the survey questionnaire, FGDs, and IDIs will be

analyzed using statistical software to determine the prevalence and associated risk

factors of malnutrition among pregnant women in Rizal, Kalinga. Qualitative data from

FGDs and IDIs will be analyzed thematically to identify common themes and patterns

related to maternal nutrition practices and experiences.

Feedback and Recommendations

The final step in the data gathering procedure will involve providing feedback

to the participants on the study findings and recommendations for improving maternal

nutrition programs in the study area. The feedback and recommendations will be

communicated through a community forum or town hall meeting, where participants

and community leaders can discuss the findings and provide input on potential

strategies for improving maternal nutrition.

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DATA ANALYSIS

The data gathered from this study will be analyzed using both quantitative and

qualitative data analysis techniques.

Quantitative Data Analysis:

Descriptive statistics will be used to summarize the demographic characteristics

of the study participants and prevalence rates of malnutrition.

Inferential statistics such as Chi-square tests, t-tests, and logistic regression will

be used to determine the association between malnutrition and associated risk factors.

Qualitative Data Analysis:

Thematic analysis will be used to analyze the data collected from the FGDs and

IDIs.

The researcher will identify themes and patterns that emerge from the data and

categorize them accordingly.

The themes identified will be linked to the research questions and objectives to

provide a comprehensive understanding of the prevalence and associated risk factors of

malnutrition among pregnant women of Rizal, Kalinga.

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Integration of Quantitative and Qualitative Data:

The results from the quantitative and qualitative data analysis will be integrated

to provide a comprehensive understanding of the prevalence and associated risk factors

of malnutrition among pregnant women of Rizal, Kalinga.

The researcher will triangulate the results from both data sources to validate

and enhance the credibility and reliability of the findings.

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