IMPACT OF MANUTRITION AMONG PREGNANCY

ATTENDING BELDAJE M.C.H BOSAASO SOMALIA

BY

HODAN BILLE MOHAMED

BMW/07494/2018

A RESEARCH THESIS SUBMITTED TO THE FACULTY OF

HEALTH SCIENCE, FOR THE PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE AWARD BACHELOR
DEGREE OF MIDWAFRY OF THE UNIVERSITY OF BOSASO

SEPTEMBER, 2022

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 DECLARATION

This study is my original work and has not been presented for degree of any other universities or
institution of learning.

I confirmed that the work reported in this thesis was carried out by the candidate under my
supervision and submitted to the faculty of health science with my approval as the academic
head of (UOB).

Researcher’s name: Hodan Bile Mohamed

Signature---------------------------------

Date-------/-----------/----------------------

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 APPROVAL SHEET

This thesis was submitted to the Senate of University of BOSASO and has been accepted as
fulfillment of the requirement for the Bachelor degree of MIDWAFRY of academic in (UOB)

SUPERVISOR: MR. Sharmake Anger

SIGNATURE------------------------------------------

DATE--------/---------------/----/----------/

DEAN OF FACULTY: Yusuf Mohamed Abdisalan

SIGNATURE------------------------------------------

DATE--------/---------------/----/----------/

ACADEMIC OFFICER

SIGNATURE------------------------------------------

DATE--------/---------------/----/----------/

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 DEDICATION

I dedicate this thesis project to my family for essential and moral support accorded to me those
was greatly facilitated to the successful completion of my project.

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 ACKNOWLEDGMENT

All praise is due to Allah who make me possible to complete to my thesis successfully and easily
and my thanks due to Allah for all thinks, specifically for given me strength, healthy and
intellectual capacity to accomplish this formidable task. After almighty Allah who endowed me
the completeness of this research, I would like to express my deepest thanks to my supervisor
Mr. Sharmake Anger for his helping, guidance, encouragement, constant support, instructions
and appropriate correction that he provided me.
My Appreciation also extends to my instructors who help me to prepare this thesis book.
Also I would like to thank my classmates for the information provided to me when we handling
this research report.
Lastly I would like to acknowledge all my family friends for their moral ideas and materials and
Financial support during the preparation of this thesis book

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TALE OF CONTENT

DECLARATION......................................................................................................................................... 2

APPROVAL SHEET .................................................................................................................................. 3

DEDICATION............................................................................................................................................. 4

ACKNOWLEDGMENT ............................................................................................................................ 5

TALE OF CONTENT ................................................................................................................................ 6

LIST OF TABLES ...................................................................................................................................... 9

LIST OF FIGURES .................................................................................................................................. 10

ACRONYMS ............................................................................................................................................. 11

ABSTRACT ............................................................................................................................................... 12

CHAPTER ONE: INTRODUCTION ..................................................................................................... 13

1.0 Introduction ................................................................................................................................ 13

1.1 Background ....................................................................................................................................... 13
1.2 Problem of the statement................................................................................................................. 15
1.3 Purpose of the study ......................................................................................................................... 16
1.4 Research objectives .......................................................................................................................... 16
1.5 Research questions ........................................................................................................................... 16
1.6 Hypothesis......................................................................................................................................... 17
1.7 Scope of the study ............................................................................................................................ 17
1.7.1 Geographical scope .................................................................................................................... 17
1.7.2 Content scope ............................................................................................................................. 17
1.7.3 Theoretical scope ....................................................................................................................... 17
1.7.4 Time scope ................................................................................................................................. 17
1.8 Significant of the study ..................................................................................................................... 18
1.9 Operational definitions of the key terms .......................................................................................... 19
CHAPTER TWO: LITERATURE REVIEW ........................................................................................ 20

2.0 Introduction ...................................................................................................................................... 20

2.1 Theoretical Framework/Review ........................................................................................................ 20

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 2.2 Conceptual Framework/Review........................................................................................................ 22
2.2.1 Impact of Malnutrition among pregnant women ........................................................................ 23
2.2.2 Socio-economic factors .............................................................................................................. 26
2.2.3 Demographic factors .................................................................................................................. 29
2.2.4 Social culture factors.................................................................................................................. 32
2.3 Related Studies ................................................................................................................................. 32
2.3.1 Related studies among different African countries ....................................................................... 33
2.3.1.1 Impact of malnutrition among pregnant in Ethiopia .................................................................. 33
2.3.1.2 Impact of malnutrition among pregnant in Sudan ..................................................................... 33
2.3.1.3 Impact of malnutrition among pregnant in South Africa ........................................................... 33
2.4 Research Gap .................................................................................................................................... 34
CHAPTER THREE: RESEARCH METHODOLOGY........................................................................ 35

3.0 Introduction ...................................................................................................................................... 35

3.1 Research design ................................................................................................................................ 35
3.2 Research population ......................................................................................................................... 35
3.2.1 Target population ....................................................................................................................... 35
3.2.2 selection criteria of the study ..................................................................................................... 35
3.3 Sample size........................................................................................................................................ 36
3.4 Sampling procedure .......................................................................................................................... 36
3.5 Research instrument ......................................................................................................................... 36
3.6 Validity and reliability of the instrument .......................................................................................... 37
3.6.1 Validity ...................................................................................................................................... 37
3.6.2 Reliability ................................................................................................................................... 37
3.7 Data collection procedures ............................................................................................................... 37
3.8 Data analysis ..................................................................................................................................... 37
3.9 Ethical considerations ....................................................................................................................... 38
3.10 Limitations of the study .................................................................................................................. 38
CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA ........... 39

4.0 Introduction ...................................................................................................................................... 39

4.1 Demographic information of the respondents ................................................................................. 39
4.2 Data presentation, analysis and interpretation of results. ............................................................... 39

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CHAPTER FIVE: FINDINGS, CONCLUSIONS AND RECOMMENDATIONS ............................ 59

5.0 Introduction ...................................................................................................................................... 59

5.1 Findings ............................................................................................................................................. 59
5.2 Conclusion ......................................................................................................................................... 60
5.3 Recommendations ............................................................................................................................ 60
REFERENCES .......................................................................................................................................... 61

APPENDICES ........................................................................................................................................... 63

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LIST OF TABLES

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LIST OF FIGURES

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ACRONYMS

 WHO :word health organization

 UNICEF :United Nations International Children’s Emergency Fund
 MCH: mother child health
 IDPs :- Internally displaced peoples

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ABSTRACT

Introduction

Pregnancy is a critical period during which maternal nutrition has a major effect on a mother’s
and baby’s health. Lack of adequate nutrition of good quality and quantity during pregnancy can
cause health problems for both the mother and her fetus. Maternal malnutrition increases the risk
of gestational anemia, hypertension, miscarriages and fetal deaths during pregnancy, pre-term
delivery and maternal mortality. For newborn, it can cause low birth weight, fetal intrauterine
growth retardation that may have long life consequences on newborn development, quality of life
and health care costs. Malnutrition also has an adverse effect on the development of the immune
system of the newborn. Therefore, identifying malnutrition of pregnancy women and fetal
development relationship is critical.

The purpose of this study is to determine the impact of maternal malnutrition among the
pregnancy women in Beldaje MCH Bosaso Samalia

Research design was cross-sectional study oof30 pregnant women was conducted in Beldaje
MCH

Conclusion

There was a significant relationship between malnutrition and pregnancy women

Recommendation

Nutritional counseling needs to be an integral part of antenatal care in order to reduce the risk of
malnutrition among pregnancy women and its complications.

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CHAPTER ONE: INTRODUCTION

1.0 Introduction

This chapter will consist of background of study, statement problem of the study, objectives of
study, research questions of study, justification of the study, significant of study and scope of the
study.

1.1 Background

Globally micronutrient malnutrition in pregnant women is widespread across regions and

countries. It is estimated that approximately 32million pregnancy women are anaemic
worldwide 19 million suffer from vitamin A deficiency, and millions suffer from insufficient
iron folate, zinc or iodine stores (WHO 2017). Vitamin and mineral deficiencies have been
associated with pregnancy complications and poor birth and infant outcomes. It is calculated
that approximately 20 million barbies are born weight less than 2500g at birth( low birth weight),
the World Health Organization (WHO) advises that intervention be part of an integrated
programme of antennal . In spite of the evidence supporting the efficacy of these interventions, (
UNICEF2017) supplementation programmes in pregnancy, generally implemented in the context
of antenatal care programmes, have had less than optimal results in many countries, including
low intervention coverage and adherence. Reasons, among others, include women’s limited
access to routine and timely antenatal care due to geographic distance, reduced number of
facilities and other gender-related factors affecting women’s access to healthcare, including their
beliefs and motivation about the daily use of the supplements and their own expectations of
care(2017).In worldwide malnutrition according world health organization (WHO) refers to
deficiencies, excesses or in balance take nutrient its well-known maternal play significant roles
in the proper growth and development including future socio economic status of the maternal and
her foetus.Macronutrients and micronutrients deficiencies predispose the foetus to preterm birth
neutral tube defects and low birth weight. (journal of public health policy, 2019).

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Pregnancy women intake of energy and other nutrients. malnutrion in remains unacceptably
across all region of the Africa through promising progress have been made in globally. Primary
studies might not be sufficient to portrait a comprehensive picture of malnutrion during
pregnancy and its made risk factors. Therefore, we intended to review the burden of
malnutrition, for the specific implies to protein energy of malnutrion, during pregnancy of the
world to present its magnitude and determinant factors (ploS one 2019). The pregnancy women
health problems are one of the aspects that attention to and still occur in Indonesia are cases of
chronic energy shortages which can have impact on the health of pregnancy women and babies
caused by factors age, education, employment, family income, parity, and knowledge of
pregnancy women (international journal research and HCR 2018). Frequency of eating and
resting patterns. Maternal malnutrition is a challenging public health issues globally affecting
women in most developing countries and consequently affect their newborns. Such information
however is scantly in the study area and thus we examined the contribution of low dietary
diversity score towards underweight among expectant mothers from rural Ethiopia.(Nigussie
Assefa 2018 )
In Africa Maternal malnutrion a is problem affecting high proportion of pregnant women. The
malnutrition is one of the major problems in which the physical function of mother is impaired
to the point that it can no longer maintain adequate body processes such as physical work, and
resistance to or recovery form diseases. (MEur J MW2019). Malnutrition is a associated with a
low economic and poor personal and environmental hygiene. In malnutrion recent studies found
that the centre of the problem is the backward socioeconomic economic development country in
Africa Maternal malnutrition is a challenging public health issues globally affecting women in
most developing countries and consequently affect their newborns. Such information however is
scantly in the study area and thus we examined the contribution of low dietary diversity score
towards underweight among expectant mothers from rural Ethiopia.The level of the healthcare in
pregnancy women in Ethiopia is low even when compared in other Africa countries like Kenya
and others (2019).

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Premature births and low birth weight for gestational age are more prevalent among women of
lower socioeconomic status More over, poor diet quality duringpregnancy is associated with
lower education and lower awareness about nutritional recommendations during pregnancy, and
a poor pre-pregnancy weight status(associated with lower education (Rifas-Shiman et al.,
2017).Nairobi(August , 2016) CARE international , aleading humanitarian organization , urges
donors to increase assistance for pregnant women and lacing mothers in the drough stricken horn
of africa . of the more than 12 million people currently needing humanitarian assistance in
ethiopia , kenya , Somalia and Djibouti .
An estimated 360,O00 women are pregnancy .
Somalia one in five women in reproductive age Somalia is actually malnutrition. In Somalia
malnutrition in pregnancy and moderate has became a chronic problem in many areas,
prevalence consistently exceeds emergency thresholds. While levels of acute malnutrition
fluctuate over season and among life hood zones, a met analysis of survey taken over the past ten
years shows a national median rate of 16.7% Global acute malnutrition is high and 4.4% for
severe acute malnutrition in the over all population with slightly in IDPS these underline causes
are perpetuated by poverty, low education level , lack of infrastructure, and public services,.
There for the aim of this study to asses impact of malnutrition among pregnancy women in
Beldaje MCH in bosaso district.

1.2 Problem of the statement

There is increasing number of prevalence of malnutrition pregnant women for the last two years
in basso, the number is rough 200 people this year while it was 10 last years in addition to this e
are there are many efforts which is going on to control the situation but has not yet success full
therefore I want to carry out research on impact o of malnutrition among pregnancy women in
Beldaje M.C.H One in five mother of reproductive age in Somalia is acutely malnourished,
compromising a mother own health during pregnant women contributing to the high prevalence
of low birth weight of children more than third of death of children under age five can be
attributed to maternal and child under nutrition. There are number of international NGO and
ministry of health trying to reduce malnutrition among pregnant women but it not yet achieved
tangible result.

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Malnutrition consisting of protein energy malnutrition and micronutrient deficiencies is the most
important risk factors for morbidity and mortality. Particularly hundreds of millions of
pregnancy women are affected malnutrion. Malnutrition in Somalia is multifaceted afffecting
mothers.

1.3 Purpose of the study

The main purpose of the study is to identify impact of malnutrition among pregnancy women in
beldaje MCH in bosaso district.

1.4 Research objectives

Impact of malnutrition among pregnancy women in beldaje MCH in bosaso district

1. To determine demographic impact of malnutrition among pregnancy women in beldaje

MCH in bosaso district
2. To examine the socio economic impact of malnutrion among pregnancy women in bedaje
MCH in bosaso district
3. To evaluate sociocultural impact of malnutrition among pregnancy women

1.5 Research questions

1. what are demographic impact of malnutrition among pregnancy in Beldaje MCH in

bosaso district
2. what are the socio economic impact of malnutrition among pregnancy women in beldaje
MCH in bosaso district?
3. what are the sociocultural impact of malnutrition among pregnancy in beldaje MCH in
basaso district?

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1.6 Hypothesis

H0: There is relationship between malnutrition among pregnancy women

#H1: there is no relationship malnutrition among pregnancy women

1.7 Scope of the study

1.7.1 Geographical scope

This study will focused on to examine Beldaje MCH and Bosaso district.

Somalia is country located In the horn of Africa which officially consists of five federal
members states namely Galmudug,Puntland, Hirshabele, Jubaland, Banadir. Its boundred by
Ethiopia to the west, Djabuuti to the north west, the Gualf of aden to the north, the Somalia sea
and to east, and Kenya to the south west.

1.7.2 Content scope

This study will focused to examine impact of malnutrition among pregnancy women at Beldaje
MCH in Bosaso district

1.7.3 Theoretical scope

This will based on of impact of malnutrition among pregnancy women in Beldaje MCH in
bosaso district

1.7.4 Time scope

The time of study will be in from December 2021 up to May 2022

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1.8 Significant of the study

 MINISTRY OF HEALTH: The maternal mortality rate in 2013 in Somalia was

reported at 62.5 per 100,000 live births, and for children under-five years of age; the
mortality rate was 25 per 100,000 live births (WHO, 2015). Although these rates declined
over years, it is still considered high. All types of malnutrition posses significant threats
to human health.
 DEVELOPING COUNTRIES:- Maternal under nutrition, common in many developing
countries; leads to poor fetal development, higher risk of pregnancy complications and
thus, higher maternal mortality rates (WHO, 2015). Together, maternal and child under
nutrition accounts for more than 10 % of the global burden of disease (WHO, 2015).
 WOMEN, especially of child-bearing age, are considered to be among the most
vulnerable groups for many reasons, such as social and economic inequalities and special
dietary requirements (McGuire et al., 2015). Around half of pregnant women in
developing countries are anemic and this contributes to 20% of all maternal deaths
(WHO, 2012a). In addition; undernourished mothers are more likely to give birth to
underweight babies, of which 20% die before age of five years (WHO, 2012a).
 Future researchers: this study will be important for the future researchers who select
such topics those who will receive more reliable information.

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1.9Operational definitions of the key terms

Impact the action of one object coming forcibly into contact with another. Of expressing
the relationship between a scale or measure and a value.

 MALNUTRITION; refers to deficiencies excesses or imbalance in a person’s intake of

energy and nutrient. Among:: in or through the midst of
 PREGNANCY; is the during which one more of spring developing side the women
(world health organization 2018). Women: an adult female person

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CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter two will contain Introduction, theoretical framework, conceptual frame work,
related study, research gap.

2.1 Theoretical Framework/Review

Word Health Organization (WHO) defines malnutrition as the cellular imbalance between the
supply of nutrients and energy and the body's demands 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, protein, and others
nutrients.( Eur J Midwifery2019)
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 ,gender, and during physiological changes such as pregnancy.
pregnancy is such a critical phase in a women's life when the expecting mother needs optimal
nutrients of superior quality to support the development fetus. ( Eur J midwifery 2019).
Malnutrition manifests itself as a function of many and complex factors that the national child
status. its directly linked to indequancy in deit and disease under living conditions factors that
include crisis I households food supply , in appropriate childcare and feeling practise, unhealthy
place of residence and insufficient basic health services for those in poor socioeconomic
situations cultural beliefs , and lactating of parents ' education, especially that of that mothers. (
Eur J midiwifery 2019) An adequate nutritional status of pregnancy women is essential for the
their health and pregnancy outcame. Due to increased nutritional requirements, pregnancy is a
critical period for for meeting the body's demand for macro/micronutrients.

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Thus anaemia and vitamin A deficiency (VAD) are common micronutrients deficiencies that
affect 53.8 pregnancy women in the word.(Eur Jmidiwifey2019).Poor nutrition in pregnancy, in
combination with infections, is a common cause of maternal and infant mortality and morbidity,
low birth weight and intrauterine growth retardation (IUGR). Malnutrition remains one of the
world’s highest priority health issues, not only because its effects are so widespread and long
lasting but also because it can be eradicated best at the preventive stage4. Maternal malnutrition
is influenced not only by lack of adequate nutrition but also influenced by social and
psychological factors, nutritional knowledge of mothers, and biological changes that influence
perceptions of eating patterns during pregnancies(Eur J midwifery 2019).Many women in Africa
suffer from chronic energy deficiency, inadequate weight gain during pregnancy, and poor
micronutrient status. Insufficient food intake, high energy expenditure, micronutrient-deficient
diets, infections, and the demands of pregnancy and lactation contribute to maternal
malnutrition6.Maternal mortality is unacceptably high. About 800 women die from pregnancy-
or childbirth-related complications around the world every day7. In 2013, 289000 women died
during and following pregnancy and childbirth. (Eur J midwifery).most all of these deaths
occurred in low-resource settings, and almost all maternal deaths (99%) occur in developing
countries. More than half of these deaths occur in sub-Saharan Africa7.Twenty per cent of
maternal deaths in Africa have been attributed to anaemia8. In sub-Saharan Africa, iron and
folate deficiencies are the most common causes of anaemia in pregnant women.(Eur J
midwifery2019).Anaemia has a variety of converging contributing factors, but iron deficiency is
the cause of 75% of anaemia cases. In Ethiopia, antenatal care (ANC) coverage by a skilled
provider in 2011 was 34%. Prevalence of anaemia among pregnant women was 22%, but only
16.8% of pregnant mothers had taken iron tablets during pregnancy9.( Eur J midwifery)Based on
the above, the present study aims to assess the factors associated with malnutrition among
pregnant women and lactating mothers attending antenatal care (ANC) clinics in Meisso Health
Centre, Ethiopia.(Eur J midwifery 2019) .

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2.2 Conceptual Framework/Review

Independent variable Dependent variable

Social demopgraphic

 Age
 Marialsatus
 Education level
Dependent variable
impact of malnutrition among
Social economic factor
pregnancy women
 Occupation
 Income  Miscerriage
 Death
Social culture factor  Pritermal labour

 Attitude
 Beliefes
 Norms

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2.2.1 Impact of Malnutrition among pregnant women

Malnutrition is still a major health concern in both the developed and developing countries.
Maternal mortality and morbidity, intra uterine growth retardation and low birth weight are
commonly caused by poor nutrition and infections during pregnancy. This is evidenced about
5 to 20% of African women being malnourished (low BMI) as a result of chronic hunger.
(Lartey A 2008).
In Bangladesh, India in three selected villages of Sirajganj, Kishoreganj and Tangail districts in
July 2014, across section study was conducted where 56 pregnant and 46 postpartum
women were recruited from community clinics by purposive sampling technique (Salim. F et al
2014). The study found out that, of the 56 subjects studied a significant number of 24
(23.5%) of the pregnant women were found to be underweight by calculating the BMI.
Among the possible reasons that were stated was knowledge about malnutrition in pregnancy
and lack of food in terms of types and amount and types to be taken during pregnancy. Another
cross sectional study done on a sample of 130 pregnant women in Algeria aged 19 –
45 years attending antenatal clinics discovered that 78.46% (more than half) of the 130 pregnant
women were found to be malnourished (39.23% are overweight and 39.23% were obese) and
only 21.54% had a healthy BMI. (S. Taleb; et al 2011). This was due to the sedentary lifestyle
and poor dieting for example 8% of pregnant women in the study reported snacking all day.
According to other survey studies done on malnutrition in pregnant women in the Gulf
region, it was discovered that overweight and obesity were the main problems in these
women. It was estimated that 54 - 70% of pregnant women in this region were overweight or
obese. In other words only 3 to 13% were found to be underweight hence a double burden of
malnutrition. (Abdulrahman .M 2007).

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Some of the factors that was found to be associated with malnutrition included frequent child
bearing and multiple pregnancies which causes several health and nutritional problems
among pregnant women (Abdulrahman .M 2007). Statistics showed that the fertility rate of
the gulf mothers is relatively high (ranging from 4.6 per 1000 women aged 15 -44 years in
Bahrain to 7.1 in both Oman and Saudi Arabia).
In addition, unsound food habits during pregnancy which may affect the weight of the fetus. Few
pregnant women consumed more fresh fruit during pregnancy and this affects their diet. In
Kuwait, Prakash et al discovered that the intake of calcium, iron and vitamin C by
pregnant mothers was below 75% of US recommended daily allowances (RDA), while
among breastfeeding mothers, all nutrients (except protein) were below the RDA.Traditional
beliefs was also found to another risk related to nutrition during pregnancy. For example, in
some areas in the Gulf, mothers decrease their intake during pregnancy believing that extra food
will cause an over large baby, while others believe that they should eat for two.
Majority of pregnant women believe that taking iron supplements may make the fetus big and
results into difficult delivery or even abortion. Finally the other factor was lifestyle where by
many pregnant mothers in the GCC are not employed and very few of them exercise. These
factors contribute to malnutrition (overweight and obese).
Also sedentary lifestyle, having housemaids, cars, televisions, sophisticated home appliances
decrease physical activity of women and together with taking fatty foods increase the weight of
women during pregnancy.
A cross-sectional study (magnitude and determinants of malnutrition among pregnant women in
eastern Ethiopia) done on 1731 pregnant women selected by a cluster random sampling method
discovered that on average, 19.06% of respondents were malnourished, while 23.3% were

underweight (body mass index < 19.8 kg m−2). Women in the 2nd and 3rd trimester had a

66% and almost two fold increased risk of malnutrition as compared to those in the 1st
trimester, respectively. Women with improved eating habits had a 53% lower risk of malnutrition
compared to those who never improved. The risk of malnutrition was 39% lower in subjects who
got prenatal dietary advice than in those who never got one. Therefore it was concluded that
Malnutrition affects at least 1/5 women in the study, calling for priority attention (Haji
Kedir 2014).

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Another cross sectional study carried out in Khartoum, Sudan to examine the prevalence of
underweight, obesity and to identify contemporary socio-demographic predictors in
malnutrition among 1690 pregnant women, revealed that 94 (5.5%) were underweight (BMI of

≤ 19.9 Kg/m2), 603 (35.6% were overweight (BMI of 25 - 29.9 Kg/m2) and 328 (19.4%) were
obese (BMI of ≥ 30 Kg/m2) (Duria A Rayis; et al 2010). Age ≥27 years , ≥ secondary level
education and parity was found to have a high prevalence.
Similarly, parity and social economic status in Tanzania and marital status and employment in
Chilly was found to be positively associated with obesity. Villamor and colleagues (2007)
Furthermore, the cultural perception towards weight and body image may be different in
some settings e.g. obesity could be perceived as a sign of prosperity as opposed to the stigma
that exists in some developing communities.
However Obesity was inversely related to HIV; HIV infection has become more prevalent
and must now be considered as a possible etiological factor for malnutrition among pregnant
women in Sub-Saharan Africa. Malnutrition in HIV/AIDS can be a result of HIV infection,
opportunistic infections and/or highly active antiretroviral therapy. In one study conducted by
Makerere University among HIV-infected pregnant women receiving antiretroviral therapy, it
was discovered that about 15% of the women lost weight over the course of their pregnancies
(Cornell chronicle journal 2012). A matched case-control study conducted in Nigeria found that
HIV-positive women were significantly more likely to have intrauterine growth restriction,
preterm labour than HIV-negative women (Olagbuji BN et al 2010).

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2.2.2 Socio-economic factors

2.2.2.1 Occupation

Women’s employment increases her economic status in their homes, this in particular
improves her nutrition status and household nutrition. Employment may increase women’s status
and power, and may bolster a woman’s preference to spend her earnings on health and nutrition.
However, employed women without control over their income and decision making authority
within the household are deprived of economic and social power and the ability to take actions
that will benefit their own well-being.
According to a survey carried out in Ethiopia where 13,057 pregnant women were studied, it
was discovered that unemployed pregnant women were more likely to be affected by under
nutrition than those working in agriculture, but the pregnant women in non- manual/professional
jobs were less likely to be affected by chronic under nutrition (Bitew et al 2010). This is in
agreement with survey studies carried out in Africa which have indicated that, at similar levels
of income, households in which women have a greater control over their income are more likely
to be food secure (Kennedy and Haddad, 2009

grains, added sugars, and fats are generally inexpensive and readily available in low-income
communities (Drewnowski, 2010; Monsivais & Drewnowski, 2009).
Households with limited resources often try to stretch their food budgets by purchasing
cheap, energy-dense foods that are filling that is, they try to maximize their calories per dollar in
order to stave off hunger (DiSantis et al., 2013; Drewnowski, 2009). While less expensive,
energy-dense foods typically have lower nutritional quality and, because of over consumption of
calories, have been linked to obesity (Hartline-Grafton et al., 2009).
A cross-sectional design and path analytic methods was used in a clinic-based in USA on a
sample of 118 low-income women in their first trimester of pregnancy. Women completed
questionnaires and received training on estimating food portion sizes. Three 24-hour dietary
recalls were collected over 2 weeks. Overall dietary quality on low income pregnant women was
assessed using the Dietary Quality Index (Eileen R. Fowles et al 2011). The results showed that
pregnant women in low-income households are more likely to eat poor diets than their wealthier
counterparts due in part to an inadequate understanding of nutritional requirements and limited
ability to purchase healthy foods, predisposing them to pregnancy complication.

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2.2.2.2 Income status

In many, nutrition is influenced by income and economic growth. Rich people have the capacity
to buy more diverse foods including fruits and vegetables rich in essential vitamins, minerals
and other nutrients plus animal products rich in proteins. (Population reference bureau
2012). Poorer populations often lack access to the right variety of foods and the right amount of
foods, leading to inadequate nutrition. For the poorer populations, economic growth can
boost household incomes, resulting in more spending on food, health, and education, and better
individual health and nutrition. In addition, when national economies are growing,
governments have more to spend on social programs and infrastructure necessary for health
systems to function, thus increasing the overall health and nutritional status of the nation.
Conversely poor people especially in developed countries like the USA are at high risk of
obesity because healthy food is often more expensive, whereas refine

2.2.2.3 Food taboos

In periods of growth and development like in pregnancy, there is increased nutrition demand. It
is estimated that recommended intakes of 14 of the 21 essential micro-nutrients increase during
pregnancy (Allen 2008). In one study among 1274 pregnant women aged 18–45 years from the
UK, it was found that for every 10 mg increase in dietary iron intake, fetal birth weight was
predicted to increase by 70g (Jessica A Grieger 2015). On that note, if women don't take
initiative to feed well, under nutrition can have drastic and wide ranging effects on them and
their children, if not managed optimally. And when it does occur in severe form, usually as a
result of food shortage, very high level of morbidity and mortality are recorded (Picot et al
2012).
According to a cross sectional comparative study on dietary intake carried out among 720
pregnant women in Ogun state Nigeria, it was discovered that 16.1% of women in rural and
19.4% in urban areas believed in food taboos that restricted them from consuming certain foods
which included beans, eggs, fish, plantain all these contributed to maternal malnutrition.

Similar findings were discovered in Burkina Faso, Ghana where women reported having food
taboos (Huybregs et al., 2009; Koryo-Dabrah et al., 2012; Madiforo, 2010).

27
This prevents women from benefiting from the nutrients that are in these foods and in turn
affect their health and that of the unborn child. Imposing of dietary taboos on some
sections of the society, mainly women and children may be in some cases dictated by men's
egoistic motives to preserve exclusive rights to a certain food (Meyer-Rochow 2009).

Several factors have been associated with adherence to food taboos including prim gravidity;
teenage pregnancy; lack of formal education; low household income, signifying low socio-
economic status and a low body mass index (Oni and Tukur, 2012). According to Gillett
(2009), the major problem with food taboos is preventing a pregnant mother from accessing a
well-balanced diet in the belief that transgression of those taboos may harm the mother and
baby. Consequently, any miscarriage, complications during childbirth or baby being born
with certain abnormalities are often believed to be caused by the mother, who may have eaten
certain foods not allowed in pregnancy. A study by Gibbs (2010) in the Wosera area in Papua
New guinea on the disabled and their families indicated that more than 7% of disabilities, in
particular sight loss and limb malformations, are believed to be caused by broken food
taboos.
Also diets and staple foods in Sub-Saharan Africa are often deficient in macro-nutrients and
micro nutrients leading to multi-nutrient malnutrition and micro nutrient deficiencies. These are
often complicated by a high burden of preventable infectious diseases and helminthes
infestations, with dire consequences among children and pregnant women (Abrahams et al
2011). The world Health Organization advocates for community-specific interventions, aimed at
improving the nutrient intake of pregnant women and the girl child, with a view to
optimize their nutritional status (WHO 2012).

28
2.2.3 Demographic factors

2.2.3.1 Age

A cross sectional study carried out in antenatal clinics in Nigeria where a total of 1,387
pregnant women took part, 910 in Owerri urban area and 477 in the rural area surrounding
Owerri (Okwu GN et al 2007). It was discovered that the effect of age on the prevalence of
PEM in pregnant women showed that the age groups, below 20years and 20-24 years,
presented the higher prevalence of PEM of 25% and 11.74% respectively. Their mean BMIs
were significantly lower than those of the other age group. The probable reason is that these
women are still young and their bodies still developing hence they need a-lot of nutrients.
The 24 years and below age group is apparently the group at greater risk for PEM especially in
the rural areas. The age effect although not seen in the urban area was quite prominent in the
rural areas. This is in contrast with a study carried out in Bangledesh, India which showed a
significant deterioration of women’s nutritional status in relation to age where women aged 35
years and above were more malnourished compared with younger women.
Another clinical trial aimed at investigating the effects of age and parity (number of children had
by mother) associated with protein energy malnutrition (PEM) on some biochemical indices in
pregnant women in Enugu metropolis of Nigeria. Serum total protein, albumin, urea, total
cholesterol, creatinine and calcium were evaluated in three groups of female subjects as
part of an investigation on the biochemical changes associated with protein energy malnutrition
(PEM) in pregnant women.
The first group were 52 pregnant women with low total protein (<52g/l), the second group were
50 pregnant women with normal total protein (>52g/l) while the third group were 50 non-
pregnant, non-lactating, apparently healthy women with normal total protein (>63kg). All the
subjects were resident in Enugu metropolis and aged between 20 to 40 years.
The results of all parameters measured for mothers in different age groups divided according to
their level of serum total protein. There was no significant difference in the means of the serum
total protein of mothers of different age ranges and other parameters measured (p>0.05).
Therefore age may not affect the level of serum total protein of a mother and also other
parameters measured.

29
A test of correlation showed that age of mother did not correlate significantly with serum total
protein. However age of mother correlated positively and significantly with parity only (r = +
0.545) (p<0.05) and no other parameter measured (p>0.05 in each case). This agrees with the
study of Okwu et al , which showed that the lower age groups (below 20 years and 20-24 years)
presented higher prevalence of PEM than other age groups, with the effect more prominent in
rural areas than in urban areas.
According to a study carried out in Ethiopia by the demographic and health research (2010), it
was revealed that the prevalence of chronic energy deficiency (under nutrition) by age showed
that women aged 15-19 and 40-49 were most affected, with prevalence of 38.4% in
2000 and 33.0% in 2005 among women age 15-19, and prevalence of 34.9% in 2000 and
30.9% in 2005 among women age 40-49.

2.2.3.2 Marital Status

According to a household survey carried out in Ethiopia by Demographic and health research
(2010), never-married pregnant women were found to be the most affected by under-
nutrition, followed by divorced/separated/widowed women. Among never-married pregnant
women, 35.7% in 2000 and 28.7% in 2005 were chronically undernourished.
Among both rural and urban women for both surveys, those married or living together were the
least affected by chronic energy deficiency. Among the reasons given is the fact that unmarried
adolescent women are often at the bottom of the food chain, with little or no decision-making
power in the household about food distribution, could lead to food security issues and may
contribute to their poor nutritional status.
Moreover, women aged 15-19 need adequate nutrients to support fast physical, mental and
emotional growth. Unawareness of adolescent women about their own health and nutritional
status could be another reason associated with their poor nutritional status.

30
2.2.3.3 Level of education

Studies on autonomy and empowerment of women suggest that, education of a woman promotes
her empowerment and influences participation in decision making in matters concerning
nutrition and access to health services. (Emina et al. 2009). Women who receive even a minimal
education are generally more knowledgeable than those who have no education of how to use
available resources for the improvement of their own nutritional status together with their
families.
In Nigeria, a cross section study was conducted in different antenatal clinics (Government
hospitals and private clinics), where a total of 1,387 pregnant mothers participated, 910 in
Owerri urban area and 477 in the rural area surrounding Owerri (Okwu GN et al 2007). It was
found out that the effect of education level on the prevalence of PEM showed that those with no
formal education and primary education had significantly lower BMI and higher percentages of
PEM than those of other groups. Hence it was concluded that the less educated pregnant women
are, the higher risk of getting PEM. However another study carried out in Nigeria disputed this
showing a negative correlation between level of education and maternal nutrition status.

Therefore education is one of the most important resources that enable women to provide
appropriate care for themselves and unborn child, which is an important determinant of healthy
pregnancies. On that note, increasing the level of education among women decreases incidence
of malnutrition among women plus their unborn children.

31
2.2.4 Social culture factors

2.2.4.1 Attitude

Regarding attitudes, pregnant women may believe there are no advantages in attending ANC in
the first 3 months of pregnancy 37, because ANC is viewed primarily as curative, rather than
preventive (MA Mbule et al 2013). Neema reported that pregnant women do not have
confidence in the health system because of inadequate services and medicines, which in part
contributes to the high usage (73%) of traditional indigenous medicine as an alternative to ANC
in Uganda (MA Mbule et al 2013). Such attitudes and misconceptions contribute to the high
prevalence of malnutrition among pregnant women. Thus, apart from availing all ANC services
and medicines at health facilities, community based health education programs are needed to
correct negative attitudes and misconceptions about ANC.

2.3 Related Studies

The term malnutrition generally refers both to under nutrition and over nutrition, but in this guide
we use the term to refer solely to a deficiency of nutrition. Many factors can cause malnutrition,
most of which relate to poor diet or severe and repeated infections, particularly in
underprivileged populations. Inadequate diet and disease, in turn, are closely linked to the
general standard of living, the environmental conditions, and whether a population is able to
meet its basic needs such as food, housing and health care.
Malnutrition is thus a health outcome as well as a risk factor for disease and exacerbated
malnutrition, and it can increase the risk both of morbidity and mortality.
Although it is rarely the direct cause of death (except in extreme situations, such as famine),
child malnutrition was associated with 54% of child deaths, in developing countries in 2001
Malnutrition that is the direct cause of death is referred to as “protein-energy malnutrition” in
this guide.
Nutritional status is clearly compromised by diseases with an environmental component, such as
those carried by insect or protozoan vectors, or those caused by an environment deficient in
micronutrients. But the effects of adverse environmental conditions on nutritional status are
even more pervasive.

32
2.3.1 Related studies among different African countries

2.3.1.1 Impact of malnutrition among pregnant in Ethiopia

In this study, the overall prevalence of under nutrition among study subjects was 21.8%. Age
greater than 31 years of women (AOR = 0.15; 95% CI: 0.03, 0.93), Birth intervals > 2 years
(AOR = 0.18; 95% CI: 0.04, 0.76), good nutritional knowledge (AOR = 0.34; 95% CI: 0.17,
0.67), and having no dietary change as a result of current pregnancy AOR = 6.02; 95% CI: 2.99,
12.14) were significantly associated with under nutrition.

2.3.1.2 Impact of malnutrition among pregnant in Sudan

Results: Of 1801 pregnant women, 226 (12.5%) were undernourished. Multivariable analysis
revealed that ≤2 antenatal care clinic visits (adjusted OR [AOR]=3.06, 95% CI 1.68 to 5.58) was
associated with under nutrition. Age (AOR=0.90, 95% CI 0.87 to 0.94) and hemoglobin levels
(AOR=0.81, 95% CI 0.67 to 0.97) were negatively associated with under nutrition. There was no
association between parity, education, interpregnancy interval, occupation and maternal under
nutrition.

2.3.1.3 Impact of malnutrition among pregnant in South Africa

23 studies involving 20,672 pregnant women were included. Using a random effect model, the
overall pooled prevalence of malnutrition among pregnant women in South Africa was 23.5%
(95%CI: 17.72–29.32; I2 = 98.5%). Based on the current review pooled odds ratio finding; rural
residency (POR = 2.6%; 95%CI: 1.48–4.65; I2 = 0%), low educational status of partners (POR =
1.7%; 95%CI: 1.19–2.53; I2 = 54.8%), multiple pregnancy (POR = 2.15%; 95%CI: 1.27–3.64; I2
= 0%) and poor nutritional indicators (POR = 2.03%; 95%CI: 1.72–2.4, I2 = 0%) were positively
determine maternal malnutrition. On contrary, better household economic status (POR = 0.47%;
95%CI: 0.36–0.62; I2 = 24.2%) negatively determine maternal malnutrition.

33
2.4 Research Gap

I have encountered many things in this book that have been a challenge have been a challenge
for me in terms of information retrieval writing and address when I was approved. I was even
annoyed at the laptop, and then lost I had collected. there was another challenge which was that
while I was writing the book it was evacuated.
Globally, hunger and malnutrition reduce a Gross Domestic Product (GDP) of a given country
by 1.4–2.1 trillion US Dollar a year. Similarly, malnutrition costs between 3 and 16% annual
GDP of the 54 African countries and for mentioning few as example: Ethiopia 16.5%, Malawi
10.3%, Rwanda 11.5%, and Burkina Faso 7.7%. [2, 6, 7]. Maternal malnutrition also plays a
central role in influencing maternal, neonatal, and child health outcomes [8]. New evidence
indicates the importance of maternal nutrition for the first 2 years of child life for prevention of
stunting and subsequent obesity and non-communicable diseases in adulthood [8, 9]. Similarly,
poor maternal nutrition prior to and during pregnancy is strongly linked with increased risk of
maternal anemia, mortality, and adverse birth outcomes such as Low Birth Weight (LBW) and
Preterm Birth (PTB) [2, 10] though the explanation for this link has been very complex [2, 8].

In Africa Malnutrition in pregnancy remains unacceptably high across all regions of Africa
though promising progresses have been made globally. Primary studies might not be sufficient to
portrait a comprehensive picture of malnutrition during pregnancy and its main risk factors.
Therefore, we intended to review the burden of malnutrition, for this specific review implies to
protein energy malnutrition, during pregnancy in Africa to present its magnitude and determinant
factors.

Somalia, Malnutrition among pregnant women was highly prevalent in the study in Somalia
Interventions aiming to reduce malnutrition should focus on discouraging teenage and
unintended pregnancy, reducing household food insecurity, and promoting antenatal care visits
and encouraging consumption of diversified diets by women. Strengthening the existing network
of the Women’s Health Development Army seems to be very important Malnutrition in
pregnancy remains unacceptably high across all regions of Somalia though promising progresses
have been made globally.

34
CHAPTER THREE: RESEARCH METHODOLOGY

3.0 Introduction

This chapter will present the research design, research population, sample size, sampling
procedure, research instrument, validity and reliability of instrument, data collection procedures,
data analysis, ethical consideration, and limitation of the study Bosaso Somalia.

3.1 Research design

The study design will be in provided information on the factors contributed of malnutrition
among pregnancy women utilize services of Beeldaje MCH Bosaso Somalia

3.2 Research population

The study population of the study will be women of malnutrition among pregnancy women utlize
services in Beeldaje MCH Bosaso Somalia

3.2.1 Target population

Target population will be 6o women of pregnancy who are malnourished by the management at
Beldaje MCH in Bosaso Somalia

3.2.2 selection criteria of the study

3.2.2.1 inclusion criterion

The inclusion criterion of the study will be malnutrition among pregnancy women in Beeldaje
MCH in bosaso Somalia

3.2.2.2 ex-clusioncriterion

The ex-clusion criterion on this study will be women those are not malnutrition at Beldaje MCH
in Bosaso Somalia

35
3.3 Sample size

The sample size of the study will be 30 women of respondents those are malnutrition among
pregnancy women utilize in Beldaje MCH in Bosaso Somalia
The sample size was being determined the slovene’s formula
N= sample size
N= Target population
E=the level of the significance which gives us (0.05)
n= sample size
N= target population
e= margin of errors
N=30
E=0.05
N=N=N/1+N(e)(e2) =30/ 1+30(0.05^2)=
30/1+30(0.0025)=
30/1+(0.0025)=
30/1+(0.075)
30/1.075
27.906
28

3.4 Sampling procedure

The respondents were selected at random, and the sample size chosen will 30 pregnant women.

3.5 Research instrument

The research will be use questionnaire and interview by gathering information from the
respondent these tools are the best ones that being avoided to use because the accurate data could
not be received by using any other method rather than these tools since some people could not
read and write and read will give them questionnaire to fill.

36
3.6 Validity and reliability of the instrument

3.6.1 Validity

The validity of questionnaire will best based on the content and construct validity to ensure that
information which is requesting from the respondent covers all relevant areas and the objectives
of the research to have validity and reliable date the researchers ensured that the questioner will
well formulate which allows error minimization the instrument of inserts to the researchers as
result its capability conveying adequate through information used for the study questioner also
helps to the obtain the actual instrument needed in the research of this work.

3.6.2 Reliability

Reliability refers to the consistency of an instrument demonstrate when applied repeatedly under
some conditions. The reliability of research instrument will establish by the research before
analysis
Analysis and consequent presentation this will achieved by comparing the point and final data
collected.

3.7 Data collection procedures

Data collection is the process of gathering and measuring information on variables of interest, in
established systemic fashion that enables one to answer started research questions and evaluate
outcomes.
The method that researcher used in this study will be questionnaire and FGD. A questionnaire is
research instrument consisting of a series of questions and other prompts for the purpose of
gathering information from the respondents.

3.8 Data analysis

The data collected will analyzed by using Microsoft excel and other programs in the windows of
my computer. The illustrations were then prepared.

37
3.9 Ethical considerations

Ethical research principles were applied. A letter of permission will taken from the University of
Bosaso [UOB] showing that I will prepare my bachelor’s degree on the topic under
consideration. I presented this letter to the MCH beldaje Besides, consent will asked of the
Respondents and anonymity and confidentiality were respected. The privacy of the respondents
will respected. Also, ethical considerations included honesty in reporting the findings.

3.10 Limitations of the study

 Financial effect, data collection, methods and electrical power used and internet will cost
communication.
 Obstacles on the book research
 The time constraints on the research Title economic has become more expensive in the
country due inflation.

38
CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

4.0 Introduction

This chapter present date collected analysis and interpretation from the field the date was
collected using instrument questionnaire and interview guide which was highlighted under the
researcher methodology in this chapter more emphasis has been placed on the interpretation of
row date in relation to the set objectives and research question as set for the study.

4.1 Demographic information of the respondents

Bosaso is located north east of Somali its capital city of Bari region and also its capital business
of puntland its calamity are different seasons it’s hot in summer time and its mild calamity in
other seasons. Bosaso has made development due to sea port and airport and it is the best one
airport in puntland regions Bosaso lives many population approximately eight thousand five
hundred people and they are living in different ways in terms of business and educational
program. Bosaso has five universities and more colleges whose studies for different educations.

4.2 Data presentation, analysis and interpretation of results.

This questionnaire is going to be used solely to assess health status impact of malnutrition among
pregnancy attending beldaje m.c.h in Bosaso district and all information provided was being kept
confidential please feel free to answer the question however you can opt out if you so desire at
any time during the survey

39
The table 4.1 what is your age ?

What is your age ?

Frequency Percentage

15-20 7 23.3%

21-25 16 53.3%

26-30 7 23.3%

Total 30 100%

Figure 4.1 what is your age

40
The table and figure 4.1 what is your age shows the respondent answer 7 respondent said their
age is between 15-20 their percentage is 23.3% and 16 of respondent said 21-25 their percentage
53.3% and 7 respondent said 26-30 their percentage is 23.3%.
Table 4.2 what is your gender?

What is your gender?

Frequency Percentage

female 30 100%

Figure 4.2 what is your gender ?

41
The table and figure 4.2 what is your gender ? respondent said 30 are female their percentage is
100%

4.3 what is your marital status ?

What is your marital status?

Frequency Percentage

single 2 6.7%

marriage 18 60.0%

Divorced 7 23.3%

widow 3 10.0%

Total 30 100%

4.3 table what is your marital status ?

42
4.3 figure what is your marital status ?
The table and figure 4.3 what is your marital status show the answer of respondent said 2
respondent are single and their percentage 6.7% and 18 respondent are marriage and their
percentage is 60.0 % and 7 respondent said divorced and their percentage 23.3% and 3
respondent said widow their percentage 16.0%.

4.4 table what is your level education ?

What is yourlevel education?

Frequency Percentage

Literature 13 43.3%

primary 11 36.7%

secondry 6 20.0%

Total 30 100%

4.4 figure what is your level education ?

43
The table and figure 4.4 what is your level education show the respondent answer 13 respondent
said literature and their 43.3% and 11 respondent said primary and their percentage 36.7% and 6
respondent said secondary and their percentage 20.0%
Table 4.5 what is your occupation ?
What is your occupation?

Frequency Percentage

House wife 13 43.3%

cleaner 6 20.0%

business
11 36.7%
women

Total 30 100%

Figure 4.5 what is your occupation

44
The table and figure 4.5 what is your occupation show the answer of respondent the 13
respondent said house wife and percentage 43.3% and 6 respondent said cleaner and their
percentage 20.0% and 11 respondent said business women and their percentage is 36.7%
Table 4.6 what is your income family

What is your income family?

Frequency Percentage

100 19 63.3%

200 6 20.0%

300 above 5 16.7%

Total 30 100%

Figure 4.6 what is your income family

45
The table and figure 4.6 what is your income family show the answer of respondent the 19
respondent said 100 and their percentage is 63.3% and 6 of respondent said 200 and their
percentage 20.0% and 5 of respondent said 300 above and their 16.7%.
Table 4.7 do you know malnutrition ?

Do you know malnutrition?

Frequency Percentage

yes 24 80.0%

no 6 20.0%

Total 30 100%

Figure 4.7 do you know malnutrition

46
The table and figure 4.7 do you know malnutrition show answer of respondent 24 respondent
said yes and their percentage is 80% and 6 respondent said no and their said no 20% .
Table 4.8 do you know body mass index
Do you Know body mass index?

Frequency Percentage

yes 24 80.0%

no 6 20.0%

Total 30 100%

47
Table 4.8 what is your weight

. What is your weight?

Frequency Percentage

33kg 3 10.0%

44kg 2 6.7%

56kg 16 53.3%

above 60kg 9 30.0%

Total 30 100%

Figure 4.9 what is your weight

48
The table and figure 4.9 what is your weight answer of respondent 3 respondent said 33kg their
percentage 10.0% and 2 respondent said 44kg their 6.7% and 16 respondent said 56kg their
percentage 53% and 9 respondent said above 60kg their percentage 30%

Table 4.10 . In your opinion what are the impact of malnutrition among pregnancy

. In your opinion what are the impact of malnutrition among

pregnancy women

Frequency Percentage

yes 21 70.0%

no 9 30.0%

Total 30 100%

Figure 4.10. In your opinion what are the impact of malnutrition among pregnancy

49
The table and figure 4.10. In your opinion what are the impact of malnutrition among pregnancy
show the answer of respondent 21 of respondent said yes and their percentage is 70.0% and 9 of
respondent said no and their percentage is 30%

Table 4.11 have you every birth malnutrituin child ?

Have you every birth malnutrition child?

Frequency Percenage t

yes 9 30%

no 21 70%

Total 30 100%

Figure 4.11 have you every birth malnutrition ?

The table and Figure 4.11 have you every birth malnutrition show the answer of respondent 9
respondent said yes and their percentage 30% and 21 respondent said no their percentage 70%

50
Table 4.12 are you still suffering from malnutrition ?

Are you still suffering from malnutrition?

Frequency Percentage

yes 6 20%

no 24 80%

Total 30 100%

Figure 4.12 are you still suffering from malnutrition ?

51
The table and 4.12 are you still suffering from malnutrition show the answer of respondent 6 of
respondent said yes and their percentage is 20% and 24 respondent said no and their percentage
is 80%

Table 4.13 are you aware of any antenatal care service avaible ?

Are you aware of any antenatal care service available?

Frequency Percentage

yes 25 83.3%

no 5 16.7%

Total 30 100%

Figure 4.13 Are you aware of any antenatal care service available?

52
The table and Figure 4.13 Are you aware of any antenatal care service available show answer
respondent 25 of respondent said yes and their percentage 83.3% and 5 of respondent said no
their percentage 16.7%
Table 4.14 do you thinks antenatal care and postnatal care important ?

Do you think antenatal care and postnatal care important?

Frequency Percentage

yes 25 83.3%

no 5 16.7%

Total 30 100%

Figure 4.14 Do you think antenatal care and postnatal care important?

53
The table and Figure 4.14 Do you think antenatal care and postnatal care important show the
answer of respondent 25 respondent said yes and their percentage is 83% and 5 respondent said
no their percentage 16.7%

Table 4.15 How many times have you visit to Antenatal care?

How many times have you visit to Antenatal care?

Frequency Percentage

1-2 Times 5 16.7%

. 2-3 Times 4 13.3%

3-4 times 9 30.0%

more 6 20.0%

none 6 20.0%

Total 30 100%

Figure 4.15 How many times have you visit to Antenatal care?

54
The table and 4.15 How many times have you visit to Antenatal care show the answer of
respondent 5 respondent said 1-2 times their percentage 16.7% and 4 respondent said 2-3 times
and their percentage 13.3% and 9 respondent said 3-4 times their percentage 30.05 and 6
respondent said more their percentage 20.0% and 6 of respondent said none and their percentage
20.0%.
Table 4.16 Have you ever take iron folic acid supplements?
. Have you ever take iron folic acid supplements?

Frequency Percent

yes 27 90.0%

no 3 10.0%

Total 30 100%

Figure 4.16 Have you ever take iron folic acid supplements?

55
The table and figure 4.16 Have you ever take iron folic acid supplements show the answer of
respondent 27 of respondent said yes their percentage 90.0% and 3 respondent said no
their percentage is 10.0%
Table 4.17 Do you know what a balanced Diet is?

. Do you know what a balanced Diet is?

Frequency Percentage

yes 27 90.0%

no 3 10.0%

Total 30 100%

Figure 4.17 Do you know what a balanced Diet is?

56
The table and figure 4.17 do you know what a balanced diet is show the answer of respondent 27
of respondent said yes and their percentage is 90.0% and 3 respondent said no their percentage is
10%
Table 4.18 What are the benefits of taking food nutrition duringpregnancy?

. What are the benefits of taking food nutrition duringpregnancy?

Frequency Percentage

Baby`s weight will be

26 86.7%
normal

. Baby`s weight will be

3 10.0%
low

Don`t Know 1 3.3%

Total 30 100%

Figure 4.18 What are the benefits of taking food nutrition duringpregnancy?

57
The table and figure 4.18 What are the benefits of taking food nutrition during pregnancy
show the answer of respondent 26 respondent said baby weight will be normal their
percentage is 86.6%
Table 4.19 . do you have any complication that caused malnutrition?
. do you have any complication that caused malnutrition?

Frequency Percentage

Yes 7 23.3%

No 23 76.7%

Total 30 100%

Figure 4.19 . do you have any complication that caused malnutrition?

58
CHAPTER FIVE: FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

5.0 Introduction

This chapter presents the summary of findings, conclusion and Recommendations of the results
from chapter four as related to the views of Scholars in the literature review and the background
of the study. The Summary and discussion given in this chapter, aim at answering the research
Questions. The conclusion reached is based on the discussion of the findings. The
recommendations are made from the findings and expert opinion from the Literature review. The
areas of further research have been explored emanating from the questions in the entire study.

5.1 Findings

The table and figure 4.1 what is your age shows the respondent answer 7 respondent said their
age is between 15-20 their percentage is 23.3% and 16 of respondent said 21-25 their percentage
53.3% and 7 respondent said 26-30 their percentage is 23.3%.
The table and figure 4.2 what is your gender? respondent said 30 are female their percentage is
100%.
The table and figure 4.3 what is your marital status show the answer of respondent said 2
respondent are single and their percentage 6.7% and 18 respondent are marriage and their
percentage is 60.0 % and 7 respondent said divorced and their percentage 23.3% and 3
respondent said widow their percentage 16.0%.
The table and figure 4.4 what is your level education show the respondent answer 13 respondent
said literature and their 43.3% and 11 respondent said primary and their percentage 36.7% and 6
respondent said secondary and their percentage 20.0%

59
5.2 Conclusion

This research work was designed to examine the impact of malnutrition during
pregnancy among women of. Research questions were formulated and questionnaires
were administered to forty-two (30) respondents in order to gather data for the
research. Results showed that the pregnant women are aware the impact of
malnutrition during the pregnancy. It was discovered that the level of education among
pregnancy women affect their level of food intake in the area of study. The result also
revealed that poor food intake can lead to malformation of the Pregnancy woman.

5.3 Recommendations

During pregnancy, babies are fed by their mothers, meat and egg to children. Some people
believed that when receiving all their nourishments through the placenta and you give a child egg
or meat, the child will start stealing Umbilical cord.
In this way the mother’s body will supply In some places, the forbidden meats are the major her
baby with everything it demands and thus the available sources of animal protein hence people
suffer in mother’s micronutrients level directly affects her baby’s the midst of plenty.
The findings of the study When it comes to eating and drinking, what showed that socio
economic factor is one of the causes of is good for a mother also benefits her child.
These natural consequences in pregnant mothers.
1. Government should sponsor giggles that centers on the usefulness of good nutrition
among pregnancy women
2. Seminars and workshops should be organized regularly for the pregnant women to
educate them on the importance of good nutrition during pregnancy.
3. Pregnant women should be encouraged to eat food rich in vitamins by the health
workers/officials
4. Any women that are in during child bearing should be empowered by government
financially to improve their health living.

60
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Series.
4. Atinmo, M. and F. Akinyele, 1998, Protein Energy Malnutrition, Macmillan Educational
Limited, London.
5. Morley, D., 1997. Pediatrics and Priorities in the Developing World, Butter Warm and co
publishers Ltd: London.
6. Philip, F.B., 1997. Obstetric and Newborn. Saunder Press Limited: Great Britain.
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APPENDICES

QUESTIONNAIRE

About Impact of malnutrtion Among Pregnancy Women

I am Hodan bile Mohamed gelle as student of university bosaso .

I have been selected to be respondent. I would like to conduct a research dissertation about

impact of malnutrition among pregnancy women attendding beldaje MCH in bosaso district . I

would highly you for helping me to have the necessary information for research, aim promising

only. this is request you to answer and complete the questionnaire gently and honestly as your

view. I am appreciating your for devoting valuable time to answer the questions below.

Please tick out the brackets In front of the following questions

Section A: Demographic Factors

1. Age:

a) 15-20 ( )

b) 21-25 ( )

c) 26 -30 ( )

2. Gender:

A) male ( )

B) female ( )

63
3. Marital status

A) Single ( )

B) Marriage ( )

C) Divorced ( )

D) Widow ( )

4. Educational level:

A) Litutatre ( )

B) primary ( )

C) secondry ( )

5. Occupation

A: House wife

B: Cleaner

C:Busniness women

6. Income your family ?

A: 100 ( )

B: 200 ( )

C: above 300 ( )

64
 Section B Malnutrition among pregnancy women

7.Do you know malnutrtion ?

A. Yes ( ) B.No ( )

8. What is your weight?

A. 33kg ( ) B. 44Kg ( ) C.56KG ( ) D. Above 60kg ( )

9. Do you Know body mass index?

A. Yes ( ) B. No ( )

10. What impact can malnutrition have on you ?

A. Yes ( ) B. No ( )

11. she has not yet given birth to malnourished child?

A. Yes ( ) B.No ( )

12. Are you still suferring from malnutrition ?

A. Yes ( ) B. No ( )

If yes ……………………………….

13.Are you aware of any antenatal care service available?

A. Yes ( ) B. No ( )

65
If yes ………………………………….

14.Do you think they are important antenatal care or postnatal care?

A. Yes ( ) B.No ( )

15. How many times should a pregnant women to visit Antenatal care ?

A. 1-2 Times ( ) B. 2-3 Times ( ) C. 3-4 times ( ) D. More ( ) E. None ( )

16. Do you take your iron folic acid supplements?

A. Yes ( ) B. No ( )

17. Do you know what a balanced Diet is ?

A. Yes ( ) B.No ( )

18. What are the benefits of taking nutritious foods during pregnancy ?

A. Baby`s weight will be normal ( )

B. Baby`s weight will be low ( )

C. Baby`s will be Overweight ( )

D. Don`t Know ( )

19. Do you have medical condition that have affected your weight?

A. Nausea ( ) B. Depression ( ) C. Liver Disease D. Ersistent diarrhea ( )

66