THE EFFECT OF NUTRITIONAL EDUCATION ON THE HEALTH OF PREGNANT WOMEN IN ODONGUNYAN AREA OF IKORODU IN LAGOS STATE.
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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Nutritional education is an essential component of antenatal care, helping to promote the health of the pregnant mother and the fetus by creating an awareness of imbibing the culture of eating well through positive change in their nutritional behavior. According to Abu-Saad and Fraser (2010), maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations. Food must be supplied in the right quantity and quality to support the growth and development of the fetus and to improve the health of the mother by making up for the required physiological needs in pregnancy. Drug supplements are not always advisable in pregnancy because some of the women may abuse and misuse drug that may lead to teratogenic effects and other health challenges in pregnancy especially among the rural, poor and illiterate women. Food, when taken, is not prone to the aforementioned abuse and are not dangerous to the growing fetus because the physiological processes in the body has a natural way of removing any nutrients in excess of body need.
Ladipo (2000) confirmed this by revealing that ‘Even in developed countries, prenatal care providers have reservations about the widespread and indiscriminate use of prophylactic minerals and vitamins because of unproven benefits in well-nourished populations, risks of teratogenicity, and side effects. These concerns need to be considered in the context of developing countries’.
Health education intervention programme has always been attested as an efficacious tool to impart positive changes in health behavior and will only be propitious when the appropriate facilities are harnessed to achieve the predetermined goals of behavioral change which is primordial to health education enterprise (Adams, 2010).
Nutrition education is a component of health education that helps to create awareness on how to source, prepare, combine and use food resources for promoting good health among all groups of human being. The focus of this research intervention was the physical application of fruits and vegetables consumption education with backup provision of readily available and financially accessible fruits and vegetables among pregnant women to improve their knowledge and motivate their positive behavioural change towards consumption.
Several studies have copiously established the fact that among many aetiological variables in illness and diseases, nutritional factors contribute almost preponderantly to the burden of preventable non-communicable diseases and premature death all over the world (WHO, 2003;Beaglehole and Yach, 2003). Having adequate diet which contains essential nutrients at its right proportion is said to be indispensable for the promotion of good health and wellbeing at every state and stage of life including pregnancy. It has also been evidently reported that dietary regimen that is high in fruits and vegetables are associated with preventing and treating metabolic syndrome (Feldeisen and Tucker, 2007). Fruit and vegetables consumption has been significantly reported to have led to reduced incidence of many non-communicable diseases such as cardiovascular conditions, some type of cancers, overweight and obesity with all its attendant ill health conditions like arteriosclerosis, musculoskeletal conditions, and so on (Donaldson, 2004). It is then obvious that failure to consume adequate quantity of fruits and vegetables may increase individual’s susceptibility to the aforementioned non-communicable diseases. Research in the field of health promotion and education has embarked on concerted effort to increase fruits and vegetables intake all over the world (WHO, 2003). Studies also revealed that women have low dietary intake of fruits and vegetables (Kimberly, Joanna, Jill, Marcia and Jesse, 2012); and several reasons have been said to bedevil fruits and vegetables consumption such as: high cost of purchase, environmental availability, lack of knowledge and socio – economic status while a handful of such studies have focused on barrier and enabling factor s to fruits and vegetables intake among pregnant women in Nigeria. Many studies have reported that Nigerians have not satisfactorily imbibed the culture of fruits and vegetables consumption especially among the urban and suburban dwellers (Ladipo , 2000).
Though, the rural agrarian dwellers may take more of local vegetables which are rich in vitamins and minerals if properly prepared due to accessibility, but there is no relevant data to determine whether the recommended quantity is been consumed by the local community members of Nigeria. In U.S. where several intervention programmes have been embarked upon by researchers to improve fruits and vegetables consumption, it is still being reported that no satisfactory significant increase has been recorded among adults between the year 1988 –1994 and 1999 –2002 and that, there is a mean daily decreases in consumption among adolescents (Larsen, Harris, Ward and Popkin, 2007).
Several counseling programmes have been adopted by community obstetrics and gynecologists, community midwives and community extension workers during antenatal clinic at both the hospitals and health centres to boost fruits and vegetables intake among pregnant women in Nigeria but not much of a success has been recorded in this direction.
So far, a handful are said to comply. Fruits and vegetables are rich sources of vitamins, minerals, fibres and they also contain antioxidative properties (Elbagermi, Edwards and Alajtah, 2012). The benefits and importance of fruits and vegetables in pregnancy are great and enormous. They include prevention of allergies in children such as wheezy babies and Eczema (Kristie – Leong, 2010) and prevention of some teratogenic ill health conditions such as spinal bifida and Neural Tube Defect (NTD). Fruits and vegetables contain high cellulose and fibres which provide benefit such as good bowel movement.
They serve as natural laxatives that prevent constipation which may eventually cause haemorrhoid and anal fistula post-nataly, if not adequately prevented in pregnancy. Fruits and vegetables contain beta-carotene, needed for baby’s cells and tissues development, vision and immune system while vitamin C is crucial for baby’s bone and teeth, and collagen in baby’s connective tissue. Folic acid helps to prevent neural tube defect and promote a healthy birth weight which makes delivery easier and prevents complications associated with second stage of labor such as laceration. The mineral and vitamin components in fruits and vegetables may prevent disease associated with toxaemia in pregnancy such as high blood pressure (P.I.H), proteinuria, pedal-edema and its associated complications. The word vegetable embraces a preponderance of plant foods.
According to Olusanya (2008) vegetables can be broadly classified into root v egetables such as carrots, parsnips and turnips, tubers vegetables e.g. potatoes, yams and coco yams, green leafy vegetables, e.g. spinach, cabbage, lettuce, water-leaf, bitter-leaf, pumpkin, amaranthus etc., fruits vegetables such as tomatoes, cucumber, okra, water melon etc and seed vegetables e.g. peas, lentils, soya-beans etc. for the purpose of this intervention, the main focus is on the green leafy vegetables because of its richness in minerals and vitamin components coupled with their accessibility and affordability. They are said to be very rich in calcium, iodine, phosphorus, iron and sulphur. It is however reported that the presence of phytic and oxalic acids in them, tend to bind calcium and iron in the vegetables and distort the bioavailability of these minerals from the vegetables. Vitamins A, B – complex, C and K are also present in varying amount and the carotene pigments present in some vegetables such as carrot, serve as a good precursor for vitamin A (Olusanya, 2008). While encouraging consumption of vegetables, it is important to educate on the preparation and consumption of these vegetables because the rich component of vitamins and minerals may be lost during preparation for example, a great percentage of the mineral elements and water soluble vitamins (B – complex and C) leak out into the boiling water during preparation which our vegetables are exposed to before cooking. Also, the process of re-warming our vegetable soups is a remarkable process of reducing its nutrients. In the case of fruits, they are primarily rich in vitamin C and cellulose, because they are commonly eaten raw, the greater amount of the vitamins are retained when consumed since they are not exposed to heat and other process that could lead to the loss of their essential nutritive components.
Fruits are made up of appreciable quantity of carbohydrate in varying forms. The main carbohydrate found in unripe fruits is in form of polysaccharides (starch), but when they are ripe, the polysaccharide is converted to monosaccharide(Fructose and Glucose). Many of the available fruits also contain some minute quantity of carotene and the vitamin B groups. Except for pears which are rich in fat, fruits are poor source of fat and contain an insignificant quantity of protein i.e. poor source of protein. Fruits are said to contain different kinds of organic acids such as citric acid commonly found in pineapples, tomatoes and other citrus fruits, tartaric acid found in grapes, oxalic acid found in unripe tomatoes and strawberries, linoleum acid found in avocadoes pear. To increase the palatability of fruits and make it more acceptable, it can be prepared in various dishes or forms such as fruits salad where different fruits are used like the combination of banana, water melon, cucumber, pawpaw, pineapples, and other fruits according to the taste of the individual.
Also, banana fritters, pawpaw fool, mango fool, pineapple drink and grape fruits and drink are forms in which fruits can be prepared for consumption. The Millennium Development Goals are a framework globally agreed for measuring development, progress, and poverty reduction through focusing efforts on achieving significant measureable improvement in people’s lives.(WHO, 2005, World Bank, 2005). Goal 5 which is the target of this intervention research is to improve maternal health indices which include good motherhood, ante-natal care including nutrition in pregnancy (The focal point of the study), good environment for child delivery and comprehensive postnatal care.
The introduction of nutrition education has been a program authorized to communities including Odonguyan area of Ikorodu Local Government Area of Lagos state for a nutrition education program that targets pregnant women, nursing mothers, children, parents, and food service workers. Appropriators have not funded the program since 1998. There are two health centres which are Ebute General Hospital , Ikorodu and Agbala Health centre.
The inception of these health centres were as a result of combination of educational strategies, accompanied by state government supports, designed to facilitate voluntary adoption of nutritional education programmes towards the pregnant women and nursing mothers and their well-being. The health centres have been found to engaged in all sorts of nutritional education to the communities primary health care services. The services rendered are to promote good healthy lifestyle of pregnant women, and prevention of all sorts of diseases. These services intend to provide lasting background for achieving social, mental, economic and intellectual development of the pregnant women in Odonguyan communities.
The aforementioned situations have not improved yet in Nigeria because the maternal mortality rate of 704 (2003), 840(2008), 630 (2010), 560 (2013) per 100,000 live birth (NPC, 2003, 2008, 2010, 2013) and NDHS, 2003, 2005) is alarming and unacceptable. Nigeria accounted for about 13% of the global maternal death with an estimated 36,000 women dying in pregnancy or at child birth each year (World Bank, 2011). Nigeria also has about 260,000 neonatal deaths annually, 13% of which can be prevented with live saving interventions such as provision of required maternal health medicines and supplies (Onyebuchi, 2015).
Accessibility to health care will affect the nutritional status and roles of pregnant women. The woman is the first health care provider within the household. A woman’s knowledge of good health and nutrition practices is crucial. This knowledge may be gleaned from school, older family members or other informal networks. Pregnant women should have the preventive knowledge of health. This will enable them to carry out their preventive multiples roles as producers, mothers and child minders. Antenatal, intranatal and postnatal care affect the viability of infants and the survival of mothers nutritional care, protect growth and development and ensure better health for pregnant and lactating women. Nutrition of well-balanced eating adherence is one of the greatest gifts a pregnant woman can give to her soon to-be-born baby. Adopting a healthy nutrition adherence before pregnancy is ideal. The eating and supplying of one’s body with a tasty blend of nutritious food can improve fertility, keep the health during pregnancy and pave the way for an easy labour. This can also help to establish essential building blocks of growth and overall health for the expected child. It is against this background that the researcher intend to carry out research study on the effect of nutritional education on the health of pregnant women in Odongunyan Area of Ikorodu In Lagos State.
1.2 Statement of the Problem
In recent times, Odonguyan communities have her own cultural (traditional) pattern of taking care of their pregnant women. Ignorance and food taboos in the community results in poor nutritional quality. Improving the nutritional value of the pregnant women by itself will not eliminate the problems. Training and nutrition education of the mothers is necessary to change feeding practices and provide correct information.
Food taboos among rural women have been identified as one of the factors contributing to maternal undernutrition in pregnancy. Pregnant and lactating women in various parts of the world are forced to abstain from nutritious and beneficial foods. In various studies, it was seen that pregnant women in various parts of the world are forced to abstain from nutritious foods as a part of their traditional food habits.
The cultural pattern of a group is based on learned behaviour, acquired partly by deliberate instruction on the part of community leaders, but mostly subconsciously by incidental observation of the behaviour of relatives and other close members of the community. Traditional beliefs and attitudes influence women’s health. Even when women have access to appropriate healthcare, they often prefer home/community based care. Women’s overall health and nutritional status, pregnancy outcomes and other reproductive health problems are considered to be the major biological causes of maternal mortality; therefore, the overall nutritional status of a pregnant woman is principally determined by the feeding practices and care facilities available to her.
The immediate problems of traditional beliefs, inadequate knowledge of pregnant women stem from the proper nutrition are inadequate diet leading to multifarious problems in pregnancy. It is against this background that the researcher sought to find out the effect of nutritional education on the health of pregnant women in Odongunyan Area Of Ikorodu In Lagos State.
- Purpose of the Study
Some of the purposes of this study are:
- The availability of nutritional education to pregnant women in Odongunyan Area of Ikorodu in Lagos State.
- To determine whether antenatal consultation provide the pregnant women knowledge on nutrition.
- To find out the extent to which nutritional education matters will influence healthy lifestyle of pregnant women in Odongunyan Area of Ikorodu in Lagos State.
- To find out the extent to which nutritional education has improved the lifestyle of pregnant women in Odongunyan Area of Ikorodu in Lagos State.
- To identify those factors affecting nutritional knowledge and habit in Odongunyan Area of Ikorodu In Lagos State.
- Research Questions
The research questions are as follows:
- What are the availability of nutritional education to pregnant women in Odongunyan Area of Ikorodu in Lagos State?
- In what way do antenatal consultation provide the pregnant women knowledge on nutrition?
- To what extent to which nutritional education matters will influence healthy lifestyle of pregnant women in Odongunyan Area of Ikorodu in Lagos State?
- To what extent to which nutritional education has improved the lifestyle of pregnant women in Odongunyan Area of Ikorodu in Lagos State?
- What are those factors affecting nutritional knowledge and habit in Odongunyan Area of Ikorodu In Lagos State?
1.5 Research Hypotheses
The following null hypotheses will be tested for this study:
- There is no basic knowledge of pregnant health services of nutritional education on the health of pregnant women in Odongunyan Area Of Ikorodu In Lagos State.
- There is no nutritional education matters on healthy lifestyle of pregnant women in Odongunyan Area of Ikorodu in Lagos State.
- There is no improved nutritional education on the lifestyle of pregnant women in Odongunyan Area of Ikorodu in Lagos State.
- There is no significant influence of nutritional programmes on the lifestyle of pregnant women in Odongunyan Area of Ikorodu In Lagos State.
1.6 Significance of Study
The research study will creates awareness on nutritional knowledge of pregnant women and non pregnant women, individual citizens, government agency, ministry of health in Nigeria.
This study might be beneficial to the government through the ministry of health, women affairs ministry will be acquainted with correct facts to challenges to nutritional knowledge and habits of pregnant women.
The study will help to discourage poor nutritional knowledge habits among the pregnant women through intervention programmes organized by the state ministry of health while organizing lectures on food and nutrition for pregnant women, health education, diet control services for individual pregnant women.
The study will enhance government agency to sponsor nutritional knowledge orientation through mobile film shows, documentary films, public lectures and, if possible, visitations to sports institute and national stadiums.
1.7 Delimitation of Study
This study is delimited to the following:
A total of 120 Pregnant women in Odonguyan in Ikorodu L.G.A., of Lagos State will be selected.
This study is delimited to pregnant women in Odonguyan in Ikorodu L.G.A., of Lagos State.
The population of study includes all the Lagos State Pregnant women in Odonguyan in Ikorodu L.G.A., of Lagos State.
1.8 Limitation of the Study
The limitation of study will be based on the outcome of study in chapter four of this study. Also the problems of restricted information from the respondents.
1.9 Definition of Terms
Nutrition: This is the provision, to cells and organisms, of the materials necessary (in the form of food) to support life. It is often classified either as proper foods (Carbohydrates, proteins and fats) for the supply energy or as accessory foods (water, inorganic salts and vitamins) which are essential for life but do not supply energy.
Health: It is described as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.
World Health Organisation (WHO): recognized health institution established by the United Nations (UN).
Environmental health services: These are medical professional services which is rendered through monitoring and control activities of medical personnel.
Health Education: This is planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions.
Health Practice: This is positive behaviour that would either promote or maintain good health and prevent diseases.
Physical exercise: This is any bodily activity that enhances or maintains physical fitness and overall health or wellness.
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