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JOURNAL OF RESEARCH IN NATIONAL DEVELOPMENT VOLUME 8 NO 2, DECEMBER, 2010


 

 

SUPERSTITIONS AND NUTRITION AMONG PREGNANT WOMEN IN NWANGELE LOCAL GOVERNMENT AREA OF IMO STATE, NIGERIA

 

Aloysius N. Maduforo

Department of Nutrition and Dietetics, Imo State University, Owerri

E-mail: preciousman179@yahoo.com

Abstract

The effects of traditional belief and taboos on the feeding practices and nutritional status of pregnant women in Nwangele Local Government Area Imo state were assessed. Structured and validated questionnaires were used to obtain information on the socio-economic characteristics, food taboos and feeding practices of the subjects. Anthropometric indices of the subjects were also assessed using weighing scale, height measuring rod and tape. The results of the survey show that 54% of the subjects receive less than N5,000.00 per month;15% of the pregnant women adhere to traditional beliefs and food taboo; 38% of the women were malnourished and 62% were within the range of the expected body weight. Nutrition education should be intensified in health centres and different villages in the local government to help teach pregnant women on healthy food selection and importance of nutrition during pregnancy.

 

Keywords: Taboos, traditional beliefs, nutrition, pregnant women

 


Introduction

All communities have their own cultural (traditional) pattern. The cultural pattern of a group is based on learned behaviour, acquired partly by deliberate instruction on the part of parents, but mostly subconsciously by incidental observation of the behaviour of relatives and other close members of the community, (Ogbeide, 1974).

 

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, (Saba, 1996).

 

Nwangele Local Government Area is one of the local governments located in the rural areas in Imo State of Nigeria. It has its headquarters located at Amaigbo Community. It comprises of ten autonomous communities which include Abajah, Amaigbo, Isu, Umunakara, Umuozu, Di Na Nume, Abba and two other newly created from Abba.

 

In all the communities in Nwangele L.G.A., they have different traditions and beliefs with various cultures and festivals like “Iri-ji festival”, “Owu” in Isu, “Okorosha” in Abajah, etc. The people of the locality engage mostly in subsistence farming, craft, business and civil service. They also have their local markets in their various communities.

 

However, the entire community has about seven (7) health centres serving the ten autonomous communities.

 

Statement of the problem

The problem of malnutrition among women poses a great challenge to nutritionist and the health sector as well as to the government. Malnutrition of the mother does not just affect the pregnant woman only but also has a devastating effect on the foetus (unborn child). Malnutrition has ranked as the major cause of maternal mortality and it is a major determinant of a successful pregnancy and a healthy well nourished baby.

According to UNICEF (2009), each year, more than half a million women die from causes related to pregnancy and childbirth. Nearly 4 million newborns die within 28 days of birth. Millions more suffer from disability, disease, infection and injury. The lifetime risk of maternal death for a woman in a least developed country is more than 300 times greater than for a woman living in an industrialized country.

Africa and Asia account for 95 percent of the world’s maternal deaths, with particularly high burdens in Sub-Saharan Africa (50 percent of the global total) and South Asia (35 percent).

 

These staggering statistics above showed while it is important that the major avoidable causes of maternal mortality and adverse pregnancy outcome are eliminated by looking into the feeding practices of women due to their traditional belief and taboos and also to determine its effect on their nutritional status.

 

Materials and methods

Study area and population

The study was carried out in Nwangele Local Government Area, Imo State. The area was chosen because it is a rural area where there is high probability of getting a more factual and homogenous information and population respectively. A total of 100 pregnant women were randomly selected from seven (7) communities in the local government.

 

Data collection

Structured and validated questionnaire was used to collect data. The questionnaire was designed to elicit information on personal, socio-economic status, food taboos, beliefs and feeding practices of the women. The literate women were given the questionnaire to fill while the illiterate ones were interviewed from the questionnaires and the answers recorded.

 

Anthropometric measurement

Weights of the pregnant women were obtained using portable body weight measurement scale (kg). Height measurement was obtained using measurement rod in centimeters (cm). These were analyzed using the World Health Organisation (WHO) (1995) expected body weight classification.

 

 Determination of weight

The actual weight was determined with a bathroom weighing scale. The weighing scale was checked and adjusted if need be to the zero mark before the subjects mounted the scale and their weight was recorded.

 

Determination of height

Heights were measured with a vertical measuring rod calibrated in centimeters (cm). The subject stood erect looking straight on a leveled surface with heels together and toes apart, without shoes. The moving head piece of the measuring rod was lowered to rest flat on the top of head and the reading was taken to the nearest centimeter.

 

Determination of wrist circumference

The wrist circumference was measured using a cloth tape wrapped around the bony part of the wrist (anatomical point) and the reading was taken to the nearest centimeter.

 

 Determination of frame size

The frame size was determined using the measure height and wrist circumference. Basically, frame size is categorized into three;

1.      Small frame: when the calculated frame size value is greater than 11.0 (FS>11.0) for females

2.      Medium frame: when the calculate FS value is between 10.1 – 11.0 (FS = 10.1 – 11.0) for females

3.      Large frame: when the calculated FS value is less than 10.1 (FS<10.1) for females.

Hence, to calculate the frame size (FS), the following formular was used;

FS = Height (cm)                    

Wrist Circumference (cm)

 

Determination of ideal body weight (ibw)

This is calculated using the height and frame size, Hamwi Formular was used to determine the IBW; 45kg for the first 5feet (60inches) + 2.3kg for each inch over 5feet (medium frame). For small frame, subtract 10% of the calculated value and for large frame add 10% of the calculated value. See examples in the appendix.

 

Determination of additional weight at each stage of pregnancy

Ellie and Sharon (2008) method for weight gain pattern during pregnancy was used to determine the expected additional weight at each stage of pregnancy.

 

For a normal- weight woman, weight gain pattern ideally follows a pattern of 3½ pounds (1.6kg) for the first trimester (12 weeks) and 1 pound (0.45kg) per week thereafter.

 

Determination of expected weight

At each stage of pregnancy, there is an expected weight for each individual, using the ideal body weight and additional weight for each stage of pregnancy. Hence, the formular for expected weight includes;

Expected Weight = IBW + Expected additional weight at each stage.

 

Data analysis

The data were analyzed using the descriptive statistics such as means with their standard deviations, frequencies, and percentages. The association of some selected variables on the Body Mass Index (expected body weight) of the subjects was analyzed using spearman’s correlation co-efficient.

 

Results

One hundred pregnant women completed the study and the result of the survey is shown in the tables below.


 

Table1:            The Existing Traditional Belief and Food Taboos in Nwangele Local Government Area

Name of food

Reasons for taboo/beliefs

Grass Cutter Meat (Nchi)

It delays labour during delivery, except the woman eats the bone of the meat, she cannot deliver

Cocoa Drinks/Beverages e.g. Milo tea, ovatea, etc.

Causes excessive bleeding during labour and delivery

Fufu (Akpu)

Causes the child to be too big

Spaghetti and Indomie

Causes the child to be too big

Beans and Local Plantain (Unene)

Causes the child to be too big

Agidi and Pap

Causes the child to be too big

Snail

Makes the child to excessively salivate

Monkey meat

So that the baby will not have six fingers

Pig meat (pork)

Results to problem in the womb during delivery

Snake

The baby will not walk but only craw

Egg

Makes the child to steal

Kite

Makes the baby to fly

Three leave yam(una) (Dioscorea dumetorum)

Makes the child to have bald head

 

Table 2:                 The Women that Personally Accepts these Beliefs/Taboos on Food and Practices them

Food

Frequency

Percentage

Monkey Meat

-

-

Snake

Grass Cutter (Nchi)

-

3

-

3

Pig Meat (Pork)

-

-

Kite

-

-

Snail

-

-

Cocoa Drinks

1

1

Local Plantain

1

1

Fufu (Akpu)

4

4

Three Leave Yam (Una)

1

1

Beans

3

3

Egg

-

-

Spaghetti

-

-

Indomie

-

-

Pap

2

2

Agidi

Total

-

15

-

15

 

 

Table 3:           Nutritional Status of Pregnant Women by Expected Body Weight

Classification

Frequency

Percentage

Underweight

17

17

Normal

62

62

Overweight

21

21

Total

100

100

 

 

 

Table 4:           Anthropometric Parameters of the Pregnant Women

Parameter

Mean ±sd

Range

Weight (kg)

64.70 ± 12.24

103.00 – 40.00

Height (m)

1.60 ± 0.04

1.71 – 1.44

Wrist Circumference (cm)

12.55 ± 3.38

19.00 – 14.00

Frame Size

10.05 ± 0.53

11.40 – 8.90

Expected Weight (kg)

61.46 ± 6.27

75.00 – 46.60

 


Discussion

Socio-economic characteristics of the subjects

The age of the women ranged from 15 to 50 years. The highest number 48 (48%) of the pregnant women were within the age range of 21 - 30 years. It is also important to note that there is a high incidence of teenage pregnancy in the local government; about 27% of the women are teenagers, which belong to the age range of 15 - 20 years. This is of a great concern in that nourishing a growing foetus adds to a teenage girl's nutrition burden, especially if her growth is still incomplete. Simply being young increases the risks of pregnancy complications independent of important socio-economic factors (Klein et al., 2005).

 

Most of the women were married and live with their husbands about 93 percent while 5% are single, 1% widowed and 1% divorced/separated. The highest number 65 (65%) attended secondary school, 12% stopped their education at the primary school level, 3% did not have any formal education while 20% attended university. "Knowledge is power" is a common adage, lack of nutrition knowledge and the inability to apply the knowledge in everyday life is a very serious threat to adequate nutrition. Poverty and shortage of nutritious foods are of the most important factors related to malnutrition. Everyone needs nutrition education to fight malnutrition (Okoli, 2009). Three accepted facts were stated by Fox, et al. (1995) in the importance of nutrition knowledge and its application. These facts include:

 

Okoli (2009) stated that there is widespread ignorance of nutrition  health benefits of  locally available foods. This precipitates faulty food choices and habit. Poor nutrition education on nutrient requirements as well as food values is common problem worldwide. Also, from the table above, all the women (100%) are Christians. A higher proportion of the women 54% receive income less than N5,000.00 in a month, while 28% receive between five and ten thousand naira monthly, 5% receive between N10,000.00 and N20,000.00 monthly while 13% receive above N20,000.00 monthly. This reveals the level of poverty in the area. Also, most of the women 48% are unemployed, 25% engage in business while alarmingly, only 3% engage in farming. Also, the major communities in the local government have representative sample, Abajah having the highest of 42%, Amaigbo 15%, Isu 11%, Umuozu 5% while Abba and Dim Na Nume had 7% each. Most of the women used in the study are in the second and third trimester stage of pregnancy having 48% and 44% respectively. Only 8% of the women are in their first trimesters.

 

Feeding practices of the subjects

The study reveals that 71% of the women eat 3 meals per day which is the highest while 18% eats more than 3 times per day. The table also revealed that most of the women do not skip any meal, 74% of them, however, the meal they most frequently skip is breakfast (11%) and lunch (14%). Nutritional status is the outcome of food consumed, absorbed and utilized by the body. Hence, weight-loss dieting, even for short periods, is hazardous during pregnancy. Low-carbohydrate diets or fasts that cause ketosis deprive the fetal brain of needed glucose and may impair cognitive development. Regardless of pre-pregnancy weight, pregnant women should never intentionally loose weight (Ellie and Sharon, 2008).

 

It is however, evident in table 2, that these women have different reasons for skipping meals such as limited fund (8%), fear of vomiting (3%), lifestyle (8%), insufficient time to prepare meals (5%), tiredness (2%) and the highest number say that they do not want the foetus to be too big (9%), hence, they skip meals. It is true that about 96% confessed that they are not on weight reducing diet but skipping meals is not good both for the foetus and the mother.

 

Another important parameter in table 2 is their intake of fruits and vegetables, which is the richest way of meeting the needs of micro-nutrients like vitamins and minerals. Only 47% actively engage in daily consumption of fruits and vegetables while 14% rarely consume it. Another way of meeting these needs is by taking their vitamin supplements daily. But however, about 18% rarely engage in the act while 61% rightly take their supplements daily.

 

Alcohol consumption during pregnancy can cause irreversible mental and physical retardation of the Fetus-Fatal alcohol Syndrome (FAS). Of the leading causes of mental retardation, FAS is the only one that is totally preventable. To that end, the surgeon generally urges all pregnant women to refrain from drinking alcohol (United States Morbidity and Mortality Weekly Report, 2004). Table 2 also reveals that  up to 19% of the women drink alcohol within the week, of these, 4% drinks daily, 13% drinks 1 - 2 times in a week and 2% drinks 3 - 4 times in a week. About 59% of the women do not drink alcohol at all.

 

Traditional belief and food taboos in study area

Most women (85%) said there are no food taboos during pregnancy. However, some women (15%) mentioned some of the foods as listed above as the taboos found within Nwangele Local Government Area.

 

Table 3 reveals that fufu (akpu), spaghetti, indomie, beans, local plantain (unene), agidi and pap were seen as taboo because they believed it results to overweight child. Most of these foods such as fufu, spaghetti, pap are good sources of carbohydrate and energy in a rural area like Nwangele Local Government. Pregnancy imposes greater need for energy in the body hence, when all these easy sources of energy foods are forbidden, the women would find little to select food from and hence, monotonous feeding will set in.

 

Also, there is a taboo on egg, snail and beans, which are good sources of protein especially beans that is easily affordable. Also, egg has very high biological value that their consumption could ameliorate the problem of protein deficiency and even other nutrients present in egg and beans. Monkey meat, snake, kite are forbidden but they are not easily available so even when there is no taboo, a pregnant women might not even see it. However, the beliefs placed on them are not scientifically proven. Three leave yam (Dioscorea dumetorum) have been believed to cause bald head but from genetics, it is known that baldness of the head is hereditary and not due to food consumed.

 

Furthermore, cocoa drunks/beverages like milo were believed to cause bleeding during labour while it is an important fast food for breakfast in Nigeria. It contains energy and protein and never results to bleeding.

 

About 15% of the women personally accept and practice one food taboo or more. These taboos on food is not only found in Nwangele Local Government Area, according to Ogbeide, (1974) in the Mid-West of Nigeria, there is also the existence of such taboos on egg, milk, meat, pounded yam, snail, porcupine with similar reasons as the one listed in table 2 above.

 

Nutritional status of pregnant women

Table 3 shows that 62% of the women were within the range of expected body weight while the other 38% were either underweight or overweight. This statistics is abnormal and needs an urgent intervention.

 

Surkan (2004) stated that without adequate nutrition during pregnancy, foetal growth and infant health are compromised. In general, consequences of malnutrition during pregnancy include fetal growth retardation, cognital malformations (birth defects), spontaneous abortion and stillbirth, preterm birth and low infant birthweight. Preterm birth and low infant birthweight, in turn, predict the risk of stillbirth in a subsequent pregnancy. Ellie and Sharon, (2008) says that malnutrition, coupled with low birthweight, is a factor in more than half of all deaths of children under four years of age worldwide.

 

Obese women have an especially high risk of medical complications such as hypertension, gestational diabetes, and postpartum infections. Compared with other women, obese women are also more likely to have other complications of labour and delivery (Young et al., 2002). Overweight women have the lowest rate of low-birthweight infants. However, overweight women are more likely to born post-term and to weigh more than 9 pounds. Large newborns increase the likelihood of a difficulty labour and delivery, birth trauma, and cesarean section. Consequently, these infants have a greater risk of poor health and death than infants of normal weight (Ellie and Sharon, 2008).

 

Of greater concern than infant birthweight is the poor development of infants born to obese mothers. Obesity may double the risk for neural tube defects. Folates role has been examined, but a more likely explanation seems to be poor glycaemic control (King, 2006). In addition, both overweight and obese women have a greater risk of giving birth to infants with heart defects and other abnormalities (Watkins, 2003). An underweight woman has a high risk of having a low-birthweight infant, especially if she is malnourished or unable to gain sufficient weight during pregnancy. In addition, the rates of preterm births and infant deaths are higher for underweight women. An underweight woman improves her chances of having a healthy infant by gaining sufficient weight prior to conception or by gaining extra pounds during pregnancy (Ellie and Sharon, 2008).

 

Weight-loss dieting during pregnancy is never advisable. Overweight women should try to achieve a healthy body weight before becoming pregnant, avoid excessive weight gain during pregnancy, and postpone weight loss until after childbirth. Weight loss is best achieved by eating moderate amounts of nutrient-dense foods and exercising to loose body fat (Krummel, 2007).

 

Conclusion

This study has revealed that there is still an existence of food taboos in Nwangele Local Government for pregnant women and about 15% of them still practice it. Their nutritional status is certainly determined by what they eat because "we are what we eat". However, about 62% has normal expected body weight but 38% of pregnant women in the local government are malnourished.

 

Recommendation

Having seen the discoveries in the survey, in order to salvage the incidence of maternal and preterm death, I therefore recommend the following to be carried out in Nwangele local government area and as well as other localities that practice similar taboos;

Ø  Nutrition intervention such as nutrition education in different villages, health centres and women organizations to be given mainly on the area of food taboos against pregnant women.

Ø  A healthy eating pattern to be taught to these women when they are pregnant and the importance of consumption of fruits and vegetables to supply micronutrients and fibre to the body.

Ø  Husbands should be educated on the importance of their wives' food and nutrition during pregnancy.

Ø  Government should also provide employment to the vast population of women that are unemployed in the area.

Ø  These women should be educated to engage in subsistence farming which will help alleviate the level of poverty and hunger in the area.

 

References

Ellie, W. and Sharon, R. R. (2008); Understanding Nutrition. Eleventh Edition. United States: International Student Edition..

 

Fox, B. A. and Cameron, A. G. (1995); Food Science, Nutrition and Health (6th Ed). Bristol,Great Britain; J. W. Arrowsmith Limited

 

King, J. C. (2006); Maternal Obesity, Metabolism, and Pregnancy Outcomes, Annual Review of Nutrition, 26:271 – 291.

 

Klein, J. D. and The Committee on Adolescence (2005); Adolescent  Pregnancy: Current Trends and Issues, Pediatrics 116:pp281 – 286.

 

Kort, H. I. (2006); Impact of Body Mass Index Values on Sperm Quantity and Quality, Journal of Andrology, 27:450 - 452.

 

Krummel, D. A. (2007); Postpartum Weight Control: A Vicious Cycle, Journal of the American Dietetics Association, 107:37 – 40.

 

Ogbeide, O. (1974); Nutritional Hazards of Food Taboos and Preferences in Mid-West Nigeria. The American Journal of Clinical Nutrition 27:Pp:213 – 216. USA.

 

Okoli, J. N. (2009); Basic Nutrition and Diet Therapy. Nsukka Nigeria: University of Nigeria Press.

 

Saba, I. (1996); Traditional Beliefs and Practices that Affect the Health of Women and Children in Africa. UNFPA/UNICEF Asmara.

 

Singer, L. T. (2002); Cognitive and Motor Outcomes of Cocaine-Exposed Infants, Journal of the American Medical Association 287:1952 – 1960.

 

UNICEF (2008); Maternal and Newborn Health in Nigeria: Developing Strategies to Accelerate Progress. The State of World’s Children 2009. Pp. 19-22

 

Watkins, M. L. (2003); Maternal Obesity and Risk for Birth Defects, Pediatrics, 111:1152 – 1158. American Dietetics Association, 102:241 – 243.

 

World Health Organization (1995); Physical Status and Interpretation of  Anthropometry. Report of a WHO Expert Committee, WHO Technical Report Series 854, Geneva.