FOOD CRAVING AND AVERSION AMONG FIRST TIME PREGNANT WOMEN IN SELECTED HEALTH FACILITIES IN ENUGU METROPOLIS ENUGU STATE BY MADU NGOZI BENEDETH PG/MSC/09/53793 MSC NURSING DISSERTATION PRESENTED TO DEPARTMENT OF NURSING SCIENCES FACULTY OF HEALTH SCIENCES AND TECHNOLOGY COLLEGE OF MEDICINE UNIVERSITY OF NIGERIA ENUGU CAMPUS APRIL, 2016 FOOD CRAVING AND AVERSION AMONG FIRST TIME PREGNANT WOMEN IN SELECTED HEALTH FACILITIES IN ENUGU METROPOLIS ENUGU STATE 1 BY MADU NGOZI BENEDETH PG/MSC/09/53793 MSC NURSING DISSERTATION PRESENTED TO DEPARTMENT OF NURSING SCIENCES FACULTY OF HEALTH SCIENCES AND TECHNOLOGY COLLEGE OF MEDICINE UNIVERSITY OF NIGERIA ENUGU CAMPUS IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF MASTERS DEGREE IN COMMUNITY HEALTH NURSING SUPERVISOR: DR. NWANERI, A, C. APRIL, 2016 Approval This is to certify that dissertation was originally carried out by Madu Ngozi, Registration number PG/M.Sc/09/53793 in the Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus. 2 …………………………… ………………………. Student Date 3 Dedication I humbly dedicated this work to God Almighty 4 Acknowledgement Unto him that sits upon the throne, with whom I have to do all by His power, I reverently appreciate Him and His loving kindness. With utmost sense of respect and humility, I wish to extend my gratitude to Dr. A Nwaneri, my erudite and worthy supervisor whose efforts make this project work a meaningful achievement and kept encouraging me to go on with her unlimited support and constructive comments in shaping this work without any hesitation. I equally express my gratitude to my Senior lecturer Dr. Mrs. Ogbonnaya .N. and other academic and non academic staff of Nursing Science Department for their contributions in one way or the other to enhance the reality of this project work. I am indebted to my husband Prince Uche Madu for his academic, moral and financial support. My special thanks goes to Rev. Fr. A.I Madu and Rev. Sr. M.C Madu and Rev. Sr. Susan N –Paul for their prayers throughout my period of study. Ifunanya, Chidiebere and Uchechukwu although very young, exhibited a great sense of understanding and calm all through the period of this research work.I wish to acknowledge the high degree of contribution of the Statistician Mr Uche ,typist Miss Oluchi and all those whose ideas have contributed in writing this dissertation (whom I have inadvertently not named here),I owe my gratitude. 5 TABLE OF CONTENTS PAGE Abstract i Table of Contents ii List of Tables v List of Figures vi CHAPTER ONE: INTRODUCTION 1 Background to the Study 1 Statement of Problem 3 Purpose of Study 5 Objectives 5 Research Question 5 Hypotheses 5 Significance of the Study 6 Scope of the Study 6 Operational Definition of Terms 7 CHAPTER TWO: LITERATURE REVIEW 8 Conceptual Review 8 Concept of Nutrition in Pregnancy 8 Nutritional Requirement in Pregnancy 10 Benefits of Good Nutrition in Pregnancy 16 Causes of Poor Nutrition in Pregnancy 17 Consequences of Poor Nutrition in Pregnancy 18 The Effects of Poor Nutrition on the Pregnant Woman 19 Concept of Food Craving in Pregnancy 20 Measures Taken by Pregnant Women to Substitute/Manage Food Craving and Aversion 24 The Reasons for Food Craving and Aversion in First Time Pregnant Women 25 6 Implication of Food Craving and Aversion 29 Demographic Status and Food Craving and Aversion in First Time Pregnant Women 30 Theoretical Review 31 Review of Empirical Studies 35 Summary of Literature and Critical Analysis of Empirical Studies Reviewed 47 CHAPTER THREE: RESEARCH METHOD 49 Research Design 49 The Area of Study 49 Population of Study 50 Sample 50 Instrument for Data Collection 52 Validity of Instrument 53 Reliability of the Instrument 53 Ethical Consideration 53 Procedure for Data Collection 54 Method of Data Analysis 54 CHAPTER FOUR: PRESENTATION OF RESULTS 55 Summary of Major Findings 71 CHAPTER FIVE: DISCUSSION 73 Discussion of Major Findings 73 Implication of the Study 81 Limitation of the Study 82 Suggestions for the Further Studies 82 Summary of the Study 82 Conclusion 84 7 Recommendations 86 References Appendix I: Questionnaire Appendix II: Sample Size Calculation Appendix III: Reliability Appendix IV: Ethical Clearance Certificate Appendix V: Administrative Permission Letter 8 LIST OF TABLES Table 1: Distribution of Sample Size in each Selected Health Facility 52 Table 2: Demography o f the Respondents 56 Table 3: Stage of Pregnancy at which the First Time Pregnant Women Experience Craving 58 Table 4: Types of Food Craved by First Time Pregnant Women 59 Table 5: Stage of Pregnancy at which the First Time Pregnant Women Experience Aversion 61 Table 6: Types of Food Aversed by First Time Pregnant Women 61 Table 7: Reasons for their Specific Food Craving and Aversion 62 Table 8: Awareness of the Implication of Food Craving and Aversion in Pregnancy 64 Table 9: Measures First Time Pregnant Women take to Substitute for Food Craving and Aversion in Order to Meet up with their Required Nutritional Value (needs) 66 Table 10: Association Between Level of Education and Food Craving 67 Table 11: Association Between level of Education and Food Aversion 68 Table 12: Association Between Residential Location and Food Craving 68 Table 13: Association Between Residential Location and Food Aversion 69 Table 14: Relationship between Awareness of Implication of Food Craving and aversion in First Time Pregnant Women 70 9 LIST OF FIGURES Fig 1: Respondents who crave for food 58 Fig 2: Respondents who have aversion for food 60 ABSTRACT 10 This study was aimed at examining the food craving and aversion among first time pregnant women in selected health facilities in Enugu metropolis. The objectives of this study were to determine the type of food first time pregnant women crave for or have aversion to, identify their reasons for their specific food craving and aversion, determine the first time pregnant women’s awareness of the implication of food craving and aversion in pregnancy and to identify measures taken by first time pregnant women to substitute for food craving and aversion in order to meet up with their required nutritional needs. Cross sectional descriptive research design was used for this study. A sample size of 366 respondents who met the inclusion criteria were drawn from the target population of 2000 first time pregnant women using Taro Yameni’s formular. Proportional stratified sampling method was used to select a representative sample size from each randomly selected health facilities and convenience sampling technique was used to reach the respondent. Data was collected using researchers developed questionnaire with a reliability of 0.87. Data collected was analyzed with the help of International Business Machine Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistic which include frequency, percentage, mean and standard deviation were used to analyze and answer research questions. Hypotheses were tested using Pearson Chi- square; level of significance was set at P less than 0.05. The result of the study showed that majority(74.8%) of respondents crave for or averse to at least one food item and the type of food craved for were fruits. The type of food aversed to are beans based products. Majority (42.6%) of the respondents indicated that they do not know most of the effect of food craving and aversion on the health of mother and fetus. Majority (52.7%) of the first time pregnant women do nothing to substitute for food nutrients needed in pregnancy when experiencing food craving and aversion. Based on these findings, it was concluded that first time pregnancy women craved for or averse to at least one food item and majority of the first time pregnancy were not aware of the implication of food craving and aversion in pregnancy. It is recommended that health personnel/nutritionist should be encouraged to educate pregnant women especially the first time pregnant women on nutritional needs during pregnancy and should involve men in nutritional education bearing in mind of male dominance in certain culture and tradition. 11 CHAPTER ONE INTRODUCTION Background to the Study Good nutrition before and during pregnancy builds a healthy fetus and protects the mothers own nutritional health. (Dickason, Silverman & Schultz, 2010). In early weeks of pregnancy significant developmental changes occur that depend on a woman’s nutrient stores. The food pregnant mothers eat on a daily basis affects how their bodies work and how they maintain energy and strength (Handisco, 2014). It also determines the basic nutritional health that their children are born with and provides a model for their eating habits during childhood and beyond. Pregnancy is the time in women’s life when their eating habits directly affect their fetus (Demissie, Muroki, & Makau, 2012). Their decision to incorporate nutritious food into their eating plan during pregnancy will give them strength and helps them to give birth to healthy baby. The risk of giving birth to a low birth weight baby is related to women’s nutritional status (Handisco, 2014). Therefore dietary consumption during pregnancy can have significant health implications for both mother and fetus. (Demissie, Muroki, & Makau 2012). According to Knox (2013) studies showed that maternal nutrition can affect a range of factors including the course of pregnancy and the incidence of prematurity and congenital malformations in the infant. Pregnancy is often accompanied by a variety of nutritionally linked problems that most of the time pregnant mothers have to cope with (Dickason et al, 2010). In order to cope with these problems and to proceed with a successful pregnancy, mothers experience a number of physiological and behavioral adjustments such as food craving and food aversion during pregnancy. Food craving are intense desire to obtain certain foods which are very interesting to the individual and may not be accessible at that time.