KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY,KUMASI. COLLEGE OF HEALTH SCIENCES SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF COMMUNITY HEALTH BIRTHWEIGHT OF NEWBORNS IN RELATION TO THE NUTRITIONAL STATUS OF PREGNANT WOMEN IN THE ATWIMA NWABIAGYA DISTRICT OF ASHANTI REGION OF GHANA. A DISSERTATION SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES, KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY, KUMASI IN PARTIAL FULFILMENT OF REQUIREMENTS FOR THE AWARD OF MASTER OF PUBLIC HEALTH (MPH) DEGREE IN POPULATION AND REPRODUCTIVE HEALTH. BENTUM JOYCE JUNE, 2011 i DECLARATION I Bentum Joyce, hereby declare that, this is the result of my own hand work and that no previous submission for a degree has been done here or elsewhere. Also the work of others which served as reference has been duly acknowledged. …………………………………. Date……………………………. Bentum Joyce (Student) ........................................................... ………………………………………. Date…................................................ Date………………………………..... Dr. Anthony Edusei Dr. Easmon Otupri (Academic Supervisor) (Head of Department) ii DEDICATION I dedicate this work to the Almighty God who has seen me through my duration of study. I also dedicate this work to my mother Mrs. Esther Bentum for her relentless moral, spiritual and financial support. iii ACKNOWLEDGEMENT Through tiring research and several set- backs, I successfully came out with this project work. I show my endless gratitude to the Almighty God for His protection. Special acknowledgement goes to all the hospital staff of the Nkawie Government Hospital, especially the RCH unit and staff of the Atwima Nwabiagya DHMT. I am also indebted to all pregnant women who voluntarily contributed to the study, without them the study would not have been possible. My work will not be complete if I fail to give a very special commendation to my academic supervisor Dr. Anthony Edusei, for his guidance and correction which resulted in the success of this work. Special thanks also go to Dr. Samuel Blay of Komfo Anokye Teaching Hospital who helped in the analysis of my research results. I wish to thank Prof. (Mrs.) Addy, Mr. Emmanuel Nakua and Mr. Dennis Dekugmen and all lecturers in the department of Community Health who have contributed to the success of this work. To all, I say God richly bless you. iv DEFINITION OF TERMS 1. The Hospital : This refers to the Nkawie Government Hospital 2. The pregnant women: This refers to pregnant women attending antenatal clinic at the Nkawie government Hospital at Nkawie. v LIST OF ABBREVIATION/ACRONYMS ANC Antenatal clinic ACOG American College of Obstetricians and Gynaecologists BMI Body Mass Index DHMT District Health Management Team DNA Deoxyribonucleic acid FAS Foetal Alcohol Syndrome GDHS Ghana Demography and Health Survey GHS Ghana Health Service Hb Haemoglobin HPD Hypertensive Pregnancy Disorders IDA Iron Deficiency Anaemia IPT Intermittent Preventive Treatment IOM Institute of Medicine ITN Insecticide Treated Net IUGR Intrauterine Growth Retardation Kg Kilogramme LBW Low Birth Weight SP Sulphadoxine Pyremithine MCH Maternal and Child Health MDG Millenium Development Goal MUAC Mid Upper Arm Circumference MVMS Multivitamin and Mineral Supplements RCH Reproductive and Child Health RDA Recommended Dietary Allowance vi UK United Kingdom US United States UNICEF United Nations International Children’s Emergency Fund WHO World Health Organization vii TABLE OF CONTENTS PAGE Title page ………………………………………………………………….................................i Declaration……………………………………………………………………………………...ii Dedication………………………………………………………………………………………iii Acknowledgement………………………………………………………....................................iv Definition of Terms………………………………………………………...................................v Abbreviation/Acronyms…………………………………………………………………………vi Table of Contents…………………………………………………………................................viii List of Tables……………………………………………………………………………………xiii List of Figures…………………………………………………………………………………...xiv List of Maps……………………………………………………………………………………...xv List of Appendices………………………………………………………………………………xvi Abstract…………………………………………………………………………………………xvii CHAPTER ONE ….…………..…………………………………………………………………1 1.0 Introduction …………………………………………………………………………………...1 1.1Background Information on nutritional status…………………………....................................1 1.2 Problem Statement……………………………………………………............ ………………4 1.3Rationale of study ……………………………………………………………………………..6 1.4 Conceptual Framework………………………………………………………………………..7 1.5 Study hypothesis………………………………………………………....................................7 1.6 Research Questions …………………………………………………………………………...7 1.7 General Objective …………………………………………………………………………….8 1.8 Specific Objectives ……………………………………………………...................................8 1.9 Organisation of report…………………………………………………………………………8 viii CHAPTER TWO ………………………..……………………………………………………..10 2.0 Literature review ……………………………………………………….................................10 2. 1 Nutrition During Pregnancy ………………………………………………………………...10 2.2 Importance of Nutrition in the Three Trimesters of Pregnancy ……………………………..11 2.2.1 The first trimester …………………………………………………….................................11 2.2.2 The second trimester …………………………………………………................................12 2.2.3 The third trimester ……………………………………………………................................12 2.3 Essential Nutrition during pregnancy ……………………………………………………….13 2.3.1 Protein and Carbohydrate …………………………………………………………………13 2.3.2 Vitamin ………………………………………………………………................................13 2.3.2.1 Vitamin D ……………………………………………………………………………….13 2.3.2.2 Vitamin E ………………………………………………………………………………..14 2.3.2.3 Vitamin K ………………………………………………………………………………..14 2.3.2.4 Vitamin A ………………………………………………………………………………..15 2.3.2.5 Folate …………………………………………………………………………………….15 2.3.3 Mineral needs in Pregnancy ……………………………………………………………….16 2.3.3.1 Iron …………………………………………………………………................................16 2.3.3.2 Calcium ……………………………………………………………………………….....17 2.3.3.3 Zinc …………………………………………………………………...............................17 2.3.3.4 Fatty Acids ……………………………………………………………………………....17 2.3.4 Water……………………………………………………………………………………….18 2.4. Assessment of nutritional Status …………………………………………………………....18 2.4.1 Anthropometry Measusrement …………………………………………. ………………...18 2.4.2 Haemoglobin Measurement ……………………………………………………………….21 2.4.2.1 Classification of Anaemia………………………………………………………………..22 2.5 Determinants of maternal nutritional status ……………………………................................22 ix 2.5.1 Health of mother …………………………………………………………………………..22 2.5.2 Socio- economic Factors …………………………………………………………………..24 2.5.3 Cultural Practices ………………………………….…………………................................24 2.5.3.1Birth Spacing …………………………………….………………………………………25 2.5.3.2 Food Preparation ……………………………………………………..............................26 2.5.3.3 Lifestyle …………………………………………………………………………………26 2.5.3.4 Care given to pregnant mother ………………………………………………………….27 2.5.4 Biological factors ………………………………………………………………………….27 2.6 Pregnancy, nutrition and parasitic infections………………………………………………...28 CHAPTER THREE …………….………………………………………….............................32 3.0 Methodology ………………………………………………………………………………..32 3.1 Study Design and Type …………………………………………………………………....32 3.2 Study Population..……….…………………………………………………………………..32 3.3 Sampling Technique ……….. ………………………………………………………………33 3.4 Sample Size………………...……………………………………………..............................33 3.5 Data Collection Techniques and Tools………………………………………………………34 3.6 Ethical Consideration …………………………………………………….............................36 3.7 Study Area …………………………………………………………………………………..36 3.7.1 Geographical Characteristics ……………………………………………………………...36 3.7.2 Demographic Characteristics………………………………………………………………37 3.7.2.1 Population Size, Growth rate and sex ratio ……………………………………………...37 3.7.2.2 Social and Communication System …………………………………..............................38 3.7.3 Health Profile ……………………………………………………………………………...38 3.8 Study Variables ………………………………………………………….............................40 3.9 Pretest of Data Collection Tools ………………………………………….............................41 3.10 Data Handling and Analysis………………………………………………………………..42 x 3.11 Limitations of Study ……………………………………………………………………….42 3.12 Basic Assumptions ………………………………………………………............................43 CHAPTER FOUR …………….………………………………………………………………..44 4.0 Results ……………………………………………………………………………………. ...44 4.1 Demographic characteristics of the Respondents…………………………………………....44 4.2 Socio economic characteristics of the respondents…………………………………………..45 4.3 Age of gestation at first antenatal care attendance………………………………………......47 4.4 Reason for late antenatal care attendance…………………………………………………....47 4.5 Gestational weight gain………………………………………………………………………48 4.6 Infant birth weight……………………………………………………………………………49 4.7 Anaemia state of pregnant women…………………………………………………………...49 4.7.1 First trimester……………………………………………………………………………....49 4.7.2 second trimester……………………………………………………………………………50 4.7.3 Third trimester……………………………………………………………………………..50 4.8 Gestational weight gain and corresponding birth weight……………………………………50 4.8.1 Gestational weight gain during second trimester and corresponding birth weight………..50 4.8.2 Gestational weight gain during third trimester and corresponding birth weight…. ………51 4.9 Relationship between gestational Hb levels and infant birth weight………………………..52 4.10 Relationship between gestational weight gain and infant birth weight……………............53 4.11 Cultural influence on food intake…………………………………………………………..53