Full Project- THE   EFFECT  OF  NUTRITIONAL  EDUCATION  ON THE HEALTH    OF  PREGNANT  WOMEN  IN ODONGUNYAN  AREA  OF  IKORODU IN LAGOS  STATE.

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:

  1. The availability of nutritional education to pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State.
  2. To determine whether antenatal consultation  provide the pregnant women knowledge on nutrition.
  3. 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.
  4. To find out the extent to which nutritional education has improved the lifestyle of  pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State.
  5. 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:

  1. What are the availability of nutritional education to pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State?
  2. In what way do antenatal consultation  provide the pregnant women knowledge on nutrition?
  3. To what extent to which nutritional education matters will influence healthy  lifestyle of  pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State?
  4. To what extent to which nutritional education has improved the lifestyle of  pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State?
  5. 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:

  1. 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.
  2. There is no nutritional education matters on healthy  lifestyle of  pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State.
  3. There is no improved nutritional education on the lifestyle of  pregnant women in Odongunyan  Area  of  Ikorodu in Lagos  State.
  4. 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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