Linda Afriyie Gyimah

Background: Adequate maternal nutritional knowledge is essential for healthy pregnancy outcomes, yet many pregnant women lack good nutritional knowledge. This study assessed nutritional knowledge and associated factors among pregnant women in the Krowor Municipality of Ghana.Methods: A facility-based cross-sectional study was conducted among pregnant women attending antenatal clinics in two public health facilities. Structured questionnaires were used to collect data on sociodemographic characteristics, obstetric factors, exposure to nutrition education and nutritional knowledge. Data were analysed using descriptive statistics and chi-square tests at a 5% significance level.Results: Most respondents demonstrated moderate nutritional knowledge (mean score = 11.24 ± 2.48), with 45% classified as having moderate knowledge. Compared with the moderate knowledge group, respondents with an income of GHC 1,100 or more were significantly more likely to have high nutritional knowledge (AOR = 2.716, 95% CI: 1.115–6.620, p = .028). Christian respondents (AOR = 0.057, 95% CI: 0.006–0.545, p = .013) and Muslim respondents (AOR = 0.093, 95% CI: 0.009–0.936, p = .044) were significantly less likely to fall into the poor knowledge category than Traditionalists. In contrast, respondents earning GHC 500–700 were more likely to have poor nutritional knowledge (AOR = 3.097, 95% CI: 1.488–6.446, p = .003). Other variables in the model were not statistically significant.Conclusion: The study highlights notable gaps in nutritional knowledge among pregnant women in Krowor Municipality. Socioeconomic and obstetric factors strongly influenced nutritional knowledge. Strengthening antenatal nutrition counselling and improving socioeconomic support may help improve the nutritional knowledge of pregnant women.

Background: Adequate maternal nutritional knowledge is essential for healthy pregnancy outcomes, yet many pregnant women lack good nutritional knowledge. This study assessed nutritional knowledge and associated factors among pregnant women in the Krowor Municipality of Ghana. Methods: A facility-based cross-sectional study was conducted among pregnant women attending antenatal clinics in two public health facilities. Structured questionnaires were used to collect data on sociodemographic characteristics and nutritional knowledge. Data were analysed using descriptive statistics and chi-square tests at a 5% significance level. Results: Most respondents demonstrated moderate nutritional knowledge (mean score = 11.24, SD = 2.48), with 45% classified as having moderate knowledge. Income level (p = 0.00), education (p = 0.007), gestational age (p = 0.042), employment status (p = 0.007), and religion (p = 0.005) were significantly associated with nutritional knowledge. Conclusion: The study highlights notable gaps in nutritional knowledge among pregnant women in Krowor Municipality. Socioeconomic and obstetric factors strongly influenced nutritional knowledge. Strengthening antenatal nutrition counselling and improving socioeconomic support may help improve the nutritional knowledge of pregnant women.

Birth outcomes have been linked to the overall maternal general health, including nutrition, as well as maternal age during pregnancy. Compared to adults, delivery outcomes during adolescence are poor. Nutrient intake and nutritional status during adolescent pregnancy may be linked to birth outcomes. This review aims to identify the association between dietary intake and nutritional status of pregnant adolescents and their maternofetal outcomes. A literature search on nutrient intake and nutritional status of pregnant adolescents (aged 11-19 years), which identified 17 English papers from 1995 to 2019, was reviewed. Papers that did not include data on birth outcomes in relation to nutrient intake or nutritional status were excluded. The review showed that most micronutrients, with the exception of riboflavin, vitamins B12, and C, were below the recommended levels, whilst macronutrient levels were above the recommended levels. Energy intakes were also below the recommended levels. Most studies presented normal hemoglobin levels in the first trimester of pregnancy, but these levels decreased as pregnancy progressed to the third trimester, leading to a high prevalence of anemia. Well-regulated provision and intake of micronutrient supplementation and nutrition education to improve healthy eating habits will significantly reduce poor birth outcomes such as low birth weights (LBW), stillbirths, preterm deliveries, small or large for gestational age (SGA and LGA), and intrauterine growth restrictions in pregnant adolescents. This review provides, to a large extent, evidence to support the importance of adolescent nutrition and birth outcomes. There is a need to implement policies to improve adolescent nutrition through a multisectoral approach.

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13–19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.

Background: Iron Deficiency Anaemia (IDA) is reportedly high in pregnant adults and the causes well studied. However, among pregnant teenagers, the levels and associated factors of IDA are not fully understood.Methods: In a prospective cohort study among Ghanaian pregnant teenagers, aged 13–19 years, IDA prevalence and associated factors were investigated. Sociodemographic data, household hunger scale (HHS), lived poverty index (LPI), FAO’s women’s dietary diversity score (WDDS) and interventions received during antenatal care (ANC) were obtained from 416 pregnant teenagers in Ashanti Region, Ghana. Micronutrient intakes using a repeated 24-hour dietary recall, and mid-upper arm circumference (MUAC) were determined and blood samples analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP).Results: Anaemia (Hb cutoff <11.0 g/dL) was 57.1%; deficient systemic supply of iron stores (31.4%), depleted body stores of iron (4.4%), inadequate dietary iron intake (94.5%), and inadequate multiple micronutrient intakes (49.5%), were all notable among study participants. Between-subject effects using Generalized Linear Modelling indicated malaria tablet given at ANC (p = 0.035), MUAC (p = 0.043), ZPP (p<0.001), ZPP/Hb ratio (p<0.001) and depleted body iron stores (DBIS) (p<0.001) to significantly affect Hb levels. Pregnant teenagers with a high ZPP/Hb ratio (OR = 9.7, p<0.001, 95%CI = 6.0–15.8) had increased odds of being anaemic compared to those with normal ZPP/Hb ratio. Participants who were wasted (OR = 1.2, p = 0.543, 95%CI = 0.6–2.3), and those with depleted iron stores (OR = 3.0, p = 0.167, 95%CI = 0.6–14.6) had increased odds of being anaemic. Participants who experienced hunger were close to 3 times more likely (OR = 2.9, p = 0.040, 95%CI = 1.1–7.8) for depleted iron stores, compared to those who did not experience hunger. Also, participants with inadequate multiple micronutrients intakes (OR = 2.6, p = 0.102, 95%CI = 0.8–8.4), and those with low serum levels of ferritin (OR = 3.3, p = 0.291, 95%CI = 0.4–29.2) had increased odds of depleted body iron stores.Conclusions: IDA is common among pregnant teenagers and the related factors include malaria tablets given at ANC, maternal hunger, maternal MUAC, a deficient systemic supply of iron, depleted body iron stores, ZPP, and ZPP/Hb ratio. Appropriate interventions are urgently needed to address the causes of IDA among pregnant teenagers.

Background: Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana.Methods: As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days’ 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires.Results: The mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents’ dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0–2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1–3.8) for inadequate dietary diversity compared with those with no hunger.Conclusions: Inadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity.

Background: Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana. Methods: As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO women’s dietary diversity index was used to determine dietary diversity score (DDS) of the participants from a 3-day repeated 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires. Results: The mean DDS for participants was 4.3 but 59.7% of participants were below the minimum DD. More rural (67.1%) than urban dwellers (53.9%) had inadequate DDS (p=0.008). Urban dwelling adolescents recorded higher odds for adequate DD (OR=1.8 CI =1.0-2.8, p=0.034) compared to the rural respondents. Other factors associated with higher odds for adequate DD are income (OR=12.1, p = 0.043, 95%CI= 1.1-136.8), moderate (OR=2.1, p = 0.019, 95%CI=1.1-3.8) and high LPI (OR=2.2, p=0.007, 95%CI=1.2-3.9), practicing food aversion (OR=1.6, p = 0.046, 95%CI= 1.0-2.4), and pica (OR 1.6, p =0.043, 95%CI= 1.0-2.5). Conclusions: Low DD is common among pregnant adolescents in this study and associated with poverty, food insecurity, rural living, pica practice, and food aversions. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity.

Background: Inadequate nutritional status during pregnancy can lead to adverse birth outcomes but this is more so for pregnant adolescents as they require nutrients to meet their needs for growth and that of the foetus. The study examined the relationship between nutritional status and birth outcomes among Ghanaian teenagers in rural and urban districts of the Ashanti Region, Ghana.Methods In this prospective cohort study, 416 pregnant teenagers recruited at hospitals/health centres during antenatal care were followed until delivery. Data on weight, height (for body mass index), mid-upper arm circumference (MUAC), and nutrients intake using a repeated 24-hour dietary recall were determined. Blood samples were also taken and analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP). Birth weight, gestational age at birth, type of delivery, and outcome of delivery were collected as each teenager gave birth. Data were analysed using Chi-square (Fisher’s exact) analysis, t-test, two-way ANOVA and multiple linear regression. Results: 15.9% had low birth weight, 12.5% had preterm birth, 11.5% had a postpartum haemorrhage, and 3.1% neonatal deaths. Majority of the participants had inadequate intakes of energy (81.4%), protein (77.2%), vitamins A (97.1%) and E (97.7%), calcium (99.8%), iron (97.6%), folate (93.0%), zinc (83.7%), riboflavin (88.4%), thiamin (74.4%), and fiber (74.4%) intakes. Anaemia and wasting prevalence were 57.1% and 27.8%. Between-subject effects determined using Generalized Linear Modelling indicated MUAC (p=0.058), and gestational age at delivery (p=0.023) significantly affected birth weight. A multiple linear regression analysis indicated MUAC (β=0.283, p=0.002), BMI (β=0.221, p=0.015), gestational age (β=0.285, p2=1.941).Conclusions: Inadequate nutrients intake, anaemia, and LBW were found in these pregnant teenagers. Maternal MUAC, gestational age, and serum ZPP were associated with birth weight. Interventions for improving the nutritional status of teenagers before and during pregnancy are urgently needed to reduce the risk of adverse birth outcomes.