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February 1997, Volume 47, Issue 2

Nutrition Related Studies

Assessment of Nutritional Beliefs and Practices in Pregnant and Lactating Mothers in an Urban and Rural Area of Pakistan

Shahid Mahrnood  ( Department of Community Medicine, Allama Iqbal Medical College, Lahore. )
Muhammad Fayyaz Atif  ( Department of Community Medicine, Allama Iqbal Medical College, Lahore. )
S.S. Azhar Mujeeb  ( Department of Community Medicine, Allama Iqbal Medical College, Lahore. )
Naira Bano  ( Department of Community Medicine, Allama Iqbal Medical College, Lahore. )
Humaira Mubasher  ( Department of Community Medicine, Allama Iqbal Medical College, Lahore. )

Abstract

Nutritional beliefs and practices in 100 pregnant and 100 lactating women were assessed in an urban and rural area of Lahore. A structured questionnaire was used for the purpose. Seventy seven percent women and 54% of their husbands were illiterate, 50.5% belonged to a family with a per capita income of more than Rs.300.oo per month, 52.5% had 7 or more family members and 56% were living in nuclear families. The age of mothers, type of family, literacy, family income, parity and gravidity had not significantly influenced the nutritional beliefs and practices, only urban and rural differences were statistically significant. Eight-four percent of mothers had knowledge that diet should be changed by increasing, adding or avoiding some special food items in the diet during pregnancy and lactation, but only 65.5% practiced them. The reasons for this deficient knowledge and practice of dietary intake are lack of nutritional knowledge and poor economy. However, this can be overcome by improving nutritional knowledge and dietary practices of population in general and vulnerable groups in particular through media and MCH services on the use of locally available low cost nutritious foods and to avoid undue food restrictions. Improvement of applied nutritional knowledge of medical professionals is also necessary (JPMA 47:60, 1997).

Introduction

According to Pakistan National nutrition survey (1985-87), 45.2% of pregnant/lactating mothers are anaemic with haemoglobin values (Hb) <11 gm% and 9.6% with Hb <19 gm%’. In poor families 25-30% of babies are born with birth weights below 2.5 kg but in affluent families the birth weight is 3.5 kg with only 10% below 2.5kg1. Among children under 5 years, 7-10% suffer from malnutrition. The infant and maternal mortality rates in Pakistan are 80/1000 and 2-4/1000 live births respectively2. Malnutrition in combination with infections is one of the major causes for the high death rates. As extra energy is required to meet the requirements associ-­ated with pregnancy/lactation3, so maternal nutrition also becomes a major contributing factor for the low infant birth weight and growth retardation1. The mother’s diet is affected by socio-cultural influences4. Such beliefs like avoiding Papaya by pregnant mothers, with a fear of spontaneous abortion, eating less for easy deliveiy, abstaining from beef to prevent infant death5-7 and avoidance of hot and cold, light and heavy foods8,9 lead to restrictions of nutrition foods during pregnancy and lactation10. The data on the nutritional beliefs and practices among pregnant and lactating mothers in developing countries world-wide provide some insight to the subject. However, such information in Pakistan is limited and this study was conducted to learn about the knowledge and beliefs on diet of urban and rural pregnant and lactating women and pmvide a basis for an intervention programme to educate mothers on improved nutritionduring pregnancy and lactation.

Methodology

Study area:
This cross sectional community based study was con­ducted inLahore, second largest city of Pakistan. Two areas, one rural (population 2895 and 345 families) and one urban community (population 51279 and 685 families) were surveyed.
Study population and assessment
Fifty women from each group, pregnant and lactating and from both rural and urban areas were randomly selected for the study. These 200 women after having given verbal consent were interviewed and a structured questioniiaire was filled which had been pretested and precoded. The interviewing team comprised of a lad doctor, a lady health visitor, one dai (traditional birth attendant) and one male attendant. Three such teams were formed and trained on the job forsix days. The dataquality was monitored and omissions reviewed.
Data analysis
Data from the questionnaires was analyzed using Epilnfo version 5.1 and results presented as frequencies and mean values (+/- standard deviation). Descriptive methods were used to present qualitative data and given in the form of frequency distribution. Quantitative analysis (chi square) was perfonned to test the association of a number of socio-economic factors that may affect the nutritional beliefs and practices in pregnant/lactating mothers.

Results

The demographic profiles of the pregnant and lactating mothers and their families are presented in Table I.

Amongst the women interviewed, 77% of them and 54% of their husbands were illiterate; 65% belonged to families with per capita income of more than Rs.300 per month; 52.5% had 7 or more family members and 42% were living in nuclear families.
Nutritional knowledge
The details of the nutritional knowledge of the pregnant and lactating women are shown in Table II.

Subjects favouring a change in diet suggested an increase in quantity with the addition of fruits, meat and milk. The lactating mothers desired fruit juices and yogurt also. Ninety four women expressed the avoidance of hot foods as eggs, Karela (bitter gourd) and fish during lactation. They also believed that gram, raw vegetables and fruits, cold and sour food should not be consumed. The dietary practices of the interviewed women can be seen in Table III.


Fifty percent of the women who had changed their diet claimed to have increased the quality by adding milk, lassi (yogurt drink) and fruits. They admitted the avoidance of the so called hot foods as eggs, fish, gram, raw fruits and vegetables and brinjal. These alterations were made on the instructions of the family members, lady health visitor, dai or neighbours. Sixty nine percent subjects were unable to take special foods due to poverty. Ninety percent women percieved costly food items to have a better nutritive value.

Discussion

The findings of the study show that 84% of the pregnant/lactating mothers have the knowledge that women need betternutritionduringpregnancy and lactation. Butatthe same time they avoid foods like beef, eggs, brinjal, fish and citrus fruits as these are considered hot and could have ill effects on their babies. These beliefs and practices during pregnancy and lactation are similar to the ones reported from different studies, as avoidance of meat and fish in Sudan, buffalo milk in TamilNadu (India), fish, curds, grapes, citrus, pineapple, mangoes, coconut in India, dal in South India, gram and lentils in Pakistan, vegetables in South Africa and chillies in Guinea Bissaue, fermented vegetable and citrus in Thailand, avocados and mangoes in Mexico, citrus, melon, sugar cane and long bananas in Vietnam10. In most cases the avoided food items are of a low cost and their replacementwith high cost foods is an economic burden on the low socio-eeonomic families. All these addition and avoidance practices in this study were independent of the education, economic status and obstetric experience of the mothers.
The study also revealed that desplie having the knowledge on nutrition during pregnancy and lactation (84% women) only 65.5% put it in practice. This discrepancy was higher in urban areas. Consideration of expensive foods to have a higher nutrition value was independent of literacy level or social status. Unfortunately all these beliefs and practices prevail more in the developing countries and in the low economic strata. The information obtained from this study conducted in two groups of women living in and near Lahore, reveals the prevalent nutritional beliefs and practices even in the relatively developed areas of the country. There is a disbelief that expensive foods have a higher nutrition value and their being unavailable to the low economic strata leads to deficiencies and poor health. Low cost alternatives are not acceptable due to socio-cultural restrictions.
Nutritional knowledge and dietary practices in the population can be improved particularly in vulnerable groups by:
1. Correction of nutritional knowledge and dietaiy practices of pregnant and lactating mothers, especially on the use of locally available low cost alternative foods and to avoid undue food restrictions. This can be done through MCH services by one to one consultation.
2. Improvement of nutritional knowledge of medical personell especially LHVs trniend dais and doctors about the use of locally available low cost alternative foods. During this training lectures on applied nutrition and practical nutritional demonstrations should be provided by nutritionists.
3. Educating the people in general about the use of locally available low cost alternative foods through the print and electronic media.

Acknowledgement

Financial support for this research was provided in whole or in part by the Applied Diarrhoeal Disease Research Project at Harvard University by means of a cooperative agreement with the U.S. Agency for International Development. We would like to thank the Primary Health Care Team, Department of Community Health Sciences, The Aga Khan University, for their cooperation in the field work at Orangi.

References

1. The Sixth Plan Report of working group on Health and Nutrition, Islamabad, Planning Commission, 1987.
2. Seventh five year plan 1988-93 and Perspective Plan 1988-2003. Planning Commiasion, Islamabad, Government of Pakistan, 1988.
3. Guide notes on Nutrition for the Nutrition Training Programme in Pakistan. (1973) Islamabad, Nutrition Division, Health Laboratories, 1973.
4. Park. J. E. Text Book of Preventive and Social Medicine, 11th Edition, India, M/s Banarsidas Bhanot Publishers, 1987, p. 424.
5. Mull, D.S. and Mull, J.D. Health beliefs and practices 150 mothers in Rural North West Frontier Province of Pakistan. Department of Community Health Sciences, Karachi, The Agha Khan University, Karachi, Pakistan 1988.
6. Ferro-Luzzi, G.E. Food avoidance at Puberty and menstruation in Tamilnad. Ecology Food Nutr., 1973;2: 165-172.
7. May, J.M. and McLellan, DL. The ecology of malnutrition in the Near East. New York, Nafner, 1971.
8. Laderman. Destructive heat and cooling prayer: Malay Humoralism. Paper presented at the Intemational Congress of Anthropological and Sociological Sciences, Vancouver, 1983.
9. Sanjiur, D. Infant nutrition and socio-cultural influences in a village in Central Mexico. J. Trop. Geogr. Med., 1970:22:443.
10. Jellif, ERR Traditional practices concerning dietary management during and after diarrhoea. Population and Health Division, School of Public Health, Los Angeles, University of California, 1986.
11. Mubasher, M. Characteristics of a community practicing family spacing. A community study, Lahore, Pakiatan. Mother Child, 1991 ;30: 11-22.

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