1.1 Background of the study
Pregnant and lactating women are nutritionally, the most vulnerable group especially in developing regions of the world because comparatively little is known of their nutritional needs(World Health Organization (WHO), 2001). The pregnant woman may find herself being alien to her most favourite dish or going for a particular type of diet that she previously hated, while some crave for non-food substances that have no nutritional value. All these are due to physiological changes occurring in pregnancy as a result of hormonal changes. This change in food or eating pattern predisposes the woman to a state of malnutrition and low iron reserve, an important cause of morbidity and when severe, could lead to mortality in pregnant women.
Malnutrition is intrinsically a problem affecting individuals and nations which the pregnant women are part of (UN/SCN, 2002). Large numbers are at risk of specific nutrient deficiencies like iron. This is because majority are either too poor to acquire foods containing essential nutrients or are ignorant of the proper cooking technique and combination of food classes and others have many children and large family size (ACC/SCN, 2003).
Women in some areas are in a state of nutritional stress always. The whole of their adult life may be continuously reproductive as pregnancies and lactation follow one another without pause (Ojo/Briggs, 2008). Their nutritional needs are high and this is more in some cultures where women may be responsible for such heavy work carried out with inefficient and clumsy tools (ACC/SCN, 2002) even during pregnancy. Such strenuous work includes farming, carrying heavy things to market, cooking, collecting water and wood and pounding foofoo. The already poor nutritional state is further aggravated by food taboos applying to women. Cultural beliefs and food taboos such as women labour, early marriage, female genital mutilations and superstitions prohibiting women from eating certain foods like chicken, eggs, mutton, snails, certain types of fish, cereals and vegetables which are the main sources of animal protein, vitamins and iron etc also influence the health and nutrition of the pregnant women.
The poor nutrition experienced by these women results to “maternal depletion syndrome”, the most common of which is protein-energy malnutrition (PEM). Others are iron deficiency, megaloblastic anaemia and iodine deficiency (East Wood, 2007) in women of child bearing age which can lead to low birth weight babies, failure to gain weight in pregnancy, decrease in subcutaneous fat and muscle tissue. All these undoubtedly contribute to premature ageing and early death seen in women in the developing countries.
Nutritional assessment is an indispensable component of nutritional care of pregnant mothers in antenatal clinics because the failure to identify and treat malnourished pregnant mothers poses a threat to the mothers and their fetus in utero.
1.2 Statement of the problem
Food consumption and state of nutrition are dependent on a whole complex of socio-economic factors which are inter-related (Ngwu, 1992). Meeting nutrient needs depends on what foods and combinations consumed. This is particularly important for pregnant women whose nutritional state is very important; the cost of iron balance on the mother is more in pregnancy than the non pregnant state. More iron and other nutrients are needed in pregnancy for the expansion of the maternal red cell mass though most of the iron is returned to stores after delivery (INACG, 2006).
A lot of women enter into pregnancy with poor or low iron reserve and general malnutrition and pass through the clinics unnoticed resulting to lots of complications during pregnancy, labour and puerperium (INACG, 2006). The low reserve of iron and general malnutrition could be due to low iron and other essential nutrients like protein, minerals, vitamins, carbohydrates content in food probably from ignorance, cultural practices, poverty, type of occupation and environment or due to bioavailability of iron and other nutrients from gastric enzyme alterations.
The pregnant women are also given nutrition education in the clinics by unqualified personnel. The nutrition education given is not meaningful with the result that they remain in the dark about the benefits and adverse effects of low or non consumption of these food components. The pregnant women are also in a more nutritional and health dilemma because of the severe economic situation in the country affecting the poor and the rich, young and old. It is therefore necessary to identify the pregnant women with poor nutritional and iron status with a view to monitoring and helping them pass through child birth with no complications to them and their babies.
It is improper to correct nutrition inadequacies of the pregnant women without understanding their food consumption pattern and socioeconomic background (DeMaeyer, 2008). This study was therefore undertaken to assess the nutritional and iron status of pregnant mothers attending antenatal clinic at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu.