This study was carried out on the factor affecting dietary choices among pregnant woman attending health care facilities in Port Harcourt municipal. Cross sectional analytical design was used and the study was carried out in Port Harcourt. A sample size of 142 pregnant women was targeted with the first respondent being randomly selected and thereafter systematic sampling was used until the required sample was reached. Mid upper arm circumference (MUAC) of the left arm of the respondents and haemoglobin levels of the women were measured to determine the nutrition status. Data were collected using researcher administered questionnaires and focus group discussion guide. Data were entered and analyzed using SPSS and summarized using descriptive statistics such as frequencies, means and percentages. Data collected using 24 hour recall was analyzed by Nutrisurvey. A P value of < 0.05 was considered statistically significant. The mean dietary choices score (DDS) was 7.49 ±1.43 with 20% having high dietary choices. Significant differences were found in DDS based on marital status with the married more likely to have a higher DDS of 7.56±1.3b and the single had a lower DDS of 5.33±3.79a, (ANOVA, p= 0.027). There were significant differences in the mean macronutrients and micronutrients with regard to the DDS where respondents with a higher DDS (> six) were more likely to have a higher macro and micro nutrient intake compared with those who had a lower DDS (<five). The mean energy intake was 1909 Kcal±630 which is below the Recommended Daily Allowances (RDA) of 2400 Kcal for pregnant women. Based on MUAC cut offs, 31.7 percent were malnourished (MUAC <21.0cm) while 68.3 percent of the respondents were normal (MUAC >21.0cm). MUAC was positively correlated with the socio economic status (r=0.229, p=0.006). Based on the WHO cut offs (Hb <11.0 mmols/l), 73.6 percent were anaemic. Regression showed that the age of the mother and the numbers of births were significant predictors of the MUAC of the pregnant women (p=0.001). It is recommended that guidelines for nutrition and diets for pregnant women be developed and disseminated and promotion of dietary choices and modification of diets be carried out through practical demonstrations in the community and health facilities. The findings of the study may be used by Ministry of Public Health and Sanitation (MOPHS) and other organizations to promote and implement programmes aimed at improving dietary choices and nutrition status among pregnant women in the Municipal and other counties with similar characteristics.



1.1 Background to the Study

Dietary choices is defined as the consumption of an adequate variety of food groups Human health is heavily dependant upon intake of adequate quantity and quality of food. All people need a variety of foods to meet requirements for essential nutrients, and the value of a diverse diet has long been recognized (Arimond and Ruel, 2004). The high nutrient demands of pregnancy put women of reproductive age in developing countries at high risk because consumption of low-quality, monotonous diets is common in these countries and thus these women risk a variety of micronutrient deficiencies (Arimond et al., 2010; Brinkman et al., 2009) 

Consumption of a variety of foods from various food groups has been found to be beneficial for human health (Mpontshane et al., 2008). Dietary choices has been shown to be an aspect of dietary quality and therefore has been accepted to give an indication of general nutritional adequacy (Becquey, Capon and Martin-Prével, 2009; FAO, 2007). Dietary variety and nutritional adequacy with regard to the key vitamins and minerals, distribution of food within the household has been found to affect nutritional status of individuals. In addition preparation of food and feeding practices have affect on nutrition and in turn the health of an individual (Conceição et al., 2011). It is therefore important for each individual to meet his/her needs for different nutrients through a healthy, varied and balanced diet (Savy et al., 2005).

Lack of diversity has been identified by other studies to be a particularly severe problem among poor populations in the developing world, whose diets are predominantly starchy staples and the consumption of animal products, seasonal fruits and vegetables is generally absent or minimal (Becquey, Capon and Martin-Prével, 2009; Arimond and Ruel, 2004). Those most likely to suffer from deficiencies include infants and young children, adolescent girls and women of reproductive age (WRA) (Arimond et al., 2010, Becquey, Capon and Martin-Prével, 2009). These vulnerable populations have been found to switch to cheaper foods that will give a feeling of fullness in their stomachs without regard to how nutritious the foods are (Brinkman et al., 2009). In developed countries, there are a number of studies linkingdietary choices to nutrient intake, particularly among adults (Arimond and Ruel, 2004). A pregnant woman requires a varied diet to meet her nutritional requirements and thus improve her nutritional status. It has been noted that a suboptimal diet that comprises inadequate intake of calories and nutrients, combined with a heavy workload, impacts adversely on the health of the mother, the developing foetus and the newborn (Government of Nigeria (GoK), 2008a).

Maternal under nutrition ranges from 10 to 19 percent in most countries across the world. A serious problem of maternal under nutrition is evident in most countries in sub-Saharan Africa, South-central and Southeastern Asia, and in Yemen, where more than 20 percent of women are malnourished (Black et al., 2008). Across Africa, it is estimated that 27-51 percent of women of reproductive age are underweight (Conceição et al., 2011). Nutritional and hormonal factors in pregnancy influence, not only immediate foetal outcome, but also morbidity and mortality in later life (Duggan, 2003). In Nigeria, nationally, 12 percent of women are wasted (thin). At provincial level, the proportion of thin women is highest in North Eastern province (26 percent) and lowest in Rivers state (3 percent) and Rift valley where the study was conducted has 14.4 percent wasting (Nigeria

National Bureau of Statistics [KNBS] & ICF Macro, 2010).