Abstract
BackgroundUndernutrition during pregnancy affects birth outcomes adversely. In Ethiopia, despite nutrition counseling on the maternal diet being given by the health workers during pregnancy, maternal undernutrition is still high in the country. Hence, this study aimed to assess the effect of guided counseling using the health belief model and the theory of planned behavior on the nutritional status of pregnant women.MethodsA two-arm parallel cluster randomized controlled community trial was conducted in West Gojjam Zone, Ethiopia, from May 1, 2018, to April 30, 2019. The nutritional status of the women was assessed using mid-upper arm circumference. A total of 694 pregnant women were recruited from the intervention (n=346 ) and control (n=348) clusters. Of which endline data were collected from 313 and 332 pregnant women in the intervention and control clusters, respectively. The intervention was started before 16 weeks of gestation and pregnant women in the intervention group attended 4 counseling sessions. Counseling was given at the participants’ homes using a counseling guide with the core contents of the intervention. Leaflets with appropriate pictures and the core messages were given for women in the intervention arm.Women in the control group got the routine nutrition education given by the health care system. Data were collected using interviewer administered structured questionnaires and mid-upper arm circumference was measured using an adult MUAC tape. Descriptive statistics and linear mixed-effects model were used to assess the intervention effect after adjusting for potential confounders.ResultsAfter the intervention, the prevalence of undernutrition was 16.7% lower in the intervention group compared with the control arm (30.6% Vs 47.3%, P = < 0.001). Women in the intervention group showed significant improvement in nutritional status at the end of the trial than the control group (β = 0.615, p = < 0.001).ConclusionThis study demonstrated that guided counseling using the health belief model and the theory of planned behavior was effective in improving the nutritional status of pregnant women. The results imply the need for the design of model and theory based nutrition counseling guidelines. The trial was registered in Clinical Trials.gov (NCT03627156).
Highlights
Maternal nutrition during pregnancy shapes intrauterine programming, fetal growth, and development [1, 2]
Socio-demographic characteristics of pregnant women From 694 pregnant women who enrolled in this study, 645 (IG = 313, Control Group (CG) = 332) of them strictly adhered to the protocol and were included in the analysis
There was no significant difference in all sociodemographic characteristics between the intervention and control groups (P > 0.05)
Summary
Maternal nutrition during pregnancy shapes intrauterine programming, fetal growth, and development [1, 2]. According to Kedir H et al, (2016), one in four (24%) pregnant women were undernourished [7] showing that the prevalence of chronic energy deficiency was higher among Ethiopian pregnant women. There is such a pattern that undernutrition was higher among rural residents compared to urban dwellers (24.7% Vs 14.8%), while overweight or obesity was higher among urban dwellers (21.4%) than women who reside in rural areas (3.5%) [6]. In Ethiopia, despite nutrition counseling on the maternal diet being given by the health workers during pregnancy, maternal undernutrition is still high in the country. This study aimed to assess the effect of guided counseling using the health belief model and the theory of planned behavior on the nutritional status of pregnant women
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