Seasonality of antenatal care attendance, maternal dietary intake, and fetal growth in the VHEMBE birth cohort, South Africa.

Carolyn A Fahey,Riana Bornman,Jonathan Chevrier,Madelein Crause,Brenda Eskenazi,Muvhulawa Obida,Dayana Farias

doi:10.1371/journal.pone.0222888

Abstract

BackgroundSeasonality of food availability, physical activity, and infections commonly occurs within rural communities in low and middle-income countries with distinct rainy seasons. To better understand the implications of these regularly occurring environmental stressors for maternal and child health, this study examined seasonal variation in nutrition and health care access of pregnant women and infants in rural South Africa.MethodsWe analyzed data from the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE) birth cohort study of 752 mother-infant pairs recruited at delivery from August 2012 to December 2013 in the Vhembe District of Limpopo Province, the northernmost region of South Africa. We used truncated Fourier series regression to assess seasonality of antenatal care (ANC) attendance, dietary intake, and birth size. We additionally regressed ANC attendance on daily rainfall values. Models included adjustment for sociodemographic characteristics.ResultsMaternal ANC attendance, dietary composition, and infant birth size exhibited significant seasonal variation in both unadjusted and adjusted analyses. Adequate frequency of ANC attendance during pregnancy (≥ 4 visits) was highest among women delivering during the gardening season and lowest during the lean (rainy) season. High rainfall during the third trimester was also negatively associated with adequate ANC attendance (adjusted OR = 0.59, 95% CI: 0.40, 0.86). Carbohydrate intake declined during the harvest season and increased during the vegetable gardening and lean seasons, while fat intake followed the opposite trend. Infant birth weight, length, and head circumference z-scores peaked following the gardening season and were lowest after the harvest season. Maternal protein intake and ANC ≤ 12 weeks did not significantly vary by season or rainfall.ConclusionsSeasonal patterns were apparent in ANC utilization, dietary intake, and fetal growth in rural South Africa. Interventions to promote maternal and child health in similar settings should consider seasonal factors.

Highlights

Seasonal food insecurity is a widespread yet overlooked phenomenon that affects rural communities in low-and middle-income countries (LMIC) [1]
Adequate frequency of antenatal care (ANC) attendance during pregnancy ( 4 visits) was highest among women delivering during the gardening season and lowest during the lean season
High rainfall during the third trimester was negatively associated with adequate ANC attendance

Summary

Introduction

Seasonal food insecurity is a widespread yet overlooked phenomenon that affects rural communities in low-and middle-income countries (LMIC) [1]. The annual pre-harvest “lean” season occurs when food stocks from the previous year’s harvest diminish and market prices rise, forcing households to reduce the quantity and nutritional quality of food consumed [2] This period often coincides with the rainy season, a time of labor-intensive land preparation and planting along with a higher incidence of infectious and parasitic diseases. As ANC presents a key opportunity to detect and intervene on pregnancy complications, including seasonal stressors, it is critical to understand whether ANC attendance is itself limited by seasonality To address this gap, this study examined seasonal trends in ANC attendance along with maternal dietary intake and infant birth size in rural South Africa

Methods

Results

Conclusion