CHAPTER ONE

INTRODUCTION

Background to the Study

Good nutrition before and during pregnancy builds a healthy fetus and protects the mothers own nutritional health. (Dickason, Silverman & Schultz, 2010). In early weeks of pregnancy significant developmental changes occur that depend on a woman’s nutrient stores. The food pregnant mothers eat on a daily basis affects how their bodies work and how they maintain energy and strength (Handisco, 2014). It also determines the basic nutritional health that their children are born with and provides a model for their eating habits during childhood and beyond.

Pregnancy is the time in women’s life when their eating habits directly affect their fetus (Demissie, Muroki, & Makau, 2012). Their decision to incorporate nutritious food into their eating plan during pregnancy will give them strength and helps them to give birth to healthy baby. The risk of giving birth to a low birth weight baby is related to women’s nutritional status (Handisco, 2014). Therefore dietary consumption during pregnancy can have significant health implications for both mother and fetus. (Demissie, Muroki, & Makau 2012). According to Knox (2013) studies showed that maternal nutrition can affect a range of factors including the course of pregnancy and the incidence of prematurity and congenital malformations in the infant.

Pregnancy is often accompanied by a variety of nutritionally linked problems that most of the time pregnant mothers have to cope with (Dickason et al, 2010). In order to cope with these problems and to proceed with a successful pregnancy, mothers experience a number of physiological and behavioral adjustments such as food craving and food aversion during pregnancy. Food craving are intense desire to obtain certain foods which are very interesting to the individual and may not be accessible at that time. On the other hand food aversion is

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strong dislike of a particular food during pregnancy (Olusanya & Ogundipe, 2012). Food craving and aversion if not properly managed may interfere with the dietary intake of the pregnant women and sometimes causing serious problem such as low birth weight baby and diet deficient in iron, calcium, protein, vitamins A,D B6 and folic acid.

Safaii (2013) however stated that some researchers believe that food craving is a mechanism to protect the fetus and the mother from nutrient deficiencies and suggest that craving is triggered when a deficiency in one or more nutrients arises. This opinion appears to be supported by a study done by Demissie, Muroki & Wambui, (2012) which revealed that 43% of pregnant women crave for nutritious foods that are lacking in their diet .According to Nyaruhucha (2012) some women crave for non-food substance like soil, clay, chalk, charcoal and some believe that ingestion of non-food substance relieves nausea and vomiting. Nyaruchucha (2012) also suggested that the ingestion of non food substances suggest deficiency of essential nutrients such as calcium or iron. Glans (2013) further noted that aversions are physiological mechanism that protects the fetus either from nutrient deficiencies by prompting mothers away from quality and monotonous foods or from excess foeto-toxic substance present in the food, thus food aversion could be beneficial.

The food crave by pregnant women includes fruits like oranges, water melon, mangoes, snacks, soft drinks, vegetables, meat, plantain and egg. In developed countries the foods commonly craved for include yoghurt, ice cream, chocolate, candies among others. (Olusanya and Ogundupe, 2012). The food aversed to pregnant women include Beans, egg, snail, pear, bush animal meat, three leafed yam (Ona), mushroom, bitter kola (Akuilu), Green vegetable, pumpkin leaf, ice fish, palm wine. In developed countries foods commonly avoided are: coffee, alcoholic beverages, cigarette.

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According to Safaii (2013) some first time pregnant women have increase desire for certain food and aversion to some and adhere to them without looking for substitutes to maintain an adequate diet. Certain demographic factors like age, religion, educational status, occupation and income level could contribute to first time pregnant women craving and aversion to certain foods. Most of the first time pregnant women may not know the implication of food craving and aversion on their health and that of their fetus and also the nutritional value of certain foods due to level of education. Some may prefer certain types of foods but may not afford them due to level of income while some may believe that certain food are appropriate because it is what is obtainable in the social class they live in; Most of the studies were carried out in developed and developing countries.

There is paucity of data on food craving and aversion among the first time pregnant women in Nigeria and Enugu metropolis in particular. Hence the researcher intends to examine the food craving and aversion of first time pregnant women using health facilities in Enugu metropolis.

Statement of Problem

Food craving and aversion in first time pregnancy is observed to be of concern to health care providers. Due to the physiological and hormonal changes in pregnancy, first time pregnant women do have increase nausea and vomiting as a result of high Oestrogen, progesterone and human chorionic gonadotrophin (HCG) (Knox, 2013), This interferes with the dietary intake of the pregnant women and sometimes cause serious problems like anaemia (Thomas, 2013).

Study by Nargia, Cooper and Kumar (2010) on assessment of pregnancy outcome in primigravida in Pakistan showed an alarming incidence in nutritional related disorder where it was observed that all the patients whether booked or unbooked were anaemic; 42% of them were severely anaemic. WHO (2011) estimatess that more than half of the pregnant women

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in the world have a haemoglobin level indicative of anaemia (<11mg/dl); the prevalence may be however as high as 52% in developing countries compared with 23% in developed world. This is a major cause of premature labour and low birth weight which are major causes of prenatal mortality and maternal mortality in developed countries.

Ojofemitimi and Tanimowo (2014), after conducting a study in which anaemia is more in primigravida, states that the higher incidence of low birth weight and anaemia in primigravida in developing countries compared to developed countries is a reflection of poor nutrition that may occur due to food craving and aversion and lack of health education on how to substitute for food craving and aversion in other to meet up with the required nutritional value for pregnant mothers.

The researchers clinical experiences in antenatal clinic revealed that about 75% of first time pregnant mothers crave for certain types of food which seem to have negative impact on them and the unborn child. Various maternal and child health program were geared towards improving the nutritional status of pregnant mothers like focused antenatal clinic and nutritional education in other to prevent complications in pregnancy and child birth. Unfortunately much importance is not given to this group of women “First time pregnant women” as study by Ezeugwu et al (2009) shows that first time pregnant women have an increased incidence of low birth weight which poor nutrition is the major predisposing factor. Most of the empirical studies reviewed were works done outside Nigeria. Only few were work done in Nigeria. However no study was found by the researcher on food craving and aversion among first time pregnant women in Nigeria. This led the researcher’s intention to study food craving and aversion among first time pregnant women in Enugu metropolis to fill the existing gap in literature. The question therefore is what are the type of food the first time pregnant women crave or averse to, their reasons, whether they are aware of the

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implication of choice of food, whether they know how to substitute for food craving and aversion in order to meet up with their required nutritional values(needs).

Purpose of Study

This study is aimed at examining the food craving and aversion among first time pregnant women in selected health facilities in Enugu metropolis

Objectives

Specifically, the objectives are to:

1.      Determine the type of food first time pregnant women crave for or have aversion to.

2.     Identify the first time pregnant women’s reasons for their specific food craving and aversion.

3.     Determine the first time pregnant women’s awareness of the implication of food craving and aversion in pregnancy.

4.      Identify measures taken by first time pregnant women to substitute for food craving and aversion in order to meet up with their required nutritional values (needs)

1.      What are the types of food preferred or aversed to by first time pregnant women?

2.     What are the first time pregnant women reason for their specific food craving and aversion?