ABSTRACT

The cases of malnutrition are high that is about 55~70% of pregnant mothers are suffering from malnutrition. The purpose of the study was to establish the factors that contributing to malnutrition among pregnant women so that to come up with solutions to improve their diet. The study was guided by three objectives which were to assess the personal, social-economic, cultural factors that contribute to malnutrition among pregnant.

The study design was cross sectional and descriptive employing both qualitative and quantitative methods of data collection. Simple random sampling procedure was used to select 30 respondents who were interviewed using an interview guide.

The results indicated that majority of respondents 16/30 (53.3%) agreed that personal factors contribute to malnutrition and 10/30 (33.3%) said they didn’t know the benefits of good nutrition. It further indicated that socio-economic factors contributed to malnutrition where majority 20/30 (63.3 %) said that they were unemployed which resulted in low expenditure on food, 24/30 (80%) of the respondents said that they spend less than 200,000 on food monthly. Cultural factors also affect nutritional status, since majority 27 (90%) said that they had food taboos against women and 29/30 (96.7%) said that there is inequality between men and women in regards to food distribution.

In conclusion, personal factors, socio-economic factors and cultural factors all contributed to malnutrition among pregnant women in Butansi therefore the study recommended that women should be sensitized on benefits of nutritious foods and encouraged to treat complications of pregnancy by a health worker and community support groups should increase their efforts in helping women get a balanced diet.

AUTHORIZATION

            RULES GOVERNING USE OF STUDENT’S WRITTEN WORK FROM PUBLIC HEALTH NURSES COLLEGE

Unpublished research report submitted to Public Health Nurses College, Kyambogo are deposited in the library, are open to inspection but are to be used with regard to the rights of the authors. The author and the school of nursing grant privilege of loan or purchase of microfilm or photocopy to accredited borrowers provided credit is given in subsequent written or published work.

Author Signature…………………………………… Date……………………………..

Nambi Susan

Kamuli District

Supervisor Signature .…………………                    Date: …………………………

Ms Nakacwa Morine

Public Health Nurses College………………………………………………………..

Principal’s Signature …………………                     Date: …………………………

Kasujja Lwanga Gertrude (Mrs)

Public Health Nurses College, Kyambogo

DEDICATION

This dissertation is dedicated to my family members Mukisa david my son, Musuula betty my mother, Mr Wambo Robert my husband who have sacrificed so much for my education and gave me support in all ways with lots of love. To my supervisor Ms Nakacwa Morine who has dedicated herself for my success.

ACKNOWLEDGEMENT

I appreciate the almighty God for enabling me to accomplish this research report

I would also like to recognize my supervisor Ms Nakacwa Moreen for guidance and direction.

I would also like to acknowledge the administration of public health nursing college allowing me to study and attain this diploma from their college.

My sincere gratitude goes to Butansi Health Center III for accepting me to curry out my study at their facility and also the pregnant women who accepted to participate in this study. I will forever be grateful

I would also like to recognize the combined efforts of my parents and everyone whose support deserves mentioning for tireless efforts accorded to me during this course may the almighty God reword you abundantly

TABLE OF CONTENTS

ABSTRACT.. i

COPY RIGHT.. ii

AUTHORIZATION.. iii

DEDICATION.. iv

ACKNOWLEDGEMENT.. v

TABLE OF CONTENTS. vi

LIST OF TABLES. x

LIST OF FIGURES. xi

LIST OF ABBREVIATIONS. xii

OPERATIONAL DEFINITIONS. xiii

CHAPTER ONE: INTRODUCTION.. 1

1.1 Background. 1

1.2 Statement of the problem.. 3

1.3 Purpose of the study. 3

1.4 Specific Objectives. 4

1.5 Research questions. 4

1.6 Justification of the study. 4

CHAPTER TWO: LITERATURE REVIEW… 6

2.1 Introduction. 6

2.2 Personal factors contributing to malnutrition among pregnant women. 6

2.3 The socio- economic factors contributing to malnutrition among pregnant women. 8

2.4 The cultural factors that contribute to malnutrition among pregnant women. 11

CHAPTER THREE: METHODOLOGY.. 13

3.1 Introduction. 13

3.2 Study design and rationale. 13

3.3 Study setting and rationale. 13

3.4 Study population. 14

3.4.1 Sample Size determination. 14

3.4.2 Sampling procedure. 14

3.4.3 Inclusion Criteria. 14

3.4.4 Exclusion criteria. 14

3.5 Definition of Variables. 14

3.6 Research Instrument 15

3.7 Data Collection Procedure. 15

3.7.1 Data Management 15

3.7.2 Data Analysis. 16

3.8 Ethical Consideration. 16

3.9 Limitations of the Study. 16

3.10 Dissemination of Results. 17

CHAPTER FOUR: RESULTS. 18

4.1 Introduction. 18

4.2 Socio-demographic Characteristics of the respondents. 18

4.3 Personal factors contributing to malnutrition among pregnant mothers. 20

4.4 The social, economic factors contributing to malnutrition among pregnant women. 24

4..5 Cultural factors that contribute to malnutrition among pregnant women. 28

CHAPTER FIVE: DISCUSSION, CONCLUSIONS, RECOMMENDATIONS AND IMPLICATIONS TO NURSING PRACTICE.. 31

5.1Introduction. 31

5.2 Discussion of the study findings. 31

5.2.1 Demographic data. 31

5.2.2 Personal factors contributing to malnutrition among pregnant mothers. 32

5.2.3 The socio-economic factors contributing to malnutrition among pregnant women. 34

5.2.4 Cultural factors that contribute to malnutrition among pregnant women. 37

5.3 Conclusion. 38

5.4 Recommendation. 39

5.4.1 To the government 39

5.4.2 Butansi health center III. 40

5.4.3 To the health workers. 40

5.4.4 To mothers. 40

5.5 Implication to the nursing practice. 40

REFERENCES. 41

APPENDICES. 45

APPENDIX 1: CONSENT FORM… 45

APPENDIX II: QUESTIONNAIRE.. 46

APPENDIX III: INTRODUCTION LETTER.. 52

APPENDIX IV: MAP OF UGANDA SHOWING KAMULI DISTRICT.. 53

APPENDIX V: MAP OF KAMUL DISTRICT SHOWING BUTANSI HEALTH CENTRE THREE   54

LIST OF TABLES

Table 1Showing response on demographic characteristics of  respondents. 18

Table 2 Showing response on Occupation of respondents. 20

Table 3 Showing the number of children a respondents have. 21

Table 4 Showing respondents’ response on child spacing. 21

Table 5 Showing the type of complication experienced by pregnant mothers. 23

Table 6 Showing how respondents solved their Pregnancy complications. 23

Table 7 Showing respondents’ monthly income. 24

Table 8 Showing the source of respondents’ food. 25

Table 9 Showing how respondents spend on food monthly. 25

Table 10 Showing whether there is food taboos against women in respondents’ culture. 28

Table 11 whether there is equality between men and women in respondents’ culture. 29

Table 12 Showing the kind of inequality that manifests itself between men and women. 30

LIST OF FIGURES

Figure 1 Showing response on Education level of respondents. 19

Figure 2 Showing whether it’s the respondent’s first pregnancy. 20

Figure 3Showing the benefits of taking nutritious foods during pregnancy. 22

Figure 4 Showing whether respondents experience any complications at the initial stages of your pregnancy  22

Figure 5 Showing whether respondents are employed. 24

Figure 6 Whether respondents’ partner contributes to their feeding during pregnancy. 26

Figure 7 Showing the how respondents’ partners contribute to their pregnancy. 26

Figure 8 Whether respondents have nutritional support groups in their community. 27

Figure 10 Showing the type of food ladies are denied. 29

LIST OF ABBREVIATIONS

AIDS                           Acquired Immune Deficiency Syndrome

ANC:                          Antenatal Care

BMI:                           Body Mass Index

DHO:                          District Health Officer

HAART:                    Highly Active Antiretroviral Therapy

HIV:                           Human Immune Virus

IFA:                            Ion Folic Acid

LBW:                         Low BirthWeight

LLIN:                         Long Lasting Insecticide Nets

OPD:                          Out Patient Department

PEM:                          Protein Energy Malnutrition

PHNC:                       Public health Nurses College

PNC:                          Post Natal Care

RDA                           Recommended daily allowances

 SSA:                          Sub Saharan Africa

STIs:                           Sexually Transmitted Infections

UDHS:                        Uganda Demographic Health Survey

UNICEF:                   United Nations International Children’s Emergency Fund

UNIMEB:                  Uganda Nurses and Midwives Examination Board

WHO:                         World Health Organization

TT:                             Tetanus Toxoid

OPERATIONAL DEFINITIONS

Malnutrition:                        lack of proper nutrition, caused by not having enough to

eat, not eating enough of the right things, or being unable to use the food that one does eat.

Pregnant woman:                  refers to a female individual carrying one or more off

springs in her uterine cavity.

Socio-economic factors:         It refers to the combination of external socio-economic

conditions that influence the operation and performance

of an individual.

Cultural factors:                      refers to a set of beliefs, moral values, traditions,

language, and laws held in common by a nation, a

community, or other defined group of people.

Personal factors:                   refers to ones’ Perceptions, Influences and Their.

Relationship with Adherence

CHAPTER ONE

INTRODUCTION

This chapter presents the introduction, background, problem statement, purpose of the study, specific objective, research questions and justification for the study.

1.1 Background

Malnutrition is a condition which occurs when there is a deficiency of certain vital nutrients in a person’s diet. The deficiency fails to meet the demands of the body leading to effects on the growth, physical health, mood, behavior and other functions of the body. (Tsiaousi, E. et al, 2008).

Tsiaousi, E. et al, (2008) further adds that malnutrition also entails conditions where diet does not contain the right balance of nutrients. This might mean a diet high on calories but deficient in vitamins and minerals. These second group of individuals may be overweight or obese but are still considered malnourished. Thus being malnourished does not always mean that the person is underweight or thin.

Eliminating hunger and malnutrition is one of the most fundamental challenges facing humanity in the whole world (Lomborg 2014). Malnutrition and its associated disease conditions can be caused by eating too little, eating too much, or eating an unbalanced diet that lacks necessary nutrients.

In sub-Saharan Africa, the oppression of women socially and culturally means they have less access to everything, including food, resources, health care, community support and information. The problems arise from cultural, political and economic realities that must be addressed in tandem. However, one significant step should be taken to educate and to make them aware of how to feed properly especially during pregnancy. Malnutrition among pregnant women has long been recognized as a serious problem in sub-Saharan Africa (Barnett, J. (2016).

According to Quist, M. A  et al, (2017), in their study on nutrition in Uganda, revealed that pregnant women in Uganda clearly goes against prevailing cultures and gender norms in many places in the country for example some cultures prohibit women from eating eggs or chicken. Good nutrition among pregnant women is not respected by most traditional men in some cultures who think they are the ones who work and get food for the family so they should feed better than their wives even pregnant ones.

According to Byamugisha, et al. (2010), there are different factors which have been identified in other studies as barriers to good nutrition among pregnant women in the Uganda and they include: Health-facility factors, Cultural factors and Socio-Economic factors. The failure to sensitize pregnant women about their nutrition discipline, maternal health promotion, and prevention and care programs by policy makers, program planners and implementers of maternal health services has had a serious impact on the nutritional status of pregnant women (Rout, S. 2016).

Yet the huge majority of African women are still unaware of how to feed themselves during pregnancy and as a result, they continue to suffer from malnutrition which threatens their health and even that of the unborn child. Therefore the researcher intended to find out the factors contributing to malnutrition among pregnant women in Butansi health center III Kamuli District.

1.2 Statement of the problem

According to Doyle, S. (2016), in his study, the recent increase in number of pregnant mothers suffering from malnutrition is a giving a concern to those in Uganda medical industry, women leaders, health care services and others.

The case of malnutrition is so high that about 55~70% of pregnant mothers are suffering from malnutrition (Opara, J. et al, 2011). This is as a result of the fact that in Uganda, it is difficult to afford three square meals a day, take varieties of food for most pregnant women and some do not know the nutritional content of food that they eat every day. The Prevalence of malnutrition among pregnant women was 53% year 2008 according to (Lancet Series, 2008).

Apparently there is no data about the prevalence to malnutrition among pregnant women  in Kamuli District especially Butansi sub county therefore, While Uganda has made great strides in reducing poverty, the rates of malnutrition in children and mothers are still unacceptably high, compromising their health and survival due to the low and declining rate of proper nutrition among pregnant women. Therefore it’s against this background the researcher got interest to establish the factors that contribute to malnutrition among pregnant women in Butansi health center III Kamuli District.

1.3 Purpose of the study

The purpose of the study was to establish the factors contributing to malnutrition among pregnant women in Butansi health center III Kamuli District so that to come up with solutions to improve nutrition among pregnant women.

1.4 Specific Objectives

1. To assess the personal factors that contribute to malnutrition among pregnant women attending Butansi health center III County Kamuli District.

1. To identify the social-economic factors contributing to malnutrition among pregnant women attending Butansi health center III kamuli district
2. To assess the cultural factors that contribute to malnutrition among pregnant women attending Butansi health center III Kamuli District

1.5 Research questions.

1. What personal factors contribute to malnutrition among pregnant women attending Butansi health center III Kamuli District?
2. What are the social-economic factors that contribute to malnutrition among pregnant women attending Butansi health center III Kamuli District?
3. What cultural factors contribute to malnutrition among pregnant women attending Butansi health center III  Kamuli District?

1.6 Justification of the study

The findings of the study would be useful in the following ways;

Fast and fore most the study would aid the ministry of health through the administration Health Centre III in Butansi Sub County in understanding the factors that contribute to malnutrition among pregnant women in Uganda and design the policies that can improve their nutritional status. This will be ensured by disseminating a copy of the research report to Butansi health center III

It would further be used to provide baseline information for further researches who would wish to carry out research on malnutrition. This is would be ensured by submitting  a copy of this research to the library of PHNC.

It would also benefit the community of Butasi Sub County LC1 Kamuli District through improving knowledge among pregnant women so as they realize the importance of having a proper nutrition. This will be ensured by submitting a copy of the research report to Butansi H/CIII

This study would help the researcher to acquire a diploma in midwifery as it’s a minimum requirement by UNMEB. This will be ensured by submitting a copy of the research report to UNMEB

This research would help pregnant women who attend Butansi Health Center III to improve on their nutrition discipline. This will be possible because they will be able to access the information from the health Centre since a copy will be delivered there.

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter reviews the related literature on factors contributing to malnutrition among pregnant women. It is organized according to the objectives which include: the personal factors that contribute to malnutrition among pregnant women the social-economic factors contributing to malnutrition among pregnant women and the cultural factors that contribute to malnutrition among pregnant women.

2.2 Personal factors contributing to malnutrition among pregnant women.

Several studies have shown that educational intervention not only increases knowledge about a proper diet in pregnancy (Rao, et al., 2008), but also are positively correlated with good eating habits (Kim, et al., 2009). In addition, (Liu, et al. 2009) observed that educational intervention enables pregnant women to change unhealthy practices and consequently decrease on the prevalence of postpartum complications. It is therefore of paramount importance to include nutrition as one of the health education topics given to pregnant women during their antenatal checkups.

MA Mbule et al (2013) carried out a cross-sectional descriptive institutional based study in Ethiopia to assess knowledge of pregnant women about maternal nutrition and factors associated with it during pregnancy on a sample of 422 pregnant women during January to June of the year 2013. It was revealed that nutrition knowledge was predictive of change in dietary habits and health advices encouraged expectant women to advance their food intake. This study revealed that out of 422 pregnant women more than half (57.8%) of the respondents did not know the meaning of food.

Regarding attitudes, pregnant women may believe there are no advantages in attending ANC in the first 3 months of pregnancy 37, because ANC is viewed primarily as curative, rather than preventive (MA Mbule et al 2013).

Schaefer, C., e al (2014), reported that pregnant women do not have confidence in the health system because of inadequate services and medicines, which in part contributes to the high usage (73%) of traditional indigenous medicine as an alternative to ANC in Uganda (MA Mbule et al 2013). Such attitudes and misconceptions contribute to the high prevalence of malnutrition among pregnant women. Thus, apart from availing all ANC services and medicines at health facilities, community based health education programs are needed to correct negative attitudes and misconceptions about ANC.

Child spacing: Child spacing means the period between two consecutive pregnancies of the same mother. Because the nutritional burden on the mother between pregnancies depends on the extent of breastfeeding, the inter-pregnancy interval and the ‘recuperative interval’ (duration of the nonpregnant, non- lactating interval) could measure whether the mother has had a chance to recover from the pregnancy. Therefore, it is expected an increased risk for maternal anemia when the inter-pregnancy interval is very short (Dewey, K. G., et al . 2007).

Presence of Minor disorders and medical conditions: A study of more than 81,000 pregnant women in the UK revealed that those who had nausea and vomiting during pregnancy that interfered with their life were 23% more likely to deliver their baby before 34 weeks in comparison with women who said their morning sickness did not substantially affect their lives (UK National Institutes of Health 2011). Poor nutrition and too little weight gain were considered to be the contributing factors to this risk.

A study carried out by Dr Pragya Singh et al (2011), revealed that energy intake of study participants in 2nd and 3^rd trimester’s pregnancy were 2308 kcal for 2340 kcal and 1420.5 kcal for 2452 kcal (. Vitamin A intake was 3 micro grams for 800 micro grams. Protein intake of the study respondents in 2nd and 3rd trimester pregnancy was 45.9 g and 31.5g for 71g. Majority (75.2 %) of study participants did not take additional meal during pregnancy. 69.3 % skipped one of their regular meals. Total of 9.2% of the study subjects were undernourished. Energy and most of the nutrients intakes of study participants were lower than recommended intakes. Dietary practices and nutritional status of study participants were not adequate to support their increased energy and nutrient requirement. Therefore (Dr Pragya Singh et al 2011 ) concluded that filling the gap in knowledge of maternal under nutrition and generating information for intervention is important to maternal nutritional during pregnancy.

2.3 The social, economic factors contributing to malnutrition among pregnant women

Employment: Women’s employment increases her economic status in their homes, this in particular improves her nutrition status and household nutrition. Employment may increase women’s status and power, and may bolster a woman’s preference to spend her earnings on health and nutrition. However, employed women without control over their income and decision making authority within the household are deprived of economic and social power and the ability to take actions that will benefit their own well-being.

Level of education: Studies on autonomy and empowerment of women suggest that, education of a woman promotes her empowerment and influences participation in decision making in matters concerning nutrition and access to health services. (Emina et al. 2009). Women who receive even a minimal education are generally more knowledgeable than those who have no education of how to use available resources for the improvement of their own nutritional status together with their families.

Household economic status: In many, nutrition is influenced by income and economic growth. Rich people have the capacity to buy more diverse foods including fruits and vegetables rich in essential vitamins, minerals and other nutrients plus animal products rich in proteins. (Population reference bureau 2012). Poorer populations often lack access to the right variety of foods and the right amount of foods, leading to inadequate nutrition. For the poorer populations, economic growth can boost household incomes, resulting in more spending on food, health, and education, and better individual health and nutrition.

In addition, when national economies are growing, governments have more to spend on social programs and infrastructure necessary for health systems to function, thus increasing the overall health and nutritional status of the nation. Conversely poor people especially in developed countries like the USA are at high risk of obesity because healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2010; Monsivais & Drewnowski, 2009)

Households with limited resources often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling that is, they try to maximize their calories per dollar in order to stave off hunger (DiSantis et al., 2013; Drewnowski, 2009). While less expensive, energy-dense foods typically have lower nutritional quality and, because of over consumption of calories, have been linked to obesity (Hartline-Grafton et al., 2009).

According to a household survey carried out in Ethiopia by Demographic and health research (2010), never-married pregnant women were found to be the most affected by under nutrition, followed by divorced/separated/widowed women. Among never-married pregnant women, 35.7% in 2000 and 28.7% in 2005 were chronically undernourished.

Khan, M., et al (2009) laments that among both rural and urban women for both surveys, those married or living together were the least affected by chronic energy deficiency. Among the reasons given is the fact that unmarried adolescent women are often at the bottom of the food chain, with little or no decision-making power in the household about food distribution, could lead to food security issues and may contribute to their poor nutritional status. Moreover, women aged 15-19 need adequate nutrients to support fast physical, mental and emotional growth. Unawareness of adolescent women about their own health and nutritional status could be another reason associated with their poor nutritional status.

Kirunda, B. E et al (2015), in their study revealed that Compared to women of urban areas, women from rural areas were at higher risk of underweight. The widow, divorced and separated women were significantly more likely to be underweight than women who were currently married. Surprisingly, Islam, M. A. (2010), currently working women had greater tendency to be undernourished than nonworking women. This finding may be attributed to the fact that, of the working women, only 9.3% were engaged in a prestigious profession, while 60.5% were engaged in low paid jobs as factory workers, labourers, farmhands, home-based manufacturing, domestic servants etc. who generally enjoy lower autonomy in households as well as in society.

These women are less likely to have a balanced and healthy diet for nutrition, resulting in higher risk of underweight as compared to the non-working women. The women with higher education serve as housewives if they do not get prestigious jobs suitable for them. However, most of the findings of this study are fairly consistent with those conducted in many other developing countries (Goffee, R., & Scase, R, 2015).

2.4 The cultural factors that contribute to malnutrition among pregnant women

According to a descriptive survey study design conducted to assess the knowledge and attitude of dietary practices among pregnant women attending Yerwa Clinic in Nigeria where a total of 294 pregnant women were selected using systematic random sampling technique. It was revealed that majority of the respondents 118 (40%) avoid some good diet during pregnancy because of cultural beliefs (Kever R.T2015).

Another cross-sectional study carried out in Nigeria, where a sample population of 200 child bearing mothers who registered with the Primary Health Centers were used, it was discovered that some causes of malnutrition involved cultural beliefs (Jacinta A et al, 2011). Many of the respondents agreed that cultural beliefs are one of the causes of malnutrition. In Nigeria, people may abstain from eating certain food items of high nutritive value simply because of their ethical or religious beliefs and taboos. Atinmo and Akinyele said that socio cultural factors are important factors in considering the quantity of food.

Food taboos among rural women have been identified as one of the factors contributing to maternal under nutrition in pregnancy. Pregnant and lactating women in various parts of the world are forced to abstain from nutritious and beneficial foods. In various studies, it was seen that pregnant women in various parts of the world are forced to abstain from nutritious foods as a part of their traditional food habits (Merchant, K. M.2014).

According to Paupério, A., et al, (2014), Food taboo is a deliberate avoidance of a food item for reasons other than simple dislike from food preferences. In some societies, food taboos are often meant to protect the human individual and the observation, for example, that certain allergies and depression are associated with each other could have led to declaring food items taboo that were identified as causal agents for the allergies.

According to Meyer-Rochow, V. B. (2009), it is believed that any food taboo, acknowledged by a particular group of people as part of its ways, aids in the cohesion of this group, helps that particular group maintain its identity in the face of others, and, therefore, creates a sense of belonging. The avoidance of certain food items and incorrect knowledge regarding their benefits can deprive women from adequate nutrition, especially during the critical periods of pregnancy when it is of great benefit to the mother and her fetus.

CHAPTER THREE

METHODOLOGY

3.1 Introduction

This chapter presents the methodology which includes the study design and rationale, study setting and rationale, study population, sample size determination, sampling procedure inclusion and exclusion criteria, definition of variables, research instruments, data collection procedure, data management data analysis, ethical consideration, limitation of the study and dissemination of results.

3.2 Study design and rationale

The study used a descriptive cross sectional survey design which used all different categories of pregnant mothers who participated. The study employed both qualitative and quantitative approaches which helped in getting the required data.

3.3 Study setting and rationale

The study was conducted in Butansi Health Centre III Butansi Sub county Kamuli district in central Uganda. Kamuli District is bordered by Buyende District to the north, Luuka District to the east, Jinja District to the south, and Kayunga District to the west. The population of Kamuli District is estimated at 500,800 (census report 2012) Butansi Subcounty has a population density of 350 people. The major economic activity is farming. The study setting was selected because the problem understudy was prevalent on the ground among the women attending Butansi Health Centre III and its familiar to the researcher.

3.4 Study population

The study targeted a population of 40 pregnant mothers who attend Butansi Health centre III in Kamuli district.

3.4.1 Sample Size determination

A sample size of 30 pregnant mothers who attend Butansi Health Centre III Butansi Subcounty Kamuli district was selected from a population of 40 respondents.

3.4.2 Sampling procedure

The researcher used simple random sampling to select the respondents. Where by pieces of paper were written on YES or NO, folded and put in an enclosed box. Potential respondents were invited by the researcher to pick a piece of paper from the box and every respondent, who picked a piece of paper with the word YES, was requested to participate in the study.

3.4.3 Inclusion Criteria

Only those pregnant mother attending Butansi Health centre III in Butansi Sub county Kamuli District were included in the study.

3.4.4 Exclusion criteria

Anyone who was not attending Butansi Health center III and was not pregnant was excluded from the study.

3.5 Definition of Variables

Variables were logical grouping of attributes and the study used both independent and dependent variables

Independent variables were variables whose variation does not depend on that of another and these included the factors contributing to malnutrition like age marital status among others

Social economic factors. Are economic factors that affects and is shaped by social processes. In general it analyzes how societies progress, stagnate, or regress because of their local or regional economy, or the global economy

3.6 Research Instrument

Questionnaire was designed and contained both close and open ended questions. The questions were based on the research questions in the study. The questionnaire was pre-tested among 5 respondents at Butansi health center III to help the researcher to assess the accuracy and reliability of the tool before using it for data collection This tool was selected because the study was conducted among literate respondent who could read and understand the questions under study.

3.7 Data Collection Procedure

After the approval of the research proposal by the supervisor, the researcher secured an introductory  letter from the school administration was obtained and presented to the Butansi Health center III Administration for permission to conduct this study. After being allowed the health center administrator introduced the researcher, she went explained the purpose and objectives of the study to the respondents and then administered the questionnaire.

3.7.1 Data Management

Data management included data editing before leaving the area of study to ensure that there are no mistakes or areas left blank. Any mistakes found were corrected before leaving the area of study. Data was then entered in computer and saved on flash disk for safe storage.

3.7.2 Data Analysis

Data was analyzed manually on paper then entered in the computer using Microsoft excel. Then it was presented in tables figures and texts in form frequency and percentages.

3.8 Ethical Consideration

A letter of introduction was obtained from PHN College which the researcher presented to the management of Butansi Health Centre III, when allowed the in charge of Butansi Health Centre III introduced the researcher to the respondents and the researcher explained the purpose and objectives of the study then she asked for the consent and proceeded to administer the research instruments.

Privacy and confidentiality was assured to the respondents by the researcher and that the information obtained from the respondents is for academic use only.

3.9 Limitations of the Study

Some respondents were not co-operative and some found hardship in answering the questionnaire but the researcher explained to the respondents the purpose and objectives of the research which helped them answer factually. In addition some health workers were fearful to share their views and in this case respondents were reassured of the confidentiality and the researcher explained to them the purpose and future benefits of the study which she convinced them to respond positively.

There was also another limitation of lack of enough resources in terms of finance and human resource to help in transport, logistics and distribution of the questionnaires to mothers but the researcher lobbied for money from relatives and also used some of her salary to fund the budget

Lack of enough time to interview all the respondents, but this was properly provided for in the work plan.

3.10 Dissemination of Results

The result of the study was compiled and three copies produced and delivered to:

• UNMEB
• PHN College
• The researcher also retained a copy for future reference
• Butansi Health Centre III

CHAPTER FOUR

RESULTS

4.1 Introduction

This chapter presents and describes the study results using tables, figures and text data was collected from 30 respondents using a questionnaire

n stands for frequency.

4.2 Socio-demographic Characteristics of the respondents

Table 1Showing response on demographic characteristics of respondents.

(n=30)

According to the finding on age, half 15/30(50%) of the respondents were in the age group 25-34 years while minority 8 (26.7%) were 35and non-44 years of age.

The results on religion in the table above indicated that most of the respondents 14/30 (46%) were Catholics while the least 3/30 (10%) were Pentecostals.

Regarding marital status, the results revealed that majority 21/30(70%) of the respondents were married while minority 1/30 (3.3%) were separated and widowed respectively.

Figure 1 Showing response on Education level of respondents

(n=30)

According to the findings in figure 4 above majority of the respondents 12/30 (40%) were secondary school dropout while minority 1/30 (3.3%) had never attended school.

Table 2 Showing response on Occupation of respondents.

(n=30)

According to the results in the study in table 2 above, Half of the respondents 15/30 (50%) were unemployed while a minority of them 3/30 (10%) were self-employed.

4.3 Personal factors contributing to malnutrition among pregnant mothers

Figure 2 Showing whether it’s the respondent’s first pregnancy

(n=30)

According  to Figue 5 above , majority of respondents 16/30 (53.3%) said that the they were pregnant for the fast time while 14/30 (46.7%) said thet it it was not their first pregnancy.

Table 3 Showing the number of children a respondents have

(n=16)

According to the Findings in the table above, majority of the respondents 7/16 (43.8%) of the respondents had 1-2 children, while a minority 4/16 (25%) of them have 3-4 children.

Table 4 Showing respondents’ response on child spacing

(n=16)

According to the Findings in table 4 above, majority of the respondents 8/16 (50%) said that their child spacing is 2 years, while a minority 3/16 (18.8%) of them said their child spacing is 3 and above years.

Figure 3 Showing the benefits of taking nutritious foods during pregnancy

(n=30)

According to the results in table 5 above majority 10/30 (33.3%) of the respondents said they didn’t know the benefits of god nutrition during pregnancy while minority 3/30 (10%) said that good nutrition will make the bother produce a low weight child.

Figure 4 Showing whether respondents experience any complications at the initial stages of your pregnancy

(n=30)

According to the findings in figure 5 above majority 23/30 (76.7%) said they experience complications during their initial stages of pregnancy while minority 7/30 (23.3) said they didn’t.

Table 5 Showing the type of complication experienced by pregnant mothers

(n=23)

According to the finding in the table above, most of respondents 10/23 (43.5%) said that the experience vomiting in the initial stages of their pregnancy while the least 2/23 (8.7%) experienced diarrhea.

Table 6 Showing how respondents solved their Pregnancy complications

(n=23)

The results in the table above revealed that majority of respondents 14/23 (60.9%) said that they did nothing to solve their initial pregnancy complications while minority 1/23 (4.3%) said that they ate food of interest.

4.4 The social, economic factors contributing to malnutrition among pregnant women

Figure 5 Showing whether respondents are employed

(n=30)

According to the findings in figure 6 above, majority of the respondents 20/30 (63.3 %) said that they were unemployed while minority 10/30 (36.7%) were employed.

Table 7 Showing respondents’ monthly income.

(n =30)

According to the results in table 5 above majority 18/30 (60%) of the respondents house hold income status  was less than 200000 shs a month while minority 12/30 (40%) house hold income status was more than 200000 shs per month.

Table 8 Showing the source of respondents’ food

(n=30)

According to the table above, majority 17/30 (56.7%) of the respondents said that the source of their food is from a garden while minority13/30 (43.3%) were getting it from the market.

Table 9 Showing how much respondents spend on food monthly

(n=30)

According to the findings in table 6 above, majority 24/30 (80%) of the respondents said that they spend less than 200000 per month on food while minority 1/30 (3.3%) said they spend more than 200000 on food.

Figure 6 Whether respondents’ partner contributed to their feeding during pregnancy

(n=30)

The results in the figure above indicate that majority of respondents 21/30 (70%) revealed that their partners contribute to feeding during their pregnancy while minority 9/30 (30%) said that their partners don’t contribute anything.

Figure 7 Showing the how respondents’ partners contribute to their pregnancy.

(n=21)

The results in the figure above indicate that majority of respondents 11/21 (52%) revealed that their spouses contribute food to their pregnancy while minority 1/21 (5%) said that their partners contribute by preparing meals.

Figure 8 Whether respondents have nutritional support groups in their community.

(n=30)

The results in the figure indicates that majority 24/30 (80%) said that they don’t have nutritional support groups while minority 6 (20%) said they have.

Table 10 Showing how nutritional support groups help them during pregnancy

(n=6)

The results in the table above indicate that majority 4/6 (66.7%) said that support groups contribute food while minority 2/6 (33.3%) said they teach on what to eat during pregnancy.

.5 Cultural factors that contribute to malnutrition among pregnant women.

Table 11 Showing whether there is food taboos against women in respondents’ culture

(n=30)

According to the findings in table 7 above indicate that majority 27/30 (90%) of the respondents said that there are food taboos against women in their culture well as a minority 3/30 (10%) said that there is no such taboos in their culture.

Figure 9 Showing the type of food ladies are denied

(n=30)

According to the findings in figure 8 above majority 10/30 (33.3%) of the respondents said that women are denied to eat eggs while minority 1/30 (3.3%) mentioned other kind of foods denied to women.

Table 12 whether there is equality between men and women in regard to food distribution in culture.

(n=30)

According to the findings in table 8 above, a great majority of respondents 29/30 (96.7%) said that there is no equality between men and women while just 1/30 (3.3%) said that there is equality between men and women.

Table 13 Showing the kind of inequality that manifests itself between men and women

(n=30)

The results in the table above indicate that majority of respondents 20/29 (69%) said that inequality that manifests itself between men and women is that Men get the biggest portions of the meal and Men are served first while minority 4/29 (13.8%) said than men are served first.

CHAPTER FIVE

DISCUSSION, CONCLUSIONS, RECOMMENDATIONS AND IMPLICATIONS TO NURSING PRACTICE

5.1 Introduction

This chapter presented discussion of findings of the study; it drew conclusions, made recommendations and implications to nursing practice.

5.2 Discussion of the study findings

5.2.1 Demographic data

Majority 15/30(50%) of the respondents were in the age group 25-34 years and none of the respondents was 45 years and above. This indicated that the respondents were mature and able to give well informed responses.

The results from the study also reveal that majority 14/30 (46%) of the respondents were Catholics Protestants and Muslims while minority 3/30 (10%) were Pentecostals. This implied that the study was not biased since all religions participated in the study because malnutrition cuts across all religions.

According to the findings of the study, majority of the respondents 12/30 (40%) were secondary school dropout while minority 1/30 (3.3%) had never attended school. This finding indicated that most of the respondents had very limited information regarding good nutrition hence were unable to articulate the dangers of malnutrition during pregnancy.

Regarding marital status, the results revealed that majority 21/30(70%) of the respondents were married while minority 1/30 (3.3%) were separated. This finding revealed that most respondents had husbands taking care of their nutritional needs.

According to the results in the study, majority of the respondents 15/30 (50%) were unemployed while a minority of them 3/30 (10%) were self-employed this implied that majority of the respondents were of Low income status therefore unable to access health foods and services.

5.2.2 Personal factors contributing to malnutrition among pregnant mothers.

Majority of respondents 16/30 (53.3%) said they had children while 14/30 (46.7%) were pregnant for the first time. This implied most mothers had experience in how to handle their nutrition during pregnancy but a significant number did not know what foods to eat during pregnany. This finding corresponded with (Rossman, et al (2015) who revaled that fist time mother experience hormonal changes whiles mother in their socond or third pregnacies have experience in handling themselves in terms of nutrition.

According to the in the study majority of the respondents 7/16 (43.8%) of the respondents have 1-2 children and 5/16 (31.2%) had 5 and above children this implied that most mothers were young and had not produced many children. This is in line with (Bitew et al, 2010) who said that women who had never had a child and women with at least five children (Parity 5+) were at a higher risk of chronic malnutrition than other women.

According to the results of the study, majority of the respondents 16/30 (53.3%) of the respondents said that their child spacing is 2 years, while a minority 5/30 (16.7%) of them said their child spacing is 3 and above years. This implied that most respondents were using family planning in order to manage malnutrition which is in line with (Dewey, K. G., et al.2007) who said that Child spacing: nutritional burden on the mother between pregnancies depended on the extent of breastfeeding, the inter-pregnancy interval and the ‘recuperative interval’ (duration of the no pregnant, non- lactating interval) could measure whether the mother has had a chance to recover from the pregnancy. Therefore, there is expected increase in the risk for maternal anemia when the inter-pregnancy interval is very short.

From the results of the study 10/30 (33.3%) of the respondents said they didn’t know the benefits of good nutrition during pregnancy while minority 3/30 (10%) said that good nutrition will make the mother produce a low weight child. This implied that most mothers has limited information about the relationship between the nutrition of the mother and the weight of the child. This was in line with a study (UK National Institutes of Health 2011) which revealed that most mothers in rural Britain had little information about the benefits of good nutrition compared to those who lived in urban areas.

According to the findings, 23/30 (76.7%) said they experienced complications during their initial stages of pregnancy while minority 7/30 (23.3) said they didn’t. this implied that due to poor nutrition most mothers experience complications during pregnancy and this is in line with (UK National Institutes of Health 2011) who carried out a study on 31,000 pregnant women in the in suburbs of Lagos Nigeria and revealed that 65% of women had complications during their initial stages of pregnancy due to rapid hormonal changes. Poor nutrition and too little weight gain were considered to be the contributing factors to this risk. Hyperemesis gravidarum affects about 1% of pregnant women, this usually disappears during the second half of pregnancy, and typically does not cause serious complications in the mother.

The finding of the study also revealed that most of respondents 10/23 (43.5%) said that the experience vomiting in the initial stages of their pregnancy while the least 2/23 (8.7%) experienced diarrhea. This implied that pregnancy caused rapid body changes which came with different complications to the mother. This finding corresponds with (Neiterman, et al, (2017) who revealed that it’s hard for mothers’ to avoid complications during pregnancy because they experiences rapid hormonal, physical and emotional changes in that period.

The findings further revealed that majority of respondents 14/23 (60.9%) said that they did nothing to solve their initial pregnancy complications while minority 1/23 (4.3%) said that they ate food of interest. This was due to the fact that these pregnancy complications were sometimes normal body changes that are not a threat to the health of the mother. This was similar to the study carried out by (Bergbom, et al, 2016), who revealed that the complications experienced by the mother during the initial stages of pregnancy are normal body changes that the body adopted with time and the mother felt better without any treatment.

5.2.3 The socio-economic factors contributing to malnutrition among pregnant women

According to the findings in the study, majority of the respondents 20/30 (63.3 %) said that they were unemployed while minority 10/30 (36.7%) were employed. This indicated that most respondents were dependents and had no economic power to handle good nutrition. This corresponds with (Dasgupta, P. 2016) who stated that women employment increases her economic status in their homes, this in particular improves her nutrition status and household nutrition. Employment may increase women’s status and power, and may bolster a woman’s preference to spend her earnings on health and nutrition.

According to the results in the  study majority 18/30 (60%) of the respondents house hold income status  was less than 200000 shs a month while minority 12/30 (40%) house hold income status was more than 200000 shs per month. This meant that these women are less likely to have a balanced and healthy diet for nutrition, resulting in higher risk of underweight. This was similar to (Emina et al. (2009) who stated that increase in a woman economic status improves her nutrition status and household nutrition. Employment may increase women’s status and power, and may bolster a woman’s preference to spend her earnings on health and nutrition.

According to the results in the study, majority 17/30 (56.7%) of the respondents said that the source of their food is from a garden while minority13/30 (43.3%) were getting it from the market. This indicated that most of the respondents have access to fresh food and vegetables which were free. This result was in line with (Okello, et al 2016) who in his study in Amuru northern Uganda stated that majority of Ugandans are peasant farmers who earn their livelihoods from subsistence farming.

The findings also revealed, majority 24/30 (80%) of the respondents said that they spend less than 200,000 per month on food while minority 1/30 (3.3%) said they spend more than 200,000 on food. Which indicated that most of the respondents don’t spend a lot on food and this is probably because most of them and their spouses are low income earners hence resulting in mulnutrition. This result corresponded with (Van Klaveren, et al, 2009) who in his study in Bostswana among 6000 pregnant women, 54% of them revealed that they only spend 500 Botswana pula per month on food.

The results in the study indicated that majority of respondents 21/30 (70%) revealed that their partners contributed to feeding during their pregnancy while minority 9/30 (30%) said that their partners don’t contribute anything. This meant that most respondents depended on their partners for feeding and other support during pregnancy which led to fairly good nutritional status. This result corresponded with (Cornwall, A. 2016) who carried out a study in Egypt about women emancipation and revealed that among 47000 sampled 52% agreed that their spouses cater for their feeding medical bills and support them at home when they are pregnant.

The results in the study further indicated that majority of respondents 11/21 (52%) revealed that their spouses contribute food during their pregnancy while minority 1/21 (5%) said that their partners contributed by preparing meals. This result indicated that most of the respondents were dependent on their spouses for food and other help during pregnancy which would contribute to good nutrition. This finding is in line with (Sokoya, 2009) study about women’s perception of husbands’ support during pregnancy, labour and delivery in  Ogun State Lagos Nigeria, among the 200 participants (92.5%) said that their husbands bring for them fruits and vegetables on their way back from work.

According to the results in the study, majority 24/30 (80%) said that they don’t have nutritional support groups while minority 6 (20%) said they have. This implied that most of the respondents were not sensitized about good nutrition especially during pregnancy at community level. This finding corresponded with (Nisbett, N., et al, 2017) who states that in many communities in Sub Saharan Africa lack nutritional structures at village levels that can sensitize people especially pregnant women about nutrition.

The results in study further indicated that majority 4/6 (66.7%) said that support groups contributed food while minority 2/6 (33.3%) said they tought on what to eat during pregnancy. This indicated that nutritional support groups in the community are very important to promote good nutrition among the people especially pregnant mothers. This finding was in line with (Corley, et al, 2016) who stated that good nutrition among pregnant women especially in rural areas can be achieved through the promotion of community support groups that can be used to sensitize and teach people on how to feed well.

5.2.4 Cultural factors that contribute to malnutrition among pregnant women.

According to the findings of the study majority 27/30 (90%) of the respondents said that there are food taboos against women in their culture while minority 3/30 (10%) said that there is no such taboos in their culture. This contributed to malnutrition among the respondents with food taboos. The findings agree with (Merchant, K. M 2014) who stated that food taboos among rural women have been identified as one of the factors contributing to maternal under nutrition in pregnancy. Pregnant and lactating women in various parts of the world are forced to abstain from nutritious and beneficial foods. In various studies, it was seen that pregnant women in various parts of the world are forced to abstain from nutritious foods as a part of their traditional food habits

The results in the study further revealed that majority 10/30 (33.3%) of the respondents said that women are denied to eat eggs 9/30 (30%) said that women are denied chicken 6/30 (20%) said meat, 4/30 (13.3%) said vegetables while minority 1/30 (3.3%) mentioned other kind of foods denied to women. This implied that denial of these women to eat the above foods contributes to malnutrition which corresponded with (Paupério, A., et al, 2014), who urged that food taboo is a deliberate avoidance of a food item for reasons other than simple dislike from food preferences. In some societies, food taboos are often meant to protect the human individual and the observation, for example, that certain allergies and depression are associated with each other could have led to declaring food items taboo that were identified as causal agents for the allergies.

According to the findings in the study, a great majority of respondents 29/30 (96.7%) said that there is no equality between men and women in regards to food distribution while just 1/30 (3.3%) said that there is equality between men and women. This implied that men got balanced diet which compromised pregnant women’s’ nutritional status. This corresponded with (Meyer-Rochow, V. B. 2009), who acknowledges that, it is believed that any food taboo, acknowledged by a particular group of people as part of its ways, aids in the cohesion of this group, helps that particular group maintain its identity in the face of others, and, therefore, creates a sense of belonging.

The results in the study indicated that majority of respondents 20/29 (69%) said that inequality that manifests itself between men and women was that men get the biggest portions of the meal and Men are served first while minority 4/29 (13.8%) said than men are served first this indicated that men took large portions of food hence women were not getting required amount of food values hence contributing to malnutrition. This result was in consistence with (Corley, A. G., et al, 2016) who stated that in sub-Saharan Africa, men dominate the households and this dictates that women serve food to them faster and they give them more food than them.

5.3 Conclusion

The study made the following conclusions;

The results of the study revealed that personal factors contributing to malnutrition were fast time pregnancy due to lack of experience were majority16/30 (53.3%) said that the they were not pregnant for the fast and 10/30 (33.3%) said they didn’t know the benefits of good nutrition while, 23/30 (76.7%) said they experience complications during their initial stages of pregnancy like vomiting diarrhea and lack of appetite.

The results further indicated that socio-economic factors also contributed to malnutrition where majority 20/30 (63.3 %) said that they were unemployed which resulted in low expenditure on food like 24/30 (80%) of the respondents said that they spend less than 200,000 on food monthly and majority 80% did not have nutritional support from their communities.

In regards to cultural factors, the study revealed that majority 27 (90%) had food taboos against women which deprives pregnant women of nutritious foods like eggs, milk chicken, meat. The results also revealed by a majority 29/30 (96.7%) of respondents that there is no equality between men and women in regards to food distribution.

 Final conclusion

In conclusion, personal factors, socio-economic factors and cultural factors all contributed to malnutrition among pregnant women in Butansi

5.4 Recommendation

The study made the following recommendations;

5.4.1 To the government

The study recommended that government of Uganda should increase on the facilitation of health Centre IIIs so that health centers like Butansi health center III can acquire facilitation that would enable it to carry out massive sensitization about the importance of proper nutrition by pregnant women.

5.4.2 Butansi health center III

The study recommended that health center management should employ skilled health workers will be in position to train pregnant women about nutrition. The health center should also avail teaching materials like chats and display them inside and outside the health Centre.

5.4.3 To the health workers.

The study recommended that health workers should act professionally while sensitizing women about nutrition of pregnant women and its importance by telling their clients about all the necessary foods they need to eat during their pregnancy. This will help the women s to make an informed choice of what to eat and also refuse to adhere to food taboos against them.

5.4.4 To mothers

The study further recommended that mothers should pay attention to health workers’ advices and make choices about the proper nutrition during pregnancy by eating the necessary foods that will help the mother and her baby.

5.5 Implication to the nursing practice

According the nursing practice, nurses should attend nutritional seminars in order to gain skills about balanced diet. This will help Health workers to counsel women on the benefits good nutrition during pregnancy in order to help them make an informed choice about which food to eat during the pregnancy period.

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APPENDICES

APPENDIX 1

 CONSENT FORM

My name is Nambi Susan a student midwife of Public Health Nurses College; I am carrying out a study about factors contributing to malnutrition among pregnant women in Butansi health center III Kamuli District.

Privacy and confidentiality. You are requested voluntarily to consent and participate in the study and numbers will be used instead of names to ensure that the information given will be kept confidential.

Time to be taken for interview. The interview will take 15 minutes.

Right not to participate. All women have the right not to participate in the study.

Monetary benefits. Once you participate in this study there is no any payment

I have explained the purpose and objective of the study to the participant and they have understood and voluntarily consented to participate in the study.

Researcher’s  signature……………………………Date………….

The topic and objectives of the study have me been explained to and understood and voluntarily agreed and consented to participate in the study.

Respondents’ Signature………………………………Date……………

APPENDIX II

QUESTIONNAIRE

Dear respondent, my name is Nambi Susan undertaking a study regarding factors contributing to malnutrition among pregnant women in butasi health center III Butansi sub county kamuli district

Respondents no…………….

Please tick were appropriate.

Section A: BIODATA

1. How old are you? (years)

• 15-25

(b) 26-35

(c) 36-45

(d) 46 and above

2. What is your religion?
3. Protestant
4. Catholics
5. Muslims
6. Pentecostals
7. What is your marital status?

(a) Single

(b) Married

(c) Widowed

(c) Separated

4. What is your level of Education?

(a) None

(b) Primary

(c) Secondary

(d) Vocational

(e) University

5. What is your occupation?

(a) None

(b) Civil servant

(c) Self employed

(d) Non-government worker

Section B personal factors contributing to malnutrition among pregnant mothers

6. Is this your first pregnancy??

(a) Yes

(b) No

7) If no how many children do you have?

1. 1-2
2. 3-4
3. 5and above

8 What is the spacing between your children?

1. 1year
2. 2years
3. Above 2 years

9 What are the benefits of taking nutritious foods during pregnancy??

1. Baby’s weight will be normal
2. Baby’s weight will be low
3. Baby will be overweight
4. Don’t know
5. 10 Did you experience any complications at the initial stages of your pregnancy??
6. Yes
7. No

11 if yes which of the following

a). Vomiting

1. b) Diarrhea
2. c) Stress
3. d) Lack of Appetites

12). How did you solve the above complications?

1. a) Nothing
2. b) Took drugs
3. c) Went for ANC counseling
4. d) Ate food of interest.

Section C:The socio- economic factors contributing to malnutrition among pregnant women

13 Are you employed?

1. Yes
2. No

14 What is your monthly income?

1. Less than 200,000
2. More than 200.000

15). what is the source of your food?

(a) Garden

(b) Market

16) How much do you spend on food monthly?

1. Les that 200000
2. More than 200000

17) Does your partner contribute to your feeding when you are pregnant?

1. a) Yes
2. b) No

18) If yes how?

1. a) Buys food
2. b) Help in digging
3. c) Advice on what to eat
4. d) Prepare meals when am unable
5. Do you have nutritional support groups in your community?
6. a) Yes
7. b) No

20) If yes how do they support your feeding during pregnancy?

1. a) Contribute food
2. b) Teach on what to eat
3. c) Council in case of stress

Section D cultural factors that contribute to malnutrition among pregnant women.

18Are there any food taboos against women in your culture?

1. Yes
2. No

19If yes what type of food are ladies denied?

1. Chicken
2. Vegetables
3. Meat
4. Milk/eggs
5. Others

20 Is there equality between men and women in your culture?

Yes

No

21 If no what kind of inequality manifests itself in regard proper nutrition of pregnant women

1. Men get big portions of the meal
2. Men are served first
3. All the above

Thank you

APPENDIX III:

INTRODUCTION LETTER

APPENDIX IV:

MAP OF UGANDA SHOWING KAMULI DISTRICT

Kamili Districh

Ugandan borders

District Borders

Water bodes

APPENDIX V:

MAP OF KAMUL DISTRICT SHOWING BUTANSI HEALTH CENTRE THREE