REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON

Paix –travail-patrie Peace –work-fatherland

************ ****************
MINISTERE DE L’ENSEIGNEMENT MINISTRY OF HIGTHER EDUCATION
SUPERIEUR ***************
************ ESTUARY ACADEMIC AND STRATEGIC
INSTITUT UNIVERSITAIRE ET
INSTITUTE
STRATEGIQUE DE L’ESTUAIRE

INSTITUT UNISVERSITAIRE ET STRATEGIQUE DE L`ESTUAIRE /ESTUARY

ACADEMIC AND STRATEGIC INSTITUTE (IUES/INSAM)

SOUS LA TITULAIRE ACADEMIQUE DE L’UNIVERSITE de DSCHANG et de BUEA

RESEARCH PROTOCOL

EFFECTS OF MATERNAL ATTRIBUTES ON

MALNUTRITION AMONG PREGNANT WOMEN

FIELD:

MEDICAL AND BIOMEDICAL SCIENCE

SEPCIALITY:

NURSING

WRITTEN BY:

NGOULA NJOU CARELLE MINUELLE

MATRICULE 21A395

SUPERVISED BY:

MR. FUH DIVINE

1
 LIST OF ABBREVIATION

WHO: Wold Health Organisation

LBW: Low Birth Weight

TABLE OF CONTENTS
2
LIST OF ABBREVIATION...........................................................................................................................2
TABLE OF CONTENTS.............................................................................................................................3
CHAPTER ONE........................................................................................................................................5
INTRODUCTION......................................................................................................................................5
1.1. Background...........................................................................................................................5
1.2. Problem Statement...............................................................................................................6
1.3. Objectives..............................................................................................................................6
1.3.1. Main Objective..............................................................................................................6
1.3.2. Specific Objectives........................................................................................................7
1.4. Research Hypotheses............................................................................................................7
1.5. Significance of Study............................................................................................................7
1.6. Scope and Limitation the Study...........................................................................................7
1.7. Definitions of Terms.............................................................................................................8
CHAPTER TWO.......................................................................................................................................9
LITERATURE REVIEW..............................................................................................................................9
2.2 Conceptional Review..................................................................................................................9
2.3 Causes of Malnutrition on Pregnant Women...........................................................................9
2.4 Signs and Symptoms Malnutrition on Pregnant Women........................................................9
2.5 Epidemiology............................................................................................................................11
2.6 Pathophysiology........................................................................................................................12
2.7 Risk factors of Malnutrition in Pregnant Women.................................................................12
2.9 Treatment and Prevention.......................................................................................................13
CHAPTER THREE.......................................................................................................................14
METHODOLOGY.........................................................................................................................14
3.1. Study Design............................................................................................................................14
3.2. Study Area...............................................................................................................................14
3.2.1 Presentation of the Study Area.........................................................................................14
3.2.2 Geographical Location of the Area..................................................................................15
3.2.3. Structural Organisation...................................................................................................15
3.2.4 Reason for Choosing the Place of Study...........................................................................15
3.3 Duration of Study.....................................................................................................................16
3.4: Study Population.....................................................................................................................16
3.5: Sampling Size...........................................................................................................................16
3.6 Sampling Method......................................................................................................................17

3
3.7 Selection Criteria......................................................................................................................17
3.7.1 Inclusion criteria................................................................................................................17
3.7.2 Exclusion Criteria..............................................................................................................17
3.8 Data Collection.........................................................................................................................17
3.9 Data Analysis............................................................................................................................17
3.10 Limitation of Study.................................................................................................................18
3.11 Ethical Consideration.............................................................................................................18
3.12 Appendix 1: Chronograms of Activities...............................................................................19
3.13 Appendix 2: Budget for the Research...................................................................................20
REFERENCES...............................................................................................................................21

4
 CHAPTER ONE
INTRODUCTION
1.1. Background

The World Health Organization (WHO) defines malnutrition as ‘the cellular imbalance

between the supply of nutrients and energy and the body’s demand for them to ensure growth,

maintenance, and specific functions’. Contrary to the common use, the term malnutrition

refers not only to deficiency states but also to excess and imbalance in the intake of calories,

proteins and/or other nutrients

Today, nearly one in three persons globally suffers from at least one form of malnutrition.

Women of reproductive age are especially vulnerable to chronic energy deficiency and other

malnutrition. Globally, approximately 13% of women were estimated to be undernourished.

Maternal and child malnutrition is the underlying cause of 3.5 million deaths. The main

nutritional issues impacting pregnant women were protein and energy under nutrition and

deficiencies of micronutrients, such as iron, folate, calcium, vitamin D and vitamin A.

Globally, 38% of all pregnant women suffered from anemia and contributing for 20% of

maternal mortality. Pregnancy increases the risk of iron deficiency anemia as there is an

increase in maternal iron requirements. Around 70% risk of anemia can be reduced through

iron supplementation during pregnancy.

Malnutrition is known to increase the risk of poor pregnancy outcomes, including obstructed

labor, premature or low-birth-weight (LBW) babies and postpartum hemorrhage. Severe

anemia during pregnancy is associated with increased maternal mortality. Besides,

malnutrition among mothers has an intergenerational effect with repeating cycles of

malnutrition and poverty in the long run. Previous studies have established that malnourished

pregnant women are at increased risk of having LBW infants. The link between LBW and

5
poor health and nutritional outcomes later in life is also well established, with several studies

reporting the

association of LBW with malnutrition, poor growth and development, and increased

morbidity and mortality in children. Besides, poor nutrition during pregnancy, especially

deficiencies of certain vitamins and minerals, have been associated with negative pregnancy

outcomes for both the mother and the infant. Severe iron deficiency anemia has been linked to

preterm labor, poor anthropometric measures and birth asphyxia. Studies on the impact of

maternal malnutrition during lactation are rare. Several reports suggested a possible

association of malnutrition among lactating mothers with production of smaller quantities of

breast milk, and low levels of B vitamins, vitamin A and essential fatty acids in breast milk.

Maternal malnutrition is caused by complex interaction of a multitude of factors. Severe

illness, breastfeeding and having several children below 2 years of age are negatively

associated with maternal nutritional status, while higher maternal age and socio-economic

status, and household food security have positive effect. In addition, social factors, such as

marital status, education, and income also have influence. Based on this background the

researcher wants to investigate effects of maternal attributes on malnutrition among pregnant

women.

Malnutrition in pregnancy and in children is a major public health problem, especially in

many low-income and middle- income countries. It adversely affects the productivity of

nations as well as creating economic and social challenges among vulnerable groups. Poor

nutrition is associated with suboptimal brain development, which negatively affects cognitive

development, educational performance and economic productivity in adulthood. (Coulter,

2014).

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Malnutrition is a broad term and it is usually referred to as undernutrition and it encompasses

all forms of nutritional disorders and includes both overnutrition and undernutrition (WHO

Nutrition 2016)

WHO defines malnutrition as; the cellular imbalance between the supply of nutrients and

energy the body demands to ensure growth maintenance and specific functions. Malnutrition

can be termed as chronic malnutrition (stunting) and acute malnutrition (underweight and

wasting). It can be termed as macronutrient deficiency malnutrition (Protein-Energy

Malnutrition) or micronutrient deficiency malnutrition e.g, iron etc. There are two main forms

of acute malnutrition, which are marasmus and kwashiorkor(WHO Nutrition, 2016).

The new SDGs state that eradication of extreme poverty and hunger by halving the number of

people living on less than $1.25 a day and the number of people suffering from hunger.

Of even more significance are the uneven rates of achievement in different parts of the globe.

For instance, the largest decline in the prevalence of malnutrition has been in East Asia,

especially in China, while substantial improvements have been made in Latin America and

the Caribbean. However, less progress was seen in South Asia, where the prevalence of

underweight remains very high, while sub-Saharan Africa saw little or no change over the

period 1990-2011.

Under nutrition during this critical phase can have irreversible consequences on the child’s

growth leading to an increased risk of morbidity and mortality in pregnant women (Murray-

Kolb., et al 2013). Under nutrition is commonly assessed through the measurement of

women’s anthropometry (height, weight), as well as through screening for biochemical and

clinical markers. Wasting, stunting and underweight are expressions of under nutrition and the

anthropometric indicators for the assessment (Duggan et al., 1999).

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1.2. Problem Statement

These individual studies also stated factors like maternal age, income, residence, marital

status, educational status, women decision, substance abuse, water source, toilet possession,

family size, dietary diversity, number of meal, dietary advice, family planning, pregnancy

intention, antenatal care follow up, parity, gestational age, any illness and iron

supplementation as a potential associated factors with malnutrition during pregnancy even

though inconsistent findings were recorded. This study will be carried out for the pool burden

of malnutrition among pregnant women at the Deido District Hospital

1.3. Objectives

1.3.1. Main Objective

To assess the Effects of Maternal Attributes on Malnutrition among Pregnant Women

1.3.2. Specific Objectives

1. To ascertain the causes of malnutrition among pregnant women in the Deido District

Hospital.

2. To ascertain the maternal attribute on malnutrition among pregnant women in the

Deido Deido Hospital.

3. To ascertain the effect of malnutrition on pregnant women in the Deido District

Hospital.

1.4. Research Hypotheses

For the successful completion of the study, the following research hypotheses were

formulated by the researcher;

H0: there are no causes of malnutrition among pregnant women at the Deido District Hospital

H1: there are causes of malnutrition among pregnant women at the Deido District Hospital

1.5. Significance of Study

It is believed that at the completion of the study, findings will be of benefit to the ministry of

health and pregnant women. The study will help pregnant women to make good dietary
8
choice. The study will also be of great benefit to the researchers who intends to embark on

research on similar topics as it will serve as a guide.

Finally, the study will be of great importance to academia’s, lecturers, teachers, students and

the general public

1.6. Scope and Limitation the Study

The scope of the study covers effects of maternal attributes on malnutrition among pregnant

women in Deido District Hospital. In the course of the study, the researcher encounters some

constrain which limited the scope of the study;

1. Availability of research material: The research material available to the researcher is

insufficient, thereby limiting the study

2. Time: The time frame allocated to the study does not enhance wider coverage as the

researcher has to combine other academic activities and examinations with the study.

1.7. Definitions of Terms

DIETARY: A dietary supplement is either intended to provide nutrients in order to

increase the quantity of dietary supplements should not be used to treat any disease or as

preventive healthcare. An exception to this recommendation is the appropriate.

PREGNANT WOMEN: Pregnancy, also known as gestation, is the time during which

one or more offspring develops inside a woman. A multiple pregnancy involves more

than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or

assisted reproductive technology.

ATTENDING: Be present at (an event, meeting, or function).

HEALTHCARE: Health care or Healthcare is the maintenance or improvement of

health via the diagnosis, treatment, and prevention of disease, illness, injury, and other

physical.

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 CHAPTER TWO

LITERATURE REVIEW

2.2 Conceptional Review

Malnutrition during pregnancy is common in low-income women in the developing world due

to inadequate dietary intake combined with increased nutrient requirements; the potential for

complications for the mother and child in this at risk population is manifest in increased

maternal and infant mortality (National Report, 2000, Rush, 2000, Black et al., 2008, Lartey,

2008, Bloomfield, 2011) and the lifelong effects of fetal malnutrition (Barker, 2006, Victora

et al., 2008). HIV infection, maternal under-nutrition and its effects have been under the

spotlight over the years with efforts towards its reduction. However, the condition has

continued to affect women of reproductive age (WRA) despite the attention it is receiving

(Black et al. 2013).

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2.3 Causes of Malnutrition on Pregnant Women

Lancet 2013 highlights that there is significant contribution of under-nutrition to children,

stemming from fetal growth restriction, stunting, wasting, micronutrient deficiencies, with a

direct link to maternal causes. Globally, approximately 13 percent of women were estimated

to be undernourished, and 38 percent of all pregnant women suffered from anemia (Black et

al 2013). . A lot of attention has been put in the assessment of malnutrition in children up to 5

years and little was done to pregnant women even though maternity under-nutrition has a

direct bearing on the outcome of pregnancy. Despite the evidence of a strong association,

global MUAC cutoffs have not been established to identify pregnant women who are

undernourished and therefore at risk of adverse birth outcomes (Tang A.M et al 2016).

2.4 Signs and Symptoms Malnutrition on Pregnant Women

Malnutrition continues to be a major public health problem throughout the developing world,

particularly in southern Asia and sub-Saharan Africa (Schofield C et al, 1996). Diets in

populations there are frequently deficient in macronutrients (protein, carbohydrates and fat,

leading to protein–energy malnutrition), micronutrients (electrolytes, minerals and vitamins,

leading to specific micronutrient deficiencies) or both (Brabin BJ et al 2003).

The high prevalence of bacterial and parasitic diseases in developing countries contributes

greatly to malnutrition there. Similarly, malnutrition increases one's susceptibility to and

severity of infections, and is thus a major component of illness and death from

disease. Malnutrition is consequently the most important risk factor for the burden of disease

in developing countries (Murrey CJL et al 1997). It is the direct cause of about 300 000 deaths

per year and is indirectly responsible for about half of all deaths in young children. The risk of

death is directly correlated with the degree of malnutrition.

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Figure 1: Deaths associated with malnutrition (WHO, 2021)

Poverty is the main underlying cause of malnutrition and its determinants (Duncan T et al,

2001). The degree and distribution of protein–energy malnutrition and micronutrient

deficiencies in a given population depends on many factors: the political and economic

situation, the level of education and sanitation, the season and climate conditions, food

production, cultural and religious food customs, breast-feeding habits, prevalence of

infectious diseases, the existence and effectiveness of nutrition programs and the availability

and quality of health services (Brabin BJ et al, 2003).

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Figure 2: Effects of malnutrition (WHO. 2020)

2.5 Epidemiology

Worldwide, an estimated 852 million people were undernourished in 2000–2002, with most

(815 million) living in developing countries. The absolute number of cases has changed little

over the last decade. However, while China had major reductions in its number of cases of

protein– energy malnutrition during this period, this was balanced by a corresponding

increase in the rest of the developing world. In children, protein–energy malnutrition is

defined by measurements that fall below 2 standard deviations under the normal weight for

age (underweight), height for age (stunting) and weight for height (wasting) (Pinstrup–

Andersen P et al, 1993). Wasting indicates recent weight loss, whereas stunting usually results

from chronic weight loss. Of all children under the age of 5 years in developing countries,

about 31% are underweight, 38% have stunted growth and 9% show wasting. Protein– energy

malnutrition usually manifests early, in children between 6 months and 2 years of age and is

associated with early weaning, delayed introduction of complementary foods, a low-protein

diet and severe or frequent infections.

2.6 Pathophysiology

After insufficient supply of protein, carbohydrates and fat, the next major cause of protein–

energy malnutrition is severe and chronic infections — particularly those producing diarrhea,

but also other diseases such as helminthic infections. The underlying mechanisms include

decreased food intake because of anorexia, decreased nutrient absorption, increased metabolic

requirements and direct nutrient losses (Chen LC et al 1983). The term protein–energy

malnutrition describes the cause (i.e., the imbalance between nutrient supplies and

requirements) more than the pathogenesis of starvation. The pathologic changes include

13
immunologic deficiency in the humoral and cellular subsystem from protein deficiency and

lack of immune mediators (e.g., tumour necrosis factor). Metabolic disturbances also play a

role in impaired intercellular degradation of fatty acids because of carbohydrate deficiency.

Synthesis of pigments in the hair and skin fails (e.g., hair colour may change and skin become

hyperpigmented) because of a lack of substrate (e.g., tyrosin) and coenzymes (Lemer AB et al

1971).

2.7 Risk factors of Malnutrition in Pregnant Women

While some scenarios discussed in this paper can occur in economically advanced countries,

sub-Saharan Africa offers paradigm examples. A large part of the continent is living rapid

changes in environments and lifestyles, including food productions and consumption, the

(global) market of consumers’ products and environmental pollution sources (e.g. mining,

petrol-related activities, e-waste). Scientific literature data from sub-Saharan Africa indicate

that toxic exposures rapidly evolve along with diet and environment (Vaccher et al., 2019;

Orisakwe et al., 2019a, 2019b; Pouokam et al., 2017; Bornman et al., 2017; Sorensen et al.,

2015; Proietti et al., 2014). As discussed in the following sections, environmental factors can

adversely influence nutritional status by eliciting an inadequate intake and/or utilization of

key micronutrients in severely polluted areas as well as in much wider settings.

2.9 Treatment and Prevention

Despite the manifold dietary approaches to severe malnutrition that have been tried, patients

with kwashiorkor (including marasmus and kwashiorkor) continue to die much more

frequently than those with marasmus alone. In sub- Saharan Africa and, increasingly, India,

an additional concern is that many patients with severe malnutrition are also infected with

HIV (Heikens GT et al 2003). The high mortality indicates a need for a systematic approach

to the severely malnourished patient that goes beyond an appropriate diet. To reduce

mortality, a complex management scheme is pivotal. Essential steps include a reduced intake

14
of volume, protein and sodium during the first phase while emergency measures are taken to

reduce the risk of hypoglycemia, hypothermia and dehydration (Briend A et al 1998) Oral,

enteral and parenteral volume loads must be checked carefully to avoid imminent heart

failure; continuous monitoring of central venous blood pressure is very desirable. In this early

phase of rehabilitation, a protein intake exceeding 1 g/kg body weight in combination with

impaired liver function (with breakdown of the urea cycle) and little urine excretion (a result

of dehydration) easily exceeds the malnourished child's metabolic capacity to rid him- or

herself of excess ammonia. Although the effectiveness of the World Health Organization

(WHO) 10-step scheme is proven, there are still pitfalls for certain patients, such as those with

extreme anemia and those who are close to cardiac failure. The need for transfusions must be

weighed against the risk of heart failure; combining transfusions with diuresis or applying

exchange transfusion can resolve the dilemma. The WHO is currently revising its protocol to

address 3 difficulties: the specific nutritional problems of children with HIV infection or

AIDS; different dietary regimens, particularly for infants younger than 6 months; and the

limited availability of potassium– magnesium– zinc– copper preparations (WHO 2005).

15
16
 CHAPTER THREE

METHODOLOGY
3.1. Study Design

In this research study we will use a descriptive, qualitative and cross-sectional research

designs. A cross sectional design will be used to gather information from a population at a

given point in time. Descriptive design will be used in describing the people who will take

part of the study. A qualitative design is based on the quality and kind, these designs will be

used since the collection, analysis and interpretation of data shall be represented on statistical

frame work and tools such as percentage and tables in order to help in the favourable success

of this research.

3.2. Study Area

DEIDO DISTRICT HOSPITAL (DDH) is located in the subdivision of Douala one (Douala

1ere). This hospital has well-equipped maternity unit for the caring of pregnant women.

3.2.1 Presentation of the Study Area.

The DDH is headed by a medical doctor. He is followed second in line by a general

supervisor. This two are followed by other persons of authority as indicated below:

 Head of the District centre

 Medical doctor/ director of all departments

 General supervisor

 Doctors

 Nurse

3.2.2 Geographical Location of the Area

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3.2.3. Structural Organisation

The Deido District Hospital comprises of services which form the whole hospital entity, they

include.

 A reception to direct and welcome individual to the hospital

 The administrative services

 Medical wards

 Theatre

 Consultation room

 Pharmacy

 Hospitalization unit

 The Antenatal, Post care and Vaccination unit

 Family planning unit

 Maternity

 Pediatric unit

3.2.4 Reason for Choosing the Place of Study

The DDH has a well-equipped pediatric unit available for hospitalization of children. The

centre receives around 10-20 children each day and is a useful facility to the community. This

led to the reason of it been chosen for the appropriate prevention of malnutrition in pregnant

woman

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3.3 Duration of Study
This research will be carried out in the space of six months that is the month of October 2022

to March 2023.

3.4: Study Population

This portion deals with the group individuals under investigation. The study population of this

research will be health personnel’s in the pediatric unit and children 0-5years with

malnutrition attending DDH.

3.5: Sampling Size

This refers to the approximation of the representative segment of the population selected to

represent the population as a whole. For this research, nurses are working in the maternity

service at DDH respectively, a derived formula can be used to have a notion of the sample
2
t × pq
size under the study; using the Daniel 1999 formula.n= 2
d

Where n= sample size

t= constant of confidence interval (1.96)

p= past prevalence
q=1-p

d= error margin constant (0.05)

Hence, taking into consideration a past prevalence (p) of 1.4

Converting the p to percentage, 1.4/100, we get 0.014%

2
(1.96) × ( 0.014 ) (1−0.014)
n=
(0.05)2

n = 21.2 ~ 21 individuals

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The above calculation is an estimation of individuals representing the overall portion while

waiting for an appropriate data collection and analysis.

3.6 Sampling Method

A sampling method is the act of selecting the group of individuals that researchers will

actually collect data from in this research. Here, a simple random sampling method was used

which help in randomly selecting a subset of participants from a population.

3.7 Selection Criteria

This are strategies that will help us to define the knowledge, attitude and qualification of a

person for him/her to fully engage and help contribute to the successful carrying of this

research under study. There are of two types inclusion and exclusion criteria.

3.7.1 Inclusion criteria

 Nurses working at the maternity unit

3.7.2 Exclusion Criteria

 Nurses who are absent

 Nurses not willing to answer the questionnaires.

 Nurses who are not working at the maternity unit

3.8 Data Collection

Data collection is the process by which the researcher collects information from all the

relevant sources to find answers to the research problem, test the hypothesis and evaluate the

outcome. The data will be conducted using a close ended questionnaires which will be used in

other to obtain demographic data and also to investigate on the experience of nurses’

intervention of nurses regarding the prevention of malnutrition. The identity of the respondent

to these questionnaires will be kept confidential.

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3.9 Data Analysis
It is the process of systematically applying statistical and/or logical techniques to describe and

illustrate, condense, recap and evaluate data. At the end, the questionnaires will be marked

and the total will be presented on different forms giving percentages in tables, chart and

others. They will be analysed and at the end the questionnaires will be annotated and enter in

Microsoft excel 2010. Each section of the questionnaires will be analysed by given aspects of

the research knowledge, attitude and practices as well as interventions put in place by nurses

on the prevention of malnutrition in pregnant woman.

3.10 Limitation of Study

 Language barrier.

 Little or no willingness of nurses to take part in the data collection.

 Lack of availability of nurses to take part in the data collection

3.11 Ethical Consideration

 An authorization from the ministry of higher education and ministry of public health.

 An authorization from the, ministry of the school and the medical centre in question.

 A voluntary participation form will be given to each participant before the data

collection.

 All participants will have equal right to decline or accept to be part of participation.

 They will not be subjected to harm in any form during the course of the study.

 All information collected from the participants will be kept strictly confidential and

Plagiarism will be avoided.

 Respect will be given to all the nurses practicing in the study.

 They will be done by me

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3.12 Appendix 1: Chronograms of Activities
October to January 2024 February to March April 2024
December 2023 2024
RESEARCH
PROPOSAL
SUMISSION
DATA
COLLECTION

DATA ANALYSIS
AND
INTERPRETATION OF
RESULTS
FINAL
SUMISSION OF
REPORT AND
DEFENSE

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3.13 Appendix 2: Budget for the Research

NUMBERS INSTRUMENTS DESCRIPTION PER UNIT PRICE TOTAL

AND PRICE
JUSTIFICATION

1 QUESTIONNAIRE 50 questionnaires 50frs per page 5000frs

S of about 2 pages
each were made

2 SOURCES OF The used of 7000frs for internet 17000frs

INFORMATION internet and services per months
FOR RESEARCH printing that is and printing cost
necessary for this 10000frs
study

3 TRANSPORT AND Transport, feeding Transport 20000frs, 55000frs

AIRTIME CREDIT and feeding 30000frs
communication and airtime 5000frs
airtime
4 MISCELLANEOUS Estimated 20000frs
expenditure not
planned

5 PRINTING Research proposal Printing per page is 10000frs

DOCUMENT AND of about 27 pages 50frs spiral blinding
SPIRAL BLINDING with 4 copies each for each copy is
being spiral 200frs
blinding

23
 TOTALS 107000frs

QUESTIONNAIRES
I am NGOULA NJOU CARELLE MINUELLE, Student of the nursing department level 3
in IUEs/INSAM, conducting a research on the topic EFFECTS OF MATERNAL
ATTRIBUTES ON MALNUTION AMONG PREGNANT WOMEN, as part of the
requirement to graduate with a Higher National Diploma in nursing sciences at the
UNIVERSITY AND STRATEGIC INSTITUTE OF THE ESTUARY (IUEs/INSAM).

You have been selected as a participant, participation is voluntary and you can choose not to
take part. It should be noted that all information would be kept discrete and confidential and
use only for academic purpose. The filled questionnaire will help me in the research work. It
includes a maximum of 24 questions and will take approximately 30 minutes. We are
counting on your sincere cooperation and thank you for your availability.

SECTION A: DEMOGRAPHIC DATA

Tick the correct answer

1)Age

a) <18 b) 18-24 c) 25-35 e) >35-45

2) Marital Status

a) Married b) widowed c) divorced d) single

3) Diploma

a) Nurse aid b) state registered nurse c) HND d) master

e) others/specify

4) Years of experience

a) 0-2yrs b) 3-5yrs c) 6-10yrs d) >11yr

24
5) Religion

a) Christian b) Muslim c) Others

SECTION B: MATERNAL ATTRIBUTES

Instruction: tick the correct answer below.

1) How tall are you? ________________________

2) What is your current weight? ___________________
3) Do you know your body mass index ?
a) Yes
b) No
If yes, what is body mass index ______________
4) How many pregnancies have you had before? _______________
5) Do you have a history of malnutrition?
a) Yes
b) No
c) I Don’t know
SECTION C : DIETARY HABITS
1) How many meals do you have a day ? ______________
2) The types of food you consume on regular basis ?________________
3)
SECTION D: KNOWLEDGE OF PREGNANT WOMEN ON THE EFFECTS AND
PREVENTION OF MALNUTRITION

1) How much do you know about malnutrition and its effects ________________
2) How often do you go for prenatal check ups ____________
3) Are health facilities easily accessible to you? ____________
4)

25
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National Report, 2000, Rush, 2000, Black et al., 2008, Lartey, 2008,
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Barker, 2006, Victora et al., 2008

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microbiome in early life: health and disease. Front Immunol.
2014;5(September):427. https://doi.org/10.3389/fimmu.2014.00427.
Stiemsma LT, Michels KB. The role of the microbiome in the developmental
origins of health and disease. Pediatrics.
2018;141. https://doi.org/10.1542/peds.2017-2437.
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children. Science. 2019;365. https://doi.org/10.1126/science.aau4732.

Raman AS, Gehrig JL, Venkatesh S, Chang H, Hibberd MC, Subramanian S, et

al. A sparse covarying unit that describes healthy and impaired human gut
microbiota development. Science.
2019;365. https://doi.org/10.1126/science.aau4735.

AL, Planer JD, Liu J, Rao S, Yatsunenko T, Trehan I, et al. Functional

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