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ABSTRACT
This study was aimed at examining the food craving and aversion among first time pregnant
women in selected health facilities in Enugu metropolis. The objectives of this study were to
determine the type of food first time pregnant women crave for or have aversion to, identify their
reasons for their specific food craving and aversion, determine the first time pregnant women’s
awareness of the implication of food craving and aversion in pregnancy and to identify measures
taken by first time pregnant women to substitute for food craving and aversion in order to meet
up with their required nutritional needs. Cross sectional descriptive research design was used for
this study. A sample size of 366 respondents who met the inclusion criteria were drawn from the
target population of 2000 first time pregnant women using Taro Yameni’s formular. Proportional
stratified sampling method was used to select a representative sample size from each randomly
selected health facilities and convenience sampling technique was used to reach the respondent.
Data was collected using researchers developed questionnaire with a reliability of 0.87. Data
collected was analyzed with the help of International Business Machine Statistical Package for
Social Sciences (SPSS) version 23. Descriptive statistic which include frequency, percentage,
mean and standard deviation were used to analyze and answer research questions. Hypotheses
were tested using Pearson Chi-square; level of significance was set at P less than 0.05. The result
of the study showed that majority(74.8%) of respondents crave for or averse to at least one food
item and the type of food craved for were fruits. The type of food aversed to are beans based
products. Majority (42.6%) of the respondents indicated that they do not know most of the effect
of food craving and aversion on the health of mother and fetus. Majority (52.7%) of the first time
pregnant women do nothing to substitute for food nutrients needed in pregnancy when
experiencing food craving and aversion. Based on these findings, it was concluded that first time
pregnancy women craved for or averse to at least one food item and majority of the first time
pregnancy were not aware of the implication of food craving and aversion in pregnancy. It is
recommended that health personnel/nutritionist should be encouraged to educate pregnant
women especially the first time pregnant women on nutritional needs during pregnancy and
should involve men in nutritional education bearing in mind of male dominance in certain culture
and tradition.
CHAPTER ONE
INTRODUCTION
Background to the Study
Good nutrition before and during pregnancy builds a healthy fetus and protects the mothers
own nutritional health. (Dickason, Silverman & Schultz, 2010). In early weeks of pregnancy
significant developmental changes occur that depend on a woman’s nutrient stores. The food
pregnant mothers eat on a daily basis affects how their bodies work and how they maintain
energy and strength (Handisco, 2014). It also determines the basic nutritional health that their
children are born with and provides a model for their eating habits during childhood and
beyond.
Pregnancy is the time in women’s life when their eating habits directly affect their fetus
(Demissie, Muroki, & Makau, 2012). Their decision to incorporate nutritious food into their
eating plan during pregnancy will give them strength and helps them to give birth to healthy
baby. The risk of giving birth to a low birth weight baby is related to women’s nutritional
status (Handisco, 2014). Therefore dietary consumption during pregnancy can have
significant health implications for both mother and fetus. (Demissie, Muroki, & Makau
2012). According to Knox (2013) studies showed that maternal nutrition can affect a range of
factors including the course of pregnancy and the incidence of prematurity and congenital
malformations in the infant.
Pregnancy is often accompanied by a variety of nutritionally linked problems that most of the
time pregnant mothers have to cope with (Dickason et al, 2010). In order to cope with these
problems and to proceed with a successful pregnancy, mothers experience a number of
physiological and behavioral adjustments such as food craving and food aversion during
pregnancy. Food craving are intense desire to obtain certain foods which are very interesting
to the individual and may not be accessible at that time. On the other hand food aversion is
strong dislike of a particular food during pregnancy (Olusanya & Ogundipe, 2012). Food
craving and aversion if not properly managed may interfere with the dietary intake of the
pregnant women and sometimes causing serious problem such as low birth weight baby and
diet deficient in iron, calcium, protein, vitamins A,D B6 and folic acid.
Safaii (2013) however stated that some researchers believe that food craving is a mechanism
to protect the fetus and the mother from nutrient deficiencies and suggest that craving is
triggered when a deficiency in one or more nutrients arises. This opinion appears to be
supported by a study done by Demissie, Muroki & Wambui, (2012) which revealed that 43%
of pregnant women crave for nutritious foods that are lacking in their diet .According to
Nyaruhucha (2012) some women crave for non-food substance like soil, clay, chalk, charcoal
and some believe that ingestion of non-food substance relieves nausea and vomiting.
Nyaruchucha (2012) also suggested that the ingestion of non food substances suggest
deficiency of essential nutrients such as calcium or iron. Glans (2013) further noted that
aversions are physiological mechanism that protects the fetus either from nutrient
deficiencies by prompting mothers away from quality and monotonous foods or from excess
foeto-toxic substance present in the food, thus food aversion could be beneficial.
The food crave by pregnant women includes fruits like oranges, water melon, mangoes,
snacks, soft drinks, vegetables, meat, plantain and egg. In developed countries the foods
commonly craved for include yoghurt, ice cream, chocolate, candies among others.
(Olusanya and Ogundupe, 2012). The food aversed to pregnant women include Beans, egg,
snail, pear, bush animal meat, three leafed yam (Ona), mushroom, bitter kola (Akuilu), Green
vegetable, pumpkin leaf, ice fish, palm wine. In developed countries foods commonly
avoided are: coffee, alcoholic beverages, cigarette.
According to Safaii (2013) some first time pregnant women have increase desire for certain
food and aversion to some and adhere to them without looking for substitutes to maintain an
adequate diet. Certain demographic factors like age, religion, educational status, occupation
and income level could contribute to first time pregnant women craving and aversion to
certain foods. Most of the first time pregnant women may not know the implication of food
craving and aversion on their health and that of their fetus and also the nutritional value of
certain foods due to level of education. Some may prefer certain types of foods but may not
afford them due to level of income while some may believe that certain food are appropriate
because it is what is obtainable in the social class they live in; Most of the studies were
carried out in developed and developing countries.
There is paucity of data on food craving and aversion among the first time pregnant women
in Nigeria and Enugu metropolis in particular. Hence the researcher intends to examine the
food craving and aversion of first time pregnant women using health facilities in Enugu
metropolis.
Statement of Problem
Food craving and aversion in first time pregnancy is observed to be of concern to health care
providers. Due to the physiological and hormonal changes in pregnancy, first time pregnant
women do have increase nausea and vomiting as a result of high Oestrogen, progesterone and
human chorionic gonadotrophin (HCG) (Knox, 2013), This interferes with the dietary intake
of the pregnant women and sometimes cause serious problems like anaemia (Thomas, 2013).
Study by Nargia, Cooper and Kumar (2010) on assessment of pregnancy outcome in
primigravida in Pakistan showed an alarming incidence in nutritional related disorder where
it was observed that all the patients whether booked or unbooked were anaemic; 42% of them
were severely anaemic. WHO (2011) estimatess that more than half of the pregnant women
in the world have a haemoglobin level indicative of anaemia (<11mg/dl); the prevalence may
be however as high as 52% in developing countries compared with 23% in developed world.
This is a major cause of premature labour and low birth weight which are major causes of
prenatal mortality and maternal mortality in developed countries.
Ojofemitimi and Tanimowo (2014), after conducting a study in which anaemia is more in
primigravida, states that the higher incidence of low birth weight and anaemia in
primigravida in developing countries compared to developed countries is a reflection of poor
nutrition that may occur due to food craving and aversion and lack of health education on
how to substitute for food craving and aversion in other to meet up with the required
nutritional value for pregnant mothers.
The researchers clinical experiences in antenatal clinic revealed that about 75% of first time
pregnant mothers crave for certain types of food which seem to have negative impact on them
and the unborn child. Various maternal and child health program were geared towards
improving the nutritional status of pregnant mothers like focused antenatal clinic and
nutritional education in other to prevent complications in pregnancy and child birth.
Unfortunately much importance is not given to this group of women “First time pregnant
women” as study by Ezeugwu et al (2009) shows that first time pregnant women have an
increased incidence of low birth weight which poor nutrition is the major predisposing factor.
Most of the empirical studies reviewed were works done outside Nigeria. Only few were
work done in Nigeria. However no study was found by the researcher on food craving and
aversion among first time pregnant women in Nigeria. This led the researcher’s intention to
study food craving and aversion among first time pregnant women in Enugu metropolis to fill
the existing gap in literature. The question therefore is what are the type of food the first
time pregnant women crave or averse to, their reasons, whether they are aware of the
implication of choice of food, whether they know how to substitute for food craving and
aversion in order to meet up with their required nutritional values(needs).
Purpose of Study
This study is aimed at examining the food craving and aversion among first time pregnant
women in selected health facilities in Enugu metropolis
Objectives
Specifically, the objectives are to:
1. Determine the type of food first time pregnant women crave for or have aversion to.
2. Identify the first time pregnant women’s reasons for their specific food craving and
aversion.
3. Determine the first time pregnant women’s awareness of the implication of food
craving and aversion in pregnancy.
4. Identify measures taken by first time pregnant women to substitute for food craving
and aversion in order to meet up with their required nutritional values (needs)
Research Question
1. What are the types of food preferred or aversed to by first time pregnant women?
2. What are the first time pregnant women reason for their specific food craving and
aversion?
3. How aware are the first time pregnant mothers of the implication of food craving and
aversion in pregnancy?
4. What measures do first time pregnant women take to substitute for food craving and
aversion in order to meet up with their required nutritional value (needs)?
Hypotheses
1. There is no statistical significant association between level of education and food
craving and aversion in first time pregnant women
2. There is no statistical significant association between residential location and food
craving and aversion in first time pregnant women.
3. There is no significant association between awareness of implication of food craving
and aversion in pregnancy and food craving and aversion in first time pregnant
women.
Significance of the Study
If the information obtained indicate that the first time pregnant women have poor awareness
on implications of food cravings and aversion, how to cope with food craving and aversion or
substitute to get adequate required nutrient for pregnant women, it will sensitize health
workers/nutritionists to provide appropriate nutrition counseling and education to guide first
time pregnant mothers make a wise choice of food in order to improve their health and
nutritional status.
The findings when communicated to the appropriate governmental agencies and ministries
will develop specific policies to control and prevent both micronutrients and energy
deficiency during pregnancy in order to reduce the high maternal morbidity and mortality due
to malnutrition and anaemia in pregnancy in Nigeria.
The findings of this study will also help the pregnant women to be aware when
communicated to them of the implication of abnormal food choice, like pica which can lead
to severe health problem such as lead poisoning, bowel blockage, iron deficiency anaemia
and other nutrient deficiencies.
The information obtained from this study may be of help to other researchers interested in
working in this field as it will serve as a reference material for further research.
Scope of the Study
The study was delimited to only first time pregnant mothers attending antenatal clinic in
health facilities in Enugu south Local Government Area of Enugu metropolis. It will also be
delimited to the assessment of food craving and aversion in pregnancy. Specifically, it is
delimited to foods craved for or aversed to, reasons for the craving/aversion, their awareness
of the implications of food craving and aversions in pregnancy, the measures they take to
substitute for food craving and aversion and if these food craving and aversions are
determined by their demographic status.
Operational Definition of Terms
1. Food craving/preference: covers edible substances that pregnant mothers have
intense urge to eat e.g. soft drinks, banana, breadfruit, popcorn, ice cream, mango,
oranges, water melon among others.
2. Food aversion: means edible substances pregnant mother avoid to eat e.g. egg,
garlic, beans, grass cutter meat, cassava, ice fish, snail among others.
3. First time pregnant women: means mother that are pregnant for the first time in
health facilities in Enugu metropolis without chronic disease
4. Reasons for food aversion and craving: means what makes the mother to take or
avoid a specific food e.g. the smell of the food, fear of gaining much weight, fear of
difficult labor among others
5. Awareness of implication of food craving and aversion by first time pregnant
women: Means what the first time pregnant women know about the effects of food
craving and aversion. The implications include abnormal brain development, low
birth weight, prematurity, increased risk of heart disease on the fetus and anaemia in
pregnancy, pregnancy induced hypertension, excessive weight gain.
6. Demographic profile: Are level of education and residential location (urban and
rural setting).