International Journal of Community Medicine and Public Health

Sanyogita et al. Int J Community Med Public Health. 2019 Jul;6(7):2874-2878

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20192818
Original Research Article

Knowledge, attitude, practice and determining factors regarding

nutrition during pregnancy among females of rural Punjab
Sanyogita*, Tejbir Singh, S. S. Deepti

Department of Community Medicine, Govt. Medical College, Amritsar, Punjab, India

Received: 16 March 2019

Revised: 06 May 2019
Accepted: 16 May 2019

*Correspondence:
Dr. Sanyogita,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: The health of a pregnant mother and her nutritional status can influence the health and survival of the
growing foetus because of the biological link between them. This study was conducted to assess the knowledge,
attitude, practice and determining factors regarding nutrition during pregnancy among females of rural Punjab.
Methods: 359 mothers of 2 months to 24 months old children were selected from Verka block of district Amritsar
using stratified random sampling technique. Data was collected using a semi structured and pretested questionnaire.
Analysis was done using frequency distribution, simple percentages and inferential statistics of chi-square was used to
test hypothesis at 5% level of significance.
Results: Findings reveal that 81.1% of respondents stressed on adding extra diet during pregnancy out of which only
77.3% of mothers actually added or increased one or more food items. Place of residence, education and parity were
significantly associated with knowledge regarding diet increase during pregnancy. Fear of caesarean section and
difficult labour were the main reasons given for not adding extra diet during pregnancy.
Conclusions: The study however suggests that there is a need for educating the mothers regarding importance of diet
during pregnancy.

Keywords: Knowledge, Determining factors, Nutrition, Pregnant females

INTRODUCTION that is deficient in protein, caloric content, and other vital

nutrients.2,3 According to NFHS-III (2005-06) 33% of
Pregnancy is one of the most nutritionally demanding women aged 15-49 yrs of age are malnourished (having
times in a woman’s life. Nutrition during preconception BMI less than normal).4
as well as throughout pregnancy has a major impact on
the outcome of pregnancy. Women who eat well and A women cannot provide essential nutrients for her child
avoid known risks tend to have fewer complications if she herself is deficient. Lack of crucial nutrients during
during pregnancy and labour and are more likely to pregnancy is associated with pre-eclampsia and
deliver normal healthier babies.1 For most women the hypertension, both of which can lead to increased
extra energy needs are easily met by adding a small snack perinatal mortality. In addition, foetal under nutrition has
or two during the day. The focus should be on increasing been found to be associated with increased risks of
the consumption of nutrient dense foods such as whole mental and neuro-behavioural impairment, as well as
grains, meat, fish, eggs, poultry, dairy products, nuts, some congenital anomalies (e.g. neural tube defects).
fruits and green leafy vegetables etc. Studies have shown Under nutrition is responsible for low birth weight which
that a majority of pregnant women in India consume food is an important factor for high infant and maternal

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 Sanyogita et al. Int J Community Med Public Health. 2019 Jul;6(7):2874-2878

mortality rate.5 Undernourished children have lower compiled, analysed statistically with the help of Epi info
resistance to infection and are more likely to die from version 3.5.3. Chi-square test was used to evaluate
common childhood ailments as diarrheal diseases and different variables and valid conclusions were drawn.
respiratory infections.6 Those who survive may be locked
into a vicious cycle of recurring sickness and faltering RESULTS
growth, often with irreversible damage to their cognitive
and social development. Malnutrition prevents The present study to assess the Knowledge, attitude,
individuals and even the whole country from achieving practice and determining factors regarding nutrition
full potential.7 during pregnancy was conducted on mothers of 2 month
to 2 year old children in Verka block of district Amritsar.
The causes of malnutrition are multidimensional and Out of total sample of 359 mothers, majority were in the
multi-factorial with poverty, food inadequacy and age group of 18-29 years, out of which almost half 178
maternal illiteracy being the main culprit of the menace (49.6%) mothers were in the age group of 18-24 years
in developing countries.8 Nag found three main reasons followed by 142 (39.6%) in the 25-29 years of age group.
for low nutritional status of pregnant women in India to Table 1 illustrates distribution of mothers according to
be poverty, discrimination against females in terms of their sociodemographic profile. 171 (47.6%) mothers
household food distribution, and insufficient antenatal were from Mudhal, 78 (21.7%) from Sanghana and 110
care.9 (30.7%) belonged to Dhaulkalan. Majority 352 (98.1%)
were Sikhs. Nearly two third 230 (64.1%) belonged to
Even though, maternal nutrition during pregnancy is schedule caste and 99 (27.6%) were of general category.
crucial in reducing maternal mortality and infant Almost two third respondents 216 (60.2%) belonged to
mortality which are the target area in achieving upper lower socioeconomic status. Almost three fourth
millennium development goal, no study has been 264 (73.5%) belonged to joint family. Around one third
conducted to assess the knowledge of mothers on 114 (31%) mothers were illiterate, only 50 (13.9%) were
nutrition and associated factors during pregnancy in the
educated above high school level. Table reveals 163
study area. As a result, there is lack of comprehensive
(45.4%) mothers were with parity 1, 131 (36.5%) with
information regarding nutritional knowledge and factors
parity 2 and 65 (18.1%) with parity >3.
associated with it in the study area. Therefore the purpose
of this study was to assess the knowledge, attitude and
practice regarding nutrition during pregnancy and analyse Table 1: Socio-demographic characteristics of
the determining factors among mothers of upto 2 year old respondents (n=359).
children of rural Punjab.
Characteristics Frequency %
METHODS Mudhal 171 47.6
Place of
Sanghana 78 21.7
residence
A cross sectional study was carried out in Verka block of Dhaulkalan 110 30.7
district Amritsar from January 2011 to December 2011. Sikh 352 98.1
Religion
Three villages i.e. Mudhal (with subsidiary health centre), Hindu 7 1.9
Sanghana (with sub centre) and Dhaulkalan (with no General 99 27.6
public health centre) were selected by stratified random Caste OBC 30 8.3
sampling. All the houses of chosen area were visited, SC 230 64.1
numbered and inquired about 2 months to 2 years old Joint 264 73.5
children. Houses having children of required age range Type of family
Nuclear 95 26.5
were marked. Help of ASHA worker and Anganwadi
Upper middle 87 24.2
worker was sought. Total children of required age group Socioeconomic
Lower middle 48 13.4
were 359, out of which 171 belonged to Mudhal, 78 status
belonged to Sanghana and 110 were in Dhaulkalan. Upper lower 216 60.2
of family
Mothers of 2 months to 24 months old children were Lower 8 2.2
personally interviewed by the author. Purpose of study Above matric 50 13.9
Education of
was explained, confidentiality was assured and informed Below matric 195 54.5
respondent
consent was taken. Information obtained was recorded by Illiterate 114 31.8
the author on a semi structured, pretested questionnaire in Parity 1 163 45.4
their local language that is the language in which the Parity Parity 2 131 36.5
respondent could understand the best. Modified Parity >3 65 18.1
Kuppuswamy socioeconomic status scale 2010 was used
to assess the socioeconomic status of the family which Table 2 reveals that more than three fourth mothers 291
takes into consideration education, occupation and (81.1%) believed in increasing diet, 19 (5.3%) stressed on
monthly income. Approval of college ethical committee routine diet and rest 49 (13.6%) had no idea about it.
was sought and granted at the time of submission of the Only 60.9% women from Dhaulkalan (village with no
plan of the study. All the information so collected was

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 Sanyogita et al. Int J Community Med Public Health. 2019 Jul;6(7):2874-2878

health care facility) stressed on adding extra diet during with parity 1 and parity 2 respectively stressed on adding
pregnancy whereas this figure approached to 89.5% and extra diet, whereas only 43 (66.2%) respondents with
91% from Mudhal and Sanghana respectively. Out of 19 parity >3 had knowledge about requirement of extra diet
who stressed on routine diet majority 12 (63.2%) during pregnancy.
belonged to Dhaulkalan. Out of 49 who had no idea,
majority 31 (63.3%) belonged to Dhaulkalan (village Main reasons given for non requirement of extra diet
with no health facility). The difference was statistically during pregnancy were heavy baby leading to difficult
significant (p<0.05). This could be attributed to the labour in 8 (42.1%), followed by more chances of
presence of subcentre and subsidiary health centre at caesarean in 6 (31.6%), 4 (21.1%) said one should eat
Sanghana and Mudhal respectively. Table illustrates that according to appetite and only 1 (5.3%) said that stomach
out of 291 mothers, 50 (100.0%) with intermediate or may get upset.
above, 72 (94.7%) with high education and 48 (85.7%)
with middle education could tell that extra diet is required Out of total 291 mothers who advocated increase in diet
during pregnancy as compared to 51 (81.0%) with during pregnancy, majority 225 (77.3%) had specially
primary education and 70 (61.4%) illiterate. The added or increased one or more food items, 44 (15.1%)
difference was statistically significant (p<0.05). Table could not add due to financial constrains and rest 22
shows that 141 (86.5%) and 107 (81.7%) respondents (7.6%) could not add due to nausea /lack of appetite.
Table 2: Factors determining knowledge about requirement of extra diet during pregnancy.

Required Not required Don’t know Total Chi

Factors P value
n=291 n=19 n=49 n=359 Square
N (%) N (%) N (%)
Mudhal 153 (89.5) 04 (2.3) 14 (8.2) 171
Place of
Sanghana 71 (91.0) 03 (3.8) 04 (5.1) 78 42.02 <0.05
residence
Dhaulkalan 67 (60.9) 12 (10.9) 31 (28.2) 110
Illiterate 70 (61.4) 12 (10.5) 32 (28.1) 114
Education Primary 51 (81.0) 03 (4.8) 09 (14.3) 63
status Middle 48 (85.7) 04 (7.1) 04 (7.1) 56 46.89 <0.05
High 72 (94.7) 00 (0.0) 04 (5.3) 76
Intermediate and high 50 (100.0) 00 (0.0) 00 (0.0) 50
Parity 1 141 (86.5) 08 (4.9) 14 (8.6) 163
Parity Parity 2 107 (81.7) 04 (3.1) 20 (15.3) 131 14.89 <0.05
Parity >3 43 (66.2) 07 (10.7) 15 (23.1) 65

Table 3: Distribution of mothers according to reasons given for non requirement of extra diet during pregnancy.

Reason for non requirement of extra diet Number Percentage (%)

Heavy baby leading to difficult labour 8 42.1
More chances of caesarean 6 31.6
Eat according to appetite 4 21.1
Any other 1 5.3
Total 19 100.0

Table 4; Distribution of mothers according to addition of extra diet during pregnancy.

Whether extra diet added / increased Number Percentage (%)

Added 225 77.3
Could not add due to financial constrains 44 15.1
Could not add due to nausea/lack of appetite 22 7.6
Total 291 100.0

DISCUSSION fourth 264 (73.5%) belonged to joint family. Majority

352 (98.1%) were Sikhs. According to Census 2011 in
Study reveals that almost half of the 178 (49.6%) mothers Punjab 57.7% were Sikhs, 38.5% were Hindus, 1.9%
were in the age group of 18-24 years followed by 142 were Muslims and 1.3% were Christians and in Amritsar
(39.6%) in the 25-29 years of age group. Almost three 68.9% were Sikhs, 27.7% were Hindus, 0.5% were

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 Sanyogita et al. Int J Community Med Public Health. 2019 Jul;6(7):2874-2878

Muslims and 2.2% were Christians and in rural Amritsar Nutrition education and counselling alone may not be
91.2% were Sikhs and 5.01% were Hindus.10 In our study sufficient; there is a need for nutrition support and
proportion of Sikhs was more as study was conducted in supplementation where food insecurity limits the capacity
rural area where majority of Sikhs reside. Nearly two of women to act upon advice. Also there is need for
third 230 (64.1%) belonged to schedule caste and almost proper antenatal care so that the problem of nausea and
two third 216 (60.2%) were of upper lower lack of appetite can be tackled in time.
socioeconomic status. According to Census 2011, in
Punjab 31.9% and in Verka block 46.7% population ACKNOWLEDGEMENTS
belonged to scheduled caste.11 In our study area
proportion of schedule caste is higher as study was The author and investigators are thankful to all health
conducted in Verka block where proportion of population workers for their help. Also we are grateful to all the
belonging to schedule caste is more as compared to mothers included in this study for their kind and
Punjab (46.7% versus 31.9%). affectionate attitude and cooperation.

Around one third 114 (31%) mothers were illiterate, only Funding: No funding sources
50 (13.9%) were educated above high school level. Conflict of interest: None declared
According to census 2011, female literacy rate in India is Ethical approval: The study was approved by the
65.46% and in Punjab is 71.34%, as was found in our Institutional Ethics Committee
study.12
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