Department of Public Health, School of Health Sciences, Madda Walabu University, Goba, Ethiopia.
Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
Nutr J. 2024 Jan 3;23(1):3. doi: 10.1186/s12937-023-00907-z.
Maternal anemia, miscarriage, low birth weight (LBW), preterm birth (PTB), intrauterine growth restriction (IUGR), prenatal and infant mortality, morbidity, and the risk of chronic disease later in life are all increased by a lack of dietary diversity during pregnancy. However, evidence for the effect of nutrition education on the dietary diversity score (DDS) among pregnant women was sparse in Ethiopia, particularly in the study areas. This study aimed to assess the effect of nutrition education on dietary diversity among pregnant women in urban settings in Southeast Ethiopia.
A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention group and 223 control group) at health facilities from February to December 2021. A multistage cluster sampling technique, followed by systematic sampling, was used to select the pregnant women. Pregnant women who participated in the interventions were given nutrition education starting at 16 weeks of gestation and continuing for 6 months. We used a pre-tested, interviewer-administered, structured questionnaire to collect the data. A 24-hour qualitative dietary recall was used to calculate the dietary diversity score (DDS). A multivariable generalized estimating equation (GEE) model was conducted to evaluate the intervention effect.
After the intervention, the proportion of adequate dietary diversity was 14.15% higher in the intervention arm compared to the control group (45.09% versus 30.94%, P = 0.002). The overall difference in adequate dietary diversity between the two groups was 8.5%. After adjusting for background characteristics, the multivariable GEE binary logistic model revealed that having received intervention [(AOR = 1.89, 95% CI: 1.27, 2.79)], being literate [(AOR = 3.41, 95% CI: 1.13, 10.23)], and having high wealth [(AOR = 1.60, 95% CI: 1.09, 2.35)] significantly improved adequate dietary diversity.
The findings indicated that having received the intervention, being literate, and having a high level of wealth significantly improved maternal dietary diversity. Efforts should be made to increase nutrition education using the health belief model (HBM) and the theory of planned behavior (TPB). Moreover, there is a need to improve literacy and economic empowerment through income-generating activities to enhance adequate dietary diversification during pregnancy.
Clinicaltrials.gov (PACTR202201731802989, Retrospectively registered on 24 January 2022).
孕期饮食多样化不足会增加母婴贫血、流产、低出生体重（LBW）、早产（PTB）、宫内生长受限（IUGR）、产前和婴儿死亡率、发病率以及日后患慢性病的风险。然而，在埃塞俄比亚，特别是在研究地区，关于营养教育对孕妇饮食多样性评分（DDS）影响的证据很少。本研究旨在评估营养教育对埃塞俄比亚东南部城市孕妇饮食多样性的影响。
2021 年 2 月至 12 月，采用社区为基础的两臂平行集群随机对照试验，在 447 名随机选择的在卫生机构接受产前保健的孕妇（224 名干预组和 223 名对照组）中进行。采用多阶段聚类抽样技术，然后采用系统抽样，选择孕妇。从 16 周妊娠开始，对参与干预的孕妇进行营养教育，持续 6 个月。我们使用经过预测试、访谈者管理的结构化问卷收集数据。使用 24 小时定性饮食回忆法计算饮食多样性评分（DDS）。采用多变量广义估计方程（GEE）模型评估干预效果。
干预后，干预组的适当饮食多样性比例比对照组高 14.15%（45.09%比 30.94%，P=0.002）。两组之间的整体适当饮食多样性差异为 8.5%。在调整背景特征后，多变量 GEE 二元逻辑模型显示，接受干预[（AOR=1.89，95%CI：1.27，2.79)]、识字[（AOR=3.41，95%CI：1.13，10.23)]和高财富[（AOR=1.60，95%CI：1.09，2.35)]显著提高了适当的饮食多样性。
研究结果表明，接受干预、识字和高财富水平显著提高了孕产妇的饮食多样性。应利用健康信念模型（HBM）和计划行为理论（TPB）加强营养教育。此外，需要通过创收活动提高识字率和经济赋权，以提高孕期适当的饮食多样化。
Clinicaltrials.gov（PACTR202201731802989，2022 年 1 月 24 日回顾性注册）。
