ASSESSMENT OF DIETARY DIVERSITY, ANTENATAL CARE, FOOD TABOOS, MEAL FREQUENCY, AND NUTRITIONAL STATUS OF PREGNANT ADOLESCENTS IN RURAL MALAWI: A CROSS-SECTIONAL STUDY

High rates of pregnancy during adolescence in Malawi compromise the nutritional status of adolescent mothers and their infants. When a pregnant adolescent is malnourished, she is at risk for health complications. Research focusing on the nutritional status of pregnant adolescents in Malawi is minimal. The purpose of this study was to assess dietary diversity, antenatal care, food taboos, meal frequency, and nutritional status of pregnant adolescents in rural Malawi. The study included sixty-two pregnant adolescents between 15-19 years old. Data collection included the use of a pre-tested questionnaire, standardized dietary diversity survey and measurements of mid-upper arm circumference (MUAC), height, and hemoglobin. Statistical analysis included descriptive analysis, linear and logistic regression. Mean (SD) age was 17.7 (1.2) years. Mean MUAC was 25.9 (2.0) cm; 31% had MUAC <25 cm. The occurrence of stunting was 19% and 21% were ≤150 cm tall. The mean hemoglobin was 10.37 (1.93) g/dL and 66% were anemic. The mean dietary diversity score was 4.06 (1.18) and 69% did not achieve minimum dietary diversity (score ≥ five.) No participants consumed dairy and only 7% consumed eggs. Eating meat and poultry or dark green leafy vegetables predicted a 1.31g/dL (p-value = 0.0306) or 1.08 g/dL (p-value =0.0331) increase in hemoglobin levels, respectively (R²=0.15). Food taboos during pregnancy were common (35%). Compared to the Malawi National Nutrition Guidelines, 87% were not eating daily from each of the six food groups and 74% were not meeting the recommended meal frequency during pregnancy (three meals and at least one snack/day). Less than 50% consumed foods from legumes/nuts and animal food groups. The majority (63%) did not take antenatal supplements and only 37% consumed ferrous sulfate. Only 52% received advice about nutrition during pregnancy and few (8%) received advice about infant and young child feeding. Girls who received nutrition advice were more likely to take an iron supplement [OR=4.19 (1.82-9.68), p=0.0008] compared to those who did not. As the number of antenatal visits increased, the participants were more likely to take a supplement [OR=11.88 (3.40-41.49) p=0.001]. Interventions for pregnant adolescents in rural Malawi should occur early in pregnancy and include education on dietary diversity, increasing hemoglobin levels, meal frequency, food taboos, antenatal supplements and infant and young child feeding.

Keywords
Adolescent nutrition; Pregnant adolescents; Dietary diversity; Food taboos; Hemoglobin