Needs and possibilities for improving maternal nutrition in rural Tanzania [Elektronische Ressource] / by Alice Gibron Temu

justus-liebig-universitat_giessen - Temu , Alice

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170 pages

English

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Publié par	justus-liebig-universitat_giessen
Publié le	01 janvier 2009
Nombre de lectures	3
Langue	English
Poids de l'ouvrage	3 Mo

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Justus-Liebig-Universität Gießen
Fachbereich Agrarwissenschaften, Oecotrophologie
und Umweltmanagement
Institut für Ernährungswissenschaft

Dissertation

Needs and Possibilities for Improving Maternal Nutrition
in Rural Tanzania

by:

cand. PhD. Nutrition
Alice Gibron Temu
from Dar es Salaam, Tanzania

Supervised by:

Prof. Dr. med. Michael Krawinkel

Prof. Dr. Ingrid Hoffmann

Giessen, October 2009
Table of Contents
List of Figures ii
List of Tables iii
List of Pictures iv
List of Appendices iv
Abbreviations iv
1 Introduction 1
2 Methods and Materials 12
2.1 Study area 13
2.2 Study design 13
2.3 Quantitative data collection 17
2.4 Qualitative data collection 22
2.5 Statistical analysis 27
2.6 Ethical consideration 30
3 Results 31
3.1 Compliance 31
3.2 Demographic and Socioeconomic Characteristics 31
3.3 Food production and livestock keeping 36
3.4 Food security 39
3.5 Food variety scores and dietary diversity 39
3.6 Food choice and food frequency 44
3.7 Anthropometric and biochemical data 47
3.8 Sanitation and infectious disease 54
3.9 Availability, accessibility and utilization of health care services 59
3.10 Women’s knowledge, awareness and practices regarding the importance of 64
micronutrients in pregnancy and the outcome
4 Discussion 68
4.1 Strategies to improve maternal health 68
4.2 Consequences of maternal malnutrition 69
4.3 Challenges to improve maternal nutrition 71
4.4 Nutritional status of women in Malinzanga village and its relation to food 73
insecurity and infections
4.5 Interaction of micronutrient deficiencies and infections 99
4.6 Knowledge, awareness and perception of women on micronutrients and 101
their importance to maternal health
4.7 Availability, accessibility and utilization of health care services 104
5 Conclusion and Recommendations 114
5.1 Conclusion 114
5.2 Recommendations 116
Summary 121
Zusammenfassung 125
Muhtasari 129
References 133
Appendices 140
Acknowledgements 163
Declaration (Eidesstattliche Erklärung) 165

i List of Figures

Figure 1.1 Hypothetical causal model analysis 11
Figure 3.1 Crops produced in Malinzanga village 36
Figure 3.2 Vegetables produced in Malinzanga village 37
Figure 3.3 Domestic animals kept in Malinzanga village 38
Figure 3.4 Number of domestic animals kept by the villagers in Malinzanga 38
Figure 3.5 Months of the year women of Malinzanga village experienced food shortage 39
Figure 3.6 Food variety scores 40
Figure 3.7 Dietary diversity scores 40
Figure 3.8 Types of food consumed by women in Malinzanga village 42
Figure 3.9 Food groups consumed by women in Malinzanga village 43
Figure 3.10 Factors influencing food choice in Malinzanga village 44
Figure 3.11 Frequency of consumption of foods in Malinzanga village 46
Figure 3.12 Nutritional status of women in Malinzanga village according to WHO BMI-criteria 48
Figure 3.13 Nutritional status of women in Malinzanga village according to WHO MUAC- 49
criteria
Figure 3.14 Vitamin A status of women in Malinzanga village according to WHO RBP-criteria 50
Figure 3.15 Anemia status of women in Malinzanga village according to WHO Hb-criteria 52
Figure 3.16 Iron deficiency among women in Malinzanga village according to Erhardt sTfR- 52
criteria
Figure 3.17 Iron deficiency anemia among women in Malinzanga village according to Hb and 53
TfR-criteria
Figure 3.18 Prevalence of acute and chronic infection among women in Malinzanga village 54
according to Erhardt CRP and AGP criteria
Figure 3.19 Common illnesses encountered in Malinzanga village 58
Figure 3.20 Time needed to reach the dispensary in Malinzanga village 60
Figure 3.21 Reasons for using iodized salt in Malinzanga village 65
Figure 3.22 Storage of iodized salt in Malinzanga village 65
Figure 3.23 Knowledge of women on micronutrients in Malinzanga village 66
Figure 4.1 Impact of undernutrition throughout the lifecycle 70
Figure 4.2 Conception framework of maternal malnutrition 74
Figure 4.3 Double burden of undernutrition and over nutrition based on WHO BMI cutoff 75
points
Figure 4.4 Co-existence of vitamin A deficiency with under- and over nutrition based on WHO 80
BMI and RBP levels cutoff points
Figure 4.5 Frequency of consumption of foods rich in vitamin A 83
Figure 4.6 Monthly prevalence and trend of food shortage 83
Figure 4.7 Co-existence of anemia with under- and over nutrition based on WHO BMI and Hb 91
concentration cutoff points
Figure 4.8 Frequency of consumption of iron-rich foods in Malinzanga village 93
Figure 4.9 Amos equation of model of factors associated with anemia and iron status among 96
women in Malinzanga village
Figure 4.10 Frequency of consumption of common foods among women in Malinzanga village 98
Figure 4.11 Amos overall equation of model showing the complexity of factors associated with 99
nutritional status among women in Malinzanga village
Figure 4.12 Knowledge of women about vitamin A in Malinzanga village 103

ii List of Tables

Table 2.1 Stratification of the sample size 15
Table 2.2 Classification of underweight, overweight and obesity according to WHO BMI 19
cutoff points
Table 2.3 Classification of adult severe, moderate and mild undernutrition based on WHO 19
MUAC cutoff points
Table 2.4 Classification for mild, moderate and severe anemia according to WHO 21
hemoglobin concentration cutoff points
Table 2.5 Criteria for vitamin A deficiencies in adults based on WHO RBP cutoff points 21
Table 2.6 Dietary diversity questionnaire 24
Table 3.1 Socio-economic characteristics among the women in the study sample 35
Table 3.2 Anthropometric and Biochemical characteristics among the women in the study 47
sample
Table 3.3 Vitamin A status among women in Malinzanga village 50
Table 3.4 Hand washing behavior and incidence of diarrhea in Malinzanga village 56
Table 3.5 Parameter estimates of nominal regression of frequency of visiting and time taken 61
to the health facility in Malinzanga village
Table 3.6 Health care seeking behavior among women in Malinzanga village 62
Table 3.7 Parameter estimates of nominal regression of frequency of visiting health facility 63
and frequency of illnesses among women in Malinzanga village
Table 3.8 Factors influenced health seeking behavior among women in Malinzanga village 63
Table 3.9 64 Summary of knowledge of women on micronutrients in Malinzanga village
Table 4.1 Prevalence of over nutrition and undernutrition by socio-economic characteristics 78
among women in Malinzanga village
Table 4.2 Prevalence of Vitamin A deficiency and Anemia by socio-economic characteristics 82
among women in Malinzanga village
Table 4.3 Prevalence of impaired dark adaptation among women in Tanzania 86
Table 4.4 Criteria for assessing the severity of the public health problem of vitamin A 88
deficiency in a population
Table 4.5 88 Severity of vitamin A deficiency as a public health problem in Malinzanga
village
Table 4.6 Classification of anemia as a problem of public health 95
Table 4.7 Maximum likelihood estimates of the equation of model (Figure 4.9) 97
Table 4.8 Number and densities of the health workforce in Tanzania 109
Table 4.9 Top ten causes of death in Tanzania 110
Table 4.10 Causes of neonatal deaths 111
Table 5.1 Recommended Logical Framework for Project Management 118
Table 5.2 Suggested strengths, weaknesses, opportunities, threats (SWOT) for project 120
management

iii List of Pictures

Picture 2.1 Training of enumerators 16
Picture 2.2 Interviewing a woman 18
Picture 2.3 The nurse is palpating a woman’s neck, observing eyes, withdrawing blood, and 22
smearing blood on a filter paper
Picture 2.4 Focus group discussions 25
Picture 3.1 Kitchen and water condition in Malinzanga village 55
Picture 3.2 Common method used to dispose of waste in Malinzanga village 57
Picture 3.3 Quality of delivery place and examination room at the dispensary in Malinzanga 62
village

List of Appendices

Appendix 1 Map of Iringa 140
Appendix 2 Interview Questionnaire 141
Appendix 3 Focus group discussion questionnaire 159

Abbreviations

MDGs Millennium Development Goals
LDC Least Development Country
GNI Gross National Income
GDP Gross Domestic Product
HBS House Budget Survey
NBS National Bureau of Statistics
DHS Demographic Household Survey
TFNC Tanzania Food and Nutrition Centre
WHO World Health Organization
UNICEF United Nations International Children’s Emergency Fund
JNSP Joint Nutrition Support Program
FAO Food and Agriculture Organization
m Meter
mm Millimeter
MUAC Mid-Upper Arm Circumference
Hb Hemoglobin
sTfR Soluble Transferrin Receptor
RBP Retinol Binding Protein
CRP C-Reactive Protein <