Nutritional status, diet diversity, food insecurity and lifestyle factors of pregnant women at community: oriented primary care sites in Pretoria East
Year: 2025
Type: article
Study design: Observational Study
Abstract: Informal settlement and inner-city living are increasingly becoming home to urban communities in South Africa. The study describes the food insecurity, diet diversity, and lifestyle factors of pregnant women attending an inner-city clinic or living in an informal settlement and how birth outcome is affected. A quantitative, comparative, descriptive, analytical, and cross-sectional study with a convenience study sample of 170 pregnant women as participants was conducted at the Woodlane Village Clinic in Moreletta and the Skinner Street Clinic in the Tshwane CBD. The Household Food Insecurity Access Scale (HFIAS) was completed to determine low, medium and high food insecurity. The Minimum Dietary Diversity for Women (MDD-W) score was calculated as a proxy of micronutrient adequacy using one open-list 24-hour recall. Edinburgh Postnatal Depression Scale (EPDS) score and the WHO-Assist V3.0 indicated the depression and suicide ideation prevalence, as well as alcohol, recreational drug and tobacco use and desire during pregnancy. Ethical approval for the study was obtained from the Nelson Mandela University Faculty Postgraduate Studies Committee (FPGSC), reference number H17-HEA-DIET-004. The NHRD reference number is GP_201803_007, and the study adhered to the principles set out in the Declaration of Helsinki (2013). Statistically significant differences between the two clinics were found regarding maternal age (p < 0.0005), citizenship (p < 0.0005), education (p < 0.0005), and employment status of both women and men (p < 0.0005) at the two sites. The association between diet diversity, food insecurity, depression score, and alcohol, recreational drug and tobacco use during pregnancy was investigated, and birth outcome was described. Self-employment of one partner and the other partner's unemployed or part-time employment had a positive association with MDD-W equal or more than five, consequently indicating a good DD. Furthermore, having a grant also indicated that a DDS of five was achieved. There was no statistically significant difference between other demographic factors. A positive association was not found between a higher education level of participants or partner or participant and partner and adequate DD. Skinner Street Clinic, despite the high-rise buildings and access to electricity and services, has statistically significantly more participants (20.73%), indicating severe food insecurity compared to the Woodlane Clinic (5.19%), where a poor living environment and lack of services are more common (p < 0.004). It is postulated that the access to food and food security in city dwellers are affected mainly by income and that those with less income can only buy smaller amounts or cheaper food, with very little food production. In this study 40.25% of participants (n = 64) experienced food insecurity, thus double the South African prevalence (Dlamini, 2023). Coping mechanisms significantly differed among the two sites for food intake (p = 0.02) and general coping mechanisms (p = 0.001). There was no statistically significant difference between the two sites (p = 0.446) for depression. When screened for antenatal depression using the screening tool (EPDS), 36.23% of participants at the Woodlane Clinic and 43.37% at the Skinner Street Clinic screened positive for antenatal depression. The suicide ideation among the Woodlane clinic participants was 30.43% (n = 21) compared to 13.25% for the Skinner Street Clinic participants (n = 11); the difference was statistically significant (p = 0.010) although the practical value was small (V = 0.21). There was a statistically significant difference between the two sites for ever-use alcohol, tobacco or recreational drugs (p < 0.0005) as well as for use during pregnancy (p < 0.004), with the Skinner Street clinic ever-using nearly four times that of the Woodlane clinic. Smoking, even second-hand smoking, is harmful and can increase the risk of intrauterine growth restriction. Both sites have fewer caeser section births than the South African, or the global average of 21%. South Africa is in epidemiological, health, and nutritional transition, and factors that affect nutritional status affect birth outcomes. The importance of promoting a healthy dietary pattern to help women enter pregnancy with normal BMI forms part of public health initiatives needed to curb the obesity pandemic that starts in utero.,Thesis (MSc) -- Faculty of Health Sciences, School of Behavioural & Lifestyle Sciences, 2025
Author: Beeforth, Marion
Institution: University of Pretoria
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7220825490