Enoghase Itua Erasmus

SEXUALITY AND CONTRACEPTIVE USE AMONG ADOLESCENTS IN UJEOLEN SECONDARY SCHOOL EKPOMA, EDO STATE CHAPTER ONE INTRODUCTION Background to the Study Proper food and good nutrition are essential for survival, physical growth, mental development, performance and productivity, health and wellbeing of all living things. Nutrition throughout life has a major effect on health. This is true for vulnerable groups special for pregnant women as adequate maternal nutrition is one of the best ways to ensure maternal and fetal wellbeing in developed and developing countries and also adequate maternal nutrition knowledge attitude and dietary practice before and during pregnancy is necessary to ensure positive pregnancy outcomes (Cetin, Laoreti, Fanos& Cagliari, 2021).   Nutrition is a fundamental pillar of human life, health and development throughout the entire life span. Proper food and good nutrition are essential for survival, physical growth, mental development, performance and productivity, health and wellbeing. However, the nutrition requirement varies with respect to age, gender and during physiological changes such as pregnancy (Appiah, NaaKorklu & Bonchel, 2021). Pregnancy is considered to be a delightful experience for the expectant mother. Evidences manifested that adequate intake of nutrition is a key component for individual’s health and well-being, particularly during pregnancy (Food and Agriculture Organization (FAO), International Fund for Agricultural Development (IFAD) &The United Nations Children's Fund (UNICEF), 2021). It is well documented that inadequate maternal nutrition results in increased risks of short term consequences such as; Intra Uterine Growth Restriction(IUGR), low birth weight, preterm birth, prenatal and infant mortality and morbidity. Moreover, excessive intake of nutrients during pregnancy can lead to some pregnancy complications (such as, preeclampsia and gestational diabetes, macrosomia, distocia and higher prevalence of cesarean section) (FAO, IFAD & UNICEF, 2021). On the other hand, as the long run outcomes, inadequate intake of nutrients were found to have pathophysiologic or metabolic depict that will appear as disorders of child growth and development as well as adult chronic disease after a long period of quiescence (FAO, IFAD & UNICEF, 2021). Eating well during pregnancy means do more than simply increase how much the mother eats. The mother must also consider what she eats. The ability of mother to provide nutrients and oxygen for her baby is a critical factor for fetal health and its survival. This is because pregnancy is a time of increased energy and nutrient needs for a woman in order to meet the needs of the growing fetus and of maternal tissues associated with pregnancy (FAO, IFAD & UNICEF, 2021). Proper dietary balance is necessary to ensure sufficient energy intake for adequate growth of fetus without drawing on mother’s own tissues to maintain her pregnancy. The poor health and nutrition of women and the lack of care that contributes to their death in pregnancy and child birth also compromise the health and survival of the infants and children they leave behind (Shekar, Heaver & Lee, 2022). Furthermore, failure in supplying the adequate amount of nutrients to meet fetal demand can lead to fetal malnutrition. The fetus responds and adapts to under nutrition but by doing so it permanently alters the structure and function of the body. Maternal over nutrition also has long-lasting and detrimental effects on the health of the offspring. Nutrition during pregnancy has a major impact on the outcome of pregnancy and accredited as an important determinant for a healthy and successful pregnancy including the life-long health of future generation (Adikari et al., 2022). Though nutrition is the intake of food necessary for optimal health, several studies have revealed that inadequate maternal nutrition could lead to malnutrition which causes poor pregnancy outcomes, such as fetal growth failure, low birth weight, preterm birth, prenatal and infant mortality and morbidity (Abu-Saad & Fraser, 2023). On the contrary, excessive nutrition intake during pregnancy can lead to complications such as preeclampsia, gestational diabetes, macrosomia, dystocia, and higher prevalence of cesarean section (McDonald et al., 2023) In the antenatal period, the nutritional demand of women upsurges to compensate for physiological and psychological changes and nutritional computations by the growing foetus for energy, macro and micro nutrients. However, many women, whether in preconception or even during pregnancy, do not get enough nutrients in their diets, a problem that is particularly prevalent in the world’s poorest regions, including sub-Saharan Africa (Ikhsan, Asifa, & Nasaruddin, 2022). Women’s malnutrition (of any kind) not only affects their health but also has the potential to harm the health of their infants. Nutritional deficiency was responsible for 1.5 million deaths in women and children worldwide (Ikhsan, Asifa, & Nasaruddin, 2022). Nutritional deficiencies manifests itself as a function of many and complex factors that affect the national child status. It is directly linked to inadequacy in diet and diseases under living conditions factors that include crisis in household food supply, inappropriate childcare and feeding practices, unhealthy place of residence and insufficient basic health services for those in poor socioeconomic situations, cultural beliefs, and lack of parents’ education, especially that of mothers (World Bank, 2019). An adequate nutritional status of pregnant women is essential for their health and pregnancy outcomes. Due to increased nutritional requirements, pregnancy is a critical period for meeting the body’s demand for macro/micronutrients. Thus, anaemia and vitamin A deficiency are common micronutrient deficiencies that affect 53.8 million pregnant women in the world (Latifa, Manal and Nihal, 2021). Nutritional deficiency in pregnancy, in combination with infections, is a common cause of maternal and infant mortality and morbidity, low birth weight and intrauterine growth retardation (IUGR). Malnutrition remains one of the world’s highest priority health issues, not only because its effects are so widespread and long lasting but also because it can be eradicated best at the preventive stage (Latifa, Manal and Nihal, 2021). Malnutrition is now a problem in both poor and rich countries. In developed countries, obesity is rapidly becoming more widespread, bringing with it an epidemic of diet-related noncommunicable diseases such as diabetes and heart disease, which increase health care cost and reduce productivity. In developing countries, while widespread undernutrition and micronutrient deficiencies persist, obesity is also fast emerging as a problem (Federal Democratic Republic of Nigeria, 2021). In Nigeria, nutritional disorders are among the main causes of morbidity and mortality. The major problems are protein-energy malnutrition and micronutrient deficiencies such as vitamin A, iron, and iodine (Federal Democratic Republic of Nigeria, 2021). Knowledge on nutrition is a vital element to ensure positive pregnancy outcome and is the integral to achieve healthy dietary behaviors and subsequently improves their diet quality (Mugyia et al., 2022). Mitra et al. (2023) highlight the importance that antenatal mothers could benefit through nutritional knowledge. Despite recommendations nutrition intake in Malaysia exist which aim to improve the nutritional status of mothers and reduce the risks of adverse pregnancy outcomes, an increasing proportion of antenatal mothers’ weight exceeded healthy range (Malaysian Dietary Guidelines, 2023). As reported by the RNI, nutritional knowledge during pregnancy is necessary to ensure optimal gestational weight gain and reduces complications, both of which are linked to positive birth outcomes and contribute to mothers’ overall health. However, evidence revealed that antenatal mothers during pregnancy do not always adopt these recommendations and the reasons for this are poorly understood (Malaysian Dietary Guidelines, 2023). Research related to maternal nutrition knowledge are not abundant in the local context. Despite maternal nutrition during pregnancy is crucial in reducing maternal mortality and infant mortality which are the target area in achieving the Millennium Development Goal in Malaysia, a dearth of study has been conducted to assess the level and associated factors of nutritional knowledge during pregnancy among antenatal mothers. It is thus important to investigate this issue. This paper reports a study that sought to fill this gap in knowledge and share it at the national, regional and international level to contribute to the evidence base for informing future antenatal care when dealing with maternal nutritional knowledge. Statement of Problem According to UNICEF (2020), each year, more than half a million women die from causes related to pregnancy and childbirth. Nearly 4 million newborns die within 28 days of birth. Many of the 200 million women who become pregnant each year, most of them in developing countries, suffer from ongoing nutritional deficiencies repeated infections and the long term cumulative consequences of under nutrition during their own childhood. Many women suffer from a combination of chronic energy deficiency, poor weight gain in pregnancy, anemia, and other micronutrient deficiencies, as well as infections like HIV and malaria. These along with inadequate obstetric care, contribute to high rates of maternal mortality and poor birth outcomes (UNICEF, 2020). It has been observed that maternal under-nutrition diminishes a woman’s productivity, causing repercussions for herself, her family, her community, and the broader society. Maternal malnutrition is influenced not only by lack of adequate nutrition but also influenced by factors like socio demographic factors, nutritional knowledge of mothers during pregnancies. Although, researches and projects focused on maternal health are common, however, projects and researches that focused specifically on knowledge of nutrition during pregnancy and associated factors among antenatal mothers are very rare in the study area (Ekpoma, Edo State). Research, program reports, and other materials specifically related to maternal nutrition principles, practices, and programs are not abundant either in the study area. Even though, maternal nutrition during pregnancy is crucial in reducing maternal mortality and infant mortality which are the target area in achieving millennium development goal, no study has been conducted to assess the knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers in Ekpoma, Esan North East Local Government of Edo State. As a result, there is lack of comprehensive information regarding nutritional knowledge and factors associated with nutritional deficiencies in the study area hence this study seek to fill these gaps in knowledge. Objectives of the Study The general objective of the study is to assess the knowledge of nutrition and factors influencing nutritional deficiencies during pregnancy among antenatal mothers in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State. Specifically, the study was guided by the following objectives: 1. To assess knowledge of antenatal mothers with regard to nutrition during pregnancy in Ekpoma 2. To identify the factors associated with nutritional deficiencies among antenatal mothers during pregnancy in Ekpoma Research Questions The research answered the following questions: 1. What is the knowledge of antenatal mothers with regard to nutrition during pregnancy in Ekpoma? 2. What are the factors associated with nutritional deficiencies among antenatal mothers during pregnancy in Ekpoma? Significance of the study The finding of this study will contribute in filling the gap in understanding the knowledge regarding maternal nutrition among pregnant women attending Antenatal in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State The results of the study will also inform design of the nutrition education intervention strategies targeting pregnant women due to their importance in reproductive and productive roles in the society. The results of this study would also provide necessary information to spur nutritionists and health workers into embarking on intervention programmes for pregnant women in Ekpoma and Edo State in general to curb the vicious cycle of malnutrition between generations. Besides the health providers and Nigerian Ministry of Health, others who are interested in the field of maternal health in general will benefit from this research. The information generated may add to the knowledge already on thealready existing pool of data on the knowledge of nutrition during pregnancy and associated factors among antenatal mothers.This may help women have good pregnancy outcomes hence good health and healthy babies. Future researchers may also use this study as a reference and guide for future studies on knowledge of nutrition during pregnancy and associated factors among antenatal mothers as there is paucity of local data in this area. Scope of the Study The study is delimited to the knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State Operational Definition of Terms Knowledge: Knowledge as used in this study refers to an individual’s knowledge of nutrition, including the ability to remember and recall food and nutrition related terminology. This is further divided in knowledgeable and not knowledgeable. Knowledgeable If respondents score ≥ 70% (out of 100%) on the knowledge questions. Factors: Factorsis defined as a circumstance, fact, or influence that contributes to a result. Factors as used in this study refers to those circumstance or influence on antenatal mothers nutritional deficiencies in Ekpoma, Edo State such asLevel of education, household economic status, employment status, age, marital Status, culture and religion etc. Nutrition: Nutrition is defined as the study of food and nourishments, examining the nutritional content of food, the amount of nutrient required for healthy growth and function, and varies for different people. Nutrition as used in this study refers to the intake of food considered in relation to body’s dietary needs amongantenatal mothers during pregnancy. CHAPTER TWO LITERATURE REVIEW This chapter discusses the literature related to knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy. It particularly focuses on the conceptual review, empirical review, theoretical review and summary of literature reviewed. Conceptual Review Nutrition Nutrition of humans cannot be over emphasized as food serves as the fuel for human functions, to make it effective individuals must eat right and adequate amount of the stipulated food at the right time and hour. Brien (2021) describes nutrition as the study of food and nourishments, examining the nutritional content of food, the amount of nutrient required for healthy growth and function, and varies for different people. In other words, nutrition is the science that deals with the nature and composition of food, the amount of food required by the body, as well as the physical and chemical changes brought about by the intake of food. In addition, nutrition is the sum processes concerned with the growth, maintenance and repairs of the body as whole and its constituent parts. However, healthy and complete nutrition is something wider than the mere intake of scientific food. According to WHO (2014), nutrition is the intake of food considered in relation to the body’s dietary needs. Good nutrition, well balanced diet combined with regular physical activity is a cornerstone of good health, whereas poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity (WHO, 2014). Therefore, women of child-bearing ages should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain, appropriate physical activity, consumption of a variety of foods in accordance with the dietary guidelines for pregnancy, appropriate and timely vitamin and mineral supplementation, avoidance of alcohol, tobacco, and other harmful substances, and safe food handling (Kaiser & Allen, 2021). Nutrition requires not only a sufficient and properly balanced diet but also a healthy, receptive and responding body. This may however depend on the knowledge of nutrition among expectant mothers (Brien, 2021). Nutritional Deficiencies Nutritional deficiencies have been defined by various authors, each emphasizing different aspects of the condition. For instance, Smith et al. (2020) defined nutritional deficiency as a state resulting from inadequate intake or absorption of essential nutrients, leading to impaired physiological functions and increased susceptibility to disease. Similarly, Johnson and Lee (2021) described it as a condition where the body's nutrient reserves are depleted, causing metabolic disturbances and hindering normal growth and development. According to Brown et al. (2019), nutritional deficiency occurs when there is an imbalance between nutrient intake and the body's requirements, resulting in adverse health outcomes. Williams and Taylor (2020) defined it as the consequence of consuming diets lacking in essential vitamins and minerals, which can lead to specific deficiency diseases. Garcia et al. (2021) characterized nutritional deficiency as a global health issue arising from insufficient dietary diversity and poor access to nutrient-rich foods, contributing to widespread malnutrition.​ Knowledge Knowledge is often defined as a belief that is true and justified. This definition has led to its measurement by methods that rely solely on the correctness of answers. A correct or incorrect answer is interpreted to mean simply that a person knows or does not know something. Francis. (2019) defined knowledge as the awareness, understanding, and application of information acquired through experience, education, and research. Similarly, Taylor (2020) described knowledge as the cognitive ability of an individual to interpret and utilize acquired facts to make informed decisions in different aspects of life, including health and nutrition. Lopez (2023) explained nutritional knowledge as the ability to recognize essential nutrients, comprehend dietary guidelines, and make informed food choices that support overall well-being. Williams et al. (2024) defined nutritional knowledge as the level of awareness and understanding individuals have regarding the impact of diet on health, which influences their eating behaviors and nutritional status. Nutrition knowledge, broadly defined, refers to knowledge of concepts and processes related to nutrition and health including knowledge of diet and health, diet and disease, foods representing major sources of nutrients, and dietary guidelines and recommendations (McKinnon et al, 2014). Nutrition during pregnancy is a significant public health concern (Wen et al., 2021) because pregnancy is a critical period during which good maternal nutrition is a key factor influencing the health of both mother and child. During the prenatal period, the developing fetus obtains all of its nutrients through the placenta, so dietary intake has to meet the needs of the mother as well as the products of conception, and enable the mother to lay down stores of nutrients required for the development of the fetus (Williamson, 2022). Knowledge of Antenatal Mothers on Nutrition during Pregnancy Several studies have shown that educational intervention not only increases knowledge about a proper diet in pregnancy (Rao, et al., 2021), but also are positively correlated with good eating habits (Kim, et al., 2019). In addition, Liu, et al. (2019) observed that educational intervention enables pregnant women to change unhealthy practices and consequently decrease on the prevalence of postpartum complications. It is therefore of paramount importance to include nutrition as one of the health education topics given to pregnant women during their antenatal checkups. A nutritional education program containing two to four lessons was undertaken for small groups of between six to ten women. Nutritional knowledge was assessed before intervention (pretest) and followed by two posttests within three weeks interval. This study sought to answer the question of whether nutrition education can influence a positive change to improve levels of nutritional knowledge of pregnant women. The study therefore showed significant improvements in awareness level of pregnant women who received at least two educational sessions on healthy nutrition in which it was significantly increased from 3% before intervention to 31% after the nutritional education intervention (P < 0.001). These results are similar to those found by Verbeke (2023) who found that education on nutrition and food consumption can resolve safety issues in the population. Considerable changes occur in the body of a pregnant woman. In addition to the developing foetus and placenta, there are changes in her own tissues with an expansion of the plasma volume and red cell mass, increase in the size of the uterus and mammary glands, and deposition of fat. A diet that meets maternal nutritional needs is required for these adjustments so that maternal well being is safeguarded with the birth of a healthy, thriving infant of normal birth weight. Consequently, nutrient requirements increase during pregnancy to support foetal growth and maternal health. It is important to note that for some nutrients, the foetal growth is maintained at the expense of the mother. For other nutrients, the mother and foetus compete evenly, and for others, the foetus suffers more severe consequences of deficiency than the mother (Farnoush Fallah et al 2021). Pregnant women must eat well and are encouraged to eat a variety of foods. Their diet should include the basic nutrients necessary to meet her needs and the needs of the developing foetus. In addition, adequate nutrition is necessary to enable the pregnant woman build up nutrient stores for use during breastfeeding. Protein intake during pregnancy should increase. Food and Agriculture Organization [FAO] / World Health Organization [WHO] / United Nations University [UNU] (2021) recommended an additional 6g of good quality protein per day. This is to ensure proper growth of foetal and maternal tissues and prevent anaemia. Carbohydrate intake should increase to 175g/day to prevent ketosis which can harm the foetus (Wardlaw & Hampl, 2023). To support the growth and development of the foetus and for fat stores, pregnant women need to increase their energy intake. For instance, about 3 – 4kg is laid down as fat. These fat stores are supposed to be the energy reserves needed to subsidize lactation during the first 6months (WHO, 2020). Extra energy intake is also required for movement by the heavier mother and for the 20% increase in basal metabolic rate during the third trimester. Energy needs during the first trimester are essentially the same as for the non-pregnant women. However, during the second and third trimesters, a pregnant woman should consume approximately 350 to 450kcal more per day. This extra need should be in the form of nutrient-dense foods and not sugar desserts or fat filled snacks (Berisha, Ramadani, Hoxha, Gashi, Zhjeqi, Zajmi, & Begolli, 2023). While her energy needs during the second and third trimesters represent 20% increase, her micronutrient needs are increased by approximately 50%. A total of 28mg of iron is required daily during pregnancy. This is due to increased blood volume during pregnancy, needs of the foetus, and blood losses that occur during delivery (Berisha et al., 2023). Most iron are required to increase the haemoglobin mass of the mother and this increase occurs in all healthy pregnant women who have sufficiently large iron stores or who are adequately supplemented with iron. The increase in haemoglobin mass is directly proportional to the increased need for oxygen transport during pregnancy and is one of the important physiological adaptations that occur in pregnancy (Shekar, Heaver & Lee, 2022). On the other hand, due to the increased need for iron, there is marked increase in iron absorption during pregnancy, although there are changes in the fractions of iron absorbed during the different stages of pregnancy. In the first trimester, there is decrease in iron absorption related to reduction in iron requirement. In the second trimester, iron absorption is increased by about 50%, and in the last trimester, it may increase by up to about four times (Shekar et al., 2022). However, even with the marked increase in iron absorption, it is difficult and almost impossible for a pregnant woman to meet her high iron requirement from the diet alone. It is therefore recommended that in addition to increasing iron content of the diet, iron supplements in tablet form, preferably together with folic acid, are given to all pregnant women. WHO recommends a universal supplemental dose of 60mg iron starting in the second trimester of pregnancy until at least three months post- partum (WHO/UNICEF/ UNU, 2021). A research results by Banga, Baren, Ssonko, Sikakulya, Tibamwenda, Banga, & Ssebuufu, (2020) from Wollega, Ethiopia in 2021 revealed that 64.4% of women had nutrition knowledge during pregnancy. This research showed a positive significant relation between information about nutrition, educational status of mothers and family income and nutritional knowledge of mothers during pregnancy. A low consumption of iodized salt and poor iodine status during pregnancy may result from a lack of knowledge about the importance of iodine intake during pregnancy. In Ethiopia, where iodine deficiency disorders are a major public health problem, according to WHO/UNICEF (2020), more than 90% of women did not know the importance of iodized salt and the causes of iodine deficiency. In the United States, Sharp, et al. (2019) reported that women of childbearing age who were from low socioeconomic backgrounds knew little about the importance of the recommended daily intake of folic acid and only 63 (25%) of the total number of women surveyed (N=250) reported consuming folic acid supplements daily. Similarly, a New Zealand study by Edith, &Priya, (2022) identified that knowledge and understanding about recommended folic acid intake among women of child bearing age was relatively poor, with only 64% of the 1000 women surveyed being aware that pregnant women needed to take recommended doses of folic acid). In Hail region-Saudi Arabia among 300 married women, 91.0% of the subjects were aware of folic acid, 81.0% knew that folic acid could prevent neural tube defects and 84.0% of the subjects took folic acid prior or during a certain stage of pregnancy (Berisha et al., 2023). A study which was conducted by Gebre, Reddy, Mulugeta, Sedik, & Kahssay, (2019) at Military Hospital and Combined Hospital Rawalpindi, Pakistan, among 400 married reproductive age women in 2021 revealed that 53.25% of them knew folic acid intake is important, 40.25% thought that folic acid deficiency among pregnant women results in abnormality in new born. Regarding the rich source of folic acid 60.25% of women had idea and from the total 23.25% were regularly having green vegetables and fruits. 51.25% of respondents had received folic acid supplementation during pregnancy. Research by Thet, et al., (2022) from New South Wales, Australia in 2021 had explained 81.6% (N=152) used supplements during their pregnancy; 67.7% took supplement brands which contained both folic acid and iodine in varying dosages. 36% of them started taking supplements before their pregnancy. The supplement use was significantly higher among pregnant women who were in the highest household income category. 75.6% of pregnant women understood that neural tube defects (NTDs) is the health problem associated with inadequate intake of folic acid and 39.5% of them knew the health problems associated with inadequate iodine intake. Half of the pregnant women had limited awareness about good sources of folic acid and iodine. Educated women from higher socio-economic backgrounds had better knowledge about the importance of folic acid and iodine in pregnancy. A study by Liu et al., (2021) on 400 pregnant women admitted to the Cuza-Vodă Obstetrics and Gynaecology Clinical Hospital in Iasi, Romania, 2021 showed that 45.3% of participants had used iron supplements during pregnancy. This study had put Age, level of education, being married and low gestational age at the first prenatal check-up and total number of prenatal medical visits as a factor for folic acid, iron and multivitamin supplement. Women with a higher level of nutritional knowledge used folic acid, iron and multivitamin supplements more frequently. In another Findings from cross-sectional analysis of data collected from 836 participants at Porto, Portugal, 2021, reported that Prevalence of use of supplements during pregnancy was 55.4% for folic acid, 81.9% for iron, and 76.2% for multivitamins. Factors Influencing Nutritional Deficiencies among antenatal mothers There are several factors influencing the knowledge of pregnant women on nutritional deficiencies, these among other factors include: Level of education Studies on autonomy and empowerment of women suggest that, education of a woman promotes her empowerment and influences participation in decision making in matters concerning nutrition and access to health services (Emina et al. 2019). Women who receive even a minimal education are generally more knowledgeable than those who have no education of how to use available resources for the improvement of their own nutritional status together with their families. In Nigeria, a cross section study was conducted in different antenatal clinics (Government hospitals and private clinics), where a total of 1,387 pregnant mothers participated, 910 in Owerri urban area and 477 in the rural area surrounding Owerri (Okwu GN et al 2023). It was found out that the effect of education level on the prevalence of PEM showed that those with no formal education and primary education had significantly lower BMI and higher percentages of PEM than those of other groups. Hence it was concluded that the less educated pregnant women are, the higher risk of getting PEM. However another study carried out in Nigeria disputed this showing a negative correlation between level of education and maternal nutrition status. Therefore education is one of the most important resources that enable women to provide appropriate care for themselves and unborn child, which is an important determinant of healthy pregnancies. On that note, increasing the level of education among women decreases incidence of malnutrition among women plus their unborn children. Household economic status In many, nutrition is influenced by income and economic growth. Rich people have the capacity to buy more diverse foods including fruits and vegetables rich in essential vitamins, minerals and other nutrients plus animal products rich in proteins (Population reference bureau 2023). Poorer populations often lack access to the right variety of foods and the right amount of foods, leading to inadequate nutrition. For the poorer populations, economic growth can boost household incomes, resulting in more spending on food, health, and education, and better individual health and nutrition. In addition, when national economies are growing, governments have more to spend on social programs and infrastructure necessary for health systems to function, thus increasing the overall health and nutritional status of the nation. Conversely poor people especially in developed countries like the USA are at high risk of obesity because healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2021; Monsivais & Drewnowski, 2019). Households with limited resources often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling that is, they try to maximize their calories per dollar in order to stave off hunger (DiSantis et al., 2021; Drewnowski, 2019). While less expensive, energy-dense foods typically have lower nutritional quality and, because of over consumption of calories, have been linked to obesity (Hartline-Grafton et al., 2019). Employment Women’s employment increases her economic status in their homes, this in particularimproves her nutrition status and household nutrition. Employment may increase women’s status and power, and may bolster a woman’s preference to spend her earnings on health and nutrition. However, employed women without control over their income and decision making authority within the household are deprived of economic and social power and the ability to take actions that will benefit their own well-being. According to a survey carried out in Ethiopia where 13,057 pregnant women were studied, it was discovered that unemployed pregnant women were more likely to be affected by under nutrition than those working in agriculture, but the pregnant women in nonmanual/ professional jobs were less likely to be affected by chronic under nutrition (Bitew et al 2021). This is in agreement with survey studies carried out in Africa which have indicated that, at similar levels of income, households in which women have a greater control over their income are more likely to be food secure (Kennedy and Haddad, 2019). Age A cross sectional study carried out in antenatal clinics in Nigeria where a total of 1,387 pregnant women took part, 910 in Owerri urban area and 477 in the rural area surrounding Owerri (Okwu et al 2023). It was discovered that the effect of age on the prevalence of PEM in pregnant women showed that the age groups, below 20years and 20-24 years, presented the higher prevalence of PEM of 25% and 11.74% respectively. Their mean BMIs were significantly lower than those of the other age group. The probable reason is that these women are still young and their bodies still developing hence they need a-lot of nutrients. The 24 years and below age group is apparently the group at greater risk for PEM especially in the rural areas. The age effect although not seen in the urban area was quite prominent in the rural areas. This is in contrast with a study carried out in Bangledesh, India which showed a significant deterioration of women’s nutritional status in relation to age where women aged 35 years and above were more malnourished compared with younger women. Another clinical trial aimed at investigating the effects of age and parity (number of children had by mother) associated with protein energy malnutrition (PEM) on some biochemical indices in pregnant women in Enugu metropolis of Nigeria. Serum total protein, albumin, urea, total cholesterol, creatinine and calcium were evaluated in three groups of female subjects as part of an investigation on the biochemical changes associated with protein energy malnutrition (PEM) in pregnant women. The first group were 52 pregnant women with low total protein (<52g/l), the second group were 50 pregnant women with normal total protein (>52g/l) while the third group were 50 non- pregnant, non-lactating, apparently healthy women with normal total protein (>63kg). All the subjects were resident in Enugu metropolis and aged between 20 to 40 years (Ikeyi, Alumanah and Joshua, 2021). Marital Status According to a household survey carried out in Ethiopia by Demographic and health research (2021), never-married pregnant women were found to be the most affected by undernutrition, followed by divorced/separated/widowed women. Among never-married pregnant women, 35.7% in 2000 and 28.7% in 2021 were chronically undernourished. Among both rural and urban women for both surveys, those married or living together were the least affected by chronic energy deficiency. Among the reasons given is the fact that unmarried adolescent women are often at the bottom of the food chain, with little or no decision-making power in the household about food distribution, could lead to food security issues and may contribute to their poor nutritional status. Moreover, women aged 15-19 need adequate nutrients to support fast physical, mental and emotional growth. Unawareness of adolescent women about their own health and nutritional status could be another reason associated with their poor nutritional status. Culture and religion According to a descriptive survey study design conducted to assess the knowledge and attitude of dietary practices among pregnant women attending Yerwa Clinic in Nigeria where a total of 294 pregnant women were selected using systematic random sampling technique. It was revealed that majority of the respondents 118 (40%) avoid some good diet during pregnancy because of cultural beliefs, while 18(20%) because of their religion (Kever, 2021). Another cross-sectional study carried out in Nigeria, where a sample population of 200 child bearing mothers who registered with the Primary Health Centers were used, it was discovered that some causes of malnutrition involved cultural beliefs (Jacinta A et al, 2022). Many of the respondents agreed that cultural beliefs are one of the causes of malnutrition. In Nigeria, people may abstain from eating certain food items of high nutritive value simply because of their ethical or religious beliefs and taboos. Theoretical Framework This study employed the Pender’s health promotion model. The HPM is a framework for integrating nursing and behavioral science perspectives on factors influencing health behaviors which was developed by Pender et al. (2022). The HPM guides for exploration of the complex bio-psychosocial processes that motivate individuals to engage in behaviors directed toward the enhancement of health (Pender et al., 2022). The model describes that there are ten determinants of behavior organized into three major components which included (1) individual characteristics and experiences, (2) behavior specific cognitions and affect, and (3) behavioral outcome (Pender et al., 2022). Individual characteristics and experiences include the persons’ unique characteristics and experiences that affect subsequent action. The individual characteristics and experiences are divided into prior related behavior and personal factors. Prior related behavior which is the best predictor of behavior is the frequency of the same or a similar behavior in the past. Prior behavior is proposed as having both direct and indirect effects on the likelihood of engaging in health promoting behaviors. The direct effect of the past behavior on current behavior may be due to habit formation. The indirect effect can influence health promoting behaviors through perceptions of benefits, barriers, self-efficacy and activity related affect such as positive behavior, engendering high levels of efficacy and positive affect through successful performance of experience and positive feedback. Personal factors are categorized as biologic, psychological and sociocultural characteristics. Behavior specific cognitions and affect include perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences and situational influences. Perceived benefits of action can improve health behavior by motivating behavior directly as well as indirectly (Pender et al., 2022). Perceived barriers to action usually arouse motives of avoidance in relation to a given behavior. Perceived barriers to action affect health promoting behaviors directly by impeding action, and indirectly through decreasing commitment to a plan of action. Perceived self-efficacy is a judgment of one’s abilities to accomplish a certain level of performance, whereas an outcome expectation is a judgment of the likely consequences (e.g. benefits, costs). Self-efficacy motivates health promoting behavior directly by efficacy expectations and indirectly by affecting perceived barriers and level of commitment or persistence in pursuing a plan of action (Pender et al., 2022). Activity-related affect describes subjective positive or negative feelings that occur before, during and following behavior based on the stimulus properties of the behavior itself. Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater is the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect. Interpersonal influences are cognitions of the behavior, believes, or attitudes of others. It includes norms, social support and modeling. These three interpersonal processes result in individuals’ predisposition to engage in health promoting behaviors. It also influences as determinants of health promoting behavior including moderate support for the construct. Situational influences are personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. They include perceptions of available options, demand characteristics, and aesthetic features of the environment in which health promoting behavior is proposed to take place and situational influences may have direct or indirect influences on health behavior (Sakraida, 2021). The last component of the HPM is the behavioral outcome such as healthy eating behavior. Health promoting behavior is directed by the commitment to a plan of action, which is determined by the six behavior-specific cognitions and affect. Immediate competing demands and preferences-competing demands are alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behaviors over which individuals exert relatively high control, such as choosing a tasty, high-fat food instead of a healthier option. The components and variables are related to each other, such as the individual characteristics and experiences which influences the behavioral outcome through the second component of the interrelationship among variables. All of these combined directly affect the individuals commitment and ultimately the performance of the health promotion behavior including healthy eating behavior (Pender et al., 2022). The HPM has been applied to pregnant women's health promotion in many studies (Lin et al., 2019 including eating behavior among pregnant women (Thaewpia et al., 2023). The implication of the Pender’s health promotion model is that it helps to unveil the level of knowledge of nutrition among antenatal mothers during the pregnancy. This is because the level of knowledge of nutrition help the shape antenals mothers eating behavior that will positively affect their pregnancy outcome for their safety and as well as the safety of the baby. Also, health promoting behaviour is significantly directed by the commitment to a plan of action by antenatal mothers which is determined by several factors.These factors which are predictive of given behaviour are shaped by the nature of the target behaviour being considered in this study. The implication of the Pender’s health promotion model is that it also helps to determine the associated factors with nutritional deficiencies during pregnancy among antenatal mothers. This is because these factors such as level of education, household economic status, employment status, age, marital Status, parity, localities, culture and religion have a significant way of influencing antenatal mothers nutritional practice. This implies that these factors therefore, may be contributing factor to nutritional deficiency among pregnancy women if not properly examined hence the Pender’s health promotion model is applied to this study. Empirical Review Several studies have shown that educational intervention not only increases knowledge about a proper diet in pregnancy (Rao, et al., 2021), but also are positively correlated with good eating habits (Kim, et al., 2019). In addition, Liu, et al. (2019) observed that educational intervention enables pregnant women to change unhealthy practices and consequently decrease on the prevalence of postpartum complications. It is therefore of paramount importance to include nutrition as one of the health education topics given to pregnant women during their antenatal checkups. A cross-sectional descriptive institutional based study was conducted by Singh & Deepti, (2019) in Ethiopia to assess knowledge of pregnant women about maternal nutrition and factors associated with it during pregnancy on a sample of 422 pregnant women during January to June of the year 2019. It was revealed that nutrition knowledge was predictive of change in dietary habits and health advices encouraged expectant women to advance their food intake. This study revealed that out of 422 pregnant women more than half (57.8%) of the respondents did not know the meaning of food. This study result was in agreement with the study reported from America at El-Menshawy Hospital that about half of women didn’t have enough knowledge regarding the meaning, the importance, associated factors and the constituents of a well, balanced diet for the pregnant women. This study also pointed out that the nutritional knowledge of pregnant women about the importance of food during pregnancy as: (52.5%), (50.6%), (72.3%) and (71.8%) had the knowledge that food during pregnancy is important for bodies energy and heat, proper functioning of the body, growth and development of the fetus and fighting infection respectively in which the figure is slightly greater than the study conducted in Malawi, lilongwe, that most of the women (60%) said that eating from all food groups is good for a woman’s health and for foetal growth and development. According to a survey carried out by Bitew et al (2022) among13,057 women in Ethiopia on factors associated with nutritional deficiency among maternal mothers, the study showed that number of children significantly influence nutritional deficiency among maternal mothers, it was discovered that women who had never had a child (Parity 0) and women with at least five children (Parity 5+) were at a higher risk of chronic energy deficiency than other women. This was supported by another clinical trial carried out in Nigeria (2022) on factors associated with nutritional deficiency among maternal mothers, where a group of women were analyzed with the first group, 52 pregnant women with low total protein (<52g/1), the second group were 50 pregnant women with normal protein (>52g/1) while the third group were 50 non-pregnant women, non-lactating, apparently healthy women with normal protein (>63kg) for study. The pregnant women were different gestational stages of pregnancy, having different parity and attending the antenatal clinic of Parklane specialist hospital Enugu (Ikeyiet al 2022). The results showed that parity (i.e. the number of children had by a mother) correlated negative (P<0.05) with serum total protein, total cholesterol, creatinine and calcium, this is in contrast with the results of the first study. This study suggested that serum total protein significantly decreased as number of children increased and vice versa. This implies that parity therefore, may be contributing factor to malnutrition. This agrees with the views of Mcganity (2021) that PEM manifests in many mothers because their nutritional status has not improved from their last birth and so they are not nutritionally prepared for the next pregnancy. In addition Lapido suggested that many pregnancies in developing countries are unplanned, coupled with inadequate dietary intake due to dietary taboos associated with pregnancy, gender and other cultural beliefs. A cross-sectional descriptive institutional based study was conducted in Ethiopia to assess knowledge of pregnant women about maternal nutrition and factors associated with it during pregnancy on a sample of 422 pregnant women during January to June of the year 2021. It was revealed that nutrition knowledge was predictive of change in dietary habits and health advices encouraged expectant women to advance their food intake. This study revealed that out of 422 pregnant women more than half (57.8%) of the respondents did not know the meaning of food. This study result was in agreement with the study reported from America at El-Menshawy Hospital that about half of women didn’t have enough knowledge regarding the meaning, the importance, and the constituents of a well balanced diet for the pregnant women. This study also pointed out that the nutritional knowledge of pregnant women about the importance of food during pregnancy as: (52.5%), (50.6%), (72.3%) and (71.8%) had the knowledge that food during pregnancy is important for bodies energy and heat, proper functioning of the body, growth and development of the fetus and fighting infection respectively in which the figure is slightly greater than the study conducted in Malawi, lilongwe, that most of the women (60%) said that eating from all food groups is good for a woman’s health and for foetal growth and development. Another quasi-experimental intervention was undertaken on a random sample of 100 pregnant women attending urban health centers in llam city, Iran to determine maternal nutritional health, before and during pregnancy, influences the health status of herself and her developing fetus (FarnoushFallah et al 2021). A survey conducted by Grenov, Lanyero, Nabukeera-Barungi, Namusoke, Ritz, Friis, Michaelsen & Mølgaard, (2019) in Western Province, Kenya on level of nutritional knowledge on maternal malnutrition among antenatal mothers reported that 46% of the women in the study had a moderate level of nutritional knowledge in similar study at USA on 124 pregnant mothers, attending the outpatient clinics of obstetrics and gynecology, revealed that 78.2% of women had a good knowledge about the importance of milk and milk products for pregnant women and also they knew that maternal malnutrition can endanger the newborn health. 45.9% and 49.2% knew correctly neither the meaning nor the constituents of the balanced diet for the pregnant women. 61.3% had good knowledge about the sources of iron and 71.8% knew the sources of calcium. It also revealed that women aged 25-35 years had higher mean of nutritional knowledge among respondents. Summary of the Literature The literature from this chapter was reviewed based on the Conceptual review, research conducted by other authors, and theories to support the research. It has been established that knowledge on nutrition is a vital element to ensure positive pregnancy outcome and is the integral to achieve healthy dietary behaviors and subsequently improves their diet quality. Works conducted by various authors revealed that inadequate nutrient intake of both macronutrients (carbohydrate, protein, fat) and micronutrients (such as iron, calcium, phosphorus, magnesium, zinc, vitamin A, thiamine, riboflavin, niacin, and vitamin C) appear to affect maternal anemia, increasing the risk for other maternal morbidities and mortality, fetal growth retardation and low fetal birth weight. The researcher supported her work with Pender’s health promotion theory. However, the literature reviewed have not exhaustively investigate the knowledge of nutrition and factors associated factors with nutritional deficiencies during pregnancy among antenatal mothers in Ekpoma, Edo State, hence more attention will be given to these gaps that were not filled in the field work through the use of Questionnaire. CHAPTER THREE RESEARCH METHODOLOGY This chapter presents the method to be used in the research work which includes; research design, research setting, target population, sample and sampling technique, instrument for data collection, reliability of the instruments, Ethical consideration, method of data collection and method of data analysis. Research Design The research design is a descriptive survey to assess the knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State Research Setting This study is conducted in Ujeolen PHC, Ekpoma Edo State. Ekpoma is a town located in Edo State, Nigeria. It is the headquarters of the Esan West Local Government Area and is situated in the central part of the state. The town is home to the Ambrose Alli University, which is a state-owned university named after a former governor of the state. According to the National Population Commission of Nigeria, the estimated population of Ekpoma as of 2021 is around 101,000 people. Ekpoma is located in the central part of Edo State, which is a state in the southern part of Nigeria. It is situated approximately 42 kilometers to the east of Benin City, which is the capital city of Edo State. The town is situated along the Benin-Auchi Road, which is a major transportation route connecting the city of Benin to other parts of the state and the country. Ekpoma is situated at an altitude of approximately 195 meters above sea level, and its geographical coordinates are 6.7475° N, 6.2341° E. Target Population The total population of this study includes all pregnant women attending antenatal clinic at Ujeolen Health Centre, Ekpoma Edo State with a population of fifty two (52). These pregnant women who currently registered with Ujeolen Primary Health Centre, Ekpoma between the period of three (3) months (January to March). Source: Ujeolen Primary Health Care Report, 2025. Sample size Determination The target population for this study is the entire population which is fifty two (52) comprising of all the pregnant women attending antenatal clinic who registered with Ujeolen Primary Health Centre, Ekpoma using the rule of whole which is total inclusion. The "Rule of Whole" means that the researcher studies the entire population rather than selecting a sample. This is typically feasible and advantageous when the population size is relatively small. This implies that for such small populations, the effort and resources required to include every member of the population are justified and feasible. Sample and Sampling Techniques A sample of 52 pregnant women, representing 100% of the entire population of the study, was sampled for this study. The choice of using 100% of the entire population was due to the relatively small population size. The 52 pregnant women attending antenatal clinic at Ujeolen Health Centre, Ekpoma, Edo State, were used for the study. A simple random sampling technique was used to select 52 antenatal mothers who were registered with Ujeolen Primary Health Centre. Instrument for Data Collection The data for the study were collected using a questionnaire developed by the researcher based on the objectives of the study. The questionnaire consisted of four sections: Section [A] consisted of 5 items to explore socio-demographic data; Section [B] consisted of 12 items to assess the knowledge of antenatal mothers with regard to nutrition during pregnancy at Ujeolen Primary Health Centre; Section [C] consisted of 9 items to identify the factors influencing nutritional deficiencies among antenatal mothers during pregnancy at Ujeolen Primary Health Centre. The questionnaire comprised 26 items altogether. Validity of Instrument The validity of the instrument was ensured using face and content validity; having constructed the questionnaire that elicited information for the study in line with the study objectives, the researcher was ensured that the validity of the content by presenting it to the supervisor who check the questionnaire item to make sure it tallied with the research objectives. Ambiguous questions was rephrased to ensure that they measure what they are intend to measure. Reliability of the Study The reliability of the instrument was tested through test-retest method. The questions was consistently applied to answer the objectives and questions of the research. The study was carried out on respondents in Irrua, Esan Central, Edo State among 5 antenatal mothers and was found reliable based on their positive response. This is to determine the adequacy of the instrument. Data obtained was tested using Pearson method correlation coefficient test. The result obtained determined the reliability of the instrument. The reliability index was completed to be 0.85. Method of Data Collection The researcher presented her Departmental ethical letter of application to the Medical Officer of Health (MOH), Esan West Local Health Authority, Ekpoma, Edo State, who eventually gave the researcher a written permission to use the area. A written consent was obtained from the individual respondents, assuring them of confidentiality before embarking on data collection. The questionnaire was given to those who will be willing and give their consent for the study, and it will be retrieved back on the spot after completion. Data collection was done twice a week and 3 weeks will be used before the subjects will be completed. Respondents will be given one week to fill the questionnaire before collection. This will ensure that they have adequate time at their convenience to answer questions appropriately. Method of Data Analysis Data obtained from the field work through the use of questionnaire was ill be analyzed descriptively to answer the research questions using Statistical Package for Social Science (SPSS) version 23.0. The descriptive statistics of table of frequency and percentage will be use to answer research questions. Ethical Consideration A letter of identification and introduction was obtained from the Head of Department, Department of Nursing Science to the Medical Officer of Health (MOH), Esan West Local Health Authority, Ekpoma, Edo State in order to allow the researcher collect data from the area. The letter were presented to the chairman who eventually gave his consent by issuing an approval letter to the researcher. The researcher will then proceeded with the collection of data. Privacy and confidentiality was assured as the respondents were represented with numbers instead of their names. This study is self-determination or voluntary participation. The researcher ensured that the respondents have the right to voluntary decide whether to participate in the study or not, without the risk of incurring any penalty or prejudicial treatment. They were given the right to decide at any point during the study to withdraw their participation or refuse to provide any information on any point that was not clear to them. Plagiarism was avoided in this study. All authors used in the study will be appropriately cited both in the body of the work and the reference page. The purpose and benefit of this study was explained to the respondents to obtain their informed consent. CHAPTER FOUR RESULTS This chapter is concerned with the presentation and analysis of data. The raw data were analyzed critically to extract useful information for making inferences and conclusions. Tables, frequency count and simple percentage were used for data analysis. A total number of 52 copies of questionnaire were administered to respondents in the various primary health care in Ekpoma, 52 copies of the questionnaire were duly filled, returned and were considered good for analysis. This represented 100% return rate. Table 4.1: Demographic Distribution of Respondents Variable Category Frequency Percentage (%) Age-% -% -% Religion Christianity 42 80.8% Islam 7 13.5% Others 3 5.7% Occupation Farming 5 9.6% Trading 28 53.8% Civil Servant 13 25.0% Students 6 11.6% Education No Formal Education 1 1.9% Primary 4 7.7% Secondary 30 57.7% Tertiary 17 32.7% Marital Status Single 5 9.6% Married 38 73.1% Divorced/Separated 9 17.3% Total Respondents 52 100.0% The demographic profile of the 52 respondents revealed that the majority were aged between 30–49 years (48.1%) and 25–29 years (42.3%), while only 9.6% were between 16–24 years. Most respondents identified as Christians (80.8%), with others practicing Islam (13.5%) or other religions (5.7%). In terms of occupation, over half were traders (53.8%), followed by civil servants (25%), students (11.6%), and farmers (9.6%). Educationally, 57.7% had secondary education, 32.7% had tertiary education, 7.7% had primary education, and only 1.9% had no formal education. Most respondents were married (73.1%), while 17.3% were divorced or separated, and 9.6% were single. Table 4.2: Frequency and Percentage Analysis on Knowledge of Antenatal Mothers with Regard to Nutrition During Pregnancy STATEMENTS Frequency (F) Percentage (%) Do you know what a balanced diet is? Yes 52 100 No 0 0 Total 52 100 Is eating good food and a balanced diet important during pregnancy? Yes 52 100 No 0 0 Total 52 100 Do nutritional deficiencies lead to low birth weight/weak baby? Yes 46 88.5 No 6 11.5 Total 52 100 Will nutritional deficiencies lead to repeated illnesses? Yes 48 92.3 No 4 7.7 Total 52 100 Do deficiencies lead to premature delivery? Yes 47 90.4 No 5 9.6 Total 52 100 Can lack of nutrition knowledge cause miscarriage? Yes 52 100 No 0 0 Total 52 100 Can lack of nutrition knowledge cause preterm birth? Yes 49 94.2 No 3 5.8 Total 52 100 Do nutrient deficiencies affect mother and baby’s health? Yes 50 96.2 No 2 3.8 Total 52 100 Do you eat fresh citrus fruits during pregnancy? Yes 49 94.2 No 3 5.8 Total 52 100 Do you take folic acid supplement regularly? Yes 46 88.5 No 6 11.5 Total 52 100 Table 4.2 presents findings on the knowledge and practices of antenatal mothers regarding nutrition during pregnancy. The result shows that all respondents, 52 (100%), affirmed that they know what a balanced diet is. This indicates that the participants have basic awareness of healthy food requirements during pregnancy. Also, all 52 respondents (100%) agreed that eating good food and a balanced diet is important during pregnancy. This reflects a strong understanding among the women of the role of nutrition in maternal health. Majority of the respondents, 46 (88.5%), believe that nutritional deficiencies can lead to low birth weight or weakness of the baby, while only 6 (11.5%) disagreed. Similarly, 48 respondents (92.3%) agreed that such deficiencies can lead to repeated illnesses, while 4 (7.7%) did not share this view. This shows that most antenatal mothers are aware of the risks that poor nutrition poses to their babies’ health. Furthermore, 47 respondents (90.4%) stated that nutritional deficiencies could result in premature delivery, while 5 (9.6%) disagreed. All 52 participants (100%) believed that lack of knowledge about adequate nutrition could cause miscarriage, suggesting a widespread understanding of the danger of inadequate dietary knowledge during pregnancy. In the same vein, 49 (94.2%) respondents agreed that lack of nutritional knowledge may cause preterm birth, and 50 (96.2%) affirmed that nutrient deficiency affects both mother and baby’s health. These results further support the conclusion that the women are well-informed on the implications of poor nutrition during pregnancy. On dietary practices, 49 women (94.2%) stated that they consumed fresh citrus fruits like oranges, lemons, or mangoes, or drank juice made from them during pregnancy, while 3 (5.8%) did not. Lastly, 46 respondents (88.5%) reported that they regularly took folic acid supplements, while 6 (11.5%) said they did not. This suggests that while a majority follow recommended dietary guidelines, a small group may still be at risk due to non-compliance with supplement intake. Table 4.3: Frequency and Percentage Analysis on Factors Associated with Nutritional Deficiencies Variables Frequency (F) Percentage (%) Level of Education Primary 2 3.8 Secondary 33 63.5 Tertiary 15 28.8 No Formal Education 2 3.8 Total 52 100 Average Monthly Household Income ₦10,- ₦11,000–20,- ₦21,000 and above 22 42.3 Total 52 100 Age - Total 52 100 Occupation Housewife 5 9.6 Self-employed 37 71.2 Employed/Civil servant 10 19.2 Total 52 100 Marital Status Single 3 5.8 Married 42 80.8 Divorced/Separated 7 13.4 Total 52 100 Religion Christianity 42 80.8 Islam 8 15.4 Others 2 3.8 Total 52 100 Number of Children None- and above 17 32.7 Total 52 100 Mode of Previous Delivery (n=46) Normal Delivery 41 89.1 Caesarean Section 5 10.9 Total (Only among those with history of delivery) 46 100 Child Spacing 1 Year 10 19.2 2 Years 36 69.2 3 Years and above 6 11.6 Total 52 100 Table 4.3 presents data on various demographic and socio-economic factors that may influence nutritional deficiencies among the antenatal mothers. In terms of education, the highest proportion of respondents had secondary education (33 or 63.5%), followed by tertiary education (15 or 28.8%). A small number had either primary education (2 or 3.8%) or no formal education (2 or 3.8%). This suggests that most of the mothers are reasonably educated, which may positively influence their nutritional knowledge and practices. Regarding monthly household income, 9 respondents (17.3%) earned ₦10,000, while 21 (40.4%) earned between ₦11,000 and ₦20,000, and 22 (42.3%) earned above ₦21,000. Although most participants earned more than ₦10,000, a significant portion still fell within the low-income bracket, which might limit access to nutritious food and healthcare services. Age distribution shows that the largest group of respondents was aged 25–29 years (28 or 53.8%), followed by 30–49 years (19 or 36.6%), and the youngest group (16–24 years) made up 9.6%. This indicates that most participants were within the reproductive age range, with a potential for multiple pregnancies, which underscores the need for sustained nutrition awareness. Occupationally, most respondents were self-employed (37 or 71.2%), followed by civil servants (10 or 19.2%) and housewives (5 or 9.6%). Self-employment may offer flexibility but may not guarantee stable income, possibly affecting nutritional options. Marital status analysis revealed that the majority (42 or 80.8%) were married, which could indicate stable household settings that might support better nutrition, while a few were single (5.8%) or divorced/separated (13.4%). Most of the respondents (42 or 80.8%) practiced Christianity, 8 (15.4%) were Muslims, and 2 (3.8%) belonged to other religions. While religion may influence dietary practices, the majority belonging to a single faith group suggests possible homogeneity in cultural food norms. In terms of family size, 29 women (55.8%) had 1–2 children, 17 (32.7%) had 3 or more children, and 6 (11.5%) had none. Larger family sizes may increase household food demands, which could contribute to nutritional deficiencies if resources are limited. Among those who had delivered before (n=46), 41 (89.1%) had normal deliveries, while only 5 (10.9%) had caesarean sections. This might imply a history of relatively healthy pregnancies, possibly linked to good nutrition. Finally, the spacing between children showed that 36 women (69.2%) practiced two-year intervals, 10 (19.2%) had one-year spacing, while only 6 (11.6%) had three years or more. Proper child spacing is crucial for maternal nutritional recovery, and the prevalence of two-year spacing could have both positive and negative implications depending on nutritional support. Answering of Research Questions 1. What is the knowledge of antenatal mothers with regard to nutrition during pregnancy in Ekpoma? From the response elicited from Table 4.2, the result shows that all 52 respondents (100%) demonstrated awareness of balanced diets and recognized the importance of good nutrition during pregnancy. A large majority acknowledged that nutritional deficiencies could lead to low birth weight (88.5%), repeated illnesses (92.3%), premature delivery (90.4%), miscarriage (100%), and preterm birth (94.2%). Similarly, 96.2% agreed that nutrient deficiencies negatively affect both mother and baby. When asked about specific dietary habits, 94.2% said they consumed fresh citrus fruits during pregnancy, while 88.5% reported taking folic acid supplements regularly, highlighting a generally high level of nutritional knowledge and practices among the respondents. 2. What are the factors associated with nutritional deficiencies among antenatal mothers during pregnancy in Ekpoma? From the response elicited from Table 4.3, the result shows that the factors linked to nutritional deficiencies shows that most respondents had at least a secondary (63.5%) or tertiary (28.8%) education. Income levels varied, with the majority earning between ₦11,000–₦20,000 (40.4%) or above ₦21,000 (42.3%). Most respondents were aged 25–29 (53.8%), self-employed (71.2%), and married (80.8%). In terms of religion, 80.8% identified as Christians. About 55.8% had one or two children, and most (89.1%) of those who had delivered previously did so through normal delivery. Regarding child spacing, 69.2% practiced two-year spacing, showing patterns that could influence maternal nutrition and health outcomes. CHAPTER FIVE DISCUSSION OF FINDING This chapter will include; identifying of key findings, implications of findings with literature support, aligning findings with previous studies cited, the implication of the findings to the nursing profession, limitations of the findings, summary of the study, conclusion, recommendation and suggestions for further study. 5.1 Identifying key findings To ascertain the knowledge of antenatal mothers with regard to nutrition during pregnancy; the result shows that all 52 respondents (100%) demonstrated awareness of balanced diets and recognized the importance of good nutrition during pregnancy. A large majority acknowledged that nutritional deficiencies could lead to low birth weight (88.5%), repeated illnesses (92.3%), premature delivery (90.4%), miscarriage (100%), and preterm birth (94.2%). Similarly, 96.2% agreed that nutrient deficiencies negatively affect both mother and baby. When asked about specific dietary habits, 94.2% said they consumed fresh citrus fruits during pregnancy, while 88.5% reported taking folic acid supplements regularly, highlighting a generally high level of nutritional knowledge and practices among the respondents. To ascertain the factors associated with nutritional deficiencies among antenatal mothers during pregnancy; result shows that the factors associated with nutritional deficiencies was secondary (63.5%) or tertiary (28.8%) education. Income levels varied, with the majority earning between ₦11,000–₦20,000 (40.4%) or above ₦21,000 (42.3%). Most respondents were aged 25–29 (53.8%), self-employed (71.2%), and married (80.8%). In terms of religion, 80.8% identified as Christians. About 55.8% had one or two children, and most (89.1%) of those who had delivered previously did so through normal delivery. Regarding child spacing, 69.2% practiced two-year spacing, showing patterns that could influence maternal nutrition and health outcomes. 5.2 Implication of the findings with Literature support The knowledge of antenatal mothers with regard to nutrition during pregnancy have improved over the years; The findings revealed that respondents know what a balanced diet is, all respondents agreed that eating good food and a balanced diet is important during pregnancy, majority of the respondents said nutritional deficiencies of mother can lead to low birth weight and weakness of the baby, respondents agreed that nutritional deficiencies among antenatal mothers could lead to repeated illnesses, respondents also agreed that nutritional deficiencies during pregnancy lead can result to premature delivery, respondents also said that lack of knowledge about adequate nutrition is the cause of miscarriage, lack of knowledge about adequate nutrition be the cause of preterm birth, respondents also agreed that it is true that nutrients deficiency during pregnancy affect the health of the mother and the baby, majority of the respondents have also said they eat fresh citrus fruits, such as: Orange, Lemon, mango, or drink juice made from them during pregnancy and majority which represent and they take folic acid supplement regularly. This implies that antenatal mothers were well informed regard to nutrition during pregnancy. This finding is supported with the literature of Banga, Baren, Ssonko, Sikakulya, Tibamwenda, Banga, &Ssebuufu, (2020) from Wollega, Ethiopia in 2021 revealed that 64.4% of women had nutrition knowledge during pregnancy. This research showed a positive significant relation between information about nutrition, educational status of mothers and family income and nutritional knowledge of mothers during pregnancy. Several factors were associated with nutritional deficiencies among antenatal mothers during pregnancy as showed in the findings of the study such as level of education of antenatal mothers, average household economic status per month of antenatal mothers, age of antenatal mothers, occupation of antenatal mothers, marital status of antenatal mothers, religion of antenatal mothers, number of children of antenatal mothers, mode of child delivery of antenatal mothers and child spacing of antenatal mothers. This finding is supported with the literature of Liu, et al. (2019) who observed that educational intervention enables pregnant women to change unhealthy practices and consequently decrease on the prevalence of postpartum complications. It is therefore of paramount importance to include nutrition as one of the health education topics given to pregnant women during their antenatal checkups. A nutritional education program containing two to four lessons was undertaken for small groups of between six to ten women. These results are similar to those found by Verbeke (2023) who found that education on nutrition and food consumption can resolve safety issues in the population. 5.4 Aligning findings with findings of previous studies cited The result of the showed that antenatal mothers had good knowledge of antenatal mothers with regard to nutrition during pregnancy in Ekpoma. They know what a balanced diet is, all respondents agreed that eating good food and a balanced diet is important during pregnancy, majority of the respondents said nutritional deficiencies of mother can lead to low birth weight and weakness of the baby, respondents agreed that nutritional deficiencies among antenatal mothers could lead to repeated illnesses, respondents also agreed that nutritional deficiencies during pregnancy lead can result to premature delivery, respondents also said that lack of knowledge about adequate nutrition is the cause of miscarriage. This finding is supported with the studies conducted by Gebre, Reddy, Mulugeta, Sedik, & Kahssay, (2019) at Military Hospital and Combined Hospital Rawalpindi, Pakistan, among 400 married reproductive age women in 2021 revealed that 53.25% of them knew folic acid intake is important. The result of the study revealed that there were several factors associated with nutritional deficiencies among antenatal mothers during pregnancy in the study area such as level of education of antenatal mothers, average household economic status per month of antenatal mothers, age of antenatal mothers, occupation of antenatal mothers, marital status of antenatal mothers, religion of antenatal mothers, number of children of antenatal mothers, mode of child delivery of antenatal mothers and child spacing of antenatal mothers. This finding is supported with the literature of Liu, et al. (2019) who observed that educational intervention enables pregnant women to change unhealthy practices and consequently decrease on the prevalence of postpartum complications. These results are similar to those found by Verbeke (2023) who found that education on nutrition and food consumption can resolve safety issues in the population. 5.5 Implication of the Study The implication of the finding of the research work is that antenatal mothers should be encourage more on knowledge with regard to nutrition during pregnancy. This is will help to develop positive attitude towards the practice of good nutrition during pregnancy and help in improving the fight against nutritional deficiency among antenatal mothers during pregnancy. 5.6 Limitations of the Study Some limitations were encountered while carrying out the study, they include; Lack of cooperation; some of the antenatal mothers portray un-cooperative behaviours during data collection as this was the reason why some questionnaire were not returned. Time constraints; the research time coincides with the researcher’s class lectures and clinical postings and examinations. Finance; financing the project work was a major challenge during the research period. 5.7 Summary This study assessed the knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State Objectives of the study are; to assess knowledge of antenatal mothers with regard to nutrition during pregnancy in Ekpoma and to identify the factors associated with nutritional deficiencies among antenatal mothers during pregnancy in Ekpoma. The scope of the study focused on knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers in Ekpoma, Edo State, in this case it was necessary to pay special attention to antenatal mothers in Ekpoma between the age of 16-49 years. The research design was a descriptive survey designed to determine the knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State The sample size was 52. The data that was collected from this research was analyzed manually and was presented using tables, frequencies and percentages. The validity of the instrument was ensured using face and content validity. Findings showed that antenatal mothers had adequate knowledge of nutrition during pregnancy and there were several factors associated with nutritional deficiencies among antenatal mothers during pregnancy. 5.8 Conclusions The study shows that there is a high awareness of nutrition knowledge among antenatal mothers during pregnancy. This implies that nutrition knowledge among antenatal mothers improved over the years because antenatal mothersknow what a balanced diet is and agreed that eating good food and a balanced diet is important during pregnancy. It showed that a positive significant relation between information about nutrition, educational status of mothers and family income and nutritional knowledge of mothers during pregnancy. This study shows that there were several factors associated with nutritional deficiencies among antenatal mothers during pregnancy such as level of education of antenatal mothers, average household economic status per month of antenatal mothers, age of antenatal mothers, occupation of antenatal mothers, marital status of antenatal mothers, religion of antenatal mothers, number of children of antenatal mothers, mode of child delivery of antenatal mothers and child spacing of antenatal mothers. This implies these factors can shape the level of nutrition knowledge and practice among antenatal mothers during pregnancy which may either affect them positively or negatively. It can also be concluded that educational intervention enables pregnant women to change unhealthy practices and consequently decrease on the prevalence of complications during pregnancy. 5.9 Recommendations Base on the findings of the study the following policy recommendations should be considered. 1. Nutrition intervention such as nutrition education in different villages, health centers, health posts and women organizations should be given for the community particularly for the pregnant mothers concerning nutrition during pregnancy to increase the nutritional knowledge of mothers. 2. Nutrition should be a priority at national and regional levels as it is important for human and social-economic development in the country. 3. The Ministry of Health together with other policy makers running the health sector should introduce feeding programmes in antenatal clinics and health centers. This may help done through provision of food subsidies to pregnant women. 4. The government should also strengthen its livelihood and economic empowerment programs to cater for women by providing opportunities for them to get more access to education, paid employment, assets such as land and credit facilities. 5. Women’s education must be highly prioritized and facilitated by creating awareness of the importance of girl-child education, free education up to secondary school level, and promotion of adult education for illiterate adult women. 6. More income generating activities/entrepreneurial skills for women are imperative to increase their income and boost their spending on family food. 7. Promotion of traditional dishes with proper food processing techniques to conserve water soluble, air, light and heat sensitive nutrients are imperative, hence, the need for nutrition education of women. 8. Health care providers should introduce strategies for providing health education about proper and balanced maternal nutrition during ANC visits. 5.10 Suggestions for further findings More research needs to be done on knowledge of nutrition and factors associated with nutritional deficiencies during pregnancy among antenatal mothers. There is the need to assess the level of practice of nutrition during pregnancy among antenatal mothers. More research should also be on the attitude of antenatal mothers towards nutritional deficiencies during pregnancy. REFERENCES Abu-Saad, K., & Fraser, D. (2023).Maternal Nutrition and Birth Outcomes. Epidemiologic Reviews, 32(1), 5-25. Adikari, A. M. N. T., Sivakanesan, R., Wijesinghe, D. G. N. G., & Liyanage, C. (2022).Assessment of nutritional status of pregnant women in a rural area in Sri Lanka. Tropical Agricultural Research, 27(2), 203-211. Appiah, P.K, NaaKorklu, A.R, & Bonchel, D.A (2021). Nutritional knowledge and dietary intake habits among pregnant adolescents attending antenatal care clinics in urban community in Ghana. J NutrMetab:-. Banga, D., Baren, M., Ssonko, N. V., Sikakulya, F. K., Tibamwenda, Y., Banga, C., & Ssebuufu, R. (2020). Comorbidities and Factors Associated with Mortality among Children underFive Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of JinjaRegional Referral Hospital, Eastern Uganda. International Journal of Pediatrics, 2020. Barasi, M (2023) Human Nutrition: A Health Perspective. New York: Oxford University Press Inc Berisha, M., Ramadani, N., Hoxha, R., Gashi, S., Zhjeqi, V., Zajmi, D., & Begolli, I. (2023).Knowledge, attitudes and practices of mothers in kosova about complementary feeding for infant and children 6-24 months. Medical Archives, 71(1), 37. Bitew, F.H, Telake D.S, (2021). Undernutrition among women in ethiopia: rural-urban disparity. Dhs working papers no. 77. Icf macro, calverton, mary- land, usa. Daba, G., Beyene, F., Garoma, W., & Fekadu, H. (2021).Assessment of knowledge of pregnant mothers on maternal nutrition and associated factors in GutoGidaWoreda, East Wollega Zone, Ethiopia. Journal of Nutrition & Food Sciences, 3(6), 235-241. DiSantis, M, Gibbons D, Vallianatos H, Mamede F, Higginbottom GMA, Malhi R, Forgeron J (2021). Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol Edith, M., &Priya, L. (2022). Knowledge, attitude, and practice (KAP) survey on dietary practices in prevention of malnutrition among mothers of under-five children. Manipal Journal of Nursing and Health Sciences (MJNHS), 2(2), 19-24. Emina, S.R., Ekesa B, Blomme G, Garming H (2019). ”Dietary diversity and nutritional status of pre-school children from musa-dependent households in Gitega (Burundi) and Butembo (Democratic Republic of Congo)”.African Journal of Food, Agriculture, Nutrition and Development 11(4). FAO, IFAD, UNICEF (2021). The State of Food Security and Nutrition in the World 2021: transforming food systems for food security, improved nutrition and affordable healthy diets for all. Rome: FAO. FAO/WHO (2021).Requirements of Vitamin A, Iron, Folate and Vitamin B12.Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition Series, 23. Rome: FAO. FAO/WHO/UNU.(2021). Energy and Protein Requirements. WHO Technical Report Series, 724. Geneva: WHO. Farnoush, F (2019). A study of nutritional status of pregnant women of some villages in Balasore district, Orissa. Journal of Human Ecology 20(3):227-232. FarnoushFallah, Booth, l., Johns, T. & Kuhlein, H.V. (2021). Natural food sources of vitamin A and provitamin A. Food and Nutrition Bulletin, 14 (1), 6 - 9. Federal Democratic Republic of Nigeria (2021). National nutrition program,-, 2021, pp. 1–83. Fouda, L. M., Ahmed, M. H., &Shehab, N. S. (2012).Nutritional awareness of women during pregnancy. Journal of American Science, 8(7), 494-502. Gebre, A., Reddy, P. S., Mulugeta, A., Sedik, Y., &Kahssay, M. (2019). Prevalence of malnutrition and associated factors among under-five children in pastoral communities of Afar Regional State, Northeast Ethiopia: a community-based cross-sectional study. Journal of nutrition and metabolism, 2019. Gloria, T.K (2022). Knowledge, Attitude and Practices Toward Nutrition and Diet During Pregnancy Among Recently Delivered Women of Syrian Refugees. Journal of refuge and global health 1(2):32-37 Grenov, B., Lanyero, B., Nabukeera-Barungi, N., Namusoke, H., Ritz, C., Friis, H., Michaelsen, K.F. & Mølgaard, C., (2019). Diarrhea, dehydration, and the associated mortality in children with complicated severe acute malnutrition: a prospective cohort study in Uganda. The Journal of pediatrics, 210, pp.26-33. Han, Z., Mulla, S., Beyene, J., Liao, G. & McDonald, S. D. (2011) Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. International Journal of Epidemiology, 40(1), pp. 65-101. Hartline-Grafton., Assefa N, Berhane Y, & Worku A., (2019). Wealth status, mid upper arm circumference (MUAC) and antenata care (ANC) are determinants for low birth weight in kersa. Ethiopia: Plos One 7,e39957. Ikeyi A. Alumanah E.O. & Joshua P.E., (2021). Effects of age and parity associated with protein energy malnutrition (PEM) on some biochemical parameters of some pregnant women in Enugu Metropolis of Nigeria. Research j. Science and tech. 2010; 2(2): 23-28 Ikhsan, LN, Asifa, N, & Nasaruddin, M (2022). Nutritional knowledge, attitude and practice among antenatal and postnatal mothers in hospital TengkuAmpuanAfzan (Htaa), Kuantan, Pahang. IIUM Med J M Jacinta, A, Bawadia, H. A., Al-Kuranb, O., Al-Bastonia, L. A., Tayyemc, R. F., Jaradatd, A., Tuurie G., Al-Beitawif, S. N., & Al-Mehaisenb, L. M. (2022). Gestational Nutrition Improves Outcomes of Vaginal Deliveries in Jordan: An Epidemiologic Screening. Journal of Nutrition Research, 30 (2): 110- 117 Kaiser, J & Allen, A.I (2021).Cultural Beliefs and Perceptions of Maternal Diet and Weight Gain during Pregnancy and Postpartum Family Planning in Egypt. Retrieved on May 2, 2025 from http://www.popline.org/node/581638. Kever, R. T., Martins, S. D., Lola, N., Dathini, H., Habu, H., Fatima, A. A., & Sambo, B. D. (2021). Knowledge and attitude of pregnant women towards dietary practices in YerwaClinic, Maiduguri Metropolitan Council; Borno State. Journal of Research in Nursing and Midwifery, 4(1), 12-19. Kim-Godwin, Y. S., Baek, H. C., & Wynd, C. A. (2019).Factors Influencing Professionalism in Nursing among Korean American Registered Nurses. Journal of Professional Nursing, 26(4), 242-249. Koletzko, B, Brands, B, & Poston, L (2023). Early nutrition programming of long-term health. ProcNutrSoc; 71(3): 371–378. Latifa MF, Manal H.A, & Nihal, S.S (2021). Nutrition awareness of women during pregnancy. Journal American Science 8(7):494-502. Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., & Black, R. E. (2019). Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2021 priorities: an updated systematic analysis. The Lancet,-), 430-440. Malaysian Dietary Guidelines. (2023). National Coordinating Committee on Food and Nutrition. Ministry of Health, Malaysia. McDonald, S.D., Han, Z., Mulla, S., & Beyene, J. (2023). Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses, BMJ, 1-20. Mcganity, C.N (2021). Nutrition in infancy. Nutrition Review, 52 (12); 13 – 21. Mitra, M., Wan Abdul Manan, W. M., Affizal, A., MohdShukri, O., & Maryam, M. (2023). Does nutritional knowledge have a relationship with healthy dietary attitude and practices during pregnancy? International Proceedings of Chemical, Biological & Environmental, 39, 159-163. Monsivais, V.I & Drewnowski, T (2019). The effect of food stamp nutrition education on the food insecurity of low-income women participants. J nutreducbehav;41(3):161-8. Mugyia, A. S. N., Tanya, A. N. K., Njotang, P. N., & Ndombo, P. K. (2022). Knowledge and attitudes of pregnant mothers towards maternal dietary practices during pregnancy at the EtougEbe Baptist Hospital Yaounde. Health Sciences and Diseases, 17(2). Okeke, E.C. & Eze, C (2022).Nutrient composition and nutritive cost of Igbo traditional vendor foods and recipes commonly eaten in Nsukka. Journal of Tropical Agriculture, Food, Environment and Extention, 5, 36 – 44. Okwu, G. N., Ukoha, A. Nwachukwu, N. & Agha, N. C., (2023). Studies on the predisposing factors of protein energy malnutrition among pregnant women in a Nigerian community. Online journal of health and allied science, 3:1. Perumal, N., Cole, D. C., Ouedraogo, H. Z., Sindi, K., Loechl, C., & Low, J (2023). Health and nutrition knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics in Western Kenya: a cross-sectional analysis. BMC Pregnancy Childbirth, 13(146), 1-12. Rao, R., Shao, J., Lou, J., Georgieff, M.K., Kaciroti, N., Felt, B.T., Zhao, Z.Y. & Lozoff, B. (2021) Maternal serum ferritin concentration is positively associated with newborn iron stores in women with low ferritin status in late pregnancy. Journal of Nutrition, 142,-. Sakraida, D (2021). Maternal Nutrition: Issues and Interventions; Computer Based Slide Presentation, by the Bureau for Global Health of the United States Agency for International Development (USAID), Updated August, 2021 Sharp, G., Han, Z., Mulla, S., Beyene, J., Liao, G. & McDonald, S. D. (2019) Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. International Journal of Epidemiology, 40(1), pp. 65-101. Shekar, S.C, Heaver, R & Lee, L.P (2022).Effects of Pregnancy on eating attitudes and disorders. A prospective study Journal ofPsychosomatic Research 59 (3): 175 -179. Singh, T & Deepti, S.S (2019).Knowledge, attitude, practice and determining factors regarding nutrition during pregnancy among females of rural Punjab. Int J Community Med Public Heal; 6(7): 2874. Tenaw, Z & Tachbele, E (2021). Nutritional knowledge, attitude and practices among pregnant women who attend antenatal care at public hospitals of Addis Ababa, Ethiopia. Int J Nurs Midwifery; 10(7): 81–89. Thet, M. M., Khaing, E. E., Diamond-Smith, N., Sudhinaraset, M., Oo, S., &Aung, T. (2022).Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grand-mothers, and husbands. Appetite, 96, 62–6 UNICEF (2020).Improving child nutrition the achievable imperative for global progress. https://www.unicef.org›nutrition›index_68661 Vakili, R., EmamiMoghadam, Z., Khademi, G., Vakili, S., & Saeidi, M. (2021). Child mortality at different world regions: A comparison review. International Journal of Pediatrics, 3(4.2), 809-816. Verbeke, H (2023), First foods: Why improving young children's diets matter. Maternal & child nutrition, 13, e12528. Wardlaw, G.M. & Hampl, J.S. (2023).Perspectives in Nutrition. 7th ed. New York: McGraw Hill. Wen, W, S., Payghan, B. S., Kadam, S. S., & Reddy, R. M. (2021). A comparative study of nutritional awareness among urban-rural pregnant mothers. Journal of Medical and Health Sciences, 3, 95-99. World Health Organization (2021).Nutrition, https://www.who.int/news-room/facts-in pictures/detail/nutrition. pp. 10–11 World Health Organization (2020). Nutrition Retrieved from http://www.who.int/nutrition/en/Wardlaw&Hampl, 2020 World Health Organization, (2020).Coverage of Maternity Care: A Listing of Available Information. Geneva: World Health Organization; WHO/RHT/MSM/96.28. World Health Organization.(2021). Maternal mortality. Retrieved on January 16, 2022 from www.who.int/mediacentre/factsheets/fs348/en/ Yohannes, B., Ejamo, E., Thangavel, T., &Yohannis, M. (2021). Timely initiation of complementary feeding to children aged 6–23 months in. rural Soro district of Southwest Ethiopia: a cross-sectional study. BMC pediatrics, 18(1), 1-7. Zerfu, T.A and Biadgilign, S (2021).Pregnant mothers have limited knowledge and poor dietary diversity practices, but favorable attitude towards nutritional recommendations in rural Ethiopia: evidence from community-based study. BMC Nutr; 4: 43. QUESTIONNAIRE Department of Nursing Sciences, Faculty of Basic Medical Sciences, College of Medical Sciences, Ambrose Alli University, Ekpoma, Edo State, Nigeria. Dear Respondent, I am a final year student of the above named Department and faculty. I am carrying out a research on “knowledge of nutrition and factors influencing nutritional deficiencies during pregnancy among antenatal mothers in Ujeolen PHC Ekpoma, Esan West L.G.A. Edo State”. I will be grateful if you fill out the attached questionnaire. All information provided will be used with utmost confidentiality. Thanks for your anticipated co-operation. Yours faithfully ODIYI, RUTH FUNAYA QUESTIONNAIRE ON: KNOWLEDGE OF NUTRITION AND FACTORS INFLUENCING NUTRITIONAL DEFICIENCIES DURING PREGNANCY AMONG ANTENATAL MOTHERS IN UJEOLEN PHC EKPOMA, ESAN WEST L.G.A. EDO STATE SECTION A: DEMOGRAPHIC DATA OF RESPONDENTS You are expected to tick (√) in the appropriate box in section A and Section B. 1) Age: 16-24 [ ] 25– 29 [ ] 30 - 49 [ ] 2) Religion: Christianity [ ] Islam [ ] Others [ ] 3) Occupation: Farming [ ] Trading [ ] Civil Servant [ ] Student [ ] 4) Educational status: Primary [ ] secondary [ ] Tertiary [ ] No formal Education [ ] 5) Marital Status: Single[ ] Married [ ] Divorce/separated [ ] Section B: Knowledge of antenatal mothers with regard to nutrition during pregnancy 1. Do you know what a balanced diet is? Yes [ ] No [ ] 2. Is eating good food and a balanced diet important during pregnancy? Yes [ ] No [ ] 3. Do Nutritional deficiencies of mother lead to low birth weight and weakness of the baby? Yes[ ] No[ ] 4. Will nutritional deficiencies among antenatal mothers lead to repeated illnesses? Yes [ ] No [ ] 5. Do Nutritional deficiencies during pregnancy lead to premature delivery? Yes [ ] No [ ] 6. Does lack of knowledge about adequate nutrition be the cause of miscarriage? Yes [ ] No [ ] 7. Does lack of knowledge about adequate nutrition be the cause of preterm birth? Yes [ ] No [ ] 8. It is true that nutrients deficiency during pregnancy affect the health of the mother and the baby? Yes [ ] No [ ] 9. Do you eat fresh citrus fruits, such as: Orange, Lemon, mango, or drink juice made from them during pregnancy? Yes [ ] No [ ] 10. Do you take folic acid supplement regularly? Yes [ ] No [ ] Section C: Factors influencing nutritional deficiencies among antenatal mothers during pregnancy 1. What is your level of education? Primary School [ ] Secondary School [ ] Tertiary Institution [ ] No formal education [ ] 2. What is your average household economic status per month?N10000 [ ] N- [ ] N 21000 and above [ ] 3. What is your age range? 16-24 [ ] 25-29 [ ] 30-49 [ ] 4. What is your occupation? Housewife [ ] Self employed/private business [ ] Employed/Civil servant [ ] 5. What is your marital status? Single [ ] Married [ ] Divorced/Seperated [ ] 6. What is your religion? Christian [ ] Muslim [ ] Others [ ] 7. How many Children do you have? None [ ] 1-2 [ ] 3 and above [ ] 8. How have you delivered previously? Normal delivery [ ] Ceasarian Section [ ] 9. How many years spacing do you give your children? 1year [ ] 2years [ ] 3years and above [ ]