Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

Prince Kubi Appiah; Anang Rhoda Naa Korklu; Duut Abdulai Bonchel; Georgina Agartha Fenu; Francis Wadga-Mieza Yankey

doi:10.1155/2021/8835704

Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

Appiah, Prince Kubi;Naa Korklu, Anang Rhoda;Bonchel, Duut Abdulai;Fenu, Georgina Agartha;Wadga-Mieza Yankey, Francis 2021-02-13 00:00:00 Hindawi Journal of Nutrition and Metabolism Volume 2021, Article ID 8835704, 9 pages https://doi.org/10.1155/2021/8835704 Research Article Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana 1,2 1 3 Prince Kubi Appiah , Anang Rhoda Naa Korklu, Duut Abdulai Bonchel, 4 5 Georgina Agartha Fenu, and Francis Wadga-Mieza Yankey Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana Department of Medical Law and Ethics, Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea Centre for Migration Studies, University of Ghana, Legon, Accra, Ghana Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana Academic Aﬀairs Directorate, University of Health and Allied Sciences, Ho, Ghana Correspondence should be addressed to Prince Kubi Appiah; appiahkubiprince23@yahoo.com Received 17 August 2020; Revised 2 February 2021; Accepted 4 February 2021; Published 13 February 2021 Academic Editor: Mar´ıa Ximena Silveyra Copyright © 2021 Prince Kubi Appiah et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Proper nutrition during pregnancy is important for the wellbeing of the mother and foetus and supports health during pregnancy, delivery, and breastfeeding. However, there are little data on nutritional knowledge and dietary intake among adolescents who are pregnant in Ghana. Hence, the study assessed the nutritional knowledge and eating habits of this vulnerable group in the Ledzokuku-Krowor Municipality, Ghana. Methods. ,e study was cross-sectional and employed a multistage sampling technique to select 423 participants. ,e study was conducted between October and November 2019. A statistical software was used to analyse data and employed Pearson’s chi-square and logistics regression to assess associations between the outcome and predictor variables. A p value<0.05 at a 95% conﬁdence interval was considered statistically signiﬁcant. Results. Less than half (44.9%) of the pregnant adolescents have high nutritional knowledge. About 19.4% of them have good eating habits, while 23.9%, 18.2%, and 6.4% of them do not take breakfast, lunch, and supper, respectively. However, 15.6%, 13.9%, and 9.2% do take snacks after breakfast, lunch, and supper, respectively. About 55.9%, 59.8%, and 23.0% do not take their breakfast, lunch, and supper on time, respectively. Additionally, only 3.8% of them do take fruits and vegetables daily, while 9.7%, 23.2%, 30.0%, and 26.5% of them do take animal products, energy drinks, carbonated drinks, and legumes/nuts/seeds daily, respectively. ,e study showed that educational level (p � 0.014), occupation (p � 0.016), ethnicity (p � 0.017), and number of pregnancies (p � 0.021) were associated with good eating habits. Conclusion. Eating habit of adolescent pregnant women was not encouraging. ,erefore, the municipal health authority with the concerned stakeholders should intensify eﬀorts, including nutritional education to improve good eating habits, such as taking snacks in between meals, eating on time, and balance diet among pregnant adolescents, and to reduce adolescent pregnancy in the municipality. pregnancy is necessary for maternal health during preg- 1. Introduction nancy, delivery, and breastfeeding [2] and inﬂuences the Adolescent pregnancy is a key public health obstacle in the growth and development of the foetus [3]. Hence, an ade- world and has been linked with substantial medical, nu- quate amount of nutrients is needed to support foetal growth tritional, social, and economic risks for individuals, the and development, along with the alterations in maternal child, family, and communities [1]. Proper nutrition during tissues and metabolism [4]. ,ough nutrients requirement 2 Journal of Nutrition and Metabolism increases during pregnancy [5], it is known that intake of It has an estimated population of 363,753. Ga-Adangbe is the essential nutrients among adolescents is below what is main ethnic group in the area, with Christianity being the recommended [6], with notable deﬁciencies of iron leading main religion of the people. ,ere are three public hospitals to cognitive and behavioural problems in childhood, zinc providing antenatal services in the area. More than half likely to limit foetal growth, vitamin A leading to impair (71.0%) of the people in the municipality are economically resistance to infection, and calcium associated with pre- active, while 3.3% of the households in the area are engaged eclampsia and intrauterine growth restriction [7]. Mean- in agricultural production [24]. while, adolescence is a life stage where there is rapid growth and development with a signiﬁcant increase in nutritional 2.2. Study Population. ,e study involved pregnant ado- requirements, and the additional nutrient demands of lescents (10–19 years) receiving antenatal care in the mu- pregnancy subject these adolescents to greater health risks nicipality and who have lived in the area for three or more [8]. Again, poor pregnancy outcomes, including low birth months. However, data was collected from only those who weight and anaemia are frequently seen among adolescents agreed to be part of the study, and they and their guardians than adult women [8, 9]. A study has also shown that in- signed informed consent and assent forms. creased trends of susceptibility among adolescents is asso- ciated with economic and social factors [10]. Adolescents have food preferences and poor eating 2.3. Study Design. ,e study was cross-sectional and we used behaviours, and for them, to make changes in their eating face-to-face interview technique to collect quantitative data habits, they must believe that changes are possible within the on nutritional knowledge and eating habits from pregnant context of their lifestyle and environment [11, 12]. Fur- adolescents in the municipality between October and No- thermore, adolescents who are pregnant may not have a vember 2019. stable food supply, food preparation skills, and facilities [13]. ,erefore, appreciating issues that limit healthy eating along with challenges for nutrition education among pregnant 2.4. Sample Size. Four hundred and twenty-three partici- pants involved in the study were determined using the adolescents are key when scheming and executing nutrition education interventions [14]. formula established by Cochran and colleague for pop- Nutritional education is aimed at transferring ample ulation-based cross-sectional studies [25]: knowledge of healthy diet even though adequate knowledge z × p(q) may not be necessarily linked to practical dietary behaviour (1) n � , [15]. A study in Nigeria reported that 80.2% of adolescent girls had a poor level of nutritional knowledge towards reducing where n is the sample size to be determined, z is the z-score malnutrition [16]. Contrary to the study in Coˆte d’lvoire, the of 1.96 at 95% conﬁdence level, p is the estimated proportion majority of the adolescents had good nutritional knowledge of an attribute that was present in the population (50% as the on nutritional health, a balanced diet, and hygiene [17]. In exact rate of good eating habits among pregnant adolescents addition, studies have revealed that the dietary intake of is not known), d is the desired level of accuracy 5%, and q is adolescents was mostly plant-based food sources and high- 1 − p. Considering a 10% nonresponse rate among ado- energy snacks and beverages, with limited intake of fruits and lescents, the sample size was 423, to ensure the prevalence of vegetables and skipping of breakfast [18, 19]. Nutritional the outcome variable falls within ±5% of the actual pop- knowledge and dietary intake of this group could inﬂuence ulation coverage. their nutritional status. For instance, studies carried out in Nigeria among female adolescents indicated that 23.4% and 9.4% of them were underweight and overweight/obese in 2.5. Sampling Method. Multistage sampling technique was 2014, respectively [20]; however, this trend changed to 38.2% applied to select the study participants. First, a total pop- underweight and 5.5% overweight/obese [21]. Additionally, a ulation purposive sampling was employed to select antenatal study in Ghana revealed that 7.1% and 54.5% of female ad- clinics in the three hospitals in the metropolis because they olescents were underweight and overweight/obese, respec- are government-owned facilities where pregnant women tively [22]. ,ese studies identiﬁed nutritional deﬁciencies receive free antenatal care; hence, it is likely that more and knowledge gap among adolescents, however, not among adolescent pregnant women will go there for services. pregnant adolescents. Again, pregnant adolescents are nor- Second, the total number of pregnant adolescents who have mally not included in national surveys, and their nutritional registered for antenatal care was taken and proportionately status around the world is limited [23]. Hence, this study allocated the sample size to the facilities. To select the ad- investigated the nutritional knowledge and eating habits of olescents from the selected antenatal care clinics, the list of pregnant adolescents in the Ledzokuku-Krowor Municipal in adolescents was sorted out from the antenatal care register, the Greater Accra Region of Ghana. and we attached unique numbers to the names of the ad- olescents and wrote the numbers on a piece of paper, folded the papers, and placed them in a box. A neutral person was 2. Materials and Methods invited to pick a folded paper from the box, and the number 2.1. Study Site. Ledzokuku-Krowor municipality is one of written on the paper was traced to the attached name and the ten Municipalities in the Greater Accra Region of Ghana. repeated the process until we got the adolescents required. Journal of Nutrition and Metabolism 3 2.6. Data Collection Tools and Procedure. Adolescent food and a comparative majority (41.6%) were receiving antenatal habits checklist adapted from Johnson et al. [26] and a 24- care from LEKMA Polyclinic (Table 1). hour dietary recall and food frequency questionnaire of the Food and Agricultural Organization of the United Nations 3.2. Nutritional Knowledge of Pregnant Adolescents. ,e [27] were used to collect food intake data, using a face-to- results showed that 44.9% of the adolescents had high nu- face interview procedure. We also used a set of questions to tritional knowledge, while 31.9% and 23.2% had moderate assess nutritional knowledge on dietary recommendations, and low nutritional knowledge, respectively (Figure 1). source of nutrients, choosing everyday foods, and diet- disease relationships. We used the adolescents’ contact in- formation at the antenatal care clinics to track them to their 3.3. Eating Habits of the Pregnant Adolescents. ,e study houses for data collection. Research assistance was trained showed that 19.3% of pregnant adolescents had good eating on the tools before data collection. habits (Figure 2). ,e majority (76.1%, 81.8%, and 93.6%) of the adolescents do take breakfast, lunch, and supper/dinner daily; however, 55.9%, 57.8%, and 23.0% of them do not take 2.7. Data Processing and Analysis. ,e STATA 12.1 version their breakfast, lunch, and supper/dinner time, respectively. software was used for data analysis. Participants who had a Furthermore, 84.4%, 86.1%, and 90.8% of the adolescents do healthy response to all questions were classiﬁed as having a not take snacks after breakfast, lunch, and supper/dinner, good eating habit. We further analysed and presented some respectively (Figure 3). details about eating habits of the adolescents as to whether they were eaten breakfast, snack after breakfast, lunch, snack 3.4. Consumption of Food Groups and Products. ,e study after lunch, supper, snack after supper, eating at the right revealed that 4.5% and 38.5% of adolescents have been time, and frequency of the intake of various food groups and consuming starchy roots/plantains and cereals/grains daily. products. Again, twenty questions were used to evaluate In addition, 9.7%, 26.5%, and 42.1% of them do consume adolescents’ nutritional knowledge, where each correct re- animal products, legumes/nuts/seeds, and fats/oil, respec- sponse was rated 1 point and a wrong response was rated tively, every day. Furthermore, 3.8% of them have been zero. Participants’ overall nutritional knowledge was cate- gorized using modiﬁed Bloom’s cut-oﬀ point, as high if the consuming fruits and vegetables every single day. About 30%, 28%, and 23% of the adolescents are consuming car- score was between 80 and 100% (16–20 points), moderate if the score was between 50 and 79% (10–15 points), and poor bonated drinks, pastries, and energy drinks, respectively, every day (Table 2). if the score was less than 50% (<10 points). ,erefore, sixteen or more points were classiﬁed as high knowledge, between ten and ﬁfteen points were rated as moderate 3.5. Association between Eating Habits and Demographic knowledge, and fewer than 10 points were regarded as low Characteristics. ,e results reveal signiﬁcant associations knowledge. Descriptive and inferential statistics comprising between good eating habits and the adolescent’s ethnicity frequency, percentage, chi-square, and logistic regression (p � 0.017), educational level (p � 0.014), occupation (p � were employed in analysing the data. All statistical analyses 0.016) , and whether the adolescent has had pregnancy were considered signiﬁcant at p value <0.05. before (p � 0.021) using bivariate analysis. Furthermore, when multiple logistic regression analysis was used to test confounding eﬀects, the analysis conﬁrmed associations 2.8. Ethical Issues. ,is study was reviewed and approved by between ethnicity and eating habits and indicated that ad- the Ethical Review Committee of the Ghana Health Service olescents who were Ga-Adangbes (AOR: 1.71, 95% CI: with a protocol number GHS-ERC 113/10/16. Consent and 1.23–6.17, p � 0.012) were more likely to be associated with assent were obtained from the adolescents and their good eating habits than those who were Akans, while ad- guardians. olescents who were Ewes (AOR: 0.63, 95% CI: 0.30–0.79, p � 0.023) and Northerners (AOR: 0.18, 95% CI: 0.12–0.72, 3. Results p � 0.018) were less likely to be associated with good eating habits than those who were Akans. Additionally, adolescents 3.1. Background Characteristics of Adolescents. Four hun- dred and twenty-three pregnant adolescents participated in who attained basic education (AOR: 0.31, 95% CI: 0.23–0.72, p � 0.021) and secondary education (AOR: 0.55, 95% CI: the study. ,eir ages were between 12 and 19 years, with the mean age being 16.3 years (±1.5 sd). ,e majority (71.4%) of 0.27–0.84, p � 0.014) were less likely to be associated with good eating habits than those who did not go to school. them were at the late adolescent stage (16–19 years). Four ethnic groups were involved with a comparative majority Again, adolescents involved in petty trading as their main (44.0%) being Ga-Adangbes, and 76.1% of adolescents were occupation (AOR: 3.33, 95% CI: 1.62–5.75, p � 0.011) were Christians. About 16.5% of them did not go to school, while more likely to be associated with good eating habits than 53.7% and 29.8% had basic and secondary education, re- those who were seamstress, while hairdressers (AOR: 0.39, spectively. ,e majority (45.2%) of the adolescents were 95% CI: 0.23–0.71, p � 0.019) were less likely to be asso- involved in petty trading as their main occupation. Almost ciated with good eating habits than those who were seam- stress. Additionally, adolescents who were experiencing their all (91.0%) of them were in cohabiting relationships. Ad- ditionally, 75.9% of them were having their ﬁrst pregnancy, ﬁrst pregnancy (AOR: 4.56, 95% CI: 2.33–6.67, p � 0.019) 4 Journal of Nutrition and Metabolism Table 1: Demographic characteristics of adolescents. Variable Frequency Percentage Health facility Teshie Hospital 110 26.0 23.2% LEKMA Hospital 137 32.4 LEKMA Polyclinic 176 41.6 Age group (years) 44.9% Early adolescent 12–15 121 28.6 Late adolescent 16–19 302 71.4 Ethnicity Akan 101 23.9 Ga-Adangbe 186 44.0 Ewe 54 12.8 Northerner 82 19.3 31.9% Religion Christian 322 76.1 Islam 89 21.1 Traditionalist 12 2.8 Educational level High knowledge None 70 16.5 Moderate knowledge Basic 227 53.7 Low knowledge Secondary 126 29.8 Occupation Figure 1: Nutritional knowledge of pregnant adolescents. Seamstress 121 28.6 Petty trader 191 45.2 Hairdresser 111 26.2 Marital status Legally married 38 9.0 Cohabitation 385 91.0 First pregnancy 19.4% No 102 24.1 Yes 321 75.9 Number of children (n � 102) One 97 95.1 Two 5 4.9 were more likely to be associated with good eating habits than those who were pregnant for the second or third time 80.6% (Table 3). 4. Discussion ,e majority (71.5%) of the pregnant adolescents were in their late adolescent (16–19 years) years, which corresponds Good eating habit with what was reported in the demographic and health Bad eating habit survey [28]. Although 83.5% of the adolescents went to Figure 2: Eating habits of pregnant adolescents. school, they could not go beyond the secondary level of education. ,is may be as a result of the early pregnancy, which forced them to terminate their education and can undesirably aﬀect their knowledge of health and nutritional usually legally binding. ,erefore, it aﬀects the adolescent care capabilities, thereby limiting their ability to mobilise needs. A comparative majority (44.0%) of the adolescents were Ga-Adangbes; this is not surprising because the study resource enough to ensure balance in diet. took place in a Ga-Adangbe dominated region. Other ethnic ,is study showed that only 44.9% of pregnant ado- groupings may have moved to the study area because most lescents had high knowledge of nutrition, which is less than socioeconomic activities in the country occur there. ,e the ﬁnding (61.1%) in South Africa [29]. However, the South majority of Ghanaians are either Christians or Muslims [28]. Africa study was among in-school adolescents who were not Despite the strong religious inclination of the people, a high pregnant. Again, only 48 adolescent girls were involved in proportion (91.0%) of the adolescents were not legally the South Africa study, while this study involved 423 married (cohabiting). Marriages of these kinds are not pregnant adolescents. ,is sample size and educational Journal of Nutrition and Metabolism 5 93.6 90.8 86.1 84.4 81.8 80 77 76.1 57.8 60 55.9 44.1 42.2 23.9 18.2 15.6 20 13.9 9.2 6.4 BF BFT BFS LH LHT LHS SUP SUPT SUPS Eating habit Bad Good Figure 3: Eating habits of meals in a day. BF: breakfast; BFT: breakfast time; BFS: snack after breakfast; LH: lunch; LHT: lunchtime; LHS: snack after lunch; SUP: supper; SUPT: supper time; and SUPS: snack after supper. Table 2: Consumption of various food groups and products. Food type 1-2 days 3-4 days 5-6 days Daily Starchy roots/plantain 143 (33.8%) 67 (15.8%) 194 (45.9%) 19 (4.5%) Cereals/grains 71 (16.8%) 92 (21.8%) 97 (22.9%) 163 (38.5%) Animal products 91 (21.5%) 260 (61.5%) 31 (7.3%) 41 (9.7%) Legumes/nuts/seeds 126 (29.8%) 72 (17.0%) 113 (26.7%) 112 (26.5%) Fats/oil 67 (15.8%) 63 (14.9%) 115 (27.2%) 178 (42.1%) Fruits 106 (25.1%) 281 (66.4%) 20 (4.7%) 16 (3.8%) Vegetables 115 (27.2%) 275 (65.0%) 17 (4.0%) 16 (3.8%) Soft drinks (carbonated drink) 156 (36.9%) 82 (19.4%) 58 (13.7%) 127 (30.0%) Energy drinks 120 (28.4%) 116 (27.4%) 89 (21.0%) 98 (23.2%) Pastries 84 (19.9%) 105 (24.8%) 116 (27.4%) 118 (27.9%) variations between the studies might explain the diﬀerences ,e regenerative health and nutrition program under in nutritional knowledge. ,e present study also revealed Ghana’s Ministry of Health has recommended daily and that the majority of adolescents do take breakfast daily, increased consumption of fruits and vegetables to maintain which is contrary to the results of a similar study in Ghana good health and prevent degenerative diseases especially [19]. Again, this study showed that most (93.6%) of ado- during pregnancy [33]; however, the frequency of fruits, lescents do take supper every daily, which is higher than vegetables, ﬁsh, meat, and egg intake recognised in this study what was reported (73%) in Mexico [30]. ,ough, the level of was very low, although these foods contain nutrients that are civil status of pregnant adolescents in both countries may of high biological value for pregnant women. ,is ﬁnding diﬀer and might have contributed to the diﬀerences in daily agrees with the study conducted among pregnant women in Malaysia [34]. ,e low consumption of these foods could be supper intake, as indicated in the Mexican study. However, the present study did not assess this index variable. Nev- attributed to several reasons, including foods meant for ertheless, both studies agree on the high consumption of worthy people, food taboos, beliefs, and myths, cost of three-square meals per day and lack of snack intake. ,e foodstuﬀs, and ﬁnancial constraints [35]. increased number of meals in a day could be attributed to the Educational level and age are risk factors for pregnant physiological changes that adolescents undergo during adolescents between 15 and 19 years old [36]. ,e present pregnancy [31], and the lack of snacks after meals may be study also showed that educational level was signiﬁcantly due to ﬁnancial constraints. Again, this study showed that associated with good eating habits and is consistent with the the majority of pregnant adolescents do not take fruits and results of a study carried out among in-school adolescents in vegetables daily, which was similar to the ﬁndings of the Belgium [37]. However, the present study involves pregnant studies conducted elsewhere [19, 32]. ,e inadequate intake adolescents and indicated that those who have been to school before were less likely to have good eating habits than of fruits and vegetables may be due to the lack of or low knowledge of their beneﬁts or lack of ﬁnancial means to buy those who have never been to school, while the Belgium fruits and vegetables. study involved in-school adolescents and showed that those Percentage (%) 6 Journal of Nutrition and Metabolism Table 3: Association between respondents eating habits and demographic characteristics. COR (95% CI) Variable Bad eating habit n � 341 (%) Good eating habit n � 82 (%) AOR (95% CI) p value ∗∗ p value Health facility Teshie Community 87 (79.1) 23 (20.9) — — LEKMA Hospital 110 (80.3) 27 (19.7) 0.92 (0.39–2.18) 0.088 — LEKMA Polyclinic 144 (78.7) 32 (21.3) 1.81 (0.35–1.87) — Age group (years) 12–15 98 (81.0) 23 (19.0) — — 0.198 16–19 243 (80.5) 59 (19.5) 1.64 (0.39–2.78) — Ethnicity Akan 78 (77.2) 23 (22.8) — — Ga-Adangbe 143 (76.9) 43 (23.1) 1.65 (1.20–6.05) 1.71 (1.23–6.17) 0.012 0.017 Ewe 43 (79.6) 11 (20.4) 0.62 (0.32–0.81) 0.63 (0.32–0.79) 0.023 Northerner 77 (93.9) 5 (6.1) 0.54 (0.20–0.87) 0.18 (0.12–0.72) 0.018 Religion Christian 251 (78.0) 71 (22.0) — — Muslim 81 (91.0) 8 (9.0) 0.61 (0.55–3.25) 0.096 — Traditionalist 9 (75.0) 3 (25.0) 2.02 (0.63–2.67) — Educational level No 37 (52.9) 33 (47.1) — — Basic 202 (89.0) 25 (11.0) 0.29 (0.21–0.66) 0.014 0.31 (0.23–0.72) 0.021 Secondary 102 (81.0) 24 (19.0) 0.47 (0.32–0.89) 0.55 (0.27–0.84) 0.014 Occupation Seamstress 98 (81.0) 23 (19.0) — — Petty trading 139 (72.8) 52 (27.2) 2.77 (1.21–5.95) 0.016 3.33 (1.62–5.75) 0.011 Hairdresser 104 (93.7) 7 (6.3) 0.26 (0.14–0.63) 0.39 (0.23–0.71) 0.019 Marital status Legally married 30 (78.9) 8 (21.1) — — 0.063 Cohabitation 311 (80.2) 74 (19.2) 0.31 (0.21–2.32) — First pregnancy? No 93 (91.2) 9 (8.8) — — 0.021 Yes 248 (77.3) 73 (22.7) 4.21 (2.21–6.96) 4.56 (2.33–6.67) 0.019 Nutritional knowledge High 144 (75.8) 46 (24.2) — — Moderate 110 (81.5) 25 (18.5) 0.54 (0.06–1.71) 0.078 — Low 87 (88.8) 11 (11.2) 0.49 (0.03–1.98) — ∗∗ p value is p value for the whole model. unemployed women were two times more likely to be with lower educational level have less healthy food habits than those with a higher level of education. Meanwhile, malnourished than employed women and women from education within a speciﬁc environment such as schools and Terai ethnic background were ﬁve times more likely to be health facilities can be a valuable strategy to inﬂuence health malnourished than women in Mountain regions [42]. and nutrition. School is an eﬀective and eﬃcient means to Studies in the Korea Republic and Israel revealed that high- reach young people and provide their needs and interest class professionals and lower socioeconomic status had a [38–40]. However, nutrition education is not in the curricula high frequency of good eating habits and low diet quality, of some grades and subject areas. Meanwhile, complete respectively [43, 44]. It could be that the more people earn, curricula incorporation can signiﬁcantly increase students’ the more they have ﬁnancial means to aﬀord healthy diets. A study also revealed that ethnic diﬀerences in determinants knowledge of nutrition-related diseases, the nutrient value of foods, and fresh vegetable preference, with a decrease in soda for nutrition exist, which showed that adolescent culture is the dominant inﬂuence for this age group. Hence, modiﬁ- drinks [41]. Yet, the present study showed that adolescents who did not go to school are more likely to be associated cations in constructs and types of foods are necessary for with good eating habits than those who attended school; most adolescent nutrition education programs [45]. hence, there is a need for further studies to ascertain con- Although pregnant women receive nutrition education tributory factors. during antenatal visits, this study showed that those expe- Furthermore, in the present study, it was revealed that riencing their ﬁrst pregnancy were more likely to have good occupation and ethnicity were major factors inﬂuencing eating habits than those who have been pregnant before. pregnant adolescents’ eating habits. ,is revelation agrees Notwithstanding, a study reported that pregnant women with a similar study in Nepal, which reported that were provided with little nutrition-related information in Journal of Nutrition and Metabolism 7 antenatal care and was perceived as presented in very general COR: Crude odds ratio terms and focused on only food safety [46, 47]. Meanwhile, AOR: Adjusted odds ratio the midwife/clinician is a dependable source of nutrition- BF: Breakfast related information, yet limited nutrition knowledge and a BFT: Breakfast time lack of nutrition training impacted the capacity to provide BFS: Snack after breakfast adequate nutrition education [47]. Nevertheless, nutrition LH: Lunch communication in antenatal care should be more focused on LHT: Lunchtime women’s dietary habits and nutritional knowledge [46]. LHS: Snack after lunch SUP: Supper SUPT: Supper time 4.1. Study Limitation. ,e study could not assess the nu- SUPS: Snack after super. tritional status of pregnant adolescents to compare with the nutritional knowledge and eating habits to determine the Data Availability eﬀect on the nutritional outcomes. Notwithstanding, we believe that the limitation cannot invalidate the ﬁndings of ,e data used to support the ﬁndings of this study can be the study. made available from the corresponding author upon request. 5. Conclusion Conflicts of Interest ,e eating habits among pregnant adolescents represent an ,e authors declare that they have no conﬂicts of interest important public health issue because of the long-term ef- regarding the study and the publication of this paper. fects on the health of the mother and child. However, eating habits among adolescent pregnant women in the Ledzo- Authors’ Contributions kuku-Krowor municipality were not encouraging, with only 19.4% of the adolescents having good eating habits despite PKA and RNKA had extensive contributions to the con- many health facilities in the municipality rendering nutri- ception and acquisition of data of this research. PKA, RNKA, tion education to the people. ,e daily intake of fruits and DAB, GAF, and FWY had considerable contributions to the vegetables and other nutrients by pregnant adolescents was design, data analysis, and interpretation of the ﬁndings. All not the best. All concerned stakeholders must come together authors critically revised the paper for important intellectual and adopt diﬀerent approaches to reduce adolescent preg- content. All authors read and approved the ﬁnal manuscript. nancies and to improve the eating habits of pregnant adolescents. Acknowledgments ,e authors thank the Ledzokuku-Krowor Municipal Di- 5.1. Recommendations. ,e municipal health authority rector of Health for granting them permission to carry out should intensify public awareness and education on nutri- the study and to all heads of antenatal clinics within the tion, especially adolescent nutrition. municipality where the study was conducted. ,e Ministry of Health and Ghana Health Service should give critical attention to adolescent nutrition as being given References to adolescent reproductive health and other health-related interventions. [1] S. M. Sawyer, R. A. Aﬁﬁ, L. H. 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Publisher: Hindawi Publishing Corporation
Copyright: Copyright © 2021 Prince Kubi Appiah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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DOI: 10.1155/2021/8835704
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Abstract

Hindawi Journal of Nutrition and Metabolism Volume 2021, Article ID 8835704, 9 pages https://doi.org/10.1155/2021/8835704 Research Article Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana 1,2 1 3 Prince Kubi Appiah , Anang Rhoda Naa Korklu, Duut Abdulai Bonchel, 4 5 Georgina Agartha Fenu, and Francis Wadga-Mieza Yankey Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana Department of Medical Law and Ethics, Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea Centre for Migration Studies, University of Ghana, Legon, Accra, Ghana Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana Academic Aﬀairs Directorate, University of Health and Allied Sciences, Ho, Ghana Correspondence should be addressed to Prince Kubi Appiah; appiahkubiprince23@yahoo.com Received 17 August 2020; Revised 2 February 2021; Accepted 4 February 2021; Published 13 February 2021 Academic Editor: Mar´ıa Ximena Silveyra Copyright © 2021 Prince Kubi Appiah et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Proper nutrition during pregnancy is important for the wellbeing of the mother and foetus and supports health during pregnancy, delivery, and breastfeeding. However, there are little data on nutritional knowledge and dietary intake among adolescents who are pregnant in Ghana. Hence, the study assessed the nutritional knowledge and eating habits of this vulnerable group in the Ledzokuku-Krowor Municipality, Ghana. Methods. ,e study was cross-sectional and employed a multistage sampling technique to select 423 participants. ,e study was conducted between October and November 2019. A statistical software was used to analyse data and employed Pearson’s chi-square and logistics regression to assess associations between the outcome and predictor variables. A p value<0.05 at a 95% conﬁdence interval was considered statistically signiﬁcant. Results. Less than half (44.9%) of the pregnant adolescents have high nutritional knowledge. About 19.4% of them have good eating habits, while 23.9%, 18.2%, and 6.4% of them do not take breakfast, lunch, and supper, respectively. However, 15.6%, 13.9%, and 9.2% do take snacks after breakfast, lunch, and supper, respectively. About 55.9%, 59.8%, and 23.0% do not take their breakfast, lunch, and supper on time, respectively. Additionally, only 3.8% of them do take fruits and vegetables daily, while 9.7%, 23.2%, 30.0%, and 26.5% of them do take animal products, energy drinks, carbonated drinks, and legumes/nuts/seeds daily, respectively. ,e study showed that educational level (p � 0.014), occupation (p � 0.016), ethnicity (p � 0.017), and number of pregnancies (p � 0.021) were associated with good eating habits. Conclusion. Eating habit of adolescent pregnant women was not encouraging. ,erefore, the municipal health authority with the concerned stakeholders should intensify eﬀorts, including nutritional education to improve good eating habits, such as taking snacks in between meals, eating on time, and balance diet among pregnant adolescents, and to reduce adolescent pregnancy in the municipality. pregnancy is necessary for maternal health during preg- 1. Introduction nancy, delivery, and breastfeeding [2] and inﬂuences the Adolescent pregnancy is a key public health obstacle in the growth and development of the foetus [3]. Hence, an ade- world and has been linked with substantial medical, nu- quate amount of nutrients is needed to support foetal growth tritional, social, and economic risks for individuals, the and development, along with the alterations in maternal child, family, and communities [1]. Proper nutrition during tissues and metabolism [4]. ,ough nutrients requirement 2 Journal of Nutrition and Metabolism increases during pregnancy [5], it is known that intake of It has an estimated population of 363,753. Ga-Adangbe is the essential nutrients among adolescents is below what is main ethnic group in the area, with Christianity being the recommended [6], with notable deﬁciencies of iron leading main religion of the people. ,ere are three public hospitals to cognitive and behavioural problems in childhood, zinc providing antenatal services in the area. More than half likely to limit foetal growth, vitamin A leading to impair (71.0%) of the people in the municipality are economically resistance to infection, and calcium associated with pre- active, while 3.3% of the households in the area are engaged eclampsia and intrauterine growth restriction [7]. Mean- in agricultural production [24]. while, adolescence is a life stage where there is rapid growth and development with a signiﬁcant increase in nutritional 2.2. Study Population. ,e study involved pregnant ado- requirements, and the additional nutrient demands of lescents (10–19 years) receiving antenatal care in the mu- pregnancy subject these adolescents to greater health risks nicipality and who have lived in the area for three or more [8]. Again, poor pregnancy outcomes, including low birth months. However, data was collected from only those who weight and anaemia are frequently seen among adolescents agreed to be part of the study, and they and their guardians than adult women [8, 9]. A study has also shown that in- signed informed consent and assent forms. creased trends of susceptibility among adolescents is asso- ciated with economic and social factors [10]. Adolescents have food preferences and poor eating 2.3. Study Design. ,e study was cross-sectional and we used behaviours, and for them, to make changes in their eating face-to-face interview technique to collect quantitative data habits, they must believe that changes are possible within the on nutritional knowledge and eating habits from pregnant context of their lifestyle and environment [11, 12]. Fur- adolescents in the municipality between October and No- thermore, adolescents who are pregnant may not have a vember 2019. stable food supply, food preparation skills, and facilities [13]. ,erefore, appreciating issues that limit healthy eating along with challenges for nutrition education among pregnant 2.4. Sample Size. Four hundred and twenty-three partici- pants involved in the study were determined using the adolescents are key when scheming and executing nutrition education interventions [14]. formula established by Cochran and colleague for pop- Nutritional education is aimed at transferring ample ulation-based cross-sectional studies [25]: knowledge of healthy diet even though adequate knowledge z × p(q) may not be necessarily linked to practical dietary behaviour (1) n � , [15]. A study in Nigeria reported that 80.2% of adolescent girls had a poor level of nutritional knowledge towards reducing where n is the sample size to be determined, z is the z-score malnutrition [16]. Contrary to the study in Coˆte d’lvoire, the of 1.96 at 95% conﬁdence level, p is the estimated proportion majority of the adolescents had good nutritional knowledge of an attribute that was present in the population (50% as the on nutritional health, a balanced diet, and hygiene [17]. In exact rate of good eating habits among pregnant adolescents addition, studies have revealed that the dietary intake of is not known), d is the desired level of accuracy 5%, and q is adolescents was mostly plant-based food sources and high- 1 − p. Considering a 10% nonresponse rate among ado- energy snacks and beverages, with limited intake of fruits and lescents, the sample size was 423, to ensure the prevalence of vegetables and skipping of breakfast [18, 19]. Nutritional the outcome variable falls within ±5% of the actual pop- knowledge and dietary intake of this group could inﬂuence ulation coverage. their nutritional status. For instance, studies carried out in Nigeria among female adolescents indicated that 23.4% and 9.4% of them were underweight and overweight/obese in 2.5. Sampling Method. Multistage sampling technique was 2014, respectively [20]; however, this trend changed to 38.2% applied to select the study participants. First, a total pop- underweight and 5.5% overweight/obese [21]. Additionally, a ulation purposive sampling was employed to select antenatal study in Ghana revealed that 7.1% and 54.5% of female ad- clinics in the three hospitals in the metropolis because they olescents were underweight and overweight/obese, respec- are government-owned facilities where pregnant women tively [22]. ,ese studies identiﬁed nutritional deﬁciencies receive free antenatal care; hence, it is likely that more and knowledge gap among adolescents, however, not among adolescent pregnant women will go there for services. pregnant adolescents. Again, pregnant adolescents are nor- Second, the total number of pregnant adolescents who have mally not included in national surveys, and their nutritional registered for antenatal care was taken and proportionately status around the world is limited [23]. Hence, this study allocated the sample size to the facilities. To select the ad- investigated the nutritional knowledge and eating habits of olescents from the selected antenatal care clinics, the list of pregnant adolescents in the Ledzokuku-Krowor Municipal in adolescents was sorted out from the antenatal care register, the Greater Accra Region of Ghana. and we attached unique numbers to the names of the ad- olescents and wrote the numbers on a piece of paper, folded the papers, and placed them in a box. A neutral person was 2. Materials and Methods invited to pick a folded paper from the box, and the number 2.1. Study Site. Ledzokuku-Krowor municipality is one of written on the paper was traced to the attached name and the ten Municipalities in the Greater Accra Region of Ghana. repeated the process until we got the adolescents required. Journal of Nutrition and Metabolism 3 2.6. Data Collection Tools and Procedure. Adolescent food and a comparative majority (41.6%) were receiving antenatal habits checklist adapted from Johnson et al. [26] and a 24- care from LEKMA Polyclinic (Table 1). hour dietary recall and food frequency questionnaire of the Food and Agricultural Organization of the United Nations 3.2. Nutritional Knowledge of Pregnant Adolescents. ,e [27] were used to collect food intake data, using a face-to- results showed that 44.9% of the adolescents had high nu- face interview procedure. We also used a set of questions to tritional knowledge, while 31.9% and 23.2% had moderate assess nutritional knowledge on dietary recommendations, and low nutritional knowledge, respectively (Figure 1). source of nutrients, choosing everyday foods, and diet- disease relationships. We used the adolescents’ contact in- formation at the antenatal care clinics to track them to their 3.3. Eating Habits of the Pregnant Adolescents. ,e study houses for data collection. Research assistance was trained showed that 19.3% of pregnant adolescents had good eating on the tools before data collection. habits (Figure 2). ,e majority (76.1%, 81.8%, and 93.6%) of the adolescents do take breakfast, lunch, and supper/dinner daily; however, 55.9%, 57.8%, and 23.0% of them do not take 2.7. Data Processing and Analysis. ,e STATA 12.1 version their breakfast, lunch, and supper/dinner time, respectively. software was used for data analysis. Participants who had a Furthermore, 84.4%, 86.1%, and 90.8% of the adolescents do healthy response to all questions were classiﬁed as having a not take snacks after breakfast, lunch, and supper/dinner, good eating habit. We further analysed and presented some respectively (Figure 3). details about eating habits of the adolescents as to whether they were eaten breakfast, snack after breakfast, lunch, snack 3.4. Consumption of Food Groups and Products. ,e study after lunch, supper, snack after supper, eating at the right revealed that 4.5% and 38.5% of adolescents have been time, and frequency of the intake of various food groups and consuming starchy roots/plantains and cereals/grains daily. products. Again, twenty questions were used to evaluate In addition, 9.7%, 26.5%, and 42.1% of them do consume adolescents’ nutritional knowledge, where each correct re- animal products, legumes/nuts/seeds, and fats/oil, respec- sponse was rated 1 point and a wrong response was rated tively, every day. Furthermore, 3.8% of them have been zero. Participants’ overall nutritional knowledge was cate- gorized using modiﬁed Bloom’s cut-oﬀ point, as high if the consuming fruits and vegetables every single day. About 30%, 28%, and 23% of the adolescents are consuming car- score was between 80 and 100% (16–20 points), moderate if the score was between 50 and 79% (10–15 points), and poor bonated drinks, pastries, and energy drinks, respectively, every day (Table 2). if the score was less than 50% (<10 points). ,erefore, sixteen or more points were classiﬁed as high knowledge, between ten and ﬁfteen points were rated as moderate 3.5. Association between Eating Habits and Demographic knowledge, and fewer than 10 points were regarded as low Characteristics. ,e results reveal signiﬁcant associations knowledge. Descriptive and inferential statistics comprising between good eating habits and the adolescent’s ethnicity frequency, percentage, chi-square, and logistic regression (p � 0.017), educational level (p � 0.014), occupation (p � were employed in analysing the data. All statistical analyses 0.016) , and whether the adolescent has had pregnancy were considered signiﬁcant at p value <0.05. before (p � 0.021) using bivariate analysis. Furthermore, when multiple logistic regression analysis was used to test confounding eﬀects, the analysis conﬁrmed associations 2.8. Ethical Issues. ,is study was reviewed and approved by between ethnicity and eating habits and indicated that ad- the Ethical Review Committee of the Ghana Health Service olescents who were Ga-Adangbes (AOR: 1.71, 95% CI: with a protocol number GHS-ERC 113/10/16. Consent and 1.23–6.17, p � 0.012) were more likely to be associated with assent were obtained from the adolescents and their good eating habits than those who were Akans, while ad- guardians. olescents who were Ewes (AOR: 0.63, 95% CI: 0.30–0.79, p � 0.023) and Northerners (AOR: 0.18, 95% CI: 0.12–0.72, 3. Results p � 0.018) were less likely to be associated with good eating habits than those who were Akans. Additionally, adolescents 3.1. Background Characteristics of Adolescents. Four hun- dred and twenty-three pregnant adolescents participated in who attained basic education (AOR: 0.31, 95% CI: 0.23–0.72, p � 0.021) and secondary education (AOR: 0.55, 95% CI: the study. ,eir ages were between 12 and 19 years, with the mean age being 16.3 years (±1.5 sd). ,e majority (71.4%) of 0.27–0.84, p � 0.014) were less likely to be associated with good eating habits than those who did not go to school. them were at the late adolescent stage (16–19 years). Four ethnic groups were involved with a comparative majority Again, adolescents involved in petty trading as their main (44.0%) being Ga-Adangbes, and 76.1% of adolescents were occupation (AOR: 3.33, 95% CI: 1.62–5.75, p � 0.011) were Christians. About 16.5% of them did not go to school, while more likely to be associated with good eating habits than 53.7% and 29.8% had basic and secondary education, re- those who were seamstress, while hairdressers (AOR: 0.39, spectively. ,e majority (45.2%) of the adolescents were 95% CI: 0.23–0.71, p � 0.019) were less likely to be asso- involved in petty trading as their main occupation. Almost ciated with good eating habits than those who were seam- stress. Additionally, adolescents who were experiencing their all (91.0%) of them were in cohabiting relationships. Ad- ditionally, 75.9% of them were having their ﬁrst pregnancy, ﬁrst pregnancy (AOR: 4.56, 95% CI: 2.33–6.67, p � 0.019) 4 Journal of Nutrition and Metabolism Table 1: Demographic characteristics of adolescents. Variable Frequency Percentage Health facility Teshie Hospital 110 26.0 23.2% LEKMA Hospital 137 32.4 LEKMA Polyclinic 176 41.6 Age group (years) 44.9% Early adolescent 12–15 121 28.6 Late adolescent 16–19 302 71.4 Ethnicity Akan 101 23.9 Ga-Adangbe 186 44.0 Ewe 54 12.8 Northerner 82 19.3 31.9% Religion Christian 322 76.1 Islam 89 21.1 Traditionalist 12 2.8 Educational level High knowledge None 70 16.5 Moderate knowledge Basic 227 53.7 Low knowledge Secondary 126 29.8 Occupation Figure 1: Nutritional knowledge of pregnant adolescents. Seamstress 121 28.6 Petty trader 191 45.2 Hairdresser 111 26.2 Marital status Legally married 38 9.0 Cohabitation 385 91.0 First pregnancy 19.4% No 102 24.1 Yes 321 75.9 Number of children (n � 102) One 97 95.1 Two 5 4.9 were more likely to be associated with good eating habits than those who were pregnant for the second or third time 80.6% (Table 3). 4. Discussion ,e majority (71.5%) of the pregnant adolescents were in their late adolescent (16–19 years) years, which corresponds Good eating habit with what was reported in the demographic and health Bad eating habit survey [28]. Although 83.5% of the adolescents went to Figure 2: Eating habits of pregnant adolescents. school, they could not go beyond the secondary level of education. ,is may be as a result of the early pregnancy, which forced them to terminate their education and can undesirably aﬀect their knowledge of health and nutritional usually legally binding. ,erefore, it aﬀects the adolescent care capabilities, thereby limiting their ability to mobilise needs. A comparative majority (44.0%) of the adolescents were Ga-Adangbes; this is not surprising because the study resource enough to ensure balance in diet. took place in a Ga-Adangbe dominated region. Other ethnic ,is study showed that only 44.9% of pregnant ado- groupings may have moved to the study area because most lescents had high knowledge of nutrition, which is less than socioeconomic activities in the country occur there. ,e the ﬁnding (61.1%) in South Africa [29]. However, the South majority of Ghanaians are either Christians or Muslims [28]. Africa study was among in-school adolescents who were not Despite the strong religious inclination of the people, a high pregnant. Again, only 48 adolescent girls were involved in proportion (91.0%) of the adolescents were not legally the South Africa study, while this study involved 423 married (cohabiting). Marriages of these kinds are not pregnant adolescents. ,is sample size and educational Journal of Nutrition and Metabolism 5 93.6 90.8 86.1 84.4 81.8 80 77 76.1 57.8 60 55.9 44.1 42.2 23.9 18.2 15.6 20 13.9 9.2 6.4 BF BFT BFS LH LHT LHS SUP SUPT SUPS Eating habit Bad Good Figure 3: Eating habits of meals in a day. BF: breakfast; BFT: breakfast time; BFS: snack after breakfast; LH: lunch; LHT: lunchtime; LHS: snack after lunch; SUP: supper; SUPT: supper time; and SUPS: snack after supper. Table 2: Consumption of various food groups and products. Food type 1-2 days 3-4 days 5-6 days Daily Starchy roots/plantain 143 (33.8%) 67 (15.8%) 194 (45.9%) 19 (4.5%) Cereals/grains 71 (16.8%) 92 (21.8%) 97 (22.9%) 163 (38.5%) Animal products 91 (21.5%) 260 (61.5%) 31 (7.3%) 41 (9.7%) Legumes/nuts/seeds 126 (29.8%) 72 (17.0%) 113 (26.7%) 112 (26.5%) Fats/oil 67 (15.8%) 63 (14.9%) 115 (27.2%) 178 (42.1%) Fruits 106 (25.1%) 281 (66.4%) 20 (4.7%) 16 (3.8%) Vegetables 115 (27.2%) 275 (65.0%) 17 (4.0%) 16 (3.8%) Soft drinks (carbonated drink) 156 (36.9%) 82 (19.4%) 58 (13.7%) 127 (30.0%) Energy drinks 120 (28.4%) 116 (27.4%) 89 (21.0%) 98 (23.2%) Pastries 84 (19.9%) 105 (24.8%) 116 (27.4%) 118 (27.9%) variations between the studies might explain the diﬀerences ,e regenerative health and nutrition program under in nutritional knowledge. ,e present study also revealed Ghana’s Ministry of Health has recommended daily and that the majority of adolescents do take breakfast daily, increased consumption of fruits and vegetables to maintain which is contrary to the results of a similar study in Ghana good health and prevent degenerative diseases especially [19]. Again, this study showed that most (93.6%) of ado- during pregnancy [33]; however, the frequency of fruits, lescents do take supper every daily, which is higher than vegetables, ﬁsh, meat, and egg intake recognised in this study what was reported (73%) in Mexico [30]. ,ough, the level of was very low, although these foods contain nutrients that are civil status of pregnant adolescents in both countries may of high biological value for pregnant women. ,is ﬁnding diﬀer and might have contributed to the diﬀerences in daily agrees with the study conducted among pregnant women in Malaysia [34]. ,e low consumption of these foods could be supper intake, as indicated in the Mexican study. However, the present study did not assess this index variable. Nev- attributed to several reasons, including foods meant for ertheless, both studies agree on the high consumption of worthy people, food taboos, beliefs, and myths, cost of three-square meals per day and lack of snack intake. ,e foodstuﬀs, and ﬁnancial constraints [35]. increased number of meals in a day could be attributed to the Educational level and age are risk factors for pregnant physiological changes that adolescents undergo during adolescents between 15 and 19 years old [36]. ,e present pregnancy [31], and the lack of snacks after meals may be study also showed that educational level was signiﬁcantly due to ﬁnancial constraints. Again, this study showed that associated with good eating habits and is consistent with the the majority of pregnant adolescents do not take fruits and results of a study carried out among in-school adolescents in vegetables daily, which was similar to the ﬁndings of the Belgium [37]. However, the present study involves pregnant studies conducted elsewhere [19, 32]. ,e inadequate intake adolescents and indicated that those who have been to school before were less likely to have good eating habits than of fruits and vegetables may be due to the lack of or low knowledge of their beneﬁts or lack of ﬁnancial means to buy those who have never been to school, while the Belgium fruits and vegetables. study involved in-school adolescents and showed that those Percentage (%) 6 Journal of Nutrition and Metabolism Table 3: Association between respondents eating habits and demographic characteristics. COR (95% CI) Variable Bad eating habit n � 341 (%) Good eating habit n � 82 (%) AOR (95% CI) p value ∗∗ p value Health facility Teshie Community 87 (79.1) 23 (20.9) — — LEKMA Hospital 110 (80.3) 27 (19.7) 0.92 (0.39–2.18) 0.088 — LEKMA Polyclinic 144 (78.7) 32 (21.3) 1.81 (0.35–1.87) — Age group (years) 12–15 98 (81.0) 23 (19.0) — — 0.198 16–19 243 (80.5) 59 (19.5) 1.64 (0.39–2.78) — Ethnicity Akan 78 (77.2) 23 (22.8) — — Ga-Adangbe 143 (76.9) 43 (23.1) 1.65 (1.20–6.05) 1.71 (1.23–6.17) 0.012 0.017 Ewe 43 (79.6) 11 (20.4) 0.62 (0.32–0.81) 0.63 (0.32–0.79) 0.023 Northerner 77 (93.9) 5 (6.1) 0.54 (0.20–0.87) 0.18 (0.12–0.72) 0.018 Religion Christian 251 (78.0) 71 (22.0) — — Muslim 81 (91.0) 8 (9.0) 0.61 (0.55–3.25) 0.096 — Traditionalist 9 (75.0) 3 (25.0) 2.02 (0.63–2.67) — Educational level No 37 (52.9) 33 (47.1) — — Basic 202 (89.0) 25 (11.0) 0.29 (0.21–0.66) 0.014 0.31 (0.23–0.72) 0.021 Secondary 102 (81.0) 24 (19.0) 0.47 (0.32–0.89) 0.55 (0.27–0.84) 0.014 Occupation Seamstress 98 (81.0) 23 (19.0) — — Petty trading 139 (72.8) 52 (27.2) 2.77 (1.21–5.95) 0.016 3.33 (1.62–5.75) 0.011 Hairdresser 104 (93.7) 7 (6.3) 0.26 (0.14–0.63) 0.39 (0.23–0.71) 0.019 Marital status Legally married 30 (78.9) 8 (21.1) — — 0.063 Cohabitation 311 (80.2) 74 (19.2) 0.31 (0.21–2.32) — First pregnancy? No 93 (91.2) 9 (8.8) — — 0.021 Yes 248 (77.3) 73 (22.7) 4.21 (2.21–6.96) 4.56 (2.33–6.67) 0.019 Nutritional knowledge High 144 (75.8) 46 (24.2) — — Moderate 110 (81.5) 25 (18.5) 0.54 (0.06–1.71) 0.078 — Low 87 (88.8) 11 (11.2) 0.49 (0.03–1.98) — ∗∗ p value is p value for the whole model. unemployed women were two times more likely to be with lower educational level have less healthy food habits than those with a higher level of education. Meanwhile, malnourished than employed women and women from education within a speciﬁc environment such as schools and Terai ethnic background were ﬁve times more likely to be health facilities can be a valuable strategy to inﬂuence health malnourished than women in Mountain regions [42]. and nutrition. School is an eﬀective and eﬃcient means to Studies in the Korea Republic and Israel revealed that high- reach young people and provide their needs and interest class professionals and lower socioeconomic status had a [38–40]. However, nutrition education is not in the curricula high frequency of good eating habits and low diet quality, of some grades and subject areas. Meanwhile, complete respectively [43, 44]. It could be that the more people earn, curricula incorporation can signiﬁcantly increase students’ the more they have ﬁnancial means to aﬀord healthy diets. A study also revealed that ethnic diﬀerences in determinants knowledge of nutrition-related diseases, the nutrient value of foods, and fresh vegetable preference, with a decrease in soda for nutrition exist, which showed that adolescent culture is the dominant inﬂuence for this age group. Hence, modiﬁ- drinks [41]. Yet, the present study showed that adolescents who did not go to school are more likely to be associated cations in constructs and types of foods are necessary for with good eating habits than those who attended school; most adolescent nutrition education programs [45]. hence, there is a need for further studies to ascertain con- Although pregnant women receive nutrition education tributory factors. during antenatal visits, this study showed that those expe- Furthermore, in the present study, it was revealed that riencing their ﬁrst pregnancy were more likely to have good occupation and ethnicity were major factors inﬂuencing eating habits than those who have been pregnant before. pregnant adolescents’ eating habits. ,is revelation agrees Notwithstanding, a study reported that pregnant women with a similar study in Nepal, which reported that were provided with little nutrition-related information in Journal of Nutrition and Metabolism 7 antenatal care and was perceived as presented in very general COR: Crude odds ratio terms and focused on only food safety [46, 47]. Meanwhile, AOR: Adjusted odds ratio the midwife/clinician is a dependable source of nutrition- BF: Breakfast related information, yet limited nutrition knowledge and a BFT: Breakfast time lack of nutrition training impacted the capacity to provide BFS: Snack after breakfast adequate nutrition education [47]. Nevertheless, nutrition LH: Lunch communication in antenatal care should be more focused on LHT: Lunchtime women’s dietary habits and nutritional knowledge [46]. LHS: Snack after lunch SUP: Supper SUPT: Supper time 4.1. Study Limitation. ,e study could not assess the nu- SUPS: Snack after super. tritional status of pregnant adolescents to compare with the nutritional knowledge and eating habits to determine the Data Availability eﬀect on the nutritional outcomes. Notwithstanding, we believe that the limitation cannot invalidate the ﬁndings of ,e data used to support the ﬁndings of this study can be the study. made available from the corresponding author upon request. 5. Conclusion Conflicts of Interest ,e eating habits among pregnant adolescents represent an ,e authors declare that they have no conﬂicts of interest important public health issue because of the long-term ef- regarding the study and the publication of this paper. fects on the health of the mother and child. However, eating habits among adolescent pregnant women in the Ledzo- Authors’ Contributions kuku-Krowor municipality were not encouraging, with only 19.4% of the adolescents having good eating habits despite PKA and RNKA had extensive contributions to the con- many health facilities in the municipality rendering nutri- ception and acquisition of data of this research. PKA, RNKA, tion education to the people. ,e daily intake of fruits and DAB, GAF, and FWY had considerable contributions to the vegetables and other nutrients by pregnant adolescents was design, data analysis, and interpretation of the ﬁndings. All not the best. All concerned stakeholders must come together authors critically revised the paper for important intellectual and adopt diﬀerent approaches to reduce adolescent preg- content. All authors read and approved the ﬁnal manuscript. nancies and to improve the eating habits of pregnant adolescents. Acknowledgments ,e authors thank the Ledzokuku-Krowor Municipal Di- 5.1. Recommendations. ,e municipal health authority rector of Health for granting them permission to carry out should intensify public awareness and education on nutri- the study and to all heads of antenatal clinics within the tion, especially adolescent nutrition. municipality where the study was conducted. ,e Ministry of Health and Ghana Health Service should give critical attention to adolescent nutrition as being given References to adolescent reproductive health and other health-related interventions. [1] S. M. Sawyer, R. A. Aﬁﬁ, L. H. 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Journal

Journal of Nutrition and Metabolism – Hindawi Publishing Corporation

Published: Feb 13, 2021

References

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S. M. Sawyer, R. A. Afifi, L. H. Bearinger et al.
Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus,

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G. Wu, B. Imhoff-Kunsch, and A. W. Girard
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S. A. Ibrahim, O. A. F. A. Al-Halim, M. A. Samy, and A. M. Mohamadin
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I. Castro-Quezada, B. Román-Viñas, and L. Serra-Majem
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N. Hovdenak and K. Haram
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Y. Belete, B. Negga, and M. Firehiwot
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P. Chantrapanichkul and S. Chawanpaiboon
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M. S. Kearney and P. B. Levine
Pickles and ice cream! food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research,

N. C. Orloff and J. M. Hormes
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A. B. B. Feeley
Pregnant adolescents, beliefs about healthy eating, factors that influence food choices, and nutrition education preferences,

N. J. Wise
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D. Gracey, N. Stanley, V. Burke, B. Corti, and L. J. Beilin
Knowledge, attitude, and practice of adolescent girls towards reducing malnutrition in Maiduguri metropolitan council, Borno State, Nigeria: cross-sectional study,

R. Charles Shapu, S. Ismail, N. Ahmad, L. P. Ying, and I. Abubakar Njodi
Adolescent nutrition and physical activity in low-income suburbs of Abidjan, Côte d’lvoire: the gap between knowledge, aspirations and possibilities,

J. Jesson, E. K. Kouakou, P. Hardy-Johnson et al.
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S. Ochola and P. K. Masibo
Socio-economic differences in adolescents’ breakfast eating, fruit and vegetable consumption and physical activity in Ghana,

D. Doku, L. Koivusilta, S. Raisamo, and A. Rimpelä
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O. Omobuwa, C. Alebiosu, F. Olajide, and W. Adebimpe
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B. A. Kola-Raji, M. R. Balogun, and T. O. Odugbemi
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J. da Mota Santana, V. A. de Oliveira Queiroz, S. M. Brito, D. B. dos Santos, and A. M. O. Assis
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J. Amo-Adjei and A. Kumi-Kyereme
Relationship between nutritional knowledge and healthy attitude and practice during pregnancy,

M. Mirsanjari, W. Muda, W. Manan et al.
Food taboos among residents at Ashongman-Accra, Ghana,

C. Gadegbeku, R. Wayo, G. Ackah-Badu, E. Nukpe, and A. Okai
Correlates of pregnancy before age 15 compared with pregnancy between the ages of 15 and 19 in the United States,

M. Smid, S. Martins, A. K. Whitaker, and M. Gilliam
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C. Vereecken, L. Maes, and D. Debacquer
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C. Perez-Rodrigo and J. Aranceta
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O. Amahmid, Y. El Guamri, Y. Rakibi et al.
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S. Bhandari, J. T. Sayami, P. Thapa, M. Sayami, B. P. Kandel, and M. R. Banjara
A study on eating habits of businessmen in urban areas,

Y. J. Shin and G. S. Park
Diet and eating habits in high and low socioeconomic groups,

D. Shahar, I. Shai, H. Vardi, A. Shahar, and D. Fraser
Designing effective nutrition interventions for adolescents,

D. M. Hoelscher, A. Evans, G. Parcel, and S. Kelder
Experiences with nutrition-related information during antenatal care of pregnant women of different ethnic backgrounds residing in the area of Oslo, Norway,

L. M. Garnweidner, K. S. Pettersen, and A. Mosdøl
Pregnancy nutrition knowledge and experiences of pregnant women and antenatal care clinicians: a mixed methods approach,

A. Lee, M. Newton, J. Radcliffe, and R. Belski

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Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

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Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

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