Heliyon 8 (2022) e09380

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Research article

Undernutrition and its associated factors among pregnant women at the

public hospitals of Bench-Sheko and Kaffa zone, southwest Ethiopia
Abel Girma Tilahun *, Dinaol Abdissa Fufa, Rahel Dereje Taddesse
School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Undernutrition in pregnant women, expressed as low mid-upper arm circumference, is responsible for
Undernutrition maternal mortality and morbidity, adverse birth outcomes, subsequent childhood malnutrition, and mortality. As
Pregnant women a result, the purpose of this study was to determine the prevalence of maternal undernutrition and associated
Antenatal care
factors during pregnancy in public hospitals in the Bench-Sheko and Kaffa zones of southwest Ethiopia.
Southwest Ethiopia
Methods: A facility-based cross-sectional study design was employed among 566 women who received antenatal
care from March–May 2021 at the public hospitals of the Bench-Sheko and Kaffa zones, Southwest Ethiopia. A
systematic random sampling technique was used to select the research unit. Undernutrition was measured by mid-
upper arm circumference. The data were entered into Epi- Data version 3.1 and then exported to Statistical
Package for Social Science (SPSS) version 21 software for analysis. Multivariate logistic regression models were
constructed using variables with a P-value <0.25 in bivariate logistic regression analysis. Finally, in multivariate
logistic regression analysis, the variable with a (P-value < 0.05) is considered statistically significant.
Results: A total of 566 pregnant women participated in our study with a response rate of 98.3%. The overall
prevalence of undernutrition among pregnant women was 42.4% (95% CI: 38.3, 46.5). In multivariate logistic
regression, the age of mothers between 16-24 years old (AOR ¼ 3.9, 95% CI: 1.60, 9.70), household food inse-
curity (AOR ¼ 1.81, 95% CI: 1.04, 3.15), and poor dietary knowledge (AOR ¼ 3.25, 95% CI: 1.94, 5.47) were the
factors significantly associated with undernutrition among pregnant women.
Conclusion: According to this study finding, the prevalence of undernutrition was very much high in the study
area, which was significantly associated with the age groups of 16–24 years older women, poor dietary knowl-
edge, and household food insecurity. Therefore, the strategies and programs targeted towards reducing and
preventing undernutrition among pregnant mothers should be made at all levels to improve their nutritional
status, and also health information, nutrition counseling, and food assistant should be provided.

1. Introduction pediatric period and develop the non-communicable disease in later life
[2, 9]. In addition it will again affect the economic development of
Women of reproductive age are vulnerable to undernutrition [1]. family, society and continue the cycle of undernutrition [2, 10].
Poor nutritional status in pregnant women, expressed as low mid-upper Maternal iron deficiency anemia and short height are also risk factors
arm circumference (MUA), is responsible for maternal mortality and for maternal mortality during delivery, for at least 20% of maternal
morbidity and adverse birth outcomes [2, 3]. Furthermore, it is a risk mortality. Mothers who have shorter height are at risk of having
factor for under-five malnutrition [4, 5, 6]. Maternal malnutrition is a caesarian delivery and cephalopelvic disproportion [11]. In most devel-
risk factor for intrauterine growth restriction (IUGR), which occurs oping countries, it is responsible for having small babies, reduced organ
frequently and is a serious complication of pregnancy. Newborns who size in babies, obstetric complications, maternal and newborn morbidity,
have IUGR are at high risk for perinatal morbidities as well as physical and subsequent childhood malnutrition and mortality [12].
and mental impairments in later life [7, 8]. Malnourished mothers have a Maternal undernutrition during pregnancy in all Africa regions remains
higher risk of giving low birth weight babies vulnerable to disease and highly prevalent, which was 20.2% [13]. In Ethiopia, it was highly
death. Low birth weight newborns are also at risk of mortality during a remaining prevalent [3], around 29.07% of pregnant women were

* Corresponding author.
E-mail address: abeloo405@[Link] (A.G. Tilahun).

[Link]
Received 26 June 2021; Received in revised form 5 August 2021; Accepted 28 April 2022
2405-8440/© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ([Link]
nc-nd/4.0/).
A.G. Tilahun et al. Heliyon 8 (2022) e09380

undernourished, of which 30.4%, 30.4%, 33.9%, and 38% were in 2.4.2. Sampling technique
Amhara, Oromia, South Nation, Nationality, and People Region (SNNPR), First, each public hospital of the Bench-Sheko and Kaffa zones
and Tigray region of Ethiopia, respectively [1]. Despite the Ethiopian received a proportionate share of the entire sample size based on their
government's development of the National Nutrition Program, which in- average number of clients attending ANC before the data collection
cludes maternal and child nutrition as a goal, undernutrition of the women period. Next, a systematic random sampling technique was used to select
during pregnancy continues to be a public health concern in Ethiopia. the study units by using the list of pregnant mothers attending ANC as a
Therefore it needs updated data on the nutritional status of pregnant sampling frame, and the sampling interval (Kth) was calculated by using
women's, which is essential to develop specific interventions in this area. In the formula of k ¼ N/n. Finally, every Kth person (roughly 2), as they
addition, there is limited information on the prevalence and factors asso- registered, was included in the study until the desired sample size was
ciated with maternal undernutrition among pregnant women in the study attained from each hospital.
area. Therefore, this study aimed to assess the prevalence of maternal
undernutrition and its associated factors among pregnant women at the 2.5. Study variables
public hospital of Bench-Sheko and Kaffa zone, southwest Ethiopia.
2.5.1. Dependent variable
2. Methods Undernutrition of pregnant women.

2.1. Study setting 2.5.2. Independent variables

Age, marital status, religion, family size, occupation, education, in-
This research was done in three public hospitals in the Bench-Sheko come level, television (TV)/radio, mobile, household food insecurity,
and Kaffa zones of SNNPR, Ethiopia. The administrative center of the meals frequency, skipping meals, eating a snack, eating additional meals,
Bench-Sheko zone is Mizan-Aman town, which is situated 562 km from excessive workload, residency, number of live birth, number of preg-
Addis Ababa, Ethiopia's capital city. According to zonal annual reports of nancies, pregnancy interval, number of ANC visits, trimester, history of
2019, the total population of the zone was 653,270, of whom 324,542 illness, nutrition information, source of nutrition information, dietary
were men and 328,728 women. There is one general hospital in the knowledge and attitude of pregnant women were independent variables.
Bench-Sheko zone with a 3-month average number of 540 antenatal care
(ANC) attendants before the data collection period. Bonga town, 468 km 2.6. Data collection procedures
from Addis Ababa, serves as the administrative center of the Kaffa zone.
In 2017, the zone's overall population was predicted to be 1,171,133, Structured and semi-structured questionnaires administered by Mid-
with 578,151 men (49.4 %) and 592,982 women (50.6 %). There is one wives and Nurses were used to collect the data. The data on socio-
general hospital and one primary hospital in the zone. with the 3- months demographic and economic, obstetric and pregnancy-related factors,
an average number of 490 and 401 ANC attendants before the data household food insecurity, dietary knowledge, dietary attitude, a dietary
collection period in each hospital respectively. The study was conducted related habit of pregnant women like, eating habit of snacks, skipping of
from March to May 2021. meals, meals frequency, eating additional meals, and nutritional status of
pregnant women were assessed. The general content validity of the
2.2. Study design questionnaires was checked by relevant professionals against the con-
ceptual framework of the study and its reliability was checked by using a
A hospital -based cross-sectional study design was used. test-retest method and the questions with less than 0.7 Pearson coeffi-
cient values were avoided from the questionnaire. The household food
2.2.1. Source population insecurity level was measured with standardized and validated tools of
All women in the Bench-Sheko and Kaffa zones, Southwest Ethiopia, Household Food Insecurity Access Scale (HFIAS)that was developed
received ANC at the public hospitals. mainly by Food and Nutrition Technical Assistance (FANTA), and clas-
sified the households as food secured or not [15, 16]. The tool consists of
2.2.2. Study population nine questions that represent the severity of food insecurity in general
All women who were systematically selected during ANC follow-up. (access). Nine "frequency-of-occurrence" questions inquire about changes
in households' diets or food consumption patterns over the previous 30
2.3. Inclusion and exclusion criteria days due to limited food resources. Participants were assigned a score
between 0 and 27 based on their responses to the nine questions and their
2.3.1. Inclusion criteria frequency of occurrence over the preceding 30 days. A higher HFIAS
All pregnant women attended ANC at public hospitals. score indicates more inadequate access to food and greater household
food insecurity, while a score of 0 indicated secure access to food.
2.3.2. Exclusion criteria Ten open-ended questions adapted from a previous study were used
The pregnant women who were sick or mentally unstable. to assess dietary knowledge, which tried to evaluate the nutritional
knowledge of pregnant women's on the nutritional aspects of pregnancy
2.4. Sample size and sampling technique [17]. Its reliability in this study was a Cronbach Alpha of 0.92. The items
measuring nutritional knowledge were scored on a dichotomous scale as
2.4.1. Sample size determination 0 ¼ does not know and 1 ¼ knows. Each correct answer was coded as 1
In this study, the sample size was calculated using a single population and each incorrect answer was coded as 0. Then the total score was ob-
proportion formula with the following assumptions in mind: The preva- tained by summation of each score. Finally, nutritional knowledge level
lence of undernutrition (P) among pregnant women from the Silte zone was categorized as knowledgeable if she correctly answered greater than
study finding, 21.8% [14], 5% marginal error(d), 95% confidence level or equal to 70% of the total nutrition knowledge questions and not
(Zα/2 ¼ 1.96), none responses rate of 10% and the design effect of 2. As a knowledgeable If respondents scored <70% [18, 19]. The attitude of
result, the sample size was calculated as follows: n¼ ((1.96)2 *0.218 pregnant women toward nutrition during pregnancy was assessed by
(1-0.218))/(0.05)2 ¼ ~ 262. Thus, a minimum number of 262 pregnant using nine questions. The reliability of the attitude questions was
women were the required number for the study. Then when we considered checked and showed a Cronbach Alpha of 0.84. The pregnant woman was
the design effect of 2 (262*2) it became 524. Finally, adding a 10% given one mark if the answer were a favorable attitude toward nutrition
none-response rate (524 *10%), 524 þ 52 ¼ 576 of sample size were used. during pregnancy and zero scores if the response were an unfavorable

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A.G. Tilahun et al. Heliyon 8 (2022) e09380

attitude [18, 20]. Following the summation of the scores, the respondent 2.10. Data quality control
was classified as having a favorable attitude if their attitude score was
greater than or equal to the median of the scores, and as having an un- A pretest was conducted on 5% of the total study population. The final
favorable attitude if their attitude score was less than or equal to the version of the questionnaire prepared in English was translated into the
median of the scores [18]. local language of the respondents and then translated back to English.
Two days of training were given for collectors and supervisors on the
instruments, data collection method, how to take anthropometric mea-
2.7. Anthropometric measurement surements, ethical issues, and the purpose of the study. The intra and
inter-observer variability of the data collector's relative technical error of
The circumference of the middle upper arm (MUAC) was measured measurement (%TEM) was calculated during training among ten preg-
with MUAC tape that was non-elastic and non-stretchable. First, we nant women to minimize random anthropometric measurement error.
removed any clothing that might cover the pregnant mother's left arm The accepted relative technical measurement errors for intra-observers
then calculated the midpoint of the pregnant mother's left upper arm by were less than 1.5%, while inter-observers were less than 2%. During
first locating the tip of the pregnant mother's shoulder, bending the training and pretesting, the accuracy of data collectors' anthropometric
pregnant mother's elbow to make a right angle, and inspected the tension measurements was standardized with their trainer. Data collectors have
of the tape on the pregnant's arm. We also made sure that the tape has measured anthropometric measurements twice and then the average
proper tension and was not too tight or loose. When the tape was in the value was taken. Double data entry was done to compare two data cells
correct position on the arm with the correct tension, read and called out and resolve whenever there was some difference.
the measurement to the nearest 0.1cm, and the average value was taken
after measuring twice. A range <23 cm was used as a cut-off point for
undernutrition and while a range of 23 cm was for normal nutritional
status. Table 1. Socio-demographic and economic characteristics of study participants
at the public hospital of Bench-Sheko and Kaffa zone, southwest Ethiopia, 2021
(N ¼ 566).
2.8. Ethical approval and consent to participate
Variables Frequency Percent
(N) (%)
This study was conducted according to the Declaration of Helsinki.
Age 16–24 167 29.5
First, ethical approval was obtained from Mizan-Tepi University Insti-
25–34 357 63.1
tutional Research Ethics and Review Committee to conduct this study. A 35 42 7.4
formal letter was sent to the Bech-Sheko and Kaffa zone health bureau Religion Orthodox 224 39.6
administrators, as well as the selected hospitals, prior to the study. Before Protestant 267 47.2
any data was collected, the study's goal, benefits, confidentiality, and Muslim 73 12.9
risks were explained to the participants, and all respondents signed a Others 2 0.4

written informed consent form. The respondents have agreed to maintain Ethnicity Bench 148 26.1
Kaffa 228 40.3
their anonymity, and the information they provide will be used solely for
Sheka 26 4.6
the purposes of the study. Amhara 132 23.3
Others 32 5.7
Marriage Married 552 97.5
2.9. Data processing and analysis Others 14 2.5
Residency Urban 371 65.5
After ensuring that all data were complete and consistent internally, Rural 195 34.5
they were coded and entered into the Epi Data 3.1 computer software Mother education No formal education 173 30.6
package. For further analysis, the data was exported to the Statistical Primary 170 30.0
Package for Social Science (SPSS) version 21 software. Undernutrition Secondary 93 16.4
College and above 130 23
was classified and coded as 1 for "yes" if the MUAC was 23 cm and 0 for
Husband education No formal education 125 22.1
"no" if the MUAC was 23 cm [14,21–25]. The household food insecurity
Primary 142 25.1
access score was calculated for each household by summing up the nine Secondary 111 19.6
food insecurity frequencies in the previous 30 days. The nine items were College and above 188 33.2
recorded as 0 for "no" to each occurrence and 1 for "yes" response, and Mother occupation Housewife 327 57.8
then it was categorized as food secure when all items had been answered Merchant 79 14.0
"no" and food insecure for "yes". For the descriptive statistics analyses, Employers 124 21.9
Others 36 6.4
percentage, frequency, mean and standard deviation were calculated. We
Husband occupation Farmer 164 29.0
used bivariate logistic regression to examine the relationship between
Merchant 173 30.6
the dependent and independent variables. Multivariate logistic regres- Employer 160 28.3
sion models were constructed using variables with a P-value <0.25 in Others 69 12.2
bivariate logistic regression analysis to control for all possible con- Family size <5 437 77.2
founders and identify factors that are independently associated with the 5 129 22.8
undernutrition of pregnant women. To determine the strength and di- Average family monthly income <1000 EBR 247 43.6
rection of association between dependent and independent variables, the 1000-2000 ETB 71 12.5
>2000 ETB 248 43.8
Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) with a 95%
Confidence Interval (CI) were calculated. Finally, in multivariate logistic TV/Radio Yes 382 67.5
No 184 32.5
regression analysis, the variable with a (P-value < 0.05) is considered
Mobile Yes 404 71.4
statistically significant. Standard error (SE) was used to test for multi-
No 162 28.6
collinearity between independent variables, and SE values greater than 2
Households food security Secure 462 81.6
were excluded from the analysis. The Hosmer-Lemeshow test was used to Insecure 104 18.4
determine the model's fitness for goodness of fit, and the model was
Notes: TV: Television, ETB: Ethiopian Birr.
considered fitted if the Hosmer-Lemeshow P-value was greater than 0.05.

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A.G. Tilahun et al. Heliyon 8 (2022) e09380

3. Results
Table 3. Dietary knowledge, attitude, and practice of pregnant women at the
public hospital of Bench-Sheko and Kaffa zone, Southwest Ethiopia 2021 (N ¼
3.1. Socio-demographic and economic related characteristics of pregnant
566).
women
Frequency Percentage
A total of 566 pregnant women participated in our study, with a Dietary knowledge level Poor knowledge 280 49.5
response rate of 98.3%. The mean (SD) age of the study participants Good knowledge 286 50.5
was 27.01 (4.86), and about 357 (63.1%) were between the age group Dietary attitude level Unfavorable attitude 308 54.4
of 25 and 34 years. Around 267 (47.2%) pregnant women were protes- Favorable attitude 258 45.6
tant religion followers, and 228 (40.3%) were Kaffa by ethnicity. Almost The habit of skipping meals Yes 123 21.7
all, 552 (97.5%) pregnant women are married, and 371 (65.5%) preg- No 443 78.3
nant women were urban dwellers. Among the study participants, 247 Iron-folic supplements Yes 466 82.3
(43.6%) of pregnant women had less than 1000 birr monthly income, and No 100 17.7
382 (67.5%) had TV/radio. In this study, 104 (18.4%) household food Following a specific Yes 62 11
insecure households (Table 1). dietary regimen No 504 89
Meal frequency <3 305 53.9
3 261 46.1
3.2. Obstetric and pregnancy-related characteristics of the study
The habit of avoiding food Yes 142 25.1
participants
No 424 74.9

It was found that 471 (83.2%) of study participants had less than or Avoiding excessive workload Yes 357 63.1

equal to two live birth, and only 65 (11.5%) had four and above ANC No 209 36.9

follow-up. Among the studied pregnant women, 269 (47.5%) were in Eating snack Yes 303 53.5
their second trimester of pregnancy. Around 335 (59.25%) pregnant No 263 46.5
women had less than or equal to two pregnancies in their lifetime. The habit of craving food Yes 194 34.3
Around 414 (73.1%) had nutrition information, and only 103 (18.1%) No 372 65.7
had a history of any types of illness (Table 2).

3.4. Nutritional status of pregnant women

3.3. Dietary knowledge, attitude, and practice of pregnant women
According to this study, the prevalence of undernutrition, based on
Half, 286 (50.5%) of study participants had good dietary knowledge. MUAC less than 23 cm among pregnant women was 42.4% (95% CI:
On the other hand, around 308 (54.4%) of pregnant women had an un- 38.3, 46.5) (Figure 1).
favorable attitude to dietary practice. Regarding specific dietary practice,
more than half, 305 (53.9%) of the study participants had <3 meal fre- 3.5. Factors associated with maternal undernutrition
quency, and about 263 (46.5%) had no habit of eating snacks during
pregnancy (Table 3). In multivariate logistic regression, women age groups between 16-24
years old, household food insecurity, and poor dietary knowledge were
significantly associated with undernutrition among pregnant women.
Table 2. Obstetric and pregnancy-related characteristics of study participants at
The women with the age group of 16–24 years were 3.94 times more
the public hospital of Bench-Sheko and Kaffa zone, southwest Ethiopia 2021 (N ¼
566). likely undernutrition (AOR ¼ 3.94,95% CI: 1.60, 9.70) than age groups of
35 years old. The mother from a food-insecure household was 1.8 times
Variables Frequency Per cent
more likely undernourished (AOR ¼ 1.8, 95% CI: 1.04, 3.15) than their
(N) (%)
counterparts. The mother who had poor dietary knowledge was 3.25
Trimester First trimester 58 10.2
Second trimester 269 47.5 more likely undernourished (AOR ¼ 3.25, 95% CI: 1.94, 5.47) than their
Third trimester 239 42.2 counterparts (Table 4).
Total number of pregnancy 2 335 59.2
3–4 163 28.8 4. Discussion
5 68 12.0
Total number of live birth 2 471 83.2
This study aimed to assess the maternal undernutrition and associated
3–4 82 14.5
5 13 2.3
factors among pregnant women at the public hospitals of Bench-Sheko
Pregnancy interval 2 352 62.2
and Kaffa zone, Southwest Ethiopia. According to this study, the preva-
3–5 138 24.4 lence of maternal undernutrition among pregnant women was 42.4%,
>5 76 13.4 which is almost consistent finding with the study from the Guji zone
Number of ANC visit One 188 33.2 (41.2%) [21], Tigray region, (40.6%) [23], from the rural district of
Two 210 37.1 Oromia region (41%) [3], Konso district of Ethiopia (43.1%) [26] and
Three 103 18.2 India (38%) [27]. This alignment might be because the measurement
Four and above 65 11.5
cut-off points used were similar to this study's cut-off points for under-
History of illness Yes 103 18.2
nutrition, which all used <23 cm, and the socio-economic status of the
No 463 81.8
study participants. However, much higher than the study reported from
Nutritional information Yes 414 73.1
No 152 26.9 Silte zone 21.8% [14] and Dessie town 19.5% [28] of Ethiopia. The
Source of nutrition information Health professionals 348 61.5 possible explanation for this discrepancy might be the socioeconomic and
Family 23 4.1 cultural variation. Likewise, the studies from Iluu Aba Bor zone 17.4%
Media 32 5.7 [29], Alamata 22.3% [30], University of Gonder Hospital 16.2% [31],
Friends 7 1.2 Dire Dawa 18.2% [32], Gambela 28.6% [33], Central Rift valley of
Others 4 0.7
Ethiopia 31.8% [34], Sudan (4.4%) [35], Nigeria (21.7%) [36] and Benin

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A.G. Tilahun et al. Heliyon 8 (2022) e09380

Figure 1. Nutritional status of the study participants at the public hospital of Bench-Sheko and Kaffa zone, Southwest Ethiopia, 2021 (N ¼ 566).

Table 4. Factors associated with undernutrition of the study participants at the public hospital of Bench-Sheko and Kaffa zone, southwest Ethiopia, 2021 (N ¼ 566).

Variables Undernutrition COR (95% CI) AOR (95% CI)

Yes No
Age of women
16–24 94 (39.2%) 73 (22.4%) 3.63 (1.71,7.70)** 3.94 (1.60, 9.70)*
25–34 135 (56.2%) 222 (68.1%) 1.70 (0.80,3.50) 1.77 (.76, 4.10)
35 11 (4.6%) 31 (9.5%) 1 1
Residency
Urban 129 (53.8%) 242 (74.2%) 1 1
Rural 111 (46.2%) 84 (25.8%) 2.48 (1.74,3.54)** 1.16 (.68, 1.98)
Nutrition information
Yes 150 (62.7%) 264 (81%) 1 1
No 90 (37.5%) 62 (19%) 2.56 (1.75,3.74)** 0.94 (.57, 1.55)
Mother education
No formal education 94 (39.2%) 79 (24.2%) 3.11 (1.91,5.06)** 1.50 (.53, 4.09)
Primary education 75 (31.2%) 95 (29.1%) 2.06 (1.26,3.36)* 1.16 (.50, 2.70)
Secondary education 35 (14.6%) 58 (17.8%) 1.58 (0.89,2.78) 1.23 (.57, 2.64)
College and above 36 (15%) 94 (28.8%) 1 1
Husband education
No formal education 71 (29.6%) 54 (16.6%) 3.02 (1.89,4.84)** 0.54 (.19,1.53)
Primary education 63 (26.2%) 79 (24.2%) 1.83 (1.16,2.89)** 0.90 (.41, 1.98)
Secondary education 49 (20.4%) 62 (19%) 1.82 (1.12,2.96)* 1.73 (0.85, 3.53)
College and above 57 (23.8%) 131 (40.2%) 1 1
Mother occupation
Housewife 162 (67.5%) 165 (50.6%) 2.31 (1.49,3.59)** 0.78 (.37, 1.64)
Merchant 41 (17.1%) 74 (22.7%) 1.30 (0.76,2.24) 0.96 (.46, 2.01)
Employers 37 (15.4%) 87 (26.7%) 1 1
Husband occupation
Farmer 106 (44.2%) 58 (17.8%) 3.80 (2.40,6.02)** 1.72 (0.70, 4.24)
Merchant 82 (34.2%) 160 (59.1%) 1.06 (0.70,1.63) 0.62 (.33, 1.19)
Employers 52 (21.7%) 108 (33.1%) 1
Food security
Food secure 2171 (71.2%) 291 (89.3%) 1 1
Food insecure 69 (28.8%) 35 (10.7%) 3.36 (2.14,5.25)** 1.81 (1.04,3.15)*
Knowledge
Poor knowledgeable 171 (71.2%) 109 (33.4%) 4.93 (3.44,7.19)** 3.25 (1.94, 5.47)**
Good Knowledgeable 69 (28.8%) 217 (66.6%) 1 1
Income
<1000 ETB 121 (50.4%) 126 (38.7%) 2.22 (1.53,3.20)** .92 (.50, 1.69)
1000-2000 ETB 44 (18.3%) 27 (8.3%) 3.76 (2.17,6.52)** 1.82 (.89, 3.73)
>2000 ETB 75 (31.2%) 173 (53.1%) 1 1
Iron-folic supplement
No 57 (23.8%) 43 (13.2%) 2.05 (1.32,3.18)* 1.39 (0.82, 2.37)
Yes 183 (76.2%) 283 (86.8%) 1 1
Avoiding excessive workload
No 119 (49.6%) 90 (27.6%) 2.58 (1.81,3.66)** 1.41 (.89, 2.24)
Yes 121 (50.4%) 236 (72.4%) 1 1

Notes: *P-value<0.05, **P-value <0.001, ETB: Ethiopian Birr.

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A.G. Tilahun et al. Heliyon 8 (2022) e09380

(29.8%) [37] showed a lesser prevalence of undernutrition then of this design nutrition intervention strategies and programs, and to strengthen
study. This discrepancy could be due to differences in measurement the health service provided during ANC follow up which mainly should
cut-off points <21–22.5cm that they used, the difference in measurement focus on specific context-based factors. It will also be used to provide the
like some other studies were used BMI and weight to determine under- information that improves the inconsistent research findings gaps
nutrition, socio-demographic and economic difference, and study setting regarding factors related to maternal undernutrition. Moreover, it uses as
variation from the current study. Nevertheless, it is lower than the study baseline information for others researchers to identify more variables
findings from Kacha Birra district (52.6%) [24], Gumay district (44.9%) that may determine undernutrition during pregnancy in the study area.
[22], Jordan (49.2%) [38], Benin (44.3%) [39], and Assam (48%) [40].
This discrepancy could be occurred due to the study participants Declarations
socio-demographic, culture and study setting variation.
According to this study, the mother with the age groups of 16–24 Author contribution statement
years was 3.9 times more likely undernutrition than 35 years old. This
study finding is consistent with the previous study findings [14, 41, 42]. Abel Girma Tilahun: Conceived and designed the experiments; Per-
This finding might be due to the increased nutritional needs of younger formed the experiments; Analyzed and interpreted the data; Contributed
pregnant women for their growing body, which increases their vulner- reagents, materials, analysis tools or data; Wrote the paper.
ability for undernutrition than their counterparts. Moreover, the younger Rahel Dereje Taddesse, Dinaol Abdissa Fufa: Analyzed and inter-
women are more exposed to unfavorable environments, increasing the preted the data; Wrote the paper.
risk of younger pregnant women for undernutrition than their counter-
parts. It might also be due to the lack of decision-making power of Funding statement
younger women about food distribution in their households. However,
this finding is inconsistent with the study findings of Alamata, which This work was supported by Mizan-Tepi University.
reported that being age groups of 15–24 years decreases the risk of un-
dernutrition compared with age groups of 35–49 years olds [30]. Data availability statement
In this study, the dietary knowledge of pregnant women was nega-
tively associated with undernutrition. For example, the mother who had Data will be made available on request.
poor dietary knowledge was 3.25 times more likely undernourished than
good dietary knowledge. This study finding is aligned with other study Declaration of interests statement
findings [14, 28]. Therefore, the possible explanations might be that poor
dietary knowledge about nutrition practice during pregnancy could The authors declare no conflict of interest.
result in inadequate dietary intake, which is one of the possible factors
for the high prevalence of undernutrition during pregnancy. Additional information
The others factor which significantly associated with undernutrition
was household food insecurity. The mother from a food-insecure house- No additional information is available for this paper.
hold was 1.8 times more likely undernourished than from food-secure
households. It is consistent with the study finding from the Illu Aba Bor Acknowledgements
zone [29], Guji zone [21], Gambella [33], Gumay [22], and Somali region
[43]. This finding might be due to pregnant women from food-insecure We would like to thank Bech-Sheko and Kaffa zone health bureau
households being unable to access optimal amounts and quality of diets administrators for their assistance in providing valuable information.
that meet the increased nutrition demands during pregnancy. Finally, we would like to express our gratitude to our data collectors and
The study's limitations: One of the study's main limitations was supervisors for their tireless efforts during data collection.
that it only looked at public hospitals and excluded other public
health institutions. This study did not include minimum dietary di- Reference
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