Predictors of Malnutrition among Pregnant Women in Ethiopia: Systematic Review and Meta-Analysis

Abstract

Background Women of reproductive age are especially vulnerable to protein energy deficiency and under nutrition. Malnutrition is the underlying cause of significant maternal morbidity and mortality. In addition, malnutrition among women is a major risk factor for adverse birth outcomes. Its extent and consequences is highly prevalent in developing countries. This major burden can be reduced through effective nutritional interventions. So, up to date meager evidences were warranted. Therefore, this systematic review and meta-analysis was aimed to estimate the overall pooled prevalence of malnutrition and its predictors among pregnant women in Ethiopia. Methods Articles were systematically searched using PubMed, EMBASE, Google Scholar, World Health Organization’s (WHO) Hinari portal data bases and institutional repositories. Newcastle‒Ottawa quality assessment scale adapted for observational studies was applied. We used Stata version 14 for data analysis. Heterogeneity and publication bias were checked using I2 statistic, funnel plot asymmetry and Egger’s test. Random effect model was applied to estimate the pooled prevalence of malnutrition and its predictors. Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to identify factors. Result 24 eligible articles were included for final analysis. The average pooled prevalence of malnutrition among pregnant women in Ethiopia was 29.07% (95% CI: 24.84, 33.30). Maternal education (OR = 1.60, 95% CI: 1.01, 2.53), income (OR = 3.07, 95% CI: 1.36, 6.92), pregnancy intention (OR = 1.33, 95% CI: 1.01, 1.37), number of meal (OR = 4.63, 95% CI: 3.00, 7.15), dietary diversity (OR = 2.89, 95% CI: 1.28, 6.53), antenatal care (OR = 2.53, 95% CI: 1.18, 5.42) and iron supplementation (OR = 0.63, 95% CI: 0.45, 0.88) were predictors of the pooled prevalence of malnutrition among pregnant women in Ethiopia. Conclusion Generally, significant number of pregnant women in Ethiopia were suffered from malnutrition. Maternal education, income, pregnancy intention, number of meal, dietary diversity, antenatal care and iron supplementation were significant predictors of malnutrition. Strategies targeting advocating women education, standard antenatal care, family planning utilization, and encouraging pregnant women to have good dietary diversity and frequent meal should be undertaken by Ministry of Health and its stake holders to handle this signficant budren of malnutrition among pregnant women.

Undernutrition and associated factors among rural pregnant women in Eastern Ethiopia

“…Several community-based studies were done in Ethiopia regarding undernutrition in pregnant women. 28 – 42 The average pooled prevalence of undernutrition from these studies was 29.07%, 43 where the lowest (14.4%) and highest (47.2%) prevalence were reported from Amhara and Oromia regions, respectively. 28 , 36 In addition, these studies identified factors associated with undernutrition in women of reproductive age including age, marital status, level of education, income, workload, women’s decision, dietary advice, dietary diversity, meal frequency, family planning, unplanned pregnancy, antenatal care follow-up, parity, gravidity, gestational age, and iron supplementation.…”

“… 28 , 36 In addition, these studies identified factors associated with undernutrition in women of reproductive age including age, marital status, level of education, income, workload, women’s decision, dietary advice, dietary diversity, meal frequency, family planning, unplanned pregnancy, antenatal care follow-up, parity, gravidity, gestational age, and iron supplementation. 30 , 32 – 35 , 43 …”

Individual and community-level factors of abortion in East Africa: a multilevel analysis

“…The higher prevalence of abortion in this study is in line with studies conducted in Ghana, Mozambique, and Ethiopia [ 13 , 34 – 36 ]. The higher burden of abortion in East Africa could be explained by inadequate coverage and access to family planning services, higher magnitudes of unwanted pregnancy, and higher burdens of acute and chronic malnutrition among reproductive-aged women [ 37 – 39 ].…”