CHAPTER ONE: INTRODUCTION

1.0 Introduction

This chapter will contains the background of the study, statement of problem, research objectives,
research questions, hypothesis of the study and scope of the study, significant of the study and
operational definitions of the study.

1.1 Background

Pregnancy is a period of significant physiological changes for women, demanding increased nutritional
requirements to support the growth and development of the fetus. Inadequate nutrition during
pregnancy can have profound consequences for both the mother and the child, including low birth
weight, preterm birth, and increased risk of chronic diseases later in life.

All human beings need a balanced amount of nutrients for proper functioning of the body system.
Nutrition is a fundamental pillar of human life, health and development throughout the entire life span
(World Bank, 2006). Proper food and good nutrition are essential for survival, physical growth, mental
development, performance and productivity, health and wellbeing. However, the nutrition requirement
varies with respect to age, gender and during physiological changes such as pregnancy. Pregnancy is
such a critical phase in a woman’s life, when the expecting mother needs optimal nutrients of superior
qualities to support the developing fetus.

Globally, micro nutrient deficiency in pregnant women is widespread across regions and countries. It is
estimated that approximately 32 million pregnant women are anemic world widely, 19 million suffer
from vitamin A deficiency, and millions suffer from insufficient iron, folate, zinc or iodine stores. Vitamin
and mineral deficiencies have been associated with pregnancy complications and poor birth and infant
outcomes. It is calculated that approximately 20 million babies are born weighing less than 2500 g at
birth (low birth weight), about 15 million are premature, and many more are born small for their
gestational age, increasing their risk of morbidity and mortality during childhood ( WHO, 2015) Women
must have the proper nutrients in their diet, such as foods with folic acid, iron calcium, protein, vitamin
B12, vitamin D and vitamin A.(WHO ,2015)

According to the World Food Programmed, half of all pregnant women in developing countries including
those in African countries are anemic (having an iron deficiency), which causes around 110,000 deaths
during childbirth per year.(WHO, 2015)

Naturally, the urge to eat more is experienced by nearly all pregnant women. Pregnancy is considered
to be a delightful experience for the expectant mother. Evidences manifested that adequate intake of
nutrition is a key component for individual’s health and well-being, particularly during pregnancy. It is
well documented that inadequate maternal nutrition results in increased risks of short-term
consequences such as; Intrauterine Growth Restriction (IUGR), low birth weight, preterm birth, prenatal
and infant mortality and morbidity.

Moreover, excessive intake of nutrients during pregnancy can lead to some pregnancy complications
(such as, pre-eclampsia and gestational diabetes, macrosomia, dystocia and higher prevalence of
cesarean section). On the other hand, as the long run outcomes, inadequate intake of nutrients were
found to have path physiologic or metabolic depict that will appear as disorders of child growth and
development as well as adult chronic disease after a long period of quiescence (Ota E, etl2015). Eating
well during pregnancy means do more than simply increase how much the mother eats. The mother
must also consider what she eats.

The ability of mother to provide nutrients and oxygen for her baby is a critical factor for fetal health and
its survival (Girard AW and, Olude O 2012.) Failure in supplying the adequate amount of nutrients to
meet fetal demand can lead to fetal malnutrition. The relationship between diet and health is Very
important. It is even more important during pregnancy since good nutrition and safe food handling play
a key role in the health of both the mother and baby. As the title implies, this brochure provides
information on healthful eating during pregnancy. (UNICEF 2015)

It will cover how to eat a balanced diet, eating a variety of foods, healthy weight gain during pregnancy,
and food safety concerns specific to pregnant women. The National Micro nutrient Survey in 2009
reported median excessive urinary iodine concentrations of 325.1 µg/L among non pregnant women
and 417.1 µg/L among preschool aged children in Somalia (the normal range is 100–199 μg/l). Since the
2009 survey, some programs have been made to combat micro nutrient deficiencies in Somalia.
However, coverage of Vitamin A for twice yearly supplementation has been less than 80 percent for all
children aged 6-59 months. Coverage for Iron Folate and multiple micro nutrient supplementation for
women have also been poor. According to recent surveys, coverage for both interventions is less than 30
per cent. UNICEF has also piloted and scaled up the delivery of micro nutrient powders integrated in
infant and young child nutrition (IYCN) to improve nutrition status of children under 5 years old (UNICEF
2015).

Besides malnutrition, maternal infections especially malaria and HIV/AIDS also contribute majorly
towards maternal under nutrition and adverse pregnancy outcomes. According to the global burden of
diseases 2010, child and maternal under nutrition risk factors including maternal micro nutrient
deficiencies, sub-optimal breastfeeding and childhood underweight are collectively accountable for
almost 7% of the global disease burden6 contributing to at least a fifth of maternal deaths along with
the increased probability of poor pregnancy outcomes7. These are most prevalent in the regions of
South East Asia, South America and Africa, with some countries in Eastern and Southern Africa Region
(ESAR) having maternal under nutrition prevalence rate as high as 35%8. Despite the declining trend
over the past few decades, the prevalence of low BMI (<18.5 kg/m2) among women of reproductive age
(WRA) in Africa and Asia still looms higher than 10%1. The eastern, northern and western African
regions have shown some improvements; however, in southern Africa the situation has not improved or
might have even worsened8. Simultaneously, prevalence of overweight (BMI ≥ 25 kg/m2) and obesity
(BMI ≥ 30 kg/m2) among WRA has been rising in all regions of the world and reached more than 30%
and 10% globally and in Africa respectively.(WHO, 2015)

Nairobi,( August 19, 2011) CARE International, a leading humanitarian organization, urges donors to
increase assistance for pregnant women and lactating mothers in the drought-stricken Horn of Africa. Of
the more than 12 million people currently needing humanitarian assistance in Ethiopia, Kenya, Somalia
and Djibouti, an estimated 360,000 women are pregnant. One in five women of reproductive age in
Somalia is acutely malnourished, compromising a mother’s own health during pregnancy and
contributing to the high prevalence of low birth weight of children. (WHO 2015)
 In Puntland, 19% of women of reproductive age (15-45 years old) are undernourished (BMI <18.5
kg/m²) while 14.2% (BMI ˃30 kg/m²) are overweight. About 53% of non-pregnant women are anemic
and almost 50% of the women are deficient in Vitamin A, an indication in both cases of a severe public
health concern (4). Delaying the first pregnancy and increased intervals between pregnancies to 3 to 4
years contribute to the best nutritional and survival outcomes for both the mother and the child. The
importance of women's nutrition and reproductive health care to break the intergenerational cycle of
malnutrition is very important and must be recognized and addressed through the same community and
facility based services working to improve infant and young child feeding practices. This is particularly
important in exceptionally difficult circumstances (UNICEF 2015).

1.2-Statement of problem of study:

Malnutrition, consisting of protein-energy malnutrition and micro nutrient deficiencies, is the most
important risk factor for morbidity and mortality. Particularly, hundreds of millions of pregnant women
and young children are affected by malnutrition. Malnutrition in Somalia is multifaceted affecting
mothers, infants, young children, adolescent girls and women. It restricts inclusive development and
overall prosperity of the nation and constitutes a violation of basic children’s rights to survival and
development and the highest attainable standard of health.( UNICEF 2015)

Although there have been improvements in the nutrition status in the last five years, pregnant women
in Somalia suffer from multiple nutritional deprivations. Pregnancy maternal nutrition has a major effect
on a mother’s and baby’s health. Lack of adequate nutrition of good quality and quantity during
pregnancy has seen so many pregnant women who continuously attend Beeldaje MCH in Bosaso which
can cause health problems for both the mother and her fetus.

Therefore, this study is designed to Knowledge, attitude and practice of poor nutritional status among
pregnant mothers at Beeldaje MCH in Bosaso district.(UNICEF 2015)

1.3 Purpose of the study

The purpose of the study is Assessment of nutritional status among pregnant women at Beeldaje MCH
in Bosaso district.

1.4 Objectives of study

1 .4.1. General Objectives

Assessment of nutritional status among pregnant women at Beeldaje MCH in Bosaso district.

1.4.2. Specific objectives

This study was guided by the following objectives

1. To assess the nutritional status among pregnant women at Beeldaje MCH in Bosaso district.
2. To identify the nutritional status among pregnant women at Beeldaje MCH in Bosaso district.
3. To determine of nutritional statusamong pregnant women at Beeldaje MCH in Bosaso district.
1.5 Research questions

1.Is there any awareness about nutritional status of food taken among pregnant women at Beel daaje
MCH in Bosaso district, puntland?

2.Is there adequate health education programme that provide knowledge on nutritional status among
pregnant women at Beeldaje MCH in Bosaso district?

3.Is there available balanced diet among pregnant women at Beeldaje MCH in Bosaso district?

1.6 Hypothesis

There is no knowledge provided on the factors affecting nutritional status among pregnant women at
beel daaje M C HS

1.7 Scope of the Study

1.7.1 geographical scope

The study focus is on Bosaso district, the Bosaso have neighbor district or village and also red sea in Bari
region red sea in southern mareero village in eastern.laag village in North, and laasQorey district in
western.used

1.7.2 Contact scope

This study was focus on examining and assessing of nutritional status among pregnant mothers at
Beeldaje MCH in Bosaso district.

This study will focus on mothers living in Bosaso and exclusively spelled mothers out from Bosaso
lactation and pregnant women is high considerable. this study will emphasise the knowledge ,attitude
and practice of poor nutritional status among pregnant motherss at Beeldaje MCH in Bosaso district.

1.7.3Theoretical scope of the study

This study was based on the: Assessment of nutritional status among pregnant mothers at Beeldaje
MCH in Bosaso district.

1.7.4 Time scope

The time scope of this study is on from November, 2024 up to Sep, 2025 where this problem arises and
researcher’s studies.
I.8 Significance of the Study

The significance of the study is to produce documented information about the assessment of nutritional
status among pregnant mothers at Beeldaje MCH in Bosaso district, Somalia.

The findings of this study should provide both the residents of the Bosaso community and the entire
Puntland region with helpful information regarding the possible consequences of nutrition in pregnancy
practice. Appropriate recommendations could generate or stimulate action for the improvement of the
nutritional circumstances of pregnancy women in the region.

Our research is important government especially ministry of health of Puntland and ONGs related
health because it founds more information about nutritional status among pregnant mothers

1.9 Operational definitions

Nutrition: nutrition is the intake of food, considered in relation to the body’s dietary needs. Good
nutrition– an adequate, well balanced diet combined with regular physical activity – is a cornerstone of
good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired
physical and mental development, and reduced productivity.

Nutritional Assessment: is an in-depth evaluation of both objectives and subjective date related to an
individual food nutrient intake ,lifestyle and medical history.

Food: Is any edible substances either solid or liquid that is consumed by the pregnant women in Kankia
which will provide them with nourishment, promote growth and maintenance of their health
status.ividuals food nutrient intake ,lifestyle and medical history.

Body Mass Index (BMI): BMI is an estimate of body fat based on height and weight. It doesn't measure
body fat directly, but instead uses an equation to make an approximation. BMI can help determine
whether a person is at an unhealthy or healthy weight.

Nutritional status: is the requirement of health of the person convinced by the diet, the levels of
nutrient containing in the body and the normal metabolic integrity.

Pregnancy: the state of carrying developing embryo or fetus within the female body.

Among:occurring or member in age between 15-45