- Title
- Provision of nutrition care services to pregnant women in Dar es Salaam, Tanzania and opportunities for incorporating digital health
- Creator
- Saronga, Naomi Jones
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Maternal dietary intake needs to provide the required nutrients for the mother’s health and for the growth and development of the foetus. Poor nutrition during pregnancy is associated with poor pregnancy outcomes such as premature birth, low birth weight, and anaemia; increasing maternal mortality risk. Antenatal clinics (ANC) can be an important source of nutrition information and nutrition education for pregnant mothers in Tanzania. Nutrition Services such as nutrition counselling and education, iron and folic acid supplementation, weight measurements, haemoglobin level check are part of Focused Antenatal Care Model implemented in Tanzania and therefore believed to be offered to pregnant women during antenatal visits. Despite this, the content of nutrition information provided during the antenatal clinic has neither been evaluated nor has the capacity of health care providers offering nutrition services been assessed. Therefore, it is essential to understand the nutrition services offered to pregnant women during antenatal visits to optimise nutrition care during this important stage of life. This thesis includes five distinct but complementary studies that aimed to address the overarching Research Question “what nutrition care services are provided to pregnant women in Dar es Salaam, Tanzania and how feasible is it to incorporate Digital Health into this setting? Results are summarised by thesis aim below. Aim 1: To evaluate the effectiveness of mHealth interventions on improving dietary/nutrient intake of pregnant women in Low and Lower-Middle Income Countries (LLMIC) (Chapter 2) To investigate this aim, a systematic review was conducted and four studies were included, with three randomised control trials and one pre-post experimental study. All articles evaluated the impact of using mHealth interventions on the use of nutrient supplements; iron supplements (n=1), vitamin supplements (composition not mentioned) (n=1) or calcium supplements (n=1). This review suggested that mHealth interventions can be used to improve the intake of micronutrient supplementation and the nutritional status of pregnant women in LLMIC. Further studies are needed to address the limited evidence base related to mHealth nutrition interventions targeting dietary intakes of pregnant women in LLMIC Aim 2: To explore and understand nutrition care services provided to pregnant women attending antenatal clinics in Dar es Salaam, Tanzania (Chapters 3 and 4) Two studies were carried out to address this aim. 1. Qualitative study Fourteen nurses who worked with pregnant women were interviewed. The study found that nurses delivered nutrition care to pregnant women during routine antenatal clinic visits, including nutrition education, iron and folic acid supplementation, weight measurements, dietary assessment, and haemoglobin level monitoring. However, the information delivered to pregnant women varied among nurses. Also, the study presented a number of barriers and enablers to the provision of nutrition care to pregnant women. 2. Exit interview Study conducted exit interviews with 50 pregnant women. Participants reported receiving nutrition care from health care workers in regard to; haemoglobin checks (79%), iron and folic acid supplementation (70%), weight measurement (70%), eating advice (60%), and dietary intake assessment (38%). However, the information recalled on each category was inconsistent. For 60% of participants, nurses were reported as the source of nutrition care during pregnancy, followed by medical doctors (22%). The most preferred mode of receiving nutrition information was individual face-to-face sessions with health practitioners, followed by mobile phones. All participants who received nutrition information indicated that they intended to implement it. Aim 3: To obtain nutritionists’ perceptions on the image-based dietary record method of collecting dietary intake and on the VISIDA web-platform in analysing nutrients intake in Dar es Salaam, Tanzania (Chapter 5) The study recruited 18 nutritionists who worked in Dar es Salaam region. Participants collected image-based dietary records of their foods and drinks consumed using a VISIDA app. Participants viewed an online demonstration of capabilities of the VISIDA web platform for analysing dietary intake data collected using the VISIDA app. Participants completed an online survey and were interviewed regarding their experiences in using VISIDA app and their views on the web platform for food and nutrient intake analysis. The data collection method using the VISIDA smartphone app was reported as acceptable and was found to be easy to use. Most participants indicated a willingness to use the VISIDA app for one week or longer and were interested in using VISIDA in their current role with their clients. Participants acknowledged that the VISIDA web platform would simplify some aspects of their current job. Aim 4: To obtain nutritionists’ perceptions of the development and content of the pregnancy-specific food guide for Tanzania (Chapter 6) The pregnancy-specific food guide for Tanzania was developed and presented as a brochure. The brochure includes eating advice, micronutrient supplements advice, food safety advice, craving, and serving sizes. The food guide was evaluated by 18 nutritionists who gave their feedback on the process of developing the food guide, the content, language, and portion size. Participants indicated their interest in using the brochure in their daily work and that it will help in the provision of nutrition education and counselling to their clients. Some perceived challenges in using brochure with pregnant women and other health care providers were mentioned Conclusion: The findings from this PhD research thesis have described the nutrition services that pregnant women receive when attending routine antenatal clinic visits in an urban setting of Tanzania. The nutrition services include nutrition education, iron and folic acid supplementation, weight measurements, dietary assessment, and haemoglobin level monitoring. The results also identified the barriers and enablers to the provision of nutrition care to these pregnant women. This research thesis demonstrated the feasibility of training nutritionists remotely using the image-based dietary record app to assess dietary intake. Nutritionists’ perceptions regarding the usability of VISIDA system were also presented; VISIDA app was accepted and was found to be easy to use by nutritionists. Most participants indicated a willingness to use the VISIDA app again and were interested in using the VISIDA system in their current role with their clients. Finally, a pregnant-specific food guide for Tanzania was developed and evaluated by the nutritionist in Tanzania; participants indicated their interest in using the brochure in their daily work and that it will help in the provision of nutrition education and counselling to their clients. Overall the results from this thesis will have a positive effect in improving nutrition care during pregnancy in Tanzania. The recommendations for practice and future research are provided.
- Subject
- nutrition care; pregnancy; nutrition services; digital health; Tanzania; image-based food record; pregnancy-specific food guide; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1505014
- Identifier
- uon:55609
- Rights
- Copyright 2022 Naomi Jones Saronga. This thesis is under embargo until 31.12.2024.
- Language
- eng
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