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in Journal of Advanced Laboratory Research in Biology

We- together to save yourself society e-ISSN 0976-7614

Volume 3, Issue 3, July 2012 Research Article

Assessment of Nutrition Profile of Pregnant Women in Rural Area (Mymensingh District)

of Bangladesh
M. Shafiur Rahman*

*Department of Food Engineering & Technology, State University of Bangladesh, Dhaka 1205, Bangladesh.

Abstract: Malnutrition is the most common nutritional disorders in the developing countries like Bangladesh. The
most vulnerable groups of population to malnutrition are under-5 children, pregnant women and lactating mother.
This study makes an attempt to investigate the nutritional status of pregnant women and to correlate different factors
with pregnancy. The cross-sectional study was followed to determine nutritional status by anthropometric and
biochemical assessment as well as clinical appearance. The obtaining result of all assessments was compared with
standard data (NCHS & UNHCR/WFP). A total of 380 pregnant women were randomly selected from health care
centers (governments and non-governments) in the Mymensingh district of Bangladesh from early June 2007 to
January 2008. The result of research showed that 30.52% severely malnourished, 36.57% moderately malnourished,
and 23.15% well nourished and 9.73% were overnourished by calculating weight gain during different stages of
pregnancy. By using Mid-Upper Arm Circumference (MUAC) 28.94%, 35%, 25.26% and 10.78% of pregnant
women were found severely malnourished, moderately malnourished, well nourished and overnourished
respectively. It observed that the prevalence of nutritional status to pregnant women were found 29.69% severely
malnourished, 34.39% moderately malnourished, 26.36% well nourished and 9.56% over nourished by observing
the clinical appearance. In average it showed that 29.71% were severely malnourished, 35.32% were moderately
malnourished, 24.92% were well nourished and 10.02% were overnourished. By estimating hemoglobin (Hb) level
during pregnancy it obtained that 5.52% severely anemic, 61.84% moderately anemic, 18.15% mildly anemic and
14.47% of pregnant women were nonanemic. In my study, 12.63% of pregnant women were under 18 years old
while 50% were severely malnourished and 30.4% were malnourished. It found that the primary education levels
were 16.57% and total monthly family incomes of 16.57% of pregnant women were below Tk. 5000. Most of them
(73.66%) were malnourished because of those stated reasons. In Mymensingh district, the major responsible factors
were younger marriage, frequent birth, illiteracy, poverty, misconceptions, food taboos, lack of nutritional
knowledge, geographical location (hill tract region) etc. The data obtained from my study is very much alarming and
need to address by governments and nongovernmental organization.

Keywords: Nutrition, Profile, Malnutrition, Pregnant women, Mymensingh.

1. Introduction infant and high depletion of mother’s body reserves of

nutrients. Premature death, maternal death and low
Pregnancy is a normal physiological phase where vitality of the infants are due to the poor nutritional
rapid growth takes place in the mother’s body. The status of pregnant mothers. Before pregnancy, a woman
fetus in the mother’s uterus grows more rapidly than needs nutrients for growth and maintenance of her
after birth. The zygote develops into a seven-pound body. Good nutrition keeps her healthy. During
baby within 9 months. At the time of birth, the infant pregnancy additional requirement for all nutrients
was 9 months old. Optimum development of the infant occurs to enable the fetus to grow normally in the
is necessarily a function of parental diet. Inadequate uterus [1]. Good nutrition and a healthy lifestyle are
maternal nutrition results in low birth weight of the central to the Clinic’s overall approach to all aspects of
*Corresponding author:
E-mail: [email protected].
Assessment of Nutrition Profile of Pregnant Women in Mymensingh District Rahman

reproductive planning. Research shows how critical a types of study design, a cross-sectional study was
good diet full of the right nutrients can be, not only to conducted. It includes their economic and socio-
your fertility but also to your health and wellness demographic data, cultural practice, food habits, food
during pregnancy and to the all round prospects for beliefs and food prices.
your baby. There is a strong correlation between a A cross-sectional study or a prevalence study
mother’s diet during pregnancy and a baby’s birth measures the prevalence of symptomatic, determinant
weight and future health. Babies born with a low birth of the symptom, or both, in a population at one point in
weight are at greater risk of ill-health and disease, time or over a short period of time. It provides a
whereas those with a good weight are likely to have a snapshot of the health experience of a population at a
higher IQ and a better start in life. Recent research by given time. This information is very useful in assessing
Professor David Barker from the Medical Research the health status and needs of the population. The
Council suggests that a mother's prenatal nutrition can prevalence of a problem, rather than the incidence, is
even influence a child's long-term health. Good recorded in a cross-sectional survey.
nutritional planning can reduce the likelihood of
complications arising for mothers-to-be too, such as 2.1 Study Design
hypertension or gestational diabetes. And it can help to
reduce common problems like pregnancy sickness, 2.1.1 Sampling Frame
heartburn and constipation, as well as helping to Survey on nutritional status of pregnant women
improve your energy levels [2]. in Mymensingh district of Bangladesh. A total of 380
Malnutrition is not unknown matter at now in any pregnant women were randomly selected from health
of the worlds. It has created interest in nutrition from care centers (governments and non-governments) in the
the last 50th decade ago at national and international Mymensingh district of Bangladesh from early June
level. In the world, 60% of total population and 70% of 2007 to January 2008.
total children have affected malnutrition and among
50% of women suffer long-term energy deficiency, 2.2 Sampling Procedure
more than 70% of total pregnant women suffer anemia.
In our country, the most vulnerable groups of 2.2.1 Selecting of Sampling Units
population to malnutrition are children, pregnant Mymensingh medical college hospital, Surjer
women and lactating mother. It has been observed that Hashi Chinito Shastho Clinic, Jamtolamor, Patgutham
during abortion 4.4 per 1000 of live births of mother are Mor, Maa o Shishu Poribar Kollan Kendra Kalibari,
dead [3]. The Sun Pathology Center, Char Para Mor, Sadar-
Half of the total female and children in Bangladesh Mymensingh, Sasto o Poribar Kollan Kendra, Fulbaria-
are suffering from malnutrition. In slum area, 95% Mymensingh, Upazila Shastho Complex, Haluaghat,
mothers suffer from malnutrition. 50% of newborn Muktagacha, Trishal, Bhaluka, Gafargaon, Nandail,
babies are born with Low Birth Weight (LBW) due to Gouripur-Mymensingh.
malnutrition of the mother. 70% female in Bangladesh
2.2.2 Study Population
is low weight for height. In our country during
The study population consists of pregnant
pregnancy 40% in anemia, 15% in infection, 13% in
women of various areas in the Mymensingh district of
abortion 8% in complication, 12% suffer from high
Bangladesh. A total of 380 pregnant women were
blood pressure and 25% suffer bleeding after abortion
examined and with interviews from various area of the
[4].
Mymensingh district.
2. Methodology 2.2.3 Study Instruments
The questionnaire and some standard technique
Methods and materials are necessary for of anthropometric and biochemical measurements.
assessment, analysis, and surveillance of nutrition.
Nutritional problems are complex in their etiology and Questionnaire: A pregnant women were interviewed
their many different nutritional deficiency diseases. directly for information like age, family member, child
Knowing how they occur is one vital part of solving of respondent, educational qualification of pregnant
and better still, preventing nutritional problems. For women & their husband, family income, work status,
determination nutritional status and analysis nutritional family status & living status of pregnant women, daily
survey is conducted for collection of a broad range of requirements of nutrients, vaccination during
dietary, clinical, biochemical, anthropometric and pregnancy, awareness about common disorder during
socioeconomic data. It is usually included the regular pregnancy, proficiency any food taboos etc.
and timely collection Data, analysis and reporting of Appropriate question were prepared to ask the mothers
nutrition-relevant data. to drive information on the subject from which were to
For determination of nutritional status of pregnant be obtained by questioning. The question was first
women in the Mymensingh district, among several prepared in Bengali and then finalized in English. The
questionnaire is described in the appendix.

J. Adv. Lab. Res. Biol. 205

Assessment of Nutrition Profile of Pregnant Women in Mymensingh District Rahman

Table 1. Level of Nutritional Status based on Mid-Upper Arm second half. With excessive vomiting in early
[5]
Circumference (MUAC). pregnancy, a slight loss of weight may occur. Sudden
Mid-Upper Arm Category (Nutritional
changes in weight, either gain or loss may be harmful.
Circumference (cm) Status) On the basis of this weight gain, it can be categorized in
< 22 Severe Malnourished the following Table 2.
22-24 Malnourished
24-26 Normal Table 2. Level of weight gain and category of pregnant women.
≥ 27 Over Nourished
Trimester & amount of
Level of Weight
The UNHCR/WFP Guidelines for Selective weight gain (kg) Category
Gain st nd rd
Feeding Programs in emergencies, 1999 mentioned 1 2 3
MUAC < 22 is severely malnourished and that pregnant No/ Little < 0.5 < 1.5 < 1.5 Severe Malnourished
Moderate 0.5-1 2-4 2-4 Malnourished
woman is selected for selective feeding program for Ideal 1-2 4-5 4-5 Well Nourished
minimizing malnutrition. On the basis of this value (< Heavy >2 >5 >5 Over Nourished
22), it can be considered above category.
2.2.5 Physical Examination/ Clinical Assessment
2.2.4 Weight Gain during Pregnancy[6] The physical examination defined by Jelliffe
The optimal weight gain for pregnant women (1966), examines those changes, believed to be related
during pregnancy is about 1.5 Kg in the first three to inadequate nutrition, that can be seen or felt in the
months. In each subsequent month, the average gain superficial epithelial tissue, especially the skin, eyes,
should be 1.5 kg, being a little more in the last two or hair, and buccal mucosa, or in organs near the surface
three month. At full term, the total gain is about 10 kg. of the body (e.g. Parotid and thyroid glands). An
Fat deposition and placental growth proceed rapidly in example of the physical assessment form used in the
the first half of pregnancy and fetal growth in the Nutrition Canada National Survey is given in Table 3.
[7]
Table 3. Normal appearance and associated sign of malnutrition of various organs of the body of pregnant women.

Normal Appearance Signs Associated With Malnutrition

Lack of natural shine; hair dull and dry; thin and sparse; hair fine, silky, and straight;
Hair: shiny; firm; not easily plucked
color changes (flag sign); can be easily plucked
Skin color loss (depigmentation); skin dark over cheeks and under eyes (malar and
Face: Skin color uniform with a smooth,
supraorbital pigmentation); lumpiness or flakiness of skin of nose and mouth; swollen
pink, healthy appearance; not swollen
face; enlarged parotid gland; scaling of skin around nostrils (nasolabial seborrhea)
Eye membranes are pale (pale conjunctivae); redness of membranes (conjunctival
Eyes: Bright, clear, shiny: no sores at
injection); bitots spots; redness and fissuring of eyelid corners (angular palpebritis);
corners of eyelids; membranes are a
dryness of eye membranes (conjunctival xerosis); cornea has dull appearance (corneal
healthy pink & are moist. No prominent
xerosis); cornea is soft (keratomalacia); scar on cornea; ring of fine blood vessels
blood vessels or mound of tissue or sclera.
around cornea (circumcorneal injection).
Redness and swelling of mouth or lips (cheilosis); especially at corners of mouth
Lips: smooth, not chapped or swollen
(angular fissures and scars).
Tongue: Deep red in appearance; not Swelling: scarlet & raw tongue; magenta (purplish) color of tongue; swollen sores;
swollen or swollen hyperemic & hypertrophic papillae.
Teeth: no cavities; no pain; bright Maybe missing or erupting abnormally; grey or black spots (fluorosis); cavities (caries).
Gums: Healthy; red; do not bleed; not
Spongy & bleed easily.
swollen
Thyroid enlargement (front of the neck): parotid enlargement (cheeks become
Face: face not swollen
swollen).

[8]
Table 4. Hemoglobin levels in anemia (from ACC/SCN, 1991a).

Hemoglobin level (gm/100ml)

Hemoglobin below these levels means anemia
Children 6 months to 5 years 11
Children 6 years to 14 years 12
Men 13
Women (not Pregnant) 12
Women (Pregnant) 11
Mild, moderate and severe anemia
Normal > 11
Mild 10-11
Moderate 7-10
Severe <7

J. Adv. Lab. Res. Biol. 206

Assessment of Nutrition Profile of Pregnant Women in Mymensingh District Rahman

2.2.6 Biochemical Assessment Table 6. Distribution of nutritional status of pregnant women by

their level of weight gain.
a) Hemoglobin: Iron is an essential component of No. of Pregnant % of Pregnant
the hemoglobin, the oxygen-carrying pigment of Nutritional Status
Women Women
the red blood cells. Each hemoglobin molecule is Severe Malnourished 116 30.52
a conjugate of a protein (globin) and four Malnourished 139 36.57
molecules of haeme. Well Nourished 88 23.15
Over Nourished 37 9.73
Total 380 100
3. Results
The table shows the distribution of pregnant
After surveying on 380 pregnant women in the women according to their nutritional status during
region of the Mymensingh district of Bangladesh & pregnancy. In the Mymensingh district of Bangladesh
comparing various data I found the following results. 30.52% of pregnant women were severely
malnourished, 36.57% malnourished, 23.15% well
Table 5. Distribution of nutritional status of pregnant women by nourished and the rest of 9.73% were overnourished.
clinical appearance.
This data were obtained by calculating the weight gain
during pregnancy and nutritional status is categorized
No. of Pregnant % of Pregnant
Nutritional Status by comparing the data with standard weight gain Table.
Women Women
Severe Malnourished 113 29.69 The graphical representation is in the following.
Malnourished 131 34.39
Well Nourished 100 26.36 160

V a lu e B o th in N o . & %
139
Over Nourished 36 9.47 140
Total 380 100 120
116
No. of Pregnant
100 88 Women
The Table shows the distribution of pregnant % of Pregnant
80
women according to their nutritional status during Women
60
pregnancy by clinical appearance. In the Mymensingh 36.57 37
40 30.52
district of Bangladesh 29.69% of pregnant women were 23.15
20 9.73
severely malnourished, 34.39% malnourished, 23.15%
0
well nourished and the rest of 9.73% were
Severe Malnourished Well Over
overnourished. This data were obtained by observing Malnourished Nourished Nourished
the clinical appearance of pregnant women during
pregnancy. The graphical representation is in the Nutritional Status
following.
Fig. 2. Total number (n=380) and percentage of pregnant women by
their nutritional status.
131
V a lue Bo th in N o . & %

140
113 Figure shows, the blue bars indicated total number
120
100
No. of Pregnant and red bars indicated total percentage of pregnant
100
Women women according to their nutritional status. The bars
80
% of Pregnant also shows, in the region of the Mymensingh about
60 Women
29.69 34.39 36 30.52% of pregnant women were severely
40 26.36
9.47
malnourished, 36.57% malnourished, only 23.15% well
20
nourished, and the rest of 9.73% were overnourished.
0
Severe Malnourished Well Over
Malnourished Nourished Nourished
Table 7. Distribution of anemic condition of pregnant women by
the level of hemoglobin status.
Nutritional Status
No. of Pregnant % of Pregnant
Anemic Condition
Women Women
Fig. 1. Total percentage and number (n=380) of nutritional status of
Severe 21 5.52
pregnant women by clinical appearance.
Moderate 235 61.84
Mild 69 18.15
Figure shows, the blue bars indicated total number Nonanemic 55 14.47
and red bars indicated total percentage of pregnant Total 380 100
women according to nutritional status by clinical The table shows the distribution of pregnant
appearance. The bars also show, in the region of women according to level of anemic condition. In the
Mymensingh malnourished pregnant women is more Mymensingh district of Bangladesh, about 5.52%
than well nourished. pregnant women were severely anemic, 61.84%
moderate anemic, 18.15% mildly anemic and only

J. Adv. Lab. Res. Biol. 207

Assessment of Nutrition Profile of Pregnant Women in Mymensingh District Rahman

14.47% of pregnant women were nonanemic. The Figure shows, the blue bars indicated total number
graphical representation is in the following. and red bars indicated total percentage of pregnant
women according to their nutritional status by using
250 235 MUAC level. The bars also shows, in the region of the
Mymensingh majority of pregnant women (35%) were
V a lue B o th in N o . & %

200 malnourished and only 10.78% were overnourished.

No. of Pregnant w omen
150
% of pregnant w omen
4. Discussion
100
69
61.84 55 Pregnancy is the carrying of one or more offspring,
50
21 18.15
known as a fetus or embryo, inside the uterus of a
5.52 14.47
female human. In a pregnancy, there can be multiple
0
gestations, as in the case of twins or triplets. Human
Severe Moderate Mild Non-anemic
pregnancy is the most studied of all mammalian
Level of Anemic Condition pregnancies. Obstetrics is the medical field that studies
and treats pregnant patients. Childbirth usually occurs
Fig. 3. Total number (n=380) & percentage of pregnant women about 38 weeks from fertilization, i.e., approximately
according to level of anemic condition.
40 weeks from the start of the last menstruation. Thus,
pregnancy lasts about nine months, although the exact
Figure shows, the blue bars indicated total number
definition of the English word “pregnancy” is a subject
and red bars indicated total percentage of pregnant
of controversy.
women according to their anemic condition. The bars
Mymensingh is the poorest district of Bangladesh.
also shows, in the region of the Mymensingh majority
Malnutrition is the nutritional disorder caused by
of pregnant women (61.84%) were moderately anemic
insufficient, unbalanced or excessive diet or by
and only 14.47% were nonanemic.
impaired absorption or assimilation of nutrients by the
Table 8. Distribution of nutritional status of pregnant women by body. Especially it is a pathological state resulting from
Mid-Upper Arm Circumference (MUAC). a relative or absolute deficiency or excess of one or
more essential nutrients. Malnutrition is one of the
Nutritional Status
No. of Pregnant % of Pregnant major causes of morbidity and mortality in Bangladesh.
Women Women Malnutrition has severe consequences on pregnancy-
Severe Malnourished 110 28.94 related complications, premature birth, intrauterine
Malnourished 133 35
growth retardation, LBW and aggravates the risk of
Well Nourished 96 25.26
Over Nourished 41 10.78 perinatal and neonatal deaths. Addressing the synergic
Total 380 100 effect of malnutrition the NNP undertakes nutritional
interventions for mothers, children, and adolescent girls
The Table shows the distribution nutritional status in 105 upazilas of Bangladesh. One of the important
of pregnant women by using MUAC level. In the aims of the program is to intervene in inter-generational
Mymensingh region of Bangladesh about 28.94% of effects of malnutrition through improving the
pregnant women were severely malnourished, 35% nutritional status of pregnant and lactating women for
malnourished, 25.26% well nourished and only 10.78% reducing the incidence of LBW and getting better
of pregnant women were overnourished. This result health of children.
obtained by comparing the MUAC level with the
recommended table in methods & materials chapter. 5. Conclusion

140 133 Bangladesh is densely populated and poorest

country in the world with a low per capita income.
120 110
V alue Both in No. & %

96 About 47% of their population lives below the poverty

100 level. Although, it is mainly an agricultural country per
No. of Pregnant
80
Women
capita availability of land is only 0.38 acres and per
60 % of Pregnant capita, food income is only 13 ounces per day. Because
35 41 Women
40 28.94 25.26
of the scarcity of food more than half of the population
20 10.78 suffers from malnutrition and the majority of there are
women and children. The nutrition situation of the
0
Severe Malnourished Well Nourished Over Nourished
Mymensingh region of Bangladesh has not improved
M alnourished satisfactorily as an educational environment & need
Level of Nutrtitional Status more attention. Malnutrition, under-weight is more
common nutritional problems in Bangladesh. This
Fig. 4. Total number (n=380) & percentage of pregnant women condition may arise different types of complications
distribution by MAUC.

J. Adv. Lab. Res. Biol. 208

Assessment of Nutrition Profile of Pregnant Women in Mymensingh District Rahman

that are life threading for pregnant women. There is no References

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J. Adv. Lab. Res. Biol. 209