Received date: March 29, 2016; Accepted date: April 30, 2016; Published date: May 14, 2016
Citation: Okunaiya GA, Fadupin GT, Oladeji D (2016) Knowledge, Attitude and Practice of Maternal and Child Food-Based Dietary Guidelines among Pregnant Women in Urban Slum of Lagos State. Clinics Mother Child Health 13:240. doi:10.4172/2090-7214.1000240
Copyright: © 2016 Okunaiya GA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Adequate nutrition is an important factor for health and well-being of the mother and child during and after pregnancy. However, studies on the influence of the Nigeria’s national dietary food guidelines on health and nutritional status of pregnant women, especially, in poor-settings are sparse. The study assessed knowledge, attitude and practice of Food-Based Dietary Guidelines (FBDG) among pregnant women in urban slum of Lagos state. A total of 430 consenting pregnant women attending five selected Primary Health Care Centres in AjeromiIfelodun Local Government Area of Lagos State volunteered for this cross-sectional study. A pretested, intervieweradministered questionnaire was used as the survey instrument. Data was analyzed using descriptive and inferential statistics. The results of study showed that, the mean age of the respondents was 27.9 ± 5.2 years. The respondents were mostly married (82.2%), with secondary level education (58.0%), unemployed (61.6%) and with an estimated monthly income of approximately 33 American dollars per household (42.2%). A majority (95.1%) of the respondents have had advice on nutrition during pregnancy, obtained through antenatal clinic attendance (93.3%). Rates on adequate knowledge and positive attitude towards FBDG were 55.8% and 61.2% respectively. Rates for high, medium and low dietary diversity levels were 57.7%, 33.5%, and 8.8%. There was a significant association between level of dietary diversity and employment status (p<0.05). Less than half (43.5%) of the respondents had good practice of the FBDG. Financial constraints (68.1%) and cultural belief and norms (61.5%) were major factors limiting adequate nutrition during pregnancy and compliance with dietary guidelines. The study concluded that, Nigerian pregnant women living in urban slum of Lagos state have above average knowledge of the nutrition information and positive attitude towards dietary guideline, as contained in the Nigerian food based dietary guideline. Unemployed pregnant women had a higher dietary diversity compared with their employed counterparts. Financial constraint and cultural belief and norms were factors that act against compliance to dietary guidelines. It is therefore, recommended that national food based dietary guidelines education be incorporated into routine of antenatal care in Nigeria. Some practical suggestions to ensure the implementation of the Food Based Dietary guidelines include providing Healthcare workers at the Antenatal clinics training and resource materials to educate pregnant women attending antenatal clinics on the Food Based Dietary Guidelines. Also, every pregnant woman should get a free copy of a pictorial version of the Food Based Dietary Guideline.
Knowledge; Attitude; Practice; Pregnant women; Foodbased dietary guidelines
Nutrition is a central element of human life that is required for health and development . Particularly, adequate nutritional intake during and after pregnancy is important for health and well-being of the mother, as well as the child [2,3]. Consequently, appropriate dietary behavior and proper nutrient intake is essential for the optimum health for both mother and child [4,5]. Unfortunately, rate of dietary inadequacies is reported to be higher during pregnancy than at any other stage of the life cycle .
The relationship between poor maternal nutritional status and adverse birth outcomes is complex and multifactorial. Studies have implicated factors not limited to biologic, socio-economic, and demographic variables as important co-founders mediating the maternal nutritional status and birth outcomes nexus [7,8]. Consequences of inadequate maternal nutrition on the mother and child are replete in literature. Bhutta et al.  highlights intra uterine growth restriction, low birth weight, preterm birth, prenatal and infant morbidity and mortality as short term consequences of inadequate maternal nutrition. Maternal healthy nutrient intake during pregnancy may affect the wellbeing of the pregnant woman and developing fetus , birth outcomes  and child’s disease in adulthood . As such, malnourished mothers face greater risks during pregnancy and childbirth; in addition, their infants are set off on a weaker physical and mental developmental path [12-14].
Dietary interventions involving use of Food–Based Dietary Guidelines (FBDG) have been reported to be effective in improving maternal malnutrition and its attendant negative birth outcomes [4,5,15]. As nutrition knowledge was predictive of change in dietary habits and health advices encouraged expectant women to advance their food intake . FBDG as a general public dietary intervention programme, are simple messages on healthy eating [16,17]. FBDG gives suggestion on what an individual should be eating in terms of food rather than nutrients. The FBDG is a professional dietician’s guide, which is helps to plan diet from all the food groups and to establish principles for good eating habits needed for disease prevention in the general population. Nigeria began developing its dietary guidelines in 2000 through a collaboration with the Ministries of Health, Agriculture and Rural Development and Information; Universities, World Health Organization, Helen Keller International, International Institute of Tropical Agriculture, and Pediatric and Nutrition societies. The dietary guideline was published in English, Hausa, Igbo and Yoruba in 2001. However, studies on the influence of the national dietary food guideline on health and nutritional status of pregnant women, especially, in poor-settings are sparse. This study assessed knowledge, attitude and practice of FBDG among pregnant women in urban slum of Lagos State.
A total of 430 consenting pregnant women attending five selected Primary Health Care Centres (PHCs) namely Layeni, Akere, Amukoko, Tolu and Ibafon in Ajeromi-Ifelodun Local Government Area (LGA), in Badagry Division of Lagos State, Nigeria volunteered in this cross-sectional study. According to the Nigerian population census of 2006, Ajeromi-Ifelodun LGA, as one of the worlds’ most densely populated areas, occupies 57,276.3 per square kilometer and has 687,316 inhabitants. Located in the heart of Lagos, Ajeromi-Ifelodun LGA is a notorious slum and home to inhabitants from all the tribes of West Africa with Ajegunle as its headquarters .
Ethical approval for the study was sought from University of Ibadan/University College Hospital Ethics Review Committee. Permission was also obtained from Ajeromi Ifelodun LGA authorities before the commencement of the study. All respondents gave signed informed consent for participation in the study. Inclusion criteria for involvement in this study were being pregnant and also registered with any of the PHCs. Volunteers was excluded if there was self-reported current illness, pregnancy-related co morbidity and if they were not literate in English or Yoruba language.
A formula n=(z α/2) (zα/2) pq /d*d  was used to estimate the Based on the assumption that 50% of the pregnant mothers were not knowledgeable, had negative attitude and did not practice dietary guidelines during pregnancy with 5% marginal error and 95%CI and a none response rate of 10%, the actual sample size for the study was determined. Where n=sample size; z=z value corresponding to a 95% level of significance=1.96; p=expected proportion, i.e. 50% or 0.5; q=(1-p)=(1-0.5)=0.5; d=absolute precision (5%); and none response rate=10%. Therefore, the sample size was 1.96*1.96*0.5*0.5/0.05*0.05. n=384+38=422.
A pretested, interviewer-administered questionnaire was used as the survey instrument. The structured questionnaire assessed knowledge and attitude. Standard nutrition knowledge questions required during pregnancy as contained in the FAO . Knowledge, Attitude and Practice (KAP) manual and also from national dietary guidelines were asked. Attitudes were measured by asking the respondents to judge whether they were positively or negatively inclined towards nutrition recommendations or FBDG. The respondent rated their answer on a five-point likert scale of ‘strongly disagree’, ‘disagree’, ‘indifferent’, ‘strongly agree’, and ‘agree’. A Dietary Diversity Questionnaire and a Food Frequency Questionnaire (FFQ) were used to assess respondent’s practice of dietary guidelines. Dietary Diversity is used as a proxy of the nutrient adequacy for individuals [20,21] while FFQ is sufficient to find out about food practices of a population. FFQ is believed to be easy to administer and less expensive than 24-hour-recall surveys [22-24]. The instruments were pre-tested for their comprehensibility in the accessible population and a Yoruba version of the combined questionnaire (Yoruba language is the native language in the accessible population) was made available for the study.
Data entry, checking and analysis were done using Statistical Package for Social Science (SPSS) software. The Data was analyzed using descriptive statistics such as mean, standard deviation, range, and percentages. Inferential statistics of Chi-Square was used to test the association between the selected variables at p<0.05.
The socio-demographic characteristics of the respondents are presented in Table 1. The mean age of the respondents was 27.9 ± 5.2 years. A majority of the respondents were; within the ages of 20-29 years (61.4%), married (82.2%), unemployed (61.6%), of the Yoruba tribe (46.2%), of secondary level education (58.0%); of Christian religion (66.9%) and makes estimated monthly income of 33 American dollars in a household (42.2%). The distribution of respondents by 1st, 2nd and 3rd trimester of pregnancy was 14.6%, 40.0% and 45.4% respectively. Lifestyle and living methods of the respondents is presented in Table 2. The respondents were mostly; never alcohol consumers (70.2%), not involved in any form of exercise (59.7%), and not involved in cigarette smoking (99.0%). About 12.7% and 7.4% of the respondents depend on personal generator and non-electric devices respectively as the source of energy. Wells were the primary source of water for drinking and other domestic uses (37.8%). The primary method of refuse disposal was mostly by city waste disposal service (66.2%). Sewage disposal were mostly by water system (41.8%), pit latrine (25.1%), VIP latrine (20.0%) and bush defecation (11.0%) respectively.
|Age (Years) 27.9±5.2 years|
|Highest level of education?|
|No formal education||5||1.2|
|Number of Children|
|Occupation of household head|
|Estimated monthly income in a household|
|Less than or equal to 33 American Dollars||178||42.2|
|36-65 American Dollars||40||9.5|
|69-98 American Dollars||49||11.6|
|100-163 American Dollars||143||33.9|
|167-327 American Dollars||12||2.8|
Table 1: Socio-demographic characteristics of the respondents.
|Frequency of taking exercise (Hours/week)?|
|Primary source of energy|
|Rural electricity boar||20||4.8|
|Primary source of water|
|Pipe borne water||4||1|
|Method of refuse disposal|
|Method of sewage disposal||47||11|
Table 2: Lifestyle and living methods of the respondents.
Knowledge about dietary guideline by the respondents is presented in Table 3. A majority (95.1%) of the respondents have had advice nutrition during pregnancy. Advice on nutrition during pregnancy was obtained via antenatal clinic (93.3%). Eating more at each meal daily (77.2%) and the use iron and folic acid supplements during pregnancy (93.1%) were mostly supported by the respondents. In addition, more than half of the respondent (55.0%) support that slower growths, being sick and dying are health risks for low-birth-weight babies. Based on mean score, 55.8% of the respondents had adequate knowledge about the dietary guidelines while 44.2% had inadequate knowledge.
|Item||Yes n(%)||No n(%)|
|Have ever been advised on what to eat during pregnancy?||409(95.1)||21(4.9)|
|Had information on what to eat during pregnancy from the antenatal clinic||401(93.3)||29(6.7)|
|A pregnant woman eat more at each meal (eat more food each day)||332(77.2)||98(22.8)|
|Most women would benefit from iron and folic acid supplements during pregnancy||393(93.1)||29(6.9)|
|Slower growths, being sick and dying are the health risks for low-birth-weight babies||232(55.0)||190(45.0)|
Table 3: Knowledge of dietary guideline by respondent.
Attitude of respondent towards compliance with dietary guidelines is presented in Table 4. A majority of the respondents agreed that: inadequate and inappropriate nutrition can determine body weight of the baby (66.8%); and financial (68.1%) and cultural (61.5%) constraints make it difficult for you to assess a variety of food from different food groups. Furthermore, the respondents agreed that taking supplements as prescribed determines good health for both mother and unborn child (84.1%). It was also agreed that financial constraints make it difficult to consume enough food to ensure adequate weight gain (72.5%). Based on the mean score obtained from correctly answering to the attitude questions, more than half (61.2%) of the respondents had positive attitude towards the dietary guidelines.
|Item||Disagree n(%)||Indifference n(%)||Agree n(%)|
|Inadequate and inappropriate nutrition can determine body weight of the baby||65(15.4)||75(17.8)||282(66.8)|
|Low birth weight babies are at risk of infections and diseases||170(43.2)||62(15.7)||162(41.1)|
|To have a balanced diet, eat a variety of foods from different food groups||137(33.1)||20(4.8)||257(62.1)|
|Financial constraints make it difficult for you to assess a variety of food from different food groups||110(26.6)||22(5.3)||282(68.1)|
|Cultural reasons make it difficult for you to assess a variety of foods from different food groups||137(32.8)||20(4.8)||261(61.5)|
|Burden of food preparation makes it difficult for you to assess variety of foods from different food groups||125(30.3)||95(23.0)||193(46.7)|
|Consuming enough food ensures adequate weight gain||107(25.4)||12(2.8)||303(71.8)|
|Financial constraints make it difficult to consume enough food to ensure adequate weight gain||107(25.6)||8(1.9)||303(72.5)|
|Cultural reasons make it difficult to consume enoughfood to ensure adequate weight gain||261(63.7)||32(7.8)||117(28.5)|
|Taking supplements as prescribed determines good health for both mother and unborn child||67(15.9)||0(0)||355(84.1)|
|Drinking alcohol during pregnancy can pose a health risk for mother and unborn baby||156(37.0)||4(0.9)||262(62.1)|
Table 4: Attitude of respondent towards compliance with dietary guidelines.
The food pattern and practice (for cereals, roots and tubers, legumes and vegetables) of the respondents is presented in Table 5. The main staple foods from roots and tubers were yam (boiled/roasted) (44.9%); cooked rice (57.2%) and whole wheat bread (78.6%). Cooked cowpea (51.6%), cowpea pudding “moinmoin” (47.0%), and fried cowpea “akara” (54.9%) were the most regularly consumed legumes.
|n (%)||n (%)||n (%)||n (%)|
|Maize/Pap “Ogi”||269 (62.5)||120 (27.9)||33 (7.7)||8 (1.9)|
|Maize/Agidi||113 (26.3)||100 (23.3)||155 (36.0)||62 (14.4)|
|Maize/Tunwomasara||2 (0.5)||8 (1.8)||45 (10.5)||375 (87.2)|
|Rice (Cooked)||24 (5.6)||65 (15.1)||95 (22.1)||246 (57.2)|
|Tunwoshinkafa||70 (16.3)||88 (20.5)||118 (27.4)||154 (35.8)|
|Whole wheat bread||0 (0.0)||14 (3.3)||78 (18.1)||338 (78.6)|
|White bread||22 (5.1)||116 (27.0)||200 (46.5)||92 (21.4)|
|Biscuit||207 (48.1)||84 (19.5)||78 (18.1)||61 (14.2)|
|Roots and tubers|
|Cassava “Eba”||70 (16.3)||134 (31.2)||158 (36.7)||68 (15.8)|
|Cassava “Lafun”||198 (46.0)||77 (17.9)||91 (21.2)||64 (14.9)|
|Cassava “Fufu”||135 (31.4)||160 (37.2)||107 (24.9)||28 (6.5)|
|Yam asted/boiled)||34 (7.9)||80 (18.6)||123 (28.6)||193 (44.9)|
|Yam flour “Amala”||111 (25.8)||124 (28.8)||115 (26.7)||80 (18.6)|
|Pounded yam||130 (30.2)||189 (44.0)||81 (18.8)||30 (7.0)|
|Yam porridge||178 (41.4)||167 (38.8)||65 (15.1)||20 (4.7)|
|Yam (Fried)||284 (66.0)||102 (23.7)||28 (6.5)||16 (3.7)|
|Cocoyam (Cooked)||313 (72.8)||93 (21.6)||16 (3.7)||8 (1.9)|
|Cocoyam (Fried)||190 (44.2)||180 (41.9)||42 (9.8)||18 (4.2)|
|Sweet potato (Cooked)||222 (51.6)||140 (32.6)||58 (13.5)||10 (2.3)|
|Sweet potato (Fried)||28(6.5)||64(14.9)||129(30.0)||209(48.6)|
|Cowpea (Cooked/boiled)||2 (0.5)||152 (35.3)||222 (51.6)|
|Cowpea (Cooked/boiled)||36 (8.4)||58 (13.5)||134 (31.2)||202 (47.0)|
|Cowpea pudding “Moinmoin”|
|Cowpea Fried “Akara”||22 (5.1)||64 (14.9)||108 (25.1)||236 (54.9)|
|Green leafy vegetables|
|Green Leafy vegetable||82 (19.1)||176 (40.9)||117 (27.2)||55 (12.8)|
|Non green leafy(Okro)||66 (15.3)||84 (19.5)||117 (27.2)||163 (37.9)|
Table 5: Food pattern and practice (for cereals, roots and tubers, legumes and vegetables) of the respondents.
Also, the food pattern and practice (for fat and oil, fruits, animal protein and beverages) of the respondents is shown in Table 6. From the result, animal protein intake was mostly from fish (49.3%) while dairy products were rarely consumed. Oranges/tangerine (46.6%), carrot (47.8%), and plantain (45.6%) constituted the regular fruits intake of the respondents. Consumption of “Okro” soup was common (37.9%) while the use of vegetable oil (47.0%) during food preparation was the major source of fat and oil.
|Fat and Oil|
|Vegetable oil||65 (15.1%)||40 (9.3%)||123 (28.6%)||202 (47.0)|
|Cashew seed nut||178 (41.4)||76 (17.7)||98 (22.8)||78 (18.1)|
|Oil palm nut||72 (16.7)||126 (29.3)||129 (30.0)||103 (24.0)|
|Coconut||307 (71.4)||80 (18.6)||33 (7.7)||10 (2.3)|
|Oranges/Tangerine||12 (2.8)||59 (13.7)||159 (37.0)||200 (46.6)|
|Mango||6 (1.4)||32 (7.4)||106 (24.7)||286 (66.5)|
|Pawpaw||178 (41.4)||76 (17.7)||98 (22.8)||78 (18.1)|
|Guava||72 (16.7)||126 (29.3)||129 (30.0)||103 (24.0)|
|Pineapple||307 (71.4)||80 (18.6)||33 (7.7)||10 (2.3)|
|Water melon||349 (81.2)||80 (18.6)||33 (7.7)||10 (2.3)|
|Cashew||82 (19.1)||176 (40.9)||117 (27.2)||55 (12.8)|
|Pear||66 (15.3)||84 (19.5)||117 (27.2)||163 (37.9)|
|Carrot||65 (15.1)||40 (9.3)||123 (28.6)||202 (47.0)|
|Banana||38 (8.8)||117 (27.2)||151 (35.1)||124 (28.8)|
|Plantain||12 (2.8)||51 (11.9)||171 (39.8)||196 (45.6)|
|(a)Beef and poultry|
|Beef||221 (51.4)||109 (25.3)||52 (12.1)||48 (11.2)|
|Poultry||128 (29.8)||151 (35.1)||91 (21.2)||60 (14.0)|
|Fish||6 (1.4)||56 (13.0)||156 (36.3)||212 (49.3)|
|Egg||118 (27.4)||113 (26.3)||122 (28.4)||77 (17.9)|
|b) Dairy products|
|Fresh milk||88 (20.5)||123 (28.6)||140 (32.6)||79 (18.4)|
|Tinned milk||239 (55.6)||88 (20.5)||65 (15.1)||38 (8.8)|
|Cheese||26 (6.0)||74 (17.2)||135 (31.4)||195 (45.3)|
|Yoghurt||120 (27.9)||83 (19.3)||98 (22.8)||129 (30.0)|
|Tea ( Lipton tea, top tea)||193 (44.9)||116 (27.0)||79 (18.4)||42 (9.8)|
|Beverages (Milo, Bournvita)||38 (8.8)||117 (27.2)||151 (35.1)||124 (28.8)|
Table 6: Food pattern and practice (for fat and oil, fruits, animal protein and beverages) of the respondents.
Dietary diversity of the respondents is shown in Table 7. Starchy staple (99.1%) and Vitamin-A rich fruits and vegetables (81.9%) were the most common dietary diversities, while the least was organ meat (2.3%). Based on dietary diversity scores, the rates for high, medium and low dietary diversity among the respondents was 57.7%, 33.5%, and 8.8%. In this study, majority of pregnant women (60%) who were unemployed had a high dietary diversity.
|Dark green leafy vegetable||203(47.2)||227(52.8)|
|Vitamin-A rich fruits and vegetables||78(18.1)||353(81.9)|
|Other fruits and vegetables||363(84.7)||66(15.3)|
|Meat and fish||140(32.6)||290(67.4)|
|Legume, nuts and seeds||207(48.1)||223(51.9)|
|Milk and milk products||260(60.5)||170(39.5)|
Table 7: Dietary diversity of the respondents.
It was also discovered that a larger percentage (16%) of the employed pregnant women were among the pregnant women with low dietary diversity compared to (3%) unemployed pregnant women. Indicating that the employment of pregnant women is associated with their dietary diversity (p<0.05). This study is similar to Sakhile et al. 2014 in Swaziland which showed a significant association between employment and nutritional practices. This might be due to the employed eating what is readily available at the workplace and having no time to prepare a more diversified diet.
The pregnant woman who may assess a diversified diet by virtue of socio-economic status based on having employment is relatively low. Majority of the unemployed pregnant women would be dependent on their partners for income. Overall, the distribution for good and poor practice of the national food based dietary guidelines was 43.5% and 56.5% respectively.
This study assessed knowledge, attitude and practice of FBDG among pregnant women in urban slum of Lagos State. FBDG is a key strategy to promoting healthy daily food consumption and appropriate lifestyles of Individuals . Majority of the pregnant women in the study were within the ages of 20-49 years which is within the reproductive age for women. Results of the study showed most of the pregnant women have had advice on maternal nutrition during pregnancy by health care providers while attending ante-natal clinics. This finding buttresses the importance of ante-natal clinics in promoting nutrition and well-being of mother and child [25,26].
According to D’Alimonte et al. , the relationship between mother and health worker seemed to influence how well they listened to the health workers' recommendations. Programs to include social support and counselling training for health workers to engage more closely with mothers; exploring the feasibility of a women's social group for mothers to share information on about healthy eating and the link between nutrition and health should be introduced. Studies by Rao et al.  show that nutritional education and counselling influences maternal and child health outcomes.
More than half of the pregnant women in the study had adequate knowledge and showed positive attitude towards compliance of dietary guidelines. However, more than half of the pregnant women had poor practice (based on dietary diversity scores) about dietary guidelines. A study carried out by  in Swaziland showed that nutritional knowledge and attitude among pregnant and lactating women did not necessarily translate to practice. Most of the pregnant women agreed that “financial constraint” and “cultural belief and norms” were factors that act against compliance to dietary guidelines. Literature has shown that low socioeconomic status is associated with the consumption of poor and monotonous diets, food insufficiency and the risk of a variety of micronutrient deficiencies is high. Therefore, food intakes of the women are likely to be more sensitive to diminishing household resources when compared to the intakes of other family members who may not be depriving themselves of food .
Cultural factors and household food security situation have been identified as underlying factors that influence the nutritional status . Pregnant women in various parts of the world are forced to abstain from nutritious foods due to traditional food habits even if the foods are available in abundance [32,33]. Also, cultural beliefs and practices may also impose restrictions to foods eaten by pregnant women of reproductive age [32,34]. Cultural taboos might have prevented pregnant women from eating seasonally available foods .
Fruits and vegetables were not frequently taken by about half of the pregnant women in the study. A study among pregnant women in three urban slums in India showed that estimates of green leafy vegetables and fruits were low while consumption of energy and fats were high . A study carried out in Swaziland by the World Health Organization  highlighted an overall low consumption of fruits and vegetables among adults. A study carried out in the United States of America by Drewnoski and Specter  found out the low prices of energy dense foods and high prices of most proteinous and vitaminrich foods affected the poorer working class from consuming these nutrient dense foods. More than two thirds of the pregnant women in this study were unemployed. Estimated monthly income per household of about half of the pregnant women was approximately 33 American dollars$ indicating poor financial conditions which may affect their food selection and food intake.
The study also reported that, majority of pregnant women who were unemployed had a high dietary diversity. Among the pregnant women who were employed, only a few had low dietary diversity. Thus, a significant association was observed between employment status of the pregnant women and dietary diversity. A study carried out in Swaziland showed a significant association between employment and nutritional practices . It is adduced that employed pregnant women eat what is readily available at the workplace and have no time to prepare a more diversified diet.
The study has some potential limitations. The self-report nature of the study may shield actual nutritional practices of the respondents, as well as the problems with recall bias that is often associated with crosssectional studies of this nature. Also, the heterogeneous nature of the sample (based on socio-demographic characteristics) and the peculiar characteristics of the study population (being an urban slum) may affect the external validity of the findings to other populations of pregnant women. Furthermore, some of the respondents felt uncomfortable answering questions on their current alcohol consumption.
Pregnant women living in urban slum of Lagos state, Nigeria have above average knowledge of the nutrition information as contained in the Nigerian food based dietary guideline. The pregnant women have adequate knowledge and positive attitude towards dietary guideline, which did not totally translate into good nutritional practices. Unemployed pregnant women had a higher dietary diversity compared with their employed counterparts. Financial constraint and cultural belief and norms were factors that act against compliance to dietary guidelines. It is recommended that national food based dietary guidelines education be incorporated into routine of antenatal care in Nigeria.
These are some practical suggestions to ensure the implementation of the Food Based Dietary guidelines; i) Healthcare providers at the Antenatal clinics should be trained and provided with resource materials to educate pregnant women attending antenatal clinics on the Food Based Dietary Guidelines. ii) Every pregnant woman should get a free copy of a pictorial version of the Food Based Dietary Guideline. iii) The government should provide food subsidy for pregnant women. iv) Charity Organizations and other stake-holders should provide free Fruits and Vegetables to pregnant women attending antenatal clinics to help them achieve a more diversified diet.