Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania.

Food cravings, aversions and pica are common during pregnancy and may have a significant input on pregnancy progress and outcome. A study was carried out to determine the frequency and duration of pronounced dietary cravings, aversions and pica during pregnancy among 204 pregnant and lactating women attending two health facilities in Dar es Salaam City, Tanzania. Nausea and vomiting were reported by 82.8% of all women of which 43.2% experienced severe nausea alone, 9.5% severe vomiting alone and 35.5% experienced severe vomiting and nausea. Mild cases of each of the symptoms either occurring alone or both of them occurring together were also reported. Both behaviours were observed more in <3 months of pregnancy. The proportions of women with dietary cravings, aversions, and pica were 73.5%, 70.1% and 63.7% of all women respectively. More women (70.1%) experienced both food cravings and aversions than either symptom alone. Foods craved most were meat (23.3%), mangoes (22.7%), yoghurt (20.0%) oranges (20.0%), plantain (15.3%) and soft drinks (13.3%). Foods avoided most were rice (36.4%), meat (36.4%) and fish (30.8%). Eggs, beans, tea and stiff porridge were also avoided. Reasons given for avoiding foods were unpleasant smell/taste (10.3%), to reduce nausea (11.8%), no particular reason (58.3%) and dislike by foetus (belief) (3.9%). Pica was experienced by 63.7%% of the women and soil, ice and ash were the most commonly non-food substances eaten. The frequency of nausea and vomiting was highest in the early months of pregnancy and most women experienced the symptoms during morning hours. Craving in most women was more intense in the first trimesters. Most women craved for meat and sour and savoury foods, and avoided rice, meat and fish. Soil consumption was the pica observed in most women. Since aversions and cravings are closely linked to dietary intake of pregnant woman understanding these behaviours is important in addressing maternal nutrition.

Nutritional status of underfive children in a pastoral community in Simanjiro district, Tanzania.

A study was conducted in Simanjiro district in northern Tanzania to determine the nutritional status of underfive children in a pastoral community. Weight and height measurements were carried out on 250 children and that of mean upper arm circumference (MUAC) on 226 children. The z-scores of weight-for-age, weight-for-height and height-for-age indicated that 31.2% of the children were underweight and 6.0% were severely underweight. Wasting was observed in 17.2% children of whom 3.2% were severely wasted. Severely stunted children were 3.2% while 14% were moderately stunted. Measurements of MUAC indicated that 35% and 3.5% of the children were moderately and severely undernourished, respectively. The nutritional status of the children under study was slightly lower than the national average. In conclusion, malnutrition in Simanjiro district is prevalent, and therefore, appropriate multidisciplinary approach on nutrition education, environmental sanitation and hygienic practices at family and community level need to be promoted to reduce childhood illnesses thereby increasing child health and nutritional status.

Maternal weight gain in second and third trimesters and their relationship with birth weights in Morogoro Municipality, Tanzania.

A prospective study was carried out to determine the relationship between weight gain in the second and third trimesters with the corresponding birth weights in Morogoro, Tanzania. A total of 270 pregnant women who gave birth to singleton deliveries and their consecutive newborns were randomly selected from among women who were attending one antenatal clinic. Average weight gains in second and third trimesters were 2.45 +/- 0.68 and 2.14 +/- 0.43 kg, respectively (a total of 4.59 +/- 1.11 kg) for the two trimesters. Weight gains per week were 0.47 +/- 0.16 and 0.33 +/- 0.13 kg for the second and third trimesters, respectively. Weight gain in the two trimesters was lower than the expected value for the same period. Results from Pearson correlation analysis found a positive correlation (P < 0.001) between birth weight and variables such as maternal age, gestational period, parity, weight gain in both second and third trimester, birth length and sex of an infant. Multiple regression analysis indicated that birth weight (dependent variable) was significantly affected by maternal weight gain in the third trimester, maternal age (both at P < 0.05) and birth length (P < 0.001). The incidence of low birth weight was about 8% and was significantly higher among infants of teenager mothers. It appears that despite of possibility of some physiological adaptations, which tend to protect the foetus when the woman is subjected to inadequate weight gain during pregnancy, weight gains in the second and third trimesters are important in determining the birth weight.

Feeding frequency and nutrient content of foods commonly consumed in the Iringa and Morogoro regions in Tanzania.

Information on the nutrient content of foods commonly consumed (especially indigenous ones) in rural communities of Tanzania is limited. A study was conducted to determine the nutrient content of foods commonly consumed in the Iringa and Morogoro regions. A survey was carried out in six representative villages to identify the types of foods and to determine the frequency of their consumption. Representative samples of the raw foods were collected from local markets and brought to the laboratory for analyses. Determination of protein was done by the micro-Kjeldahl method, fat by Soxhlet extraction and moisture by an oven-drying method. The mineral content was determined by atomic absorption spectrophotometer. The results showed that there is a wide range of foods commonly consumed in the two regions, especially legumes and vegetables. The frequency of consumption depended mainly on the season, whereby during the dry season the frequency of consumption was two to three meals per day and in the rainy season was one to two meals per day. Foods rich in fats were nuts and oil seeds, while good sources of protein included legumes, nuts and oil seeds especially pumpkin seeds, which contained 34.36 g/100 g edible portion. Indigenous vegetables such as mnavu (Solunum nigrum), twangabilidiga, mlenda (Corchorusolitarus) and mkochwe were rich in iron and calcium, with values as high as 24.78 mg iron in twangalibidiga and 812.41 mg calcium/100 g edible portion in mkunungu. Magnesium was highest in mtosi (288.58 mg) and copper was highest in mkunungu (0.49 mg). Mkochwe contained the highest amount of manganese. This study shows that foods locally produced in these regions are rich in nutrients, especially micronutrients, and therefore if consumed in adequate amounts may help to prevent dietary-related disorders.

Nutritional status and feeding practices of under-five children in Simanjiro District, Tanzania.

This study was undertaken to assess the nutritional status and feeding practices of < 5 year children among the pastoral communities of Simanjiro district, northern Tanzania. Face-to-face interviews with the sampled mothers were conducted using a semi-structured questionnaire. Anthropometric measurements using weight-for-age criterion were employed to assess the nutritional status. The study showed that 31% of the children were undernourished, some (6%) of them severely. Children 2 - 3 years old were the most affected. Breastfeeding duration of more than one year was common among the mothers. Fifty-four percent of the mothers weaned their children as early as two months after birth. The most common type of weaning food was maize porridge (gruel) mixed with cow's milk (46%). Generally, 87% of households were facing some degree of food insecurity where some of them either experienced food shortage for 3-4 months (40%) or reported to eat less than three meals per day (75%). An educated mother was less likely to have an undernourished child, while a child from a teenage mother was more likely to be undernourished. Small size of a household was in favour of nutrition status. There is a great need to undertake interventions through community education to rescue the situation in Simanjiro district. Efforts should also be undertaken to mobilize the community members to adopt practices that favour good nutrition of children.

Nutritional status, functional ability and food habits of institutionalised and non-institutionalised elderly people in Morogoro Region, Tanzania.

OBJECTIVE: To determine nutritional status, food habits and functional abilities of the institutionalised and non-institutionalised elderly. DESIGN: A cross-sectional population survey. SETTING: Free living and institutionalised elderly of Morogoro municipality, Tanzania. SUBJECTS: A total of 100 elderly people, fifty institutionalised and fifty non-institutionalised were included. Gender distribution was of equal numbers. MEASUREMENTS: Anthropometric measurements of weights and heights were taken to enable calculation of Body Mass Index (BMI) of each subject. Questionnaires were used to collect information on types of foods, amount and frequency of consumption and functional abilities of the elderly. Amount of food consumed was expressed in grams per person per day. RESULTS: There were significant differences (p=0.001) in nutritional status between the institutionalised and the non- institutionalised males, but this relationship did not exist among the females. Similarly, 30% and 26% of the institutionalised males and females, respectively, and none of the non- institutionalised males was observed to be overweight. On the other hand, 39% and 23% of the non-institutionalised males and females, respectively, were underweight or malnourished. Consumption of sardines was higher (p=0.05) among the institutionalised subjects, but the situation was opposite for the case of fruits. Alcohol consumption was higher (p<0.05) among non- institutionalised subjects in both sexes. No difference was noted in consumption of beans, vegetables, cereals and meat. The most common functional disability was urinary incontinence (36%) while feeding (5%) was the least common. The most affected by urinary incontinence were institutionalised male subjects. CONCLUSION: There was a great variation between elderly people who are cared for in institutional centres and those who are cared for by their relatives in terms of nutritional status, reflected by their BMI levels. The institutionalised ones appear to be better off than their counterparts. However, this condition is not equally reflected in their eating habits. Generally, most of the elderly have poor or no source of income, which make them to have poor living conditions. They are also faced with problems of functional disabilities of which urinary incontinence was more common among males.

Does preventive health care have a chance in the changing health sector in Tanzania?

OBJECTIVE: To investigate the status and practice of preventive health care (relative to curative) in the health delivery system at the time when the health sector reforms are taking place. DESIGN: A cross-sectional, descriptive study. SETTING: The study was conducted in Morogoro District between January and May 1999. SUBJECTS: Eighty six medical personnel and two hospital administrators from thirty four health facilities. The health facilities included twenty five dispensaries, five health centres and four hospitals. Care was also taken to include health facilities owned by various institutions and organisations, including governmental and non-governmental. RESULTS: Generally, preventive health received little attention compared to the curative health measures whereby more than 80% of the medical personnel in some of the facilities were assigned to curative services. Health personnel reported to spend an average of up to six hours per day providing curative services such as chemotherapy, surgical treatment, psychotherapy and radiography. On the contrary, they spent about four hours or less on providing child immunisation and education on nutrition, health and family planning. As expected, the type of ownership of a health facility influenced the extent to which preventive measures were included. For example, while all the government owned facilities did provide child immunisation, nutrition education and family planning services, some non-governmental facilities were lacking such services. CONCLUSION: It is obvious that while the provision of curative health care can be left to the hands of the private suppliers, that of preventive health care needs strong government involvement. It is suggested that deliberate efforts be taken to shift resources from curative to preventive measures. One way in which such a strategy can be attained is for the government to set, as a condition for private operators, a minimum level of preventive measures to be provided by every operator before a permit is issued. However, caution should be taken to ensure that such deliberations do not discourage investors in the health sector.

Prevalence and awareness of obesity among people of different age groups in educational institutions in Morogoro, Tanzania.

OBJECTIVE: To determine the prevalence rates and level of awareness of obesity among people of different age groups in Morogoro Municipality, Tanzania. DESIGN: A cross-sectional, descriptive study. SUBJECTS: One hundred adults aged 19-50 years old and 40 pupils aged 14-18 years old. SETTING: Four educational institutions in Morogoro Municipality were included in the study. The four institutions included a primary and a secondary school, a teacher's training college and a university. RESULTS: The prevalence of obesity among the sampled subjects in Morogoro Municipality was 25 %, whereby 15.7% had a Body Mass Index (BMI) of between 25 and 30, and 9.3% had a BMI of more than 30. Age and occupation of all the subjects, together with marital status of adult subjects, were significantly related with obesity status. Prevalence of obesity increased with the increased age whereby subjects in the 41-50 years had the highest rate (45.4%). Employed subjects had higher rate of obesity (22.2%) than pupils or students. Similarly, married adults had higher rate of obesity (27.8%) than the single ones (4.7%). Unlike the old age group (41-50 years), 70% of the youngest subjects were not aware about the harmful effects of obesity. On the other hand, more than two thirds of all the subjects could not associate excess body weight with chronic non-communicable diseases such as coronary heart disease, high blood pressure and breathing problems. CONCLUSION: Results of the current study indicate that obesity is increasingly becoming a public health problem in Morogoro Municipality, and probably in many other places in Tanzania. There is need for more public awareness on the effect of obesity on people's health through information, education and communication. It would be of great importance if such interventions were introduced at early age of life, for example by inclusion in school curricula.