Factors associated with maternal dietary practices among pregnant women attending antenatal care services in the Southern Province of Rwanda

Abstract

Maternal dietary practices during pregnancy are vital for maternal and foetal health. Poor dietary practices, common in developing countries, lead to complications such as low birth weight, preterm births, and maternal morbidity. These outcomes also increase healthcare costs and economic burdens. Despite the tragic history of Rwanda that led to a major loss of resources, Rwandan government interventions, including kitchen gardens, the Girinka program where the Government gives the cow to the poor family, and antenatal care (ANC) education, aim to address these issues. In addition, the journey to motherhood is influenced by healthcare professionals in ANC services as well as the male partners considering the Rwandan nuclear family structure. However, significant gaps remain, particularly in Rwanda's Southern Province, where maternal anaemia, underweight and associated neonatal complications are highly prevalent. This study assesses dietary practices, their determinants, and the role of male partners and healthcare providers in supporting pregnant women to inform targeted interventions. In this research, I used a two-phase approach. Phase one was a scoping review guided by Arksey and O’Malley's framework, exploring literature from Sub-Saharan Africa (SSA) published from 2012 to 2022 through databases such as PubMed and CINHAL. Phase two utilized a parallel convergent mixed method study design to explore dietary diversity and dietary practices among pregnant women, as well as factors associated with dietary diversity and dietary practices. In addition, the perspectives of male partners and healthcare providers in supporting the dietary practices of pregnant women and the challenges met when providing support were explored in this phase. The scoping review identified key drivers of dietary practices, including maternal education, male partner support, food insecurity, cultural beliefs, and health system dynamics. This review also highlights the research gap in SSA because the majority of included studies were conducted in one country (Ethiopia). Quantitative findings showed that 44.1% of pregnant women achieved good dietary diversity, 40% exhibited good dietary practices, but 23% were undernourished. Key positive factors included maternal education, kitchen gardens, and dietary knowledge, while food insecurity was a major barrier. Qualitative insights highlighted the role played by supportive male partners and healthcare providers, but showed how challenges like poverty, cultural norms, limited knowledge and inadequate healthcare resources hindered effective dietary support. More than half of pregnant women in the study exhibited poor dietary practices driven by complex socioeconomic, cultural, and systemic factors. Strengthening education, addressing food insecurity, promoting male involvement, and improving healthcare infrastructure are essential for enhancing maternal nutrition and achieving better pregnancy outcomes in Rwanda. Collaborative efforts viii among stakeholders are critical to addressing these challenges and improving maternal and neonatal health.