Education and pregnancy outcomes in Sub-Saharan Africa

Over the course of the last century, improvements in prenatal care have massively improved the survival rates and health of mothers and babies. However, high infant and maternal mortality rates have remained a persistent issue in Sub-Saharan Africa. Several steps, such as hiring experienced birth clinicians, have been made to improve health infrastructure and education in post-pregnancy care. However, not as much effort has been concentrated in the realm of prenatal health for either mothers or children. Undernutrition in pregnant mothers can lead to poor health outcomes for both the mother and the child, and potentially lead to death for both. One study evaluated the nutritional status of mothers and their children in Sub-Saharan Africa and concluded that improvement in infrastructure and education would greatly benefit maternal and fetal health in the region [1].


During pregnancy, a crucial nutritional requirement is iron. Iron also aids in the growth and development of the fetus and placenta. Mothers have an increased need for iron that can be attributed to the increase in blood volume during pregnancy to compensate for the growing fetus. However, the body does not increase the number of red blood cells at the same rate as it increases the plasma, and the concentration of red blood cells decreases. Because of this, pregnancy results in anemia (low hemoglobin levels) due to hemodilution, a phenomenon which can be further exacerbated by iron deficiency. Undernutrition can lead to low iron levels, so prenatal clinics have begun to supply nutritional supplements during pregnancy to combat this issue. In addition, poor sanitation practices, traditional farming practices, and lack of in-house latrines can lead to iron deficiency — these factors can lead to intestinal parasites hypothesized to cause anemia directly [2]. To combat this, steps must be taken to educate mothers about sanitation methods and improve general sanitation in this region.


In addition, proper education and follow-up with mothers can also allow them to maintain a healthier lifestyle after giving birth [3]. Improving nutrition and sanitation increases the life expectancy for both mother and child [2]; educating mothers is a crucial step in ensuring these proper nutrition and sanitation practices for the health of both parties. In Sub-Saharan Africa, traditional cultural practices around pregnancy do not emphasize visiting prenatal clinics [3]. Mothers often do not feel it is necessary to have multiple prenatal care visits, or their husbands do not encourage multiple care visits. Integrating education with cultural practices will increase prenatal clinic attendance and better health monitoring for the mother and child. An example of a topic on which many women are uneducated is HIV and breastfeeding practices. The World Health Organization recommends that infants be exclusively breastfed for the first six months of life. However, women with HIV are fearful of transmitting the disease to their child, and therefore breastfeed for shorter periods of time [4]. Breast milk provides essential immune support and nutrients for infant growth, and antiretroviral medications allow mothers to feed their children without transmitting HIV [4]. By providing this information to expecting and new mothers, they will be more educated on how to breastfeed without risking transmission. This will help prevent undernutrition of infants by allowing them to breastfeed for longer.


Maternal and child undernutrition and mortality is an immediate, large-scale problem in this region, but it can be fixed. Educational programs that target issues of sanitation, prenatal care, and nutrition can reduce unnecessary deaths.

References:

  1. Alles, M., Eussen, S., Ake-Tano, O., Diouf, S., Tanya, A., Lakati, A., . . . Mauras, C. (2013). Situational analysis and expert evaluation of the nutrition and health status of infants and young children in five countries in sub-Saharan Africa. Food Nutr Bull, 34(3), 287-298. doi:10.1177/156482651303400301

  2. Kumera, G., Gedle, D., Alebel, A., Feyera, F., & Eshetie, S. (2018). Undernutrition and its association with socio-demographic, anemia and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Northwest Ethiopia. Maternal health, neonatology and perinatology, 4, 18. doi:10.1186/s40748-018-0087-z

  3. Kung'u, J. K., Ndiaye, B., Ndedda, C., Mamo, G., Ndiaye, M. B., Pendame, R., . . . De-Regil, L. M. (2018). Design and implementation of a health systems strengthening approach to improve health and nutrition of pregnant women and newborns in Ethiopia, Kenya, Niger, and Senegal. Matern Child Nutr, 14 Suppl 1. doi:10.1111/mcn.12533

  4. Lindsay, K. L., Gibney, E. R., & McAuliffe, F. M. (2012). Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. J Hum Nutr Diet, 25(6), 534-546. doi:10.1111/j.1365-277X.2012.01253.x

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