Food taboo among pregnant Ethiopian women: magnitude, drivers, and association with anemia

Shimels Hussien Mohammed, Hailu Taye, Bagher Larijani, Ahmad Esmaillzadeh, Shimels Hussien Mohammed, Hailu Taye, Bagher Larijani, Ahmad Esmaillzadeh

Abstract

Background: There are pervasive pregnancy-related food taboos and myths (PRFT) in Ethiopia. The evidence, however, is limited on whether PRFT contributes to the burden of maternal anemia. Thus, this study was aimed to determine the magnitude of PRFT, the reasons for adherence to PRFT, and the association of adherence to PRFT with anemia, among pregnant Ethiopian women.

Methods: The study was case-control in design and recruited a sample of 592 pregnant women attending antenatal care in four health facilities in Addis Ababa, Ethiopia. Participants were classified into anemic cases (n = 187) and non-anemic controls (n = 405) based on their hemoglobin level. PRFT was assessed by the participants' subjective reporting of avoidance of certain food items during the current pregnancy due to taboo reasons. The specific types of food items avoided and the underlying reasons for the avoidance were also assessed. The relation of PRFT with anemia was evaluated by multiple logistic regression analysis, controlling for covariate factors.

Result: Almost a fifth of the study participants (18.2%) avoided one or more food items due to PRFT. Adherence to PRFT was 26.2 and 14.6% among the anemic and the non-anemic individuals, respectively. The food items most avoided due to adherence to PRFT were green chili pepper, organ meat, and dark green leafy vegetables like spinach, lettuce, kale, and broccoli. The underlying reasons for the adherence to PRFT were largely traditionally held beliefs and misconceptions. After controlling for covariates, PRFT was significantly and independently associated with a higher odds of anemia [adjusted odds ratio (AOR) = 2.12, 95% confidence interval (CI) = 1.32-3.42, P = 0.002].

Conclusion: PRFT might be contributing to the burden of maternal anemia in Ethiopia. It is time for public health authorities in Ethiopia to recognize PRFT as a public health risk, strengthen maternal nutrition counseling, and create public awareness of the consequences of PRFT.

Trial registration: ClinicalTrials.gov (NCT03251664), 16 August 2017.

Keywords: Anemia; Dietary behavior; Ethiopia; Food taboo; Pregnancy.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Institutional Review Boards (IRB) of University of Gondar and Addis Ababa City Health Bureau, (Ref: AAHB-217/15). A written letter of permission to conduct the study was obtained from Addis Ababa City Health Bureau. Besides, the participating health facilities were informed about the study and the study participants provided written consent of participation in the study and sharing of findings based on the information collected. The data collectors counseled the study subjects on nutritional recommendations during pregnancy and advised those found anemic to seek further medical care. The study was registered on American https://ichgcp.net/clinical-trials-registry/NCT03251664.

Consent for publication

The study participants provided consent for communicating the findings based on the information they provided, including through publications.

Competing interests

The authors declared no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of the sample selection procedure
Fig. 2
Fig. 2
Magnitude (prevalence) of taboo by food items

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