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Effect of Antenatal Nutrition Counselling on Maternal Dietary Diversity among Pregnant Women in Nigeria

Abstract

Maternal nutrition is an important determinant of maternal health, fetal growth, pregnancy outcomes, and newborn wellbeing. In Nigeria, inadequate dietary diversity among pregnant women remains a concern because poor dietary intake may contribute to micronutrient deficiencies, maternal anaemia, inadequate gestational weight gain, impaired fetal growth, and other adverse pregnancy outcomes. Antenatal nutrition counselling provides an important opportunity to educate pregnant women on appropriate food choices, dietary diversity, meal planning, nutrient requirements, food safety, and healthy eating practices during pregnancy. However, limited access to qualified nutrition personnel, inadequate counselling time, inconsistent antenatal attendance, low maternal awareness, socioeconomic constraints, food insecurity, and cultural dietary practices may limit the effectiveness of nutrition counselling services in Nigeria. Against this background, this study investigates the effect of antenatal nutrition counselling on maternal dietary diversity among pregnant women in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of the importance of adequate nutrition, perceived benefits of dietary diversity, perceived barriers, and cues to action may influence their dietary behaviours. The Social Ecological Model emphasizes the influence of individual, household, community, cultural, socioeconomic, and environmental factors on maternal dietary practices. The Health Systems Framework emphasizes antenatal service delivery, health workforce, nutrition information, availability of counselling services, financing, governance, and accessibility as important components of effective maternal nutrition programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how antenatal nutrition counselling may influence maternal dietary diversity among pregnant women in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise pregnant women attending antenatal care in selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, and eligible pregnant women. Antenatal nutrition counselling will be assessed using indicators such as frequency of counselling sessions, timing of counselling, duration and content of counselling, healthcare provider involvement, individualized dietary advice, education on micronutrient-rich foods, food safety guidance, meal planning education, and documentation of counselling. Maternal dietary diversity will be assessed using dietary recall methods and appropriate dietary diversity indicators, including the number and variety of food groups consumed within a specified reference period. Information on consumption of grains, roots and tubers, legumes, nuts and seeds, dairy products, eggs, meat and other animal-source foods, fruits, vegetables, and other relevant food groups will be collected where appropriate. Data will be obtained using structured questionnaires, dietary assessment tools, antenatal care records, nutrition counselling records, and maternal health records. Descriptive statistics will be used to summarize maternal characteristics, nutrition counselling exposure, dietary patterns, and dietary diversity scores. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of antenatal nutrition counselling on maternal dietary diversity. Where a quasi-experimental design is adopted, dietary diversity scores before and after exposure to structured nutrition counselling may be compared, while relevant socioeconomic, household, and maternal factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that antenatal nutrition counselling has a significant positive effect on maternal dietary diversity among pregnant women in Nigeria. Pregnant women who receive regular and comprehensive nutrition counselling are expected to consume a wider variety of foods and achieve higher dietary diversity scores than women who receive limited or no nutrition counselling. Appropriate counselling may improve knowledge of nutrient-rich foods, encourage consumption of diverse food groups, promote healthier meal planning, and increase awareness of the nutritional requirements of pregnancy. However, the effect of counselling may be influenced by household income, food availability, food insecurity, cultural beliefs, food preferences, education level, household decision-making, and access to diverse foods. Therefore, knowledge gained through counselling may not always translate into dietary behaviour where economic and environmental barriers limit food choices. The study consequently expects effective nutrition counselling, combined with interventions addressing food access and household-level barriers, to contribute significantly to improving maternal dietary diversity in Nigeria. The study is expected to contribute to the literature on antenatal nutrition counselling, maternal dietary diversity, maternal nutrition, pregnancy, dietary practices, antenatal care, food security, maternal health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, maternal and child health programmes, nutritionists, dietitians, obstetricians, midwives, community health workers, development partners, and policymakers regarding strategies for strengthening maternal nutrition services. The study will also provide evidence-based recommendations for integrating structured nutrition counselling into antenatal care, strengthening the capacity of healthcare workers to provide nutrition education, improving individualized dietary counselling, addressing socioeconomic and food-access barriers, promoting locally available nutrient-rich foods, strengthening nutrition monitoring during pregnancy, and integrating maternal nutrition interventions into broader maternal and newborn health programmes across Nigeria.

Keywords: Antenatal nutrition counselling, maternal dietary diversity, pregnant women, maternal nutrition, dietary practices, antenatal care, food security, nutrition education, pregnancy, Nigeria, public health.