Determinants of the Adoption of Nutritional Practices among Pregnant and Lactating Women Following a Nutrition Education Intervention in Rural Moyamba District, Sierra Leone

Abstract

Background: Maternal malnutrition remains a major public health challenge in low- and middle-income countries, particularly in sub-Saharan Africa, where it contributes significantly to adverse maternal and child health outcomes. In Sierra Leone, especially in rural districts such as Moyamba, inadequate dietary practices among pregnant and lactating women are influenced by multiple factors, including limited nutrition knowledge, food insecurity, socioeconomic constraints, cultural beliefs, and restricted access to health services. Although nutrition education interventions have been implemented to improve maternal nutrition, evidence remains limited regarding the factors that influence the adoption of recommended nutritional practices among women in rural Sierra Leone. Understanding these determinants is essential for designing effective, context-specific interventions to improve maternal and child nutrition outcomes. Aim: To determine the socioeconomic, cultural, health service, and household factors influencing the adoption of recommended nutritional practices among pregnant and lactating women in rural Moyamba District, Sierra Leone, following a nutrition education intervention Method: A quasi-experimental study was conducted among 266 pregnant and lactating women (133 intervention and 133 control) in rural Moyamba District. Data were collected using structured questionnaires, 24-hour dietary recall, and interviews. Statistical analyses included descriptive statistics, independent t-tests, chi-square tests, and logistic regression at a significance level of p < 0.05. Results: Nutrition education significantly improved maternal knowledge (2.48 ± 0.52 vs 1.89 ± 0.61; p = 0.001). However, the adoption of nutritional practices was significantly influenced by maternal education (p = 0.002), wealth status (p = 0.001), and food security (p = 0.003), while larger household size negatively affected dietary practices (p = 0.015). Cultural beliefs and food taboos significantly reduced dietary diversity (p = 0.003). Access to antenatal care and nutrition counseling, as well as household and community support, significantly improved the adoption of recommended practices (p < 0.05). Conclusion: Although nutrition education improves maternal knowledge, the uptake of nutritional practices is determined by a combination of socioeconomic, cultural, and environmental factors. Integrated, multi-sectorial interventions are required to improve maternal nutrition outcomes.