# How Anaemia Perceptions Shape Dietary Diversity Practice in Pregnancy: A Health Belief Model Study in Tanzania

## TL;DR

This study in Tanzania explores how pregnant women's beliefs about anemia influence their dietary diversity, finding that perceived risk and education level are key predictors.

## Contribution

The study applies the Health Belief Model to identify behavioral predictors of dietary diversity among pregnant women in Tanzania.

## Key findings

- Only 35.1% of pregnant women had good dietary diversity practice.
- Perceived risk of anemia and higher education level were significant predictors of better dietary diversity.
- Accessibility and cost barriers limit consumption of iron-rich foods.

## Abstract

Maternal dietary diversity can significantly impact pregnancy outcomes for both the mother and the fetus. A varied and balanced diet during pregnancy provides crucial nutrients that support the baby's growth and development, as well as the mother's overall health, including being free from maternal anaemia. However, not much is known about the maternal dietary diversity practice in Tanzania. Identifying the magnitude and addressing the possible factors associated with maternal dietary diversity would have a significant contribution to enhancing the nutritional and health status of both the mother and her fetus. The use of the health belief model in this study helped to identify the belief factors influencing the behavioral practice, and this marked the aim of this study.

This was a community-based analytical cross sectional study that was conducted in Ilala Municipality. It involved 367 pregnant women with gestational ages ranging from 13 to 40 weeks who were selected using a multistage sampling. The data were collected using an interviewer administered structured questionnaire. The data was described using descriptive statistics, and a Pearson correlation test and a linear regression model were used to determine the associations between the outcome variable and its explanatory variables. A standardized beta coefficient, a 95% confidence interval (CI), and a P value were reported. A statistically significant variable in the final model was declared at the P value of <.05.

Nearly half of the participants were between the ages of 25 and 34 years (46.4%) and (45.2%) were primigravida. Only (35.1%) of women had good dietary diversity practice with a mean dietary diversity score of 3.97±1.4. The food groups that were mostly consumed were grains and tubers (100%), dark green leafy vegetables (61.3%) and other types of vegetables (53.7%). The majority of pregnant women (84.7%) believed they are at high risk of getting anaemia in any stage of pregnancy. Over 90% of pregnant women believed that anaemia in pregnancy can led to foetus complications, and maternal and foetus death. Substantial proportion of pregnant women reported barriers to access and afford iron rich food. Predicators of good dietary diversity practice for the studied pregnant women include perceived moderate risk of anaemia (Beta = 0.19; CI = 0.2–1.8), and perceived high severity (Beta = −0.09; CI = −0.7 − 0.01), having a higher education level (Beta = 0.8; CI = 0.1–0.8).

Pregnant women are not meeting adequate nutritional requirements. Accessibility and costs are barriers that contribute to low consumption of vitamin A-rich fruits, eggs, nuts, seeds, and dairy products. Higher education level, perceiving the risk, and severity of anaemia during pregnancy are the predictors of good dietary diversity practice. We recommend a tailored intervention, highlighting the risk and severity of pregnancy-related anemia and the benefits of dietary diversification with locally available iron sources.