CHAPTER ONE
1.0                                         INTRODUCTION
The nutritional status of a community is influenced by a lot of interrelated and complex factors. At the level of households, the nutritional status is affected by the household ability to provide adequate food in both quantity and quality, mother’s pattern of upbringing children, nutrition knowledge, and other socio-cultural factors. This indicates a close relation between food security along with its nutritional status and public health. Therefore, efforts in improving food security and a community nutrition must become a global commitment. In the International Conference on Nutrition 1992 and World Food Summit 2002, it was confirmed that it is necessary for each nation including Indonesia to have commitment to continue to improve food security, to eliminate poverty and malnutrition [1].

The major nutritional issue in Indonesia is centered on 4 problems: namely, protein-energy malnutrition, iron anemia, vitamin A deficiency, and iodine deficiency disorders. Another problem, predicted to become worse if not solved immediately, is over-nutrition. An analysis of some random data indicates that there is little or weak nutritional extension because of limited quality of cadres and fund available.

A study conducted in the mountainous regions and coastal areas of Indonesia indicates that the mothers of poor households turned out to have better nutrition knowledge than those of non-poor households [16]. This may be due to the fact that the mothers of the poor households go more frequently to Posyandu, having more interaction to their cadres. This is supported or confirmed by the finding of research in West Java - mothers who often go to Posyandu have a higher score for the knowledge of nutrition than those who rarely do so [17].

Nutritional extension has a positive impact on public health and nutrition because with a good knowledge of nutrition, mothers will apply it in their households, and in this way a healthy generation is created, in which children can grow and develop optimally. The involvement of cadres who are responsible in the villages can guarantee the elements of capacity building and sustainability.

This research would be useful for the improvement of nutritional knowledge, attitude, and practices among mothers participated in Posyandu (Integrated Nutrition and Health Services). The participating mothers of Posyandu in Indonesia commonly have a low education. They have no adequate access to any media to increase their nutritional knowledge. For this reason, this research, one activity of which is to give nutritional education to mothers, would be very important and beneficial. With an improved nutritional knowledge of mothers, it is expected that they can apply it for a better feeding pattern to their children, thus preventing the risk of moderate or severe malnutrition.
This study investigated the relationship between potential criteria mothers use to select foods for their children, their food knowledge, and food consumption of their children. These data indicate that families can be segmented according to the importance of beliefs about healthfulness of foods and that this segmentation predicts quality diet of children. This study suggests that interventions should be designed to increase mothers’ beliefs in the importance of health in choosing foods. For those mothers whose food choices are dominated by children's tastes, interventions should be directed at how to prepare healthful foods to taste good to children [5].
1.1                           BACKGROUND OF THE STUDY

Eating is one activity most of us take for granted (Donatelle & Davis 1989). At times, according to Donatelle and Davis we are concerned about eating sufficient food that would get us though the day and less attention is given on their nutritional contents. The trend towards a healthful lifestyle calls for healthy eating yet in the effort to eat nutritionally, many people, wonder if they are actually eating a balanced diet or if they have been duped by fed while for some others, any food can go.
Although our choices of food are determined by many factors such as the availability of food in the locality, the money available to purchase these foods, the food supplies including the ways the foods are being processed or prepared and the knowledge and appreciation the individual feels about certain food values (Okafor, 2002), it is important that we realize that we are what we eat and that nutrition has become very important in both preventive and curative healthcare system (United Nations Children Fund, UNICEF 1995). According to UNICEF, dietary factors have been implicated in the etiology of many diseases such as diabetes, heart diseases, cancer and several diseases of children, UNICEF (1995) also pointed the out that Nutrition has shifted from its previous focus on the minimum amount needed to prevent or cure acute deficiency diseases, for example scurvy, and beriberi, to the need to promote health, longitivity and resistance to chronic disorders like cardiovascular diseases, cancer, hypertension, diabetes and even acquires immune deficiency syndrome (AIDS). In pregnancy, the importance of nutrition is being emphasized in the newspapers, magazines and health journals and even in many health related television shows to mention but a few.
Nutrition can be defined as the science of food, its use within the body, and its relationship to good health. It includes the study of the major food components – proteins, carbohydrates, fats, vitamins and minerals including water and more than 50 various nutrients of which they are composed (Levy, Digman & Shirref, 1984). It is therefore clear that for somebody to eat healthfully he or she must have adequate knowledge of the different components of food we eat.
Nutrition also can be defined as the science that investigates the relationship between physiological functions and the essential elements of the food we eat (Donatelle & Davis 1998). The world book encyclopedia on health (1996) simply puts nutrition as the process by which living things take in foods and use it. It is therefore the study of food and the process of receiving nourishment from the food we eat after digestion and metabolism. Brien (2010) defines it as the study of food and nourishments, examining the nutritional contents of foods, the amount of nutrients required for healthy growth and function and varies for different people.
The extent of practices of nutrition is dependent among other things on the level of knowledge one has about nutrition. According to Ayo (2003) Nutritional knowledge refers to that aspect of education that prepares one for meaningful nutritional practices. Ayo emphasized that every living thing has the right to have access and the right to affordability of nutritious food and at when due. However,  Donatelle et. al. (1998) were of the view that many were accessible to vast number of choices of food or to almost every nutrient by implications should have fewer nutritional problems than their counterparts who do not have such affluence but unfortunately, nutritionists according to them, believe that “diet of affluence” were responsible for many of their diseases and disabilities such as heart diseases, certain types of cancer, hypertension, cirrhosis of the liver, tooth decay and chronic obesity.

Nutritional knowledge without practice is not meaningful. Nutritional practice is outward demonstration of nutritional knowledge in our homes, outside our homes and even in social gatherings. Knowledge about nutrition prepares one for meaningful nutritional practices and it is acquired through formal and non-formal education and it is as old as culture itself since the knowledge is passed on from generation to generation and from parents to their offspring. As such every locality has different kinds of foods available to them and are being prepared differently.

Nutritional knowledge and practices are being emphasized upon according to Williams (2007), because of their role in determining the pregnancy outcome as well as the state of health of the mother after childbirth. In support of this, Karger and Basel (2010) emphasized that nutrition is important to expectant mothers because it can spell the difference between a healthy new born and a sickly child. Karger and Basel advised the expectant mother to follow scientifically – proven – practices to make sure that the baby is healthy and strong when it is bor. This according to them will be achieved by eating food rich in vitamins and nutrients.

An expectant mother according to Crowder (1995) is a woman that is pregnant. According to him, pregnancy is the fertilization of an Ovum and its implementation in a woman’s uterus. He noted further, that for approximately nine months the mother carries the developing child within her and that the pregnancy terminates with delivery of the child, Nash (2002) observed that the relationship that exists between the mother and her unborn child is much. According to her, “even while the child is still in the womb, its genes engage the environment of the womb in an elaborate conversation, which is a two-way dialogue that involves not only the air the mother breathes and the water she drinks but also what drugs she takes, what diseases she contacts and what hardship she suffers” pg24. According to Nash (2003;19) once the beginning embryo is able to obtain good nutrition directly from the mother, development can proceed more rapidly. But if what is obtained form the mother is not nutritional healthy or balanced, so many complications are bound to arise in pregnancy. Williams (1981) noted that hazards increase with age, the number of pregnancies and the intervals between pregnancies influence the nutritional needs of the mother and the out come of pregnancy. Furthermore, Zhn et al (1999) observed that pregnant women that are underweight or overweight and those advanced or young maternal age need nutritional support and counseling programmes that will improve birth weight, decrease infant mortality and improve participant’s diet. Also, White head, (1994) maintained that those women delivering first child at over 30 years old were not nutritionally prepared. This is because at that age upwards, many women had been on some type of weight reduction diet which makes their nutritional status not better than that of many teenagers.
More so, an expectant mother who lacks good education and exposure may be easily deceived by smooth talks of nutritional quacks who advocate fad diets. Not only that, the habits and practices of those who lack good education would be affected by taboos, superstitions and prejudices as Mankinde (1980) noted.

Pre-study investigation from some hospitals within the Local Government Areas revealed that, majority of the women of study start antennal care very late and as such do not start their nutritional supplements early enough. The expectant mothers of these local Government Areas still at these century have children with birth defects of the brain and spinal cord (Neural tube), and other malformation of the bone, have very low birth weight while some are over weight most of the expectant mothers themselves have low resistance, diabetes and many are anemic. All these problems may be associated to poor eating habits. It becomes necessary therefore that an expectant mother should have adequate knowledge of nutrition and should be able to eat nutritionally. The writer therefore, is of the view that if the level of knowledge and practices of nutrition among expectant mothers in Oviri-Okpe Delta State are identified and adequate information about what constitutes good nutrition is given to them, their nutritional behaviour will improve with motivation. It is against this background that this topic has been chosen to survey the nutritional knowledge and practices of expectant mothers in Oviri-Okpe Delta State.

                                                           1.2   STATEMENT OF THE PROBLEM

Ayo (2003:20) mentioned that in the World Health organization (WHO) sponsored conference of delegates on 134 countries and 67 United Nations members in 1978, adequate nutrition was classified as “a fundamental human rights” the aim being in pursuance of an acceptable level of nutrition for the people of the world. The women of the Area lack the knowledge of good nutrition and this will expose them to diseases associated with malnutrition for example, chronic obesity, tooth decay, overweight & low birth weight and associated problems.

Williams (1981) pointed out that optimal nutrition is a fundamental aspect of therapy for many complication of pregnancy like iron deficiency anemia, Hemorrhagic anemia, megloblastic anemia and toxemia. These health problems have a high morbidity and mortality consequences. Poor nutrition according to Ramakrishna (2008) is a known cause of low birth weight which remains the significant public health problem in many development countries. Nash (2002) clearly stated that although there may be long-term health threat to the fetus, maternal undernourishment which stunts growth even when they are born full-term, may top such lists.To the best knowledge of the researcher no work has been done on these women in the two LAGs to determine how much they knew and practice nutrition. It is against his background that this study that this study has been designed to find out the following purpose of the study.

1.3                                       AIM OF THE STUDY
The objectives of this research were to evaluate the effects of nutrition education to the nutritional knowledge, attitude and practice among expectant mother in Oviri-Okpe Delta State.

1.4                                 PURPOSE OF THE STUDY

The main purpose of this study was to: determine the nutritional knowledge and practices among expectant mothers in Oviri-Okpe Delta State. The specific purposes were:-

1. Ascertain the level of nutritional knowledge possessed by the expectant mothers in Oviri-Okpe Delta State
2. Determine the level of nutritional practices, of those expectant mothers of study.
3. Ascertain the relationship between the nutritional knowledge of these expectant mothers’ and those of their practices.

1. Ascertain the nutritional knowledge of the subjects of study based on their level of education, age and parity.
2. Determine the nutritional practice of the subjects of study based on their level of education, age and parity.
3. Determine the relationship between the nutritional knowledge and practices of the subjects of study in relation to their education.
4. Determine the relationship between the nutritional knowledge and practices of the subjects of study in relation to age.
5. Determine the relationship between the nutritional knowledge and practices of the subjects of study in relation to parity.

1.5                            SIGNIFICANCE OF THE STUDY

This study is expected to access the levels of knowledge and the practices of nutrition among the expectant mothers in Oviri-Okpe Delta State. The anticipated results of the study will help in the overall improvement of the health status of the community since the pregnant mothers who prepare meals for the family will get an insight to what constitutes adequate nutrition. This information will be useful to other health professionals who are seeking ways of improving health care.

To the government ministries of health and education, this study will help the planners to know the state of knowledge of these women and make preparation for enlightening them. It will help the curriculum planners to incorporate nutrition in school curriculum as well as findings ways of making the students appreciate the need for good nutrition and practice them. Fellow researchers reviewing literature and who wish to learn from the experience of previous researchers on a similar subject will also find the work both useful and stimulating. For future researchers, it will form a baseline for those interested in such areas of study.

1.6                                   SCOPE OF THE STUDY

This study would not cover every aspect of nutrition. It will be limited to five essential food nutrients including water and fiber as they play important roles in the body. The six essential nutrients to be studied are proteins, vitamins and minerals, simple carbohydrates and fats. Although there are many categories of pregnant women, this study will consider only those that are not vegetarians and those without degenerative health problems that require specific nutrition or dieting like in diabetic, heart and liver cases.