CONSUMPTION OF CLAY, HERBS AND ALCOHOL BY WOMEN OF CHILDBEARING AGE IN ...

267 Pages·2016·3.2 MB·English

CONSUMPTION OF CLAY, HERBS AND ALCOHOL
BY WOMEN OF CHILDBEARING AGE
IN KAMPA LA, UGANDA
By
BETTY ANN NAMAROME W AK.OU
Bachelor of Education
Makerere University
Kampala, Uganda
1992
Master of Science
Oklahoma State University
Stillwater, Oklahoma
1998
Submitted to the Faculty of the
Graduate College of the
Oklahoma State University
in partial fulfillment of
the requirements for
the Degree of
DOCTOR OF PHILOSOPHY
May,2003

CONSUMPTION OF CLAY, HERBS AND ALCOHOL
BY WOMEN OF CHILDBEARING AGE
IN KAMP ALA, UGANDA
Thesis Approved:
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ACKNOWLEDGMENTS
I would like to thank several people without whom I could not have completed this
research study and my doctoral studies at Oklahoma State University (OSU). I would like
to first of all thank all members ofmy graduate committee: Dr. Gail Gates (Chair), Dr.
Patricia Bell, Dr. Beth Caniglia, Dr. Kathy Keim, Dr. Tay Kennedy, and Dr. Maria
Spicer. Dr. Gates, is appreciated for her friendship, expert advice, and patient help during
my research endeavor. Dr. Barbara Stoecker is thanked for her unfailing support during
my study at OSU and various faculty and staff, Diane Jones and Linda O'Brien, who
were always willing to help in academic and non-academic areas.
Nicholas, my husband and children, Dora, Jonah, and Eleanor W akou, my family
and friends miles away are thanked for the support, understanding, and prayers during my
entire school engagement. Staying apart was the hardest part of my studies.
This research would not have been possible without the support of funds from
Oklahoma Agricultural Experiment Station (OAES) and the Barthelmes Foundation in
Tulsa, OK. Thanks go to Debra and Joe Hull and partner Terry Collins and the Dept. of
Nutritional Sciences at OSU. Special thanks to mothers, obstet/gyns and midwives who
cooperated and willingly shared their experiences and Mulago Administration, Local
Council Chairmen in Kampala District for permission to conduct this study in their area.
The Child Development Center staff is sincerely thanked for the perfect work
environment. Last but not least, I extend my appreciation to Mr. Richard Sekiwunga and
Mrs. Gertrude Njuba for their unrelenting support in conducting the interviews.
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TABLE OF CONTENTS
Chapter Page
I. INTRODUCTION ...................................................................................................... 1
Problem and Need for the Study ................................................................................. l
Health Issues in Uganda. ....................................................................................... 3
Significance of the Study ............................................................................................ 4
Purpose of the Study ................................................................................................... 4
Definition ofTerms. .................................................................................................... 5
Assumptions ................................................................................................................ 7
Principal Investigator's Brief Background ................................................................. 7
Organization of the Dissertation ................................................................................. 8
II. REVIEW OF LITERATURE ..................................................................................... 9
Background Information about Uganda ...................................................................... 9
Pregnancy Outcome .................................................................................................. 10
Low Birth Weight ............................................................................................... 11
Pica. ........................................................................................................................... 12
Pica Prevalence ................................................................................................... 15
Risk Factors for Pica ........................................................................................... 16
Geophagy .................................................................................................................. 16
Geophagy During Pregnancy .............................................................................. 20
Harmful Effects of Pica Practice ......................................................................... 23
Herbal Medicine in Pregnancy. ................................................................................. 24
Health Implications of Herb Use ........................................................................ 26
Common Herbs Used in Pregnancy .................................................................... 28
Alcohol Consumption and Pregnancy Outcome ....................................................... 28
Brief History of Alcohol in East Africa ................................................................... .30
Prenatal Care ............................................................................................................. 31
Uses and Content of Prenatal Care .................................................................... .31
Delivery of Prenatal Care by Health Professionals ............................................ .32
Grounded Theory Method. ........................................................................................ 34
Summary ................................................................................................................... 35
III. METHODOLOGY ................................................................................................... 40
Research Design ........................................................................................................ 40
Methods and Procedures ........................................................................................... 41
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Chapter Page
General Setting .......................................................................................................... 42
Study 1: Focus Group Discussions with Community Women ................................ .42
Question Development. ....................................................................................... 43
Focus Group Methods ......................................................................................... 44
Focus Group Staff. .............................................................................................. 45
Focus Group Data Collection ............................................................................. .46
Data Analysis ...................................................................................................... 48
Study 2: Interviews with Newly Delivered Mothers ................................................ 49
Subject Recruitment ............................................................................................ 49
Materials and Instrumentation ............................................................................ 50
Pilot Study of the Survey .................................................................................... 50
Interview Staff .................................................................................................... 52
Data Collection ................................................................................................... 52
Study 3: Survey with Health Care Providers ............................................................ 53
Sample Selection ................................................................................................. 53
Subject Recruitment ............................................................................................ 54
Materials and Instrumentation ............................................................................ 54
Data Collection Procedures ................................................................................. 55
Data Analysis ...................................................................................................... 55
IV. CONSUMPTION OF SMOKED CLAY, HERBAL CLAY, AND HERBS
INGRAY ID NON-PREGNANT WOMEN IN UGANDA ............................... 58
Abstract ..................................................................................................................... 58
Introduction ............................................................................................................... 59
Methods ..................................................................................................................... 60
Results and Discussion ............................................................................................. 64
References ................................................................................................................. 7 4
V. BELIEFS ABOUT ALCOHOL CONSUMPTION AMONG WOMEN OF
CHILDBEARING AGE IN UGANDA .............................................................. 79
Abstract ..................................................................................................................... 79
Introduction ............................................................................................................... 80
Methods ..................................................................................................................... 81
Results ....................................................................................................................... 85
Discussion .................................................................................................................. 91
References ............................................................................................................... 1O 1
V
Chapter Page
VI. BELIEFS AND PRACTICES OF GEOPHAGY AMONG PREGNANT
WOMEN IN KAMPALA, UGANDA .............................................................. 111
Abstract ................................................................................................................... 111
Introduction ............................................................................................................. 112
Methods ................................................................................................................... 115
Results ..................................................................................................................... 117
Discussion ............................................................................................................... 120
Conclusions ............................................................................................................. 127
References ............................................................................................................... 130
VII. HEALTH CARE PROVIDER'S CONCERNS ABOUT THE HEALTH OF
WOMEN IN KAMPALA, UGANDA .............................................................. 139
Abstract ................................................................................................................... 13 9
Introduction ............................................................................................................. 140
Methods ................................................................................................................... 141
Results ..................................................................................................................... 143
Discussion ............................................................................................................... 145
References ................................................................................................................ 152
VIII. DIFFERENT NUTRITION-RELATED ADVICE IS GIVEN TO
PREGNANT WOMEN BY OBSTETRICIANS AND MIDWIVES IN
KAMPALA, UGANDA ................................................................................... 159
Abstract ................................................................................................................... 159
Introduction ....... , ..................................................................................................... 160
Methods ................................................................................................................... 161
Results ..................................................................................................................... 162
Discussion ............................................................................................................... 164
References ............................................................................................................... 170
IX. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS .......................... 177
Summary ................................................................................................................. 177
Conclusion .............................................................................................................. 180
Recommendations ................................................................................................... 183
BIBLIOGRAPHY ............................................................................................................ 188
APPENDICES ................................................................................................................. 202
APPENDIX A-OKLAHOMA STATE UNIVERSITY INSTITUTIONAL
REVIEW BOARD ............................................................................................... 203
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Chapter Page
APPENDIX B-UGANDA NATIONAL COUNCIL OF SCIENCE AND
TECHNOLOGY ..................................................................................................... 205
APPENDIX C-MULAGO HOSPITAL COMPLEX .................................................... 207
APPENDIX D-FOCUS GROUP QUESTION GUIDE FOR
COMMUNITY WOMEN ....................................................................................... 209
APPENDIX E-DEMOGRAPHIC INFORMATION SHEET FOR
COMMUNITY WOMEN ........................................................................................ 213
APPENDIX F-ANALY SIS WORKSHEET ................................................................. 215
APPENDIX G-FOCUS GROUP CODES WORDS AND DEFINITIONS ................. 217
APPENDIX H-SURVEY FOR NEW MOTHERS ....................................................... 222
APPENDIX I-COVER LETTER FOR HEALTH CARE PROVIDERS ..................... 230
APPENDIX J-SURVEY FOR HEALTH CARE PROVIDERS ................................... 232
APPENDIX K-HEALTH CARE PROVIDERS QUALITATIVE RESPONSES ........ 235
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LIST OF TABLES
Table Page
Chapter II
1 Estimates of maternal Mortality in Three East African Countries and
Three Developed Countries ............................................................................... 37
2 Total and Bioavailable Nutrients after O. lM HCL Extraction in
Soil Samples from Uganda ............................................ ·. ................................... 38
3 Local Alcoholic Beverages Consumed in Uganda ..... ;. ........................................... .39
Chapter IV
1 Focus Group Questions .............................................................................................. 76
2 Herbs Used for Easy Pregnancy and Health of Baby ............................................... 78
ChapterV
1 Focus Group Questions .......................................................................................... 104
2 Selected Characteristics of Individual Interviews and Focus
Group Participants ...... , ........................................................................................ 105
3 Alcoholic Beverages Consumed by Newly Delivered Mothers and
Community Women During Pregnancy. .............................................................. 106
4 Reported Frequency of Alcohol Use During Pregnancy by Newly
Delivered Mothers (N=9) ..................................................................................... 107
5 Perceived Effects of Alcohol Consumption on the Fetus by Newly
Delivered Mothers (N=59) ................................................................................... 108
6 Advice Newly Delivered Mothers Received from Health Care Providers
About Alcohol Intake (N= 59) ............................................................................. 109
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Table Page
7 Newly Delivered Mothers' Beliefs about Alcohol Consumption (N=59) .............. 108
Chapter VI
1 Maternal Sociodemographic Characteristics (N=59) .............................................. 134
2 Maternal Reported Clay and Herbal Clay Use During Pregnancy ......................... 135
3 Mothers' Responses to Belief Statements about the Easting of Clay
During Pregnancy (N=59) .................................................................................... 136
Chapter VII
1 Nutrition-and Health-Related Concerns Identified by Health Providers ................ 154
2 Health Providers' Concerns about Maternal and Health Institutions
in Uganda ............................................................................................................. 155
3 Health Care providers' Opinions of Hindrances to Effective Health Care
Delivery to pregnant Women ............................................................................... 156
4. Health Providers Perceived Benefits of Maternal Alcohol Consumption .............. 157
5 Perception's of Health Providers' Pertaining to Maternal Beliefs about
Alcohol Consumption .......................................................................................... 158
Chapter VIII
1 Health Provider Demographic Information ............................................................ 173
2 Frequency of Healthcare Providers' Advice Regarding Nutrition-Related
Topics Provided to Pregnant Women in Routine Antenatal Care (N=53) ........... l 74
3 Difference in Frequencies with which Nutrition Advice was Given by
Healthcare Provider ............................................................................................. 175
4 Reported Health Issues Between Obstetricians and Midwives in Health
Issues of Pregnant Women (N=53) ...................................................................... 176
Chapter IX
1 Summary of Reported Consumption by Community Women and Newly
Delivered Mothers and Health Care Providers' Advice ...................................... 186
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