Maternal nutritional depletion in a rural area of Papua New Guinea

Abstract

In the Wosera area of Papua New Guinea, the nutritional status of 899 women of child-bearing age (measured by weight, body mass index, and skinfolds thickness) showed a strong negative correlation with parity, independent of age. This maternal depletion occurred despite a mean birth interval of three years. Average maternal weight gain during pregnancy was about 5 kg, thus the estimated weight gain from fat deposition, blood and extracellular volume expansion was only 650 g. Evidence of increasing fertility in recent years highlights the need for effective family planning to limit the impact on women of child-bearing age.

PIP: The impact was examined of age and parity on nutritional status among a stratified random sample of 899 reproductive-age women in the Wosera subdistrict, East Sepik Province, Papua New Guinea. The village sample was stratified by clinic zone, population, and distance from the road in 21 out of 46 villages. Anthropometric measurements of height, weight, mid upper arm circumference, and triceps and subscapular skin folds were taken in addition to a full birth history among all village nonpregnant women. Separate information on weight gain during pregnancy was collected on pregnant women at prenatal clinics at intervals of not less than 4 weeks. The results among nonpregnant women showed parity was strongly negatively correlated with body weight. In the analysis of variance and multiple regression analysis, both parity and age were highly significantly related to maternal weight (F = 6.3; df = 10,711; p = 0.0001). Similar patterns were found for body mass index, mid upper arm circumference, and skin fold values. Height was only significantly related to age (F = 2.3; df = 6892; p = 0.06). In the analysis of covariance, village of residence with controls for age and parity was significantly related to both weight and height of nonpregnant women. Villages east of the Amogu River housed women with mean height standardized by parity and age of under 150.0 cm, while in 6 or more of the 14 villages west of the river, women had mean standardized heights of over 150.0 cm. Mean weight gain among pregnant women was 0.202 kg/week or 4.8 kg during 2 trimesters. Average overall weight gain for the entire pregnancy was 5.3 kg. There was a negative relationship between initial weight gain and weight gain within a month of delivery. Weight change in the 6 months after delivery ranged from -8.2 kg to 7.5 and a mean of -1.39 kg. The mean birth interval based on pregnancy histories was 2.98 years if the preceding child survived infancy. The mean interval following a stillbirth was 1.67, following a neonatal death was 1.91, and following a postneonatal death was 2.22. The interval length was found to decrease over time and was unrelated to birth order, maternal age, or data quality. Women were 5 cm taller than in the 1960s and taller if living in villages closer to the road.