Socio-Demographic and Health Characteristics Associated with Maternal Malnutrition Among Pregnant Women in Kenema District, Sierra Leone

Abstract

This study examines the socio-economic, cultural, and health system characteristics associated with maternal malnutrition among pregnant women in Kenema, Sierra Leone. Using a descriptive cross-sectional design, 127 pregnant women attending antenatal clinics were surveyed between January and July 2025. Data were collected through structured questionnaires administered in local languages and analyzed using descriptive statistics. The findings reveal that poverty is the dominant driver of malnutrition, with 63.8% of respondents earning less than Le5, 000 monthly (approximately \$0.25 USD per day), 75.6% skipping meals due to financial constraints, and 66.1% experiencing hunger during pregnancy. Dietary patterns were heavily carbohydrate-based (90.6%), with limited access to protein and micronutrient-rich foods. Adolescent pregnancy was prevalent (43.4%), and most women were single (72.4%), unemployed, or students. Despite high antenatal care attendance (94.5%) and supplement provision (93.7%), adherence to supplementation and nutrition education remained suboptimal. Cultural and religious food restrictions affected a minority, but poverty overshadowed these as the primary barrier. The study concludes that maternal malnutrition in Kenema is a multidimensional issue requiring integrated interventions that address economic vulnerability, food insecurity, adolescent health, and health system strengthening. These findings provide critical evidence for policymakers and health practitioners designing context-specific nutrition programs in similar low-resource settings.