Predictors of malnutrition among pregnant women in Ethiopia: A systematic review and meta-analysis

Background: Reproductive aged women are especially vulnerable to protein energy deficiency and under nutrition. Malnutrition is the underlying cause of significant maternal morbidity and mortality. In addition, malnutrition among women is a major risk factor for adverse birth outcomes. Its extent and consequences is highly prevalent in developing countries. This major burden can be reduced through effective nutritional interventions. So, up to date meager evidences were warranted. Therefore, this systematic review and meta-analysis was aimed to estimate the overall pooled prevalence of malnutrition and its predictors among pregnant women in Ethiopia. Methods: Articles were systematically searched using PubMed, EMBASE, Google Scholar, World Health Organization's (WHO) Hinari portal data bases and institutional repositories. Newcastle‒Ottawa quality assessment scale adapted for observational studies was applied. We used Stata version 14 for data analysis. Heterogeneity and publication bias were checked using I2 statistic, funnel plot asymmetry and Egger's test. Random effect model was applied to estimate the pooled prevalence of malnutrition and its predictors. Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to identify factors. Result: Generally, 24 eligible articles were included for final analysis. The average pooled prevalence of malnutrition among pregnant women in Ethiopia was 29.07% (95% CI: 24.84, 33.30). Maternal illiteracy (OR = 1.60, 95% CI: 1.01, 2.53), low income (<1000 Ethiopian Birr) (OR = 3.07, 95% CI: 1.36, 6.92), unplanned pregnancy (OR = 1.33, 95% CI: 1.01, 1.37), number of meal < three/day (OR = 4.63, 95% CI: 3.00, 7.15), poor dietary diversity (OR = 2.89, 95% CI: 1.28, 6.53), absence of antenatal care (OR = 2.53, 95% CI: 1.18, 5.42) and iron supplementation (OR = 0.63, 95% CI: 0.45, 0.88) were predictors of the pooled prevalence of malnutrition among pregnant women in Ethiopia. Conclusion: significant number of pregnant women in Ethiopia were suffered from malnutrition. Maternal illiteracy education level, low income, unplanned pregnancy, low number of meal, poor dietary diversity, absence of antenatal care and iron supplementation were significant predictors of malnutrition. This meta-analysis suggests that global methods to improve girls’ education, access to health care, and economic opportunities to reduce poverty will be needed to reduce burden of malnutrition