A Predictive Modelling Approach on Socioeconomic and Cultural Determinants of Dietary Practices among Pregnant Women in Sierra Leone

Abstract

Aim: This study aimed to identify the socioeconomic and cultural determinants of dietary practices among pregnant women attending antenatal care (ANC) in Sierra Leone and to develop and validate a predictive model of dietary practices. Methods: The study employed a descriptive cross-sectional survey using structured, interviewer-administered questionnaires. Dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD-W) indicator. Multiple linear regression analysis was used to model the predictors of dietary practices, and socioeconomic gradients were examined using Kruskal-Wallis tests with Dunn’s post-hoc comparisons. A total of 470 pregnant women attending government ANC clinics in the Port Loko and Moyamba districts of Sierra Leone were recruited between September and December 2025. Results: Household income had a large effect on dietary diversity (Kruskal-Wallis H = 47.32, p < 0.001; η² = 0.18), with mean dietary diversity scores ranging from 3.4 in the low-income group to 5.6 in the high-income group. Educational attainment was significantly associated with dietary practices across all levels (H = 68.45, p < 0.001). Cultural food taboos were reported by 38% of participants and were associated with significantly lower dietary diversity scores (U = 19,234, p < 0.001; mean DDS: 3.6 versus 4.6). The multiple regression model was statistically significant (F (7, 463) = 58.42, p < 0.001; R² = 0.468) and explained 46.8% of the variance in dietary practices. Nutritional knowledge was the strongest predictor (β = 0.38), followed by income (β = 0.24), food avoidance (β = −0.18), education (β = 0.16), and receipt of nutrition education (β = 0.11). Conclusion: Dietary practices among pregnant women in Sierra Leone were associated with nutritional knowledge, income, education, and cultural food taboos. Effective interventions may require a multilevel approach combining nutrition education, social protection measures, community engagement, and culturally sensitive counselling to address structural barriers to adequate maternal nutrition.