Dietary practices, nutritional knowledge, and socio-cultural influences among pregnant adolescents in rural Ghana: a qualitative study from North Dayi District

BACKGROUND: Adolescent pregnancy is associated with heightened nutritional vulnerabilities due to the concurrent demands of adolescent growth and fetal development. Despite the critical importance of adequate dietary intake during this period, dietary practices among pregnant adolescents in rural Ghanaian settings are poorly understood. This study assessed dietary practices, nutritional knowledge, and socio-economic and cultural influencing factors among pregnant adolescents in North Dayi District, Volta Region, Ghana. METHODS: A qualitative study design was employed, using in-depth interviews with eleven (11) pregnant adolescents aged 16-19 years. Participants were recruited via a combination of purposive and snowball sampling from rural communities in North Dayi District. Data were collected using a semi-structured interview guide and analysed using Braun and Clarke's six-phase thematic analysis framework. The Health Belief Model (HBM) provided the theoretical framework for interpreting how adolescents' perceptions of susceptibility, barriers, benefits, and self-efficacy shaped their dietary behaviours. RESULTS: Three overarching themes emerged: (1) dietary habits centred on starchy staples (banku, kenkey, rice, fufu) with reportedly limited dietary diversity and irregular meal patterns; (2) severely limited nutritional knowledge, with most participants unable to define a balanced diet or identify pregnancy-appropriate foods despite attending antenatal care (ANC); and (3) multiple intersecting barriers to adequate nutrition, including financial constraints, cultural food taboos, limited household decision-making autonomy, and reportedly inadequate dietary counselling at ANC. Food cravings frequently went unmet due to financial limitations, and ANC services reportedly focused predominantly on hygiene and medication rather than dietary guidance. CONCLUSIONS: Pregnant adolescents in North Dayi District face significant dietary challenges stemming from poverty, knowledge gaps, cultural food restrictions, and perceived inadequate health system support. Current ANC nutrition education approaches appear insufficiently tailored to the needs of this population. Comprehensive, multi-level interventions may be needed, including food assistance programmes, adolescent-friendly nutrition education, enhanced health worker training, family engagement strategies, and policy reforms addressing adolescent-specific nutritional needs.