Impact of Maternal Undernutrition on Pregnancy Outcomes in Conflict-Affected Al-Dhalea, Yemen: A Nurse-Led Cross-Sectional Study

This project investigates the critical intersection of maternal nutrition, pregnancy outcomes, and nursing interventions in one of the world's most severe humanitarian crises. Conducted in Yemen's Al-Dhalea Governorate—a region devastated by prolonged conflict—the study provides the first governorate-level evidence on maternal nutritional status and its association with adverse pregnancy outcomes while evaluating the effectiveness of nurse-delivered nutrition counseling. STUDY DESIGN & METHODOLOGY: • Design: Facility-based analytical cross-sectional study • Sample: 341 pregnant and postpartum women from 4 primary healthcare centers (urban, peri-urban, rural, remote rural) • Timeline: April-October 2025 • Measurements: Objective anthropometric (BMI, MUAC) and biochemical (hemoglobin) indicators • Analysis: Multivariable logistic regression, subgroup analyses, sensitivity testing, ROC validation KEY FINDINGS: 1. High prevalence of maternal undernutrition (27.9%) and anemia (31.7%) 2. Substantial burden of adverse outcomes: low birth weight (21.7%), preterm birth (15.5%) 3. Nurse-delivered nutrition counseling associated with 48% reduced odds of low birth weight (aOR=0.52) and 51% reduced odds of preterm birth (aOR=0.49) 4. Critical barriers: medication shortages (78%), inadequate staffing (65.7%), insecurity (54%) PRACTICAL CONTRIBUTIONS: • Develops the "NUTRITION" framework for nurse-led maternal care in conflict settings • Provides complete implementation toolkit for frontline nursing practice • Offers context-adapted protocols for humanitarian nursing research • Establishes evidence-based referral pathways for malnutrition management RESEARCH SIGNIFICANCE: This study makes five key contributions: (1) first localized evidence from active conflict Yemen, (2) nursing-specific effectiveness data, (3) validated implementation framework, (4) comprehensive methodological transparency, and (5) immediate practice applicability. The findings directly inform humanitarian health programming, nursing workforce development, and maternal health policies in fragile settings. OPEN SCIENCE COMMITMENT: All materials are shared to promote reproducibility, secondary analysis, and practical application: • Complete de-identified dataset (File S11) • Full analysis code (SPSS & R scripts) • Research instruments (Arabic/English) • Quality assurance documentation • Security protocols for conflict-zone research • Complete implementation toolkit TARGET AUDIENCE: • Nurses and midwives in humanitarian settings • Maternal and child health program managers • Humanitarian health researchers • Nursing educators and curriculum developers • Health policymakers in conflict-affected regions ETHICAL APPROVAL: Health Research Ethics Committee, Al-Dhalea Governorate Health Office, Yemen (Ref: H/ER/2025/45) Keywords: maternal nutrition, conflict settings, nursing interventions, Yemen humanitarian crisis, low birth weight, preterm birth, implementation science, humanitarian nursing, task-shifting, health systems in fragility