Factors Associated with Recommended Nutritional Practices among Pregnant and Lactating Women in Rural Communities of Moyamba District, Sierra Leone

Background: Maternal malnutrition remains a major public health challenge in Sierra Leone, particularly in rural communities where poverty, food insecurity, and inadequate access to health services negatively affect maternal dietary practices and health outcomes. Aim: This study aimed to determine the factors associated with the uptake of recommended nutritional practices among pregnant and lactating women in rural communities of Moyamba District, Sierra Leone. Methodology: A community-based quasi-experimental study was conducted between June and December 2025 among 266 pregnant women and lactating mothers selected using a multistage sampling technique. Data were collected using pretested interviewer-administered questionnaires covering socio-demographic characteristics, maternal health service utilisation, nutrition education exposure, food security status, cultural beliefs, and nutritional practices. Dietary diversity was assessed using the Minimum Dietary Diversity for Women indicator based on a 24-hour dietary recall. Data were analysed using SPSS version 27, with descriptive statistics, chi-square tests, and multivariable logistic regression analysis conducted at a 5% level of significance. Results: Overall, 64.3% of respondents demonstrated good uptake of recommended nutritional practices. Regular attendance at antenatal and postnatal care services was the strongest predictor of good nutritional practices (AOR = 3.10; 95% CI: 1.62–5.94; p = 0.001). Other significant positive predictors included spousal support (AOR = 2.85; p = 0.004), participation in community nutrition activities (AOR = 2.40; p = 0.004), exposure to nutrition education (AOR = 2.18; p = 0.010), and access to health information (AOR = 1.96; p = 0.021). Household food insecurity (AOR = 0.52; p = 0.006), cultural food taboos (AOR = 0.61; p = 0.021), and large household size (AOR = 0.70; p = 0.034) significantly reduced the likelihood of adopting recommended nutritional practices. Conclusion: Uptake of recommended nutritional practices among pregnant and lactating women in Moyamba District was significantly influenced by maternal health service utilisation, nutrition education exposure, community participation, access to health information, and spousal support, while food insecurity and sociocultural constraints remained major barriers. Integrated interventions addressing both behavioural and socioeconomic determinants are required to improve maternal nutrition outcomes in rural Sierra Leone.