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Singh A, Rahut DB, Sonobe T. Exploring minimum dietary diversity among cambodian children using four rounds of demographic and health survey. Sci Rep 2024; 14:14719. [PMID: 38926408 PMCID: PMC11208556 DOI: 10.1038/s41598-024-64714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Dietary diversity among children is a crucial factor influencing their nutritional status; therefore, this paper uses data from four rounds of the Cambodia Demographic and Health Survey (CDHS) to examine the minimum dietary diversity among children aged 6-23 months. Multilevel binary regression is used to evaluate the variation in minimum dietary diversity at the cluster and province levels. The results show that nearly half of Cambodian children consistently lacked access to vitamin A-rich fruits and vegetables. Although the prevalence of inadequate minimum dietary diversity (MDD) among children significantly dropped from 76% in 2005 to 51% in 2021-2022, it is still high and needs attention. A decomposition analysis (Blinder-Oaxaca decomposition) was further used to understand the drivers of this temporal change in dietary diversity. The empirical results show that clusters represented the most significant source of geographic variation with respect to all eight food groups and MDD. Nutritional policy should improve education and awareness, reduce socio-economic disparities, leverage media, and promote full antenatal care to improve dietary diversity in Cambodia. Initiatives targeting the enhancement of insufficient minimum dietary diversity intake should encompass individual aspects and be customized to suit geographic and community settings.
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Affiliation(s)
- Anjali Singh
- Project Associate (MLE), Project Concern International, New Delhi, Delhi, 110020, India
| | - Dil B Rahut
- Asian Development Bank Institute, 3-2-5 Kasumigaseki, Chiyoda-ku, Tokyo, 100-6008, Japan.
| | - Tetsushi Sonobe
- Asian Development Bank Institute, 3-2-5 Kasumigaseki, Chiyoda-ku, Tokyo, 100-6008, Japan
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Aboagye RG, Seidu AA, Ahinkorah BO, Cadri A, Frimpong JB, Dadzie LK, Budu E, Eyawo O, Yaya S. Prevalence and predictors of infant and young child feeding practices in sub-Saharan Africa. Int Health 2024; 16:68-82. [PMID: 37042267 PMCID: PMC10759300 DOI: 10.1093/inthealth/ihad022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND This study assessed the prevalence and predictors of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) in sub-Saharan Africa (SSA). METHODS A sample of 87 672 mother-child pairs from the 2010-2020 Demographic and Health Surveys of 32 countries in SSA was used. Multilevel binary logistic regression analysis was carried out to examine the predictors of MDD, MMF, and MAD. Percentages and adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings. RESULTS The prevalence of MDD, MMF, and MAD in SSA were 25.3% (95% CI 21.7 to 28.9), 41.2% (95% CI 38.8 to 43.6), and 13.3% (95% CI 11.6 to 15.0), respectively. Children aged 18-23 months were more likely to have MDD and MAD but less likely to have MMF. Children of mothers with higher education levels were more likely to have MDD, MMF, and MAD. Children who were delivered in a health facility were more likely to have MDD and MAD but less likely to have MMF. CONCLUSIONS Following the poor state of complementary feeding practices for infants and young children, the study recommends that regional and national policies on food and nutrition security and maternal and child nutrition and health should follow the internationally recommended guidelines in promoting, protecting, and supporting age-appropriate complementary foods and feeding practices for infants and young children.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul Cadri
- Department of Social and Behavioural Science, School of Public Health, University of Ghana, Legon, Ghana
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - James Boadu Frimpong
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Oghenowede Eyawo
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- George Institute for Global Health, Imperial College London, London, UK
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Rahman MA, Kundu S, Rashid HO, Tohan MM, Islam MA. Socio-economic inequalities in and factors associated with minimum dietary diversity among children aged 6-23 months in South Asia: a decomposition analysis. BMJ Open 2023; 13:e072775. [PMID: 38128933 DOI: 10.1136/bmjopen-2023-072775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE This study aimed to determine the factors associated with minimum dietary diversity (MDD) and estimate the socioeconomic inequalities in MDD among children from five South Asian countries. DESIGN Cross-sectional. SETTING The study used the most recent round of secondary databases of Demographic Health Survey data of Bangladesh (2017-2018), India (2019-2021), Maldives (2016-2017), Nepal (2018) and Pakistan (2017-2018). PARTICIPANTS This study used information on MDD and other explanatory variables from a total of 136 980 (weighted) children aged 6-23 months. METHODS Multivariable logistic regression was employed to identify the factors associated with MDD and concentration index (CIX) and Lorenz curve were used to measure the socioeconomic inequalities in MDD. RESULTS The overall weighted prevalence of MDD in South Asia was 23.37%. The highest prevalence of MDD was found among children from Maldives (70.7%), while the lowest was in Pakistan (14.2%). Living in affluent versus poor households, having a mother who is employed versus a mother who is unemployed, exposure to various forms of media (newspapers and magazines), seeking antenatal care (ANC) more than four times compared with those who sought ANC less than four times and having children older than 4 years old are the most common significant factors associated with MDD deficiency. This study found the value of the CIX for MDD (MDD: CI=0.0352; p<0.001) among children with a higher socioeconomic status, suggesting inequality in MDD in favour of the more among well-off households. CONCLUSION Inequality in the prevalence of MDD favours the affluent. Health policy and intervention design should prioritise minimising socioeconomic inequalities concerning the MDD. In addition, policy-makers should prioritise the associated factors of MDD such as education, wealth status, employment, media exposure while designing intervention or policies.
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Affiliation(s)
| | - Satyajit Kundu
- Biochemistry and Food Analysis, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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Das S, Fahim SM, Rasul MG, Afrin S, Alam MA, Uz Zaman M, Chowdhury M, Arifeen SE, Ahmed T. Nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals living in Bhasan Char relocation camp, Bangladesh: a cross-sectional survey. BMJ Open 2023; 13:e068875. [PMID: 36990487 PMCID: PMC10069579 DOI: 10.1136/bmjopen-2022-068875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To generate baseline evidence regarding the nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals (FDMN) relocated to Bhasan Char relocation camp of Bangladesh. DESIGN Cross-sectional survey. SETTING Bhasan Char relocation camp, Bangladesh, 7 November 2021-12 November 2021. PARTICIPANTS 299 under-5 children (both male and female) and 248 adolescent girls (11-17 years) were surveyed. OUTCOME MEASURES Anthropometric indices and nutritional status of the study participants. RESULTS Nearly 17% of the adolescent girls were suffering from severe thinness/thinness, while 5% were overweight/obese. Severe thinness was more prevalent (2% vs 3.9%) in older adolescents (15-17 years) than their younger counterparts (11-14 years). The prevalence of severe stunting and stunting in adolescents were 14% (95% CI 11.21 to 16.87%) and 29% (95% CI 25.93 to 31.59%), respectively. One-third of the surveyed under-5 children were severely (8.50% (95% CI 5.60 to 11.33%)) or moderately (23.08% (95% CI 20.24 to 25.90%)) stunted, 27% were either severely (4.43% (95% CI 1.60 to 7.27%)) or moderately (22.98% (95% CI 20.15 to 25.81%)) underweight and 12% were severely (1.21% (95% CI 0.00 to 4.04%)) or moderately (10.88% (95% CI 8.05 to 13.72%)) wasted. The prevalence of moderate and severe acute malnutrition in children was low. Surveyed adolescents took a mean of 3.10 (SD 1.03) of nine food groups and 25% (95% CI 22.97 to 28.64%) of under-5 children took minimum diversified diet. The survey respondents mostly consumed carbohydrate-based poorly diversified diets. Nutritional status of the participants did not show any statistically significant association to the dietary diversity status. CONCLUSION A significant number of surveyed under-5 children and adolescent girls of relocated FDMN living in Bhasan Char of Bangladesh were suffering from thinness, stunting, underweight and wasting. Dietary diversity was poor among the surveyed population.
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Affiliation(s)
- Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Golam Rasul
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sazia Afrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahabub Uz Zaman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Paramashanti BA, Dibley MJ, Alam A, Huda TM. Wealth- and education-related inequalities in minimum dietary diversity among Indonesian infants and young children: a decomposition analysis. Glob Health Action 2022; 15:2040152. [PMID: 35389332 PMCID: PMC9004518 DOI: 10.1080/16549716.2022.2040152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Over the last two decades, Indonesia has experienced remarkable economic growth. However, the percentage of infants and young children meeting the minimum dietary diversity (MDD) criteria has stagnated. Despite the growing body of evidence of the association between MDD and socioeconomic factors, there is little information about socioeconomic inequalities in MDD in Indonesia. Objectives The current study seeks to quantify the wealth- and education-related inequalities in MDD among infants and young children in Indonesia and determine the contribution of different factors to these disparities. Methods We included a total of 5038 children aged 6–23 months of the 2017 Indonesia Demographic and Health Survey. We measured wealth- and education-related inequalities using the concentration curve and Wagstaff normalised concentration index. Using a concentration index decomposition analysis, we then examined factors contributing to wealth- and education-related inequalities in MDD. Results The concentration indices by household wealth and maternal education were 0.220 (p < 0.001) and 0.192 (p < 0.001), respectively, indicating more concentration of inequalities among the advantaged population. The decomposition analysis revealed that household wealth (29.8%), antenatal care (ANC) visits (16.6%), paternal occupation (15.1%), and maternal education (11.8%) explained the pro-rich inequalities in MDD in Indonesia. Maternal education (26.1%), household wealth (19.1%), ANC visits (14.9%), and paternal occupation (10.9%) made the most considerable contribution to education-related inequalities in MDD. Conclusions There is substantial wealth- and education-related inequalities in MDD. Our findings suggest an urgent need to address the underlying causes of not reaching dietary diversity by promoting infant and young child feeding equity in Indonesia.
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Affiliation(s)
- Bunga A Paramashanti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta, Indonesia
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tanvir M Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Kundu S, Das P, Rahman MA, Al Banna MH, Fatema K, Islam MA, Srivastava S, Muhammad T, Dey R, Hossain A. Socio-economic inequalities in minimum dietary diversity among Bangladeshi children aged 6-23 months: a decomposition analysis. Sci Rep 2022; 12:21712. [PMID: 36522494 PMCID: PMC9755277 DOI: 10.1038/s41598-022-26305-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to measure the socio-economic inequalities in having minimum dietary diversity (MDD) among Bangladeshi children aged 6-23 months as well as to determine the factors that potentially contribute to the inequity. The Bangladesh Demographic and Health Survey (BDHS) 2017-2018 data were used in this study. A sample of 2405 (weighted) children aged 6-23 months was included. The overall weighted prevalence of MDD was 37.47%. The concentration index (CIX) value for inequalities in MDD due to wealth status was positive and the concentration curve lay below the line of equality (CIX: 0.1211, p < 0.001), where 49.47% inequality was contributed by wealth status, 25.06% contributed by the education level of mother, and 20.41% contributed by the number of ante-natal care (ANC) visits. Similarly, the CIX value due to the education level of mothers was also positive and the concentration curve lay below the line of equality (CIX: 0.1341, p < 0.001), where 52.68% inequality was contributed by the education level of mother, 18.07% contributed by wealth status, and 14.69% contributed by the number of ANC visits. MDD was higher among higher socioeconomic status (SES) groups. Appropriate intervention design should prioritize minimizing socioeconomic inequities in MDD, especially targeting the contributing factors of these inequities.
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Affiliation(s)
- Satyajit Kundu
- grid.443020.10000 0001 2295 3329Global Health Institute, North South University, Dhaka, 1229 Bangladesh ,grid.263826.b0000 0004 1761 0489School of Public Health, Southeast University, Nanjing, 210096 China ,grid.443081.a0000 0004 0489 3643Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602 Bangladesh
| | - Pranta Das
- grid.24434.350000 0004 1937 0060Department of Statistics, University of Nebraska–Lincoln, Lincoln, NE 68583-0963 USA ,grid.8198.80000 0001 1498 6059Department of Statistics, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Md. Ashfikur Rahman
- grid.412118.f0000 0001 0441 1219Development Studies Discipline, Khulna University, Khulna, 9208 Bangladesh
| | - Md. Hasan Al Banna
- grid.443081.a0000 0004 0489 3643Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602 Bangladesh
| | - Kaniz Fatema
- grid.8198.80000 0001 1498 6059Department of Statistics, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Md. Akhtarul Islam
- grid.412118.f0000 0001 0441 1219Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, 9208 Bangladesh
| | - Shobhit Srivastava
- grid.419349.20000 0001 0613 2600Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, 400088 India
| | - T. Muhammad
- grid.419349.20000 0001 0613 2600Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088 India
| | - Rakhi Dey
- grid.472353.40000 0004 4682 8196Department of Statistics, Government Brajalal College, National University of Bangladesh, Gazipur, 1704 Bangladesh
| | - Ahmed Hossain
- grid.412789.10000 0004 4686 5317College of Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates ,grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
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Harvey CM, Newell ML, Padmadas S. Maternal socioeconomic status and infant feeding practices underlying pathways to child stunting in Cambodia: structural path analysis using cross-sectional population data. BMJ Open 2022; 12:e055853. [PMID: 36328394 PMCID: PMC9639063 DOI: 10.1136/bmjopen-2021-055853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify and investigate complex pathways to stunting among children aged 6-24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting. DESIGN, SETTING AND PARTICIPANTS We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children's height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients. OUTCOME MEASURE The primary outcome measure was height-for-age Z-scores as a continuous measure. RESULTS Findings suggest that children's dietary diversity and continued breast feeding mediate the association between socioeconomic status and children's height. While there was no significant direct effect of maternal education on children's height, results suggested significant indirect pathways through which maternal education effects children's height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children's height was mediated by either dietary diversity or continued breast feeding. CONCLUSION We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status.
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Affiliation(s)
| | - Marie-Louise Newell
- Faculty of Medicine, School of Human Development and Health, Global Health Research Institute, University of Southampton, Southampton, UK
- Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Sabu Padmadas
- Social Statistics and Demography, University of Southampton, Southampton, UK
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Nurokhmah S, Middleton L, Hendarto A. Prevalence and Predictors of Complementary Feeding Practices Among Children Aged 6-23 Months in Indonesia. J Prev Med Public Health 2022; 55:549-558. [PMID: 36475320 DOI: 10.3961/jpmph.22.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). METHODS We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children's Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design. RESULTS The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali. CONCLUSIONS It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low.
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Affiliation(s)
- Siti Nurokhmah
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Nutrition Science, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
| | - Lucinda Middleton
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Ellengowan Drive, Australia
| | - Aryono Hendarto
- Department of Child Health, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Jalata DD, Asefa BG. Trends and Determinants of Dietary Diversity in Children Aged 6-59 Months in Ethiopia: Analysis of 2005-2016 Demographic and Health Survey. Curr Dev Nutr 2022; 6:nzac135. [PMID: 36475020 PMCID: PMC9718648 DOI: 10.1093/cdn/nzac135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/23/2022] [Accepted: 08/25/2022] [Indexed: 04/22/2024] Open
Abstract
Background Dietary diversity may be associated with health and optimum growth in children. Objectives In this study we analyzed the trends and determinants of minimum dietary diversity (MDD) among Ethiopian children aged 6 to 59 mo. Methods Ethiopian Demographic Health Survey (EDHS) data of 3 consecutive years (2005, 2011, and 2016) were analyzed. A total of n = 2396 (2005), n = 3385 (2011), and n = 3723 (2016) children aged 6 to 59 mo were included for measurement of trends and identification of the determinants of MDD. The associations between the study factors and MDD were investigated using multiple logistic regression analysis. Results The proportion of children who fulfilled the MDD decreased from 2.46% in 2005 to 1.57% in 2011 but sharply increased to 7.82% in 2016. Adjusted regression analysis revealed that exposure of mothers to media, particularly watching television, maternal education, and household wealth were associated with a greater likelihood of mothers providing diversified diets to their children across the 3 y of EDHS data. Conclusions A decrease in MDD was observed from the years 2005 to 2011, after which a sharp increase was noted in 2016. In all 3 y of the EDHS, media exposure, maternal education, and household wealth were the consistent factors positively affecting dietary diversity among children aged 6 to 59 mo. Future intervention programs to increase dietary diversity in children should emphasize improving access to media exposure, education, and antenatal care visits.
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Affiliation(s)
- Dassalegn Daraje Jalata
- Food Science and Nutrition Research Department, Ethiopian Institute of Agricultural Research, Addis Ababa, Ethiopia
| | - Bezuayehu Gutema Asefa
- Food Science and Nutrition Research Department, National Fishery and Aquatic Life Research Center, Ethiopian Institute of Agricultural Research, Sebeta, Ethiopia
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Ba DM, Ssentongo P, Gao X, Chinchilli VM, Richie JP, Maiga M, Muscat JE. Prevalence and determinants of meeting minimum dietary diversity among children aged 6-23 months in three sub-Saharan African Countries: The Demographic and Health Surveys, 2019-2020. Front Public Health 2022; 10:846049. [PMID: 36081474 PMCID: PMC9445207 DOI: 10.3389/fpubh.2022.846049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Abstract
Background Dietary diversity is an indicator of nutritional adequacy, which plays a significant role in child growth and development. Lack of adequate nutrition is associated with suboptimal brain development, lower school performance, and increased risk of mortality and chronic diseases. We aimed to determine the prevalence and determinants of meeting minimum dietary diversity (MDD), defined as consuming at least five out of eight basic food groups in the previous 24-h in three sub-Saharan African countries. Methods A weighted population-based cross-sectional study was conducted using the most recent Demographic and Health Surveys (DHS). MDD data were available between 2019 and 2020 for three sub-Saharan African countries (Gambia, Liberia, and Rwanda). The study population included 5,832 children aged 6-23 months. A multivariable logistic regression model was developed to identify independent factors associated with meeting MDD. Results Overall, the weighted prevalence of children who met the MDD was 23.2% (95% CI: 21.7-24.8%), ranging from 8.6% in Liberia to 34.4% in Rwanda. Independent factors associated with meeting MDD were: age of the child (OR) = 1.96, 95% CI: 1.61, 2.39 for 12-17 months vs. 6-11 months], mothers from highest households' wealth status (OR = 1.86, 95% CI: 1.45-2.39) compared with the lowest, and mothers with secondary/higher education (OR = 1.69, 95% CI: 1.35-2.12) compared with those with no education. Mothers who were employed, had access to a radio, and those who visited a healthcare facility in the last 12 months were more likely to meet the MDD. There was no significant association between the child's sex and the odds of fulfilling the MDD. Conclusions There is substantial heterogeneity in the prevalence of MDD in these three sub-Saharan African countries. Lack of food availability or affordability may play a significant role in the low prevalence of MDD. The present analysis suggests that policies that will effectively increase the prevalence of meeting MDD should target poor households with appropriate materials or financial assistance and mothers with lower literacy. Public health interventions working with sectors such as education and radio stations to promote health education about the benefits of diverse diets is a critical step toward improving MDD in sub-Saharan Africa and preventing undernutrition.
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Affiliation(s)
- Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,*Correspondence: Djibril M. Ba
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, United States,Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - John P. Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Mamoudou Maiga
- Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
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Akbar M, Asif AM, Hussain F. Does maternal empowerment improve dietary diversity of children? Evidence from Pakistan demographic and health survey 2017-18. Int J Health Plann Manage 2022; 37:3297-3311. [PMID: 35983643 DOI: 10.1002/hpm.3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/25/2022] [Accepted: 07/22/2022] [Indexed: 11/08/2022] Open
Abstract
The role of maternal empowerment (ME) to improve child nutrition in patriarchal societies of developing countries remains ambiguous. This study provides empirical evidence about the impact of ME and some other factors selected under United Nations International Children's Emergency Fund theoretical framework, on dietary diversity of children (under 5 years age) in Pakistan. Partial proportional odds model is estimated to obtain varying estimates of the parameters by using data of Pakistan Demographic and Health Survey 2017-18. Significant positive role of empowered mothers to improve child dietary diversity (CDD) is explored (OR = 1.135; Confidence Interval [CI] = 1.001-1.288). Moreover, positive association of maternal higher education on CDD (OR = 1.329; 95% CI = 1.085-1.628) supports the productive and allocative efficiency hypotheses of health economics. Maternal agricultural employment, paternal education, and paternal employment were not significantly associated with CDD. This requires further exploration. Positive association of household socioeconomic status with CDD (OR = 1.768; 95% CI = 1.314-2.380) and significance of some demographic variables call for social welfare programs. Positive association of mother's age and CDD demands for amendment in Child Marriage Restraint Act. The observed adverse association of family size with CDD induces effective family planning to control high birth rate in Pakistan. It may be concluded that ME and creation of awareness about nutrition security through maternal education are the important factors to overcome child malnutrition in Pakistan. Since, socioeconomic and cultural environment in South Asian countries is homogeneous, the analysis in this study might be relevant to the South Asian region. Moreover, the study provides evidence informing the debate on the role of ME to improve child nutrition in patriarchal societies.
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Affiliation(s)
- Muhammad Akbar
- Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan
| | - Atta Muhammad Asif
- Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan
| | - Fazil Hussain
- Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan
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Belay DG, Aragaw FM, Teklu RE, Fetene SM, Negash WD, Asmamaw DB, Fentie EA, Alemu TG, Eshetu HB, Shewarega ES. Determinants of Inadequate Minimum Dietary Diversity Intake Among Children Aged 6-23 Months in Sub-Saharan Africa: Pooled Prevalence and Multilevel Analysis of Demographic and Health Survey in 33 Sub-Saharan African Countries. Front Nutr 2022; 9:894552. [PMID: 35845763 PMCID: PMC9284213 DOI: 10.3389/fnut.2022.894552] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Inappropriate feeding practices result in significant threats to child health by impaired cognitive development, compromised educational achievement, and low economic productivity, which becomes difficult to reverse later in life. There is minimal evidence that shows the burden and determining factors of inadequate dietary intake among children aged under 2 years in sub-Saharan African (SSA) countries. Therefore, this study aimed to assess the pooled magnitude, wealth-related inequalities, and other determinants of inadequate minimum dietary diversity (MDD) intake among children aged 6-23 months in the SSA countries using the recent 2010-2020 DHS data. Methods A total of 77,887 weighted samples from Demographic and Health Survey datasets of the SSA countries were used for this study. The Microsoft Excel and STATA version 16 software were used to clean, extract, and analyze the data. A multilevel binary logistic regression model was fitted. The concentration index and curve were applied to examine wealth-related inequalities in the outcomes. P-value < 0.05 with 95% CI was taken to declare statistical significance. Results The pooled magnitude of inadequate MDD intake among children aged 6-23 months in SSA was 76.53% (95% CI: 73.37, 79.70), ranging from 50.5% in South Africa to 94.40% in Burkina Faso. Individual-level factors such as women having secondary and above education (AOR = 0.66; 95% CI; 0.62, 0.70), being employed (AOR = 0.76; 95% CI; 0.72, 0.79), having household media exposure (AOR = 0.69; 95% CI; 0.66, 0.72), richest wealth (AOR = 0.46; 95% CI; 0.43, 0.50), having health institution delivery (AOR = 0.87;95% CI; 0.83, 0.91), and community-level factor such as living in upper middle-income country (AOR = 0.42; 95% CI; 0.38, 0.46) had a significant protective association, whereas rural residence (AOR = 1.29; 95% CI; 1.23, 1.36) has a significant positive association with inadequate MDD intake among children aged 6-23 months. Inadequate MDD intake among children aged 6-23 months in SSA was disproportionately concentrated on the poor households (pro-poor) (C = -0.24; 95% CI: -0.22, -0.0.26). Conclusion and Recommendations There is a high magnitude of inadequate minimum dietary diversity intake among children aged 6-23 months in SSA. Variables such as secondary and above maternal education, having an employed mother, having exposure to media, richest wealth, having health institution delivery, and living in the upper middle-income country have a significant negative association, whereas living in rural residence has a significant positive association with inadequate MDD intake. These findings highlight that to increase the MDD intake in the region, policy makers and other stakeholders need to give prior attention to enhancing household wealth status, empowering women, and media exposure.
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Affiliation(s)
- Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ever Siyoum Shewarega
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dwari S, Subhadarsini S, Panda N, Panigrahy SR, Panigrahi SK. Association of mobile screen media use among children 6 months to 2 years of age with Minimum Dietary Diversity: A Case Control Study. Nutrition 2022; 103-104:111790. [DOI: 10.1016/j.nut.2022.111790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 10/31/2022]
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Shifti DM, Chojenta C, Holliday EG, Loxton D. Maternal anemia and baby birth size mediate the association between short birth interval and under-five undernutrition in Ethiopia: a generalized structural equation modeling approach. BMC Pediatr 2022; 22:108. [PMID: 35227241 PMCID: PMC8883659 DOI: 10.1186/s12887-022-03169-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Studies assessing the association between short birth interval, a birth-to-birth interval of less than 33 months, and under-five undernutrition have produced inconclusive results. This study aimed to assess the relationship between short birth interval and outcomes of stunting, underweight, and wasting among children aged under-five in Ethiopia, and potential mediation of any associations by maternal anemia and baby birth size. Method Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used. Stunting, wasting, and underweight among children aged under-five were outcome variables. Generalized Structural Equation Modeling (GSEM) was used to examine associations between short birth interval and outcomes, and to assess hypothesized mediation by maternal anemia and baby birth size. Results Significant associations between short birth interval and stunting (AOR = 1.49; 95% CI = 1.35, 1.66) and underweight (AOR = 1.43; 95% CI = 1.28, 1.61) were found. There was no observed association between short birth interval and wasting (AOR = 1.05; 95% CI = 0.90, 1.23). Maternal anemia and baby birth size had a significant partial mediation effect on the association between short birth interval and stunting (the coefficient reduced from β = 0.337, p < 0.001 to β = 0.286, p < 0.001) and underweight (the coefficient reduced from β = 0.449, p < 0.001 to β = 0.338, p < 0.001). Maternal anemia and baby birth size mediated 4.2% and 4.6% of the total effect of short birth interval on stunting and underweight, respectively. Conclusion Maternal anemia and baby birth size were identified as mediators of the association between short birth interval and under-five undernutrition status. Policies and programs targeting the reduction of under-five undernutrition should integrate strategies to reduce maternal anemia and small baby birth size in addition to short birth interval.
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Affiliation(s)
- Desalegn Markos Shifti
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. .,Centre for Women's Health Research, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
| | - Catherine Chojenta
- Centre for Women's Health Research, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Elizabeth G Holliday
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
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Cavalcanti AUA, Boccolini CS. Desigualdades sociais e alimentação complementar na América Latina e no Caribe. CIENCIA & SAUDE COLETIVA 2022; 27:619-630. [DOI: 10.1590/1413-81232022272.31862020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/07/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo Este artigo tem como objetivo avaliar o papel das desigualdades sociais nos padrões de alimentação complementar nos países da América Latina e do Caribe. Trata-se de um estudo ecológico que utilizou dados agregados de inquéritos de base populacional. A unidade de análise da pesquisa foram 16 países da América Latina e do Caribe com informações disponíveis. Foram selecionados como desfechos a prevalência dos seguintes indicadores de alimentação complementar: introdução alimentar de alimentos sólidos, semissólidos e pastosos” (IASSP), “diversidade alimentar mínima” (DAM), “frequência alimentar mínima” (FAM) e “alimentação mínima aceitável” (AMA). As diferenças da prevalência dos indicadores entre os quintis de riqueza mais ricos e mais pobres foram calculadas de forma absoluta e relativa. Comparando os quatro indicadores de alimentação complementar, o IASSP teve o melhor desempenho, com 10 países, entre os 11 avaliados, apresentando prevalência acima de 80%. O indicador com pior desempenho foi o AMA, com apenas um país, entre os oito avaliados, com prevalências acima de 60%. Na quase totalidade dos países, a população mais pobre possuía prevalências de indicadores de alimentação complementar menores que os mais ricos.
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Paramashanti BA, Huda TM, Alam A, Dibley MJ. Trends and determinants of minimum dietary diversity among children aged 6-23 months: a pooled analysis of Indonesia Demographic and Health Surveys from 2007 to 2017. Public Health Nutr 2021; 25:1-12. [PMID: 34743776 PMCID: PMC9991623 DOI: 10.1017/s1368980021004559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine minimum dietary diversity (MDD) trends and determinants among children aged 6-23 months. DESIGN Secondary analysis of the Indonesia Demographic and Health Surveys (IDHS) between 2007 and 2017. The primary outcome was MDD, the consumption of at least five out of eight food groups (MDD-8). We included a total of 5015 (IDHS 2007), 5050 (IDHS 2007) and 4925 (IDHS 2017) children aged 6 to 23 months to estimate trends of MDD-8 and to identify factors associated with MDD-8. We used multiple logistic regression analysis adjusted for the complex sampling design to investigate the association between the study factors and MDD-8. SETTING Indonesia. PARTICIPANT A total of 14 990 children aged 6-23 months. RESULTS Over the 10 years, the percentage of children who consumed a diversified diet was 53·1 % in 2007, 51·7 % in 2012 and 53·7 % in 2017. Multivariate analyses showed that older age children, higher maternal education, maternal weekly access to media, paternal non-agricultural occupation, history of at least four antenatal care visits and wealthier households were associated with the increased odds of MDD-8. Children living in rural areas, Sulawesi and Eastern Indonesia, were less likely to eat a diversified diet. CONCLUSIONS The proportion of children meeting MDD-8 has stagnated in the last decade. Child, parental, health care, household and community factors are associated with MDD-8. Therefore, nutrition education programmes and behaviour change communication activities should target mothers and families from socio-economically and geographically disadvantaged populations.
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Affiliation(s)
- Bunga A Paramashanti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
- Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta55183, Indonesia
| | - Tanvir M Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
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Windus JL, Burrows TL, Duncanson K, Collins CE, Rollo ME. Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia. J Hum Nutr Diet 2021; 34:953-968. [PMID: 34231266 DOI: 10.1111/jhn.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
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Worku T, Gonete KA, Muhammad EA, Atnafu A. Sustainable under nutrition reduction program and dietary diversity among children's aged 6-23 months, Northwest Ethiopia: Comparative cross-sectional study. Int J Equity Health 2020; 19:14. [PMID: 31992299 PMCID: PMC6986108 DOI: 10.1186/s12939-019-1120-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Adequate dietary diversity is vital for the survival, growth and development of infants and children. Inadequate dietary diversity is the major cause of micronutrient deficiency in Sub-saharan Africa, including Ethiopia, where only less than one-fourth of the children aged 6-23 months obtain adequate diversified diet. Thus country implemented a strategy known as the Sustainable Undernutrtion Reduction (SUR) programs to alleviate the problem. However, empirical evidences are scarce on the impact of the program on children aged 6-23 months. Therefore, this study aimed to compare the level of dietary diversity among children aged 6-23 months in districts covered and not covered by SURE program in West Gojjam zone. METHODS A community based comparative cross-sectional study was conducted in three districts of West Gojjam zone, Ethiopia, from February 29 to April 20, 2019. A total of 832 mother and child pairs were selected by the simple random sampling technique. A pretested and structured interviewer-administered questionnaire was used to collect data. A binary logistic regression model was fitted to identify factors associated with dietary diversity. Crude odds and adjusted odds ratios with 95% confidence intervals (CI) were calculated to assess the strength of associations and significance of the identified factors for dietary diversity score. RESULT The overall proportion of adequate dietary diversity among children aged 6-23 months was 29.9% (95% CI: 27.0-33.0), whereas in SURE covered and uncovered districts it was 33.4% (95%CI: 29.0-38.and 26.4%(95% CI: 22.0, 31.0), respectively. ANC (Antenatal care) (AOR = 1.7; 95% CI: 1.16, 2.55) and postnatal care services (AOR = 2.1; 95% CI: 1.38, 3.28), participating in food preparation programs (AOR = 1.9; 95% CI: 1.19, 2.96), GMP (AOR = 2.74,95%CI:1.80, 4.18), vitamin A supplementation (AOR = 2.10,95%CI:1.22, 3.61) and household visits by health extension workers (AOR = 2.0; 95% CI: 1.25, 3.21) were significantly associated with dietary diversity. CONCLUSION The proportion of adequate dietary diversity was higher among children in the program than those out of the program. ANC visits, PNC follow-ups, women's participating in food preparation programs and household visits by health extension workers were significantly associated with dietary diversity. Therefore, and strengthening and scaling up the program to non covered districts and providing health and nutrition counseling on Infant and Young Child Feeding (IYCF) during ANC and PNC services are recommended for achieving the recommended dietary diversity.
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Affiliation(s)
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, University of Gondar, College of Medicine and Health Sciences, P.O. Box 196, Gondar, Ethiopia
| | - Esmael Ali Muhammad
- Department of Human Nutrition, Institute of Public Health, University of Gondar, College of Medicine and Health Sciences, P.O. Box 196, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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