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Mardani RAD, Wu WR, Hajri Z, Thoyibah Z, Yolanda H, Huang HC. Effect of a Nutritional Education Program on Children's Undernutrition in Indonesia: A Randomized Controlled Trial. J Pediatr Health Care 2024; 38:552-563. [PMID: 38613537 DOI: 10.1016/j.pedhc.2024.02.006] [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] [Received: 01/02/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION To assess effects of a nutritional education program on improving mothers' undernutrition knowledge, self-efficacy, and complementary feeding practices, and reducing undernutrition in children aged <2 years. METHOD A randomized controlled trial was conducted at a community healthcare center in Indonesia. The intervention group participated in a 4-week nutritional education program; the control group received standard care (n = 80; 1:1 ratio). Measurements consisted of mothers' knowledge of undernutrition, self-efficacy, and complementary feeding practices, and children's anthropometric indicators. RESULTS Intervention group mothers improved their understanding of undernutrition, self-efficacy, and complementary feeding practices compared to the control group. Additionally, children in the intervention group exhibited increased mean Z-scores for stunting, wasting, and being underweight at 12 and 24 weeks following the intervention. DISCUSSION Healthcare professionals can regularly provide nutritional education programs related to managing undernutrition and complementary feeding practices for mothers with children aged <2 years to prevent and improve undernutrition.
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Atosona A, Mohammed JA, Issahaku H, Saani K, Addae HY, Azupogo F. Maternal employment status and child age are positive determinants of minimum dietary diversity among children aged 6-23 months in Sagnarigu municipality, Ghana: a cross-sectional study. BMC Nutr 2024; 10:57. [PMID: 38622652 PMCID: PMC11020657 DOI: 10.1186/s40795-024-00865-7] [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: 09/21/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Intake of a diversified diet is key to the prevention of malnutrition among children as it results in improved intake of energy and micronutrients, which are deemed critical for better nutritional status of children. This study assessed minimum dietary diversity (MDD) and its determinants among children aged 6-23 months in the Sagnarigu Municipality of Ghana. METHODS This was an analytical cross-sectional study, carried out in the Sagnarigu Municipality, Ghana and involved 369 mother-child pairs selected through a systematic random sampling. A semi-structured questionnaire was used to obtain respondents' socio-demographic characteristics, feeding practices, nutritional knowledge and anthropometry. MDD was assessed using a repeated 24-hour dietary recall method. Chi-square/Fisher exact test and binary logistic regression analysis were used to determine the factors associated with MDD. RESULTS The study found that 24.9% of the children were between the ages of 6-8 months and 75.1% were between the ages of 9-23 months. About 64.2% of the children met the MDD. Children of mothers who were self-employed were approximately 2 times more likely to meet the MDD as compared to children of mothers who were unemployed [Adjusted Odd Ratio (AOR): 1.93, 95% CI (1.13-3.31), P = 0.017]. Also, children aged 9-23 months were approximately 14 times more likely to meet MDD as compared to younger children aged 6-8 months [AOR: 13.98, 95% CI (7.54-25.91), P < 0.001]. CONCLUSION Our study suggests that maternal empowerment may have positive effects on improving the MDD of infants and young children.
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Affiliation(s)
- Ambrose Atosona
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
| | - Jawahir Abukari Mohammed
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Huzaifa Issahaku
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Khadija Saani
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | | | - Fusta Azupogo
- Faculty of Agriculture, Department of Family and Consumer Sciences, Food and Consumer Sciences, University for Development Studies, Tamale, Ghana
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Wassie EG, Tenagashaw MW, Tiruye TY. Women empowerment and childhood stunting: evidence from rural northwest Ethiopia. BMC Pediatr 2024; 24:30. [PMID: 38195435 PMCID: PMC10775445 DOI: 10.1186/s12887-023-04500-5] [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] [Received: 03/09/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Women are often the primary caregivers of children, and as such, their empowerment could influence the nutritional status of their children. However, the role of maternal empowerment on the nutritional status of children in Ethiopia is largely unknown. AIM To determine the association of women's empowerment with childhood stunting in rural northwest Ethiopia. METHODS A community-based cross-sectional study was conducted among 582 mothers with children aged 6-59 months. A multistage sampling technique was used to select the study participants. Binomial logistic regression analyses were used to assess whether women's empowerment (categorized as low, moderate and high) and its five dimensions (household decision-making, educational status, cash earnings, house/land ownership, and membership in community groups) were associated with stunting in children. Odds ratios with 95% CI were estimated, and statistical significance was declared at a p-value of < 0.05. RESULTS A total of 114 (19.6%), 312 (53.6%), and 156 (26.8%) participants had low, moderate, and high empowerment levels, respectively. In addition, 255 (43.8%) mothers had children who were stunted (too short for their age). In the adjusted models, mothers with moderate empowerment (AOR 0.60, 95% CI: 0.35, 0.97) and high empowerment (AOR 0.56, 95% CI: 0.37, 0.86) had lower odds of having stunted children compared to mothers with low empowerment. Mothers who had a secondary education or higher (AOR 0.57, 95% CI: 0.35, 0.93), owned a house or land (AOR 0.64, 95% CI: 0.44, 0.94) and were members of community groups (AOR 0.54, 95% CI: 0.36, 0.80) were less likely to have stunted children. CONCLUSION High women empowerment was significantly associated with a lower likelihood of childhood stunting. The findings suggest a need to look beyond the direct causes of stunting and incorporate targeted strategies for empowering women into child nutrition programs.
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Affiliation(s)
| | - Mesfin Wogayehu Tenagashaw
- Applied Human Nutrition Department, Faculty of Chemical and Food Engineering, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Tenaw Yimer Tiruye
- School of Public Health, Debre Markos University, Debre Markos, Ethiopia.
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
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Uusimäki K, Schneider L, Lubeka C, Kimiwye J, Mutanen M. Mothers' knowledge and practices on breastfeeding and complementary feeding in an urban slum area and rural area in Kenya: A cross-sectional interview study. J Child Health Care 2023; 27:612-627. [PMID: 35428403 PMCID: PMC10676620 DOI: 10.1177/13674935221083451] [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: 11/16/2022]
Abstract
Maternal breastfeeding and complementary feeding knowledge is an important determinant of childrens' long-term health and development. This study aims to account for associations between knowledge and practices in Kenya and report the food consumption of children from birth to 18 months. In 2015 mother-child pairs were recruited from Mother-and-Child Health Centers; 415 in an urban slum in Nairobi and 364 in rural Machakos. Knowledge and practice scores were calculated from questionnaire variables and 24-h food frequency questionnaire. The associations of knowledge and practices were studied with regression analysis. Breastfeeding knowledge (Nairobi 6.3/9, Machakos 5.9/9) and practices (Nairobi 7.5/8, Machakos 7.2/8) were good in both areas. Complementary feeding knowledge was not as good (Nairobi 7.5/14, Machakos 7.1/14). Minimum meal frequency was reached by almost 80% of the children but dietary diversity was low (Nairobi 2.7 [SD 1.4], Machakos 2.4. [SD 1.3]). Only 27% of children in Nairobi and 13% in Machakos were fed a minimum acceptable diet. The complementary feeding knowledge score was associated only with minimum dietary diversity in Nairobi (OR: 1.29; 95% CI: 1.105-1.514). Infant and young child feeding knowledge and practices were on a similar level in both areas. Future interventions should focus on improving dietary diversity.
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Affiliation(s)
- Kerttu Uusimäki
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Lauriina Schneider
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Crippina Lubeka
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Judith Kimiwye
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Marja Mutanen
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
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Tessema M, Hussien S, Ayana G, Teshome B, Hussen A, Kebebe T, Mogese T, Petros A, Fikresilassie G, Wodajo B, Mokenen T, Tollera G, Whiting SJ. Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia. MATERNAL & CHILD NUTRITION 2023; 19:e13525. [PMID: 37139835 PMCID: PMC10483948 DOI: 10.1111/mcn.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%-46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%-77%). Women involved in home gardening significantly increased (73%-93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.
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Affiliation(s)
- Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Shimelis Hussien
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Girmaye Ayana
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Beza Teshome
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Alemayehu Hussen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Tadesse Kebebe
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Tseday Mogese
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Alem Petros
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Getinet Fikresilassie
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Berhanu Wodajo
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Tadesse Mokenen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Getachew Tollera
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Susan J. Whiting
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonSaskatoonCanada
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Flax VL, Bose S, Escobar-DeMarco J, Frongillo EA. Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive. MATERNAL & CHILD NUTRITION 2023:e13559. [PMID: 37735818 DOI: 10.1111/mcn.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.
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Affiliation(s)
- Valerie L Flax
- RTI International, Research Triangle Park, North Carolina, USA
| | - Sujata Bose
- Alive & Thrive, FHI Solutions, Washington, District of Columbia, USA
| | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, USA
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Women's multidimensional empowerment index and essential newborn care practice in Bangladesh: The mediating role of skilled antenatal care follow-ups. PLoS One 2023; 18:e0281369. [PMID: 36749769 PMCID: PMC9904503 DOI: 10.1371/journal.pone.0281369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The World Health Organization recommended a set of five neonatal care practices that are most essential for good health of a newborn. As good essential newborn care (ENC) practice reduces the risk of neonatal morbidity and mortality, this paper focuses how women's multidimensional empowerment index is associated with this practice through the skilled antenatal care. To the best of knowledge, no such study has been conducted yet. The composite index of women's multidimensional empowerments was constructed using family decision, intimate partner violence, social status, healthcare access and economic status of women; and skilled antenatal care was defined if a pregnant woman received eight or more checkups during pregnancy from skilled health professionals. MATERIALS AND METHODS Data extracted from Bangladesh Demographic and Health Survey, 2017-18 have been utilized in the study. A total of 2441 mothers have been considered who delivered their last live birth at home within three years preceding the survey. A mediation analysis was performed considering the structural equation modeling to find out the adjusted association of women's empowerment on both skilled antenatal care and good ENC practice, but the unadjusted associations were also checked using a chi-square test. To test the indirect as well as total effect of women's empowerment through skilled antenatal care on good ENC practice, bias-corrected standard errors were estimated using a bootstrapping sampling. RESULTS Good ENC practice was considerably low in Bangladesh with 7.6% of newborns receiving the practice. Both adjusted and unadjusted analyses showed the significant association of women's empowerment with both skilled antenatal care and good ENC practice. The study revealed that the indirect effect of high empowerment through skilled antenatal care was greater than its direct effect on good ENC practice. CONCLUSION This study explored that the prevalence of good ENC practice can be accelerated through women's empowerment, where skilled antenatal care plays an important mediating role in improving good ENC practice among highly empowered mothers. The study suggests that a woman should follow the latest guidelines recommended by WHO for antenatal care follow-up. Policymakers can modify some of the maternal and child health care interventions based on the research findings.
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Moga Lencha F, Jebero Zaza Z, Ena Digesa L, Mulatu Ayana T. Minimum dietary diversity and associated factors among children under the age of five attending public health facilities in Wolaita Soddo town, Southern Ethiopia, 2021: a cross-sectional study. BMC Public Health 2022; 22:2368. [PMID: 36527009 PMCID: PMC9758836 DOI: 10.1186/s12889-022-14861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Poor quality diets are the greatest obstacles to survival, growth, development, and learning in children. Dietary diversity is a major problem in developing countries including Ethiopia. For better feeding practices and focused interventions, it is essential to identify dietary diversity in children. In order to draw firm conclusions, previous studies in Ethiopia were unable to get a thorough picture of the dietary diversity among children under the age of five. Therefore, the purpose of this study was to identify minimum dietary diversity and associated factors among children under the age of five attending public health facilities in Wolaita Soddo town, Southern Ethiopia. METHODS An institution-based cross-sectional study design was used from February to March, 2021. The sample size of the study was 406. A simple random sampling was used to select the study participants. The minimum dietary diversity of the children was assessed by a standardized dietary assessment tool. The information was gathered using a standardized questionnaire that was administered by an interviewer. The collected data were entered into Epi Data 4.6 then exported to SPSS 26 for analysis. A multivariable logistic regression model was used to identify the independent predictors of the study. The statistical significance level was set at P < 0.05, and the degree of the association was measured using an AOR with a 95% CI. RESULTS A total of 399 participants were involved in this study. Nearly half (52.1%) of the study children met the minimum dietary diversity. The most popular foods were grains, roots, and tubers (79.2%), followed by dairy products (58.1%), vitamin A-rich fruits and vegetables, and grains, roots, and tubers (58.1%). Children whose mothers worked as daily workers had a lower likelihood of meeting the minimal dietary diversity requirement. However, children with separate eating plates from adults, households with food security, low monthly food expenditure, collaborative decision-making on household spending, birth intervals greater than 24 months, and health education on infant and young child feeding were more likely to achieve the minimal dietary diversity requirements. CONCLUSION The proportion of the minimum dietary diversity was higher than in previous studies from Ethiopia. The minimum dietary diversity was higher than in previous studies from Ethiopia. Family planning for birth spacing, nutritional counseling on infant and young child feeding, and parent communication in a child's feeding are critical to improve dietary diversity in a child's feeding.
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Affiliation(s)
- Fikre Moga Lencha
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
| | - Zenebe Jebero Zaza
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
| | - Lankamo Ena Digesa
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
| | - Tegegn Mulatu Ayana
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
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Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey. J Nutr Sci 2022; 11:e88. [PMID: 36304826 PMCID: PMC9554528 DOI: 10.1017/jns.2022.87] [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] [Received: 03/09/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.
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Li H, Kim Y, Park C, Kang M, Kang Y. Gender-common and gender-specific determinants of child dietary diversity in eight Asia Pacific countries. J Glob Health 2022; 12:04058. [PMID: 36181506 PMCID: PMC9526379 DOI: 10.7189/jogh.12.04058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Optimal child feeding practices contribute to reducing child undernutrition in low- and middle-income countries. Minimum dietary diversity (MDD) is a key indicator of complementary feeding quality for children aged 6-23 months. We aimed to examine the gender-common and gender-specific factors associated with the failure to meet MDD in eight Asia Pacific countries. Methods The study used data of children aged 6-23 months from the Demographic and Health Surveys (DHS) conducted in Afghanistan (n = 8410), Bangladesh (n = 2371), Nepal (n = 1478), Pakistan (n = 3490), Cambodia (n = 2182), Indonesia (n = 5133), Myanmar (n = 1379), and Timor-Leste (n = 2115). A total of 41 household, maternal, and child-level variables were examined for association with MDD using univariate and multivariable logistic regressions. All analyses accounted for the survey design and sampling weights. Results Being aged 6-11 months, not receiving Vitamin A supplementation, low maternal education, belonging to a low wealth quintile, and having two or more young children in the household were factors related to the failure to meet MDD among both male and female children. Mothers’ not watching TV or not being exposed to media at least once a week, delivery at home, young age, and engagement to non-agricultural work were only significant risk factors among female children. Non-professional delivery assistance, unsafe disposal of children’s stool, tolerant attitudes towards domestic violence, and rural residence were significant factors only among male children. Conclusions It is possible that male and female children in the region may consume food in various ways, because the factors for meeting MDD are not the same for different genders of children. It is advised to enhance dietary diversity in child nutrition programmes through gender-specific activities.
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Affiliation(s)
- Huilin Li
- Johns Hopkins University School of Education, Baltimore, Maryland, USA
| | - Yunjeong Kim
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chulwoo Park
- Department of Public Health and Recreation, San José State University, San Jose, California, USA
| | - Minji Kang
- Brain Korea 21 FOUR Education and Research Team for Sustainable Food & Nutrition, Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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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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Jamee AR, Kumar Sen K, Bari W. Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross-sectional study. Health Sci Rep 2022; 5:e791. [PMID: 35989946 PMCID: PMC9382035 DOI: 10.1002/hsr2.791] [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: 09/20/2021] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Aims Essential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices. Methods The study used a cross-sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast-feeding), χ 2 test and t-test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design. Results Only about 24% (95% confidence interval [CI]: 22.95%-25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice. Conclusion The study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.
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Affiliation(s)
| | | | - Wasimul Bari
- Department of StatisticsUniversity of DhakaDhakaBangladesh
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Allotey D, Flax VL, Ipadeola AF, Kwasu S, Adair LS, Valle CG, Bose S, Martin SL. Fathers' Complementary Feeding Support Strengthens the Association Between Mothers' Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria. Curr Dev Nutr 2022; 6:nzac098. [PMID: 35854939 PMCID: PMC9283102 DOI: 10.1093/cdn/nzac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Evidence about the effects of mothers' decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers' decision-making autonomy and the practice of complementary feeding. Objectives This study examined the moderation effect of fathers' complementary feeding support on the association of mothers' decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers' and fathers' perspectives of mothers' autonomy and fathers' complementary feeding support. Methods Data were from cross-sectional surveys of 495 cohabiting parents of children aged 6-23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents. Results The moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents' perspectives of mothers' autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents' perspectives of fathers' complementary feeding support. Conclusions In Nigeria, high levels of fathers' complementary feeding support strengthen the association of mothers' decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662).
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Affiliation(s)
- Diana Allotey
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie L Flax
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | - Sarah Kwasu
- Alive & Thrive, Kaduna State, Kauna, Nigeria
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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George CM, Coglianese N, Bauler S, Perin J, Kuhl J, Williams C, Kang Y, Thomas ED, François R, Ng A, Presence AS, Jean Claude BR, Tofail F, Mirindi P, Cirhuza LB. Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program). MATERNAL & CHILD NUTRITION 2022; 18:e13340. [PMID: 35313062 PMCID: PMC9218309 DOI: 10.1111/mcn.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/05/2022]
Abstract
The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children. Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo. Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes. This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health.
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Affiliation(s)
- Christine Marie George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | - Sarah Bauler
- Health Division Food for the Hungry Phoenix Arizona USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Jennifer Kuhl
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Camille Williams
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yunhee Kang
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Elizabeth D. Thomas
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ruthly François
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Angela Ng
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | | | - Fahmida Tofail
- Nutrition Division International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
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Allotey D, Flax VL, Ipadeola A, Kwasu S, Bentley ME, Worku B, Kalluru K, Valle CG, Bose S, Martin SL. Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria: The continuum of gender roles in urban and rural settings. MATERNAL & CHILD NUTRITION 2022; 18:e13325. [PMID: 35080111 PMCID: PMC8932823 DOI: 10.1111/mcn.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/11/2023]
Abstract
Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision‐making, intra‐household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through father engagement. This study describes household gender roles among A&T participants and how they influence maternal and paternal involvement in complementary feeding. We conducted 16 focus group discussions with mothers and fathers of children aged 6–23 months in urban and rural administrative wards and analysed them using qualitative thematic analysis methods. Most mothers and fathers have traditional roles with fathers as ‘providers’ and ‘supervisors’ and mothers as ‘caregivers’. Traditional normative roles of fathers limit their involvement in ‘hands‐on’ activities, which support feeding and caring for children. Less traditional normative roles, whereby some mothers contributed to the provision of resources and some fathers contributed to caregiving, were also described by some participants and were more salient in the urban wards. In the rural wards, more fathers expressed resistance to fathers playing less traditional roles. Fathers who participated in caregiving tasks reported respect from their children, strong family relationships and had healthy home environments. Our research findings point to the need for more context‐specific approaches that address prevalent gender normative roles in complementary feeding in a variety of settings. Some mothers and fathers still hold traditional attitudes about their roles in feeding and caring for children. Traditional gender normative roles of fathers limit their involvement in the ‘hands‐on’ activities that support feeding and caring for children. Some mothers and fathers are performing ‘non‐traditional’ gender normative roles despite social disapproval. The shifts from the traditional roles of mothers and fathers are more salient in urban compared with rural wards.
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Affiliation(s)
- Diana Allotey
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | | | | | | | - Margaret E. Bentley
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Beamlak Worku
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Keerti Kalluru
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Carmina G. Valle
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Sujata Bose
- Alive & Thrive Washington District of Columbia USA
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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Molani Gol R, Kheirouri S, Alizadeh M. Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:65-83. [PMID: 35000681 DOI: 10.1016/j.jneb.2021.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years. DESIGN This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. SETTING AND PARTICIPANTS PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles. MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight. CONCLUSIONS AND IMPLICATIONS The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.
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Affiliation(s)
- Roghayeh Molani Gol
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Molla W, Adem DA, Tilahun R, Shumye S, Kabthymer RH, Kebede D, Mengistu N, Ayele GM, Assefa DG. Dietary diversity and associated factors among children (6-23 months) in Gedeo zone, Ethiopia: cross - sectional study. Ital J Pediatr 2021; 47:233. [PMID: 34895268 PMCID: PMC8665621 DOI: 10.1186/s13052-021-01181-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Different foods and food groups are good sources for various macro- and micronutrients. Diversified diet play an important role in both physical and mental growth and development of children. However, meeting minimum standards of dietary diversity for children is a challenge in many developing countries including Ethiopia. OBJECTIVE To assess dietary diversity and associated factors among children (6-23 months) in Gedieo Zone, Ethiopia. METHOD Community based cross-sectional study was carried out at Gedieo Zone, Ethiopia, from January to March 15, 2019. Multi-stage sampling technique was used to get a total of 665 children with the age of between 6 and 23 months from their kebeles. Data was collected by using face-to-face interview with structured questionnaire. Data was entered into Epidata version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. Variables having p < 0.25 at bivariate analysis were fitted to multivariable analysis. Multivariable logistic regression model was used at 95% confidence interval and with P-Value < 0.05. Bivariate. RESULT A total of 665 children were participated with response rate of 96.2%. Only 199(29.9%) of children were met the minimum requirements for dietary diversity. Age of children [AOR 4.237(1.743-10.295))], Educational status [AOR 2.864(1.156-7.094)], Number of families [AOR 2.865(1.776-4.619))] and household wealth index [AOR4.390(2.300-8.380)] were significantly associated with Dietary Diversity of children. CONCLUSION Only, one out of four children aged of 6-23 months attained the minimum dietary diversity score. Children from low socioeconomic status and mothers with no formal educational attainment need special attention to improve the practice of appropriate feeding of children.
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Affiliation(s)
| | | | - Ruth Tilahun
- Department of Midwifery, Dilla University, Dilla, Ethiopia
| | - Seid Shumye
- Department of Psychiatry, Dilla University, Dilla, Ethiopia
| | | | - Daniel Kebede
- Department of Midwifery, Dilla University, Dilla, Ethiopia
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Tiruneh SA, Fentie DT, Yigizaw ST, Abebe AA, Gelaye KA. Spatial distribution and geographical heterogeneity factors associated with poor consumption of foods rich in vitamin A among children age 6-23 months in Ethiopia: Geographical weighted regression analysis. PLoS One 2021; 16:e0252639. [PMID: 34081718 PMCID: PMC8174682 DOI: 10.1371/journal.pone.0252639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vitamin A deficiency is a major public health problem in poor societies. Dietary consumption of foods rich in vitamin A was low in Ethiopia. This study aimed to assess the spatial distribution and spatial determinants of dietary consumption of foods rich in vitamin A among children aged 6-23 months in Ethiopia. METHODS Ethiopian 2016 demographic and health survey dataset using a total of 3055 children were used to conduct this study. The data were cleaned and weighed by STATA version 14.1 software and Microsoft Excel. Children who consumed foods rich in vitamin A (Egg, Meat, Vegetables, Green leafy vegetables, Fruits, Organ meat, and Fish) at least one food item in the last 24 hours were declared as good consumption. The Bernoulli model was fitted using Kuldorff's SaTScan version 9.6 software. ArcGIS version 10.7 software was used to visualize spatial distributions for poor consumption of foods rich in vitamin A. Geographical weighted regression analysis was employed using MGWR version 2.0 software. A P-value of less than 0.05 was used to declare statistically significant predictors spatially. RESULTS Overall, 62% (95% CI: 60.56-64.00) of children aged 6-23 months had poor consumption of foods rich in vitamin A in Ethiopia. Poor consumption of foods rich in vitamin A highly clustered in Afar, eastern Tigray, southeast Amhara, and the eastern Somali region of Ethiopia. Spatial scan statistics identified 142 primary spatial clusters located in Afar, the eastern part of Tigray, most of Amhara and some part of the Oromia Regional State of Ethiopia. Children living in the primary cluster were 46% more likely vulnerable to poor consumption of foods rich in vitamin A than those living outside the window (RR = 1.46, LLR = 83.78, P < 0.001). Poor wealth status of the household, rural residence and living tropical area of Ethiopia were spatially significant predictors. CONCLUSION Overall, the consumption of foods rich in vitamin A was low and spatially non-random in Ethiopia. Poor wealth status of the household, rural residence and living tropical area were spatially significant predictors for the consumption of foods rich in vitamin A in Ethiopia. Policymakers and health planners should intervene in nutrition intervention at the identified hot spot areas to reduce the poor consumption of foods rich in vitamin A among children aged 6-23 months.
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Affiliation(s)
- Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Dawit Tefera Fentie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seblewongel Tigabu Yigizaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asnakew Asmamaw Abebe
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Endalifer ML, Andargie G, Mohammed B, Endalifer BL. Factors associated with dietary diversity among adolescents in Woldia, Northeast Ethiopia. BMC Nutr 2021; 7:27. [PMID: 33926578 PMCID: PMC8082914 DOI: 10.1186/s40795-021-00430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Consuming diversified food during the adolescent period is essential to build a healthy and active mind for their later life. Food prices increased in the local market due to fewer production of crops. Thus, exploring the dietary diversity of adolescents in this area is crucial to estimate diet quality. So the aim of the study was to identify determinant factors of dietary diversity. Methods An institution-based cross-sectional study was conducted among adolescent students in Woldia town. A total of four hundred eleven students were included in the study. A simple random sampling technique was used to select the participants. The outcome variable was dietary diversity; it was calculated by summing of the number of food group consumed by individuals in the given reference period. Bivariable and multivariable logistic analysis was done. The odds ratio with a 95% confidence interval was computed to measure an association. A variable with a P-value less than 0.05 is considered a significant factor. Results The proportion of inadequate dietary diversity was 49.1% (95% CI 44.5–53.8). Being female (AOR =5.53, 95% CI 3.447–8.859), secondary and above mothers’ education level (AOR=0. 27, 95%CI 0.153–0.477), living in a family size five and above (AOR= 2.09, 95CI% 1.31–3.34), and poor knowledge about nutrition (AOR=4.56, 95% CI 2.727–7.639) were significantly associated with inadequate dietary diversity. Conclusions and recommendations Inadequate dietary diversity was associated with sex, knowledge of nutrition, maternal education level, and family size. It is better to design a nutrition intervention program that focus on nutrition education to scale up diversified food consumption among adolescents. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00430-6.
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Affiliation(s)
- Melese Linger Endalifer
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Gashaw Andargie
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bekri Mohammed
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bedilu Linger Endalifer
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Irenso AA, Letta S, Chemeda AS, Asfaw A, Egata G, Assefa N, Campbell KJ, Laws R. The Facilitators and Barriers of Adopting Amylase-Rich Flour to Enhance Complementary Foods in the Kersa District Community of Eastern Ethiopia. Nutrients 2021; 13:838. [PMID: 33806617 PMCID: PMC7999009 DOI: 10.3390/nu13030838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/02/2022] Open
Abstract
Achieving the optimal transition to a family diet over the first two years of life has remained a challenge in Ethiopia. The use of amylase-rich flour (ARF) can improve complementary foods. However, utilisation requires an effective delivery strategy for upskilling the community to use ARF. The aim of this study was to explore facilitators and barriers of cascading ARF skills to improve complementary foods. The study was conducted in Gale Mirga kebele of Kersa district in Eastern Ethiopia in 2016. The study utilised exploratory qualitative research that used participatory action. Focus group discussions (FGDs) were conducted with the Health Development Army (HDA) leaders, religious leaders, and observation of participatory complementary food demonstrations. Cultural acceptability and the presence of HDA structure that supports skill development were identified as key facilitators to ARF use. On the other hand, the potential barriers to expanding ARF skill were lack of sustainability of external skill support for HDA leaders, perceived time constraints, unsuitable demonstration settings, cooking method, and large group size. The indigenous community's knowledge of germination has not been used to improve complementary foods. The universal use of ARF requires integration into the Health Extension Programme (HEP) with support and supervision for HDA leaders.
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Affiliation(s)
- Asnake Ararsa Irenso
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (K.J.C.); (R.L.)
- School of Public Health, Haramaya University, P.O. Box 235 Harar, Ethiopia
| | - Shiferaw Letta
- School of Nursing, Haramaya University, P.O. Box 235 Harar, Ethiopia; (S.L.); (A.A.); (N.A.)
| | - Addisu S. Chemeda
- Department of Food Science and Postharvest Technology, Ambo University, P.O. Box 19 Ambo, Ethiopia;
| | - Abiyot Asfaw
- School of Nursing, Haramaya University, P.O. Box 235 Harar, Ethiopia; (S.L.); (A.A.); (N.A.)
| | - Gudina Egata
- School of Public Health, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia;
| | - Nega Assefa
- School of Nursing, Haramaya University, P.O. Box 235 Harar, Ethiopia; (S.L.); (A.A.); (N.A.)
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (K.J.C.); (R.L.)
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (K.J.C.); (R.L.)
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Sema A, Belay Y, Solomon Y, Desalew A, Misganaw A, Menberu T, Sintayehu Y, Getachew Y, Guta A, Tadesse D. Minimum Dietary Diversity Practice and Associated Factors among Children Aged 6 to 23 Months in Dire Dawa City, Eastern Ethiopia: A Community-Based Cross-Sectional Study. Glob Pediatr Health 2021; 8:2333794X21996630. [PMID: 33748344 PMCID: PMC7905725 DOI: 10.1177/2333794x21996630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/30/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: Malnutrition because of poor dietary diversity contributing to child morbidity and mortality. Two-thirds of child mortality occurs within the first 2 years. However, there is limited data related to dietary diversity among children aged 6 to 23 months in Ethiopia. Thus, this study aimed to assess dietary diversity and factors among children aged 6 to 23 months in the study setting. Methods: A community-based cross-sectional study conducted on 438 children aged 6 to 23 months in Dire Dawa, 1-30/02/2019. Simple random sampling was used to select study subjects. Data collected using a structured and pretested interview administered questionnaire. Data entered using EpiData 4.2 and analyzed with SPSS Version 22. Multivariable logistic regression was used to examine associated factors. Adjusted odd-ratio with 95% confidence interval (CI) used, and P-value <.05 considered statistically significant. Results: The overall minimum dietary diversity practice was 24.4% (95% CI: 20.3, 28.5). Maternal education [AOR 2.20; 95% CI: 1.08, 4.52], decision-making [AOR = 2.5; 95% CI: 1.19, 5.29], antenatal care [AOR = 2.19; 95% CI: 1.20, 3.99], postnatal care [AOR = 6.4; 95% CI: 2.78, 14.94] and facility delivery [AOR = 2.66; 95% CI: 1.35, 5.25] were maternal factors. Moreover, child’s age [AOR = 2.84; 95% CI: 1.39, 5.83], and child’s sex [AOR = 2.85; 95% CI: 1.64, 4.94] were infant factors. Conclusion: One-fourth of children practiced minimum dietary diversity. Child’s age, birth interval, postnatal care, antenatal care, child’s sex, mothers’ decision-making, mothers’ education, and place of delivery were significant predictors. Therefore, maternal education, empowering women, and improve maternal service utilization are crucial to improving dietary diversity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alemu Guta
- Dire Dawa University, Dire Dawa, Ethiopia
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22
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Risk Factors Associated with Malnutrition among Children Under-Five Years in Sub-Saharan African Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8782. [PMID: 33256022 PMCID: PMC7731119 DOI: 10.3390/ijerph17238782] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
Background/Purpose: Malnutrition is a significant global public health burden with greater concern among children under five years in Sub-Saharan Africa (SSA). To effectively address the problem of malnutrition, especially in resource-scarce communities, knowing the prevalence, causes and risk factors associated with it are essential steps. This scoping review aimed to identify the existing literature that uses classical regression analysis on nationally representative health survey data sets to find the individual socioeconomic, demographic and contextual risk factors associated with malnutrition among children under five years of age in Sub-Sahara Africa (SSA). Methods: The electronic databases searched include EMBASE (OVID platform), PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science (WoS) and Cochrane Library. Only papers written in the English language, and for which the publication date was between 1 January 1990 and 31 July 2020, were included. Results: A total of 229 papers were identified, of which 26 were studies that have been included in the review. The risk factors for malnutrition identified were classified as child-related, parental/household-related and community or area-related. Conclusions: Study-interest bias toward stunting over other anthropometric indicators of malnutrition could be addressed with a holistic research approach to equally address the various dimension of the anthropometric indicators of malnutrition in a population.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.J.W.); (R.J.)
- Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic. Bida Campus, Bida 912231, Nigeria
| | - Stephen J. Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.J.W.); (R.J.)
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.J.W.); (R.J.)
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK;
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23
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Acharya Y, Luke N, Naz S, Sharma D. Exposure to conflict-related violence and nutritional status of children in Iraq. SSM Popul Health 2020; 11:100585. [PMID: 32490134 PMCID: PMC7256318 DOI: 10.1016/j.ssmph.2020.100585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/18/2020] [Accepted: 04/05/2020] [Indexed: 01/10/2023] Open
Abstract
There is limited empirical evidence of the health effects of war-related violence on child nutritional status. Using unique micro-level data from Iraq, we create measures of cumulative exposure to violence since conception for children ages two to five based on their date of birth and geographic location. We examine the relationship between height-for-age z-scores, a measure of chronic malnutrition, and four indicators of violence in a regression framework, adjusting for potential confounders and trends. We find that a child exposed to the maximum number of violent incidents is likely to experience a 0.5 standard deviation reduction in height-for-age z-score compared to a child who is exposed to no incidents. Each type of attack we evaluate is negatively associated with height-for-age. Further analysis reveals that the associations are the strongest for children in the northern and central regions where the bulk of the violent incidents occurred. Contrary to our expectation, the associations are similar for boys and girls. Our findings suggest that, in addition to efforts aimed at decreasing violent conflict in Iraq in general, the government and its development partners should focus relief, recovery, and reconstruction efforts in the central and northern regions of the country.
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Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 601L Ford Building, University Park, PA, 16802, USA
| | - Nancy Luke
- Department of Sociology and Criminology, The Pennsylvania State University, 702 Oswald Tower, University Park, PA, 16802, USA
| | - Saman Naz
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 601L Ford Building, University Park, PA, 16802, USA
| | - Dhiraj Sharma
- The World Bank, 1818 H Street, NW Washington, DC, 20433, USA
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24
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Abreha SK, Walelign SZ, Zereyesus YA. Associations between women's empowerment and children's health status in Ethiopia. PLoS One 2020; 15:e0235825. [PMID: 32687506 PMCID: PMC7371184 DOI: 10.1371/journal.pone.0235825] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Although women's empowerment has gained attention over the last two decades, our understanding of the associations between different dimensions of women's empowerment and different children's health outcomes is limited. This study aims to measure the extent of women's empowerment and to examine its associations with the children's health status in Ethiopia. Data were obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). The sample is restricted to a sub-sample of 10,641 women from 15 to 49 years old and their children under the age of five years. We used children's height-for-age and weight-for-height Z-scores and pneumonia and anemia experience as indicators of children's health outcome. Women's empowerment is measured by five indices reflecting their participation in decision-making, attitudes towards wife-beating by husband, barriers to health care access, asset ownership, and socio-economic variables. These indicators of empowerment were constructed using exploratory and confirmatory factor analysis. A Multiple Indicators Multiple Causes (MIMIC) model was employed to examine the relationship between women's empowerment and latent child health outcomes, after controlling for relevant covariates. Results suggests that enhancing women's empowerment in the household in terms of their socio-economic status (i.e., increasing women's access to education, information, media, and promoting saving) was associated with less likelihood of the children's being stunted or wasted (p<0.05). Higher women's empowerment in terms of household decision-making power were also associated with better children's health status measured by the children's experience of pneumonia and anemia (p<0.05). All aspects of women's empowerment are not related with children's health indicators. Women's empowerment dimensions related with child health have a varying degree of association with the different children's health indicators. Gender-specific policies focusing on increasing women's access to education, media, information, and promoting saving and their participation in the household decision making are some of the strategies for improving their children's health and wellbeing.
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Affiliation(s)
| | - Solomon Zena Walelign
- Department of Geography, Norwegian University of Science and Technology, Trondheim, Norway
- School of Economics, University of Gondar, Gondar, Ethiopia
| | - Yacob Abrehe Zereyesus
- Department of Agricultural Economics, Kansas State University, Manhattan, NY, United States of America
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25
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Dietary Diversity Practice and Associated Factors among Children Aged 6-23 Months in Robe Town, Bale Zone, Ethiopia. J Nutr Metab 2020; 2020:9190458. [PMID: 32685209 PMCID: PMC7350076 DOI: 10.1155/2020/9190458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/01/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background Diet diversification is essential to prepare adequate food that is useful for children's physical and cognitive development. Despite the limited studies performed in different parts of Ethiopia, the information about the feeding practice of children in the current study area is not documented. Thus, this study intended to assess the dietary diversity practices and associated factors among children aged 6-23 months. Methods Community-based cross-sectional study was conducted on 517 children aged 6-23 months paired with their mothers in Robe town. Systematic sampling technique was applied to select a child-mother pair. Data were collected using a pretested and structured questionnaire. Multivariate logistic regression analyses were used to identify the factors associated with the dependent variable. Adjusted odds ratios with 95% confidence interval were used to assess the strength of association and level of significance. Results From a total of 508 children included, making a 98% response rate, 77% of them did not meet the minimum dietary diversity. Children aged 12-23 months were more likely fed diversified food when compared with those aged 6-11 months (AOR = 2.99). Mothers whose educational level was secondary and above (AOR = 3.21), had media exposure (AOR = 3.99), and were knowledgeable about diet diversification (AOR = 8.5) were more likely to feed their child diversified food than their counterpart. Children whose father was a merchant were more likely to receive a diversified diet compared to those whose fathers were daily laborers. Conclusions Inadequate practices of minimum dietary diversity observed in the current study area were mainly associated with the child's age, maternal education, mothers' knowledge on diet diversification, and media exposure. Improving knowledge of mothers, increasing their education, and promoting appropriate infant and child feeding practices through media are an important intervention to improve dietary diversity practices.
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26
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Kuche D, Moss C, Eshetu S, Ayana G, Salasibew M, Dangour AD, Allen E. Factors associated with dietary diversity and length-for-age z-score in rural Ethiopian children aged 6-23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation. MATERNAL & CHILD NUTRITION 2020; 16:e12852. [PMID: 31124274 PMCID: PMC7038872 DOI: 10.1111/mcn.12852] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length-for-age z-score (LAZ) in children 6-23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May-June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio-economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership. LAZ was positively associated with age, socio-economic status, maternal education, fruit and vegetable production, and land ownership.
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Affiliation(s)
- Desalegn Kuche
- Food Science and Nutrition Research DirectorateEthiopian Public Health InstituteAddis AbabaEthiopia
| | - Cami Moss
- London School of Hygiene and Tropical MedicineLondonUK
| | - Solomon Eshetu
- Food Science and Nutrition Research DirectorateEthiopian Public Health InstituteAddis AbabaEthiopia
| | - Girmay Ayana
- Food Science and Nutrition Research DirectorateEthiopian Public Health InstituteAddis AbabaEthiopia
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