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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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Shibeshi AH, Mare KU, Kase BF, Wubshet BZ, Tebeje TM, Asgedom YS, Asmare ZA, Asebe HA, Lombebo AA, Sabo KG, Fente BM, Seifu BL. The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model. PLoS One 2024; 19:e0298647. [PMID: 38771790 PMCID: PMC11108208 DOI: 10.1371/journal.pone.0298647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/30/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. OBJECTIVE To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. METHODS The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. RESULTS The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. CONCLUSION Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.
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Affiliation(s)
- Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Betel Zelalem Wubshet
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Kassaw A, Kassie YT, Kefale D, Azmeraw M, Arage G, Asferi WN, Munye T, Demis S, simegn A, Agimas MC, Zeleke S. Pooled prevalence and its determinants of stunting among children during their critical period in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0294689. [PMID: 38019780 PMCID: PMC10686443 DOI: 10.1371/journal.pone.0294689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Stunting is a major public health concern, particularly in low and middle-income countries. Globally, nearly 149 million under-five children are suffering from stunting. Despite it can occur in all age groups, the impact is more severe among children age less than 24 months as this period is critical time of very rapid growth and development. Therefore, this review aimed to determine the pooled prevalence and determinants of stunting among children during this critical period in Ethiopia. METHODS The literature search was conducted using international electronic data bases (pumed, Google scholar, CINHAL, Hinari, open Google) and the hand search of reference lists of eligible articles. The presence of heterogeneity between studies was evaluated using Cochrane Q-test and I2 test statistics and sensitivity analysis was also checked. Small study effect was checked through graphical and statistical test. Sub-group analysis was performed to handle heterogeneity. RESULTS This study included 14 studies with a total sample size of 8,056 children. The overall pooled estimate of stunting was 35.01(95% CI: 24.73-45.28, I2 = 98.98%) in the country with the highest prevalence in Amhara region. Increased Child's age (OR = 3.83; 95% CI: 2.47-5.18, I2 = 97.76%), no maternal education (OR = 2.90; 95%CI: 1.59-4.20, I2 = 89.73%), no maternal postnatal follow up (OR = 1.81; 95% CI:1.51-2.10) less than four food diversity of the child (OR = 2.24;95%CI; 1.94-2.55,I2 = 21.55%), low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were significant factors of stunting. CONCLUSION AND RECOMMENDATIONS The pooled prevalence of stunting among children during their critical time is high. Increased Child's age, no maternal education and no maternal postnatal follow up, less than four food diversity of the child, low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were determinants of stunting. Therefore, providing continuous maternal postnatal follow up, increase awareness of mothers on importance of colostrum and exclusive breast feeding, feeding of children the recommended variety of foods and at large to improve the wealth status of the households are crucial interventions to meet national and international targets of zero stunting in children less than 2 years.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Getachew Arage
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferi
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare simegn
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Debela SA, Sisay D, Negassa M, Daba C, Mesfin Tefera Y, Debela EA, Goyomsa GG, Luke AO, Benayew Shiferaw M, Asmare M, Gebrehiwot M. Determinants of undernutrition among children aged 6-59 months during the COVID-19 pandemic: A hospital-based cross-sectional study in Ethiopia. J Public Health Res 2023; 12:22799036231181174. [PMID: 37333033 PMCID: PMC10264850 DOI: 10.1177/22799036231181174] [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: 07/27/2022] [Accepted: 04/26/2023] [Indexed: 06/20/2023] Open
Abstract
Background The public health problem of undernutrition is common in Ethiopia, particularly among children aged 6-59 months. However, determinants of undernutrition among children in this age group are not well investigated particularly within the context of COVID-19 pandemic. This study was, therefore, designed to assess the magnitude and determinants of undernutrition among children aged 6-59 months at Tirunesh Beijing general hospital, Ethiopia. Methods and materials An institutional-based cross-sectional study was conducted involving 283 children aged 6-59 months in March 2022. The data were collected using structured questionnaire and anthropometric measurements. Undernutrition was defined as a Z-score value of weight for height (WFH), height-for-age (HFA), and weight-for-age (WFA) <2SD as calculated by the world health organization plus software. A multivariable logistic regression model was used to identify the independent factors associated with undernutrition. p-values less than 0.05 were considered statistically significant. Results The response rate in this study was 97.9%. The overall magnitude of undernutrition was 34.3%, of which 21.2%, 12.7%, and 9.5% were stunted, underweight, and wasted, respectively. Occupation of mothers [AOR = 13.64, 95% CI (4.21-14.77)], amount of meal [AOR = 14.68, 95% CI (4.09-52.81)], feeding by caregivers [AOR = 8.96, 95% CI (2.81-18.60)], and breastfeeding [AOR = 0.06, 95% CI (0.02-0.22)] were significant predictors of undernutrition. Conclusions The prevalence of undernutrition among children under the age of five remains high. Therefore, promoting breastfeeding and motivating children to feed adequate amount of meal are recommended. Besides, counseling and/or guiding caregivers on how to feed children shall be suggested. The findings could help inform the design and prioritization of effective intervention strategies at early life stage.
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Affiliation(s)
- Sisay Abebe Debela
- Department of Public Health, College of Health Science, Salale University, Fitche, Ethiopia
| | - Dereje Sisay
- Department of Nursing, College of Medicine and Health science, Mizant Tepi University, Ethiopia
| | - Moti Negassa
- Tirunesh Beijing Hospital, Addis Ababa, Ethiopia
| | - Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yonatal Mesfin Tefera
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, Australia
| | | | - Girma Garedew Goyomsa
- Department of Public Health, College of Health Science, Salale University, Fitche, Ethiopia
| | - Amana Ogeto Luke
- Department of Public Health, Rift Valley University, Addis Ababa, Ethiopia
| | | | - Melese Asmare
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesfin Gebrehiwot
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Moramarco S, Roster Mwaba I, Chafula Muyaba L, Palombi L, Buonomo E. Improvement in dietary diversity and feeding habits of malnourished under-five children attending supplementary feeding programmmes: a community-based cross-sectional study in Zambia. Int J Food Sci Nutr 2023; 74:82-94. [PMID: 36356200 DOI: 10.1080/09637486.2022.2144148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A community-based cross-sectional study was conducted on 390 under-five malnourished children enrolled in the Rainbow Project supplementary feeding programmmes-SFPs. Dietary diversity, feeding habits and nutritional status at admission (T1) and at discharge (T2) were compared. At T1 the diet was monotonous and unbalanced, with a progressive decline in dietary diversity and anthropometric values noted with children's age growth (p < 0.001). Significant improvements were registered at T2: DDS 5.1 ± 1.1 SD vs. 8.3 ± 1.0 SD; meal frequency 3.0 ± 0.6 SD vs. 4.9 ± 0.2 SD; animal-protein consumed 62.8% vs. 90.5%; drinking water treated 41.0% vs. 97.2%. At T1, the risk of having ZMUAC < 2.5SD increased when teenage motherhood (AOR: 5.3; CI: 1.8-15.2; p = 0.002), followed by children's age >2 years (AOR: 1.9; CI: 1.1-3.5; p = 0.020). Children's age was associated with an increased risk of WAZ < 2.5 SD (AOR: 4.9; CI: 2.4-10.4; p < 0.001). When considering inadequate DDS, the variable associated was breastfeeding cessation (AOR: 12.0; CI: 4.6-31.4; p < 0.001). Rainbow's SFPs have proved effective in treating under-five malnourished children, irrespective of the severity of malnutrition.
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Affiliation(s)
- Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Rainbow Project, Association Pope John the 23rd, Ndola, Zambia
| | | | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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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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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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Dulal S, Prost A, Karki S, Merom D, Shrestha BP, Bhandari B, Manandhar DS, Osrin D, Costello A, Saville NM. Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey. BMC Public Health 2022; 22:1721. [PMID: 36088374 PMCID: PMC9464411 DOI: 10.1186/s12889-022-13776-8] [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] [Received: 11/10/2021] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices. Methods We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. Results The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children’s books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices. Conclusions Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13776-8.
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Demsash AW, Chereka AA, Kassie SY, Donacho DO, Ngusie HS, Tegegne MD, Melaku MS, Wubante SM, Hunde MK. Spatial distribution of vitamin A rich foods intake and associated factors among children aged 6-23 months in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey. BMC Nutr 2022; 8:77. [PMID: 35953835 PMCID: PMC9367059 DOI: 10.1186/s40795-022-00573-0] [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: 04/03/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Inadequate micronutrients in the diet and vitamin A deficiency are worldwide public health problems. In developing regions, many preschool children are undernourished, become blind every year and died before the age of 23 months. This study was aimed to explore the spatial distribution of vitamin A rich foods intake among children aged 6–23 months and identify associated factors in Ethiopia. Methods Ethiopian Mini Demographic and Health Survey 2019 dataset with a total 1407 children aged 6–23 months was used. Data management and processing were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for mapping and spatial visualization of the distribution. Spatial scan statistics was performed using SaTScan version 9.5 software for Bernoulli-based model. Multilevel mixed effect logistic regression model was employed to identify associated factors. Results Overall, 38.99% (95% CI: 36.46–41.62) of children aged 6– 23 months took vitamin A rich foods. Poor intake of vitamin A rich foods was significantly clustered Dire Dawa city, Somali and Harari regions of Ethiopia. Children aged 6–23 months lived in the primary cluster were 70% (RR = 1.70, P-value < 0.001) more likely to intake vitamin A rich foods than children lived outside the window. In the multilevel mixed effect logistic regression analysis, Primary educational status (AOR:1.42, 95% CI: 1.05, 1.93) and higher educational status (AOR:3.0, 95% CI: 1.59, 5.65) of mother, Dire Dawa (AOR:0.49, 95% CI: 0.22, 1.12) city, Afar (AOR: 0.16, 95% CI: 0.07, 0.36), Amhara (AOR: 0.37, 95% CI: 0.19, 0.71) and Somali (AOR: 0.02, 95% CI: 0.003, 0.08) regions of Ethiopia, children aged 13–23 months (AOR: 1.80, 95% CI: 1.28, 2.36), Mothers’ exposure to media (AOR: 1.41, 95% CI: 1.04, 1.92) were statistically significant factors for vitamin A rich foods intake among children aged 6–23 months. Conclusions Only 4 out of ten children took vitamin A rich foods which is too low compared to the national target and significantly clustered in Ethiopia. Mother’s educational status, Region, Child age and Mother’s media exposure are significant factors vitamin A rich foods intake. Stakeholders should strengthen mothers’ education status, creating awareness for mothers on child feeding and using locally available natural resource to produce vitamin A rich foods.
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Affiliation(s)
| | - Alex Ayenew Chereka
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Dereje Oljira Donacho
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Habtamu Setegn Ngusie
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Masresha Derese Tegegne
- Health Informatics Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mequannent Sharew Melaku
- Health Informatics Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Sisay Maru Wubante
- Health Informatics Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Kenate Hunde
- Lifelong Learning and Community Development Department, College of Education and Behavioral Scieence , Mattu University, Mettu, Ethiopia
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Gao Y, Sheng J, Mi X, Zhou M, Zou S, Zhou H. Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China. Nutrients 2022; 14:nu14030458. [PMID: 35276816 PMCID: PMC8840283 DOI: 10.3390/nu14030458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/28/2022] Open
Abstract
Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.
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Affiliation(s)
- Yaqing Gao
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Jie Sheng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University, Beijing 100191, China;
| | - Xiaoyi Mi
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Mo Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Siyu Zou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
- Correspondence: ; Tel.: +86-10-8280-1222
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12
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Seboka BT, Hailegebreal S, Yehualashet DE, Gilano G, Kabthymer RH, Ewune HA, Demeke AD, Amede ES, Tesfa GA. Exploring Spatial Variations and Determinants of Dietary Diversity Among Children in Ethiopia: Spatial and Multilevel Analysis Using EDHS (2011-2016). J Multidiscip Healthc 2021; 14:2633-2650. [PMID: 34584420 PMCID: PMC8464345 DOI: 10.2147/jmdh.s327456] [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: 07/11/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Dietary diversity has a significant impact on children’s nutritional health. For developing and implementing interventions, it is critical to understand the regional distribution of dietary diversity and underlying factors. However, the application of spatial techniques in dietary studies has not been well documented. The study’s goal was to look into the regional variances and factors that influence children’s dietary diversity. Further, we have discussed the spatial correlation of dietary diversity with nutritional status. Methods Data from the National Demographic and Health Survey were used during analyses. This work evaluated the overall dietary diversity of children aged 6–23 months based on the 2017 WHO and UNICEF classification of minimum dietary diversity (MDD). The Local Anselin Moran’s I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariate multilevel logistic regression was used for factor analyses. Results Overall, only 13.3% (95% CI: 10.2–14.7%) of children in 2011 and 24% (95% CI: 15.5–26.5%) in 2016 achieved MDD. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) in the districts of northern Ethiopia, notably in the Amhara, Tigray, and Afar regions, and clusters of low inadequate dietary diversity (cold spots) in the country’s central and western regions. In both studies, the frequency of dietary diversity was significantly higher among older children, those who had media exposure, and mothers and fathers who had received formal education. Conclusion According to our findings, the MDD of children in Ethiopia, as measured by WHO dietary assessment, slightly increased from 2011 to 2016. The dietary diversity of children was distributed non-randomly in different districts across regions of Ethiopia. Localized intervention and preventative methods to improve dietary patterns and culture can be developed using existing socio-demographic factors and districts with a larger distribution of inadequate dietary diversity.
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Affiliation(s)
| | - Samuel Hailegebreal
- Department of Health Informatics, Arba Minch University, Arba Minch, Ethiopia
| | | | - Girma Gilano
- Department of Health Informatics, Arba Minch University, Arba Minch, Ethiopia
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Aboagye RG, Seidu AA, Ahinkorah BO, Arthur-Holmes F, Cadri A, Dadzie LK, Hagan JE, Eyawo O, Yaya S. Dietary Diversity and Undernutrition in Children Aged 6-23 Months in Sub-Saharan Africa. Nutrients 2021; 13:nu13103431. [PMID: 34684435 PMCID: PMC8537414 DOI: 10.3390/nu13103431] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/06/2023] Open
Abstract
Dietary diversity plays a major role in the health status of children. However, evidence on its crucial role on children's health status remains inconclusive in sub-Saharan Africa (SSA). In this study, we examined the association between dietary diversity and undernutrition among children aged 6-23 months in SSA. We pooled data from the most recent Demographic and Health Surveys of 32 countries in SSA from 2010 to 2020. A sample of 48,968 mother-child pairs of children within the ages of 6-23 months and mothers aged 15-49 years were included in this study. Multilevel logistic regression analysis was carried out to examine the association between dietary diversity and stunting, wasting, and underweight. The results were presented as crude odds ratios (cOR) and adjusted odds ratios (aOR) with their 95% confidence intervals. Statistical significance was set at p < 0.05. The overall prevalence of minimum dietary diversity was 25.1%, with South Africa recording the highest prevalence (43.9%) and Burkina Faso recording the lowest prevalence (5.6%). The highest prevalence of stunting was recorded by Burundi (51.8%) while the lowest prevalence was found in Ghana (13.6%), with an overall regional prevalence of 28.6%. For wasting, prevalence from all countries was found to be 9.4%. South Africa recorded the lowest prevalence of wasting (2.1%) while Niger recorded the highest prevalence (27.3%). Lastly, the prevalence of underweight ranged from 5.3% in South Africa to 41.8% in Niger, with an all-country prevalence of 16.4%. Children who had adequate minimum dietary diversity had 12% less likelihood of being stunted (aOR = 0.88, 95% CI = 0.83, 0.94), compared to those who had inadequate minimum dietary diversity. Having an adequate minimum dietary diversity significantly lowered the risk of underweight among children by 17% (aOR = 0.83, 95% CI = 0.77, 0.91). Having an adequate minimum dietary diversity was associated with 13% reduced odds of wasting among children (aOR = 0.87, 95% CI = 0.78, 0.97), compared to those who had inadequate minimum dietary diversity. This study highlights the significant association between minimum dietary diversity and stunting, wasting, and underweight among 6-23 month-old children in SSA. There is an urgent need for additional nutrition-specific interventions and strengthening of existing interventions aimed at improving infant and young child feeding practices, including complementary feeding practices among children aged 6-23 months in the 32 countries in SSA. Such interventions should focus more on countries where the prevalence of adequate minimum dietary diversity was low and undernutrition was high.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe PMB 31, Ghana;
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast TF0494, Ghana; (A.-A.S.); (L.K.D.)
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Department of Estate Management, Takoradi Technical University, Takoradi P.O. Box 256, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia;
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong, China;
| | - Abdul Cadri
- Department of Social and Behavioural Science, School of Public Health, University of Ghana, LG 25, Legon, Accra 23321, Ghana;
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC H3S 1Z1, Canada
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast TF0494, Ghana; (A.-A.S.); (L.K.D.)
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast TF0494, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Postfach 100131, 33501 Bielefeld, Germany
- Correspondence:
| | - Oghenowede Eyawo
- School of Global Health, Faculty of Health, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada;
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada;
- The George Institute for Global Health, Imperial College London, 84 Wood Lane, London W12 0BZ, UK
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