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Kimuli D, Nakaggwa F, Namuwenge N, Nsubuga RN, Kasule K, Nyakwezi S, Odong J, Isabirye P, Sevume S, Mubiru N, Mwehire D, Matovu F, Wandera B, Amuron B, Bukenya D. Prevalence and determinants of minimum dietary diversity for women of reproductive age in Uganda. BMC Nutr 2024; 10:39. [PMID: 38429646 PMCID: PMC10908097 DOI: 10.1186/s40795-024-00858-6] [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: 08/02/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Globally, over a billion women of reproductive age (WRA) suffer from some kind of undernutrition micronutrient deficiencies, and/or anemia as a result of inadequate dietary diversity. This leads to poor maternal and child health outcomes, however, there is limited research on population level research on minimum dietary diversity for women (MDD-W). This study assessed the prevalence and predictors of MDD-W among WRA in Uganda. METHODS This study was a secondary analysis of data from the lot quality assurance sampling (LQAS) survey conducted across 55 Ugandan districts between May and September 2022. Women of various ages were interviewed across 5 study subgroups that this study used to construct its study population (WRA). Descriptive analyses, tests for outcome differences, and multilevel mixed-effects logistic regression were conducted at a 5% statistical significance level using STATA version 17. The results were reported using Adjusted Odds Ratios (aOR) as the measure of the outcome. RESULTS The study analyzed responses from 29,802 WRA with a mean age of 27.8 (± 6.8) years. Only 8.8% (95% CI 8.5-9.3) achieved the MDD-W, the least proportion was observed in the South-Central region (3.13%). In the adjusted analysis, WRA who were older than 25 years (aOR 1.1, 95% CI 1.1-1.3, p < 0.001), had secondary education (aOR = 1.4, 95% CI 1.1-1.7, p = 0.003) or above (aOR = 1.7, 95% CI 1.3-2.2, p < 0.001), and used modern contraceptives (aOR = 1.1, 95% CI 1.0-1.3, p = 0.01) were more likely to achieve the MDD-W. Conversely, WRA who travelled longer distances to the nearest household water source (aOR = 0.8, 95% CI 0.7-0.9, p = 0.002) and those residing in larger households (aOR = 0.9, 95% CI 0.8-1.0, p = 0.019) were less likely to achieve the MDD-W. CONCLUSION A low proportion of WRA met the MDD-W. Age, education level, household sizes and use of modern contraception were predictors of MDD-W among WRA in Uganda. MDD-W-related program efforts in Uganda should strengthen multisectoral collaboration with prioritization of younger women, education, household sizes and access to safe water sources.
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Affiliation(s)
- Derrick Kimuli
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda.
| | - Florence Nakaggwa
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Norah Namuwenge
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Rebecca N Nsubuga
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Kenneth Kasule
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Sheila Nyakwezi
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Jimmy Odong
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Paul Isabirye
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Solome Sevume
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Norbert Mubiru
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Daniel Mwehire
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Fatuma Matovu
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Bonnie Wandera
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Barbara Amuron
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Daraus Bukenya
- Social & Scientific Systems, Inc., DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
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Uwase A, Nsereko E, Pillay N, Levin J. Dietary diversity and associated factors among pregnant women in the Southern Province of Rwanda: A facility-based cross-sectional study. PLoS One 2024; 19:e0297112. [PMID: 38394158 PMCID: PMC10889653 DOI: 10.1371/journal.pone.0297112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
The inadequate dietary diversity of pregnant women in low- and middle-income countries, including Rwanda, is rising and leading to macro and micronutrient deficiencies. The extent of dietary diversity and the factors contributing to it are unknown in Rwanda. This cross-sectional study, with 612 women who attended antenatal care services in Rwanda's Southern Province, identified determinants of dietary diversity among pregnant women. A multistage sampling scheme was used in which four districts were sampled, thereafter one urban and one rural health centre was sampled in each district and finally, a systematic sample of pregnant women was selected in each sampled health centre. Dietary diversity was measured using Minimum Dietary Diversity for Women (MDD-W), and multiple logistic regression models were fitted to identify factors associated with dietary diversity. Only 44.1% (95% confidence interval (CI) of [40.1%, 48.0%]) of participants had adequate dietary diversity. Approximately 95.4% of participants consumed grains, white roots, and tubers. The food groups that were the least consumed consisted of eggs (n = 99, 16.4%), as well as those consisting of milk and milk products (n = 112, 18.5%). The factors which were positively associated with dietary diversity were owning a radio (adjusted odds ratio [aOR] = 1.90 [95% CI 1.27, 2.85]), maternal education (aOR = 1.85 [95% CI 1.28, 2.65]), having a kitchen garden (aOR = 1.69 [95% CI 1.11, 2.57]) and nutrition knowledge score (aOR = 1.45 [95% CI 1.21, 1.74]) for a five-point increase in nutrition knowledge score. The factors negatively associated with dietary diversity include food insecurity, which reduced the odds of dietary diversity (aOR = 0.19 [0.07, 0.50]) per five-unit increase in food insecurity. Furthermore, the odds of adequate dietary diversity were lower among urban residents than rural residents (aOR = 0.69 [0.47, 1.03]). The household size was associated with dietary diversity with the odds of dietary diversity decreasing by 12% for a five-unit increase in household size (aOR = 0.88 [0.79; 0.99]). 23% had poor nutritional status, indicated by their mid-upper arm circumference (MUAC; < 23 cm). Enhanced nutritional education is needed to improve the nutritional knowledge of this population with particular emphasis on the consumption of animal-source foods. Sensitisation activities promoting ownership of kitchen gardens and radios could improve dietary diversity among Rwanda's pregnant women.
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Affiliation(s)
- Aline Uwase
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Etienne Nsereko
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Nirvana Pillay
- University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Jonathan Levin
- University of Witwatersrand School of Public Health, Pretoria, South Africa
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Muriithi FG, Banke-Thomas A, Forbes G, Gakuo RW, Thomas E, Gallos ID, Devall A, Coomarasamy A, Lorencatto F. A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002950. [PMID: 38377077 PMCID: PMC10878526 DOI: 10.1371/journal.pgph.0002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
The rate of decline in the global burden of avoidable maternal deaths has stagnated and remains an issue of concern in many sub-Saharan Africa countries. As per the most recent evidence, an average maternal mortality ratio (MMR) of 223 deaths per 100,000 live births has been estimated globally, with sub-Saharan Africa's average MMR at 536 per 100,000 live births-more than twice the global average. Despite the high MMR, there is variation in MMR between and within sub-Saharan Africa countries. Differences in the behaviour of those accessing and/or delivering maternal healthcare may explain variations in outcomes and provide a basis for quality improvement in health systems. There is a gap in describing the landscape of interventions aimed at modifying the behaviours of those accessing and delivering maternal healthcare for improving maternal health outcomes in sub-Saharan Africa. Our objective was to extract and synthesise the target behaviours, component behaviour change strategies and outcomes of behaviour change interventions for improving maternal health outcomes in sub-Saharan Africa. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Our protocol was published a priori on PROSPERO (registration number CRD42022315130). We searched ten electronic databases (PsycINFO, Cochrane Database of Systematic Reviews, International Bibliography of Social Sciences, EMBASE, MEDLINE, Scopus, CINAHL PLUS, African Index Medicus, African Journals Online, and Web of Science) and included randomised trials and quasi-experimental studies. We extracted target behaviours and specified the behavioural interventions using the Action, Actor, Context, Time, and Target (AACTT) framework. We categorised the behaviour change strategies using the intervention functions described in the Behaviour Change Wheel (BCW). We reviewed 52 articles (26 randomized trials and 26 quasi-experimental studies). They had a mixed risk of bias. Out of these, 41 studies (78.8%) targeted behaviour change of those accessing maternal healthcare services, while seven studies (13.5%) focused on those delivering maternal healthcare. Four studies (7.7%) targeted mixed stakeholder groups. The studies employed a range of behaviour change strategies, including education 37 (33.3%), persuasion 20 (18%), training 19 (17.1%), enablement 16 (14.4%), environmental restructuring 8 (7.2%), modelling 6 (5.4%) and incentivisation 5 (4.5%). No studies used restriction or coercion strategies. Education was the most common strategy for changing the behaviour of those accessing maternal healthcare, while training was the most common strategy in studies targeting the behaviour of those delivering maternal healthcare. Of the 52 studies, 40 reported effective interventions, 7 were ineffective, and 5 were equivocal. A meta-analysis was not feasible due to methodological and clinical heterogeneity across the studies. In conclusion, there is evidence of effective behaviour change interventions targeted at those accessing and/or delivering maternal healthcare in sub-Saharan Africa. However, more focus should be placed on behaviour change by those delivering maternal healthcare within the health facilities to fast-track the reduction of the huge burden of avoidable maternal deaths in sub-Saharan Africa.
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Affiliation(s)
- Francis G. Muriithi
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aduragbemi Banke-Thomas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, London, United Kingdom
| | - Gillian Forbes
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Ruth W. Gakuo
- Department of Nursing, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Lenton, Nottingham, United Kingdom
| | - Eleanor Thomas
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ioannis D. Gallos
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adam Devall
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Arri Coomarasamy
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
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Heri R, Malqvist M, Yahya-Malima KI, Mselle LT. Dietary diversity and associated factors among women attending antenatal clinics in the coast region of Tanzania. BMC Nutr 2024; 10:16. [PMID: 38254189 PMCID: PMC10801968 DOI: 10.1186/s40795-024-00825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is crucial for reducing maternal morbidity and mortality, especially in low-resource settings. During antenatal care, women are provided with resources for enhancing their dietary diversity, like nutrition education and counseling. Improved nutrition knowledge influences positive nutritional behavior change, like women's improved dietary diversity, which may increase the likelihood of a healthier pregnancy and delivery experience. OBJECTIVE This study aim was to assess dietary diversity and associated factors among pregnant women attending antenatal care in the Coast region of Tanzania. METHODS The descriptive cross-sectional study design was used to assess dietary diversity and associated factors among 338 pregnant women. A semi-structured questionnaire collected information from pregnant women on social demographic characteristics, nutrition knowledge and dietary diversity. Women were classified as having a varied diet if they had consumed at least five of the ten food groups over the previous twenty-four hours. Multivariable logistic regression analyses were used to identify predictors of dietary diversity in pregnant women. RESULTS Only 28% (95% CI: 23.5-33.1) (n = 95) of pregnant women met the minimum dietary diversity, and 18% (95% CI: 13.8-21.9) (n = 59) were considered to have a high level of nutrition knowledge. Living near a health facility (AOR = 1.77, CI 1.02, 3.06), having high nutrition knowledge (AOR = 2.58, 95% CI: 1.36, 4.89), and being pregnant for the first time (AOR = 2.44, 95% CI: 1.09, 5.44) were associated with adequate dietary diversity. CONCLUSION Pregnant women in the study were found to have low knowledge about nutrition and inadequate dietary diversity intake. The findings underscore the need to improve nutrition knowledge provision in antenatal clinics by emphasizing the importance of a diversified and high-quality diet. Healthcare providers in antenatal care clinics should consistently provide nutrition education and counseling to pregnant women and promote their diversified food consumption. Such knowledge may eventually promote healthier pregnancy and child development by curbing the nutritional deficiencies experienced during pregnancy.
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Affiliation(s)
- Rashidi Heri
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Mats Malqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Khadija I Yahya-Malima
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lilian Teddy Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ezzeddin N, Kalantari N, Abdollahi M, Amiri P, Amini B, Zayeri F. Outcomes of a homestead food production program on nutritional knowledge, dietary diversity, food security and empowerment of rural women in Tehran province, Iran. BMC Public Health 2024; 24:118. [PMID: 38191378 PMCID: PMC10775463 DOI: 10.1186/s12889-024-17658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled "Nutrition Improvement of Rural and Nomadic Women" in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province. METHODS The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women's empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software. RESULTS The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women's empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women's empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p < 0.05), while household food insecurity predicted it negatively (r=-0.138) (p < 0.05). CONCLUSION Because the current evaluated program has not been able to improve the expected indicators, modification of the program implementation may be needed, such as: addressing the probable barriers and challenges and strengthening the facilities in the covered villages. The current study presents a model of the dietary diversity predictors for consideration in redesigning or enhancing the program.
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Affiliation(s)
- Neda Ezzeddin
- Department of Community Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Kalantari
- Department of Community Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Abdollahi
- Faculty of Nutrition Sciences and Food Technology, and Social Determinants of Health Research Center, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Centre for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Amini
- Department of Community Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center, Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Darband Street, Tehran, Iran.
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Beressa G, Whiting SJ, Belachew T. Effect of nutrition education integrating the health belief model and theory of planned behavior on dietary diversity of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial. Nutr J 2024; 23:3. [PMID: 38166908 PMCID: PMC10763129 DOI: 10.1186/s12937-023-00907-z] [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: 07/24/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Maternal anemia, miscarriage, low birth weight (LBW), preterm birth (PTB), intrauterine growth restriction (IUGR), prenatal and infant mortality, morbidity, and the risk of chronic disease later in life are all increased by a lack of dietary diversity during pregnancy. However, evidence for the effect of nutrition education on the dietary diversity score (DDS) among pregnant women was sparse in Ethiopia, particularly in the study areas. This study aimed to assess the effect of nutrition education on dietary diversity among pregnant women in urban settings in Southeast Ethiopia. METHODS A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention group and 223 control group) at health facilities from February to December 2021. A multistage cluster sampling technique, followed by systematic sampling, was used to select the pregnant women. Pregnant women who participated in the interventions were given nutrition education starting at 16 weeks of gestation and continuing for 6 months. We used a pre-tested, interviewer-administered, structured questionnaire to collect the data. A 24-hour qualitative dietary recall was used to calculate the dietary diversity score (DDS). A multivariable generalized estimating equation (GEE) model was conducted to evaluate the intervention effect. RESULTS After the intervention, the proportion of adequate dietary diversity was 14.15% higher in the intervention arm compared to the control group (45.09% versus 30.94%, P = 0.002). The overall difference in adequate dietary diversity between the two groups was 8.5%. After adjusting for background characteristics, the multivariable GEE binary logistic model revealed that having received intervention [(AOR = 1.89, 95% CI: 1.27, 2.79)], being literate [(AOR = 3.41, 95% CI: 1.13, 10.23)], and having high wealth [(AOR = 1.60, 95% CI: 1.09, 2.35)] significantly improved adequate dietary diversity. CONCLUSION The findings indicated that having received the intervention, being literate, and having a high level of wealth significantly improved maternal dietary diversity. Efforts should be made to increase nutrition education using the health belief model (HBM) and the theory of planned behavior (TPB). Moreover, there is a need to improve literacy and economic empowerment through income-generating activities to enhance adequate dietary diversification during pregnancy. TRIAL REGISTRATION Clinicaltrials.gov (PACTR202201731802989, Retrospectively registered on 24 January 2022).
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Affiliation(s)
- Girma Beressa
- Department of Public Health, School of Health Sciences, Madda Walabu University, Goba, Ethiopia.
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Tefera Belachew
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Dewidar O, John J, Baqar A, Madani MT, Saad A, Riddle A, Ota E, Kung'u JK, Arabi M, Raut MK, Klobodu SS, Rowe S, Hatchard J, Busch‐Hallen J, Jalal C, Wuehler S, Welch V. Effectiveness of nutrition counseling for pregnant women in low- and middle-income countries to improve maternal and infant behavioral, nutritional, and health outcomes: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1361. [PMID: 38034903 PMCID: PMC10687348 DOI: 10.1002/cl2.1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background Nutritional counseling, which includes two-way interactive education, has been hypothesized to improve the health and nutritional status of pregnant women, but little is known about the impact such practice of care might have on maternal and infant health and behavioral outcomes of pregnant women living in low income, low-middle income, and upper-middle-income countries (LMIC)s. Objectives We conducted a systematic review to appraise the effectiveness and impact on health equity of two-way nutritional counseling practices in LMICs on maternal and infant behavioral, nutritional, and health outcomes. Search Methods We conducted electronic searches for relevant studies on Medline, Embase, CINAHL, PsychInfo, and the Cochrane CENTRAL for randomized and non-randomized trials on the effectiveness of two-way interactive nutritional counseling among pregnant women from the date of database inception up to June 22, 2021. In addition, we searched references of included studies in systematic reviews, gray literature resources, and unpublished studies or reports that satisfied our eligibility criteria using a focused Google search. Selection Criteria We included randomized and non-randomized controlled studies (NRS), controlled before and after, and interrupted time series that assessed the effectiveness of two-way interactive nutrition counseling targeting pregnant women in LMICs. Data Collection and Analysis Data extraction and risk of bias were conducted in duplicate. The risk of bias (ROB) for randomized trials (RCT) was assessed according to the Cochrane Handbook of Systematic Reviews, and ROB for NRS was assessed using the Newcastle-Ottawa scale (NOS). RCT and NRS were meta-analyzed separately. Main Results Our search identified 6418 records and 52 studies met our inclusion criteria, but only 28 were used in the quantitative analysis. Twenty-eight studies were conducted in Asia, the most in Iran. Eight studies were conducted in Africa. Two-way interactive nutritional counseling during pregnancy may improve dietary caloric intake (mean difference [MD]: 81.65 calories, 95% confidence interval [CI], 15.37-147.93, three RCTs; I 2 = 42%; moderate certainty of evidence using GRADE assessment), may reduce hemorrhage (relative risk [RR]: 0.63; 95% CI, 0.25-1.54, two RCTs; I 2 = 40%; very low certainty of evidence using GRADE assessment), may improve protein (MD: 10.44 g, 95% CI, 1.83-19.05, two RCTs; I 2 = 95%; high certainty of evidence using GRADE assessment), fat intake (MD: 3.42 g, 95% CI, -0.20 to 7.04, two RCTs; I 2 = 0%; high certainty of evidence using GRADE assessment), and may improve gestational weight gain within recommendations (RR: 1.84; 95% CI, 1.10-3.09, three RCTs; I 2 = 69%). Nutrition counseling probably leads to the initiation of breastfeeding immediately after birth (RR: 1.72; 95% CI, 1.42-2.09, one RCT). There was little to no effect on reducing anemia (RR: 0.77; 95% CI, 0.50-1.20, three RCTs; I 2 = 67%; very low certainty of evidence using GRADE assessment) risk of stillbirths (RR: 0.81; 95% CI, 0.52-1.27, three RCTs; I 2 = 0%; moderate certainty of evidence using GRADE assessment) and risk of cesarean section delivery (RR: 0.96; 95% CI, 0.76-1.20, four RCTs; I 2 = 36%; moderate certainty of evidence using GRADE assessment). Authors’ Conclusions Our review highlights improvements in maternal behavioral and health outcomes through interactive nutrition counseling during pregnancy. However, we are uncertain about the effects of nutrition counseling due to the low certainty of evidence and a low number of studies for some key outcomes. Moreover, the effects on health equity remain unknown. More methodologically rigorous trials that focus on a precise selection of outcomes driven by the theory of change of nutrition counseling to improve maternal and infant behavioral and health outcomes and consider equity are required.
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Affiliation(s)
- Omar Dewidar
- Bruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Jessica John
- Eat, Drink and Be HealthyTunapunaTrinidad and Tobago
| | - Aqeel Baqar
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | - Ammar Saad
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Alison Riddle
- Bruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Erika Ota
- Global School of Nursing Science, Global Health NursingSt. Luke's International UniversityChuo‐kuJapan
| | | | | | | | - Seth S. Klobodu
- Department of Nutrition and Food ScienceCalifornia State University, ChicoChicoCaliforniaUSA
| | - Sarah Rowe
- Nutrition InternationalOttawaOntarioCanada
| | | | | | - Chowdhury Jalal
- Global Technical Services, Nutrition InternationalOttawaOntarioCanada
| | | | - Vivian Welch
- Bruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
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Ma L, Xu H, Zhang Z, Li L, Lin Z, Qin H. Nutrition knowledge, attitudes, and dietary practices among parents of children and adolescents in Weifang, China: A cross-sectional study. Prev Med Rep 2023; 35:102396. [PMID: 37705881 PMCID: PMC10495675 DOI: 10.1016/j.pmedr.2023.102396] [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: 04/15/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
Parent's nutrition knowledge, attitudes, and dietary practices (KAP) play imperative roles in preventing malnutrition for themselves and their children. Our study aimed to determine the status and contributing factors of nutrition KAP among parents of children and adolescents. A total of 1746 parents (mean age 39.67 ± 5.38 years, females accounting for 69.82%) of primary and junior high school students in Weifang, China, completed a self-reported KAP questionnaire in August 2021. An analysis of Pearson product-moment correlation was conducted to determine the relationship between knowledge, attitudes, and practices. Chi-square test, followed by a multivariable robust Poisson regression analysis, was performed to identify the contributing factors to parents' KAP. A 65.94% awareness rate of nutritional knowledge was observed. The correlations between nutrition knowledge and attitudes (r = 0.03, P = 0.23), knowledge and practices (r = 0.02, P = 0.34), and attitudes and practices (r = 0.16, P < 0.01) were relatively weak. After adjusting for other contributing factors, females [prevalence ratio (PR) = 1.28, 95% confidence interval (CI) = 1.13-1.45], participants with secondary education (PR = 4.64, 95% CI = 1.60-13.50), junior college education (PR = 5.87, 95% CI = 2.01-17.13) and college degree or above education (PR = 6.58, 95% CI = 2.25-19.23) acquired higher nutrition knowledge scores. Moreover, healthy diet behaviors were more commonly implemented by females than males (PR = 1.42, 95% CI = 1.14-1.76), and which needed to be improved in those with abnormal body mass indexes (BMIs) [overweight (PR = 0.86, 95% CI = 0.74-0.99) and obese (PR = 0.76, 95% CI = 0.56-0.99)]. It was necessary for nutrition KAP promotion to be emphasized in nutritional knowledge and dietary practices, as well as health behavior guidance, especially for parents with low education and elevated BMIs.
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Affiliation(s)
- Lirong Ma
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Huasheng Xu
- Department of Health Education, Weifang Center for Disease Control and Prevention, 4801 Huixian Road, Weifang, Shandong 261061, China
| | - Zhuoran Zhang
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Liyang Li
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Zhijuan Lin
- School of Basic Medical Sciences, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
- Key Laboratory of Immune Microenvironment and Inflammatory Disease Research in Universities of Shandong Province, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Hao Qin
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
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9
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Kushi EN, Belachew T, Tamiru D. Antenatal care follow-up was significantly associated with a higher probability of high dietary diversity score among pregnant women in okra-producing areas of western Ethiopia: proportional odds model. Food Nutr Res 2023; 67:9608. [PMID: 37533449 PMCID: PMC10392863 DOI: 10.29219/fnr.v67.9608] [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: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 08/04/2023] Open
Abstract
Background Dietary diversity is important for pregnant women since it has been associated with nutrient adequacy. It is very crucial to ensure optimal fetal health and development. There is no evidence at the community level on the magnitude of dietary diversity and its predictors among pregnant women in okra-producing areas of western Ethiopia. Objective This study aimed to assess the level of dietary diversity and its associated factors among pregnant women. Design A community-based cross-sectional study was employed among randomly selected 224 pregnant women in western Ethiopia. An interviewer-administered questionnaire was used to collect the data. The qualitative open 24-h recall was used to assess the level of dietary diversity. Ordinal logistic regression analyses were used by SPSS version 25. An adjusted proportional odds ratio along with a 95% confidence interval [CI] was computed to measure the strengths of the association at a P ≤ 0.05. Result This study revealed that more than one-fourth, 64 (28.6%), of the respondents were found to have high dietary diversity scores. Antenatal Care [ANC] visits (Adjusted Odds Ratio [AOR] = 2.10, [95% CI: 1.13, 3.90], P = 0.01), changing food intake (AOR = 2.97, [95% CI: 1.16, 3.67], P = 0.002), and being food secure household (AOR = 2.63, [95% CI: 1.38, 5.00], P = 0.003) were significantly associated with a higher probability of having high dietary diversity score. However, lack of formal education (AOR = 0.34, [95% CI: 0.61, 0.89]) was inversely associated with the probability of having high dietary diversity. Conclusion More than half of pregnant women in western Ethiopia were found to have low dietary diversity. Therefore, ANC follow-up, dietary modification, and promotion of frequent use of wild edible plants (okra) to maintain household food security were very crucial.
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Affiliation(s)
- Efrem Negash Kushi
- Department of Public Health, College of Health and Medical Science, Mettu University, Mettu, Ethiopia
| | - Tefera Belachew
- Departments of Nutrition and Dietetics, Public Health Institute, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Departments of Nutrition and Dietetics, Public Health Institute, Jimma University, Jimma, Ethiopia
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10
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Watson D, Mushamiri P, Beeri P, Rouamba T, Jenner S, Proebstl S, Kehoe SH, Ward KA, Barker M, Lawrence W. Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000401. [PMID: 36996036 PMCID: PMC10062616 DOI: 10.1371/journal.pgph.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Mushamiri
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Simone Proebstl
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sarah H Kehoe
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Kate A Ward
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
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11
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Wakwoya EB, Belachew T, Girma T. Determinants of nutritional status among pregnant women in East Shoa zone, Central Ethiopia. Front Nutr 2022; 9:958591. [PMID: 36590215 PMCID: PMC9797973 DOI: 10.3389/fnut.2022.958591] [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: 05/31/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Undernutrition is an insufficient intake of energy and nutrients to meet an individual's needs to maintain good health. Undernutrition during pregnancy severely affects the health of mothers and her baby. Globally it contributes directly or indirectly to 3.5 million maternal deaths annually. This study aimed to determine the level of undernutrition and identify factors associated with undernutrition among pregnant women attending public health facilities in the East Shoa Zone, Central Ethiopia. Methods Institution-based cross-sectional study was conducted among 472 randomly selected pregnant women from June to August 2021. Sociodemographic, obstetrics, and knowledge related data were collected using a structured interviewer-administered questionnaire, and maternal nutritional status was measured using the Mid Upper Arm Circumference (MUAC). The collected data were entered to EPI-info version 3.5.4 and then exported to SPSS for windows version 26.0 software for analysis. Multivariable regression analysis was fitted to identify determinants of undernutrition. An adjusted odds ratio with 95% confidence intervals and a p-value < 0.05 was considered a statistically significant. Results The prevalence of undernutrition among pregnant women was 13.9% [95% CI: 11.0-17.4]. On multivariable logistic regression model after adjusting background variables, wealth (AOR: 4.9, 95% CI 1.34-18.20), women's decision making power (AOR: 3.31, 95% CI 1.18-7.79), and nutritional counseling (AOR: 3.53, 95% CI 1.29-9.60) were independently associated with nutritional status of pregnant women. Conclusion Findings indicated that significant number of pregnant women in the study were undernourished. Higher wealth index, nutritional counseling, and women's decision-making power were inversely associated with undernutrition. The findings imply the need for economic empowerment of women, enhancing decision-making ability of women and routine and consistent nutritional counseling to decrease undernutrition among pregnant women.
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Affiliation(s)
- Ermias Bekele Wakwoya
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia,*Correspondence: Ermias Bekele Wakwoya
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia,Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
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12
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Kebede AN, Sahile AT, Kelile BC. Dietary Diversity and Associated Factors Among Pregnant Women in Addis Ababa, Ethiopia, 2021. Int J Public Health 2022; 67:1605377. [PMID: 36405528 PMCID: PMC9668879 DOI: 10.3389/ijph.2022.1605377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/25/2022] [Indexed: 08/04/2023] Open
Abstract
Objective: This study aimed to assess the dietary diversity and its associated factors among pregnant women in Addis Ababa, Ethiopia, 2021. Methods: An institution-based Cross-sectional was conducted among 320 participants from four health facilities in Addis Ababa selected based on a simple random sampling method from 01 September to 30 December 2021. An Interviewer-administered structured questionnaire was used, following informed consent. Binary (Bivariate and multivariate) logistics regression was applied for the identification factors associated with dietary diversity with their respective 95% confidence interval and less than 5% p-value. Results: The prevalence of inadequate dietary diversity during pregnancy was 51.6% (95% CI: 46.1%-57.0%). Being illiterate (AOR: 0.591; 95% CI: 1.88-1.901; p < 0.05) and primary education (AOR: 0.347; 95% CI: 0.166-0.728; p < 0.05), having poor knowledge (AOR: 0.437; 95% CI: 0.252-0.757; p < 0.05) and lower monthly income (AOR: 0.395; 95% CI: 0.184-0.845; p < 0.05) were factors associated with inadequate dietary diversity. Conclusion: A higher level of inadequate dietary diversity was reported. Being illiterate, having primary education, having poor knowledge, and having lower monthly income were associated with inadequate dietary diversity during pregnancy. Concerned bodies were suggested to work on the identified factors.
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13
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Frates B, Smith A. Nutrition and behavior change: a review of recent literature. Curr Opin Clin Nutr Metab Care 2022; 25:407-414. [PMID: 35975962 DOI: 10.1097/mco.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article will highlight recent trends and novel approaches to behavior change strategies in nutrition. Physicians, nurses, and other healthcare professionals play key roles in counseling patients on lifestyle change, which is critical for patients with chronic conditions. Nutrition science continues to advance, and new approaches to behavior change are needed for successful implementation at the individual and population level. RECENT FINDINGS The solutions to obstacles around healthful eating patterns are varied, population-dependent, and require a multipronged approach. One area of focus is the language around behavior change, ensuring it is clear and emphasizes its multifactorial nature. For young adults, the careful use of video games and social media may be essential. For older adults, altering food consistency and ensuring proper nutrient intake are crucial factors. Vulnerable populations remain susceptible to malnutrition and need special attention. Despite significant advances in managing and treating diseases, there are still gaps in nutrition counseling and behavior change efforts. SUMMARY Every age and stage of life needs a focus on healthful foods, and nutrition counseling at each stage has its unique nuances. Careful attention to the language of change and the phrasing used in counseling is vital for educating, connecting with, and empowering patients to change. Changing healthcare operations and provider behavior around nutrition counseling is a part of the solution to the worldwide problem of unhealthy eating patterns and practices.
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Affiliation(s)
- Beth Frates
- Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital
| | - Alexis Smith
- Department of Surgery at Mass General Hospital, Boston, Massachusetts, USA
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14
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Wu Y, Wang S, Shi M, Wang X, Liu H, Guo S, Tan L, Yang X, Wu X, Hao L. Awareness of nutrition and health knowledge and its influencing factors among Wuhan residents. Front Public Health 2022; 10:987755. [PMID: 36276389 PMCID: PMC9580461 DOI: 10.3389/fpubh.2022.987755] [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: 07/14/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
Background Nutrition and health knowledge play a crucial role in promoting healthy dietary behaviors, and have been found to be related to sociodemographic characteristics. However, the existing evidence is limited and inconsistent. We aimed to evaluate the awareness level of nutrition and health knowledge and its influencing factors among Wuhan residents, and to provide scientific basis for carrying out targeted nutrition education programmes. Methods By stratified random sampling, residents aged 18-64 in Wuhan were selected for self-administered questionnaire survey. We adopted the structured questionnaire to investigate respondents' sociodemographic characteristics, nutrition and health knowledge, and the way to acquire knowledge. Among them, nutrition and health knowledge includes the following four parts: dietary guidelines recommendations, food and nutrients, nutrition and disease prevention, and nutrition skills. Chi-square tests were used to analyze the associations between total awareness rate and sociodemographic characteristics. Multiple linear regression models were used to analyze the influencing factors of nutrition and health awareness. Results A total of 33,436 valid questionnaires were obtained, with a response rate of 97.8%. The total awareness rate was 20.4%, with the highest in nutrition and disease prevention (72.7%) and the lowest in nutrition skills (46.3%). Responders aged 35-44 (23.3%), females (22.8%), educational workers (24.8%), obtaining a master's degree or above (34.1%), living in downtown area (23.1%), and without a history of chronic disease (24.6%) were more likely to have higher awareness rates (all p < 0.001). The multiple linear regression models showed that age, gender, education level, occupation, residential address, and the history of chronic disease were the potential factors affecting individual nutrition awareness. Conclusion The total awareness rate of nutrition and health knowledge among Wuhan residents was not optimistic. Besides, our findings suggested that sociodemographic characteristics are closely related to nutrition awareness, which may provide important clues for carried out nutrition education campaigns.
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Affiliation(s)
- Yating Wu
- Institute of Environmental Health and Food Safety, Wuhan Centre for Disease Control and Prevention, Wuhan, China
| | - Shanshan Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengdie Shi
- Institute of Environmental Health and Food Safety, Wuhan Centre for Disease Control and Prevention, Wuhan, China
| | - Xinzheng Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongjuan Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le Tan
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Wu
- Institute of Environmental Health and Food Safety, Wuhan Centre for Disease Control and Prevention, Wuhan, China,*Correspondence: Xiaomin Wu
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Liping Hao
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15
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Geta TG, Gebremedhin S, Omigbodun AO. Dietary Diversity Among Pregnant Women in Gurage Zone, South Central Ethiopia: Assessment Based on Longitudinal Repeated Measurement. Int J Womens Health 2022; 14:599-615. [PMID: 35497262 PMCID: PMC9048948 DOI: 10.2147/ijwh.s354536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Dietary diversity is a key proxy indicator of nutrient adequacy; however, limited studies have been done on it among pregnant women in Ethiopia. The study aimed to examine the prevalence of sub-optimal dietary diversity and its associated factors among pregnant women in Gurage zone, South Central Ethiopia. Materials and Methods A mixed-method approach, a longitudinal study complemented with an exploratory qualitative study, was conducted. In the longitudinal study, a consecutively included sample of 668 pregnant women was followed in three rounds of survey. Dietary diversity was assessed using the minimum dietary diversity score for women (MDD-W) tool. The average of three dietary diversity scores was used to define overall diversity. Consuming less than 5 of 10 standard food groups was considered as suboptimal dietary diversity. Multivariable logistic regression analysis was used to identify predictors of suboptimal dietary diversity. Qualitative data were analysed using the thematic analysis method. Results During the 16 to 20, 28 to 29 and 36 to 37 weeks of gestation surveys, 75.0, 78.7 and 76.5% of the women had sub-optimal dietary diversity. In aggregate, 84.4% (95% CI: 81.6, 87.3) of the women had sub-optimal dietary diversity. Rural residents (AOR: 1.91, 95% CI: 1.01, 3.62), women with no formal education (AOR: 5.51, 95% CI: 1.96, 15.53) and from food insecure households (AOR: 2.44, 95% CI: 1.07, 5.59) had higher odds of suboptimal dietary diversity. Women with higher nutritional knowledge (AOR: 0.92, 95% CI: 0.87, 0.98) were less likely to have suboptimal dietary diversity. Food taboos, poor nutritional literacy and pregnancy complications were also reported as factors affecting dietary diversity. Conclusion Majority of pregnant women in the area had sub-optimal dietary diversity. Improving the socio-economic status and promoting nutrition knowledge may improve women’s dietary diversity.
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Affiliation(s)
- Teshome Gensa Geta
- Department of Biomedical Science, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.,Pan African University, Life and Earth Science Institutes (Including Health and Agriculture), Ibadan, Nigeria
| | - Samson Gebremedhin
- School of Public Health, College of Health Science and Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Akinyinka O Omigbodun
- Pan African University, Life and Earth Science Institutes (Including Health and Agriculture), Ibadan, Nigeria.,Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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