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Liu Y, Che CC, Hamdan M, Chong MC. Measuring empowerment in pregnant women: A scoping review of progress in instruments. Midwifery 2024; 134:104002. [PMID: 38669756 DOI: 10.1016/j.midw.2024.104002] [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: 06/22/2023] [Revised: 02/25/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The empowerment of pregnant women is a meaningful strategy that profoundly impacts the health of women and their children. Despite a significant increase in the empowerment of pregnant women and its measurement, little attention was given to a consensus on the selection and application of assessment instruments used for pregnant women. OBJECTIVE To identify the available assessment instruments for measuring the empowerment of pregnant women and to describe the appraisal content and their psychometric properties. METHODS We searched nine bibliographic databases for original studies that focus on the measurement of empowerment in pregnant women. Arksey and O'Malley's methodology and PRISMA-ScR were selected to guide the implementation of this scoping review. The COSMIN criteria was employed to assess the methodological quality and the quality of psychometric properties. RESULTS A total of 23 studies were included and 13 instruments were extracted. Given comprehensive considerations, Kameda's prenatal empowerment scale may be deemed suitable. The included instruments comprehensively measured the attributes of empowerment, with a particular focus on facilitating women's choice and decision-making. Except for the four most recent self-designed questionnaires, the remaining instruments had been tested for reliability and/or validity. CONCLUSION There were heterogeneous results regarding the included instruments' appraisal content and psychometric properties. Future studies focusing on the development or validation of measurement instruments should be guided by influential and identical standards.
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Affiliation(s)
- Yanjia Liu
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Mukhri Hamdan
- Department of Obstetric and Gynaecology, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Malaysia.
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Mahal S, Kucha C, Kwofie EM, Ngadi M. A systematic review of dietary data collection methodologies for diet diversity indicators. Front Nutr 2024; 11:1195799. [PMID: 38577154 PMCID: PMC10992480 DOI: 10.3389/fnut.2024.1195799] [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: 03/28/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024] Open
Abstract
The purpose of the current study was to critically assess the gaps in the existing methodologies of dietary data collection for diet diversity indicators. The study proposed the importance of smartphone application to overcome the drawbacks. The review paper identified and assessed the conventional methodologies used in diet diversity indicators including Minimum Dietary Diversity for Women (MDD-W), Minimum Dietary Diversity of Infant and Young Child Feeding Practices (IYCF-MDD), and Household Dietary Diversity Score (HDDS). The 80 research studies from 38 countries were critically assessed on the basis of their research aim, study design, target audience, dietary data collection methodology, sample size, dietary data type, dietary data collection frequency, and location point of dietary data collection. Results indicated that most studies employed interviewer-administered 24-h recall assessing the dietary diversity. The review paper concluded that smartphone application had potential to overcome the identified limitations of conventional methodologies including recall bias, social-desirability bias, interviewer training, and cost-time constraints.
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Affiliation(s)
- Subeg Mahal
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, QC, Canada
| | - Christopher Kucha
- Department of Food Science and Technology, University of Georgia, Athens, GA, United States
| | - Ebenezer M. Kwofie
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, QC, Canada
| | - Michael Ngadi
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, QC, Canada
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Geremew H, Abdisa S, Zerihun E, Gizaw YK, Kassa Y, Gashu C, Simegn MB. Dietary diversity practice and its associated factors among pregnant women in Eastern Ethiopia: A community-based cross-sectional study. Food Sci Nutr 2024; 12:1965-1972. [PMID: 38455219 PMCID: PMC10916598 DOI: 10.1002/fsn3.3892] [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: 09/27/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 03/09/2024] Open
Abstract
Micronutrient insufficiencies during pregnancy have a marked impact on the health of the woman and her offspring. Evidence about the dietary practice of pregnant women is limited in Ethiopia, particularly in drought-prone areas where food insecurity is widely seen. Therefore, this research aimed to assess the dietary diversity practice and associated factors among pregnant women in Chiro district, Eastern Ethiopia. We employed a community-based cross-sectional survey in Chiro district, Eastern Ethiopia. The data were collected from 417 randomly selected pregnant women using an interview-administered structured questionnaire. EpiData-3.1 and STATA-14 were used for data entry and analysis, respectively. The binary logistic regression analysis was deployed to assess the association between dietary diversity practice and predictor variables. Out of 420 calculated sample size, 417 pregnant women completed the survey giving a response rate of 99.3%. The overall prevalence of optimal dietary diversity was 38.4% (95% CI: 33.7%, 43.2%). Educational status (adjusted odds ratio [AOR]: 2.71, 95% CI: 1.08, 6.81), meal frequency (AOR: 1.91, 95% CI: 1.11, 3.28), home gardening (AOR: 4.21, 95% CI: 2.48, 7.16), and household food security (AOR: 0.23, 95% CI: 0.13, 0.40) were independent predictors of dietary diversity practice.This study found that a substantial proportion of pregnant women had suboptimal dietary diversity, indicating a fundamental micronutrient inadequacy. Educational status, meal frequency, home gardening practice, and household food security were independent determinants of dietary diversity practice. The findings suggest that promoting maternal education and home gardening practice, and controlling food insecurity might enhance optimal dietary diversity.
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Affiliation(s)
| | - Samuel Abdisa
- Department of Midwifery, College of Health ScienceOda Bultum UniversityChiroEthiopia
| | - Ebisa Zerihun
- Department of Nursing, College of Health ScienceOda Bultum UniversityChiroEthiopia
| | - Yitagesu Kifelew Gizaw
- Department of Statistics, College of Natural and Computational ScienceOda Bultum UniversityChiroEthiopia
| | - Yoseph Kassa
- Department of Statistics, College of Natural and Computational ScienceOda Bultum UniversityChiroEthiopia
| | - Chalachew Gashu
- Department of Statistics, College of Natural and Computational ScienceOda Bultum UniversityChiroEthiopia
| | - Mulat Belay Simegn
- Department of Public Health, College of Medicine and Health ScienceDebre Markos UniversityDebre MarkosEthiopia
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Magfirah N, Ansariadi A, Amiruddin R, Wijaya E, Maria IL, Salmah U, Ibrahim E. Inadequate food diversity and food taboo associated with maternal iron deficiency among pregnant women living in slum settlements in Makassar City, Indonesia. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:67. [PMID: 38559487 PMCID: PMC10979773 DOI: 10.4103/jehp.jehp_824_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Anemia in pregnancy is a major public health problem, especially in developing countries. The most common cause is nutritional deficiencies, especially iron deficiency. Adequate nutritional intake from food is essential during pregnancy. Therefore, this study aimed to investigate the relationship between food access and intake patterns with the incidence of iron deficiency among pregnant women living in the slum settlement in Makassar City. MATERIALS AND METHODS This research is a sub-study of the Indonesian Birth Cohort Study based in Makassar City. This sub-study used a cross-sectional design and recruited 173 pregnant women in their second and third trimesters using total sampling. All data were collected using a structured questionnaire and recorded using KoboToolbox software. Serum ferritin levels were examined for iron status using the ELISA method at the Microbiology Laboratory Unit at Hasanuddin University Teaching Hospital. The statistical data were analyzed using STATA version 14 with Chi-square analysis and logistic regression. RESULTS The prevalence of iron deficiency in pregnant women living in slum settlements in Makassar City was 78%. Logistic regression analysis showed that inadequate food diversity (AOR: 2.58; 95% CI: 1.17-5.69; P = 0.019) and food taboos (AOR: 2.81; 95% CI: 1.26-6.26; P = 0.011) were significantly associated with the incidence. CONCLUSIONS Most pregnant women living in slum settlements in Makassar City experienced iron deficiency. Pregnant women who experience iron shortages have been connected to food taboos and dietary diversity.
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Affiliation(s)
- Nurul Magfirah
- Master Program in Public Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Ansariadi Ansariadi
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Ridwan Amiruddin
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Eri Wijaya
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Ida L. Maria
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Ummu Salmah
- Department of Biostatistic, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Erniwati Ibrahim
- Department of Environmental Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
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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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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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Verger EO, Eymard-Duvernay S, Bahya-Batinda D, Hanley-Cook GT, Argaw A, Becquey E, Diop L, Gelli A, Harris-Fry H, Kachwaha S, Kim SS, Nguyen PH, Saville NM, Tran LM, Zagré RR, Landais E, Savy M, Martin-Prevel Y, Lachat C. Defining a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity Among Pregnant Adolescent Girls and Women: A Secondary Analysis of Quantitative 24-h Recalls from Rural Settings in Bangladesh, Burkina Faso, India, and Nepal. Curr Dev Nutr 2024; 8:102053. [PMID: 38187987 PMCID: PMC10767136 DOI: 10.1016/j.cdnut.2023.102053] [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: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. Objective This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Methods We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. Results In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). Conclusions The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.
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Affiliation(s)
- Eric O Verger
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | | | - Dang Bahya-Batinda
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Giles T. Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Loty Diop
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sunny S Kim
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Phuong Hong Nguyen
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | | | | | - Rock R Zagré
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Edwige Landais
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Mathilde Savy
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Yves Martin-Prevel
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Etea TD, Yalew AW, Sisay MM. Mediating effects of women's empowerment on dietary diversity during pregnancy in Central West Ethiopia: A structural equation modelling. Glob Health Action 2023; 16:2290303. [PMID: 38126365 PMCID: PMC10763841 DOI: 10.1080/16549716.2023.2290303] [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: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Considerable proportions of pregnant women consume inadequately diversified diets in Ethiopia. On the other hand, women's empowerment is identified as a means of achieving maternal nutrition improvement. However, evidence on the relationship between multiple dimensions of women's empowerment and dietary diversity during pregnancy is limited in Ethiopia. OBJECTIVE This study aimed to assess the mediating effects of women's empowerment in the pathway between women's education and dietary diversity during pregnancy in West Shewa zone, Ethiopia. METHODS A health facility-based cross-sectional study was conducted among 1,383 pregnant women in 2021. Dietary diversity was measured using the minimum dietary diversity for women (MDD-W) tool. Exploratory and confirmatory factor analyses were employed to identify and validate women's empowerment dimensions. Structural equation modelling (SEM) was used to examine the pathways linking pregnant women's education and empowerment to dietary diversity during pregnancy. RESULTS From the latent dimensions of women's empowerment produced by factor analyses, pregnant women's education was directly associated with household decision-making power, psychological and time dimensions. In turn, household decision-making power, psychological and time dimensions were associated with dietary diversity during pregnancy. The direct relationship between pregnant women's education and dietary diversity was insignificant, but the total indirect effect and total effect were significant. Household decision-making power, psychological and time dimensions were significant mediators in the relationship between pregnant women's education and dietary diversity. However, economic dimension was related to neither pregnant women's education nor dietary diversity. CONCLUSION This study highlights pregnant women with better education are more likely to be empowered in household decision-making, psychological and time dimensions; and those empowered pregnant women are more likely to consume more diverse diets, suggesting women's access to higher education could have a positive indirect effect on consumption of more diverse diets during pregnancy by empowering women in the study area.
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Bikila H, Ariti BT, Fite MB, Sanbata JH. Prevalence and factors associated with adequate dietary diversity among pregnant women in Nekemte town, Western Ethiopia, 2021. Front Nutr 2023; 10:1248974. [PMID: 38162525 PMCID: PMC10756138 DOI: 10.3389/fnut.2023.1248974] [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: 06/28/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024] Open
Abstract
Background Dietary diversity refers to increasing the consumption of a variety of foods. The consumption of diversified food during pregnancy enables the adequate intake of 11 important micronutrients. Inadequate dietary intake during pregnancy is the major determinant factor in the risk of low birth weight infants. It is capable of ensuring the adequate intake of essential nutrients, which can promote good physical health and mental development. Pregnant women require more protein, iron, iodine, vitamin A, folate, and other nutrients. Adequate intake of fruit, vegetables, and animal products throughout the life cycle helps ensure that women enter pregnancy and lactation without deficiencies. Micronutrient deficiency and protein, carbohydrate, and fat intake imbalances are also linked to an increased risk of chronic disease. Objective To assess the prevalence and associated factors with adequate dietary diversity among pregnant woman in Nekemte town, western Ethiopia, 202.1. Methods A community-based cross-sectional study was conducted among 475 pregnant women in the town. We used a systematic random sampling technique. Data were collected through face-to-face interviews by trained data collectors using a validated questionnaire. Before being exported to STATA version 14, data were entered into EpiData version 3.1, cleaned, coded, and checked for missing values. Results from bivariable analysis of p-value less than 0.25 were moved to a multivariable binary logistic regression model for analysis. Finally, multivariable logistic regression with p-value of less than 0.05 was considered statistically significant. Results The Prevalence of adequate dietary diversity was 43.6% (95% CI; 39.1-48.1). Households with the richest wealth index adjusted odds ratio (AOR = 3.17; 95%Confidence Interval = 1.60-6.28), those who have antenatal care (AOR = 2.16; 95%CI = 1.22-3.84), and women who were government employees (AOR = 1.87; 95%CI = 1.01-3.48) were positively associated with adequate dietary diversity. On the other hand, food-insecure households (AOR = 0.34; 95%CI = 0.17-0.66), women who had not changed their meal frequency (AOR = 0.613; 95%CI = 0.38-0.99), and women in their third trimester (AOR = 0.40; 95%CI = 0.20-0.81) were negatively associated with adequate dietary diversity during pregnancy. Conclusion The findings showed that there was a low acceptable level of dietary diversity among pregnant women in the town. Wealth index, antenatal care, women's occupation, household food insecurity, gestational age, and not changing meal frequency were identified as factors associated with adequate dietary diversity. Therefore, multi-sectoral collaboration is needed to enhance the dietary diversity of pregnant women by promoting women's employment and strengthening sustainable income-generating activities.
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Affiliation(s)
- Haile Bikila
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | | | - Meseret Belete Fite
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Mohammed F, Abdirizak N, Jibril A, Oumer A. Correlates of minimum dietary diversity among pregnant women on antenatal care follow up at public health facility in Puntland, Somalia. Sci Rep 2023; 13:21935. [PMID: 38081930 PMCID: PMC10713561 DOI: 10.1038/s41598-023-48983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
In Somalia, where a poorly diversified diet is leading to adverse pregnancy and neonatal outcomes, there is a significant dearth of evidence that needs to be studied. Hence, this study was to identify factors associated with minimum dietary diversity among pregnant women in Somalia. A facility-based survey was conducted among 361 pregnant women attending antenatal care (ANC) using a structured questionnaire. Dietary diversity was measured using consumption of 10-food groups. Bivariable and multivariable binary logistic regression analyses were used, along with odds ratios and 95% confidence intervals. About 48.2% (42.9-53.5) of women had an inadequately diversified diet. The risk of having an inadequately diversified diet was higher among rural residents (AOR = 1.20; 0.30-4.75), multigravida (AOR = 2.85; 1.43-5.68), young women (AOR = 2.15; 0.82-5.61), extended families (AOR = 1.19; 0.68-2.10), with infrequent ANC visits (AOR = 4.12; 2.06-8.27), fewer frequent meals (AOR = 1.84; 1.09-3.10) and from food-insecure households (AOR = 3.84; 2.28-6.49) as compared to their counterparts. Consumption of poorly diversified diet was prevalent and associated with dietary diversity was prevalent among women which could be strongly predicted by parity, ante-natal care and food security, which needs to be targeted for interventions.
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Affiliation(s)
- Feiruza Mohammed
- Faculty of Nutrition, University of Health Science, Bossaso, Puntland, Somalia
| | | | - Abdulfetah Jibril
- United Nations High Commissioner for Refugees, Bossaso, Puntland, Somalia
| | - Abdu Oumer
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
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Madzorera I, Bliznashka L, Blakstad MM, Bellows AL, Canavan CR, Mosha D, Bromage S, Noor RA, Webb P, Ghosh S, Kinabo JL, Masanja H, Fawzi WW. Women's input and decision-making in agriculture are associated with diet quality in rural Tanzania. Front Public Health 2023; 11:1215462. [PMID: 38125846 PMCID: PMC10731380 DOI: 10.3389/fpubh.2023.1215462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Background Women's empowerment is one critical pathway through which agriculture can impact women's nutrition; however, empirical evidence is still limited. We evaluated the associations of women's participation, input, and decision-making in key agricultural and household activities with women's diet quality. Methods We analyzed data from a cross-sectional study of 870 women engaged in homestead agriculture. We used food frequency questionnaires to assess women's diets and computed women's diet quality using the Prime Diet Quality Score (PDQS) (range 0-42), which captures healthy and unhealthy foods. We evaluated women's decision-making in 8 activities, food crop farming, cash crop farming, livestock raising, non-farm economic activities, wage/salary employment, fishing, major household expenditures, and minor household expenditures. Generalized estimating equations (GEE) linear models were used to evaluate associations between (a) women's participation, (b) decision-making, (c) adequate input, (d) adequate extent of independence in decision-making in agriculture, and (e) adequate input in use of agricultural income with their PDQS. Adequate input was defined as input into some, most or all decisions compared to input into few decisions or none. Adequate extent of independence was defined as input to a medium or high extent compared to input to a small extent or none. Findings Median PDQS was 19 (IQR: 16-21). Women's adequate input in decision-making on wage and salary employment (estimate: 4.19, 95% CI: 2.80, 5.57) and minor expenditures were associated with higher PDQS vs. inadequate input. Women with independence in decision-making on livestock production (estimate: 0.97, 95% CI: 0.05, 1.90) and minor household expenditures, and women with adequate decision-making in the use of income from wages/salaries (estimate: 3.16, 95% CI: 2.44, 3.87) had higher PDQS. Participation in agricultural activities was positively associated with PDQS. Conclusions Women's participation and input in decision-making in wage and salary employment, livestock production, and minor household expenditures were strongly associated with the consumption of better-quality diets. Women participating in multiple farm activities were also likely to have better diet quality. This study adds to the growing evidence on the pathways through which women's empowerment may influence women's nutrition in rural Tanzania.
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Affiliation(s)
- Isabel Madzorera
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Lilia Bliznashka
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, DC, United States
| | - Mia M. Blakstad
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Alexandra L. Bellows
- Department of International Health (Human Nutrition), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chelsey R. Canavan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | | | - Sabri Bromage
- Institute of Nutrition, Mahidol University, Salaya, Thailand
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Ramadhani A. Noor
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Joyce Ludovick Kinabo
- Department of Food Science Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Kaur S. Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review. Nutr Res Rev 2023; 36:420-447. [PMID: 36004512 DOI: 10.1017/s0954422422000166] [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] [Indexed: 11/06/2022]
Abstract
This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.
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Affiliation(s)
- Sukhdeep Kaur
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab141004, India
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13
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K. C. D, Shrestha N, Shrestha R, Sunuwar DR, Poudyal A. Household food security access and dietary diversity amidst COVID-19 pandemic in rural Nepal; an evidence from rapid assessment. PLoS One 2023; 18:e0293514. [PMID: 37910536 PMCID: PMC10619797 DOI: 10.1371/journal.pone.0293514] [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: 07/26/2022] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to surging concerns about food insecurity status throughout the world. In response to global and national concerns on food and nutrition security, this study aimed to examine the prevalence and determining factors of household food insecurity and dietary diversity among people from selected rural municipalities of Lalitpur district, Nepal. METHODS A community-based cross-sectional study was conducted among 432 households. Pretested structured questionnaires were used to collect socio-demographic characteristics of the participants, household income; influence of COVID-19 on their income and livelihood, household's access to food and dietary diversity. Food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS) and the Household Dietary Diversity Score (HDDS). A multivariable analysis was done using binary logistic regression model following a bivariate analysis to assess the association between the dependent and independent variables. RESULTS More than one-third (36%) of the households reported some form of food insecurity. The overall mean score for Household Dietary Diversity Score (HDDS) was 6.0 (±1.1). Multivariable logistic regression analysis showed that participants aged 41-64 years (aOR = 0.35, 95% CI: 0.21-0.59), those over 64 years (aOR = 0.22, 95% CI: 0.07-0.66), as well as those in service occupation (aOR = 0.22, 95% CI: 0.06-0.77) were associated with lower odds of HFIAS. Conversely, Participants belonging to a disadvantaged ethnic group (aOR = 2.73, 95% CI: 1.23-6.07), having no education (aOR = 3.70, 95% CI: 1.16-11.71) or primary education (aOR = 3.67, 95% CI: 1.23-9.89), and those suffering from chronic illness (aOR = 3.12, 95% CI: 1.53-6.35) were associated with higher odds of HFIAS. As for HDDS, participants aged 41-64 years (aOR = 0.48, 95% CI: 0.28-0.83) were associated with lower odds of HDDS, while participants having no education (aOR = 10.05, 95% CI: 4.05-24.01) were associated with significantly higher odds of HDDS. CONCLUSION Owing to the pandemic, our study showed a substantial prevalence of food insecurity among diverse community residing in rural outskirts of Kathmandu Valley, particularly among disadvantaged ethnic group and people with lower level of education. Interventions targeting these particular groups may help in improving HFIAS and HDDS among them during emergencies.
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Affiliation(s)
- Dirghayu K. C.
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Namuna Shrestha
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Rachana Shrestha
- Public Health and Environment Research Center, (PERC), Kathmandu, Nepal
- Knowledge To Action (K2A), Kathmandu, Nepal
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Anil Poudyal
- Public Health Promotion and Development Organization, Kathmandu, Nepal
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Flax VL, Bose S, Escobar-DeMarco J, Frongillo EA. Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive. MATERNAL & CHILD NUTRITION 2023:e13559. [PMID: 37735818 DOI: 10.1111/mcn.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.
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Affiliation(s)
- Valerie L Flax
- RTI International, Research Triangle Park, North Carolina, USA
| | - Sujata Bose
- Alive & Thrive, FHI Solutions, Washington, District of Columbia, USA
| | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, USA
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Bhanot A, Sethi V, Murira Z, Singh KD, Ghosh S, Forissier T. Right message, right medium, right time: powering counseling to improve maternal, infant, and young child nutrition in South Asia. Front Nutr 2023; 10:1205620. [PMID: 37743925 PMCID: PMC10512175 DOI: 10.3389/fnut.2023.1205620] [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: 04/14/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Quality counseling can positively impact maternal, infant and young child nutrition (MIYCN) behaviors linked to poor nutrition outcomes. Global guidance includes 93 recommendations on MIYCN counseling. Methods A desk review and key informant interviews sought to assess compliance to the recommendations, reach and quality, systemic gaps and opportunities for MIYCN counseling in seven South Asian countries. Ninety-three (93) policies and guidelines, 180 counseling materials and over 50 documents were reviewed; 115 key informant interviews were conducted. Information synthesis captured eight domains. Data from national surveys were analyzed to determine MIYCN counseling reach, quality and association with nutrition behaviors. Results Results showed that national guidelines were inconsistent with global recommendations for seven thematic areas. Coverage of contacts points like antenatal and postnatal care (ANC, PNC) with potential to deliver MIYCN counseling was highly variable. Having at least four ANC contacts was significantly associated with consumption of 100+ iron folic acid tablets in all countries. Rates of early initiation of breastfeeding (18% Pakistan to 90% Sri Lanka) were lower than institutional delivery rates, except for Bangladesh and Sri Lanka. PNC contact within 48 h of birth was positively correlated with exclusive breastfeeding in India, Pakistan and Sri Lanka (OR 1.4, 3.1, 3.2). Health worker contacts and wealth status equally influenced child's dietary diversity in India. MIYCN services were add-on roles for community-based workers, except in India. Supervision mechanisms exist but were not focused on quality of MIYCN services. Counseling resources were predominantly paper based (>70%), had rural-focused messaging on diets and mainly targeted women. Platforms to engage men were largely missing. Health management information systems included indicators on maternal contact points in all countries but not for children. Assessing funding for MIYCN counseling was challenging as costs were subsumed across several budget line-items. Discussion The research findings can be used to (1) align country guidance with global recommendations, (2) review workforce responsibilities and capacity building with supervision, (3) assess the need for new counseling materials based on coverage of content, service providers and audience, (4) integrate MIYCN counseling indicators in information systems and (5) include MIYCN counseling services with activities and budget in country plans.
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Affiliation(s)
- Arti Bhanot
- Alive & Thrive, FHI360/FHI Solutions, New Delhi, India
| | - Vani Sethi
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Zivai Murira
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | | | - Sebanti Ghosh
- Alive & Thrive, FHI360/FHI Solutions, New Delhi, India
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de Oliveira TI, dos Santos L, Höfelmann DA. Dietary patterns and socioeconomic, demographic, and health-related behaviors during pregnancy. A cross-sectional study. SAO PAULO MED J 2023; 142:e2022629. [PMID: 37646767 PMCID: PMC10452006 DOI: 10.1590/1516-3180.2022.0629.r1.190523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The identification and understanding of dietary factors and other characteristics that influence gestational weight gain can contribute to the formulation of strategies to promote healthy eating habits before and during pregnancy. OBJECTIVE To investigate the association between dietary patterns, sociodemographic and obstetric characteristics, and health-related behaviors in pregnant women. DESIGN AND SETTING A cross-sectional study was conducted on women undergoing prenatal care in the Unified Health System of Colombo, Paraná, Brazil, from February 2018 to September 2019. METHOD A weekly food frequency questionnaire was administered, and dietary patterns were identified through factor analysis. Median regression models were constructed to identify the associations between dietary pattern scores and variables. RESULTS Complete data were obtained from 495 pregnant women. Three dietary patterns were identified: 1) "healthy," with higher factor loadings for the weekly consumption of raw vegetables, cooked vegetables, and fresh fruits; 2) "Western," including soft drinks or artificial juice, candies, milk, and dairy products, and processed cold meat; and 3) "traditional," beans and meat. Pregnant women aged 30 years or older (coefficient [Coef.] 0.86, 95% confidence interval [CI] 0.38-1.33) with moderate/intense physical activity (Coef. 0.32, 95% CI 0.02-0.62) had higher adherence to the "healthy" pattern. Adolescents and smokers adhered more to the "traditional" pattern (Coef. 0.17, 95% CI 0.01-0.33). CONCLUSION Age, smoking status, and physical activity were associated with dietary patterns in pregnant women.
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Affiliation(s)
- Tatiane Irene de Oliveira
- MSc. Nutritionist, Department of Nutrition, Postgraduate Program in Food and Nutrition (PPGAN), Universidade Federal do Paraná (UFPR), Curitiba (PR), Brazil
| | - Lais dos Santos
- Nutricionist, Masters’ Student, Postgraduate Program in Collective Health, Departament of Public Health, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Doroteia Aparecida Höfelmann
- MSc, PhD. Nutritionist and Associate Professor, Department of Nutrition, Postgraduate Program in Food and Nutrition (PPGAN), Universidade Federal do Paraná (UFPR), Curitiba (PR), Brazil
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Haque S, Salman M, Rahman MS, Rahim ATM, Hoque MN. Mothers' dietary diversity and associated factors in megacity Dhaka, Bangladesh. Heliyon 2023; 9:e19117. [PMID: 37636472 PMCID: PMC10450986 DOI: 10.1016/j.heliyon.2023.e19117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Mothers in developing countries are nutritionally vulnerable due to an undiversified diet. Dietary diversity and healthy dietary patterns of mothers are necessary for the health and nutrition of both the mother and the child. Keeping these in mind, the study was designed to investigate the determinants of mothers' dietary diversity in the capital city (Dhaka) of Bangladesh. A total 613 mothers who had at least one child aged 6-59 months were surveyed in 2020. Dietary diversity (DD) was measured by 24 h recall period following the established guidelines. To explore the determinants of dietary diversity, a log linear regression model was employed. The findings revealed that the overall DD of mothers was low, with less than 15% of respondents consuming more than 5 of the 9 food groups. The study found that if a mother receives one more year of formal education, her DD, on average, would increase by 0.70%. Receiving antenatal care (ANC) for four or more times during pregnancy increases DD by 5.13% compared to mothers who receive ANC less than four times. The findings also showed that mothers with access to assets have 10.18% higher DD than mothers without access to assets. On the other hand, mothers' employment status was negatively associated with DD. Redistributing the household workload between mother and other household members can play a critical role in increasing mothers' DD. Providing care facilities and counseling to mothers about the nutritional value of consuming different food groups can substantially improve the situation.
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Affiliation(s)
- Sadika Haque
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Salman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Sadique Rahman
- Department of Management and Finance, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
| | | | - Md Nazmul Hoque
- Students' Affairs Division, Bangladesh Agricultural University, Mymensingh, Bangladesh
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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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Shourove JH, Meem FC, Rahman M, Islam GMR. Is women's household decision-making autonomy associated with their higher dietary diversity in Bangladesh? Evidence from nationally representative survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001617. [PMID: 37467185 DOI: 10.1371/journal.pgph.0001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
In Bangladesh, a low-quality repetitive diet characterized by starchy staple foods is typical, leading to disorders associated with micronutrient deficiencies, particularly among mothers and their children. The purpose of the study was to validate the link between women's decision-making autonomy and higher dietary diversity score. Participants were ever married women aged 15-49 years old with comprehensive dietary information (n = 17,842), selected from the Bangladesh Demographic and Health Survey, 2014. The dietary diversity score (DDS) was obtained from a 24-h recall of dietary intake from nine food groups, categorized into lower DDS (DDS ≤ 4) and higher DDS (DDS ≥ 5). Descriptive analysis, bivariate and multivariate logistic regression were conducted using STATA version 15. Almost all women consumed starchy foods, flesh (83.86%), and fruits (67.30%). Using logistic regression, the odds of achieving dietary diversity score were higher among women who participated in household purchases (OR 2.40; 95% CI: 1.52-3.83; p = 0.022). Women who had higher and secondary education were 2.72 (95% CI: 1.49-3.02; p = 0.025) and 1.31 (95% CI: 0.58-2.18; p = 0.029) times more likely to achieve higher DDS than women having no education, as well as women in the richest quintile (OR 6.49; 95% CI: 4.12-8.5; p = 0.037) compared to women in the lowest quintile. This study highlighted the association of several socioeconomic conditions of ever married women and their dietary diversity score in Bangladesh. Therefore, promoting the women's education status, improving the socioeconomic conditions, and prioritizing their decisions are recommended for the attainment of higher dietary diversity score.
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Affiliation(s)
- Jahid Hasan Shourove
- Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Fariha Chowdhury Meem
- Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Mustafizur Rahman
- Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - G M Rabiul Islam
- Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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Agustina R, Rianda D, Lasepa W, Birahmatika FS, Stajic V, Mufida R. Nutrient intakes of pregnant and lactating women in Indonesia and Malaysia: Systematic review and meta-analysis. Front Nutr 2023; 10:1030343. [PMID: 37063336 PMCID: PMC10098007 DOI: 10.3389/fnut.2023.1030343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/02/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionOptimizing dietary intake during pregnancy and lactation is crucial to the growth and development of children and their lifelong health. We performed a systematic review and meta-analysis to describe the nutrient intakes of pregnant and lactating women in Indonesia and Malaysia, countries that are experiencing rapid nutrition transition in Southeast Asia.MethodsWe screened 2,258 studies published between January 1980 and March 2021. The nutrient intakes of pregnant and lactating women were quantitatively analyzed to calculate the percentage of adequacy using national recommended daily allowances or nutrient intakes (RDA/RNI) and estimated average requirements (EAR) for micronutrients. Standardized mean differences (SMD) between dietary intake and RDA/RNI were determined for selected nutrients.ResultsFifty-three studies were included and showed that energy and macronutrient intakes among pregnant and lactating women in both countries were below the RDA/RNI. In addition, most studies reported that women failed to meet the EAR for vitamin D (<70% EAR), vitamin E (<50% EAR), and water-soluble vitamins (<80% EAR) except for vitamin C and A among Malaysians. Moreover, calcium, potassium, and iron intakes of pregnant women were <60% EAR in Indonesia and <80% EAR in Malaysia. Phosphorus intake among pregnant women in both countries and sodium intake among Malaysian pregnant women exceeded 100% EAR. Indonesian lactating women had <60% EAR for calcium and potassium intakes, while Malaysian women had more than 100% EAR. For 21 studies reporting overall protein intakes, the standard mean difference (SMD) was −2.26 (95% CI; −2.98, −1.54) below the RDA/RNI for pregnant women and −0.67 SMD (95% CI −15.7, −11.5) for lactating women. When the four studies from Malaysia were analyzed separately, protein intakes of pregnant women were above the RNI. Moreover, low intakes of vitamin D, vitamin C, calcium, and iron, but sufficient intakes in vitamin A, zinc, and phosphorus were observed in pregnant women in both countries.ConclusionDietary intakes of energy, macronutrients, and micronutrients (vitamin D, vitamin E, water-soluble vitamins, calcium, and iron) of pregnant and lactating women in Indonesia and Malaysia were below the recommendations. Important heterogeneities were observed even between these two countries for specific essential nutrient intakes. Innovative research and targeted programs to address specific deficiencies should be prioritized.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021252204, identifier: CRD42021252204.
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Affiliation(s)
- Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- *Correspondence: Rina Agustina ;
| | - Davrina Rianda
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Wanda Lasepa
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fitya S. Birahmatika
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vladimir Stajic
- Blackmores Institute, Blackmores Limited, Sydney, NSW, Australia
| | - Rachmi Mufida
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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The assessment of dietary diversity score and associated factors among pregnant women of Batu district, Southern Ethiopia, 2021: a community-based cross-sectional study. Ann Med Surg (Lond) 2023; 85:383-389. [PMID: 36923764 PMCID: PMC10010828 DOI: 10.1097/ms9.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/02/2023] [Indexed: 03/18/2023] Open
Abstract
Malnutrition remains a global problem, particularly in sub-Saharan Africa, where Ethiopia is located. During pregnancy, inadequate nutritional diversification increases the risk of unfavorable maternal and fetal outcomes. Therefore, the aim of this study was to assess the dietary diversity score and associated factors among pregnant women in Batu district, Southern Ethiopia, in 2021. Methods A community-based cross-sectional study was conducted among randomly selected 594 pregnant women. Data were collected with a two-stage sampling technique through face-to-face interviews. The data were coded and entered into Statistical Package for the Social Sciences (SPSS) version 23. Bivariate and multivariable logistic regression analyses were applied to identify independent predictors of dietary diversity. Results The magnitude of the unmet minimum dietary diversity score among pregnant women was 356 (59.9%). Furthermore, pregnant women with no formal education [adjusted odds ratio (AOR)=3.46; 95% CI: 1.99, 5.66], poor by the wealth index (AOR=2.23, 95% CI: 1.33, 3.73), having five or more children (AOR=1.75, 95% CI: 1.14, 2.71), multigravida (AOR=2.18, 95% CI: 1.34, 3.56), and pregnant women from only male-headed households (AOR=4.46, 95% CI: 2.86, 6.94) were associated with an unmet minimum dietary diversity score among pregnant women. Conclusion The prevalence of unmet minimum dietary diversity scores among pregnant women was found to be high. Moreover, low dietary diversity was linked to pregnant women with no formal education, multigravida, having more than five family members, male-headed households, and being poor by household wealth. As a result, nutritional diversity education should be prioritized, and health experts should provide guidance on dietary diversity and family planning services.
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Sunuwar DR, Bhatta A, Rai A, Chaudhary NK, Tamang MK, Nayaju S, Singh DR. The factors influencing inappropriate child feeding practices among families receiving nutrition allowance in the Himalayan region of Nepal. BMC Nutr 2023; 9:33. [PMID: 36803665 PMCID: PMC9940375 DOI: 10.1186/s40795-023-00691-3] [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: 08/30/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Child feeding practices during the first two years of life are crucial to ensure good health and nutrition status. This study aimed to assess the factors influencing inappropriate child feeding practices in children aged 6 - 23 months in families receiving nutrition allowance in the remote Mugu district, Nepal. METHODS A community-based cross-sectional study was conducted among 318 mothers who had children aged 6 - 23 months of age in the seven randomly selected wards. Systematic random sampling technique was used to select the desired number of respondents. Data were collected using pre-tested semi-structured questionnaire. Bivariate and multivariable binary logistic regression was used to estimate crude odds ratio (cOR), and adjusted odds ratio (aOR), and 95% confidence intervals (CIs) to understand factor associated with child feeding practices. RESULTS Almost half of the children aged 6 - 23 months were not consuming a diverse diet (47.2%; 95% CI: 41.7%, 52.7%), did not meet the recommended minimum meal frequency (46.9%; 95% CI: 41.4%, 52.4%) and did not consume minimum acceptable diet (51.7%; 95% CI: 46.1%, 57.1%). Only 27.4% (95% CI: 22.7%, 32.5%) of children met the recommended complementary feeding practices. Multivariable analysis showed maternal characteristics such as mothers who gave birth at home (aOR = 4.70; 95% CI: 1.03, 21.31) and mothers in unpaid employment (aOR = 2.56; 95% CI: 1.06, 6.19) were associated with increased odds of inappropriate child feeding practices. Household economy (i.e. family with < 150 USD monthly income) was also associated with increased odds of inappropriate child feeding practices (aOR = 1.19; 95% CI: 1.05, 2.42). CONCLUSION Despite the receipt of nutritional allowances, child feeding practices among 6 - 23 months children were not optimal. Additional context-specific behavior change strategies on child nutrition targeting mothers may be required.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal. .,Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal.
| | - Anuradha Bhatta
- grid.444739.90000 0000 9021 3093Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Anjana Rai
- grid.1024.70000000089150953School of Public Health and Social Work, Queensland University of Technology, Brisbane City, Australia
| | | | - Man Kumar Tamang
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Suvash Nayaju
- grid.444739.90000 0000 9021 3093Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Devendra Raj Singh
- grid.15751.370000 0001 0719 6059School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK ,Research Section, Swadesh Development Foundation, Siraha, Nepal
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Mesfin BA, Argaw AT, Getahun Negash F, Emiru DA, Aserese AD, Matebe GY. Minimum Dietary Diversity and Associated Factors Among Pregnant Women Living in Arba Minch Health and Demographic Surveillance Sites, Southern Ethiopia, 2022. Health Serv Res Manag Epidemiol 2023; 10:23333928231166671. [PMID: 37122558 PMCID: PMC10134103 DOI: 10.1177/23333928231166671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Background Worldwide 1.2 billion women suffer from micronutrient deficiency. Feeding diversified foods during pregnancy prevents pregnancy complications such as severe anemia, low birth weight, and birth defects. However, the status of minimum dietary diversity and associated factors among pregnant women were not explored in the study area; therefore, this study was conducted at the Arba Minch Health and Demographic Surveillance Sites (AMHDSS). Method A community-based cross-sectional study was conducted from December 19, 2021, to October 30, 2022, on randomly selected 635 pregnant women. The data were collected through face-to-face interviews, and measurements of mid-upper arm circumference using a tablet; then exported to Statistical Package for Social Sciences version 25. Descriptive statistics were used to describe the characteristics of the study participants and presented by text, figures, and tables. Binary logistic regression was used to determine factors associated with pregnant women MDD-W. Independent variables with a P-value < .05 were considered as associated factors. Findings 98.2% of the pregnant women responded to this survey, more than half, (53.3%) of them achieved MDD-W, and 24.2% of the pregnant women were undernourished. The MDD-W was associated with household food security (AOR = 0.55, CI: .36, .83), meal frequency, (AOR = 1.62, CI: 1.1, 2.5), house ownership (AOR = 0.52, CI: .29, .9), ownership of banana farms (AOR = 1.7, CI: 1.02, 2.8), antenatal follow-up (ANC) (AOR = 1.9, CI: 1.1, 3.3), and occupational status (AOR = 6, CI: 2.1, 17.6). Conclusion The MDD-W outcome in this study was higher than that in other studies. The MDD-W is associated with, ANC follow-up, meal frequency, living in a food-secured household, ownership of a house, and pregnant women's merchant occupation. For optimal pregnancy outcomes; the AMHDSS and stakeholders might need to work in collaboration to increase ANC coverage and meal frequency for pregnant women. In addition, micronutrient supplementation, and increasing the availability/production capacity of food-insecure households are expected.
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Affiliation(s)
- Bezawit Afework Mesfin
- Department of Midwifery, Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
- Bezawit Afework Mesfin, Department of Midwifery, Arba Minch University College of Medicine and Health Sciences, Arba Minch, P.O. Box 21, Ethiopia.
| | - Abinet Teshome Argaw
- Department of Biomedical Sciences, Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
| | - Firdawek Getahun Negash
- Department of Epidemiology, Arba Minch University College of Medicine and Health Sciences School of Public Health, Arba Minch, Ethiopia
| | - Dagninet Alelign Emiru
- Department of Medical Laboratory Science, Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
| | - Adisalem Damtei Aserese
- School of Public Health Department of Human Nutrition, Arba Minch University College of Medicine and Health Sciences School of Public Health, Arba Minch, Ethiopia
| | - Girum Yihun Matebe
- Department of Health Economics, Addis Ababa University College of Health Sciences, School of Public Health, Arba Minch, Ethiopia
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Shaun MMA, Nizum MWR, Shuvo MA, Fayeza F, Faruk MO, Alam MF, Hawlader MDH, Mali SK. Determinants of minimum dietary diversity of lactating mothers in rural northern region of Bangladesh: A community-based cross-sectional study. Heliyon 2022; 9:e12776. [PMID: 36632115 PMCID: PMC9826838 DOI: 10.1016/j.heliyon.2022.e12776] [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: 03/08/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Breastfeeding requires additional diversified foods for the nutritional requirements of mothers and children, especially in preventing micronutrient deficiencies. The minimum dietary diversity for women (MDD-W) is a proxy indicator of micronutrient adequacy for women. Objectives This study aimed to identify the determinants associated with MDD in lactating women. Methods A community-based cross-sectional study was conducted among lactating mothers having at least one live birth in last three years from two districts of Bangladesh between 31st May 2021 and 9th June 2021. Dietary and socio-demographic information was obtained using a single 24-h recall and socio-economic status questionnaires. MDD was defined as at least four food groups consumed in the last 24 hours. In binary logistic regression, adjusted models were used to assess the relationship between MDD and socio-economic factors. Results The mean Dietary Diversity Score (DDS) was 3.9 ± 1.2. The MDD was met by 29.7% of women. Respondent's ages 20-24 years [Adjusted Odds Ratio (AOR) = 0.5; 95% CI: 0.3-0.9], 25-34 years [AOR = 0.5; 95% CI: 0.3-0.8], and 35-49 years [AOR = 0.5; 95% CI: 0.2-0.9], husband's academic qualifications more than 12 years [AOR = 1.9; 95% CI: 1.0-3.7], family income more than 15000 BDT per month [AOR = 2.3; 95% CI: 1.2-4.3], and husband's profession as a day labor [AOR = 0.5; 95% CI: 0.3-0.7] were significant factors to have MDD. Conclusions DDS and MDD were very poor among the mothers, whereas women's age, husband's education, and the family's monthly income were independent determinants of MDD. Special interventions may be needed to improve MDD.
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Affiliation(s)
- Md Mahbubul Alam Shaun
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
- Corresponding author.
| | - Md Wahidur Rahman Nizum
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229, Bangladesh
| | - Md Asaduzzaman Shuvo
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229, Bangladesh
| | - Fahmida Fayeza
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
| | - Md Omar Faruk
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
| | - Md Fakrul Alam
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
| | | | - Sujan Kanti Mali
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
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Sah SK, Sunuwar DR, Baral JR, Singh DR, Chaudhary NK, Gurung G. Maternal hemoglobin and risk of low birth weight: A hospital-based cross-sectional study in Nepal. Heliyon 2022; 8:e12174. [PMID: 36578405 PMCID: PMC9791333 DOI: 10.1016/j.heliyon.2022.e12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Background Maternal hemoglobin during pregnancy is an important predictor of neonatal outcomes such as birth weight. The newborn weight of an infant is considered a crucial factor for morbidity and mortality. This study aimed to assess the association between maternal hemoglobin concentration and newborn weight at term pregnancy. Methods A hospital-based cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 14th April 2018 to 13th April 2019. Term singleton pregnant women who were admitted for delivery in the labor room of TUTH were included in this study. Maternal characteristics such as age, parity, birth space, ethnicity, education level, dietary habit, body mass index (BMI), and hemoglobin level were recorded. The newborn weight was taken immediately after delivery. The main outcome of this study was the birth weight. The association between hemoglobin level and newborn weight was analyzed using bivariate and multivariable logistic regression analysis. Results Of 2,418 term pregnant women, the prevalence of low hemoglobin and high hemoglobin levels were 24% (95% CI: 22-25.4), and 17% (95% CI: 15.7-18.7), respectively. The prevalence of low birth weight (LBW) was 12.9% (95% CI: 11.7-14.4). Multivariable logistic regression analysis showed that those mothers who had low hemoglobin concentration (adjusted Odds Ratio/aOR = 3.77, 95% CI: 2.84-5.01), and high hemoglobin concentration (aOR = 3.07, 95% CI: 2.23-4.24) had higher odds of having LBW compared to mothers having normal hemoglobin level. Mothers with both young age pregnancy (aged 16-20 years) and older pregnancy (aged ≥31 years) (aOR = 1.60, 95% CI: 1.01-2.52) and (aOR = 1.60, 95% CI: 1.06-2.41), respectively had higher odds of LBW compared to mothers aged 21-25 years. Those mothers who attended a primary level of education had higher odds of (aOR = 1.93, 95% CI: 1.05-3.55) LBW compared to those mothers with a higher level of education. Moreover, mothers who belonged to Janajati ethnic group (aOR = 0.47, 95% CI: 0.34-0.65) compared to the Brahmin/Chhetri ethnic group, and mothers with a birth space of more than three years (aOR = 0.63, 95% CI: 0.41-0.97) compared to those who had less than three years of birth spacing and mothers who were overweight/obese (aOR = 0.74, 95% CI: 0.55-0.99) compared to normal nutritional status had lower odds of having LBW. Conclusions Our study concludes that both low and high hemoglobin had an increased risk of having low birth weight. Policies and programs can benefit by adopting the findings of this study. More empirical research is critical to understanding the impact of hemoglobin levels on birth weight.
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Affiliation(s)
- Sandeep Kumar Sah
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal,Corresponding author.
| | - Josie R. Baral
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | | | - Geeta Gurung
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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Zhong W, Zhao A, Lan H, Mao S, Li P, Jiang H, Wang P, Szeto IMY, Zhang Y. Dietary Diversity, Micronutrient Adequacy and Bone Status during Pregnancy: A Study in Urban China from 2019 to 2020. Nutrients 2022; 14:4690. [PMID: 36364952 PMCID: PMC9656709 DOI: 10.3390/nu14214690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Diet quality during reproduction is crucial to maternal and infant health. However, the association between dietary diversity and bone health of pregnant women remains unclear. We aimed to evaluate the dietary quality of Chinese urban gravidas using the dietary diversity score (DDS), and to explore the relationship of the DDS with micronutrient adequacy and bone health. In this cross-sectional study, we analyzed data from 775 pregnant women aged 18 years or older in urban China. Dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD-W) indicator. A 24-h dietary recall was used to collect diet data and to calculate the MDD-W and the nutrient intake. Bone health was measured using quantitative ultrasound and assessed by the speed of sound (SOS). Pearson's correlation coefficients between the DDS and the nutrient adequacy ratio (NAR) were calculated. A multivariable linear regression model was used to estimate the effect size of the DDS on the SOS. The mean DDS was 6.61 ± 1.53 points and 91.0% of participants reported the consumption of five or more food groups. Women in the diverse diet subgroup (DDS ≥ 7 points) were more likely to consume all kinds of food except starchy staples and had higher NARs. Pearson's correlation coefficients between the DDS and the NAR ranged from 0.161 to 0.484. For participants in the second trimester, those with a diverse diet had a higher SOS. A multivariable linear regression analysis showed that the DDS was positively and significantly associated with the SOS (β = 17.18, 95% CI = 5.97-28.39, p = 0.003), but this was not the case for women in the first and third trimesters. Urban Chinese women had good dietary diversity during pregnancy. A higher dietary diversity was associated with a higher NAR. From the point of view of bone, a diverse diet was positively correlated with better bone status, suggesting the importance of improving diet diversity for pregnant women, especially from mid-pregnancy.
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Affiliation(s)
- Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Hua Jiang
- School of Nursing, Peking University Health Science Center, Beijing 100191, China
| | - Peiyu Wang
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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Diamond‐Smith N, Puri M, Neuhaus J, Weiser S, Kadiyala S. Do changes in women's household status in Nepal improve access to food and nutrition? MATERNAL & CHILD NUTRITION 2022; 18:e13374. [PMID: 35615780 PMCID: PMC9218303 DOI: 10.1111/mcn.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Women's nutritional status remains poor in South Asia, impacting maternal and infant health outcomes. Women's household status is also low, as evidenced by eating behaviours. We started with triadic qualitative interviews with newly married women, husbands and mothers-in-law to explore the link between women's status and eating patterns, followed by longitudinal data from a cohort of 200 newly married women in rural Nepal to measure associations over time. Quantitative data were collected every 6 months for 18 months (four rounds of data) between 2018 and 2020. Interviews suggested that household relationships, women's status, and how much and what types of food she was given were intricately linked. Using mixed effects logistic regression models, we explore the association between markers of changing women's status (becoming pregnant, giving birth and working outside the home) on two outcomes (eating last always/usually and achieving minimum dietary diversity). We also explore for interaction between women's status and household food insecurity. Pregnancy increases women's dietary diversity, but this is not sustained post-partum. Women who work outside the home are less likely to eat last in the household. Food insecurity is associated with both the order of household eating and dietary diversity. Interactions between food insecurity and giving birth suggested that women who give birth in food insecure households are more likely to eat last in the household. Changes in women's household status are associated with some improvements in dietary diversity and order of household eating, but the associations are not long-lasting and depend on food security status.
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Affiliation(s)
- Nadia Diamond‐Smith
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mahesh Puri
- Center for Research on Environment, Health and Population ActivitiesKathmanduNepal
| | - John Neuhaus
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sheri Weiser
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Determinants of Dietary Diversity Practice among Pregnant Women in the Gurage Zone, Southern Ethiopia, 2021: Community-Based Cross-Sectional Study. Obstet Gynecol Int 2022; 2022:8086793. [PMID: 35586393 PMCID: PMC9110235 DOI: 10.1155/2022/8086793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background Dietary diversification is considered the proxy indicator of dietary quality and nutrient adequacy during pregnancy. Pregnant women have been considered susceptible to malnutrition because of their increased nutrient demands and thus consuming a variety of foods in their diet plays a lion's role in ensuring adequate nutrient intake. So understanding bottleneck factors associated with dietary diversity practice is very crucial to encouraging adequate dietary diversity practice. Therefore, this paper aimed to assess determinants of dietary diversity practice among pregnant women in the Gurage zone, Southwest Ethiopia. Methods A community-based cross-sectional analytical study was conducted among 726 pregnant women, 13 key informants, and 27 focus group discussion discussants in the Gurage zone, southwest Ethiopia, from 1 September to 1 November 2021. A face-to-face interviewer-administered questionnaire was used to collect the data. According to the Minimum Dietary Diversity Score for Women (MDD-W) tool, women who consumed more than or equal to 5 of 10 food groups in the previous 24 hours had a diverse diet. Epi data version 3.1 was used for data entry, while SPSSversion 26 was used for analysis. To determine factors associated with dietary diversity, bivariate and multivariable logistic regression models were used to obtain crude odds ratio (COR), adjusted odds ratios (AOR), and 95 percent confidence intervals (CIs). Statistical significance was determined using adjusted odds ratios (AORs) with 95 percent confidence intervals (CIs) and p values less than 0.05. In narrative form, qualitative results were triangulated with quantitative data. Results The overall prevalence of the adequate dietary diversity practice was found to be 42.1% with 95% CI (48.4–46.1%) and the mean dietary diversity score was 5.30 ± 1.49 standard deviation (SD). Multivariable analysis revealed that primary school level [AOR = 6.471 (2.905, 12.415)], secondary school level (9–12) [AOR = 7.169 (4.001, 12.846)], college and above level [AOR = 32.27 (15.044, 69.221)], women with higher empowerment [AOR = 3.497 (2.301, 5.315)], women with a favorable attitude toward dietary diversity [AOR = 1.665 (1.095, 2.529)], women from wealthier households [AOR = 2.025 (1.252, 3.278)], and having well-secured food status [AOR = 3.216 (1.003, 10.308)] were variables that influence dietary diversity practice. Three FGD and 13 key informant interviews were conducted, and the results of qualitative data generated three major themes. Conclusion The overall prevalence of adequate dietary diversity practice was found to be low in this study when compared to studies conducted in Ethiopia. Maternal educations, mothers' attitudes toward dietary diversity, women empowerment, food security status, and wealth index level of the household were determinant factors that influence dietary diversity practice in this study. Therefore, programs aimed to improve pregnant women's dietary diversity practice should focus on improving the socioeconomic status and creating a congenial environment to promote women's empowerment.
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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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Fite MB, Tura AK, Yadeta TA, Oljira L, Roba KT. Prevalence and determinants of dietary practices among pregnant women in eastern Ethiopia. BMC Nutr 2022; 8:3. [PMID: 35012664 PMCID: PMC8751267 DOI: 10.1186/s40795-021-00494-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Appropriate dietary practices in pregnancy are critical to meet the increased metabolic and physiological demands; however, information about dietary practices among pregnant women, particularly rural residents, is limited. The study aimed to assess the level of appropriate dietary practices and associated determinants among pregnant women in Haramaya District, eastern Ethiopia, 2021. Methods A community-based cross-sectional study was conducted among 448 pregnant women in Haramaya District, Eastern Ethiopia. Data was collected through face-to-face interviews by trained research assistants, using a validated frequency questionnaire. The pregnant women were labeled as “appropriate dietary practice” when they consumed at least four meals daily, had a good food variety score, high dietary diversity score, and high consumption of animal source foods during the reference period. Otherwise, they were defined as “inappropriate.” A Poisson regression model with robust variance estimation was used to investigate the association of the independent variables with the dietary practice. An adjusted prevalence ratio with a 95% confidence interval was reported to show an association using a p-value < 0.05. Results The appropriate dietary practice among the study participants was 15.2% (95% CI = 12–18%). Of the respondents, 29.46, 37.5, and 24.7% had a high dietary diversity, high food variety score, and high consumption of animal source foods. The appropriate dietary practice was more prevalent among merchant women (APR = 2.07; 95% CI 1.07–4.02) and those whose husbands have at least a high school educational level (APR = 1.96; 95% CI 1.06–3.46). However, the prevalence of appropriate dietary practice was significantly lower among those who chewed khat (APR = 0.58; 95% CI 0.37–0.90) and among respondents who reported restriction of the intake of some foods (APR = 0.36; 95% CI 0.20–0.65). Conclusion We found sup-optimal appropriate dietary practice among pregnant women in this predominantly rural setting. Additionally, the lower appropriate dietary practice was observed among women who reported chewing khat and experienced restriction of dietary consumption during pregnancy. Therefore, nutrition policy programs and interventions aimed at encouraging maternal nutritional guidance and counseling are recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00494-4.
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Affiliation(s)
- Meseret Belete Fite
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mulatu S, Dinku H, Yenew C. Dietary diversity (DD) and associated factors among Lactating women (LW) in Pawie district, Northwest, Ethiopia, 2019: community-based cross-sectional study. Heliyon 2021; 7:e08495. [PMID: 34917799 PMCID: PMC8645438 DOI: 10.1016/j.heliyon.2021.e08495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/30/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Low Dietary Diversity (DD) result in severe problem among the vulnerable group in low-income countries (LICs), whose diets are predominantly starchy staples. Lactating Women (LW) from LICs are considered a nutritionally vulnerable group. It results in many consequences on the health and well-being of children, households, communities, and the nation. However, there is little empirical evidence on factors contributing to low DD among LW in Ethiopia and the proposed study site. Therefore, this study aimed at assessing the DD and associated factors among LW in Pawie district, Northwest Ethiopia. Methods A Community-based cross-sectional study was conducted among 806 LW from March to May 2019 G.C. DD assessed using 24 h dietary recall methods with structured questionnaires. A mean dietary diversity score (DDS) was computed for ten food groups. Food insecurity measured using a 9-item Household Food Insecurity Access Scale (HFIAS). The multivariable logistic regression model was used to see the relevant associations. The variables which have a significant association with DD were identified based on AOR, P-value ≤ 0.05, and 95% Cl. Results A total of 806 LW aged 15–49 years were interviewed with a response rate of 100%. About two-third of LW had low DD (<5 food groups). Fathers occupation being daily laborer [AOR = 1.82, 95% CI (.339, 9.784)], birth interval less than 24 months [AOR = 3.7, 95 % CI (1.743, 7.885)], family size greater than six members [AOR = 1.55, 95 % CI (1.046, 2.313)] and food insecurity [AOR = 2.23, 95 % CI (1.626, 3.066)] were more likely associated with the low DD among LW compared to their counterpart. Conclusion The DD among LW was low. Low Dietary Diversity was statistically associated with low birth intervals, large family sizes, and food insecurity. Hence, attention should be paid to the identified factors of low DD of LW to improve their health, and that of their children as well as their family.
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Affiliation(s)
- Sileshi Mulatu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habtamu Dinku
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Yenew
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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