Animal Source Food Consumption in Young Children from Four Regions of Ethiopia: Association with Religion, Livelihood, and Participation in the Productive Safety Net Program

Low awareness and affordability are major drivers of low consumption of animal-source foods among children in Northern Ethiopia: A mixed-methods study

Animal-source foods (ASFs), contain high amounts of essential nutrients that are readily absorbed by the body. However, children in resource-constrained settings often have limited access to these nutritious foods. This study aimed to investigate the reasons for the low consumption of ASFs among children in the Amhara region of Ethiopia. A community-based mixed-methods study was conducted, using exploratory qualitative methods supplemented by the analysis of secondary data from the Ethiopian Demographic and Health Survey (EDHS). The qualitative study employed a multiphase stepwise design and the maximum variation purposive sampling technique, enroling a diverse range of participants such as mothers and/or caregivers, household heads, religious and community leaders, health and nutrition experts, and others. The qualitative data were analysed using a thematic framework analysis method, while the quantitative data were analysed using SPSS v22 statistical software. Multivariable logistic regression analysis was performed to identify the predictors of ASFs among children under 5 years of age in the region. Despite the large and diverse livestock populations available, only 13.2% of children consumed at least one animal-source food (ASF) in the prior day. The most consumed ASFs were dairy and eggs, whereas beef, organ meat, and seafood were the least consumed. Household demographics such as residence, literacy level, paternal age, and household wealth quintiles influenced the overall consumption of ASFs. The main reasons for the low consumption of ASFs among children were unaffordability and poor awareness among caregivers. In addition, religious misconceptions, price hikes, limited availability during certain seasons, low productivity, insufficient support from health professionals, and time constraints for caregivers were also mentioned as significant barriers to ASF consumption in the area. The consumption of ASFs among children in Ethiopia, particularly in the Amhara region, remains very low. This is mainly due to the caregivers' levels of awareness and unaffordability of ASFs. It is recommended that behavioural and sociocultural interventions be implemented that target caregivers to improve the consumption of ASFs among children.

Animal source food consumption and its determinants among children aged 6 to 23 months in sub-Saharan African countries: a multilevel analysis of demographic and health survey

INTRODUCTION

Child undernutrition is a major public health problem in sub-Saharan Africa. Children who eat animal-based foods have higher intakes of various nutrients that are important for optimal linear growth. However, the prevalence of animal-source food consumption was low across many countries. Therefore, this study aimed to determine the prevalence of good consumption of animal-source foods and its determinants among children aged 6 to 23 months in sub-Saharan African countries.

METHODS

A cross-sectional pooled dataset using recent demographic and health surveys from 19 sub-Saharan African countries was employed. A total weighted sample of 65,742 children aged 6 to 23 months was included in the study. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Descriptive analysis was carried out to present both individual and community-level variables using frequencies and percentages. A multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Finally, variables with a p-value less than 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

RESULTS

In this study, 43.1% (95% CI: 42.7-43.5%) of children aged 6 to 23 months consumed animal-source foods. Factors like maternal education [AOR = 1.36; 95% CI (1.28, 1.44)], maternal occupation [AOR = 1.24; 95% CI (1.18, 1.31)], exposure to media [AOR = 1.30; 95% CI (1.24, 1.36)], wealth index [AOR = 1.16; 95% CI (1.10, 1.23)] & [AOR = 1.28; 95% CI (1.21, 1.36)], owned a mobile telephone [AOR = 1.23; 95% CI (1.17, 1.29)], ANC visits [AOR = 1.20; 95% CI (1.15, 1.25)], place of delivery [AOR = 1.09; 95% CI (1.04, 1.14)], PNC checkup [AOR = 1.34; 95% CI (1.28, 1.39)], the current age of the child [AOR = 1.99; 95% CI (1.85, 2.14)], [AOR = 3.34; 95% CI (3.14, 3.56)], & [AOR = 4.3; 95% CI (4.10, 4.66)], birth interval [AOR = 0.92; 95% CI (0.87, 0.97)], residence [AOR = 1.43; 95% CI (1.35, 1.50)], community illiteracy [AOR = 0.91; 95% CI (0.86, 0.96)], and community poverty [AOR = 1.07; 95% CI (1.01, 1.14)] were significantly associated with consumption of animal-source foods.

CONCLUSION

Less than half of children aged 6 to 23 months consumed any type of animal-source foods in sub-Saharan African countries. Higher educational level, non-agricultural work, exposure to media, high economic status, having a mobile telephone, attending 4 + ANC visits, health facility delivery, PNC checkups, older children, a birth interval of 24 months, urban residency, community literacy, and low community poverty were determinates of good consumption of animal source foods. Women empowerment, dissemination of nutrition-related information through mass media, promotion of health facility delivery, and improving utilization of maternal health services are recommended to improve infant and child feeding practices.

How Livelihood Change Affects Food Choice Behaviors in Low- and Middle-Income Countries: A Scoping Review

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.

Does livestock ownership predict animal-source food consumption frequency among children aged 6-24 months and their mothers in the rural Dale district, southern Ethiopia?

Background

Animal-source foods are food items that come from animals. Animal-source foods provide a variety of micronutrients that plant-source foods cannot provide to the same extent and without extra precaution. Milk, eggs, poultry, flesh meat and fish are animal-source foods mainly used in Ethiopia. Low animal-source food consumption among children and mothers is a great concern in many low-income settings. This study aimed to describe animal-source food consumption frequencies among children aged 6-24 months and their mothers in rural southern Ethiopia where livestock farming is very common. We also analysed the association between livestock ownership and animal-source food consumption among children and mothers.

Methods

A community-based cross-sectional study was conducted among 851 randomly selected households with child-mother pairs from August to November 2018. The study was conducted in the rural Dale District, southern Ethiopia. Structured and pre-tested questionnaires were used to collect data on mother and child information, livestock ownership, and animal-source foods consumption frequencies. Ordinal logistic regression analysis was used to describe associations between animal-source foods consumption and livestock ownership.

Result

Nearly, three-quarters (74.1%) of the households owned cows, and a quarter (25%) had goats or sheep. Dairy, egg and meat consumption among children during the past month was 91.8%, 83.0% and 26.2%, respectively. Likewise, the consumption of dairy, eggs and meat among mothers was 96.0%, 49.5% and 34.0%, respectively. The percentage of children who had not consumed any animal-source foods during the month prior to our survey was 6.6%, and the figure was 2.2% for the mothers. Dairy consumption was 1.8 times higher among children (aOR = 1.8, 95% CI [1.3-2.5]) and 3.0 times higher among mothers (aOR = 3.0, 95% CI [2.2-4.2]) in households that kept cows than in households without cows. The egg consumption frequency was positively associated with hen and goat/sheep ownership for both children and mothers. Meat consumption frequency among children was negatively associated with cow ownership (aOR = 0.66, 95% CI [0.45-0.95]); however, cow ownership was not associated with meat consumption among mothers.

Conclusion

Dairy products were common animal-source foods consumed by young children and mothers in the study area. However, meat consumption was low among children and mothers. Strategies like promoting the keeping of goats/sheep and hens to improve complementary feeding and mothers' nutrition are warranted in the study area.

Diet quality of preparatory school students in Awi Zone, Ethiopia: a cross-sectional study

OBJECTIVE

The study aimed to assess diet quality and associated factors among preparatory school students in Awi Zone, Ethiopia.

DESIGN

A school-based cross-sectional study design was used in this study.

SETTING

The study was carried out in Awi Zone, Amhara Region, Ethiopia.

PARTICIPANTS

A total of 834 preparatory school students participated in the study.

OUTCOME MEASURES

Diet quality was the outcome variable, and it was computed using the dietary diversity score, food variety score and consumption of animal-source foods. Students with high dietary diversity scores, appropriate animal-source food consumption and adequate food variety scores were labelled as having good-quality diets. Data were collected using a pretested structured self-administered questionnaire. Bivariate and multivariable logistic regressions were employed to analyse the data. Variables with p≤0.2 in the bivariate logistic regression analysis were included in the multivariable logistic regression model. Multivariable logistic regression analysis was done to determine the strength of the association. Statistical significance was determined at p value less than 0.05.

RESULTS

Only 24.7% (95% CI: 21.7%, 27.7%) of preparatory school students had good-quality diets. Being female (adjusted OR (AOR)=2.88, 95% CI: 2.0, 4.1), residing in an urban setting (AOR=1.90, 95% CI: 1.1, 3.2), having an educated mother (AOR=1.78, 95% CI: 1.1, 2.7), having pocket money (AOR=1.83, 95% CI: 1.2, 2.6) and nutrition information (AOR=1.90, 95% CI: 1.2, 3.1), and family monthly income >8000 Ethiopian birrs (AOR=3.90, 95% CI: 2.2, 7.1) were factors significantly associated with having good-quality diet.

CONCLUSION

The majority of the preparatory school students had poor-quality diets. These findings highlight the necessity of nutrition education that considers the sociodemographic characteristics of the students and their families. Implementing income-generating interventions for low-income households was also recommended by the findings.

Trends in and predictors of animal source food consumption among 6-23 months age children in Tigrai, Northern Ethiopia: evidence from three consecutive ethiopian demographic and health surveys, EDHS 2005-2016

BACKGROUND

Despite numerous interventions, child undernutrition continues as a problem of global concern. Although consumption of animal source foods has shown positive associations with child undernutrition, no much evidence exists on its trends and predictors among children in Tigrai.

OBJECTIVES

This study aimed to investigate the trends in and predictors of consumption of animal source foods among children 6-23 months of age in Tigrai.

METHODOLOGY

This study used complex data of 756 children extracted from three consecutive Ethiopian Demographic and Health Surveys. Data were analyzed using STATA 14.0 by accounting for sampling weight and cluster and strata variables. Multivariable logistic regression was used to determine the independent predictors of animal source foods consumption. Odds ratio and 95% confidence interval were used to measure strength of association at a statistical significance of p < 0.05.

RESULTS

Although statistically not significant (p-trend = 0.28), animal source foods consumption increased from 31.3% to 2005 through 35.9% in 2011 to 41.5% in 2016. For every month increase in the age of a child, a 9% increment in the odds of animal source food consumption was observed. Muslim children showed 3.1 times higher odds of animal source food consumption than Orthodox Christians. The likelihood of animal source foods consumption were 33% lower among children born to mothers who didn't attend formal education as compared to their counterparts. A unit increase in the number of household assets and number of livestock led to a 20% and 2% increase in the odds of animal source foods consumption, respectively.

CONCLUSION

Animal source foods consumption showed a statistically non-significant increase over the three consecutive Ethiopian Demographic and Health Surveys. This study found out that consumption of animal source foods might be increased through pro-maternal education policies, programs with household asset increasing schemes, and pro-livestock projects. Our study also highlighted the need for considering religion as one important player when planning or undertaking ASF programs.

Effect of community-based nutritional education on dietary diversity and consumption of animal-source foods among rural preschool-aged children in the Ilu Abba Bor zone of southwest Ethiopia: Quasi-experimental study

Dietary diversity (DD) is a concern for poor people in developing countries, particularly in Africa. Most people's diets consist primarily of monotonous carbohydrate staples, with little or no animal products and few fresh fruits and vegetables. The aim of this intervention was to see how nutrition education delivered by trained health professionals improved preschool-aged children's consumption of DD and animal-sourced foods. The study used a quasi-experimental design with 588 preschool-aged children. Researchers used a multistage sample technique followed by a systematic random sampling technique. A χ2 test was used to determine the baseline differences in demographic and socioeconomic factors between the two groups, as well as the relationship between predictors and child DD and animal-source foods (ASFs). The researchers used generalized estimating equations to assess the change in the difference in outcomes between the intervention and control groups, as well as the association between predictors and child DD and ASFs. The adjusted odds ratio with the corresponding 95% confidence intervals was reported to show the strength of the association. The findings of this study revealed that there was a highly significant difference in both DD scores (DDS) and ASFs between the control and intervention groups DDS (p < 0.003) and ASF (p < 0.001). According to the findings of this study, nutrition education can significantly improve DDS and ASF consumption among preschool-aged children.

Individual and community-level factors associated with animal source food consumption among children aged 6-23 months in Ethiopia: Multilevel mixed effects logistic regression model

BACKGROUND

Diversified diet in childhood has irreplaceable role for optimal growth. However, multi-level factors related to low animal source food consumption among children were poorly understood in Ethiopia, where such evidences are needed for decision making.

OBJECTIVES

To investigate the magnitude and individual- and community-level predictors of animal source food (ASF) consumption among children aged 6-23 months in Ethiopia.

METHODS

We utilized a cross-sectional pooled data from 2016/19 Ethiopia Demographic and Health Surveys. A stratified two-stage cluster design was employed to select households with survey weights were applied to account for complex sample design. We fitted mixed-effects logit regression models on 4,423 children nested within 645 clusters. The fixed effect models were fitted and expressed as adjusted odds ratio with their 95% confidence intervals and measures of variation were explained by intra-class correlation coefficients, median odds ratio and proportional change in variance. The deviance information criterion and Akaike information Criterion were used as model fitness criteria.

RESULT

in Ethiopia, only 22.7% (20.5%-23.9%) of children aged 6-23 months consumed ASF. Younger children aged 6-8 months (AOR = 3.1; 95%CI: 2.4-4.1), home delivered children (AOR = 1.8; 1.4-2.3), from low socioeconomic class (AOR = 2.43; 1.7-3.5); low educational level of mothers (AOR = 1.9; 95%CI: 1.48-2.45) and children from multiple risk pregnancy were significant predictors of low animal source consumption at individual level. While children from high community poverty level (AOR = 1.53; 1.2-1.95); rural residence (AOR = 2.2; 95%CI: 1.7-2.8) and pastoralist areas (AOR = 5.4; 3.4-8.5) significantly predict animal source food consumption at community level. About 38% of the variation of ASF consumption is explained by the combined predictors at the individual and community-level while 17.8% of the variation is attributed to differences between clusters.

CONCLUSIONS

This study illustrates that the current ASF consumption among children is poor and a multiple interacting individual- and community level factors determine ASF consumption. In designing and implementing nutritional interventions addressing diversified diet consumption shall give a due consideration and account for these potential predictors of ASF consumption.

Magnitude and determinants of animal source food consumption among children aged 6-23 months in Ethiopia: secondary analysis of the 2016 Ethiopian demographic and health survey

Background

Undernutrition puts children in a physical and cognitive disadvantage. Animal source foods (ASFs) are important components of nutritious diets and play a significant role in increasing dietary diversity and minimizing the risk of undernutrition among children. Ethiopia still suffers from child undernutrition and there’s no adequate information regarding consumption of ASFs. The objective of this study was to determine the magnitude and determinanats of ASF consumption among children 6–23 months of age.

Methodology

A total weighted sample of 2861 children drawn from the 2016 Ethiopian demographic and health survey was analyzed using “SVY” command of STATA 14.0. Multivariable logistic regression was used to determine the independent determinants of ASF consumption. The strength of the association was measured by odds ratio and 95% confidence interval and p-value < 0.05 was considered statistically significant.

Results

Nearly half (46.5%) of the children reported consuming any type of ASF. Religion, child age, number of household assets, number of livestock owned by a household, and ownership of land usable for agriculture were significant determinants of the outcome variable. The odds of ASF consumption were six times, twice, and 70% lower in orthodox children compared to other (catholic, traditional, or others), muslim, and protestant children, respectively. Household ownership of assets and livestock led to an increase in consumption of ASF by 19 and 2%, respectively. Children aged 18–23 months were more likely to consume ASF as compared to the younger age group (6–8 months old children). In the contrary, children from households that own land usable for agriculture were 33% less likely to consume ASFs as compared to those from households that do not own.

Conclusions

In Ethiopia, only nearly half of children aged 6–23 months consume any type of ASF. The findings of this study imply that ASF consumption can be increased through integrated actions that involve community and religious leaders and programs focused on empowering households’ capability of owning other socioeconomic entities including assets and livestock. This study also may contribute to the growing body of research works on the importance of ASF provision in preventing child undernutrition.

The influence of fasting on energy and nutrient intake and their corresponding food sources among 6-23 months old children in rural communities with high burden of stunting from Northern Ethiopia

BACKGROUND

Limited studies in Ethiopia showed that infants and young children are at high risk of inadequate intake of energy and nutrients. However, inclusive assessment of both nutrient intakes and their food sources are lacking. We aimed at assessing energy and nutrient intakes and their food sources during religious fasting and non-fasting periods among 6-23 months old children in Northern Ethiopia.

METHODS

Data for this longitudinal study were collected following repeated multiple-pass 24-h dietary recall technique through face-to-face interviews with primary caregivers. Using a two-stage systematic random sampling method, a total of 570 and 551 children participated respectively in the lent fasting and non-fasting periods. Energy and nutrient intakes were estimated and compared with WHO daily requirements. All foods that a child consumed on the day preceding the date of data collection were recorded and processed with database software. Chi-square and t- tests were used to analyze the data. Non-normally distributed data were analyzed using Wilcoxon signed-rank test and statistical significance was set at p < 0.05.

RESULTS

The overall prevalence of child stunting was 41.4%. Almost all of children (99.6%) consumed grains, roots, and tubers. The inadequacy prevalence of energy, protein and eight selected micronutrients (calcium, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C) intake were 96.2, 44.9, and 95.5%, respectively. Calcium and zinc were the highest (100%) deficits observed across all age groups. Although consumption of animal source foods (ASFs) was very low (dairy 10.1%, meat 2.3% and eggs 23.6%), there was significantly higher consumption of meat and eggs during the non-fasting compared to fasting period (p < 0.001).

CONCLUSIONS

Inadequate intake of energy and nutrients was common among 6-23 months old children. Cereals were found to be the main sources of many of the nutrients. The consumption of ASFs among 6-23-month-old children was low which was also affected by the religious fasting period. Hence, strengthening social and behavior change communication, supporting rural households to raise poultry and small ruminants is recommended.

Health and economic burden of foodborne zoonotic diseases in Amhara region, Ethiopia

Diseases from food of animal origin are common health problems in Ethiopia. A cross-sectional study was carried out to estimate health and economic burden, and to identify demographic factors associated with community awareness of foodborne zoonotic diseases in Amhara region, Ethiopia. Data was collected from 435 households in three towns: Gondar, Lalibela and Debark. A retrospective data was also collected from health records in each town. The health burden due to zoonotic diseases was estimated at 0.2, 0.1 and 1.3 DALYs per household per year and at 73.2, 146.6 and 1,689.5 DALYs out of 100,000 populations per year in Gondar, Lalibela and Debark, respectively. The overall health burden due to foodborne zoonotic diseases (aggregated over the 435 households in the three towns) was estimated to be 89.9 DALYs per 100,000 populations per year. The economic impact of foodborne zoonotic diseases in the three towns of Amhara regional state was 278.98 Ethiopian Birr (ETB) (1ETB = 0.025 US Dollar) per household per year and 121,355.68 ETB per year. Costs of preventive measures followed by costs of patients’ time made the highest contribution while costs of diagnosis made the lowest contribution to the total economic burden of foodborne zoonotic diseases. From a total of 435 respondents, 305 (70.1%) had known the presence of zoonotic diseases. Level of education, number of families in the house and income were highly associated with awareness of zoonosis. Although majority of respondents had known zoonotic diseases exists (70.1%) and disease can be acquired from animal source food (63.2%), the health and economic burden associated to foodborne zoonotic diseases are still high. Therefore, changing mindset and practical training aiming in controlling foodborne zoonotic diseases may be suggested to the community in the health improvement extension service.

Fasting, food and farming: Value chains and food taboos in Ethiopia

The impact of food taboos–often because of religion–is understudied. In Ethiopia, religious fasting by Orthodox Christians is assumed to be an important impediment for the sustainable development of a competitive dairy sector and desired higher milk consumption, especially by children. However, evidence is limited. Relying on unique data, we shed light on three major issues. First, we observe that the average annual number of fasting days that Orthodox adults are effectively adhering to is 140, less than commonly cited averages. Using this as an estimate for extrapolation, fasting is estimated to reduce annual dairy consumption by approximately 12 percent nationally. Second, farms adapt to declining milk demand during fasting by increased processing of milk into storable products–fasting contributes to larger price swings for these products. We further note continued sales of milk by non-remote farmers and reduced production–by adjusting lactation times for dairy animals–for remote farmers. Third, fasting is mostly associated with increased milk consumption by the children of dairy farmers, seemingly because of excess milk availability during fasting periods. Our results suggest that fasting habits are not a major explanation for the observed poor performance of Ethiopia’s dairy sector nor low milk consumption by children. To reduce the impact of fasting on the dairy sector in Ethiopia further, investment is called for in improved milk processing, storage, and infrastructure facilities.

Animal Source Food Social and Behavior Change Communication Intervention Among Girinka Livestock Transfer Beneficiaries in Rwanda: A Cluster Randomized Evaluation

A social and behavior change communication intervention designed to promote consumption of cow’s milk among families that received a cow from a government livestock transfer program increased mothers’ knowledge and awareness of milk consumption. Although intervention exposure was associated with increased frequency of children’s cow’s milk intake, it did not lead to increased consumption or dietary diversity.

Animal source foods (ASFs), including cow’s milk, contain essential nutrients and contribute to a healthy diet, but frequency of intake is low among children in low- and middle-income countries. We hypothesized that an ASF social and behavior change communication (SBCC) intervention implemented by community health workers (CHWs) would increase child milk consumption and dietary diversity in households that received a cow from the Government of Rwanda’s Girinka livestock transfer program. We tested the 9-month SBCC intervention among children aged 12–29 months at baseline in administrative cells randomly assigned to the intervention or control. Most mothers in the intervention group were exposed to CHWs’ home visits (90.7%) or community-level activities (82.8%). At endline, more mothers in the intervention group compared with the control group knew that cow’s milk was an ASF (90.1% vs. 81.7%, P=.03) and could be introduced to children at 12 months (41.7% vs. 18.7%, P<.001). More mothers in the intervention group compared with the control group knew they should feed their children ASFs (76.2% vs. 62.1%, P=.01) and give them 1 cup of cow’s milk per day (20.6% vs. 7.8%, P<.001). Children’s consumption of fresh cow’s milk 2 or more times per week increased in the intervention group, although not significantly (8.0 percentage points, P=.17); minimum dietary diversity was unchanged. Children in the intervention group had increased odds of consuming cow’s milk 2 or more times per week if their mothers recalled hearing that children should drink 1 cup of cow’s milk per day during a CHW’s home visit [odds ratio (OR) 2.1, 95% confidence interval (CI) (1.1, 3.9)] or a community activity [OR 2.0, 95% CI (1.2, 3.5)]. Approximately half of the children had no milk during the past week because their households produced too little or sold what was produced. In poor households receiving a livestock transfer, strategies to further tailor SBCC and increase cow’s milk production may be needed to achieve larger increases in children’s frequency of milk consumption.

Early breastfeeding and complementary feeding in Ethiopia: cross-sectional data from implementation of nutrition programming on regional inequalities

Improving nutrition for young children remains an urgent priority globally. Ethiopia has made great strides over the last two decades in improving health and nutrition for children. The task of scaling improved nutrition services now turns to addressing progress on the regional level. This research sought to highlight regional disparities identified in scaling nutrition services for child nutrition in Ethiopia, by identifying variations in early breastfeeding and child feeding practices and associated socio-demographic characteristics by geographic area in four regions of the country. The cross-sectional study data derived from an evaluation of nutrition services and programming and included 1299 participants, of whom 50% reported practicing recommended early breastfeeding practices. This varied from less than 8% in one zone of Afar region to 84% in a zone of Tigray, with differences also noted by socio-demographic characteristics. Among the total sample, 70% of respondents met the recommendation for minimum number of feedings per day, and 16% met the recommendation for dietary diversity. Less than 8% of families in the service population in Northwestern Tigray zone met the dietary diversity recommendation compared to 36% in South Wollo, Amhara region. Utilizing regional and zonal data will allow for government and other agencies involved in improving nutrition and health outcomes to appropriately provide services and programs for families and children over the life course.

Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study

BACKGROUND

Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density.

OBJECTIVE

Explore barriers and facilitators for the consumption of animal source foods among 6-23 months old children from the rural communities of Northern Ethiopia.

METHODS

A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data.

RESULTS

Consumption of animal source foods among 6-23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children's diet. Lack of nutrition knowledge, high cost of animal source foods, mothers' workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities.

CONCLUSIONS

Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6-23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6-23 months old children in the rural communities of Northern Ethiopia are recommended.