Factors Influencing Dietary Diversity in Infants in India: Study Undertaken in Two Districts

Adequate feeding practices in early life have a lasting impact on child nutrition and development. This paper examines the dietary diversity and its associated factors among children aged 6-12 months, in the age that they transition from breastfeeding to complementary feeding, in two districts in India: Udupi (Karnataka) and Sambalpur (Odisha). In 2019, a citizen-led survey, that can be scaled up further very rapidly and cost-effectively, was conducted covering 976 mothers of children below 1 year of age by 90 trained local volunteers. The survey tool uses the Knowledge, Access and Practices Framework and was developed, tested and refined over 4 years through diverse pilots in various locations in India. In the sample, only 12% children aged 6-12 months met the WHO’s minimum dietary diversity requirement. A linear probability regression model was used to assess significant factors for an adequate diversified diet intake in infants. Maternal education, child’s age and meal frequency were found to be significantly associated with dietary diversity. Other factors such as household wealth, gender of child, birth order and homegrown gardens did not present a strong association. Integrated interventions targeted at mothers and children that include nutrition education components into mothers’ education are more likely to be effective in improving infant dietary diversity.

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A six-week healthy eating intervention with family engagement improves food knowledge and preferences but not dietary diversity among urban preschool children in Sri Lanka

Public Health Nutrition ◽

10.1017/s1368980021001877 ◽

2021 ◽

pp. 1-22

Author(s):

Fathima Sirasa ◽

Lana Mitchell ◽

Aslan Azhar ◽

Anoma Chandrasekara ◽

Neil Harris

Keyword(s):

Sri Lanka ◽

Nutrition Education ◽

Healthy Eating ◽

Child Nutrition ◽

Dietary Diversity ◽

Family Engagement ◽

Food Preferences ◽

Healthy Food ◽

Food Knowledge ◽

The Impact

Abstract Objective: To evaluate the effectiveness of a multicomponent intervention (MCI) on children’s dietary diversity and its impact pathway components of children’s food knowledge and healthy food preferences. Design: A six-week cluster randomised controlled trial with a MCI consisting of child nutrition education plus family engagement, through parental nutrition education, meal preparation and tasting was compared with two groups: single component intervention (SCI) of child nutrition education, and control, conducted during February to July 2018. Preschool centres were randomly assigned to one of the three arms. Children’s food knowledge, healthy food preferences and dietary diversity scores were collected. Intervention effects were analysed using a pre-post analysis and a difference-in-difference model. Setting: Fourteen preschool centres in an urban area of Kurunegala, Sri Lanka Participants: Child-parent dyads of children aged 4-6 years. Final analyses included 306 (for food knowledge and preferences) and 258 (for dietary diversity) dyads. Results: MCI significantly influenced the impact pathways to children’s dietary diversity by increasing children’s food knowledge and healthy food preferences scores by 3.76 and 2.79 (P<0.001) respectively, but not the dietary diversity score (P=0.603), compared to control arm. Relative to SCI, MCI significantly improved children’s food knowledge score by 1.10 (P<0.001), but no significant effects were noted for other outcome variables. Conclusion: Improved food knowledge and preferences require a positive food environment and time to develop into healthy eating behaviours. Research into dietary diversity should broaden to incorporate the contextual roles of the home and general food environments to more completely understand food choices of children.

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Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008–2009

Public Health Nutrition ◽

10.1017/s1368980012002856 ◽

2012 ◽

Vol 15 (9) ◽

pp. 1715-1727 ◽

Cited By ~ 40

Author(s):

Peninah K Masibo ◽

Donald Makoka

Keyword(s):

Health Survey ◽

Urban Areas ◽

Child Nutrition ◽

Maternal Education ◽

Sampling Technique ◽

Household Wealth ◽

Demographic And Health Survey ◽

Demographic And Health Surveys ◽

Double Burden ◽

Percentage Points

AbstractObjectiveTo report on the trends and determinants of undernutrition among children <5 years old in Kenya.DesignData from four nationwide Kenya Demographic and Health Surveys, conducted in 1993, 1998, 2003 and 2008–2009, were analysed. The Demographic and Health Survey utilizes a multistage stratified sampling technique.SettingNationwide covering rural and urban areas in Kenya.SubjectsThe analysis included 4757, 4433, 4892 and 4958 Kenyan children aged <5 years in 1993, 1998, 2003 and 2009–2009, respectively.ResultsThe prevalence of stunting decreased by 4·6 percentage points from 39·9 % in 1993 to 35·3 % in 2008–2009, while underweight decreased by 2·7 percentage points from 18·7 % in 1993 to 16·0 % in 2008–2009. The effects of household wealth, maternal education and current maternal nutritional status on child nutrition outcomes have changed dynamically in more recent years in Kenya. Inadequate hygiene facilities increased the likelihood of chronic undernutrition in at least three of the surveys. Small size of the child at birth, childhood diarrhoea and male gender increased the likelihood of undernutrition in at least three of the surveys. Childhood undernutrition occurred concurrently with maternal overnutrition in some households.ConclusionsThe analysis reveals a slow decline of undernutrition among young children in Kenya over the last three decades. However, stunting and underweight still remain of public health significance. There is evidence of an emerging trend of a malnutrition double burden demonstrated by stunted and underweight children whose mothers are overweight.

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Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED

Journal of Nutrition ◽

10.1093/jn/nxz055 ◽

2019 ◽

Vol 149 (8) ◽

pp. 1460-1469 ◽

Cited By ~ 2

Author(s):

Benjamin J J McCormick ◽

Stephanie A Richard ◽

Laura E Caulfield ◽

Laura L Pendergast ◽

Jessica C Seidman ◽

...

Keyword(s):

Cognitive Development ◽

Early Life ◽

Maternal Education ◽

Burden Of Illness ◽

Household Wealth ◽

Cognitive Reasoning ◽

Micronutrient Status ◽

Multivariable Models ◽

Diet Intake ◽

Child Cognitive Development

ABSTRACT Background Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: −1.81, 95% CI: −2.75, −0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.

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Using National Survey Data From Nigeria to Assess Maternal-Child Dietary Concordance and Inform Nutrition Program Strategy

Current Developments in Nutrition ◽

10.1093/cdn/nzab038_001 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 389-389

Author(s):

Nadia Akseer ◽

Rebecca A Heidkamp ◽

Andrew Thorne-Lyman

Keyword(s):

Maternal Education ◽

Fruits And Vegetables ◽

Dietary Diversity ◽

Maternal Diet ◽

Food Group ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Food Groups ◽

Diet Diversity ◽

Maternal Child

Abstract Objectives Improving child diet diversity is a policy priority in many settings. Multiple factors influence complementary feeding practices in low-income countries including household food access, caregiver-level factors and cultural practices. Child's dietary data is often available in national surveys (i.e., Demographic and Health Surveys, DHS), but they typically lack diet data from adults. The 2018 Nigeria DHS was among the first to measure food group intake in both young children and women. We describe the relationship between child and maternal diet diversity in Nigeria and highlight implications for design of infant and young child feeding (IYCF) programs. Methods Using the Nigeria DHS 2018 dataset, we estimated consumption of individual food groups in the previous 24 hours as well as minimum dietary diversity for children 6–23 months (MDD-C) and their mothers, women 15–49 years (MDD-W) using WHO-UNICEF definitions. We compare rates of concordance and discordance between n = 8975 mother-child pairs for individual food groups and MDD using McNemar's tests. Probit regression was used to identify drivers of MDD-C. Results Nationally, 22% of children achieve MDD-C; 51% of mothers achieve MDD-W. For both populations, the most commonly consumed group is grains, roots and tubers (>80%) Dairy and eggs are the least consumed. Maternal-child (age 12–23 months) discordance is highest for consumption of legumes and nuts (36%), vitamin A rich fruits and vegetables (39%) and other fruits and vegetables (57%); mothers consume these more frequently. Children are more likely than mothers to consume dairy (19% vs 8%) and eggs (8% vs 4%). Maternal-child food group discordance is consistently higher for children 6–11months than children 12–23 months. Results vary at state level and by maternal age group. Children's MDD probability is increased by MDD-W (27%, P < 0.001), higher maternal education (8%, P < 0.01) and household wealth (7%, P < 0.01). Conclusions Maternal and child diet diversity is suboptimal in Nigeria. Maternal diet is a primary driver of child diet in Nigeria. Legumes and nuts and fruits and vegetables are available but not consistently fed to children; an important finding for IYCF program design. The forthcoming DHS-8 core questionnaire will provide child and maternal diet data for more than 90 countries. Funding Sources Bill & Melinda Gates Foundation.

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Trends and determinants of minimum dietary diversity among children aged 6-23 months: a pooled analysis of Indonesia Demographic and Health Surveys from 2007 to 2017

Public Health Nutrition ◽

10.1017/s1368980021004559 ◽

2021 ◽

pp. 1-28

Author(s):

Bunga A Paramashanti ◽

Tanvir M Huda ◽

Ashraful Alam ◽

Michael J Dibley

Keyword(s):

Nutrition Education ◽

Rural Areas ◽

Health Surveys ◽

Maternal Education ◽

Dietary Diversity ◽

Multiple Logistic Regression Analysis ◽

Demographic And Health Surveys ◽

Food Groups ◽

Community Factors ◽

Minimum Dietary Diversity

Abstract Objective: To examine minimum dietary diversity trends and determinants among children aged 6-23 months. Design: Secondary analysis of the Indonesia Demographic and Health Surveys (IDHS) between 2007 and 2017. The primary outcome was minimum dietary diversity, the consumption of at least five out of eight food groups (MDD-8). We included a total of 5015 (IDHS 2007), 5050 (IDHS 2007), and 4925 (IDHS 2017) children aged 6 to 23 months to estimate trends of MDD-8 and to identify factors associated with MDD-8. We used multiple logistic regression analysis adjusted for the complex sampling design to investigate the association between the study factors and MDD-8. Setting: Indonesia. Participant: A total of 14990 children aged 6-23 months. Results: Over the ten years, the percentage of children who consumed a diversified diet was 53.1% in 2007, 51.7% in 2012, and 53.7% in 2017. Multivariate analyses showed that older age children, higher maternal education, maternal weekly access to media, paternal non-agricultural occupation, history of at least four ANC visits, and wealthier households were associated with the increased odds of MDD-8. Children living in rural areas, Sulawesi and Eastern Indonesia, were less likely to eat a diversified diet. Conclusions: The proportion of children meeting MDD-8 has stagnated in the last decade. Child, parental, health care, household, and community factors are associated with MDD-8. Therefore, nutrition-education programmes and behaviour change communication activities should target mothers and families from socio-economically and geographically disadvantaged populations.

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An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone

Current Developments in Nutrition ◽

10.1093/cdn/nzaa174 ◽

2020 ◽

Vol 4 (12) ◽

Author(s):

Bridget A Aidam ◽

Carolyn A MacDonald ◽

Rebecca Wee ◽

Joseph Simba ◽

Judi Aubel ◽

...

Keyword(s):

Young Child ◽

Nutrition Education ◽

Sierra Leone ◽

Child Nutrition ◽

Dietary Diversity ◽

Intervention Group ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child ◽

Inclusive Approach

ABSTRACT Background Suboptimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition; however, in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated. Objectives We examined how an innovative grandmother-inclusive approach (GMIA) can be used to address suboptimal IYCF practices. Methods Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children aged <2 y, and 219 grandmothers. Statistical analyses utilized t tests and χ2 tests to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest. Results Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children aged 0–23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% compared with 79.4%, P = 0.01). Among infants aged 6–23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% compared with 51.8%, P < 0.001; and 53.8% compared with 22.6%, P < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants aged 9–23 mo, with the intervention group achieving a higher MMF (54.6% compared with 36.9%, P = 0.02). Conclusions Results suggest that a GMIA that recognizes grandmothers’ roles and strengthens their knowledge can contribute to improved IYCF practices.

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Evaluating interventions to improve child nutrition in Eastern Democratic Republic of Congo

Public Health Nutrition ◽

10.1017/s1368980018002859 ◽

2018 ◽

Vol 22 (1) ◽

pp. 3-14 ◽

Cited By ~ 3

Author(s):

Shannon Doocy ◽

Jillian Emerson ◽

Elizabeth Colantouni ◽

Johnathan Strong ◽

Kimberly Amundson-Mansen ◽

...

Keyword(s):

Nutrition Education ◽

Child Nutrition ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Dietary Diversity ◽

Women's Empowerment ◽

Women’S Empowerment ◽

Farmer Field Schools ◽

Quasi Experimental ◽

Republic Of The Congo

AbstractObjectiveThe prevention of malnutrition in children under two approach (PM2A), women’s empowerment and agricultural interventions have not been widely evaluated in relation to child diet and nutrition outcomes. The present study evaluated the effectiveness of PM2A, women’s empowerment groups (WEG), farmer field schools (FFS) and farmer-to-farmer training (F2F).DesignCommunity-matched quasi-experimental design; outcome measures included children’s dietary diversity, stunting and underweight.SettingCommunities in South Kivu, Democratic Republic of the Congo.ParticipantsA total of 1312 children from 1113 households.ResultsAchievement of minimum dietary diversity ranged from 22·9 to 39·7 % and was significantly greater in the PM2A and FFS groups (P<0·05 for both comparisons). Fewer than 7·6 and 5·8 % of children in any group met minimum meal frequency and acceptable diet targets; only the PM2A group differed significantly from controls (P<0·05 for both comparisons). The endline stunting prevalence ranged from 54·7 % (PM2A) to 69·1 % (F2F) and underweight prevalence from 22·3 % (FFS) to 34·4 % (F2F). No significant differences were found between intervention groups and controls for nutrition measures; however, lower prevalences of stunting (PM2A, −4 %) and underweight (PM2A and FFS, −7 %) suggest potential impact on nutrition outcomes.ConclusionsChildren in the PM2A and FFS groups had better child diet measures and nutrition outcomes with the best results among PM2A beneficiaries. Interventions that address multiple aspects nutrition education, health, ration provision and income generation may be more effective in improving child diet and nutrition in resource-poor settings than stand-alone approaches.

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Factors associated with dietary diversity among adolescents in Woldia, Northeast Ethiopia

BMC Nutrition ◽

10.1186/s40795-021-00430-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Melese Linger Endalifer ◽

Gashaw Andargie ◽

Bekri Mohammed ◽

Bedilu Linger Endalifer

Keyword(s):

Nutrition Education ◽

Family Size ◽

Intervention Program ◽

Maternal Education ◽

Dietary Diversity ◽

Scale Up ◽

Education Level ◽

Food Prices ◽

Outcome Variable ◽

Local Market

Abstract Background Consuming diversified food during the adolescent period is essential to build a healthy and active mind for their later life. Food prices increased in the local market due to fewer production of crops. Thus, exploring the dietary diversity of adolescents in this area is crucial to estimate diet quality. So the aim of the study was to identify determinant factors of dietary diversity. Methods An institution-based cross-sectional study was conducted among adolescent students in Woldia town. A total of four hundred eleven students were included in the study. A simple random sampling technique was used to select the participants. The outcome variable was dietary diversity; it was calculated by summing of the number of food group consumed by individuals in the given reference period. Bivariable and multivariable logistic analysis was done. The odds ratio with a 95% confidence interval was computed to measure an association. A variable with a P-value less than 0.05 is considered a significant factor. Results The proportion of inadequate dietary diversity was 49.1% (95% CI 44.5–53.8). Being female (AOR =5.53, 95% CI 3.447–8.859), secondary and above mothers’ education level (AOR=0. 27, 95%CI 0.153–0.477), living in a family size five and above (AOR= 2.09, 95CI% 1.31–3.34), and poor knowledge about nutrition (AOR=4.56, 95% CI 2.727–7.639) were significantly associated with inadequate dietary diversity. Conclusions and recommendations Inadequate dietary diversity was associated with sex, knowledge of nutrition, maternal education level, and family size. It is better to design a nutrition intervention program that focus on nutrition education to scale up diversified food consumption among adolescents.

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Nutrition Education of Mothers and Zinc Supplementation among Children in the Rural Community, Cameroon

European Journal of Nutrition & Food Safety ◽

10.9734/ejnfs/2021/v13i130348 ◽

2021 ◽

pp. 59-69

Author(s):

Nicolas Policarpe Nolla ◽

Marie Modestine Kana Sop ◽

Marlyne Joséphine Mananga ◽

Inocent Gouado

Keyword(s):

Nutritional Status ◽

Nutrition Education ◽

Rural Community ◽

Maternal Education ◽

Zinc Supplementation ◽

Dietary Diversity ◽

Public Health Problem ◽

Baseline Survey ◽

Control Group ◽

The Impact

Aims: Malnutrition among children, especially stunting is a public health problem in Cameroon. This study assesses the impact of zinc supplementation of children and nutrition education of mothers on the nutritional status of the children in the Bangang rural community. Study Design: This was a descriptive and prospective study. Place and Duration of Study: The study took place in the Bangang community in the Region of West Cameroon, during the period from March to December 2015. Methodology: The children aged 6 to 48 months and mothers aged 20 to 34 years were selected after the baseline survey and enrolled. Dietary surveys were used to evaluate the frequency of foods consumed by 150 children. Zinc supplementation group of children (ZSG, n= 25) received 10 mg of zinc sulfate tablets per day for 14 days and control group (CG, n=25) was formed by children whose mothers received nutrition counseling. The nutrition education sessions organized into 4 modules were conducted quarterly for 9 months on a sample of 100 mothers. After interventions, impact of zinc supplementation and maternal education was assessed by determining height for age and weight for age indices, and biochemistry parameters. Results: The results showed that zincemia of ZSG varied significantly (P = .0001) and not significantly (P = .23) for CG. After nutrition education, dietary diversity was improved; reduction of chronic malnutrition (10.9%) and increasing number of children with good nutritional status (6.6%) were observed. Increased for phosphoremia (3.6 ± 2.4 to 5.7 ± 1.8 mg/dl; P = .001) and albuminemia (34.8 ± 15.5 to 46.9 ± 8.9 g/l; P = .002) were significant which was not the case of calcemia, zincemia, magnesemia and serum iron. Conclusion: This study showed positive impact of zinc supplementation and maternal education on the nutritional status of children.

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Predictors of stunting among children age 6–59 months in Ethiopia using Bayesian multi-level analysis

Scientific Reports ◽

10.1038/s41598-021-82755-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amare Muche ◽

Lemma Derseh Gezie ◽

Adhanom Gebre-egzabher Baraki ◽

Erkihun Tadesse Amsalu

Keyword(s):

Nutrition Education ◽

Maternal Education ◽

Maternal Nutrition ◽

Sampling Technique ◽

Household Wealth ◽

Community Level ◽

Cluster Sampling ◽

Wealth Status ◽

Public Health Burden ◽

Childhood Stunting

AbstractIn developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6–59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6–59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child’s age (AOR = 1.022; 95% CrI 1.018–1.026), being a male child (AOR = 1.16; 95%CrI 1.05–1.29), a twin (AOR = 2.55; 95% CrI 1.78–3.56), having fever (AOR = 1.23; 95%CrI 1.02–1.46), having no formal education (AOR = 1.99; 95%CrI 1.28–2.96) and primary education (AOR = 83; 95%CrI 1.19–2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20–1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93–0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35–2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices.

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