Applied nutritional investigationPredictors of dietary diversity in children ages 6 to 23 mo in largely food-insecure area of South Wollo, Ethiopia
Introduction
Despite encouraging progress in reducing child mortality, childhood undernutrition remains a major public health concern in Ethiopia. As reported by a recent national survey, 9%, 25%, and 40% of children under the age of 5 y are wasted, underweight, and stunted, respectively [1]. In preschool children, the prevalence of anemia (44%) [2] and subclinical vitamin A deficiency (38%) [3] are alarmingly high. Factors contributing to undernutrition include widespread poverty, natural resource degradation, high population pressure, poor access to health care and other social services, household food insecurity, poor sanitation, and high rates of infections [4], [5].
Starting at age 6 mo, the high nutrient demand of children cannot be satisfied by breast milk alone. Complementary feeding from the age of 6 to 23 mo is critical to help each child achieve its full potential [6]. The period is an exceptionally vulnerable time when undernutrition frequently starts to occur [7]. Insufficient quantity and nutrient-poor complementary diet coupled with unsanitary feeding practice lead to growth faltering, micronutrient deficiencies, and common childhood illnesses such as diarrhea [8], [9]. Globally, ensuring optimal complementary feeding can avert an estimated 100 000 childhood deaths per annum [10]. Yet, in the developing world there has been little progress in the implementation of interventions for improving complementary feeding practices [11].
Dietary diversity (DD) is a qualitative measure of food consumption that reflects household access to a variety of foods [12]. It has been recognized as a proxy measure for nutrient adequacy [13]. Minimum DD—proportion of children ages 6 to 23 mo who received food from four or more out of the standard seven food groups—is among the core infant and young child feeding (IYCF) indicators [14]. Studies indicated that DD in children is an important predictor of acute malnutrition, stunting, and micronutrient intake [10], [15], [16].
In Ethiopia, few studies have assessed the level of DD during the complementary feeding period and little evidence is available regarding its determinants especially in food-insecure areas. The Ethiopian Demographic and Health Survey (DHS) 2011 reported that only 5% of Ethiopian children had acceptable DD despite a higher proportion (50%) receiving the minimum recommended feeding frequency [2]. Secondary data analysis based on the recent Ethiopian National Food Consumption survey reported only 8.6% of children had acceptable DD [17]. A study conducted in an urban setting in northwest Ethiopia found that DD is affected by various factors including maternal education, media exposure, and backyard gardening [18].
Accordingly, the purpose of the present study was to assess the level and predictors of DD in children ages 6 to 23 mo in predominately food-insecure area of South Wollo, Ethiopia.
Section snippets
Study design
This is a secondary data analysis on the basis of a survey conducted in October 2014 in South Wollo zone, Amhara region, Ethiopia. The survey was done as a baseline evaluation of Alive & Thrive (A&T) and Concern Worldwide (CWW) IYCF program in the area. A&T is an initiative to save lives, prevent illness, and ensure healthy growth and development through improved breast-feeding and complementary feeding practices in Ethiopia.
Study setting
The study was conducted in 72 kebeles of South Wollo zone. A kebele is
Sociodemographic characteristics
The data from 2080 children were included in the analysis. About 18.2%, 19.4%, and 62.4% of the children were in the age groups of 6 to 8 mo, 9 to 11 mo, and 12 to 23 mo, respectively. The male-to-female ratio was 1.09.
In most cases (98.2%), data were collected from the mothers of the index children; whereas, in the remaining 1.8% other primary caregivers were interviewed. The mean (±SD) age of the respondents was 28.9 (±6.8) y. More than half (62.6%) had no formal education and 94.3%
Discussion
Results from the present study demonstrate that DD during the complementary feeding period is extremely low in South Wollo Zone. Although the DD of the children and their mothers were related, food groups such as legumes, fruits, and vegetables consumed by the mothers were not always provided to the children. It also indicated that, even in food-insecure area, exposure to nutrition education in different forms, husbands' engagement in child feeding and agricultural practices like backyard
Conclusions
The level of DD in the study districts is extremely low. Apart from improving the socioeconomic and household food-security status; increasing the exposure of mothers to nutritional education, promotion of husbands' involvement in IYCF, and implementation of nutrition-sensitive agriculture like home gardening and keeping poultry can significantly improve the quality of children's diet.
Acknowledgments
The authors acknowledge Alive and Thrives—FHI 360° for sponsoring the baseline study and for permitting to use the data for publication. They acknowledge Silvia Alayón (nutrition and monitoring advisor at A&T) and Kim Winnard (senior program director at A&T) for commenting on an earlier report from which this manuscript partly emanates.
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Cited by (0)
The survey was sponsored by Alive and Thrives (A&T)—FHI 360°. SG participated in the design and implementation of the survey, analyzed and interpreted the data, and drafted the manuscript. KB participated in the design and implementation of the survey and worked with SG in the analysis of the data. TB participated in the design and implementation of the survey. MT, Y Asrat, and Y Abebe conceived and designed the survey from which the study emanates. NR participated in the designing and implementation of the survey. All authors revised the draft manuscript critically for important intellectual content; and read and approved the final manuscript. The authors have no conflicts of interest to declare.