Minimum Dietary Diversity and Its Associated Factors Among Children of 6–23 Months in Rural, Ethiopia, 2023

doi:10.21203/rs.3.rs-4716612/v1

Download PDF

Article

Minimum Dietary Diversity and Its Associated Factors Among Children of 6–23 Months in Rural, Ethiopia, 2023

https://doi.org/10.21203/rs.3.rs-4716612/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background: Dietary diversity is a useful indicator of diet quality and nutrient adequacy, which plays an important role in children's growth and development. Meeting this standard of dietary diversity remains a challenge in developing countries. However, in Ethiopia, including the study area, there is limited evidence on dietary diversity and associated factors in children aged 6 to 23 months.

Objectives: To assess the prevalence of dietary diversity and associated factors among children aged 6-23 Months in rural, Ethiopia, 2023.

Methods: A Community -based cross-sectional study design was conducted from April 11, 2023 to May 20, 2023 among 597 study participants. Face-to-face interviews were conducted by structured questioners, and the data was entered into Epi-data version 3.1 software. Later, IBM SPSS version 27 was used to perform bivariate and multivariate logistic regression analyses. To check for multicollinearity, the tolerance test and variance inflation factors (VIF) were used. The Hosmer-Lemeshow goodness of fit test was used to assess model fitness. Adjusted odds ratios and their 95% confidence intervals were used to identify statistically significant factors at P values 0.05.

Result: The results showed that the prevalence of optimal dietary diversity was 35.5% [95% CI: 31.5, 39.7]. The study also found that factors such as Decision-making power (AOR: 2.46, 95% CI: (1, 24, 4.9)), participation in cooking demonstrations (AOR = 1.61, 95% CI (1.10, 2.363), attendance at ANC follow-ups (AOR = 5.027, 95% CI (2.02, 12.46)), have nutrition counseling (AOR=2.450, 95% CI, (1.32), 4.54), good food security (AOR=2.7, 95% CI, (1.8, 4.06), child growth and development-monitoring behavior (AOR=1.8, 95% CI: 1.24, 2.6) were significantly associated with unacceptable dietary diversity.

Health sciences/Health care

Health sciences/Medical research

Diversify

Dietary

optimal feeding

children aged between 6-23 months

Ethiopia

Dietary diversity is the sum of the food groups consumed by a person in a 24-hour period(1), The Dietary Diversity Score (DDS) was calculated by summing the number of food groups eaten daily and averaging it over the three days(2). The mean DDS for the 3 days is called the minimum adequacy score for diet variety. According to the United Nations International Children's Fund (UNICEF) and the World Health Organization (WHO), the following eight food groups are used to declare DDS: 1. breast milk; 2. Grains, roots, tubers and plantains; 3. Legumes (beans, peas, lentils), nuts and seeds; 4. Dairy products (milk, baby food, yogurt, cheese); 5. Meaty foods (meat, fish, poultry, offal); 6. Eggs; 7. Fruits and vegetables rich in vitamin A; and 8. other fruits and vegetables(3).

Diet diversity is an indicator of nutritional adequacy, which plays an important role in children's growth and development(4). The inability to maintain this optimal varied diet, defined by UNICEF and WHO as minimum dietary diversity, as a percentage of children aged 6 to 23 months who had consumed food and drink from at least five of eight defined food groups the previous day, is categorized according to its severity into the child food poverty category as follows: Severe child food poverty: when children under 5 years of age consumed food from zero, one or two of eight defined food groups the previous day, and moderate food child poverty when children under the age of 5 consume food from three food groups or four out of eight defined food groups the previous day(5).

The first 1,000 days of life, from the first day of pregnancy to the 24th month of the child, is a crucial time window for a child's health and development, as rapid physical development takes place. Children during this period are more susceptible to infection, have heightened sensitivity to biological programs, and are completely dependent on others for nutrition, care, and social interactions(6,7). The proportion of children who eat a minimally varied diet is almost twice as high in urban areas 39 % as in rural areas 23%. Over the past decade, disparities in food distribution and dietary diversity between children living in poorer and wealthier households have not narrowed(8). The double burden of malnutrition is a global challenge. Micronutrient deficiencies are associated with high levels of over- and under nutrition. It is estimated that 46% of children aged 6 to 23 months suffer from anemia caused by an inadequate and varied diet(9,10).

Data from UNICEF, WHO and the World Bank Group on the extent and trends of under nutrition in 2020 shows that more than half (54%) of all underdeveloped children under the age of five lived in Asia, while 40% lived in Africa, 69% of wasted children were found in Asia, 27% lived in Africa, while 45% of obese children lived in Asia and 24% in Africa. However, diet-related factors alone are responsible for about 45% of deaths in children aged 6 to 23 months(11).

According to the 2019 Ethiopia Population and Health Survey (EDHS) report, 37% of children under the age of 5 are stunted or underdeveloped, 7% are emaciated (thin for their height), 21% are underweight, and 2% are overweight. Almost all children born by age 2 (96%) were breastfed at some point. Minimum diet: Only 11% of the children aged 6 to 23 months received an acceptable minimum diet in the 24-hour recall, 14 percent of the children had a sufficiently varied of diet(12).

Ethiopia recognizes that children should be offered a varied of diet and follows the release of the Sequota Declaration to End Child Malnutrition(13). However, due to various factors, still now children dietary diversity is the public health concern at the national level in Ethiopia, therefore this study aims assess the prevalence of dietary diversity and associated factors among children aged 6- 23 months in rural Ethiopia.

Study area, design and Period

A community-based cross-sectional study design was from April 11, 2023 to May 20, 2023, in rural south west Ethiopia. The estimation population in this area is 46843, of which 22156 were males and 24687 were females and the total estimation number of children under two years were 2469. Major food crops in this area include maize, godere (taro root), and enset, while sorghum, teff, wheat, and barley are grown in significant quantities. Although cattle, sheep and poultry are produced in limited quantities, meat and milk are highly valued. Cash crops include fruits (bananas, pineapples, oranges) and spices (e.g. coriander and ginger); Honey is also an important local source. However, coffee is the most important source of income.

Source population and study population

The source population were all children aged 6 to 23 months live with their mothers/caregivers in the rural south west Ethiopia and the study population consisted of all mothers or caregivers with infants aged 6 to 23 months enrolled in the study from the study area.

Eligibility Criteria

Inclusion criteria: All children aged 6 to 23 months who had lived in the study area for at least the last 6 months were included.

Exclusion criteria: Seriously ill mothers/careers and mothers/careers with hearing impairments.

Sample Size Determination

Sample size was determined by using single and double population proportion formula and the largest sample size was taken.

A single population proportion was used the following assumption P= 42.3%(14),

Z = 95% confidence level 1.96, d = 0.05,

N= (1.96)2 (0.423) (1-0.423) / (0.05)2 = 375, including 10% of non–response rates and 1.5 design effect. N= 620.

Also double population proportion formula was used the following assumption Two-sided confidence level of 95%; Power of 80; 0.5 margins of error; and 10% of contingency non-response rate by using Epi Info Version 7 statistical software. See table 1

Table 1: Sample size calculation using different variables associated with Optimal DD.

Variables	Proportions of Dietary diversity		Level of confidence	Power	Exposed to the unexposed ratio	AOR	Design effect (1.5)	Non-response rate	Sample size	Reference
Availability of Media	Yes	P1=33.6%	95%	80	1	3.22	1.5	10	316	(15)
	No	P2=10.4%
GMP	Yes	P1 =74%	95%	80	1	2.7	1.5	10	314	(16)
	No	P2 =17.8%
PNC follow up	Yes	P1 =67%	95%	80	1	2.1	1.5	10	587	(16)
	no	P2=14 %

Finally 620 was taken the sample size for this study which were the largest sample to get representative study population.

Sampling Procedure and Techniques

Giedi Bench district was randomly selected from the south west Ethiopia regime and three rural kebeles (the small administrative unit of Ethiopia), namely Taste, Giedi Bench and Berehan Shay, were randomly selected. For each Keble, the sample size was assigned proportionally to the total number of children aged 6 to 23 months living in the study area. Households with at least one child (aged 6 to 23 months) were identified and coded and sample frames were formed. If there are more than children of the same age in the selected households (children aged 6 to 23 months) one was selected by lottery method.

Finally, study participants were identified from each selected Keble using a systematic random sampling method. The first respondent is selected using the lottery method, and subsequent respondents are determined using the sampling interval (k).

Operational Definition

Minimum dietary diversity : UNICEF and WHO define minimum dietary diversity as the percentage of children aged 6 to 23 months who consumed food and drink from at least five out of eight defined food groups in the previous day/24 hours. Then, meet dietary diversity is defined as consuming foods from at least five different food groups when optimal dietary diversity exists and when fewer than 5 food groups are considered unmeet MDD(3).

Minimum meal frequency: At least as often as the day before, the child is given solid, semi-solid or soft food (but also milk for children who are not breastfed). The minimum frequency is: 2 times for breastfed children aged 6 to 8 months, 3 times for breastfed children aged 9 to 23 months and 4 times for non-breastfed children aged 6 to 23 months(17).

Food Security: Households that do not have any of the conditions for food insecurity (access) or are only concerned but have rarely been classified as food secure in the past four weeks, or households with food secure diets that had fewer than the first two indicators of food insecurity(18,19).

Data Collection Tools and Procedures.

Data was collected by 10 health professionals and supervised by two individuals.

A structured and pre-tested questioner was used to collect the required information by face to face interviewing mother/ care givers and measuring the anthropometric measurement of children aged between 6-23 months.

The questionnaire covers children's socio-demographic characteristics, economic status, use of child and maternal health services, agricultural output, and household food security status.

Household food security status nine questions that quantify occurrence and frequency. It is measured using nine questions representing increasing degrees of severity and nine frequency-of-occurrence questions asking about changes in diet or food consumption behavior that households have made in the past 30 days due to limited resources. Participants received a score between 0 and 27 based on their answers to nine questions and the number of times they occurred over the past 30 days. A lower HFIAS score indicates better access to food and lower household food insecurity, while a high HFIAS score indicates a lack of food access and lack of food insecurity, adapted from previous literatures and FANTA(19).

Data on dietary diversity was collected using the WHO indicators to assess IYCF practices(5). Data on dietary diversity was collected using a 24-hour recall procedure; That is, mothers are asked to remember any foods given to their child in the 24 hours prior to the survey. The foods consumed were then divided into eight food groups: grain, tubers and roots; legumes and nuts; Fruits and vegetables; foods rich in vitamin A; eggs; meat and dairy products. Good dietary diversity is considered good for children who eat foods from 5 food groups.

Household wealth status was assessed after data collection of all household assets using the adapted EDHS instruments(12).

Data Quality Control

To assure data quality the following measure were taken: the questionnaire was prepared in English and then translated into Amharic by language expert and then back into English to check for consistency by the individual who was blind to the original version, Before data collection began, a pre-test was performed on 5% of not selected in to study area, Data collectors are trained and every step is tracked and monitored; the completeness of the questioner was checked on site and during data entry and the data collected are entered and verified using Epi-Data software version 3.1. Every effort is made to improve mothers' recall skills, and face-to-face interviews are conducted in a separate, private area to avoid social desirability and memory bias.

Data Processing and Analysis

The collected data was reviewed daily for completeness. Following that, every completed questionnaire was given a unique code, interred into EPI-DATA, and exported to IBM SPSS version 27 for analysis.

Descriptive analysis was used to investigate the socioeconomic characteristics of the respondents, and the findings were reported in frequency tables.

The outcome variable was recoded as either "sub-optimal" or "optimal dietary diversity". Those with acceptable dietary diversities were coded "1", whereas those with suboptimal dietary diversities were marked "0".

We created the family wealth index data using the principal component analysis approach and then computed the composite score. Finally, the household wealth quintiles were determined by assigning a household score to each household, rating each household in the community based on their score, and dividing the distribution into three equal categories: poor, middle, and rich.

The household Food Insecurity Access Scale was used to determine if a household was food insecure or not.

The Dietary Diversity (DDs) status of children aged 6-23 months was assessed by comparing the proportion of children who fed fewer than five main food categories to those who fed five or more major food groups out of eight food groups. Children who were fed less than five of the major food categories were considered to have suboptimal dietary variety.

The multicollinearity effect was assessed using the standard error. Only non-collinear variables were used in binary logistic regression to determine the potential relationship between each independent and dependent variable. Factors having a P-value ≤0.25 in bivariate analyses were selected for additional analyses using multiple logistic regressions to account all possible confounders and find factors substantially linked with the outcome variable. The study's model fitness was assessed using the Hosmer-Lemeshow goodness of fit test. The study found statistically significant associations with adjusted odds ratios (AOR) and 95% confidence intervals (CI) at P values ≤0.05.

Ethical Considerations

This study adhered to the principles outlined in the Declaration of Helsinki. Ethical clearance was obtained from the Mizan-Tepi University Institutional Health Research Ethics Review Committee (IHRERC) IRB 032/23. Additionally, a permission letter was acquired from Mizan-Tepi University and submitted to the regional health office. Voluntary written informed consent and signed informed consent was obtained from each child's mother or caregiver after a thorough explanation of the study's purpose, procedures, duration, and potential risks and benefits within the manuscript.

Data availability

The datasets used and/or analyses during the current study available from the corresponding author on reasonable request.

Socio-Demographic Characteristics of the Study Participants

A total of 597 study participant had involved in the present study with a response rate of 96%. From the total involved in the current study about 97.3% of mother or care giver were married, 51.8% of study participants had fewer than 5 family members and The majority of respondents (532 (89.1%)) have one child within 6-23 months. See table 2.

Table 2: Socio-demographic characteristics of study participants in rural, Ethiopia, 2023.

Variable	Category/Response	F	%
Religions	Orthodox	170	28.4
	Protestant	343	57.4
	Muslim	52	8.7
	Catholic	32	5.3
	Others	1	0.2
Ethnicity	Bench	487	81.6
	Amhara	24	4.0
	Oromo	11	1.8
	Keffa	75	12.6
	Others	0	0.0
Educational level of the Mothers/ caregiver	cannot reads and writes	182	30.5
	1-4 grade	83	13.9
	5-8 grade	185	31.0
	9-10 grade	121	20.3
	11-12 grade	26	4.4
	college and above	0	0.0
Father Educational Levels	cannot reads and write	48	8.0
	1-4 grade	43	7.2
	5-8 grade	230	38.5
	9-10 grade	100	16.8
	11-12 grade	64	10.7
	college and above	112	18.8
Occupation mothers or Care Givers	Housewife	406	68.0
	Farmer	101	16.9
	Merchant	53	8.9
	Government employee	37	6.2

Occupation of Husbands	Farmer	253	42.4
	Day Laborer	96	16.1
	Merchant	235	39.4
	Government Employ	13	2.2
	Others	0	0.0
Age of child	6-11 month	251	42
Age of child	12-23 months	346	58
Residence	Urban	210	35.2
Residence	Rural	387	64.8
Households decider	only my husband	9	1.5
	Both together	520	87.1
	Myself	68	11.4

Indoor/Home gardens	No	144	24.1
Indoor/Home gardens	Yes	453	75.9
Household food security status	Insecure	376	63.0
Household food security status	Secure	221	37.0
Household Wealth Status
	Lowest	194	33
	Second	68	11.4
	Middle	93	15.6
	Fourth	98	16.4
	Highest	141	23.6

Child's and maternal health seeking behavior.

About 55.8% of children aged between 6-23 months were fully immunized in the study area, and almost 98.7% of mothers had ANC follow-up during their last pregnancy. See table 3

Table 3: Children and maternal health seeking behavior

Variable	Response	Frequency	%
participating in cooking demonstrating	Yes	270	45.2
participating in cooking demonstrating	No	327	54.8
PNC service in the resent child	Yes	320	53.6
PNC service in the resent child	No	277	46.4
ANC	No	8	1.3
ANC	Yes	589	98.7
Child vaccinations status	Unvaccinated	0	0.0
	vaccinations for partial Age	264	44.2
	vaccinations for full ages	333	55.8
Child births order	1^st	107	17.9
	2^nd	26	4.4
	3^rd	131	21.9
	4^th	26	4.4
	5^th	307	51.4
Childhood illness in the last two weeks	No	493	82.6
	Cough	78	13.1
	Fever	13	2.2
	Diarrhea	13	2.2
Counseling professionals	No	3	0.5
Counseling professionals	Yes	594	99.5
GMP	No	316	52.9
GMP	Yes	281	47.1

Note: ANC: Antenatal Care, PNC: Postnatal Care

Children aged between 6-23 months feeding practice

Among all study participants, nearly all (99.8%) of the children aged between 6-23 months began breastfeeding within one hour after delivery. However, only 4.9% of them continued to be breastfed until they reached the age of 2 years. See table 4

Table 4: Children aged between 6-23 months feeding practice

Variable	Response	Frequency	%
Starts breast feeding within 1 hours	Yes	596	99.8
Starts breast feeding within 1 hours	No	1	0.2
Feeding Colostrum	Yes	517	86.6
Feeding Colostrum	No	80	13.4
weaning	Before 6 months	2
	After 6months	16	69.7
	at 1years	50	24.3
	at 23months	29	4.9
Breast feeding frequency per day	1-5,times	315	52.8
	5-10,times	147	24.6
	10,times,and,above	135	22.6
	Others	0	0.0
Breast feeding habit	when, she/he, cries	220	36.9
	As Childs need	363	60.8
	on, schedules	7	1.2
	continues Breast feeding	7	1.2
Supplementary feeding per day	1-2times	69	11.6
	2-4times	437	73.2
	5 times and above	91	15.2
food taboos	Yes	0	0.0
food taboos	No	597	100.0
Feeding habit	Bottle	120	20.1
	Cup, and spoon	415	69.5
	others with Hands	62	10.4

Dietary diversity score of children aged between 6-23 months

The overall prevalence of minimal acceptable dietary diversity (more than 5 food groups) among the study participants was 35.5% (95% CI: 31.5–39.7) during the previous 24 hours of the survey. The food groups most consumed by children aged between 6-23 months were vitamin A-rich foods (65%), other fruits and vegetables (60%), followed by grains and roots (58.6%). The least consumed food group by study participants were flesh foods. See fig 1

Factors associated with children aged between 6-23 months dietary diversity score

In multiple logistic regression, the variables significantly associated with unacceptable minimum dietary variety among children aged 6-23 months were identified at a p-value of 0.05: decision-making power, participation in cooking demonstrations, attendance at ANC follow-ups, nutrition counseling, food security status, and child growth and development-monitoring behavior.

In the current study, decision-making power was positively associated with adequate minimum dietary diversity in children aged between 6-23 months. Those children whose fathers and mothers made decisions together on major productive assets were 2.42 times more likely to have acceptable minimum dietary diversity than those whose parents did not make decisions together (AOR 2.42, 95% CI: 1.22, 4.70). Similarly, children who benefited from mother/caregiver participation in cooking demonstrations were 1.54 times more likely to achieve minimum acceptable dietary diversity compared to their counterparts (AOR 1.54, 95% CI: 1.06, 2.25).

Attendance at ANC follow-ups also showed an association in the present study. Children aged between 6-23 months whose mothers attended ANC follow-ups during the last pregnancy were 6.38 times more likely to be protected from poor dietary diversity compared to their counterparts (AOR 6.38, 95% CI: 2.6, 15.4). Similarly, nutrition counseling was positively associated with acceptable dietary diversity in children aged between 6-23 months. Children whose mothers or caregivers received nutrition counseling were 2.25 times more likely to achieve acceptable minimum dietary diversity than those whose mothers or caregivers did not receive nutrition counseling (AOR 2.25, 95% CI: 1.22, 4.16).

Household food security status also showed a significant association with minimum acceptable dietary diversity in children aged between 6-23 months. Children from food-secure households were 2.7 times more likely to have minimum acceptable dietary diversity compared with children from food-insecure households (AOR 2.7, 95% CI: 1.9, 4.06). Similarly, monitoring child growth and development also showed an association in the current study. Children from families that followed or monitored the growth and development of their children were 1.9 times more likely to achieve minimum acceptable dietary diversity compared to their counterparts (AOR 1.9, 95% CI: 1.34, 2.85). See table 5

Table 5: Both Bivariate and multivariable logistic regression analysis of factors associated with acceptable dietary diversity in children aged 6 to 23 months in south Ethiopia, 2023

Risk Factor variables	Category	Prevalence of MDD		COR (95% C.I.)	AOR (95% C.I.)
Risk Factor variables	Category	Optimal	Sub optimal	COR (95% C.I.)	AOR	P-Value
Who Decides on major purchase of the households	My husband Only	15	13	1.02(0.4, 2.6)	1.94(0.66, 5.54)	0.283
	Both together	171	350	2.41(1.33,4.39)	2.42(1.22, 4.70)	0.010
	Myself	26	22	1		Ref
Participating in cooking demonstrating	Yes	136	191	1.81(1.28,2.56)	1.54(1.06, 2.25)	0.022
Participating in cooking demonstrating	No	76	194	1	1	Ref
ANC follow up	Yes	30	7	8.9(3.8,20.6)	6.38(2.6, 15.4)	<0.001
ANC follow up	No	182	378	1		Ref
Received nutritional advices	Yes	29	24	2.38(1.38,4.2)	2.25(1.22,4.16)	0.009
Received nutritional advices	No	183	361	1		Ref
Taking Growth monitoring and promoting services	Yes	131	150	2.53(1.7, 3.57)	1.9(1.34, 2.85)	0.000
Taking Growth monitoring and promoting services	No	81	235	1		Ref
Food security	Yes	115	106	3.12(2.6,4.55)	2.77(1.9, 4.063)	<0.001
Food security	No	97	279	1	0.024

Poor nutritional variety in early life is a serious issue that can have long-term consequences. The ramifications of such a diet throughout the vital growth phases of infancy and early childhood can be far-reaching. This can lead to delayed growth, decreased immunity, and impaired cognitive development, potentially impairing academic achievement and earning ability in adulthood.

This study was conducted to determine the prevalence of minimum acceptable dietary diversity and its associated factors among children aged between 6-36 months. The result of the current study indict that the overall prevalence of minimal diet diversity among children aged 6 to 23 months was 35.5±4% (95% CI 31.5, 39.7). This finding indicate that suboptimal level of dietary diversity score.

The prevalence of the current study is slightly higher than the finding of study conducted in Gedeo zone(20), and east Gojjam, North West Ethiopia(21). The possible reason might be the time when the research were conducted. Mean that the study were conducted before 4 years and three years respectively. And another explanation might be behavioral characteristics of households and socio cultural condition.

Decision-making power was positively associated with adequate minimum dietary diversity in children aged between 6-23 months in the present study. Children from Fathers and mothers made decisions together on major productive assets were more likely to have acceptable minimum dietary diversity than those whose parents did not make decisions together. This is in line with study conducted in different area(22–25). The possible explanation are equal decision-making power between women and their husbands can lead to enhanced influence over household nutrition choices, potentially resulting in improved dietary diversity for their children. Furthermore, women’s empowerment may grant them greater access to resources, thereby elevating the quality and variety of food accessible to children.

Attendance at ANC follow-ups and nutrition counseling during the last pregnancy was also showed positively associated with children adequate dietary diversity. Children aged between 6-23 months from mothers’ who attending ANC follow ups and had nutrition counseling during the last pregnancy were more likely to had good dietary diversity as compared whit their counterpart. This finding is in line with study conducted in Nepal(26). The possible explanation might be mothers who attend ANC follow-up appointments receive more information and education about healthy pregnancy nutrition and the importance of nutritional diversity for their children's health. This understanding may drive them to offer their children with a more diversified diet, so increasing their nutritional variety.

Food security status also positively associated with adequate dietary diversity of children aged between 6-23 months in the present study. Children who from household food secure were more likely to had adequate dietary diversity than children who from household food insecure. This is similar with other study conducted in different area(27–30). Children from food-secure families are more likely to have a diverse diet because their parents have constant access to a wide range of foods. This promotes a more appropriate intake of key nutrients. On the other hand, families with food insecurity may struggle to procure enough food, let alone a varied selection of foods, resulting in low dietary diversity and associated nutritional deficiencies.

Child growth and development-monitoring behavior also shows association with children aged between 6-23 months adequate dietary diversity. Children who get monitoring from a mother or guardian about their growth and development are more likely to consume a diverse diet than their competitors. This is in line with other study(31,32). This might be due to parental participation frequently involves nutrition advice, which can lead to healthier eating choices and a wider range of foods ingested.

Furthermore, the cross-sectional research design makes it difficult to demonstrate a cause-and-effect link between predictors and outcome variables. Furthermore, recall bias has possible limits that may have influenced the accuracy of the information, particularly in terms of 24-hour dietary group recall.

Food and Agriculture Organization. Guidelines for measuring household and individual dietary diversity [Internet]. Fao. 2011. 1–60 p. Available from: www.foodsec.org
Abdullah Al Mamun M, Ghosh S, Halima O, Parvez Sabuj M, Chowdhury R, Ruhul Kabir M, et al. Assessment of dietary diversity of mothers (0-2 years childbearing) in Noakhali District of Bangladesh. J Noakhali Sci Technol Univ [Internet]. 2020;4(2):1–11. Available from: https://www.researchgate.net/publication/349180744
UNICEF. Child food poverty : A nutrition crisis in early childhood. Unicef [Internet]. 2022;1–16. Available from: https://ecdan.org/download/childhood-poverty-report-2022-unicef%0A
Ba DM, Ssentongo P, Gao X, Chinchilli VM, Richie JP, Maiga M, et al. Prevalence and determinants of meeting minimum dietary diversity among children aged 6–23 months in three sub-Saharan African Countries: The Demographic and Health Surveys, 2019–2020. Front Public Heal. 2022;10.
World Health Organisation; UNICEF. Indicators for assessing infant and young child feeding practices [Internet]. Vol. WHA55 A55/, World Health Organization. 2021. 19 p. Available from: https://creativecommons.org/licenses/by-nc-sa/3.0/igo%0Ahttp://apps.who.int/iris/bitstream/handle/10665/44306/9789241599290_eng.pdf?sequence=1%0Ahttp://whqlibdoc.who.int/publications/2008/9789241596664_eng.pdf%5Cnhttp://www.unicef.org/programme/breastfeed
Less A, Months T, Zone M, Edris MM, Atnafu NT, Abota TL. Magnitude and Determinants of Exclusive Breast Feeding Among Children Age Less Than 23 Months in Bench Maji Zone , Southwest Ethiopia : Cross Sectional Study. Res Gate. 2019;(April):1–6.
Keeley B, Chief E, Little C, Vrolijk K, Analyst D, Wauchope S, et al. Children , food and nutrition.
Index LH. G lobal hunger index. 2019;(October).
Wells JC. Europe PMC Funders Group The double burden of malnutrition : aetiological pathways and consequences for health. 2022;395(10217):75–88.
Tarekegn BT, Assimamaw NT, Atalell KA, Kassa SF, Muhye AB, Techane MA, et al. Prevalence and associated factors of double and triple burden of malnutrition among child-mother pairs in Ethiopia: Spatial and survey regression analysis. BMC Nutr [Internet]. 2022;8(1):1–12. Available from: https://doi.org/10.1186/s40795-022-00528-5
UNICEF/WHO/WORLD BANK. Levels and trends in child malnutrition UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates Key findings of the 2021 edition. World Heal Organ [Internet]. 2021;1–32. Available from: https://www.who.int/publications/i/item/9789240025257
Ethiopian Public Health Institute (EPHI), ICF. Ethiopia Mini Demographic and Health Survey 2019: Final Report [Internet]. 2021. 1–207 p. Available from: https://dhsprogram.com/pubs/pdf/FR363/FR363.pdf
Ojewunmi EA. Implementation Plan ( 2016 – 2030 ). Int J Innov Sci Res Technol. 2020;5(7):1504–10.
Forsido SF, Tsegaye NK, Belachew T. Complementary foods in Southwest Ethiopia : diversity , composition and nutrient adequacy “ Global food security and food safety : The role of universities ” Complementary Foods in Southwest Ethiopia : Diversity , Composition and Nutrient Adequacy. 2018;(June 2019):37213.
Temesgen H, Yeneabat T, Teshome M. Dietary diversity and associated factors among children aged 6–23 months in Sinan Woreda, Northwest Ethiopia: a cross-sectional study. BMC Nutr. 2018;4(1):1–8.
Worku T, Gonete KA, Muhammad EA, Atnafu A. Sustainable under nutrition reduction program and dietary diversity among children’s aged 6-23 months, Northwest Ethiopia: Comparative cross-sectional study. Int J Equity Health. 2020;19(1):1–11.
Frances E.ThompsonAmy F.Subar. Data4Diets: Building Blocks for Diet-related Food Security Analysis About Data4Diets. Int Diet Data Inddex [Internet]. 2013;(February):5–46. Available from: https://inddex.nutrition.tufts.edu/data4diets.%0Ahttp://dx.doi.org/10.1016/B978-0-12-391884-0.00001-9
Girma A, Genetu A, Ayalew E, Getachew D. Determinants of dietary practice among pregnant women at the public hospitals in Bench-Sheko and Kaffa Zones, Southwest Ethiopia. BMC Nutr [Internet]. 2022;8(1):1–12. Available from: https://doi.org/10.1186/s40795-022-00588-7
Coates J, Bilinsky P, Coates J. Household Food Insecurity Access Scale ( HFIAS ) for Measurement of Food Access : Indicator Guide VERSION 3 Household Food Insecurity Access Scale ( HFIAS ) for Measurement of Food Access : Indicator Guide VERSION 3 [Internet]. 2007. Available from: https://www.fantaproject.org/sites/default/files/resources/HFIAS_ENG_v3_Aug07.pdf
Keno S, Bikila H, Shibiru T, Etafa W. Dietary diversity and associated factors among children aged 6 to 23 months in Chelia District, Ethiopia. BMC Pediatr. 2021;21(1):1–10.
Assefa D, Belachew T. Minimum dietary diversity and associated factors among children aged 6-23 months in Enebsie Sar Midir Woreda, East Gojjam, North West Ethiopia. BMC Nutr [Internet]. 2022;8(1):1–10. Available from: https://doi.org/10.1186/s40795-022-00644-2
McKenna CG, Bartels SA, Pablo LA, Walker M. Women’s decision-making power and undernutrition in their children under age five in the Democratic Republic of the Congo: A cross-sectional study. PLoS One. 2019;14(12):1–19.
Aboagye RG, Donkoh IE, Okyere J, Seidu AA, Ahinkorah BO, Yaya S. Can women empowerment boost dietary diversity among children aged 6–23 months in sub-Saharan Africa? Trop Med Health [Internet]. 2024;52(1). Available from: https://doi.org/10.1186/s41182-024-00579-3
Abreha SK, Walelign SZ, Zereyesus YA. Associations between women’s empowerment and children’s health status in Ethiopia. PLoS One [Internet]. 2020;15(7):1–24. Available from: http://dx.doi.org/10.1371/journal.pone.0235825
Bliznashka L, Udo IE, Sudfeld CR, Fawzi WW, Yousafzai AK. Associations between women’s empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data. PLoS Med [Internet]. 2021;18(9):1–30. Available from: http://dx.doi.org/10.1371/journal.pmed.1003781
Na M, Aguayo VM, Arimond M, Dahal P, Lamichhane B, Pokharel R, et al. Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014. Matern Child Nutr. 2018;14(October 2017):1–13.
Ahmed JA, Sadeta KK, Lembo KH. Complementary Feeding Practices and Household Food Insecurity Status of Children Aged 6-23 Months in Shashemene City West Arsi Zone, Oromia, Ethiopia. Nurs Res Pract. 2022;2022.
Bwalya R, Chama-Chiliba CM, Malinga S, Chirwa T. Association between household food security and infant feeding practices among women with children aged 6–23 months in rural Zambia. PLoS One. 2023;18(10 October):1–16.
Elolu S, Agako A, Okello DM. Household food security, child dietary diversity and coping strategies among rural households. The case of Kole District in northern Uganda. Dialogues Heal [Internet]. 2023;3(July):100149. Available from: https://doi.org/10.1016/j.dialog.2023.100149
Adugna G, Egata G, Fufa DA, Desta DT. Effect of nutrition education on improving dietary diversity of children aged 6–23 months in Horo district, Oromia region, Ethiopia. Hum Nutr Metab. 2024;35(October 2022).
Haque S, Salman M, Hossain MS, Saha SM, Farquhar S, Hoque MN, et al. Factors associated with child and maternal dietary diversity in the urban areas of Bangladesh. Food Sci Nutr. 2024;12(1):419–29.
Waters HR, Penny ME, Creed-Kanashiro HM, Robert RC, Narro R, Willis J, et al. The cost-effectiveness of a child nutrition education programme in Peru. Health Policy Plan. 2006;21(4):257–64.

No competing interests reported.

Download PDF

Reviews received at journal
03 Sep, 2024
Reviews received at journal
02 Sep, 2024
Reviews received at journal
02 Sep, 2024
Reviews received at journal
19 Aug, 2024
Reviewers agreed at journal
12 Aug, 2024
Reviewers agreed at journal
11 Aug, 2024
Reviewers agreed at journal
11 Aug, 2024
Reviewers agreed at journal
10 Aug, 2024
Reviewers agreed at journal
09 Aug, 2024
Reviewers agreed at journal
09 Aug, 2024
Reviewers agreed at journal
08 Aug, 2024
Reviewers agreed at journal
08 Aug, 2024
Reviewers invited by journal
08 Aug, 2024
Editor assigned by journal
07 Aug, 2024
Editor invited by journal
11 Jul, 2024
Submission checks completed at journal
11 Jul, 2024
First submitted to journal
10 Jul, 2024

You are reading this latest preprint version

Minimum Dietary Diversity and Its Associated Factors Among Children of 6–23 Months in Rural, Ethiopia, 2023

Status:

Version 1

Abstract

Figures

Introduction

Methods and materials

Study area, design and Period

Source population and study population

Eligibility Criteria

Sample Size Determination

Sampling Procedure and Techniques

Operational Definition

Data Collection Tools and Procedures.

Data Quality Control

Data Processing and Analysis

Ethical Considerations

Results

Socio-Demographic Characteristics of the Study Participants

Child's and maternal health seeking behavior.

Children aged between 6-23 months feeding practice

Dietary diversity score of children aged between 6-23 months

Factors associated with children aged between 6-23 months dietary diversity score

DISCUSSION

References

Additional Declarations

Status:

Version 1