The association between dietary diversity and anthropometric indices of children aged 24-59 months: A cross-sectional study in northern Ghana

Abstract

The quality of diet has been shown to influence the nutritional status of children and women in some developing contexts. However, studies on the association between diet quality and the nutritional status of children aged 24-59 months are scanty in sub-Saharan Africa. More so, the conclusions from the few studies that are available are inconsistent. The objective of this study was to determine the association between the dietary diversity score (DDS) and the nutritional status of children aged 24-59 months in the Tolon District of Ghana. The study population included 200 child-mother pairs, randomly selected from 2 large rural communities in the Tolon district of Ghana. A single qualitative 24-hour recall (24HR) and semi-structured questionnaires were used to collect children’s data through face-to-face interviews with their mothers/caregivers. Anthropometry measures were used to define wasting (WHZ < -2SD), underweight (WAZ < -2SD) and stunting (HAZ < -2SD). A summated DDS was based on the Food and Agriculture Organization’s 13 food groupings. Multiple linear regression models, adjusting for potential confounding variables (including the child’s age, sex, birth order, sickness, mother’s age, literacy and occupation, paternal age, occupation and household size, wealth and food security) were fitted to analyse the association between DDS and nutritional status (WHZ, WAZ and HAZ). The prevalence rates of stunting, underweight and wasting among the sampled children were 58.3%, 20.3% and 4.2%, respectively. The mean DDS was 6.3 ± 1.2 out of a possible maximum score of 13, with the dietary pattern mostly plant foods with little consumption of animal source foods. There was a significant positive association between DDS and WHZ (β=0.16, P=0.03) and adjusting for potential confounding variables did not change the observed association. The association between DDS and WAZ was significantly positive only after adjusting for confounding variables (β=0.17, P=0.01). Although positive, the association between DDS and HAZ was not statistically significant in both crude (β=0.03, P=0.73) and adjusted (β=0.10, P=0.29) models. The high prevalence of stunting and underweight among the children requires urgent attention from the ministry of health and its development stakeholders. The findings of the present study suggest improvement in dietary diversity may be an effective approach to improving wasting and underweight during the life phase when young children are completely reliant on family meals. Sensitization programmes on dietary diversification need to be strengthened in child-welfare clinics. Intervention programmes such as backyard gardening, small ruminant rearing and income-generation activities may improve access to a diverse diet. Keywords: Dietary diversity, wasting, stunting, underweight, weight-for-height, weight-for-age, height-for-age