Child Dietary Diversity Score Research Articles

Socio-demographics, dietary diversity score, and nutritional status of children aged 2–5 years: A cross-sectional study of Indonesian coastal areas

BackgroundClimate change has negatively impacted both food security and food diversity, including malnutrition (stunting, wasting, and underweight), especially among children in coastal areas. The dietary diversity score (DDS) is a good indicator used to assess the quality of food for children. This study aimed to investigate the association between socio-demographic characteristics, DDS, and nutritional status in children aged 2–5 years in the coastal area of Demak, Indonesia. MethodsA cross-sectional study was conducted on 130 households with children aged 2–5 years living in the coastal area of Demak from April to July 2022. The socio-demographic characteristics were determined by interviewing the mother or child caregiver, followed by anthropometric measurements of the children. The DSS was calculated based on the 24-h food recall method. Descriptive statistics, independent samples t-test, and Chi-square were used for statistical analysis. ResultsThe mean age of the subjects was 3.11 ± 0.93 years (girl 46.9% and boy 53.1%). Maternal education was significantly associated with children's DDS (P = 0.016). There was a significant association between the history of acute respiratory infection (ARI) and nutritional status based on HAZ (P = 0.023), and there was also a significant association between exclusive breastfeeding history and family type with nutritional status based on WHZ (P < 0.05). ConclusionThe study indicated a significant association between socio-demographic factors (mother's education, ARI history, exclusive breastfeeding history, and family type) with DDS and children's nutritional status in Demak.

Critically High Burden of Acute Malnutrition and Its Associated Factors Among Children Under 5 Years in the Rural Settings of Southern Ethiopia.

Globally, acute malnutrition threatens the lives of several million children under 5 years of age. Malnutrition affects the social, economic, and medical aspects of all countries. In Ethiopia, acute malnutrition is not decreasing at the intended rate for unclear reasons. This study aimed to assess the burden of acute malnutrition and its associated factors among children under 5 years of age in a rural setting of southern Ethiopia. A community-based cross-sectional study was conducted from January to March 2022. A multistage sampling technique was used to select 421 children. Mothers/caretakers were interviewed using interviewer-administered questionnaire, while their children's height/length and weight were measured. Logistic regression analyses were used and presented as the crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence intervals (CI). The burden of acute malnutrition among children under 5 years of age in the study area was 22.6% (95% CI = 18.5-26.8). Fathers with primary education (AOR = 4.48; 95% CI = 1.93-10.39), households with improper solid waste disposal (AOR = 2.54; 95% CI = 1.11-5.82), not usually sleeping under insecticide-treated bed net (ITN) (AOR = 1.79; 95% CI = 1.01-3.19), unacceptable children dietary diversity score (DDS) (AOR = 2.56; 95% CI = 1.28-5.14), and unacceptable household DDS (AOR = 2.26; 95% CI = 1.02-5.00) were factors associated with acute malnutrition. The prevalence of acute malnutrition among children was critically high. Upgrading paternal educational status, encouraging safe solid waste disposal, ensuring consistent use of ITN, and improving both child and household DDS should be stressed.

Access to food markets, household wealth and child nutrition in rural Cambodia: Findings from nationally representative data.

Access to informal fresh food markets plays a vital role in household food security and dietary quality in transitioning rural economies. However, it is not well understood if market access also improves child nutrition and if the improvement applies to all socioeconomic groups. In this secondary research study, we combined a national listing of food markets (n = 503) with a national household survey to examine the associations of market access with diet and height across wealth groups in children aged 6 to 23 months in rural Cambodia. All children under two years of age with dietary data (n = 1537) or anthropometry data (n = 989) were selected from the household survey. Food markets were geocoded using Google Maps or villages' geographical coordinates publicly available in the Open Development Mekong data platform. Regression calibration was then used to estimate household distance to the nearest market. Descriptive results indicated a highly uneven distribution of food markets with median household distance to the nearest markets ranging between 4 km (IQR: 3-8 km) in the lowland areas and 9 km (IQR: 4-17 km) in the highland areas. Results from the multivariate linear regressions showed that distance to the nearest market was modestly associated with child dietary diversity score (β: -0.17; 95% CI: -0.29, -0.05) but it was not related to child height-for-age z-score, and that household wealth did not modify the associations between distance to markets and child dietary diversity score. These findings suggest that improving access to food markets alone might not lead to meaningful improvement in child diet. Detailed surveys on household food acquisition are needed to clarify the role of food markets relative to other food sources such as subsistence fisheries, subsistence gardening and mobile food traders.

Prevalence and determinants of stunting among children under 5 years in remote Nepal

AbstractIntroductionThe growth and development of an individual is greatly influenced by their nutritional state during the first 5 years of life. Stunted growth and suboptimal weight gain remain major public health concerns during the most critical stages of growth and early childhood development. This study aims to assess the prevalence of stunting among children under 5 years of age and identify its associated factors in remote district of Nepal.MethodsWe conducted a survey with 487 mothers of children under 5 years of age in a remote area of Nepal. Smartphones were installed with KoBocollect software to collect the data. Trained health researchers collected the data including the anthropometric measurement (height, weight and mid‐upper arm circumference, MUAC) for assessment of the nutritional status. We followed World Health Organization guidelines for the anthropometric measurement and calculated the Z‐score using Emergency Nutrition (ENA) software. Regarding the questions related to dietary diversity, we used a validated questionnaire: household dietary diversity score, child dietary diversity score and women dietary diversity score. We analysed all the data from the survey using SPSS version 24. We performed descriptive and multivariable analyses to find the nutritional status and factors associated with stunting.ResultWe found a high prevalence of stunting, that is, 56.7% among children under 5 years of age. Sociodemographic variables like age, sex of the child and ethnicity were significantly associated with the prevalence of stunting. Male children (60.7%) were more likely to be stunted compared to females (51.8%). We found that children from the Brahmin/Chhetri ethnic group were more likely to be stunted compared to children from Dalit and Janajati. Mothers who delivered their youngest child by skilled health personnel were less likely to have their children to be stunted. Similarly, children aged 24–59 months were 2.5 times more likely to be stunted than those aged 6–23 months.ConclusionStunting among children under 5 years of age is very high in the remote district of Nepal. Sex, age of the child, ethnicity and delivery by a health professional were associated with the prevalence of stunting. There is a need for awareness and public health intervention to reduce the prevalence of stunting and improve the nutritional status of children under 5 years of age in remote districts of Nepal. Furthermore, assessment of the nutritional status of children in other remote districts of Nepal is important.

Agricultural production diversity, child dietary diversity and nutritional status in poor, rural Gansu Province of China.

Research has shown mixed findings on the link between production diversity and household dietary diversity. The question is whether this link holds for children. In this study we examine the relationship between household's agricultural production diversity and child dietary diversity, and between production diversity and child nutritional status. Smallholder farm households (n = 1067) and children (n = 1067) aged 3-16 years from two then nationally designated poverty counties in Gansu Province of China were interviewed in 2019. Production diversity was assessed with the production richness score and production diversity score. Production diversity was calculated from agricultural production data covering a period of 12 months. Child dietary diversity was assessed with food variety score (FVS) and dietary diversity score (DDS). DDS was calculated based on 9 food groups using a 30-day recall method. Data were analysed using Poisson and Probit regression models. We find that both agricultural production richness score and revenue generated from selling agricultural products are positively associated with food variety score, with the relationship being stronger for the latter. Moreover, production diversity score is positively associated with children's dietary diversity score whereas negatively associated with their probability of being stunted, but not with their probabilities of being wasted or zinc deficient. Household social economics status were also positively associated with child dietary diversity.

Prevalence and associated factors of stunting and thinness among primary school-aged children in Gudeya Bila district, West Ethiopia: a cross-sectional study

ObjectivesThis study aimed to assess the prevalence and associated factors of stunting and thinness among primary school-age children in the Gudeya Bila district.Methods and analysisA community-based cross-sectional study was conducted...

Association between consumption of edible insects with dietary diversity, and household food and nutrition security in Southern Zimbabwe

Edible insects are nutritious with potential to improve nutritional outcomes and livelihoods in low-income countries. However, it is not clear whether consumption of edible insects is positively correlated with improved dietary diversity and food security indicators. Therefore, this cross-sectional study was designed to investigate the relationship between consumption of edible insects and diet diversity and food security indicators among children and adults from Gwanda district, Matabeleland province in Southern Zimbabwe. The survey collected data on the following; household sociodemographic characteristics, household dietary diversity score (HDDS), food consumption score (FCS), and child dietary diversity score (CDDS). Logistic regression was used to examine the associations between edible insect consumption and food security indicators. A total of 303 households were surveyed. A high proportion were edible insect consumers (80.9%) and the rest non-consumers (19.1%). The most consumed insect was mopani worms (Gonimbrasia belina, madora, amacimbi) (74.8%). The consumption of mopani worms was highest in the age group 20-49 years (34.4%) and significantly associated with being married and age of the household head. There was no difference between the mean CDDS for consumers (5.9±1.7) and for non-consumers (6.0±2.0) (p=0.802). The median (IQR) FCS for consumers was lower at 49 (35, 65) than for non-consumers 53 (36.5, 64). This difference was not statistically significant (p=0.526). There also was no difference between the average HDDS for consuming households (6.2±1.7) and for non-consuming households 6.2±1.5 (p=0.866). There was no significant association between consumption of edible insects and CDDS (p=0.802), HDDS (p=0.866), and FCS (p=0.585). In conclusion, this study showed that Gonimbrasia belina (mopani worms, madora, amacimbi) were the commonly consumed insect mostly as relish due to their palatable taste. Overall, the consumption of edible insects did not seem to improve diet diversity and food security indicators in this setting. National level studies with bigger sample sizes that investigate the contribution of edible insects to overall nutrient intake and dietary diversity are required. Furthermore, interventions to promote the consumption of edible insects, including their commercialization should adopt a social ecological approach to maximise impact. Key words: Entomophagy, food security, mopani worms, stunting, gender, Zimbabwe

Parental food neophobia, feeding practices, and preschooler’s food neophobia: A cross-sectional study in China

This study explores the relationship between parental food neophobia, feeding practices, and preschoolers' food neophobia in China. Methods: A cross-sectional study was conducted among 1616 pairs of preschoolers and their parents. Electronic questionnaires were conducted to collect information about social and demographic characteristics, scores of food neophobia among both children and their parents, parents' feeding patterns and children's dietary quality. Results: Children's average food neophobia score was 23.73 ± 4.45. There was a positive correlation between parental food neophobia score (β: 0.154; 95%CI: 0.113, 0.195), pressure to eat (β: 0.694; 95%CI: 0.423, 0.964), postpartum breastfeeding initiation (β: 0.010; 95%CI: 0.002, 0.018), and children's score of food neophobia. However, parental modeling (β: -0.470; 95%CI: -0.732, −0.207) and the frequency of children eating with their families at home (β: -0.407; 95%CI: -0.707, −0.108) were negatively associated with children's food neophobia scores. The consumption frequencies of vegetables (P < 0.001), fruits (P < 0.001), domestic animals and poultry (P < 0.01), aquatic products (P < 0.05), beans and their products (P < 0.01), eggs (P < 0.05) and nuts (P < 0.05) and children's dietary diversity score (P < 0.001) are negatively associated with children’ food neophobia score. While the consumption frequencies of fast food (P < 0.001), sweets (P < 0.01) and puffed/fried food (P < 0.001) were positively associated with children's food neophobia. Conclusion: Chinese preschoolers' food neophobia needs more attention because children with high food neophobia tend to have lower dietary quality. Children whose parents have high-level food neophobia should be the focus of early prevention. Earlier postpartum breastfeeding, more use of parental modelling, less pressure to eat and higher frequency of children eating with families are helpful to reduce the incidence of children's food neophobia.

Sustainable aquatic food systems: Multisectoral analysis of determinants of child nutrition in coastal Kenya

Marine foods produced by small-scale fishers can make vital contributions to sustainable, healthy food systems with multisectoral considerations of public health nutrition, gender equity, economics, and marine ecology. This pilot study aimed to map the multidimensional determinants of fish food security and young child nutrition in four coastal communities of Kenya with a view toward designing a large intervention trial. We compared anthropometric and dietary diversity indicators of children under 5 years in fishing vs. non-fishing households. Mixed methods included household surveys, 24-h recalls for dietary intake, and anthropometric measures of children. Child dietary diversity score (CDDS) and height-for-age Z (HAZ) were primary outcomes tested in ordinary least square regression modeling. Stunting was widely prevalent (20.2%), as were morbidities for acute diarrhea (29.0%) and fever (46.5%), with no statistically significant differences in fishing compared to non-fishing households. High proportions of children showed nutrient intake inadequacies for vitamins A, C, and E, iron and zinc; &amp;lt;50% met requirements for all nutrients except protein, which was derived primarily from plant-based foods. Regression modeling showed children living in fishing households were associated with lower CDDS. Maternal education, maternal body mass index (BMI), and household livelihood diversity were positively associated with both CDDS and HAZ, while child morbidities and north coast (of Mombasa) residence showed negative associations. Our findings highlight nutritional vulnerabilities within a coastal food system of Kenya and the need to involve multiple sectors—education, environment, health, finance, communications, and governance and policy—in deriving solutions.

Impact evaluation of a community nutrition and livelihood program on child nutrition in rural Bangladesh.

Given the high prevalence of child undernutrition in Bangladesh, multi-sectoral approaches involving livelihood promotion have potential to mitigate the burden of undernutrition. This study examined the impact of an economic development (ED) program providing poultry assets, gardening skillsand saving training added to the Positive Deviant (PD)/Hearth program (PDH/ED), compared toPD/Hearth only (PDH). A total of 1029 children who attended PD/Hearth sessions in September-November 2018 at 6-13 months of age were enrolled in the cohort study in July-August 2019. The cohort, comprised of 532 children in the PDH/ED group and 593 children in the PDH group, was reassessed in November 2020. The program impact on child nutrition, food security, crop production, dietary qualityand household income was estimated using a difference-in-differences approach accounting for the sociodemographic differences between PDH/ED and PDH groups. Compared tothe PDH group, the PDH/ED group showedincreases in child dietary diversity score(DDS) (+0.32), child minimum dietary diversity (13.7 percentage points [pp]), and maternal DDS(+0.28) (all p < 0.05). From 2019 to 2020, the PDH/ED households improved food security by 12.6 pp and diversified crop production (bananas (9.7 pp), papaya (11.1 pp), carrots (3.8 pp)and lemons (5.9 pp)), and increased the proportion of annual income ≥60,000 Taka by 12.4 pp and last month income ≥5000 Taka by 7.8 pp, compared toPDH group (all p < 0.05). However, there was no impact on child nutritional status, morbidity, livestockownership and total annual/last income. Incorporating an ED program into nutrition programming could benefit food security and dietary diversity in rural Bangladesh.

Association Between Nutrition Social Behavior Change Communication and Improved Caregiver Health and Nutrition Knowledge and Practices in Rural Tanzania.

BackgroundEfforts to improve infant and young child feeding practices include the use of nutrition behavior change communication among caregivers of children under 5 years. We assessed the association between monthly participation in community-level nutrition group meetings on caregiver health and nutrition knowledge and practices (KPs).MethodsData from a community-based cross-sectional survey conducted in the Eastern and Southern Highland Zones of Tanzania were used. Indices were developed for caregivers' knowledge of nutrition, health and childcare, household (HDD) and young child dietary diversity (CDD), and vitamin A (VA) intakes. The comparison of means and proportions was assessed using Student's t-test and the Chi-square test, respectively, between the caregivers participating in nutrition group meetings and non-participants. The impact of the number of nutrition meeting attendance on caregiver KPs scores was examined using multiple regression.ResultsOf 547 caregivers surveyed, 49.7% attended nutrition group meetings and received information on nutrition social behavior change communication (SBCC). Overall, 28% of participating women had a moderate level of nutrition knowledge, 62% had a high level of VA knowledge, and 57% had a high level of health and childcare knowledge. Participation in nutrition group meetings was significantly associated with the health and childcare knowledge score (HKS), HDD and CDD scores, and household and young child VA intake; the magnitude of the associations was greater for caregivers who attended at least four meetings.ConclusionThe findings emphasize the need for programs that seek to address the issues present in the use of nutrition SBCC at the community level to improve maternal or caregiver KPs and subsequently the nutrition status of infants and young children.

Dietary Diversity Among U.S. Infants and Toddlers: Associations With Caregiver Sociodemographic Characteristics

ObjectivesThe introduction to a variety of foods during the first two years of life is recommended to ensure adequate intake of essential nutrients required for optimal growth and development. The purpose of this study was to assess dietary diversity among children 4–26 months and to identify associations between caregiver sociodemographic characteristics and child dietary diversity.MethodsCaregivers, recruited via Qualtrics panels, reported on how often foods (n = 57) were offered to their child in the prior month using a food frequency questionnaire designed to assess usual intakes of infant/toddler foods. Foods were grouped (vegetables, fruits, grains, meat and meat alternatives, snacks, sweets, and dairy) and summed into a 7-point dietary diversity score (DDS). Tertiles of dietary diversity were used to classify children by age into low, average, and high diversity. Ordinal logistic regression tested the association between caregiver sociodemographic factors (age, race/ethnicity, household income, partner status, household size) and tertile of child DDS.ResultsCaregivers (n = 344; 70.3% female; M ± SD age 31.5 ± 6.3 y), identified as White (73%), and had attended at least some college (74%). The average DDS for the sample was 4.2 ± 2.35. Among infants (< 12 months; n = 150), 50.8% received breastmilk, 39% consumed 0–2 food groups and 42.0% consumed ≥ 5 food groups (DDS 3.6 ± 2.5). Among toddlers (>12 months; n = 194), 24.8% received breastmilk, 18% consumed 0–2 food groups and 62% consumed ≥ 5 food groups (DDS 4.7 ± 2.1). A Pearson's Chi-Squared test revealed a significant association between breastfeeding status and DDS (c 2 (2) = 8.272, P < 0.05). 23% of children who were receiving breastmilk were classified as low DDS compared with 35% of children not receiving breastmilk. Children from households with ≥ 5 members had 2.7 (95% CI, 1.44 to 4.95) times the odds of high DDS than children from households with ≤ 2 members (P < 0.01). No other caregiver sociodemographic factors were significantly associated with child DDS.ConclusionsCaregiver sociodemographic factors, other than household size, were not related to children's DDS. Given the importance of dietary variety on nutrition adequacy, future work should consider other factors that might influence DDS among infants and toddlers.Funding SourcesThis project was unfunded.

Impact Evaluation of a Community Nutrition and Livelihood Program on Child Nutrition in Rural Bangladesh

ObjectivesChild undernutrition remains high in Bangladesh. Multi-sectoral approaches involving livelihood programs are needed to address the burden of undernutrition. This study examined the impact of an economic development (ED) program receiving poultry assets with/without gardening training added to the Positive Deviant (PD)/Hearth program in rural Bangladesh, compared to the PD/Hearth only (PDH), on child nutrition and health. MethodsA total of 1,125 children aged 6–13 months with weight-for-age (WAZ) z-score<–1.0 who attended PD/Hearth sessions in September – November 2018 were enrolled in a cohort group in July – August 2019 for the program evaluation. Out of them, 532 were from ED households (PDH/ED). The cohort group was re-assessed in November 2020. A year of program impact between 2019 and 2020 on food security, dietary quality, and health behaviors, accounting for the socio-economic differences between two groups, was estimated using a difference-in-differences approach. ResultsThe prevalence of underweight in the PDH and PDH/ED group decreased to 18.6% and 24.7% (p = 0.02) in 2019, but increased to 47.7% vs. 56.2% (p = 0.003) in 2020 without significant difference in program impact by adding the ED. Compared to the PDH group, the PDH/ED group increased a child dietary diversity score by 0.32 score and minimum dietary diversity (defined as four out of seven food groups) by 13.7 percentage points (pp), and a maternal dietary score by 0.28 score. The PDH/ED increased the proportion of food secured households by 12.6 pp, diversified crop production for banana (9.7 pp), papaya (11.7 pp), carrot (3.8 pp), and lemon (5.9 pp) (all p < 0.05), compared to the PD group. The proportion of households having income ≥ 84,000 Taka during the last year increased by 12.4 pp among PDH/ED group, compared to the PDH group (p = 0.003). There was no significant impact on child morbidity, maternal hand-washing practices. ConclusionsAdding an ED program to the PD/Hearth program improved food security and dietary diversity among children and mothers in rural Bangladesh. Funding SourcesWorld Vision Bangladesh.

The nutritional benefits of cash transfers in humanitarian crises: evidence from Yemen

At the World Humanitarian Summit in 2016 the long-standing divide between humanitarian and development approaches was challenged with a call for responses that both meet immediate needs and protect human capital for eventual recovery. In this regard, the use of cash transfers in humanitarian settings is an emerging trend; however, it has been limited by a lack of evidence on how well cash transfers improve nutritional outcomes given the challenges of conducting rigorous evaluations in a crisis context. This study makes use of a cluster randomized control trial that was left in place when a pilot cash-plus intervention evolved during the civil conflict into a major program within the Yemen Emergency Crisis Response program. The results provide uniquely rigorous evidence of the potential for long-run nutritional benefits of cash transfers in humanitarian crisis settings. The “Cash for Nutrition” intervention provides cash transfers as well as nutritional training to targeted households with young children in Yemen in the context of what is considered the world’s worst humanitarian crisis. Differences-in-differences estimates indicate that the intervention significantly increased purchases of non-staple foods which translated into large positive impacts on child dietary diversity scores. Impacts on consumption patterns and dietary diversity are significant for the full sample and strongest among the poorest tercile of households where the transfers are largest relative to baseline household food budgets. In this poorest sub-group we also find large and statistically significant program impacts on height-for-age z-scores of 0.3. These results support the increased use of cash transfers and provide a benchmark for comparison with more traditional food distribution and supplementation strategies for supporting child nutrition in protracted crisis contexts.

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.

Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women's empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women's empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women's empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy-numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <-2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women's empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy-numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women's empowerment was associated with socioemotional, literacy-numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. Women's empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women's empowerment as a potential strategy.

Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh.

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post‐natal combinations of lipid‐based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet‐based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age‐appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24‐h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non‐significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food‐secure and severely food‐insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

Do Siblings Reduce Children’s Dietary Quality in China?

Abstract Using data from the China Health and Nutrition Survey, we examine the effect of the number of siblings on dietary quality with a sample of 2–12-year-old children in China. We use instrumental variables to address the potential endogeneity of the number of siblings. We show that the effect of the number of siblings on children’s dietary quality is significantly negative. Child dietary diversity score will decrease by 0.274 with one more siblings. In terms of children’s nutrition, the intake of fat and protein also significantly decrease. A robustness check using the fixed effects models also validates our findings that child quantity–quality trade-off is apparent in Chinese families.

A Nutrition-Sensitive Agroecology Intervention in Rural Tanzania Increases Children's Dietary Diversity and Household Food Security But Does Not Change Child Anthropometry: Results from a Cluster-Randomized Trial.

ABSTRACTBackgroundThere are urgent calls for the transformation of agriculture and food systems to address human and planetary health issues. Nutrition-sensitive agriculture and agroecology promise interconnected solutions to these challenges, but evidence of their impact has been limited.ObjectivesIn a cluster-randomized trial (NCT02761876), we examined whether a nutrition-sensitive agroecology intervention in rural Tanzania could improve children's dietary diversity. Secondary outcomes were food insecurity and child anthropometry. We also posited that such an intervention would improve sustainable agricultural practices (e.g., agrobiodiversity, intercropping), women's empowerment (e.g., participation in decision making, time use), and women's well-being (e.g., dietary diversity, depression).MethodsFood-insecure smallholder farmers with children aged <1 y from 20 villages in Singida, Tanzania, were invited to participate. Villages were paired and publicly randomized; control villages received the intervention after 2 y. One man and 1 woman “mentor farmer” were elected from each intervention village to lead their peers in agroecological learning on topics including legume intensification, nutrition, and women's empowerment. Impact was estimated using longitudinal difference-in-differences fixed-effects regression analyses.ResultsA total of 591 households (intervention: n = 296; control: n = 295) were enrolled; 90.0% were retained to study end. After 2 growing seasons, the intervention improved children's dietary diversity score by 0.57 food groups (out of 7; P < 0.01), and the percentage of children achieving minimum dietary diversity (≥4 food groups) increased by 9.9 percentage points during the postharvest season. The intervention significantly reduced household food insecurity but had no significant impact on child anthropometry. The intervention also improved a range of sustainable agriculture, women's empowerment, and women's well-being outcomes.ConclusionsThe magnitude of the intervention's impacts was similar to or larger than that of other nutrition-sensitive interventions that provided more substantial inputs but were not agroecologically focused. These data suggest the untapped potential for nutrition-sensitive agroecological approaches to achieve human health while promoting sustainable agricultural practices.

The association between dietary diversity and development among children under 24 months in rural Uganda: analysis of a cluster-randomised maternal education trial.

To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children. A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6-8 months with child development domains (communication, fine motor, gross motor, personal-social and problem solving) at 20-24 months of age. Rural areas in Kabale and Kisoro districts of south-western Uganda. Children under 24 months. After multivariable analysis, DDS at 6-8 months were positively associated with normal fine motor skills development at 20-24 months (AOR = 1·18; 95 % CI 1·01, 1·37; P = 0·02). No significant association was found between DDS and other development domains. Children who were not ill at 6-8 months had higher odds of developing normal communication (AOR = 1·73; 95 % CI 1·08, 2·77) and gross motor (AOR = 1·91; 95 % CI 1·09, 3·36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0·58; 95 % CI 0·33, 0·98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0·05). We found an association between child DDS at 6-8 months and improvement in fine motor skills development at 20-24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20-24 months.

Impact Evaluation of a Comprehensive Nutrition Program for Reducing Stunting in Children Aged 6–23 Months in Rural Malawi

The prevalence of stunting in central rural Malawi is ∼50%, which prompted a multipronged nutrition program in 1 district from 2014 to 2016. The program distributed a daily, fortified, small-quantity lipid-based nutritional supplement, providing 110kcal and 2.6g of protein to children aged 6-23mo, and behavior change messages around optimal infant and young child feeding (IYCF) and water, sanitation, and hygiene. Our objective was to perform an impact evaluation of the program using a neighboring district as comparison. Using a quasi-experimental study design, with cross-sectional baseline (January-March, 2014; n=2404) and endline (January-March, 2017; n=2453) surveys, we evaluated the program's impact using a neighboring district as comparison. Impact on stunting was estimated using propensity score weighted difference-in-differences regression analyses to account for baseline differences between districts. No differences in mean length-for-age z-score or prevalence of stunting were found at endline. However, mean weight, weight-for-length z-score, and mid-upper arm circumference were higher at endline by 150g, 0.22, and 0.19cm, respectively, in the program compared with the comparison district (all P<0.05). Weekly reports of high fever and malaria were also lower by 6.4 and 4.7 percentage points, respectively, in the program compared with the comparison district (both P<0.05). There was no impact on anemia. Children's dietary diversity score improved by 0.17, and caregivers' infant and young child feeding and hand-washing practices improved by 8-11% in the program compared with the comparison district (all P<0.05). An impact evaluation of a comprehensive nutrition program in rural Malawi demonstrated benefit for child ponderal growth and health, improved maternal IYCF and hand-washing practices, but a reduction in stunting prevalence was not observed.