Child Dietary Diversity Research Articles

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.

A 6-week healthy eating intervention with family engagement improves food knowledge and preferences but not dietary diversity among urban preschool children in Sri Lanka.

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. A 6-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. Fourteen preschool centres in an urban area of Kurunegala, Sri Lanka. Child-parent dyads of children aged 4-6 years. Final analyses included 306 (for food knowledge and preferences) and 258 (for dietary diversity) dyads. 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 with the 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. 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.

Seasonal Variations in Dietary Diversity and Nutrient Intakes of Women and Their Children (6–23 Months) in Western Kenya

Seasonal variations in food availability and access contributes to inadequate nutrient intakes, particularly in low income countries. This study assessed the effect of seasonality on dietary diversity (DD) and nutrient intakes of women and children aged 6–23 months in a rural setting in Western Kenya. A longitudinal study was conducted among 426 mother-child pairs during the harvest and post-harvest seasons in 2012. Dietary intakes were assessed using 24-h dietary recalls and dietary diversity scores (DDS) and nutrient intakes calculated for both seasons. Effect of seasonality on women dietary diversity scores (WDDS) and children's dietary diversity scores (CDDS) were assessed using generalised linear mixed models (GLMM). The proportion of women consuming diets with high DDS (>4 out of 9 food groups) increased from 36.4 to 52.4% between the two seasons, with mean WDDS being significantly higher in November compared to July/August (4.62 ± 1.43 vs. 4.16 ± 1.14, P < 0.001). A significantly higher proportion of children consumed foods from ≥4 out of 7 food groups in November compared to July/August (62.4 vs. 52.6%, P = 0.004). Mean CDDS (3.91 vs. 3.61, P = 0.004) was low but significantly higher in November compared to July/August. Estimated marginal mean WDDS increased from 4.17 to 4.38, and decreased for CDDS from 3.73 to 3.60 between the seasons. Seasonality had a small but significant effect on WDDS, P = 0.008 but not on CDDS, P = 0.293. Increase in CDDS in November was due to age and not seasonal effect. Higher women education and household food security were associated with higher WDDS and CDDS. Intakes of iron, calcium and vitamin E were higher among women in November and significantly different between the seasons. Agro-ecological zone, ethnic group and home gardening influenced nutrient intakes of the women. Seasonality had an effect on the DD of women but not of children, thus other factors apart from food availability influence the quality of children's diets during the complementary feeding period. With increasing age and transition to family foods, children's DD is expected to be affected by seasonality. Integrated interventions to alleviate seasonal food insecurity and strengthen rural households' resilience against seasonal deterioration in diet quality are recommended.

Effect of a Short-Message-Service (SMS) and Inter-Personal Communication (IPC) Strategy on Maternal and Child Nutrition Outcomes: A Factorial Design Cluster Randomized Trial

Background: Sub-optimal infant and child feeding and growth faltering persist in Tanzania. We evaluated the effects of delivering nutrition/health messages through short-message-service (SMS) and interpersonal communication (IPC) strategies, separately and in combination, on maternal and child dietary diversity and nutritional status. Methods: This study was a 2×2 factorial, 40-cluster-randomized trial (10 clusters per group) with three intervention groups (SMS, IPC, and SMS+IPC) and a usual care (or ‘control’) among households containing a pregnant woman and/or a child <12 m of age at baseline (600 per group). Results: Data were complete for 2245 woman-child pairs. Compared to the control group, the odds of consuming a diet that met the women’s minimum dietary diversity (MDD) threshold were 1·46 (95%CI: 1·02, 2·09) and 2·03 (95%CI: 1·41, 2·92) times higher in IPC and SMS+IPC groups, respectively. Relative to the control group, the odds of meeting child’s MDD, minimum meal frequency, and minimum acceptable diet, respectively were 1·33 (95%CI: 0·99, 1·80, not significant), 1·77 (95%CI: 1·42, 2·21), and 1·65 (95%CI: 1·35, 2·03) times higher in the IPC and 1·90 (95%CI: 1·49, 2·41), 1·75 (95%CI: 1·38, 2·23), and 2·22 (95%CI: 1·71, 2·90) times higher in the SMS+IPC group. There were significant improvements in maternal nutrition knowledge, relative to the control group, in all intervention groups but no effects on maternal or child anthropometric outcomes. Conclusions: An interactive IPC strategy significantly improved maternal and young child diets. Combining IPC with an SMS component appeared to improve diets slightly more, but SMS alone had no impact. Funding: This research was funded by the Eleanor Crooke Foundation (grant number 66450). Conflict of Interest: None to declare. Ethical Approval: This study was registered on ClinicalTrials.gov (NCT03297190). Ethical approval was obtained from the Medical Research Coordinating Committee of Tanzania’s National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/2684).

Impact of women’s autonomy and health care practices on nutritional status of U5 children in the slums of English Bazar municipality of Malda District, India

The impact of women’s autonomy and under-five child health care practices on nutritional status of under-five child were determined with the sample of 300 women and child pairs in the slums of English Bazar municipality of Malda district, West Bengal, India. We examined the women autonomy in four areas, financial autonomy, physical autonomy, decision-making autonomy and child health care-related autonomy. Also the child health care practices were determined by immunization, hygiene care, exclusively breastfeeding up to age five, oral rehydration solution taking during diarrhea and dietary diversity. Women have better autonomy resulted better nutritional status for the children. Women who have greater than 20 years of age have a better nutritional status for the children. The same way educational attainment of the mother and her body mass index level has a positive impact on the nutritional status of the children. Dietary diversity of children has a strong impact on child nutritional outcomes. Other health care variables also have some sort of impact of the nutritional status of children.

Complementary Feeding Knowledge, Practice, Dietary Diversity and Associated Factors among Mothers of Children 6-23 Months in Guto Gida District, Oromia, Ethiopia.

The period for complementary feeding is crucial for growth, development and overall health of infants and young children. Lack of awareness in knowledge and practices towards complementary feeding among mothers will lead to improper practice of complementary feeding which may causes of children malnutrition, slower in recovery after illness and death. Hence, this study was aimed to assess complementary feeding knowledge, practice, dietary diversity and associated factors among mothers of children 6-23 months of age in Guto Gida District, Oromia, Ethiopia. Community based cross sectional study design was conducted among 410 mothers who had children aged 6-23 months in the study area. Cluster and simple random sampling techniques were used to select the required sample. A face to face interview was conducted to collect data using semi-structured and structured questionnaire. In addition, focus group discussion was also included in this study. The collected data was coded, organized and entered in to SPPSS windows version 22.0 and analyzed by using frequency, percentage and multi-logistic regression model. The result of this study revealed that about two-third (66.3%) of the respondents had good knowledge whereas nearly half (52.2%) of the mothers had good practices toward complementary feeding. The minimum dietary diversity identified from this study was 27.3%. Education levels of mothers had significant effect on mothers’ knowledge on complementary foods. In addition, age of mothers, mother occupation and wealthy index of the family had a significant effect on mothers’ complementary feeding practices. Furthermore, age of children, birth orders of children, wealthy index and educational level of mothers had a significant effect on dietary diversity of children. The overall findings were indicative of the problems of mothers’ knowledge and feeding practice toward complementary foods, and dietary diversity of 6-23 months of age children. Therefore, all possible interventions should be applied by all the concerned bodies to improve mothers’ knowledge and practice towards complementary foods, dietary diversity of children and thus to improve child survival.

Climate impacts associated with reduced diet diversity in children across nineteen countries

It is widely anticipated that climate change will negatively affect both food security and diet diversity. Diet diversity is especially critical for children as it correlates with macro and micronutrient intake important for child development. Despite these anticipated links, little empirical evidence has demonstrated a relationship between diet diversity and climate change, especially across large datasets spanning multiple global regions and with more recent climate data. Here we use survey data from 19 countries and more than 107 000 children, coupled with 30 years of precipitation and temperature data, to explore the relationship of climate to child diet diversity while controlling for other agroecological, geographic, and socioeconomic factors. We find that higher long-term temperatures are associated with decreases in overall child diet diversity, while higher rainfall in the previous year, compared to the long-term average rainfall, is associated with greater diet diversity. Examining six regions (Asia, Central America, North Africa, South America, Southeast Africa, and West Africa) individually, we find that five have significant reductions in diet diversity associated with higher temperatures while three have significant increases in diet diversity associated with higher precipitation. In West Africa, increasing rainfall appears to counterbalance the effect of rising temperature impacts on diet diversity. In some regions, the statistical effect of climate on diet diversity is comparable to, or greater than, other common development efforts including those focused on education, improved water and toilets, and poverty reduction. These results suggest that warming temperatures and increasing rainfall variability could have profound short- and long-term impacts on child diet diversity, potentially undermining widespread development interventions aimed at improving food security.

Household Food Security, Child Dietary Diversity and Copping Strategies Among Rural Households. The Case of Kole District in Northern Uganda

Household food security, feeding practices, dietary diversity and copping strategies to household food insecurity are largely interconnected. Using a cross sectional study approach involving 162 mothers and care givers in Kole district of Northern Uganda, this study examined the scenarios of household food security status, child feeding practices, dietary diversity and copping strategies. The study revealed that majority of the households (55%) were food secure with an overall observation of low dietary diversity at the household level (72.8%), largely showing dominance of starch-based Cereals, roots and tubers (82%) and limited consumption of other food groups, notably fruits, vegetables, meats and dairy products (18% combined). In terms of feeding practices, majority of the children were fed breast milk for at least 24 months, with mandatory exclusive breastfeeding highly adhered to, but the introduction of complementary foods often delayed and not well planned. Results also showed that a wide range of coping strategies are employed however the major ones were, reliance on less preferred food (54.9%), limiting portions of meals (35.2%), reducing number of melas taken in a day (29%), and gathering wild fruits and harvesting immature crops (29.6%). Generally, it was observed that household food security is a strong determinant of dietary of child dietary diversity, may influence feeding practices and the range of coping strategies applicable to households when they experience food insecurity. It is apparent that nutritional education, household size and livelihood diversity also play a significant role in as far as household food security status, child feeding, diversity and food insecurity copping are concerned within rural households.

Dietary diversity and mental health in preschoolers in rural China.

To investigate the prevalence of mental health problems among preschoolers in rural China and examine the relationship between dietary diversity and mental health. A cross-sectional survey analysis was performed. Child mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ). Child dietary diversity was assessed with the dietary diversity score (DDS), which was calculated based on nine food groups using a 24-h recall method. Data were analysed using unadjusted and adjusted logistic regression models. Two nationally designated poverty counties in Hunan Province of China. Preschoolers (n 1334) aged 3-5 years, preschools (n 26). Of 950 preschoolers with data on both dietary diversity and mental health, 663 (70 %) were classified as having at least one kind of mental health problem. The prevalences of emotional symptoms, conduct problems, symptoms of hyperactive/inattention, peer relationship problems and poor prosocial behaviour were 39, 27, 23, 12 and 26 %, respectively. Male preschoolers showed higher risks of having mental health problems than their female counterparts on each SDQ subscale except for conduct problems. Moreover, a higher DDS was significantly associated with a lower likelihood of having symptoms of hyperactivity/inattention, peer relationship problems and prosocial behaviour problems after adjustment for confounders (preschoolers' age, gender, cognitive ability, parental migration status, primary caregiver's education and household socio-economic status). The prevalence of mental health problems was high among preschoolers in rural China. Improving child dietary diversity might be an important strategy to consider in the design of interventions to improve child mental health.

An empirical study of factors associated with height-for-age z-scores of children aged 6-23 months in northwest Rwanda: the role of care practices related to child feeding and health.

We aimed to identify the factors influencing child height-for-age z-scores (HAZ) as a measure of child nutritional status in Rwanda, and to examine the role of child feeding and health practices. We conducted a cross-sectional study involving 379 children (aged 6-23 months) and their mothers in northwest Rwanda. Data were collected using a pre-tested, structured questionnaire. An infant and young child feeding practices index (ICFI) and health practices index (HPI) were developed and categorised into tertiles, and linear regression analyses were performed to assess their association with child HAZ. Overall, mothers of non-stunted children exhibited better feeding and health practices than those of stunted children. ICFI was positively associated with child HAZ. We found an adjusted mean HAZ difference of 0·14 between children whose mothers were in high ICFI tertile compared with those in low tertile. Neither HPI nor any of its components were significantly associated with child HAZ. Other factors that were positively associated with child HAZ were infant birth weight (P < 0·001) and maternal height (P < 0·001). Child age, sex (male) (P < 0·05) and altitude (P < 0·05) were negatively associated with child HAZ. Diarrhoea (P < 0·05) and respiratory infections (P < 0·05) were negatively associated with HAZ in younger children aged 6-11 months. Policies to reduce stunting in this population must focus on both pre- and postnatal factors. Appropriate child feeding practices, particularly breast-feeding promotion and improvement in children's dietary diversity combined with measures to control infections should be given priority.

Child dietary diversity and food (in)security as a potential correlate of child anthropometric indices in the context of urban food system in the cases of north-central Ethiopia

ObjectiveTo investigate the relation of child dietary diversity and household food insecurity along with other socio-demographic with child anthropometric indices in north-central Ethiopia, an area with a high level of food insecurity and inadequate diet quality.DesignA community-based cross-sectional study was used.SettingsThe study was conducted in Dessie and Combolcha towns of north-central Ethiopia from April to May 2018.ParticipantsRandomly selected 512 mother-child pairs with child’s age range of 6–59 months.ResultsThe mean (± SD) scores of weight-for-height/length, height/length-for-age, weight-for-age, and BMI-for-age Z-scores were 1.35 (± 2.03), − 1.89 (± 1.79), 0.05 (± 1.54), and 1.39 (± 2.06), respectively. From all anthropometric indicators, stunting and overweight/obesity remained the severe public issues hitting 43% and 42% of the children, respectively. In the model, mothers’ age and education and child’s age, sex, and dietary diversity were significantly related with child height-for-age Z-score while place of residence, sex of household head, child’s age, and dietary diversity score were the predictors of child BMI-for-age Z-score in the urban contexts of the study area. Nevertheless, food insecurity was not related to any of the child anthropometric indices.ConclusionThe double burden of malnutrition epidemics (stunting and obesity) coexisted as severe public health concerns in urban settings. Anthropometric statuses of children were affected by multidimensional factors and seek strong integration and immediate intervention of multiple sectors.

Who lacks and who benefits from diet diversity: evidence from (impact) profiling for children in Zimbabwe

BackgroundThe impact of diet diversity—defined as the number of different foods or food groups consumed over a given reference period—on child nutrition outcomes strongly interacts with agro-ecological, institutional, and socio-economic drivers of child food and nutrition security. Yet, the literature on the impact of diet diversity typically estimates average treatment effects, largely ignoring impact heterogeneity among different groups.MethodsIn this paper, we introduce a new method of profiling to identify groups of treatment units that stand to gain the most from a given intervention. We start from the ‘polling approach’ which provides a fully flexible (non-parametric) method to profile vulnerability patterns (patterns in ‘needs’) across highly heterogeneous environments [35]. Here we combine this polling methodology with matching techniques to identify ‘impact profiles’ showing how impact varies across non-parametric profiles. We use this method to explore the potential for improving child nutrition outcomes, in particular stunting, through targeted improvements in dietary diversity in a physically and socio-economically diverse country, namely Zimbabwe. Complex interaction effects with agro-ecological, institutional and socio-economic conditions are accounted for. Finally, we analyze whether targeting interventions at the neediest (as identified by the polling approach) will also create the largest benefits.ResultsThe dominant profile for stunted children is that they are young (6–12 months), live in poorer/poorest households, in rural areas characterized by significant sloping of the terrain and with one-sided emphasis on maize cultivation and medium dry conditions. When moving from “need” to “maximal impact”, we calculate both the coverage in “need” as well as the impact coverage, and find that targeting on need does not always provide the largest impact.ConclusionsPolicy-makers need to remain alert that targeting on need is not always the same as targeting on impact. Estimation of heterogeneous treatment effects allows for more efficient targeting. It also enhances the external validity of the estimated impact findings, as the impact of child diet diversity on stunting depends on various agro-ecological variables, and policy-makers can relate these findings to areas outside our study area with similar agro-ecological conditions.

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.

The effect of productive SafetyNet program on wasting among under-five children in the rural community of South Gondar Zone, Northwest Ethiopia

BackgroundUndernutrition is a significant public health problem in a developing country like Ethiopia. Even if the cause of malnutrition is multifactorial, it is mainly related to socioeconomical, political, and health-related problems. All these problems will lead to more severe nutrient deficiencies among households without assets. The Productive SafetyNet program is implemented for beneficiaries in the rural community to prevent household assets depletion. So, this study aimed to assess the effect of a Productive SafetyNet program on wasting among under-five children in the rural community of South Gondar Zone.MethodsA community-based cross-sectional study was done among 803 children paired with their mother/caregivers. Particepnts were selected by a simple random sampling technique. The data were collected by using a structured and pre-tested questionnaire. AnthroPlus software was used to analyse anthropometric data. The data entry employed by EpiInfo version 7.0 software for Windows. Then, the data exported to SPSS version 20.0 to carryout further statistical analysis. The anthropometric index (weight for height) was constructed to determine wasting. Both binary and multivariable logistic regression models were used to identify associated factors. Finally, P-Value ≤0.05 was used to declare statistical significance.ResultsIn this study, the response rate was 95.76%. Of the total participants, 195(25.36%) children were from SafetyNet program beneficiaries. The overall prevalence of wasting was 29.9% (95% CI: 26.6, 33.2%). More than One-fourth of the children from SafetyNet beneficiary households were wasted. While considering all other variables constant, Productive SafetyNet Program reduce wasting by 46% (COR = 0.54. 95% CI (0.37, 0.79)). Wasting were significantly associated with marital status (divorced and/or separated: AOR = 3.33, 95% CI (1.71, 6.45)), being on the SafetyNet program (AOR: 0.63, 95% CI (0.40, 0.99)), family size (AOR = 0.13, 95% CI (0.09, 0.21)), father educational status (AOR: 0.25, 95% CI (0.09, 0.66)), age of the child (AOR = 0.51, 95% CI (0.33, 0.77)), and child dietary diversity score (AOR = 2.99, 95% CI (1.67, 5.35)).ConclusionWasting was a severe public health problem. In this study, the Productive SafetyNet Program reduce wasting significantly. Marital status, SafetyNet program status, family size, father educational status, age of the child, and dietary diversity were factors associated with wasting among children. Early detection of household asset depletion and SafetyNet program implementation is vital with the usual nutritional assessment and counseling.

Maternal Characteristics Are Associated with Child Dietary Diversity Score, in Golina District, Northeast Ethiopia: A Community-Based Cross-Sectional Study.

Background Dietary diversity is part of the set of indicators developed to assess infant and young child feeding practices. In developing countries, only a quarter of children met the required minimum dietary diversity. In Ethiopia, only 14% of children aged 6–23 months met the minimum dietary diversity score, with regional variation. Therefore, this study aimed to assess dietary diversity score and associated factors among children aged 6–23 months in Golina district, Afar region, Ethiopia. Method A community-based cross-sectional study was conducted among 345 study participants from February 15 to March 30, 2017, in Golina district, Afar, Northeast Ethiopia. The study kebeles were selected randomly and the study subjects were selected using a cluster sampling technique. The child dietary diversity score was determined by the WHO child dietary diversity score scale, using a 24-hour dietary recall method, and data were collected using an interviewer-administered questionnaire. Multivariable logistic regression was used to identify predictor variables, and the level of significance was determined at P value <0.05. Result This study revealed that children who met the required minimum dietary diversity score were 35.1% (95% CI, (30%–40%)). Children whose mothers have not attended formal education were 3.042 times (AOR = 3.042 95% CI: (1.312–7.052)) less likely to meet the minimum dietary diversity score than children whose mothers have attended secondary and above. Children whose mothers had normal BMI were 51.2% (AOR = 0.488, 95% CI: (0.259–918)) and 68.1% (AOR = 0.319, 95% CI: (0.119–0.855)) more likely to meet the minimum dietary diversity score than children whose mothers' BMI was underweight and overweight, respectively. Conclusion Maternal characteristics (educational status and nutrition status) were found to be associated with their child's dietary diversity score. This study also revealed that children who met the minimum dietary diversity score were few. Therefore, the increased emphasis on the importance of the education of girls (future mothers) and nutrition counseling for girls/women who currently have received little education on ways to improve the family and child dietary feeding practice is needed.

Scaled-up nutrition education on pulse-cereal complementary food practice in Ethiopia: a cluster-randomized trial

BackgroundImproving children’s weight status through nutrition education (NE) for mothers about using pulses in complementary feeding has been demonstrated in pilot studies, but no effect on stunting was reported. The aim of the study was to assess the impact of a 9-month pulse-nutrition education program on improving mothers’ knowledge, attitude, and practices (KAP) towards pulses, as well as its effect on children’s diet diversity, and nutritional status. The NE was delivered by Health Extension Workers (HEWs).MethodsA cluster randomized study was employed for the community-based interventional study. Twelve randomly selected villages in Sidama Zone, Southern Ethiopia were included in the study. A total of 772 mother-child pairs involved in the study; where 386 mother-child pairs in the intervention group received additional messages about pulse-cereal complementary food, and 386 pairs (the control) received only routine health education for 9 months. A survey on mothers’ KAP and anthropometric measurements of the children were taken at baseline, midpoint, and end point. ANOVA and descriptive statistics were used to analyzed data.ResultsAt baseline and end point, maternal KAP and the dietary diversity score of the children (mean age at end point 18.8 ± 2.9 mo) were assessed. Intervention mothers’ KAP improved (p < 0.001) at midpoint and end point compared to that of the control group, as did frequency of pulse consumption and Dietary Diversity Score (DDS) among children. At 9 months, the prevalence of stunting, wasting, and underweight was significantly reduced in the intervention group compared to the control group (p = 0.001).ConclusionsNE delivered by HEWs improved KAP of mothers regarding pulse consumption and dietary diversity of children led to improved nutritional status of the children. Training HEWs on the use of pulses for complementary food may be an effective way to improve the health of children in Ethiopian communities.Trial registrationClinicaltrials.gov #NCT02638571.Date of registration: 12/18/2015.Prospectively registered.

Obstetrical care is associated with child's dietary diversity in Indonesia: analysis from Demographic and Health Survey 2017.

To explore the influence of obstetrical care factors on dietary diversity and individual food group consumption in Indonesia. Cross-sectional study to assess the association between pregnancy care factors and dietary diversity score, minimum dietary diversity (MDD) and consumption of seven food groups. Data from the Indonesia Demographic and Health Survey 2017. A total of 5113 children aged 6-23 months. Dietary diversity score was significantly higher for children whose mothers received four or more prenatal care visits, were delivered at a health facility, had a professionally trained delivery assistant and were delivered by C-section. Children born at a health facility and delivered by a health professional had higher odds of meeting MDD (adjusted OR (AOR) 1·45, 95 % CI 1·18, 1·79 and OR 2·10, 95 % CI 1·54, 2·87, respectively). Four or more antenatal visits, delivering at a health facility and having a professional delivery attendant were associated with higher odds of consumption of lentils (AOR 1·66, 95 % CI 1·23, 2·25, AOR 1·30, 95 % CI 1·02, 1·65 and AOR 1·79, 95 % CI 1·19, 2·69). Four or more antenatal visits, delivering at a health facility and having a professional delivery attendant had higher odds of consumption of other fruits and vegetables (AOR 1·70, 95 % CI 1·23, 2·35, OR 1·23, 95 % CI 1·03, 1·61 and OR 1·90, 95 % CI 1·29, 2·79). Efforts focusing on providing nutritional education during antenatal care and delivery should be encouraged, especially for mothers seeking care outside of a health facility.

Demonstration gardens improve agricultural production, food security and preschool child diets in subsistence farming communities in Panama.

To explore impacts of a demonstration garden-based agricultural intervention on agricultural knowledge, practices and production, food security and preschool child diet diversity of subsistence farming households. Observational study of households new to the intervention or participating for 1 or 5 years. Variables measured were agricultural techniques learned from the intervention and used, agricultural production, household food insecurity (FIS) and child diet diversity (DDS), over one agricultural cycle (during land preparation, growing and harvest months). Fifteen rural subsistence farming communities in Panama. Households participating in intervention (n 237) with minimum one preschool child. After 1 year, participants had more learned and applied techniques, more staple crops produced and lower FIS and higher DDS during land preparation and growing months compared with those new to the intervention. After 5 years, participants grew more maize, chickens and types of crops and had higher DDS during growing months and, where demonstration gardens persisted, used more learned techniques and children ate more vitamin A-rich foods. Variables associated with DDS varied seasonally: during land preparation, higher DDS was associated with higher household durable asset-based wealth; during growing months, with greater diversity of vegetables planted and lower FIS; during harvest, with older caregivers, caregivers working less in agriculture, more diverse crops and receiving food from demonstration gardens. The intervention improved food production, food security and diets. Sustained demonstration gardens were important for continued use of new agricultural techniques and improved diets.

Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

Safety nets are expanding in African countries as a policy instrument to alleviate poverty and food insecurity. Whether safety nets have improved household food security and child diet and nutrition in sub-Saharan Africa has not been well documented. This paper takes the case of Ethiopia's Productive Safety Net Program (PSNP) and provides evidence of the impact of safety nets on household food security and child nutritional outcomes. Prior studies provide inconclusive evidence as to whether PSNP has improved household food security and child nutrition. These studies used analytical approaches that correct for selection bias but have overlooked the effect of time-varying confounders that might have resulted in biased estimation. Given that household food security status is both the criteria for participation and one of the desirable outcomes of the program, estimating the causal impact of PSNP on household food security and child nutrition is prone to endogeneity due to selection bias and time-varying confounders. Therefore, the objectives of this paper are (1) to examine the impacts of PSNP on household food security, child meal frequency, child diet diversity, and child anthropometry using marginal structural modeling approach that takes into account both selection bias and time-varying confounders and (2) to shed some light on policy and programmatic implications. Results show that PSNP has not improved household food insecurity, child dietary diversity, and child anthropometry despite its positive impact on child meal frequency. Household participation in PSNP brought a 0.308 unit gain on child meal frequency. Given the consequence of food insecurity and child undernutrition on physical and mental development, intergenerational cycle of poverty, and human capital formation, the program would benefit if it is tailored to nutrition-specific and nutrition-sensitive interventions.

Community-level interventions for improving access to food in low- and middle-income countries.

Community-level interventions for improving access to food in low- and middle-income countries.