Maternal Dietary Diversity Research Articles

A health facility based case-control study on determinants of low birth weight in Dassie town, Northeast Ethiopia: the role of nutritional factors

BackgroundLow birth weight remains a major public health problem affecting developing countries. Evidence shows that low birth weight has long lasting negative health consequences through its contribution to stunting, mental impairment and non-communicable chronic diseases in later life. Thus, it is worth investigating the role of nutritional factors as determinants of low birth weight to suggest nutritional interventions to curb its negative health outcomes. This study aimed to investigate the determinants of low birth weight with main focus on the role of nutritional factors in Ethiopia.MethodsA facility-based case-control study was conducted from 3 February to 29 April, 2017. The data were collected using structured, pretested interviewer-administered questionnaire in all public health facilities of Dessie Town. Anthropometric measurements were made following standard procedures for both mothers and their newborns. Consecutive live births of < 2500 g and two succeeding normal weight babies were selected as cases and controls, respectively. Data were entered in to Epi-data software version 3.1, and exported to SPSS version 21, and analyzed using frequency, mean and percentage. Factors with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model to determine significant determinants of LBW. Statistical significance was considered at p < 0.05. Results were reported with odds ratio and 95% CI.ResultsMean ± SD of birth weight (g) was 2138 ± 207 for cases and 3145 ± 415 for controls. After adjusting for potential confounders using multivariable logistic regression analysis, the absence of iron and folate supplementation, receiving no nutritional counseling and consuming no additional meal, maternal undernutrition, maternal anemia and inadequate dietary diversity during the current pregnancy were found to be significant determinants of low birth weight in our study.ConclusionLack of nutritional counseling, absence of additional meal intake and iron and folate supplementation during pregnancy, and maternal undernutrition, maternal anemia and inadequate maternal dietary diversity were significant determinants of low birth weight. The importance of nutritional counseling, improving iron and folate supplementation during pregnancy, and nutritional status of pregnant women need to be strengthened to reduce the incidence of LBW in Ethiopia. In addition, behavioral change communications targeting pregnant women to improve women dietary diversity and their extra meal intake practice need to be enhanced in Ethiopia.

Maternal dietary diversity and odds of low birth weight: Empirical findings from India

ABSTRACTIndia has the highest proportion of low birth weight (LBW) babies born in the developing world. Poor maternal nutrition during pregnancy is associated with adverse infant health outcomes. The main objective of this paper was to assess the socioeconomic factors associated with dietary diversity among pregnant women and to investigate the association between maternal dietary diversity and LBW among their babies. The data for these analyses were derived from a survey conducted in November and December, 2014 among 230 women who had newly delivered in hospitals in Uttar Pradesh, the largest Indian state that has the poorest maternal outcomes in the country. The results from multivariate binary logistic regression model indicated that low maternal education and economic status was significantly associated with poor dietary diversity among participants. Also, women with low maternal dietary diversity had a significantly higher proportion of LBW babies compared to those in the medium to high dietary diversity categories. From a policy perspective, these findings suggest that continuous tracking of pregnant women’s nutritional needs through existing monitoring systems, e.g., the Nutrition Resource Platform and Health Management Information System, and necessary interventions through Integrated Child Development Services may yield better results, thereby, addressing maternal under-nutrition and LBW.

Factors influencing animal-source food consumption in Timor-Leste

Poor dietary quality is an underlying contributor to the high rates of maternal and child undernutrition in Timor-Leste. The majority of households own livestock: however, the consumption of domestic animal-source food (ASF) is low, and there are few reports of the utilisation of non-domesticated species. This mixed-methods study was conducted in three villages from mid-2015 to mid-2017. Two hundred and three households with children under 24 months were enrolled in the quantitative study of maternal and child dietary diversity. To explore factors affecting household ASF consumption, 12 key informants were recruited for in-depth interviews and 312 participants, mostly mothers and fathers of young children, for focus group discussions. Participants expressed a desire to consume more ASF. Barriers to ASF consumption include having low income or limited income streams, high levels of small livestock morbidity and mortality leading to small or unstable flock or herd sizes, reserving livestock for sale and ceremonies, and living far from forested areas or where hunting is not allowed. Factors that enable greater ASF consumption include villages being located near forested areas with wild animal populations, those that observe a large number of ceremonies of long duration, households with a greater number of small livestock, and where women are able to make autonomous decisions about livestock assets. Findings suggest that policies and programs designed to achieve sustainable improvements in household nutrition would include a focus on women and improving the health and production of small livestock species frequently utilised by households.

Determinants of child anthropometric indicators in Ethiopia

BackgroundMalnutrition is one of the major contributors to child mortality in Ethiopia. Currently established, child nutrition status is assessed by four anthropometric indicators. However, there are other factors affecting children’s anthropometric statuses. Thus, the main objective of this paper is to explore some of the determinants of child anthropometric indicators in Ethiopia.MethodsData from GROW (the Growing Nutrition for Mothers and Children), a survey including 1261 mothers and 1261 children was carried out in Ethiopia in 2016. Based on the data gathered, the goal of GROW is to improve the nutritional status of women of reproductive age (15–49), as well as boys and girls under 5 years of age in Ethiopia. In order to investigate the association between different factors and child anthropometric indicators, this study employs various statistical methods, such as ANOVA, T-test, and linear regressions.ResultsChild’s sex (confidence intervals for (wasting = − 0.782, − 0.151; stunting = − 0.936,-0.243) (underweight = − 0.530, − 0.008), child’s age (confidence intervals for (wasting = − 0.020, 0.007; stunting = − 0.042,-0.011) (underweight = − 0.025, − 0.002), maternal MUAC (confidence intervals for (wasting = 0.189, 0.985; BMI-for-age = 0.077, 0.895), maternal education (stunting = 0.095, 0.897; underweight = 0.120, 0.729), and open defecation (stunting = 0.055, 0.332; underweight = 0.042, 0.257) were found to be significantly associated with anthropometric indicators. Contrary to some findings, maternal dietary diversity does not present significance in aforementioned child anthropometric indicators.ConclusionDepending on the choice of children anthropometric indicator, different conclusions were drawn demonstrating the association between each factor to child nutritional status. Results showed child’s sex, age, region, open defecation, and maternal MUAC significantly increases the risk of child anthropometric indicators. Highlighting the factors influencing child undernutrition will help inform future policies and programs designed to approach this major problem in Ethiopia.

Maternal Dietary Diversity and Growth of Children Under 24 Months of Age in Rural Dodoma, Tanzania.

To identify predictors of maternal dietary diversity in rural Dodoma, Tanzania and assess its association with child growth outcomes. A cross-sectional survey of 361 mothers with children under 24 months of age was conducted in 5 villages in rural Dodoma, Tanzania. Maternal diets were assessed using food frequency questionnaires, and dietary diversity was categorized using Minimum Dietary Diversity for Women (MDD-W) guidelines. Child anthropometric measures were taken to calculate height-for-age z-score (HAZ), weight-for-height z-score (WHZ), and weight-for-age z-score (WAZ). Linear and logistic regressions were used to examine the association between maternal dietary diversity and children's growth outcomes. About 40% of mothers did not consume a diverse diet (MDD-W < 5), and 35% of children were stunted. Household production of greater number of crops was associated with greater MDD-W scores ( P < .01). Greater maternal dietary diversity was associated with significantly greater child WHZ (mean difference = 0.44; 95% confidence interval [CI]: 0.10-0.78; P = .01), WAZ (mean difference = 0.37; 95% CI: 0.08-0.65; P = .01), and reduced risk of wasting (odds ratio = 0.22; 95% CI: 0.07-0.66; P = .01). Greater maternal dietary diversity was associated with improved child WHZ and WAZ outcomes. Sustainable interventions to increase maternal dietary diversity may improve WHZ and WAZ in young children in similar settings.

Integrating Nutrition Interventions into an Existing Maternal, Neonatal, and Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster-Randomized Program Evaluation

Background: Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh.Objectives: We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices.Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n ∼ 300 and 1000 pregnant or recently delivered women, respectively, per survey round). We derived difference-in-difference effect estimates, adjusted for geographic clustering and infant age and sex.Results: Coverage of interpersonal counseling was high; >90% of women in the nutrition-focused MNCH group were visited at home by health workers for maternal nutrition and breastfeeding counseling. The coverage of community mobilization activities was ∼50%. Improvements were significantly greater in the nutrition-focused MNCH group than in the standard MNCH group for consumption of iron and folic acid [effect: 9.8 percentage points (pp); 46 tablets] and calcium supplements (effect: 12.8 pp; 50 tablets). Significant impacts were observed for the number of food groups consumed (effect: 1.6 food groups), percentage of women who consumed ≥5 food groups/d (effect: 30.0 pp), and daily intakes of several micronutrients. A significant impact was also observed for exclusive breastfeeding (EBF; effect: 31 pp) but not for early initiation of breastfeeding.Conclusions: Addressing nutrition during pregnancy by delivering interpersonal counseling and community mobilization, providing free supplements, and ensuring weight-gain monitoring through an existing MNCH program improved maternal dietary diversity, micronutrient supplement consumption, and EBF practices. This trial was registered at clinicaltrials.gov as NCT02745249.

Association Between Women's Empowerment and Maternal and Child Nutrition in Kalalé District of Northern Benin.

Evidence on effectiveness of women's empowerment (WE) to reduce undernutrition is limited in sub-Sahara Africa, and few studies incorporate multidimensional measures of WE. To examine whether a WE status, in sum and across leadership, decision-making, mobility, economic security, male involvement in housework, and nonfamily group domains, is associated with women and their children nutritional status in Kalalé district of northern Benin. Data were obtained from the 2014 Solar Market Garden baseline study: 767 paired reproductive-age women aged 15 to 49 years and children 6 to 59 months old. Exploratory principal component (cross-validate with confirmatory) factor analysis was first conducted to identify the structure of empowerment. Then, using a new survey-based index, regression analysis was conducted to examine associations between WE measures and maternal dietary diversity score (DDS) and body mass index (BMI), as well as their child's DDS, height-for-age z score (HAZ), weight-for-height z score (WHZ), and weight-for-age z score (WAZ). Positive associations were observed between women's composite empowerment, leadership, maternal DDS and BMI, and female child's DDS. However, opposite signs were found between economic security and child's DDS. Mobility was positively associated with female children's WHZ and male children's HAZ and WAZ, while decision-making was correlated with male child's WHZ and female children's WAZ. Women's empowerment can be associated with undernutrition. Efforts to improve nutrition may benefit from empowerment initiatives that promote women's self-confidence and decision-making in Benin. However, additional qualitative and longitudinal research may enhance understanding of WE in the present area.

Homestead Food Production and Maternal and Child Dietary Diversity in Nepal: Variations in Association by Season and Agroecological Zone

Suaahara, a large-scale integrated program, aimed to improve diets and nutritional status among women and children, in part by facilitating enhanced homestead food production (EHFP). This study examines associations between EHFP and maternal and child dietary diversity and variations by season and agroecological zone (AEZ): mountains and terai. We used data from household monitoring surveys (n = 2101 mothers; n = 994 children, 6-23 months), which included a 7-day dietary recall and maternal report on participation in 5 EHFP activities-received vegetable seeds, chicks, and technical support and participated in training and EHFP groups. We constructed binary variables for each activity and a scale (0-5) summing participation. For dietary diversity, we used the Women's Dietary Diversity Score using 10 food groups and 7 food groups for child diets. Multivariable linear regression analyses were used to assess associations between EHFP participation and dietary diversity by season and AEZ, controlling for potential confounders and clustering. In adjusted models, we found positive associations between dietary diversity and chicks, technical support, and EHFP beneficiary groups; the magnitude of the associations varied by season and AEZ. The degree of participation in 5 EHFP activities was positively associated with maternal dietary diversity in the terai (β = .24, P < .001) and mountains (β = .12, P = .01) and child dietary diversity in the terai (β = .35, P < .001) during the winter. No associations were found in the rainy season. Our findings highlight the potential for EHFP to address dietary diversity constraints among this population. Variation by subnational setting and seasonality suggest that policies and programs should be contextualized.

Changes in Underlying Determinants Explain Rapid Increases in Child Linear Growth in Alive & Thrive Study Areas between 2010 and 2014 in Bangladesh and Vietnam

Background: Child linear growth sometimes improves in both intervention and comparison groups in evaluations of nutrition interventions, possibly because of spillover intervention effects to nonintervention areas or improvements in underlying determinants of nutritional change in both areas.Objective: We aimed to understand what changes in underlying socioeconomic characteristics and behavioral factors are important in explaining improvements in child linear growth.Methods: Baseline (2010) and endline (2014) surveys from the Alive & Thrive impact evaluation were used to identify the underlying determinants of height-for-age z scores (HAZs) among children aged 24–48 mo in Bangladesh (n = 4311) and 24–59 mo in Vietnam (n = 4002). Oaxaca-Blinder regression decompositions were used to examine which underlying determinants contributed to HAZ changes over time.Results: HAZs improved significantly between 2010 and 2014 in Bangladesh (∼0.18 SDs) and Vietnam (0.25 SDs). Underlying determinants improved substantially over time and were larger in Vietnam than in Bangladesh. Multiple regression models revealed significant associations between changes in HAZs and socioeconomic status (SES), food security, maternal education, hygiene, and birth weight in both countries. Changes in HAZs were significantly associated with maternal nutrition knowledge and child dietary diversity in Bangladesh, and with prenatal visits in Vietnam. Improvements in maternal nutrition knowledge in Bangladesh accounted for 20% of the total HAZ change, followed by maternal education (13%), SES (12%), hygiene (10%), and food security (9%). HAZ improvements in Vietnam were accounted for by changes in SES (26%), prenatal visits (25%), hygiene (19%), child birth weight (10%), and maternal education (7%). The decomposition models in both countries performed well, explaining >75% of the HAZ changes.Conclusions: Decomposition is a useful and simple technique for analyzing nonintervention drivers of nutritional change in intervention and comparison areas. Improvements in underlying determinants explained rapid improvements in HAZs between 2010 and 2014 in Bangladesh and Vietnam.

Household Coverage of Fortified Staple Food Commodities in Rajasthan, India.

A spatially representative statewide survey was conducted in Rajasthan, India to assess household coverage of atta wheat flour, edible oil, and salt. An even distribution of primary sampling units were selected based on their proximity to centroids on a hexagonal grid laid over the survey area. A sample of n = 18 households from each of m = 252 primary sampling units PSUs was taken. Demographic data on all members of these households were collected, and a broader dataset was collected about a single caregiver and a child in the first 2 years of life. Data were collected on demographic and socioeconomic status; education; housing conditions; recent infant and child mortality; water, sanitation, and hygiene practices; food security; child health; infant and young child feeding practices; maternal dietary diversity; coverage of fortified staples; and maternal and child anthropometry. Data were collected from 4,627 households and the same number of caregiver/child pairs. Atta wheat flour was widely consumed across the state (83%); however, only about 7% of the atta wheat flour was classified as fortifiable, and only about 6% was actually fortified (mostly inadequately). For oil, almost 90% of edible oil consumed by households in the survey was classified as fortifiable, but only about 24% was fortified. For salt, coverage was high, with almost 85% of households using fortified salt and 66% of households using adequately fortified salt. Iodized salt coverage was also high; however, rural and poor population groups were less likely to be reached by the intervention. Voluntary fortification of atta wheat flour and edible oil lacked sufficient industry consolidation to cover significant portions of the population. It is crucial that appropriate delivery channels are utilized to effectively deliver essential micronutrients to at-risk population groups. Government distribution systems are likely the best means to accomplish this goal.

Maternal Dietary Diversity Decreases with Household Food Insecurity in Rural Bangladesh: A Longitudinal Analysis

Household food insecurity (HFI) can lead to a poor diet and malnutrition. Yet, little is known about the extent to which maternal diet covaries with food insecurity during pregnancy and lactation. Longitudinal associations between HFI and maternal dietary diversity from early pregnancy to 3 mo postpartum were examined in rural Bangladesh. We repeatedly assessed dietary intake by using a 7-d food-frequency questionnaire in the first and third trimesters of pregnancy and at 3 mo postpartum among 14,600 women enrolled into an antenatal micronutrient supplementation trial. Maternal dietary diversity score (DDS) was constructed as the sum of 10 food groups reportedly consumed at each assessment. Households were classified at 6 mo postpartum as being food secure or having mild, moderate, or severe HFI on the basis of a 9-item standard scale. Generalized estimating equations were used to estimate the longitudinal relation between HFI status and DDS and the likelihood of individual food-group consumption, adjusting for confounders at the maternal and household levels. The DDS decreased with progressively worse HFI, an association best explained by a derived household wealth index. Compared with women from food-secure households, women of mild, moderate, and severe HFI were less likely, in a dose-response fashion, to have consumed dairy products [adjusted ORs (95% CIs): 0.73 (0.69, 0.78), 0.62 (0.58, 0.66), and 0.52 (0.48, 0.55), respectively], eggs [0.81 (0.76, 0.85), 0.73 (0.68, 0.77), and 0.61 (0.57, 0.65)], meat [0.83 (0.79, 0.88), 0.73 (0.69, 0.78), and 0.60 (0.56, 0.64)], fish [0.87 (0.80, 0.94), 0.76 (0.70, 0.83), and 0.59 (0.54, 0.65)], legumes and nuts [0.88 (0.83, 0.93), 0.81 (0.76, 0.87), and 0.79 (0.74, 0.85)], and yellow and orange fruit and vegetables [0.85 (0.80, 0.91), 0.78 (0.73, 0.84), and 0.72 (0.67, 0.78)]. Neither intakes of dark-green leafy vegetables nor of vegetable oil were associated with HFI status. Antenatal and postnatal maternal dietary diversity, especially intakes of animal-source foods, fruit, and vegetables, declined with worsening food insecurity in rural Bangladesh.

Maternal Nutritional Status and Dietary Diversity in Ghana

BackgroundEating from a limited number of food groups which are mainly micronutrient poor starchy staples contributes to the burden of malnutrition and increases the risk for obesity and its related non‐communicable diseases. This study assessed dietary patterns and diversity among women in rural and semi‐rural areas in Ghana due to the paucity of data for those areas outside the cities.MethodsA cross‐sectional survey was undertaken among 1185 households in Eastern, Volta and Brong Ahafo regions of Ghana. Households with children under age 5 years were sampled. Women were surveyed at the household level using a pretested semi‐structured questionnaire. Dietary intake patterns and dietary diversity of the women were assessed using a 24‐hour recall. Pearson's chi‐square was used to determine associations between region and dietary patterns and diversity.ResultsAmong the 1185 women recruited, 21.3%, 24.5% and 54.3% were from Brong Ahafo, Eastern and Volta regions, respectively. The mean ± SD age of the women was 38.4 ± 15.1 years. Drinks frequently consumed by the women were tealeaf and cocoa drink and this varied across the regions. The women consumed high amounts of assorted fats and oils but nutritional supplement use was reported by only 7.3% of the women. About More than 70% of the women in Volta region and 96% of the women in Brong Ahafo regions had ever used iodated salt but 60% of the women from Eastern region had never used iodated salt. The women (71.5%) consumed foods from roots and tubers, 82.4% consumed fish and sea foods and 85.7% consumed cereals and these consumption patterns varied from region to region. Whereas 98.1% of the caregivers consumed some sort of vegetables, only 13.4% consumed fruits of any kind. Milk and milk products and eggs were the least frequently consumed food groups. Majority (61.4%) of the women ate from at least 5–8 food groups (medium dietary diversity) whilst 37.9% ate from at least 1–4 food groups (low dietary diversity). There were significant differences in dietary diversity across the three regions (p&lt;0.0001). BMI was within normal range for 54.2% of the women but 23.5% and 14.7% of the women were overweight and obese respectively. There was no association between BMI and dietary diversity (p=0.18).ConclusionPoor dietary diversity and intake of energy dense diets saturated with fats and oils is high in rural Ghanaian women. Future studies should evaluate the relationship between these dietary patterns and health and nutritional outcomes.Support or Funding InformationThis Research was supported in part by a grant from the Department of Global Health and Population, Harvard T.H.Chan School of Public Health, as well as the Department of Nutrition, Harvard T.H.Chan School of Public Health.

Infant and Young Child Feeding (IYCF) Practices Among Mothers of Children Aged 6–23 Months in Two Agro-ecological Zones of Rural Ethiopia

It is estimated that 6% of all deaths of under 5 years old children in developing countries can be prevented by appropriate complementary feeding, in particular good dietary diversity and meal frequency. The aim of this paper is to assess infant and young child feeding practices among mothers of children aged 6-23 months in rural Ethiopia. A community based cross-sectional study design was employed among mothers living in two agro-ecological zones. Trained data collectors conducted the interviews, anthropometric measurements, and the blood test for anaemia. To determine the predictors of minimum meal frequency, multivariable logistic regression models were used with 95% confidence intervals. We found that 95.4% of the children were breastfed, of whom 59.7% were initially breastfed within one hour after their birth, 83.3% fed on colostrum, 22.2% received pre-lacteal feeds and 50.9% of the children received complementary feedings by 6 months of age. In the 24 hours preceding the survey date, 39.8% of the children were fed using bottle; 4.6% and 1.9% of them consumed vitamin A-rich and iron-rich foods, respectively. Likewise 50.5%, 22.2%, and 12.0% of the children achieved minimum meal frequency, adequate dietary diversity and minimum acceptable diet, respectively. A significant proportion of children in the lowland fed on colostrum and had adequate dietary diversity compared to the midland agro-ecological zone. However, bottle feeding and minimum meal frequency were higher in the midland zone. There are also associations between the agro-ecological zones and initiation of breast feeding, pre-lacteal feeds, bottle and colostrum feeding. The predictors of poor minimum meal frequency were age of the child, being anaemic, stunting, while predictors of infant dietary diversity were maternal dietary diversity and age of the child. One out of nine children received appropriate diet for their age, which was very low. Mothers of child bearing age should be educated on the importance of infant and young child feeding.

Association between Maternal and Child Dietary Diversity: An Analysis of the Ghana Demographic and Health Survey.

Objective (s)This study examined the association between maternal and child dietary diversity in a population-based national sample in Ghana.MethodsThe data for this analysis are from the 2008 Ghana Demographic and Health Survey. We used data obtained from 1187 dyads comprised of mothers’ ages 15–49 and their youngest child (ages 6–36 months). Maternal and child dietary diversity scores (DDS) were created based on the mother’s recall of her own and her child’s consumption of 15 food groups, during the 24 hours prior to the in-home survey. The same food groups were used to compose both maternal and child DDS. Linear regression was used to assess the relationship between the predicted outcome – child DDS -- and maternal DDS, taking into account child age and sex, maternal factors (age, education, occupation, literacy, empowerment, number of antenatal visits as an indicator of health care use), household Wealth Index, and urban/rural place of residence.ResultsThere was a statistically significant positive association between child and maternal DDS, after adjusting for all other variables. A difference of one food group in mother’s consumption was associated with a difference of 0.72 food groups in the child’s food consumption (95% CI: 0.63, 0.82). Also, statistically significant positive associations were observed such that higher child DDS was associated with older child age, and with greater women’s empowerment.ConclusionsThe results show a significant positive association between child and maternal DD, after accounting for the influence of child, maternal and household level factors. Since the likely path of influence is that maternal DDS impacts child DDS, public health efforts to improve child health may be strengthened by promoting maternal DDS due to its potential for a widened effect on the entire family.

Women’s Empowerment Mitigates the Negative Effects of Low Production Diversity on Maternal and Child Nutrition in Nepal

We use household survey data from Nepal to investigate relationships between women’s empowerment in agriculture and production diversity on maternal and child dietary diversity and anthropometric outcomes. Production diversity is positively associated with maternal and child dietary diversity, and weight-for-height z-scores. Women’s group membership, control over income, reduced workload, and overall empowerment are positively associated with better maternal nutrition. Control over income is positively associated with height-for-age z-scores (HAZ), and a lower gender parity gap improves children’s diets and HAZ. Women’s empowerment mitigates the negative effect of low production diversity on maternal and child dietary diversity and HAZ.

An exploration of maternal dietary diversity and household food security in undernourished pregnant women living in Northern Bangladesh

Purpose: Inadequate dietary intake during pregnancy is a major problem in many low-income countries. This study aimed to investigate dietary diversity of pregnant women in fi rst, second or third trimester of pregnancy, and associations with household food security in a rural district of northern Bangladesh. Design: In September 2012, skilled community nutrition volunteers (n 5 8) interviewed undernourished pregnant women (n 5 10) using a questionnaire which consisted of three components 1. demographics 2. household food security and 3. dietary diversity. The Household Food Insecurity Access Scale (HFIAS) was adapted to explore household food access and the individual dietary diversity questionnaire to explore women’s dietary diversity. Data were analysed using HFIAS and dietary diversity validated methodology. Findings: This study found that half of households were identifi ed as food insecure, and two thirds of women had inadequate dietary diversity, which may contribute to the burden of undernutrition and micronutrient defi ciencies. There appeared to be no relationship among women with low dietary diversity scores and household food security. Study fi ndings indicate that additional research is required to identify the relationship between maternal nutrition status, dietary diversity scores and household food security.

Iodized salt benefits children school readiness: preliminary results from a cluster randomized trial in Ethiopia (635.2)

Iodine deficiency is thought to contribute to delayed mental development. The effectiveness of iodized salt programs in reducing this delay has not been studied in children 6 years and under. Using a randomized cluster design, 1835 children 54 to 60 mo old were sampled from 60 villages in the Amhara region of Ethiopia. The iodized salt and control groups were comparable on all baseline variables, including maternal schooling (89.6% had none) and child dietary diversity (mean: 2.2 out of 7 food categories). Once national production of iodized salt began, the project facilitated early delivery to intervention village marketplaces; iodized salt arrived to control village marketplaces approximately 6 months later. The same children (92% of the original sample) were re‐assessed at 69 to 78 mo of age. Intervention group children had a significantly higher score on the 25‐item school readiness test (mean: 8.3 vs 7.8, respectively, p&lt;0.05). No significant differences were found on the two Wechsler tests of reasoning, analyzing raw or standardized scores (0‐19); standardized mean values were very low: Matrix Reasoning (4.0) and Similarities (5.5). In conclusion, along with the exposure to iodized salt, the school readiness skills of 5‐ and 6‐year‐old children benefited possibly because they had exposure to older siblings' literacy and math skills but not to cognitive and verbal reasoning.Grant Funding Source: Supported by Micronutrient Initiative, Canada

Maternal and Child Dietary Diversity Are Associated in Bangladesh, Vietnam, and Ethiopia1, 2

Dietary diversity (DD) reflects micronutrient adequacy of the diet and is associated with better child growth. Emerging evidence suggests that maternal and child DD are associated. This could have measurement and programmatic implications. Data on mother-child (6–24 mo) dyads in Bangladesh, Vietnam, and Ethiopia were used to examine agreement and association between maternal and child DD and identify determinants of maternal and child DD. The DD scores were derived from a 24-h recall of intake of foods from 7 groups. Multivariable regression was used to examine for the association, adjusting for covariates at child, maternal, and household levels. There was mother/child agreement for staple foods across the 3 countries but disagreement for flesh foods, dairy, fruits, and vegetables. A strong positive association was seen between maternal and child DD; a difference of one food group in mother’s consumption was associated with a difference of 0.29, 033, and 0.24 groups in child’s consumption in Bangladesh, Vietnam, and Ethiopia, respectively. The odds of achieving minimum DD (≥4 groups) were higher among children whose mother consumed 4 groups compared with ≤3 food groups [Bangladesh: OR = 2.73 (95% CI: 1.76, 4.25); Vietnam: OR = 2.30 (95% CI: 1.45, 3.43); Ethiopia: OR = 5.11 (95% CI: 2.36, 11.04)]. Maternal education was associated with both maternal and child DD; food security and socioeconomic status were associated only with maternal DD. Given the disagreements in mother/child intake for nutrient-rich foods, both maternal and child DD should be measured in surveys. Behavior change communications should focus on promoting both mother and child DD and encouraging mothers to feed young children all family foods, not just a subset.

Do babies eat what mothers eat? The relationship between maternal and child dietary diversity in Bangladesh, Vietnam and Ethiopia

Diverse diets are linked to better child growth from 6 mo onwards. Interventions typically focus on educating mothers about the importance and ways of improving child dietary diversity (DD). However, new evidence suggests that maternal and child DD are associated. Data from surveys on mother and child (6–24 mo) dyads in Bangladesh (BD), Vietnam (VN) and Ethiopia (ET) were used to explore the concordance and strength of the association between maternal and child DD and determine if maternal DD can predict child's minimum DD. DD scores were derived from 24‐hour recall of intake of foods from 7 groups. Fair mother/child concordance (kappa = 0.23–0.40) was found for intake of legumes, dairy and eggs in BD and ET; animal‐source foods (0.26) and eggs (0.27) in VN; and vitamin A‐rich vegetables in ET (0.23). Multivariate regression analysis showed a strong association between maternal and child DD in all 3 countries, suggesting that education should focus on improving both maternal and child DD, rather than child DD only, to maximize benefits for both mother and child. The area under the curve values from receiver operating characteristic analysis were greater than 0.7 and significant in all 3 countries, indicating that maternal DD could predict child DD. However, because a standard maternal DD cut‐off point could not be identified, both indicators should be measured in large surveys to accurately estimate mother and child DD.Funding support from Bill &amp; Melinda Gates Foundation, through Alive &amp; Thrive, managed by FHI360

Maternal Dietary Diversity and Infant Outcome of Pregnant Women in Northern Ghana

Objective: Little is known regarding the role of maternal dietary diversity score (DDS) in predicting poor outcomes of pregnancy including preterm delivery, and low birth weight (LBW). The main aim of this study was to explore the relationship between dietary diversity scores of urban Ghanaian women and infant weight at birth. Methods: This analytical cross-sectional study comprised 524 pregnant women who delivered singleton babies. A Structured questionnaire was used to collect data on socio-demographic variables (e.g. educational status, age, maternal occupation, household wealth index), obstetric history (for example, gravidity, gestational weight gain), dietary intake, malarial infection and Sulphadoxine pyrimethamine (SP) uptake, blood pressure (BP), haemoglobin concentration (Hb), anthropometric measurements (e.g. weight of mother and new born baby). Results: This study showed that maternal dietary diversity as measured by individual dietary diversity score scores (IDDS) was a significant independent predictor for mean birth weight and LBW. Analysis of covariance (ANCOVA) showed there was a significant difference in adjusted mean birth weight between women on low and high diversified diets , F (1, 415) = 8.935, p = 0.003. The results further showed that maternal IDDS was negatively associated with the incidence of LBW (Adjusted OR = 0.43, 95% CI = 0.22–0.85, p = 0.014). Conclusion: In nutritional deprived populations, maternal diet in the third trimester appears to be an important determinant of LBW and that DDS can serve as useful predictive indicator of maternal nutrition during pregnancy and the likelihood of delivering LBW babies.