Women's Dietary Diversity Score Research Articles

Can nutrition education mitigate the impacts of COVID-19 on dietary quality? Cluster-randomised controlled trial evidence in Myanmar's Central Dry Zone.

We evaluate the immediate impact of a nutrition and gender behaviour change communication on dietary quality in rural communities in Myanmar and assess whether the communication helped mitigate the effect of the COVID‐19 crisis on dietary quality. The intervention was designed and implemented as a cluster‐randomised controlled trial in which 15 villages received the intervention and 15 control villages did not. The intervention was implemented from June to October 2020. This paper provides an assessment of the intervention's impact on dietary quality based on the results of two phone surveys conducted in August and October 2020. Immediate impacts of the intervention indicate an improvement in women's dietary diversity scores by half a food group out of 10. At baseline, 44% of women were likely to have consumed inadequately diverse diets; results indicate that 6% (p‐value: 0.003, SE: 0.02) fewer sample women were likely to have consumed inadequately diverse diets. More women in treatment villages consumed pulses, nuts, eggs and Vitamin A‐rich foods daily than in control villages. In response to economic shocks related to COVID‐19, households in the treatment villages were less likely to reduce the quantity of meat and fish consumption than in control villages. The long‐term impacts of the intervention need to be continuously evaluated.

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.

Impact of Adopting Improved Seeds on Access to Broader Food Groups Among Small-Scale Sorghum Producers in Tanzania

In this study, we use double-robust estimators (i.e., inverse probability weighting and inverse probability weighting with regression adjustment) to quantify the effect of adopting climate-adaptive improved sorghum varieties on household and women dietary diversity scores in Tanzania. The two indicators, respectively, measure access to broader food groups and micronutrient and macronutrient availability among children and women of reproductive age. The selection of sample households was through a multistage sampling technique, and the population was all households in the sorghum-producing regions of Central, Northern, and Northwestern Tanzania. Before data collection, enumerators took part in a 1-week training workshop and later collected data from 822 respondents using a structured questionnaire. The main results from the study show that the adoption of improved sorghum seeds has a positive effect on both household and women dietary diversity scores. Access to quality food groups improves nutritional status, food security adequacy, and general welfare of small-scale farmers in developing countries. Agricultural projects that enhance access to improved seeds are, therefore, likely to generate a positive and sustainable effect on food security and poverty alleviation in sorghum-producing regions of Tanzania.

Dietary Practice and Nutritional Status Among Pregnant Women Attending Antenatal Care at Mettu Karl Referral Hospital, Southwest Ethiopia

Background: Sufficient maternal nutrition is paramount to ensure maternal and fetal wellbeing. It further determines the health of the offspring throughout the lifecycle and prevents adverse health outcomes of the upcoming generation. Therefore, dietary practice and nutritional status of pregnant women and contributing factors among pregnant women visiting antenatal care services at Mettu Karl Hospital, Southwest Ethiopia, were assessed. Methods: Facility-based cross-sectional study was conducted from March to April 2018. A systematic random sampling technique was employed to select 378 study participants. Data were collected via face to face interviews using semi-structured questionnaires. Women Dietary Diversity Score (WDDS) was measured using a qualitative 24- hr dietary recall and nutritional status was assessed by Mid-upper arm circumference measurements. Analyses were done using the statistical package of social science (SPSS version 20). Results: The prevalence of sub-optimal dietary practices was 22% and under-nutrition was 17.5%. Family size &gt;5 [AOR=8.2, 95%CI: 12.383, 46.217] and severe food insecurity [AOR=3.661, 95%CI, 1.289, 10.394] were significantly associated with sub-optimal dietary practices. Being non married woman[AOR= 3.188, 95% CI: 1.219, 8.336], lack of formal education[AOR=9.405, 95%CI: 1.079, 81.943], lack of iron supplementation [AOR=3.189, 95%CI: 1.513, 6.720], WDDS &lt;6 [AOR= 4.057, 95% CI: 2.157, 7.634], not taking additional meal (3+) [AOR=2.267, 95%CI: 1.211, 4.244], skipping meals [AOR=3.856, 95%CI: 1.099, 13.530) were significantly associated with under-nutrition. Conclusion and Recommendations: The present study revealed that there is a burden of suboptimal dietary practice and undernutrition among the studied participants. Predictors identified for suboptimal dietary practice were the family size and household food insecurity. Similarly, undernutrition was predicted by marital status, educational status, iron supplementation, additional meal intake, and meal skipping. Strategies should be designed at different levels by concerned bodies considering dietary practice and nutritional intake of pregnant women, with possible identified factors.

A Garden-Based Intervention to Improve Dietary Diversity in Kenyan School Children: Results from a Natural Experiment

Abstract Objectives School gardens may improve child diet, but little is known about their effectiveness in rural areas in low-income countries. We evaluated the ability of school gardens to improve child diet in rural Kenya. We hypothesized that children in intervention schools would improve their dietary diversity and specifically their produce intake. Methods An non-government organization installed gardens in 2 primary schools. We selected 2 geographically proximal additional schools as comparisons. We conducted baseline assessments in 2013, prior to garden installation, and follow-up assessments a year later in 2014 in all 4 schools. We measured child dietary intake via a single 24-hour recall. We calculated dietary diversity using the women's dietary diversity score (WDDS) (continuous) and also examined each of the 10 food group components defined as adequate ≥15 g (binary). We conducted marginal linear or logistic regression models using a generalized estimating equation and included an exposure x time interaction to assess differences in outcomes between intervention and comparison schools from baseline to follow up. We controlled for child age, gender, and orphan status. Results We assessed 855 children (n = 438 intervention; n = 417 comparison) at baseline and 688 children (n = 383 intervention; n = 305 comparison) at follow up. Children in intervention schools were 51.8% male, compared to 56.5% in comparison schools. Mean (standard deviation) age was 11.6 (2.1) years in intervention and 11.8 (2.3) years in comparison schools. All children's WDDS worsened post-intervention. In adjusted difference in difference analyses, WDDS did not differ in intervention vs. comparison schools pre- to post-intervention (β 0.04, CI −0.19, 0.27). However, we observed less of a decrease in meeting adequate intake for pulses (OR 2.18, CI 1.18, 4.01) and other fruits (OR 1.55, CI 1.00, 2.40) in intervention versus comparison schools. Conversely, children in comparison schools had less of a decrease in meat, poultry, and fish compared to children in intervention schools (OR 0.67, CI 0.45, 0.99). Conclusions Children's WDDS worsened in all 4 schools, likely due to a severe drought that affected the region in 2014. We observed some differences in intervention vs. comparison children, but cannot attribute these improvements to school gardens. Funding Sources Duke Global Health Institute.

Maternal dietary diversity and pattern during pregnancy is associated with low infant birth weight in the Cape Coast metropolitan hospital, Ghana: A hospital based cross-sectional study

BackgroundThis study investigated the associations between mother's dietary diversity score and dietary patterns during pregnancy and the odds of low birth weight at the Cape Coast Metropolitan Hospital in Ghana. MethodsMothers attending the postnatal clinic from January to August 2016 at the Cape Coast Metropolitan Hospital were included. Dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the women's dietary diversity score, women were categorized into low, medium or high dietary diversity score groups. The primary outcome was low birth weight and was defined as weight <2500 g at birth. Factor analysis was conducted to identify maternal dietary patterns and a multivariable logistic regression analysis was used to determine the associations between dietary diversity score and dietary patterns with low birth weight. ResultsThe prevalence of low birth weight in infants was 43.8% (95% CI = 39%–49%). After adjusting for covariates, the odds of low birth weight was four times higher in the low dietary diversity score group compared to the high dietary diversity score group (odds ratio [OR] = 4.29, 95% confidence interval [CI], 1.24–6.48). Three dietary patterns namely "Western", "Traditional" and "Healthy", which explained 58.23% of the total variance in food intake were identified. The subjects in the highest quartiles of “healthy” and “traditional” dietary pattern scores had significantly lower odds of low birth weight (healthy: OR = 0.23, 95% CI, 0.19–0.39, P trend <0.0001; traditional: OR = 0.14, 95% CI, 0.06–0.35, P trend <0.0001, respectively) compared to those in the lowest quartiles of dietary pattern score. ConclusionLow dietary diversity score during pregnancy was associated with higher odds of infant low birth weight whereas dietary patterns considered as “healthy” and “traditional” during pregnancy were associated with lower odds of infant low birth weight. Findings of this study suggests that higher dietary diversity and “healthy” and “traditional” dietary patterns during pregnancy may be protective of LBW in the study area.

Dietary diversity in eight Latin American countries: Results from ELANS Study

AbstractDietary diversity, define as the number of food items or food groups consumed over a given period of time measured at the household or individual level, is widely recognized as a key dimension of diet quality. This analysis investigated dietary diversity in eight Latin-American countries and its associations with sociodemographic and anthropometric parameters.Data from the ELANS study conducted in eight Latin-American countries (Argentina, Brazil, Colombia, Costa Rica, Chile, Ecuador, Peru and Venezuela) were analyzed. The ELANS study interviewed 9,218 subjects living in the main cities in each country. Food intake were collected using two 24-hour dietary recalls, following the Multiple Pass Method. For calculation of diet diversity score, only the first 24-hour recall was analyzed. Dietary diversity was assessed at individual level. All food items reported to be consumed during the first 24-hour recall were classified into nine food groups: 1. Cereals, 2. White roots and tubers, 3. Vegetables, 4. Fruits, 5. Meat, poultry and offal, 6. Fish and seafood, 7. Eggs, 8. Pulses, legumes and nuts and 9. Milk and milk products. The selection of these groups was based on the Women's Dietary Diversity Score Projectfood groups classification. Consumption of at least 15 g of each food group was assigned 1 point or 0 points if consumption was less than 15 g. Thus, the score ranged from a minimum of 0 and a maximum of 9 points. Higher scores indicated higher diversity as more food groups were eaten. Analysis was performed by age group, gender, and socioeconomic level (SES) as well as anthropometric measurements.Mean diet diversity score (DDS) for the whole sample was 4.48 ± 1.16, ranging from 0 to 9 points. Men showed significant higher DDS. No difference was observed among age groups. Among countries, Ecuador and Peru showed the highest DDS, 4.88 ± 1.22 and 4.82 ± 1.12 points, respectively; while Argentina (4.20 ± 1.13) and Venezuela (4.27 ± 1.04) reported the lowest. We found a statistically significant trend (p &lt; 0.001) to a higher DDS among those subjects in the high socio-economic level. Regarding anthropometric measurements, no differences were found in DDS among different nutritional status or based on waist and neck circumference measures.This study revealed that dietary diversity is limited among Latin American countries regardless of sex, age, socioeconomic level, and nutritional status. Nutritional interventions emphasizing the importance of maximizing dietary diversity should be encouraged to ensure optimum nutritional adequacy within the region

Changes in women's dietary diversity before and during pregnancy in Southern Benin.

Dietary diversity before and during pregnancy is crucial to ensure optimal foetal health and development. We carried out a cohort study of women of reproductive age living in the Sô‐Ava and Abomey‐Calavi districts (Southern Benin) to investigate women's changes in dietary diversity and identify their determinants both before and during pregnancy. Nonpregnant women were enrolled (n = 1214) and followed up monthly until they became pregnant (n = 316), then every 3 months during pregnancy. One 24‐hr dietary recall was administered before conception and during each trimester of pregnancy. Women's dietary diversity scores (WDDS) were computed, defined as the number of food groups out of a list of 10 consumed by the women during the past 24 hr. The analysis included 234 women who had complete data. Mixed‐effects linear regression models were used to examine changes in the WDDS over the entire follow‐up, while controlling for the season, subdistrict, socio‐demographic, and economic factors. At preconception, the mean WDDS was low (4.3 ± 1.1 food groups), and the diet was mainly composed of cereals, oils, vegetables, and fish. The mean WDDS did not change during pregnancy and was equally low at all trimesters. Parity and household wealth index were positively associated with the WDDS before and during pregnancy in the multivariate analysis. Additional research is needed to better understand perceptions of food consumption among populations, and more importantly, efforts must be made to encourage women and communities in Benin to improve the diversity of their diets before and during pregnancy.

Factors Influencing Dietary Diversity of Pregnant Women Attending Antenatal Care in Western Regional Hospital, Nepal: A Cross-sectional Study

Background: Diet during pregnancy is important to fulfill the nutritional demand of physiological changes as well as to create environment for fetal development. Studies have shown that micronutrient deficiencies are high due to low dietary diversity. In Nepal, meal diversity scores of mother and children are low. The situation of dietary diversity among pregnant women was unknown in Western Region of Nepal. Thus, this study was conducted togenerate evidence regarding status and determinants of dietary diversity among pregnant women.&#x0D; Methods: It was a cross sectional study. Systematic random sampling was done to select 282 pregnant women of third trimester attending antenatal care in Western Regional Hospital, Nepal. Semi-structured questionnaire, 24 hour recall tool andHousehold Food Insecurity Access Scale were used to collect information from participants. Univariate, bivariate and multivariate analysis was done to assess the status, association as well as strength of association between study variables respectively.&#x0D; Results: The mean (±SD) Women's Dietary Diversity Score was 4.96 (±1.42). Pregnant women having education level &lt; SLC compared to ≥ SLC were 74.7% less likely to have high dietary diversity to lowest dietary diversity (AOR: 0.253, CI: 0.103 – 0.620, p=0.003). Similarly, pregnant women having unpaid occupation of husbands compared to paid were 74.5% less likely to have high dietary diversity to lowest dietary diversity (AOR: 0.255, CI: 0.074 – 0.876, p=0.030).&#x0D; Conclusions: Consumption of medium dietary diversity was predominant among pregnant women. Education of the pregnant women and occupation of her husband werethe two significantly associatedfactors with dietary diversity.

Determinants of dietary diversity among women of reproductive age in two different agro-ecological zones of Rongai Sub-County, Nakuru, Kenya.

BackgroundEmpirical evidence on the link between agrobiodiversity and dietary diversity appears to be inconclusive. Thus, there arises a need to determine other factors that could significantly influence dietary diversity in different agro-ecological zones, as factors may vary from region to region.ObjectiveThe objective of this study was to document the status of agrobiodiversity and dietary diversity and to assess the determinants of dietary diversity among women of reproductive age in two different agro-ecological zones of Rongai Sub-County in Kenya.DesignA cross-sectional study of 384 women aged 18–49 years was conducted. Agrobiodiversity was measured using the Shannon-Wiener index, species richness (count) and production diversity score. A 24-hour dietary recall was used to determine minimum dietary diversity for women (MDD-W) of reproductive age.ResultsAlthough the level of agrobiodiversity was different between the low and high agro-ecological zones (using Shannon-Wiener index); the women’s dietary diversity was not different (p > 0.05) between low (3.78 ± 0.99) and high potential areas (3.84 ± 1.05). In multivariate logistic regression, there was no association (p > 0.05) between agrobiodiversity indicators and dietary diversity across the two agricultural zones. Factors influencing MDD-W in two agricultural zones were different. In low potential areas, woman’s education level positively determined dietary diversity, while in high potential areas household gender, woman’s education level, woman’s age and family size influenced MDD-W.ConclusionThe proportion of women who met minimum dietary diversity was low. Although agrobiodiversity was different in the two agro-ecological zones, women’s dietary diversity scores were similar. In low agricultural potential areas, only education level influenced women’s dietary diversity while household gender, education level, age and family size were the important determinants in high agricultural potential areas. Therefore, it is recommended that nutrition interventions focusing on lessening malnutrition and improving dietary quality should pay special attention to differences in agro-ecological zones to develop region-specific interventions instead of generalizing interventions.

Effects of multiannual, seasonal unconditional cash transfers on food security and dietary diversity in rural Burkina Faso: the Moderate Acute Malnutrition Out (MAM'Out) cluster-randomized controlled trial.

To evaluate the impact of multiannual, seasonal unconditional cash transfers (UCT) provided within the Moderate Acute Malnutrition Out (MAM'Out) research project on households' food security and children's and caregivers' dietary diversity. A two-arm cluster-randomized controlled trial with sixteen villages in the intervention group and sixteen others in the control group. A monthly allowance of 10 000 XOF was transferred to caregivers of eligible children via a personal mobile phone account from July to November 2013 and 2014. Tapoa province in the eastern region of Burkina Faso. Data on household food access (monthly adequate household food provisioning (MAHFP); household food insecurity access scale (HFIAS)) and maternal and child dietary diversity were analysed for 1143 households, 1219 caregivers of reproductive age (15-49 years) and 1247 under-5 children from both intervention and control groups. The mean women dietary diversity score in intervention caregivers and the mean dietary diversity score (DDS) in intervention children with inadequate minimum DDS at baseline were respectively 7 % (95 % CI 2, 11 %; P = 0·002) and 17 % (95 % CI 11, 23 %; P <0·001) higher compared with the control group. However, no difference was found in the intervention effect on household food security measured with HFIAS (relative risk = 1·03; 95 % CI 0·92, 1·15; P = 0·565) and MAHFP (relative risk = 0·98; 95 % CI 0·96, 1·01; P = 0·426). Multiannual, seasonalUCT increased dietary diversity in children and their caregivers. They can be recommended in actions aiming to improve maternal and child diet diversity.

Maternal Diet and Morbidity Factors Associated with Low Birth Weight in Haiti: A Case-Control Study.

Objective: A matched, case–control study was conducted to examine the association between development of low birth weight (LBW) and maternal factors, including dietary intake, comorbidities, and socioeconomic factors, among women in Cap Haitien, Haiti.Design: Mothers who delivered LBW babies; defined as ≤2.5 kg, were identified by review of the medical record and matched to mothers of similar age, parity, with normal birth weight (NBW) babies. A survey was administered consisting of Women's Dietary Diversity Score (WDDS), maternal reporting of comorbidities, income, and educational level.Subjects: Women were eligible if they delivered and had newborns weighed within the last 2 years. Total study participants consisted of 32 cases and 34 controls matched for age, parity, and month of delivery.Results: Mothers who consume eggs were 78% less likely to have given birth to a LBW infant (OR 0.22 (95% CI: 0.05–0.87). Mothers with NBW babies had a nonsignificant trend towards higher WDDS. The prevalence of hypertension in mothers who were seen in the clinic at least once over the past 2 years was found to be 27%, and 78% of mothers were not aware of their diagnosis.Conclusion: Enhancing maternal nutrition during pregnancy has broad implications for reducing LBW, improving fetal health and reducing fetal predilection for chronic diseases in adulthood. Longitudinal prospective studies are needed to evaluate the selective benefit of eggs and other high-quality foods in protecting fetal growth. Efforts to improve knowledge and awareness of hypertension in Haiti should be undertaken.

Dietary Diversity Predicts the Adequacy of Micronutrient Intake in Pregnant Adolescent Girls and Women in Bangladesh, but Use of the 5-Group Cutoff Poorly Identifies Individuals with Inadequate Intake

BackgroundThe Minimum Dietary Diversity for Women (MDD-W) indicator based on a 10-food group women dietary diversity score (WDDS-10) has been validated to assess dietary quality in nonpregnant women. Little is known about its applicability in pregnant women, and specifically pregnant adolescent girls with higher nutrient requirements.ObjectivesThis study aimed to 1) compare the adequacy of micronutrient intakes between pregnant adolescent girls and women, 2) examine the performance of WDDS-10 in predicting the mean probability of adequacy (MPA) of 11 micronutrients, and 3) assess how well the MDD-W cutoff of 5 groups performed in pregnant adolescent girls and women.MethodsWe used data from a 2015 household survey in Bangladesh (n = 600). Nutrient intakes were estimated with a multiple-pass 24-h recall and WDDS-10 was assessed through the use of a list-based method. Multiple linear regression models adjusted for geographical clustering assessed the association between WDDS-10 and MPA. Sensitivity and specificity analysis assessed the accuracy of MDD-W in correctly classifying individuals into high (MPA >0.6) or low MPA.ResultsDietary intakes of pregnant adolescent girls and women were similar in energy intake, WDDS-10 (5.1 ± 1.4), MPA (0.40 ± 0.12), and micronutrient intakes. Probabilities of adequacy were ~0.30 for riboflavin, vitamin B-12, calcium, and zinc; 0.12–0.15 for folate; 0.16–0.19 for vitamin A; and extremely low for iron at 0.01. The WDDS-10 was significantly associated with MPA in both groups and predicted MPA equally well at population level (SD of residuals 0.11 for both). Use of the 5-food groups cutoff for MDD-W to classify individuals’ diets into MPA >0.6, however, resulted in a low correct classification (~40%). A cutoff of 6 food groups markedly improved correct classification.ConclusionsThe WDDS-10 predicted MPA equally well for pregnant adolescent girls and women at population level. The MDD-W indicator performed poorly in classifying individuals with MPA >0.6. J Nutr 2018;148:790–797

Mothers' dietary practices in the Amoron'i Mania region Madagascar.

IntroductionMadagascar has one of the highest prevalence's of malnutrition worldwide. Dietary practice is an important element to consider in the fight against malnutrition. This study aims to describe mothers' dietary patterns and dietary diversity and to identify characteristics associated with this dietary diversity.MethodsA cross sectional study was carried-out among 670 non-pregnant mothers aged 18 to 45, who had delivered more than 6 months earlier and were living in the Amoron'i Mania region of Madagascar. The study was conducted during the post-harvest period. A food frequency questionnaire were used to assess the dietary pattern and the women's dietary diversity score was established from the 24-hour recall data.ResultsAlmost all (99%) of mothers ate rice every day and 59% ate green leaves. Fifty three percent of mothers had consumed fruit less than once per week, 55% for legumes, 67% for vegetables and 91% for meat. Dietary diversity score ranged from 1 to 7 and 88% of mothers had a low dietary diversity score (<5). On multivariate analysis, factors significantly associated with low dietary diversity were: low education level (AOR=3.80 [1.58-9.02], p=0.003), parity higher than 3 (AOR=2.09 [1.22-3.56], p=0.007), birth interval ≥ 24 months (AOR=4.01 [2.08-7.74], p<0.001), rice production availability ≤ 6 months (AOR=2.33 [1.30-4.17], p=0.013), low attendance at market (AOR=4.20 [1.63-10.83], p<0.001) and low movable property possession score (AOR=4.87 [2.15-11.04], p<0.001).ConclusionMother's experience poor diet diversity. Unfavorable socioeconomic conditions are associated with this poor food diversification.

Chronic Energy Deficiency and Associated Factors among Lactating Mothers (15-49 years old) in Offa Woreda, Wolayita Zone, SNNPRs, Ethiopia

The lactating mothers in developing countries like Ethiopia are the first targeted and nutritionally vulnerable groups to under nutrition due to different socio demographic factors which influence the health and well being of mothers and children. During lactation periods, mothers need more nutritious food than the rests of the household members. The aim of this study was to determine the nutritional status, associated factors and dietary diversity of lactating mothers 15-49 years old in Offa woreda. A cross-sectional community based study was carried out to determine the Chronic Energy deficiency of lactating mothers in the studied woreda. The lactating mothers were randomly selected from four rural and two urban kebeles. A total of 422 households were visited and the required data were collected as scheduled in all selected kebeles. The prevalence of under nutrition among the lactating mothers in the studied area was determined using BMI by Anthropometric measurements and the blood sample test for hemoglobin (Hb) concentration was done using Haemocue methods. The collected data were analyzed using Stata version 14.2 software. Among the participated lactating mothers the values 15.8%, 74.2%, 8.3% and 1.7% were obtained for under weight, normal, over weight and obese in their BMI (kg/m2), respectively. The studied participants of 15.8% were in chronic energy deficiency according to WHO guidelines. The lactating mothers’ percentage value 36.4%, 59.3%, 4.3% were in age group of 15-24, 25-34 and 35-49 years, respectively. The blood test showed that among the lactating mothers 11.4% were found anemic which had got hemoglobin level less than normal level (12g/dl). The daily dietary diversity intake per day of lactating mothers was classified as high (>5 DDS) 1.2%, medium (4-5 DDS) 50.7% and low (<3 DDS) 47.4% among the nine food groups recommended for women dietary diversity score (WDDS). The independent variables: education, family size, marital status and occupation were significantly associated with nutritional status of the lactating mothers at P<0.05. In conclusion the majority of the lactating women in the study area had normal BMI. The researchers would like to recommend that the government and development agencies should focus on the risk factors identified, to ensure better health and nutrition for lactating mothers in this woreda.

Examining Nutritional Adequacy and Dietary Diversity Among Women in Niger.

Objective The purpose of this study was to examine the nutritional adequacy and dietary composition among women residing in Zinder and Maradi of Niger, and the factors that affect the variety of their dietary intake. Methods Data from 3360 women of ages 15-49 were used in the analysis. The variable of interest was the Women Dietary Diversity Score (WDDS), which is the simple sum of scores of the 9 categorized food groups, ranging from 0 to 9. Lower values for WDDS indicate nutritionally inadequate dietary diversity. Analysis included descriptive, Mann-Whitney U test and linear regression. Results The majority of the participants were residing in the Maradi Region (56.7%) and were living in households with both male and female adults (94.9%). The mean WDDS was 3.5 in Zinder compared to 2.5 in Maradi (p < .05). The most frequently consumed food items in both Zinder and Maradi were starchy staple food (98.3%). Region of residence was one of the strong predictor of WDDS. A total number of farmers in the household and Household Dietary Diversity Score (HDDS) had positive and significant effects on WDDS whereas Household Hunger Scale (HHS) had a negative and significant effect on WDDS. Conclusion Niger has one of the highest concentrations of malnutrition in the world. In 2012, approximately 2.5million Nigeriens were affected by malnutrition. Our study results reinforce the importance to conduct more studies that examine the nutritional intake of women in Niger.

Dietary diversity during pregnancy is associated with reduced risk of maternal anemia, preterm delivery, and low birth weight in a prospective cohort study in rural Ethiopia

Anemia during pregnancy is a leading nutritional disorder with serious short- and long-term consequences for both the mother and the fetus. The objective was to investigate the association between dietary diversity during pregnancy and maternal anemia, low birth weight (LBW), preterm birth (PTB), and stillbirth in rural Ethiopia. We conducted a prospective cohort study and enrolled 432 pregnant women in their first antenatal care visit (24-28 gestational weeks); 374 women completed the follow-up. By using the FAO Women's Dietary Diversity Scores (WDDSs), subjects were categorized into "inadequate" (WDDS <4) and "adequate" (WDDS ≥4) groups and were followed until delivery. Primary outcomes were maternal anemia, birth weight, term delivery, and stillbirth. The attrition rate was 13.7% and was balanced across the 2 groups. The proportion of women consuming dairy, animal-source foods, fruits, and vegetables including vitamin A-rich ones was higher in the adequate than in the inadequate WDDS group (P < 0.05). The overall incidence of maternal anemia increased from 28.6% to 32.4% during the follow-up period. The overall proportion of LBW, PTB, and stillbirth were 9.1%, 13.6%, and 4.5%, respectively. After control for baseline differences, women in the inadequate group had a higher risk of anemia [adjusted RR (ARR: 2.29; 95% CI: 1.62, 3.24], LBW (ARR: 2.06; 95% CI: 1.03, 4.11), and PTB (ARR: 4.61; 95% CI: 2.31, 9.19) but not of stillbirth (ARR: 2.71; 95% CI: 0.88, 8.36) than women in the adequate group (P < 0.05). A WDDS of ≥4 food groups during pregnancy was shown to be associated with lower risk of maternal anemia, LBW, and PTB. Population-based controlled trials of various options to improve dietary diversity are needed before conclusive recommendations can be made. This trial was registered at clinicaltrials.gov as NCT02620943.

The association between dietary diversity score and iron deficiency anemia among reproductive‐aged women in Ghana

A dietary diversity score (DDS) is often used as a proxy for diet quality but little is known on its association with nutrients status, such as iron deficiency anemia in Ghana. This is needed to help curb the high prevalence of micronutrients deficiencies. The aim of this study was to examine the association between DDS and iron deficiency anemia among reproductive‐aged women in Ghana. We hypothesized that women's dietary diversity score is positively associated with blood hemoglobin level and inversely associated with the prevalence of iron deficiency anemia. The 2008 Ghana Demographic and Health Survey dataset was analyzed to test our hypotheses. From the data set, 1,216 women who were aged 15–49 years and had complete data on both food group intake and blood hemoglobin values were included in the data analyses. The DDS was calculated based on the data from women's 24hr recall about 15 food groups consumption. Hemoglobin was measured in grams per deciliter using the HemoCue testing system. Iron deficiency anemia was defined as having a hemoglobin level less than 11.9g/dl. Detailed classification of iron deficiency anemia included: severe (HB &lt; 7.0g/dl), moderate (HB: 7.1 – 9.9g/dl), and mild (HB: 10 – 10.9g/dl for pregnant women, 10 – 11.9g/dl for nonpregnant). Correlation analysis was used to find the relationship between DDS and hemoglobin level and logistic regression analysis was performed to examine the association between DDS and the prevalence of iron deficiency anemia. Women's education level and household wealth index were positively associated with their DDS (p‐value &lt; 0.001). Between consumers and non‐consumers of each of the six food groups, there was a significant difference in DDS (all p‐values &lt; 0.001). The DDS was positively correlated with hemoglobin level (correlation coefficient = 0.08, p‐value = 0.007). However, no significant association between DDS and the prevalence of iron deficiency anemia was observed. DDS is associated with hemoglobin levels but has no significant association with anemia among Ghanaian women. This might be partly due to not catering for individual foods effects. It is thus suggested that future researches should explore dietary patterns and nutrients status among reproductive‐age women in Ghana.

Homestead Food Production (HFP) with or without Aquaculture Improves Women's Dietary Diversity Scores, Household Food Security and Income in Prey Veng Province, Cambodia

ObjectivesTo determine the impact of plant‐based HFP (diversified home gardens) with or without aquaculture (fishponds) on women's dietary diversity, household food security, and income in Prey Veng province, Cambodia.MethodsThis was a three‐arm cluster‐randomized control trial conducted during July 2012 to June 2014. In total, 900 households in 90 villages (clusters) from four districts in Prey Veng province were randomized to one of three groups: 1) plant‐based HFP only; 2) plant‐based HFP plus aquaculture; and 3) control. Surveys were administered at baseline and end‐line, which included models on Individual Dietary Diversity (DD); a Household Food Insecurity Access Scale (HFIAS) tool; and the money earned from selling HFP products in the previous 2 months. Women were categorized into one of three groups based on their DD score: low DD (consumption of &lt;=3 food groups in the previous 24h), medium DD (consumption 4 or 5 food groups); and high DD (consumption of &gt;= 6 food groups). Households were categorized to one of four groups according to their degree of food security from food secure to severely food insecure. Data were analyzed as intent‐to‐treat. Missing values were handled using the maximum likelihood method, which takes all available data for each subject to construct the maximum likelihood function and estimates parameters in relevant models. To address the clustering effect, changes from baseline to endpoint were analyzed using generalized linear mixed models with multinomial distribution, using cumulative logit link for categorical variables and Gamma distribution for continuous measures.ResultsWomen in the intervention groups (plant‐based HFP and plant‐based HFP + fishponds) were more likely to have consumed &gt;=6 foods groups (high dietary diversity) versus &lt;=3 food groups (low dietary diversity) in the previous 24h, as compared to women in the control group (OR: 1.63, 95% CI: 1.01, 2.12; p&lt;0.01; and OR: 1.46, 95% CI: 1.01, 212; p=0.01, respectively). Similarly, households in the plant‐based HFP + fishponds group were more likely (OR: 1.73; 95% CI: 1.09, 2.75) to be food secure as compared to control households (p=0.02), with a similar trend observed among households in the plant‐based HFP only group when compared to control (OR: 1.57, 95% CI: 1.00, 2.52; p&lt;0.127). Income from HFP increased from baseline to end‐line in the intervention households, with no change observed in the control households. Specifically, the average income (in USD) from HFP was 30.00 and 39.28 times greater for households in the plant‐based HFP and plant‐based HFP + fishponds groups, respectively, as compared to control (p&lt; 0.001).ConclusionsHFP with or without fishponds is an efficacious means of improving food security, dietary diversity, and livelihoods of poor, rural women farmers’ in Prey Veng province, Cambodia.Support or Funding InformationThis work was carried out with the aid of a grant from the International Development Research Centre, Ottawa, Canada www.idrc.ca, and with financial support from the Government of Canada, provided through Foreign Affairs, Trade and Development Canada (DFATD), www.international.gc.ca.”

Associations of dietary diversity scores and micronutrient status in adolescent Mozambican girls.

In low-income settings, dietary diversity scores (DDSs) often predict the micronutrient adequacy of diets, but little is known about whether they predict levels of biochemical indicators of micronutrient status. In 2010, we studied two samples of non-pregnant 14- to 19-year-old girls in central Mozambique, the first in January-February ('hunger season'; n=227) and the second in May-June (harvest season; n=223). In this paper, we examined whether a low Women's Dietary Diversity Score (WDDS) predicts a low concentration of haemoglobin, serum ferritin, zinc, and folate, and plasma retinol in adolescent Mozambican girls. We constructed three scores: WDDS based on 24-h recalls, WDDS15g based on 24-h recall and employing a 15g limit, and 7dWDDS based on 7-day food frequency questionnaires. Logistic regression models, stratified by season, were used to estimate the odds of having a low concentration of a status indicator (≤25th percentile of the season-specific distribution or cut-off from the literature) in those with a low score compared to those with a higher score. In January-February, after adjusting for confounders, a low (≤3) WDDS and a low (≤5) 7dWDDS were each associated with higher odds of having low serum zinc compared to having a higher score, regardless of which of the two types of cut-offs for serum zinc was used. These associations were not present in May-June. Our data from Mozambique suggest that dietary diversity is associated with serum zinc, but this association seems to be limited to the hunger season.