Women's Dietary Diversity Score Research Articles

Exploring the FAO Minimum Dietary Diversity Indicator as a Suitable Proxy of Micronutrient Adequacy in Men and Women Across Reproductive and Non-reproductive Ages in 8 Latin American Countries.

Women's Dietary Diversity Score (WDDS) is an indicator of dietary diversity, a key component of diet quality in women of reproductive age (WRA). Limited information is available regarding its applicability in other population groups. To examine the ability of the Minimum Dietary Diversity for Women (MDD-W) of 5-food groups cutoff to predict micronutrient adequacy in men and women 15 to 65 years old from 8 Latin American countries. We used a 24-hour recall from 9216 participants in the Latin American Study on Nutrition and Health (ELANS) to determine Dietary Diversity Score (DDS) based on the consumption of 10 food groups. The Mean Probability of Adequacy (MPA) was associated with DDS for the overall sample, for men, WRA, and women of nonreproductive age (WNRA). Sensitivity and specificity analyses were performed to determine if the 5-food groups cutoff point for MDD can be used to correctly identify men, WRA, and WNRA with adequate micronutrient adequacy (MPA ≥ 0.70). We found a mean DDS of 4.78 ± 1.33 and an MPA of 0.64 ± 0.16, with 59% of participants showing a diverse diet (DDS ≥ 5). The 5-food groups-cutoff point showed a better balance between sensitivity and specificity predicting an MPA ≥0.70 in men, WRA, and WNRA. MPA was significantly associated with DDS in WRA and for men and WNRA, as well. The 5-food group MDD, originally intended to be used in WRA, performed equally well in predicting MPA ≥0.70 in men, WRA, and WNRA, and can be used as a proxy of micronutrient adequacy in Latin American population.

Home-Garden Production and Women Dietary Diversity: An Experience from Success of Micro-Intervention in Boru Meda Kebele, Ethiopia

Background: In order to combat malnutrition and micronutrient deficiencies, Nutrition Sensitive Agriculture (NSA) gives nutrient-dense foods, dietary diversity, and food fortification the highest priority. This micro-intervention project's goal is to increase home-gardening system's contribution to raising women's dietary diversity score (WDDS) by diversifying family farming practices. Methods: In Ethiopia's Boru-Meda Kebele, The authors applied the intervention to 40 specifically chosen female beneficiaries between the ages of 15 and 49. FAO's standardized questionnaire was used as a tool to conduct an initial and end-line dietary diversity survey by giving careful consideration to cultural and religious elements. The qualitative information was also gathered using case studies, key informant interviews, and focus group discussions. Results: The local population's diet was dominated by staple cereal crops, and women were less knowledgeable about home gardening and diverse diets. Before intervention, the average number of food groups produced and consumed was 2.63±1.00 and 3.68±1.16 respectively. The intervention enhanced the WDDS to 6.13±0.76, and the production diversity to 5.63±0.90. The intervention changed the community's consumption and production patterns, especially among women. Conclusion: Home-garden agriculture helps to increase WDDS. As a result, development partners must concentrate on farming system diversification by increasing the accessibility of vegetable seeds and educating local farmers about the contribution of diversified vegetable production and consumption. Strengthening the cooperation among stakeholders and maintaining monitoring of activities should also be given due emphasis.

Defining a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity Among Pregnant Adolescent Girls and Women: A Secondary Analysis of Quantitative 24-h Recalls from Rural Settings in Bangladesh, Burkina Faso, India, and Nepal

BackgroundThe Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. ObjectiveThis study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15–49 y in LMICs. MethodsWe used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. ResultsIn the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). ConclusionsThe WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15–49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.

Empowering rural women through gender and nutrition education amid the COVID-19 crisis: Evidence from Myanmar's Central Dry Zone

The COVID-19 pandemic had negative impacts on nutrition and strained intrahousehold relations, particularly among poorer households. Social protection programs intended to mitigate these impacts mainly operated through handing out cash or in-kind items to vulnerable households. Yet social and behavior change communication (SBCC) intervention on gender and nutrition could be another option. We assess the impact of a nutrition and gender SBCC intervention implemented as a cluster-randomized controlled trial in 30 villages in Myanmar's Central Dry Zone during the first year of the COVID-19 pandemic. We rely on data from a baseline survey implemented in February 2020 and a phone survey implemented in February–March 2021. Two indicators of women's empowerment―input in productive decisions and access to and input in decisions over credit―improved, indicating that SBCC interventions can contribute to changing gendered perceptions and behaviors. Some empowerment indicators did not change, indicating it may take more time to change deeply ingrained gender norms—including tolerance toward intimate partner violence. In treatment villages, women's dietary diversity scores were higher by half a food group out of 10. More women in treatment villages consumed nuts, milk, meat or fish, and vitamin A–rich foods daily than in control villages.

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

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

Nutritional status and dietary diversity of pregnant and nonpregnant reproductive-age Rohingya women.

There are no data on the nutritional status and dietary diversity of the pregnant and nonpregnant reproductive-age Rohingya women who have recently shifted to the Bhasan Char Relocation Camp located on an island in the Bay of Bengal. A cross-sectional survey was conducted in November-December, 2021 to assess the nutritional status and evaluate the dietary diversity of two vulnerable groups of the forcibly displaced Rohingya population: nonpregnant reproductive-age women and pregnant mothers. Multivariable logistic regression was applied to identify the factors associated with nutritional impairments. Overall, 7.6% of the nonpregnant reproductive-age women were underweight (Body Mass Index [BMI] < 18.5 kg/m2), and nearly one-third of them had a BMI ≥ 25 kg/m2. However, 26.7% of the pregnant mothers were undernourished (BMI < 20.0 kg/m2) and almost one-fourth of them were either overweight or obese (BMI ≥ 25.0 kg/m2). The prevalence of thinness (Mid Upper Arm Circumference [MUAC] < 23 cm) was 34.5% among pregnant mothers, and 10.1% of them were severely thin (MUAC < 21 cm). The mean (±SD) of the Women's Dietary Diversity Score (WDDS) was 3.3 (±1.1) for nonpregnant reproductive-age women and 3.7 (±1.3) for pregnant mothers enrolled in this study. Overall, 63.8% of the nonpregnant women of childbearing age and 46% of the pregnant mothers had a low WDDS (WDDS < 4). The WDDS was found to be protective against thinness among nonpregnant reproductive-age women (AOR = 0.61; 95% CI = 0.37, 0.93; p-value = .03) and low BMI in pregnant mothers (AOR = 0.71; 95% CI = 0.55, 0.91; p-value = .01). The results of this survey will assist in early recognition of the nutritional demands, and act as a guide to planning nutrition-based programs among Rohingya reproductive-age women relocated to the Bhasan Char Island.

Dietary diversity of women from soybean and non-soybean farming households in rural Zambia

IntroductionSoybean farming in Zambia is promoted to increase farm productivity and diversification away from maize, and improve cash income and livelihoods for farmers. However, the impact of soybean farming on women's dietary intake is not clear. This study compares the dietary diversity of women from soybean (S) and non-soybean (NS) farming households as a pathway to understanding policy efficacy.MethodsA cross-sectional survey involving 268 women of reproductive age from 401 rural households was conducted in two soybean-producing districts of Central Province, Zambia. Data from a qualitative 7-day food frequency questionnaire (FFQ) was used to calculate dietary diversity scores (DDS), women's dietary diversity scores (WDDS-10) and assess dietary patterns. Information on household sociodemographic and agricultural characteristics was used to explore determinants of dietary diversity.ResultsResults show there were no significant differences in the mean DDS (S: 10.3 ± 2.4; NS:10.3 ± 2.6) and WDDS-10 (S:6.27 ± 1.55; NS:6.27 ± 1.57) of women from soybean and non-soybean farming households. Both cohorts had similar dietary patterns, plant-based food groups with additional fats and oils. Agricultural diversity was not associated with dietary diversity. Household wealth status was the most important determinant of dietary diversity, as women from wealthier households were more likely to have higher DDS (β = 0.262, 95% CI = 0.26 to 0.70, P &amp;lt; 0.001) and WDDS-10 (β = 0.222, 95% CI = 0.08 to 0.37, P &amp;lt; 0.003) compared to those from poorer households. Women from households that spent more on food had a higher DDS (β = 0.182, 95% CI = 0.002 to 0.07), but not WDDS-10 (β = 0.120, 95% CI = −0.01 to 0.03); for every additional dollar spent on food in the past 7 days, the DDS increased by 0.18. Meanwhile, soyabean farming was not statistically associated with higher wealth.ConclusionsPolicymakers and promoters of agricultural diversification and nutrition-sensitive agriculture need to consider how women can benefit directly or indirectly from soybean farming or other interventions aimed at smallholder farmers.

The Global Diet Quality Score predicts diet quality of women of reproductive age in Addis Ababa, Ethiopia.

Improving diet quality is recognised as a double-duty action that can simultaneously address multiple forms of malnutrition. This study aimed to assess diet quality among non-pregnant non-lactating women of reproductive age (WRA) in Addis Ababa, Ethiopia. A 1-d quantitative 24 h recall was conducted among 653 non-pregnant/non-lactating women. Diet quality, assessed using the women dietary diversity score (WDDS), the Global Diet Quality Score (GDQS) and the Nova 4 classification reflecting consumption of ultra-processed foods (UPF), was compared. The proportion that meets the minimum dietary diversity for women (MDD-W) was estimated. The average MDD-W score was 2·6 (sd 0·9), with only 3 % of women meeting the MDD-W (≥ 5 food groups). Consumption of wholegrain and legumes was high, but UPF were also consumed by 9 % of the women. GDQS was positively associated with WDDS, age and skipping breakfast and was negatively associated with eating out of home and UPF consumption (P < 0·05). The multivariate regression model showed that GDQS (total) was not associated with wealth but was significantly associated with both UPF and WDDS (P < 0·001). Unlike UPF and WDDS alone, GDQS was able to predict both nutrient adequacy and unhealthy dietary practices. The diet quality of WRA in Addis Ababa is low in diversity, possibly exposing them to higher risk of nutrient inadequacy and non-communicable diseases as reflected by the low GDQS. Understanding what drives food and dietary choices in urban settings is urgently needed.

Effects of dietary diversification during pregnancy on birth outcomes in east Gojjam, northwest Ethiopia: A prospective cohort study.

Adequate nutrient intake during pregnancy is an important key factor affecting fetal growth and birth outcomes, as well as maternal health, as demonstrated by experimental animal studies. However, the few human studies available, especially those conducted in the least developed countries (LDCs), are much less consistent. Therefore, this study aimed to investigate the association between dietary diversification during pregnancy and birth outcomes in Gojjam, Ethiopia. A facility-based prospective cohort study was conducted on 416 pregnant mothers (exposed and non-exposed) from December 2019 to January 2020. Information about the Women's Dietary Diversity Score (WDDS) was collected using the Food and Agricultural Organization's guidelines. Data were collected through interviewer-administered questionnaires and measurements. Log-binomial regression analysis was performed to estimate the relative risk of adverse birth outcomes. Energy, macronutrient, and micronutrient amounts were calculated using the nutrition survey software version 2007. The differences between groups were noticed using analysis of variance. Eta squared was estimated in the current study. The overall magnitude of low birth weight, preterm birth, and stillbirth in the study area, respectively, was 41%, 38%, and 4%. After adjustment for baseline characteristics, this study revealed that pregnant women in the inadequate WDDS group were at increased risk of LBW (ARR = 6.4; 95% CI: 3.4, 12) and PTD (ARR = 6.3; 95% CI: 3.3, 11.95) as compared with their counterparts but no difference in the occurrence of stillbirth (ARR = 1.08; 95% CI: 0.20, 5.79). Overall, this study found a large magnitude of low birth weight and preterm birth. Inadequate intake of dietary diversity during pregnancy significantly increased the rate of low birth weight and preterm birth. Thus, we recommend the concerned body to work on improving the feeding practices of pregnant mothers in the study area.

Respondent Fatigue Reduces Dietary Diversity Scores Reported from Mobile Phone Surveys in Ethiopia during the COVID-19 Pandemic

ABSTRACTBackgroundThe computer-assisted telephone interview (CATI) has been used extensively during the COVID-19 pandemic, but the effects of respondent fatigue during these interviews on responses to questions about diet are unknown.ObjectivesWe designed an experiment that randomized the placement of a survey module on the dietary diversity of rural Ethiopian women and assessed whether responses were altered by placing this module earlier or later in a phone survey.MethodsTwo CATIs were implemented; in the second, women were randomly assigned to answer questions on diet diversity either earlier or later in the interview. Women's Dietary Diversity Scores were the primary outcome. Secondary outcomes were dichotomous measures of consumption from four or more and five or more food groups and consumption of food groups consumed frequently, often, and rarely. Impacts were assessed using a respondent fixed effects model.ResultsDelaying the food consumption module by 15 min in the interview led to an 8%–17% (P < 0.01) decrease in reported Dietary Diversity Scores, a 28% (P < 0.01) decrease in the number of women who consumed a minimum of four dietary groups, and a 40% (P < 0.01) and 11% (P < 0.01) decrease in the reporting of consumption of animal source foods and fruits and vegetables, respectively. Moving the food consumption module closer to the beginning of the interview increased the number of reported food groups consumed by older women, women with a below-median education level, and women in larger households.ConclusionsOur findings suggest that comparisons of descriptive statistics across studies and countries on metrics such as food security and dietary quality may be confounded by where these modules are placed in the interview, thus highlighting trade-offs between volume of information collected and data quality when designing CATI surveys.

Irrigation improves weight‐for‐height z‐scores of children under five, and Women's and Household Dietary Diversity Scores in Ethiopia and Tanzania

Evidence on the potential for agricultural intensification to improve nutrition has grown considerably. While small‐scale irrigation is a key factor driving agricultural intensification in sub‐Saharan Africa, its impact on nutrition has not yet been thoroughly explored. In this study, we assess the impact of adoption of small‐scale irrigation in Ethiopia and Tanzania on household and women's dietary diversity, as well as children's nutrition. We use two rounds of primary data collected from irrigators and nonirrigators in Ethiopia and Tanzania. We used a panel fixed effects econometric approach to control for observed household, women and children specific characteristics as well as observed and unobserved time‐invariant confounding factors. The results show that among Ethiopian households who reported having faced drought, women in irrigating households have higher Women's Dietary Diversity Score (WDDS) compared to women in nonirrigating households. In Tanzania, women in irrigating households have higher WDDS compared to nonirrigators and the impact of irrigation on WDDS more than doubles among households facing drought. In addition, among Tanzanian households who reported having faced a drought shock, irrigating households have higher Household Dietary Diversity Score compared to nonirrigators. Children in irrigating households in Ethiopia have weight‐for‐height z‐scores (WHZ) that are 0.87 SDs higher, on average, than WHZ of children in nonirrigating households. In Tanzania, irrigation leads to higher WHZ‐scores in children under‐five among households who reported having experienced a drought in the 5 years preceding the survey. The study shows small‐scale irrigation has a strong effect on households' economic access to food and on nutritional outcomes of women and children.

Assessment of sleep quality and nutritional status of antenatal mothers—A community-based study

Introduction: Sleep is an essential part of the overall well-being of health. Good quality of sleep is required for everyone to be free from physically, mentally, and socially caused disease and disability. The quality of sleep is more important during pregnancy where women are carrying one more life in their womb. Socioeconomic and demographic factors have a substantial effect on nutritional status and the food intake of women, especially pregnant and lactating women in the family. The available literature has highlighted the influence of factors such as women’s education status, family size, and community to which a woman belongs on their nutritional status and intake. Very few studies highlighted the sleep pattern in the different trimester and nutritional score of pregnant women. Therefore, the present study was an attempt to evaluate the quality of sleep and nutritional status among pregnant women in field practice areas. Materials and Methods: The present study was a prospective cross-sectional observational study and was carried out in urban and rural field practice areas of the Department of Community Medicine. A total of 104 pregnant women from randomly selected households in both rural and urban areas were included in the study as a convenient sampling. Data on the quality of sleep were collected using standardized Pittsburgh sleep quality index scale from participants, and women dietary diversity score was collected by 24 h diet history in their own language. Result: Of them, 75% have sleep difficulty with a score of >3; 54% of them were consuming more than six food groups in their daily diet. Conclusion: Our study concludes that an imbalance among antenatal mothers between resident areas related to nutrition score was due to literacy status, occupation, and the type of family of the antenatal mothers.

Seasonal variation in maternal dietary diversity is reduced by small‐scale irrigation practices: A longitudinal study

Some agricultural practices, such as irrigation, have the potential to buffer seasonal dietary gaps and through increased production and consumption improve diets, particularly of the rural poor relying on subsistence farming but also for rural and urban households purchasing irrigated produce on local markets. The study aimed to evaluate the effect of seasonality and irrigation on women's diet in rural Ethiopia. Using a longitudinal study design, three rounds of surveys were conducted among women of reproductive age (15–49 years). Data on socioeconomic status, food consumption and haemoglobin concentration was collected. Energy and nutrient intakes were estimated using an interviewer‐administered multiple‐pass 24‐h recall. Women's dietary diversity score (WDDS), the proportion of women meeting the minimum dietary diversity for women (MDDW), haemoglobin concentration, the prevalence of anaemia and energy and nutrients intakes were compared between irrigators and nonirrigators and by season. Associations between MDDW/WDDS and irrigation status were assessed using fixed‐effect models, after adjusting for covariates. WDDS was low (3–4 out of 10 food groups) and exhibited high seasonal variability (p < 0.05). Diets were predominantly cereal‐based, with little consumption of nutrient‐dense foods like fruits and animal source foods. High seasonal variability in energy, protein, vitamin C, calcium, iron and zinc intakes were observed (p < 0.01). Irrigators were more likely to meet the MDDW than women from non‐irrigating households (p < 0.05). No cases of malaria were reported from the three rounds of screening. There is a high seasonal variation in women's diet, but this could be partly offset by irrigation practices.

Consumption of animal source foods, especially fish, is associated with better nutritional status among women of reproductive age in rural Bangladesh.

In rural Bangladesh, intake of nutrient‐rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity, consumption of specific food groups and markers of nutritional status, including underweight [body mass index (BMI) < 18.5 kg/m2], overweight (BMI ≥ 23 kg/m2) and anaemia (haemoglobin < 120 g/dl) among WRA in Bangladesh. This analysis used data from the third round of a longitudinal observational study, collected from February through May of 2017. Dietary data were collected with a questionnaire, and Women's Dietary Diversity Score (WDDS) was calculated. Associations between WDDS, food group consumption and markers of nutritional status were assessed with separate adjusted logistic regression models. Among WRA, the prevalence of underweight, overweight and anaemia was 13.38%, 40.94% and 39.99%, respectively. Women who consumed dark green leafy vegetables (DGLV) or eggs were less likely to be anaemic or underweight, respectively, and women who consumed ASFs, particularly fish, were less likely to be underweight compared with women who did not consume these foods. WDDS did not show any consistent relationship with WRA outcomes. Interventions that focus on promoting optimal nutritional status among WRA in Bangladesh should emphasise increasing consumption of specific nutrient‐rich foods, including ASFs, DGLV and eggs, rather than solely focusing on improving diet diversity in general.

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.