Women's Dietary Diversity Research Articles

Women's dietary diversity is associated with homestead production and market access: A cross-sectional study in rural Rwanda.

Dietary diversity has been widely used as a proxy indicator for micronutrient adequacy. In low- and middle-income countries (LMICs), including Rwanda, women are at high risk of inadequate micronutrient intake resulting from poorly diversified diets. This study was conducted to examine the factors associated with women's dietary diversity, with emphasis on homestead production diversity and market access in the Northern Province of Rwanda. A cross-sectional design was used, involving 606 women aged 18-49 years. Linear regression analyses were performed to examine the association between various factors and women's dietary diversity. Results show that 84% of the sample households raised at least one livestock species. Seventy-one percent of the households had no agricultural land. Eighty percent of those without land had a homestead garden on which they grew food crops, mainly vegetables and fruit trees. The average crop species was 2.3. On average, women consumed 3 out of 9 food groups. The homestead production diversity score was positively associated with women's dietary diversity score (β = 0.16, p < 0.001). Women's dietary diversity score was negatively associated with distance from the household to the nearest market (β = -0.08, p = 0.027) and household food insecurity (β = -0.06, p < 0.001). Maternal education (p < 0.001), household wealth index (p < 0.05), and ownership of more than 2.5 acres compared to being without land (p < 0.05) were associated with women's dietary diversity score. The dietary diversity of women could be enhanced through interventions that promote the diversity of livestock and crop species produced through homestead production. Potential interventions to explore may include integrated farming systems that combine small livestock and crop production utilising improved livestock breeds and high-quality seeds and planting materials of high-yielding varieties of fruits and vegetables, along with rainwater harvesting to facilitate small-scale irrigation. The impact of such interventions on women's dietary diversity can be further reinforced by parallel programmes aimed at improving women's education and the socioeconomic status of households.

An evaluation of interventions within a Growth Through Nutrition project aimed at enhancing optimal nutrition and water, sanitation and hygiene (WASH) and nutrition practices among nutritionally most vulnerable households (MVHHs) in Ethiopia.

Despite a downward trend, Ethiopia still faces significant challenges with high rates of stunting and acute malnutrition in children. To tackle these issues, the Feed the Future Ethiopia Growth Through Nutrition Activity, a USAID-funded project aligned with Ethiopia's National Nutrition Program, was executed from 2016 to 2023. This initiative aimed to enhance nutrition for women and young children across six regions through multisectoral interventions. Annual surveys conducted in 2017, 2018, and 2020 evaluated the impact of livelihood support and Water, Sanitation, and Hygiene (WASH)-focused social behavior change communication (SBCC) on vulnerable households with children under two. The results showed significant improvements in child nutrition. Dietary diversity among children increased from 12% to 34% (p<0.001), and the percentage of children receiving a minimal acceptable diet rose from 12% to 30.7% (p<0.001). Women's dietary diversity also improved markedly, from 2% to 16% (p<0.001). Handwashing practices saw improvements, with the proportion of households having handwashing facilities rising from 14% to 31% (p<0.001), and the adherence to critical handwashing moments increased from 16% to 23%. However, challenges in water treatment and latrine use persisted, with less than 25% improvement. The findings suggest that integrating livelihood support with SBCC interventions can positively enhance nutritional outcomes. Continued focus on these strategies is recommended to further support vulnerable households.

Food purchase diversity is associated with market food diversity and diets of children and their mothers but not fathers in rural Tanzania: Results from the EFFECTS baseline survey.

Rural households in East Africa rely on local markets, but the influence of market food diversity and household food purchase diversity on diets has not been well-characterized. We quantify the associations among market food diversity, household food purchase diversity and dietary diversity of mothers, fathers and children in rural Tanzania. This study uses baseline data from a randomized controlled trial, Engaging Fathers for Effective Child Nutrition and Development in Tanzania. We used the 10 food groups for women's dietary diversity to assess the seasonal availability of nutritious foods in 79 markets. Using data from 957 rural households in two districts in Mara, Tanzania, we measured household food purchase diversity over the previous month and dietary diversity among children (6-23 months), mothers and fathers. Overall, 63% of markets sold all 10 food groups throughout the year, indicating high-market food diversity and minimal seasonality. However, only 33% of women and 35% of children met dietary diversity recommendations. Households that reported higher purchasing power (0.14, p < 0.001), lived within 30 min of a market (0.36, p = 0.001) and had access to a highly diverse market (0.37, p = 0.01) purchased a higher diversity of foods. In turn, food purchase diversity was positively associated with the dietary diversity of mothers (p < 0.001) and children 9-23 months (p < 0.001) but not fathers (p = 0.56). Interventions must account for food availability and access in local markets, and promoting diverse food purchases may be an effective strategy to improve women's and children's diets in rural areas.

Dietary diversity and nutrient adequacy among women in Bosomtwe District, Ghana.

The sustainable development goals seek to end all forms of malnutrition of women of reproductive age (WRA) by 2030. As such, recent data on nutrient adequacy are needed to aid in tracking progress. However, data on specific dietary nutrient intakes includes only iron, folate, vitamin A, and vitamin B12 in Ghana. Therefore, women's dietary diversity score (W-DDS) is often used as a proxy measure of nutrient adequacy. It is hypothesised that there is no association between W-DDS and Nutrient Adequacy among WRA in peri-urban Ghana. Hence, this research evaluated the associations between W-DDS and nutrient adequacy ratio (NAR) and assessed the determinants of mean nutrient adequacy ratio (MAR) in the Bosomtwe District of Ghana. A community-based cross-sectional study was conducted, and data collected on anthropometry, food insecurity, socio-demographic characteristics and dietary intake using the 24-hour recall from 407 WRA. In all, 21 nutrients were assessed. The mean age, W-DDS, and MAR were 29.0 ± 6.7 years, 5.3 ± 1.9, and 0.65 ± 0.19 respectively. The NAR were generally high for the macronutrients as compared to micronutrients and the nutrients with low NAR included vitamin C (0.27 ± 0.19), vitamin A (0.15 ± 0.23), vitamin B12 (0.54 ± 0.32), calcium (0.28 ± 0.20), zinc (0.52 ± 0.23) and iron (0.57 ± 0.28) - signifying the WRA may be consuming monotonous carbohydrate-based diet. The hierarchical multivariable linear regression found a significant association between W-DDS and MAR after controlling for confounders (β = 0.404, p < 0.001). The determinants of MAR were ethnicity (β = 0.110, p = 0.006) and body mass index (β = 0.189, p < 0.001). This study supports the use of W-DDS as a proxy indicator of nutrient adequacy. Strategies meant to address nutrient inadequacies should be adaptable to different ethnic groups and overweight-reducing strategies should be incorporated into broader nutrition initiatives.

Increased food crop diversification and gathering of wild plants associated with women's dietary diversity in Chad.

Women of reproductive age are particularly vulnerable to low-quality diets due to their higher micronutrients needs. The minimum dietary diversity for women (MDDW) is a proxy for micronutrient adequacy in this group of women. Its relationship with other aspects that lead to malnutrition is not fully elucidated and depends on the context. In this study, we assessed the prevalence of MDDW among women of a rural area in Chad and its association with socioeconomical, agricultural, dietary and food security data. A cross-sectional study was conducted. Following a multistage cluster sampling, 984 women of reproductive age were randomly selected and interviewed in March 2019. We obtained food consumption data through unquantified 24 h recalls and computed MDDW as consuming at least five out of 10 predefined food groups. We constructed a Food Production Diversity Score (FPDS) with crop and livestock information. We obtained multivariable logistic regression models including different covariates. MDDW was achieved by only 33% of women in the sample. In our final model, we identified a significant association of MDDW with the FPDS and gathering ofwild plants. Women in households with the highest FPDS had 70% more chances of achieving MDDW than those with the lowest FPDS. Gathering wild plants doubled these chances. Areas of cultivated land,Water, Sanitation and Hygiene resources, and a high level of food security, measured with the Household Food Insecurity Access Scale,were also significantly related to the achievement of MDDW. This illustrates the importance of nutrition-sensitive policies, also considering biodiversity and food production diversification.

Women's empowerment, household dietary diversity, and child anthropometry among vulnerable populations in Odisha, India.

Women's empowerment has been promoted by researchers and development practitioners as one of the most promising strategies to address widespread hunger and malnutrition. However, the relationship between women's empowerment and dietary diversity and child nutrition has rarely been studied among vulnerable populations or individuals at greater risk of poor physical and social health status. Moreover, the effects of different domains of women's empowerment on nutritional outcomes, including dietary diversity and child anthropometry, have rarely been examined, especially with panel data. Using two rounds of panel data from 1900 households and fixed effects regression models, we analyze the effect of women's empowerment on household dietary diversity score (HDDS) and child anthropometry among the particularly vulnerable tribal groups in Odisha, India. We also estimate the effects of various decision-making domains of women's empowerment on HDDS and child anthropometry to understand which empowerment domains matter for nutrition. Results show that women's empowerment is positively associated with HDDS (coef. 0.41 food groups; p < 0.1) and reduces the prevalence of underweight (coef. 39%; p < 0.05) and wasting (coef. 56%; p < 0.1) in children but has no effect on the prevalence of child stunting. Women's empowerment in agricultural input use; output sales; income; food purchases; and credit, group membership, and employment contribute to improved dietary diversity and child nutrition. We conclude that women's empowerment contributes to improved dietary diversity and child nutrition and is a promising strategy to improve farm household diets and child nutrition among vulnerable populations. Strengthening women's empowerment through the promotion of women's access to land and other agricultural inputs, market participation, access to information, capital, and credit is important.

Maternal dietary diversity and its association with infant birth weight: a healthcare centre based cross-sectional study

BackgroundMaternal nutrition during pregnancy is essential to fetal growth and producing a healthy child. This study aims to investigate the relationship between maternal dietary diversity and neonatal weight among pregnant women referred to health centers in Qazvin.MethodsThis was a cross-sectional study of 1076 pregnant women referred to healthcare centers affiliated by Qazvin University of Medical Sciences from April to June 2019. The dietary information of study participants was collected by a food frequency questionnaire. It was used to determine their dietary patterns by applying a factor analysis with a varimax rotation using SPSS software, version 20. Regarding the women's Dietary Diversity Score (DDS), women were categorized into two groups: inadequate (DDS < 4) and adequate (DDS ≥ 4) dietary diversity. The primary outcome was birth weight, and a log-binomial model was run to test the association between DSS and birth outcomes in the study population. The analysis was performed using SPSS Statistics for Windows version 20.0.ResultsStudy findings revealed that mothers with higher dietary diversity scores were those with normal BMI and normal levels of hemoglobin who had 8–10.9 kg maternal weight gain and were headed by an employed husband (P < 0.05). Furthermore, the risk of low birth weight in newborns of mothers with inadequate dietary patterns was 2.6 times higher (ARR = 95% CI 2.6, 1.4, 5.12) compared to the newborns from mothers with adequate diets.ConclusionInsufficient intake of dietary diversity during pregnancy can potentially increase the likelihood of low birth weight in newborns. Thus, we recommend that health system authorities prioritize the planning for healthy nutrition of pregnant mothers in different geographical regions, specifically remote, rural, and deprived areas of the country.

SUBSISTENCE FARMER'S PRODUCTION DIVERSITY AND MARKET ACCESS: IMPACT ON RURAL WOMEN AND CHILDREN'S DIETARY DIVERSITY

Hunger and poverty are severe threats to developing nations like Pakistan. Rural people in developing countries are facing malnutrition and undernourishment due to low-income levels and limited access to nutritious food. Women's diets are the most crucial factor for their health and children. Increased dietary diversity is a significant approach to improving nutrition and health, and it can be enhanced by improving the production diversity among rural subsistence farming households. The study was conducted in four districts of the south Punjab region of Pakistan. Using the well-structured and pretested questionnaire, multistage stratified random sampling was employed to collect data from 600 rural households. The women's dietary diversity score, children's dietary diversity score, and production diversity score were calculated. The results indicate that women's dietary diversity is concerned with production diversity score; its interaction with market access, education, family size, and farming experience positively impacts dietary diversity. In contrast, the age of the respondent has a negative impact. The same association among factors was also observed for children's dietary diversity score. Based on the study results, it is recommended that there is a need to diversify the crops produced by small farmers, especially food crops so that they can get balanced food and not rely much on external purchases. Overall, the Government can play a crucial role by providing opportunities and facilities to grow non-conventional crops instead of conventional cash crops.

Factors Influencing Dietary Practices of Pregnant Women at Njoro Sub County Hospital, Nakuru County, Kenya

Worldwide, factors influencing maternal dietary practices has been a major issue of concern among pregnant women. This is because good dietary practices are important to the mother and the baby. Negative inappropriate dietary practices is one of the greatest challenges globally and in Kenya respectively. Inappropriate dietary practices may bring out several complications such as pre mature births, low birth weight and macrosomic babies among others. The current study therefore assessed the factors influencing dietary practices of pregnant women at Njoro Sub County Hospital, Nakuru County, Kenya. Descriptive survey research design was used in the study. Simple random sampling technique was used to sample 80 pregnant women attending ante natal clinic at Njoro Sub County Hospital, Nakuru County. Data was harvested through questionnaires to assess the dietary practices as well as dietary diversity of the expectant mothers. Data was analyzed using descriptive statistics, more so the use of percentages. The study indicates that more than half of the pregnant women attending antennal clinic at Njoro Sub County hospital had good dietary practices with 66.7% of the respondents consuming three meals a day with 13.3% having two meals. However, 20.0% of the pregnant mothers had one meal (others) daily. Moreover, a majority of the pregnant women attained women dietary diversity scores with 90% consuming more than 5 food groups (WDDS) with 10% not meeting the indicator of more than 5 food groups. Although starches were fairly consumed (chapatti at 33.3%, rice 56.7% and ugali 36.7% 2-4 times a week), animal proteins like chicken were less frequently taken. Additionally, vegetable and fruit intake was low (Managu/kunde 23.3%, spinach, 30%). The study recommends that pregnant women attending ante natal clinic at Njoro Sub County Hospital should be sensitized on the importance of balanced diet and encouraged to consume balanced meals three times a day. Furthermore, mothers should start kitchen gardening to enable them have diversified diets at a cheaper price. Secondly, the County government should establish policies and guidelines on diversity of diets and frequency of consumption to support mothers in maintaining appropriate and healthy dietary practices.

PERAN CITRA TUBUH, FAKTOR SOSIAL EKONOMI, KUALITAS KONSUMSI PANGAN DAN HUBUNGANNYA DENGAN KEJADIAN KEK PADA WANITA USIA SUBUR DI KECAMATAN MENES KABUPATEN PANDEGLANG

Chronic energy deficiency (CED) is a condition resulting from prolonged or chronic lack of food intake, especially energy and protein, and is characterized by Mid-upper Arm Circumference (MUAC) &lt; 23.5 cm. The CED can occur due to low socio-economic status and dissatisfaction with the body, which will affect the lack of variety of food consumed. This research aims to see the relationship between socio-economic status, quality of food consumption and body image on the incidence of CED among women of reproductive age (WRA) in Menes District, Pandeglang Regency. This research is quantitative research with a cross sectional design, and analyzed using the Chi Square test. The sample was determined using purposive sampling and obtained 123 respondents. Data collection was carried out by measuring MUAC, 2x24 hour recall and interviews using socioeconomic status questionnaires, women dietary diversity score (WDDS) and Body Shape Questionnaire (BSQ-16). The results of the study showed that 29.3% of respondents experienced CED, which shows that there is a relationship between recent education (p = 0.036), income (p = 0.009), and body image (p = 0.005) with the incidence of CED among WRA in Menes District, Pandeglang Regency. The research results also show that there is no relationship between nutritional knowledge (p = 0.106), employment (p = 0.364), and quality of food consumption (p = 0.392) with the incidence of CED among WRA in Menes District, Pandeglang Regency. The conclusion of this research is that the incidence of KCED in WRA can be influenced by education, income and body image.

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.

Maternal dietary diversity increases with women's high decision-making autonomy in Northwest Ethiopia, 2022

BackgroundDietary diversification is one of several approaches for improving micronutrient levels in women of reproductive age. Therefore, this study aimed to assess the magnitude of minimum dietary diversity among pregnant women, explore the association between women's decision-making autonomy and dietary diversity, and identify other potential determinants of dietary diversity in Northwest Ethiopia. MethodA community-based cross-sectional study of 621 pregnant women was conducted from November 2022 to December 2022. A cluster random sampling technique was employed. A binary logistic regression model was used to explore the association between dietary diversity and women's decision-making autonomy. Adjusted odds ratios with 95 % CIs were estimated to identify factors associated with the dietary diversity of pregnant women, and they were considered to be statistically significant at a P-value <0.05. ResultsThe minimum dietary diversity among pregnant women was 22.4 %. The study revealed a significant association between dietary diversity and women's decision-making autonomy (AOR: 2.82, 95 % CI: 1.73, 4.59; p value: 0.001). Primary education and above (AOR = 4.0, CI: 2.1, 7.67), monthly income 1000–2000 ETB (AOR = 4.46, CI: 2.53, 7.87) and >2000 ETB (AOR = 6.05, CI: 3.16, 11.59), having nutritional information (AOR = 2.15, CI: 1.32, 3.51), being food secure (AOR = 2.63, CI:1.6, 4.34), morbidity status (AOR: 0.278, CI: 0.14, 0.56), ANC visits one time (AOR = 2.08, CI = 1.003, 4.33) and two or three times (AOR = 2.45, CI: 1.15, 5.24) were potential predictors of pregnant women's dietary diversity. ConclusionMaternal dietary diversity was significantly associated with women's decision-making autonomy. Thus, the government should strengthen women's empowerment, rights, access to education, and economic opportunities.

Perceptions and experiences of an intervention to improve diets of women and young children in Ghana

BackgroundEfficacious integrated intervention strategies to address the drivers of malnutrition at multiple levels are hardly implemented at scale, although opportunities for cross-sectoral action exist. In 2020, the Improved Feeding Practices (IFP) Project was implemented in Ghana to improve the dietary diversity and well-being of women of reproductive age (15-49 years) and children &gt;2 years.ObjectiveThis paper reports the perceptions and experiences of project beneficiaries and the lessons learned from the IFP project.MethodsUsing a socio-ecological framework, data from the IFP project documents (n=8) and in-depth interviews with key stakeholders, including local government officers, and direct and indirect beneficiaries (n=61), were triangulated to construct an evidence-based overview of the implementation of the complementary strategies of the IFP project. The interviews explored respondents' knowledge, experiences of the project activities, and perceptions of how the project affected their lives. The data were analysed and synthesized thematically using ATLAS.ti.ResultsThe IFP project envisaged an impact pathway through promoting community- or home-based nutrient-rich crop production and poultry to enhance diet quality, child care and feeding practices. Multi-sectoral partners facilitated training and service delivery at community, farm, facility, and household levels. Beneficiaries reported an overall positive experience of participating in the project, including enhanced dietary knowledge, capacity to produce and use eggs and orange fleshed sweet potatoes (OFSP), earned revenues, and access to nutritious foods. Caregivers reported that the IFP project contributed to enhancing children’s diet quality, reduced disease incidence, and improved child growth. Community-level program implementers experienced capacity strengthening. The dry season, increased poultry feed input prices, diseases (such as fowl pox, Newcastle and smallpox), and poultry deaths, limited the scale of benefits. Key implementation lessons include leveraging local resources to produce poultry feed at home, crossbreeding local and commercial poultry, and enhancing disease management, leading to improved potential for project sustainability.ConclusionsOverall, the communities reported a positive experience of an integrated nutrition-sensitive agriculture (NSA) intervention, leading to improved diets of households, women of reproductive age, and young children &gt;2 years. These strategies can be adapted for use in other to improve women's and children's dietary diversity in similar settings, giving due consideration to lessons learned.

Spillover effects of food and nutrition security interventions on non-treated population: Evidence from Madagascar

Benefits from development interventions may extend beyond their direct target group. This article evaluates both direct and spillover effects of multisectoral food and nutrition security interventions targeting rural smallholder women in Madagascar. The study uses cross-sectional data obtained from 715 rural women of reproductive age (15–49 years) with at least one child aged between 6 and 23 months who were selected from three different treatment groups (treated, control, and nonbeneficiary women within project villages). We used endogenous switching regression (ESR) and propensity score matching (PSM) to analyse both direct and spillover effects of the intervention. Furthermore, we employed several regressions to identify the pathways through which direct effects occurred. Results reveal that the project positively impacted the food security status of the treated group, as well as the dietary diversity of women and children. In addition, we find positive spillover effects on nonbeneficiaries within target villages. Spillover effects are smaller than direct effects, but still significant, with 36% of the direct effect for women’s dietary diversity and 50% of the direct effect for children’s dietary diversity. The analysis of impact pathways shows that positive direct effects can be explained by reducing postharvest losses and increasing field crop and vegetable diversity. Policy-makers and development organizations should consider not only the direct effect but also the spillover effect and impact pathways when planning and designing any intervention.

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.

Inequality in iron and folic acid consumption and dietary diversity in pregnant women following exposure to maternal nutrition interventions in three low- and middle-income countries.

Research is available on improved coverage and practices from several large-scale maternal nutrition programmes, but not much is known on change in inequalities. This study analyses wealth and education inequality using Erreygers and Concentration indices for four indicators: adequate iron and folic acid (IFA) consumption, women's dietary diversity, and counselling on IFA and dietary diversity. A pre-test-post-test, control group design. Maternal nutrition intervention programmes conducted in Bangladesh, Burkina Faso and Ethiopia during 2015-2022. Recently delivered women (RDW) and pregnant women (PW). Statistically significant reductions in education inequality were observed for adequate IFA consumption, counselling on IFA and dietary diversity in intervention areas of Bangladesh and for adequate IFA consumption in intervention areas of Burkina Faso.A significant decrease in wealth inequality was observed for adequate IFA consumption in the intervention areas of Bangladesh, whereas a significant increase was observed in the non-intervention areas for counselling on IFA in Ethiopia and for dietary diversity in Burkina Faso. The results can be attributed to the extensive delivery system at community level in Bangladesh and being predominantly facility-based in Burkina Faso and Ethiopia. COVID-19 disruptions (in Burkina Faso and Ethiopia) and indicator choice also had a role in the results.The main takeaways for nutrition programmes are as follows: (a) assessing inequality issues through formative studies during designing, (b) monitoring inequality indicators during implementation, (c) diligently addressing inequality through targeted interventions, setting aside resources and motivating frontline workers to reduce disparities and (d) making inequality analysis a routine part of impact evaluations.

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.

Drivers of food and nutrition security during the lean period in southeastern Madagascar

The rural population in southeastern Madagascar faces widespread poverty and weak resilience to frequent climate shocks, both contributing to severe food and nutrition insecurity. For effective policy responses and tailored interventions, development stakeholders need to know which factors determine household food and nutrition security status. In particular, the relative contributions of on-farm production diversity versus cash income are of importance since they would suggest different intervention priorities. We collected survey data on household food security and women's diets during the lean season, where improvements are most needed, as well as on households' agricultural activities, market participation, and sources of cash income from 413 randomly sampled households. Regression results suggest that frequent market participation and cash income from non-farm self-employment improve food security, but on-farm diversity does not. Other determinants of household food security include livestock assets and maternal education. Women's dietary diversity, in contrast, is associated only with market participation. The importance of market participation for food and nutrition security reflects the situation in the lean period, when farm production is low and many households' food supply relies, in part, on market purchases enabled by non-agricultural income. Our findings imply that a focus on developing food markets and enabling opportunities for income generation are likely viable strategies for improving the rural food and nutrition security situation during the lean period in southeastern Madagascar. Relatively food- and nutrition-secure households are characterized by their ability to mobilize cash (e.g., from non-farm self-employment) to purchase food.

Factors associated with child and maternal dietary diversity in the urban areas of Bangladesh.

Dietary diversity is an indicator of nutrition that has been found positively associated with diet quality, micronutrient adequacy, and improved maternal health and child growth. Due to the cultural responsibility of women in providing food at the household level, their status is very important to perform this role. Hence, this study has been conducted on the status of dietary diversity of the mother and child to understand how it relates to various factors of women in urban settings. Data were obtained from 1978 mother-child pairs living in different cities in Bangladesh. The foods taken by the women and children were categorized into 10 and 7 groups to measure women's dietary diversity (WDD) and children's dietary diversity (CDD), respectively. The study found that more than three-fourths of the mothers and half of the children had low dietary diversity. The household wealth holdings and access to resources by the women were found inadequate, while two-thirds of them had the lowest to medium level of nutritional knowledge. The binomial logistic regression model was used to measure the factors influencing WDD and CDD. The findings also indicated that children's dietary diversity was influenced by the mother's age, education, supportive attitude and behavior of husband, and access to and control over resources. While the household wealth index can enhance both child and mother's dietary variety, nutrition knowledge, dietary counseling, and access to and control over resources can improve maternal dietary diversity. This study recommends improving women's socioeconomic status by increasing their wealth and access to resources and enhancing their nutrition knowledge by providing food and nutrition counseling.

The importance of nutrition-sensitive fisheries management: Women's dietary diversity in Marovo Lagoon, Solomon Islands

Feeding a growing global population is one of the most significant challenges currently facing society. Global malnutrition rates remain high, and tackling this problem in the context of global population growth and ecosystem declines will require con­certed effort across many sectors. Fish has been suggested as key to addressing high rates of malnu­trition in the South Pacific region, given that it is a rich source of highly bioavailable micronutrients and is common in traditional diets. Unfortunately, there are predictions that fish catch in this region may decline by more than 20% in the coming decades, threatening food and nutritional security. Women are key to breaking the cycle of malnutri­tion and play important roles in small-scale coastal fisheries in the South Pacific. This study assessed women’s dietary diversity and the importance of fresh fish to women’s diets in a rural coastal com­munity in Marovo Lagoon, Solomon Islands, over four sampling periods. We found that women’s dietary diversity in the community was low (mean MDD-W = 3.03 ± 0.06) and that fresh fish was consumed by more than 70% of the women sur­veyed in three of the four sampling periods. Our results showed some seasonal differences in dietary diversity, highlighting the importance of sampling across seasons to better capture true nutrition. We consider these results in the context of community-based fisheries management and argue for the need to improve fisheries management by including con­sideration of women’s fishing and promoting the importance of fish to human health.