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Choudhury S, Shankar B, Aleksandrowicz L, Tak M, Dangour A. Caste-Based Inequality in Fruit and Vegetables Consumption in India. Food Nutr Bull 2021; 42:451-459. [PMID: 34275340 PMCID: PMC8442122 DOI: 10.1177/03795721211026807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Fruit and vegetable (F&V) consumption is of central importance to many
diet-related health outcomes. In India, caste is a major basis of
socioeconomic inequality. Recent analysis shows that more disadvantaged
“lower” castes consume less F&V than the rest. This article explores
whether this consumption gap arises due to differential distribution of
drivers of consumption such as income and education across castes, or
whether behavioral differences or discrimination may be at play. Design: The Oaxaca-Blinder regression decomposition is applied to explain the gap in
F&V consumption between “upper” castes and “lower” castes, using data
from the 68th (2011-2012) round of the National Sample Survey Organization
household survey. Results: Differences in the distribution of F&V drivers account for all of the 50
grams/person/day consumption gap between upper and lower castes. In
particular, much of the gap is explained by income differential across
castes. Conclusions: In the long run, India’s positive discrimination policies in education and
employment that seek to equalize income across castes are also likely to
help close the F&V consumption gap, leading to health benefits. In the
medium run, interventions acting to boost lower caste income, such as cash
transfers targeting lower castes, may be effective.
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Affiliation(s)
- Samira Choudhury
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Bhavani Shankar
- Institute for Sustainable Food, The University of Sheffield, Sheffield, United Kingdom
| | - Lukasz Aleksandrowicz
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London United Kingdom
| | - Mehroosh Tak
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London United Kingdom
| | - Alan Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Thakwalakwa C, Flax VL, Phuka JC, Garcia H, Jaacks LM. Drivers of food consumption among overweight mother-child dyads in Malawi. PLoS One 2020; 15:e0243721. [PMID: 33332387 PMCID: PMC7745992 DOI: 10.1371/journal.pone.0243721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
To address the increase in overweight and obesity among mothers and children in sub-Saharan Africa, an understanding of the factors that drive their food consumption is needed. We hypothesized food consumption in Malawi is driven by a combination of factors, including season, food accessibility (area of residence, convenience of purchasing food, female autonomy), food affordability (household resources, food expenditures, household food insecurity), food desirability (taste preferences, body size preferences), demographics, and morbidity. Participants in Lilongwe and Kasungu Districts were enrolled across three types of mother-child dyads: either the mother (n = 120), child (n = 80), or both (n = 74) were overweight. Seven-day dietary intake was assessed using a quantitative food frequency questionnaire during the dry and rainy seasons. Drivers associated with intake of calories, macronutrients, and 11 food groups at p<0.1 in univariate models were entered into separate multivariate linear regression models for each dietary intake outcome. Mother-child dyads with an overweight child had a higher percent of calories from carbohydrates and lower percent of calories from fat compared to dyads with a normal weight child (both p<0.01). These mothers also had the highest intake of grains (p<0.01) and their children had the lowest intake of oil/fat (p = 0.01). Household food insecurity, maternal taste preferences, and maternal body size preferences were the most consistent predictors of food group consumption. Household food insecurity was associated with lower intake of grains, fruits, meat and eggs, oil/fat, and snacks. Maternal taste preferences predicted increased consumption of grains, legumes/nuts, vegetables, fish, and oil/fat. Maternal body size preferences for herself and her child were associated with consumption of grains, legumes/nuts, dairy, and sweets. Predictors of food consumption varied by season, across food groups, and for mothers and children. In conclusion, indicators of food affordability and desirability were the most common predictors of food consumption among overweight mother-child dyads in Malawi.
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Affiliation(s)
- Chrissie Thakwalakwa
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | - Valerie L. Flax
- RTI International, Research Triangle Park, North Carolina, United States of America
- * E-mail:
| | - John C. Phuka
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Harrison Garcia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Ambikapathi R, Passarelli S, Madzorera I, Canavan CR, Noor RA, Abdelmenan S, Tewahido D, Tadesse AW, Sibanda L, Sibanda S, Munthali B, Madzivhandila T, Berhane Y, Fawzi W, Gunaratna NS. Men's nutrition knowledge is important for women's and children's nutrition in Ethiopia. MATERNAL AND CHILD NUTRITION 2020; 17:e13062. [PMID: 32755057 PMCID: PMC7729551 DOI: 10.1111/mcn.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
In an effort to address undernutrition among women and children in rural areas of low‐income countries, nutrition‐sensitive agriculture (NSA) and behaviour change communication (BCC) projects heavily focus on women as an entry point to effect nutritional outcomes. There is limited evidence on the role of men's contribution in improving household diets. In this Agriculture to Nutrition trial (Clinicaltrials.gov identifier: NCT03152227), we explored associations between men's and women's nutritional knowledge on households', children's and women's dietary diversity. At the midline evaluation conducted in July 2017, FAO's nutrition knowledge questionnaire was administered to male and female partners in 1396 households. There was a high degree of agreement (88%) on knowledge about exclusive breastfeeding between parents; however, only 56–66% of the households had agreement when comparing knowledge of dietary sources of vitamin A or iron. Factor analysis of knowledge dimensions resulted in identifying two domains, namely, ‘dietary’ and ‘vitamin’ knowledge. Dietary knowledge had a larger effect on women's and children's dietary diversities than vitamin knowledge. Men's dietary knowledge had strong positive associations with households' dietary diversity scores (0.24, P value = 0.001), children's dietary diversity (0.19, P value = 0.008) and women's dietary diversity (0.18, P value < 0.001). Distance to markets and men's education levels modified the effects of nutrition knowledge on dietary diversity. While previous NSA and BCC interventions predominantly focused on uptake among women, there is a large gap and strong potential for men’s engagement in improving household nutrition. Interventions that expand the role of men in NSA may synergistically improve household nutrition outcomes.
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Affiliation(s)
- Ramya Ambikapathi
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA.,Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Simone Passarelli
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isabel Madzorera
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Chelsey R Canavan
- Departments of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ramadhani A Noor
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | - Lindiwe Sibanda
- Food, Agriculture and Natural Resources Policy Analysis Network, Pretoria, South Africa
| | - Simbarashe Sibanda
- Food, Agriculture and Natural Resources Policy Analysis Network, Pretoria, South Africa
| | - Bertha Munthali
- Food, Agriculture and Natural Resources Policy Analysis Network, Pretoria, South Africa
| | | | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie Fawzi
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Departments of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nilupa S Gunaratna
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
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Choudhury S, Headey DD, Masters WA. First foods: Diet quality among infants aged 6-23 months in 42 countries. FOOD POLICY 2019; 88:101762. [PMID: 31853163 PMCID: PMC6894322 DOI: 10.1016/j.foodpol.2019.101762] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 05/05/2023]
Abstract
Diet quality is closely linked to child growth and development, especially among infants aged 6-23 months who need to complement breastmilk with the gradual introduction of nutrient-rich solid foods. This paper links Demographic and Health Survey data on infant feeding to household and environmental factors for 76,641 children in 42 low- and middle-income countries surveyed in 2006-2013, providing novel stylized facts about diets in early childhood. Multivariate regressions examine the associations of household socioeconomic characteristics and community level indicators of climate and infrastructure with dietary diversity scores (DDS). Results show strong support for an infant-feeding version of Bennett's Law, as wealthier households introduce more diverse foods at earlier ages, with additional positive effects of parental education, local infrastructure and more temperate agro-climatic conditions. Associations with consumption of specific nutrient-dense foods are less consistent. Our findings imply that while income growth is indeed an important driver of diversification, there are strong grounds to also invest heavily in women's education and food environments to improve diet quality, while addressing the impacts of climate change on livelihoods and food systems. These results reveal systematic patterns in how first foods vary across developing countries, pointing to new opportunities for research towards nutrition-smart policies to improve children's diets.
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Affiliation(s)
- Samira Choudhury
- Centre for Development, Environment and Policy, School of Oriental & African Studies, London WC1H 0XG, UK
| | - Derek D. Headey
- Poverty, Health and Nutrition Division, The International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - William A. Masters
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA, USA
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Schneider K, Masters WA. Orange Fanta versus orange fruit: A novel measure of nutrition knowledge in Malawi. MATERNAL & CHILD NUTRITION 2019; 15:e12656. [PMID: 30142703 PMCID: PMC7199062 DOI: 10.1111/mcn.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/30/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
This paper introduces a novel survey instrument to identify distinct components of nutrition knowledge and test for links between knowledge and dietary choices in Southern Malawi. Our first aim is to distinguish respondents' familiarity with recommended behaviours, such as when to start breastfeeding or introduce solid foods, from respondents' factual knowledge about mechanisms, such as whether biscuits or papaya and orange fruit or orange Fanta contribute more to future health. We find knowledge of nutrition behaviours to be strongly associated with more schooling, older age, and being female, whereas knowledge of mechanisms is associated only with training and employment as a health professional. We then test whether this expanded definition of nutrition knowledge is associated with dietary intake when controlling for other factors and find no significant links in these data. Results point to the need for knowledge surveys and public health behaviour-change campaigns to address the kinds of information that might have the most influence on actual behaviour, potentially including the mechanisms involved in food composition, food safety, and disease transmission.
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Affiliation(s)
- Kate Schneider
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - William A. Masters
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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