Household food production is positively associated with dietary diversity and intake of nutrient-dense foods for older preschool children in poorer families: Results from a nationally-representative survey in Nepal

Measuring characteristics of wild and cultivated food environments: a scoping review

BACKGROUND

Global food systems are essential to sustain life; however, unhealthy diets are the leading cause of poor health and death worldwide. Natural food environments are a critical source of healthful food such as fresh fruit and vegetables, lean meat and aquatic foods, particularly in low- and middle-income countries (LMICs) and Indigenous food systems. Understanding and monitoring natural food environments is critical to protecting the supply of healthy food, and the land and water it comes from, for current and future generations.

METHODS

A scoping review was applied to classify and summarise empirical methods and measures used for characterising natural food environments. The ways in which food environment characteristics are conceptualised and measured for natural (wild and cultivated) food environments were explored. Data were extracted from the included studies using the following fields: study country, aim/objective(s), type of natural food environment (wild vs. cultivated), method or measure used to measure the food environment, key food environment characteristic/s (up to four) measured and key findings in relation to the food environment measurement.

RESULTS

One hundred forty seven studies were found to be relevant in this review. Most studies investigated food environments in LMICs, with almost two-thirds of all studies focussing on middle-income countries (n = 89, 61%). There was a strong focus on food security and home-based agriculture from studies that measured the cultivated food environment in LMICs, while the majority of studies on the cultivated food environment from high-income countries focussed on urban and community gardening. In addition to the most common survey-based methodological approaches, our review yielded a broad range of both qualitative and quantitative methods for measuring natural food environments, such as geospatial analysis; biochemical analysis of food, soil and water; citizen science; photovoice and food availability calendars.

CONCLUSIONS

Our review demonstrated that the concept and characteristics of the food environment are a promising conceptualization for measuring natural food environments, particularly in relation to food availability, healthiness and food security. Mapping the currently used methods and measures to assess natural food environments is important to help identify critical leverage points for strengthening policy interventions, and monitoring and evaluation of progress.

What Lithuanian First-Graders Eat: Results of a 15-Year Semi-Longitudinal, Cross-Sectional Surveillance Study

This article presents the dietary habits of Lithuanian first-grade (7-8-year-old) students over a 15-year surveillance period to understand the trends and changes in their nutrition patterns. The presented data were collected from three study rounds of the Lithuanian Growth Surveillance Study conducted between 2008 and 2023, with a total sample of 11,594 first-grade students from all 10 counties of Lithuania. The main findings reveal significant shifts in breakfast consumption, with an increase in daily breakfast intake observed over the surveillance period. Conversely, the consumption of cereal porridge showed a notable decrease, particularly in the frequency of consumption. Positive changes were noted in the consumption of vegetables and fresh fruits, indicating an improvement in dietary quality. Also, a concerning trend of declining consumption of certain nutritious food groups like fish and dairy products is identified, whereas the consumption of sugary beverages is low. These findings underscore the importance of ongoing efforts to promote healthier eating habits among school-age children in Lithuania. Addressing these trends requires a multifaceted approach involving education, policy changes, and community-based interventions to ensure the long-term health and well-being of children.

Evidence on Milk Consumption and Production Linkages from Rural Bihar, India

Background

Milk is an important source of protein for many Indian households. However, milk intake is very low. Hence, it is necessary to examine production-consumption linkages of milk within the paradigm of accessibility, availability, and affordability.

Objectives

This study examined linkages between milk consumption and production, accounting for sales and factors associated with production investments in rural Bihar, a major milk-producing state of India with very poor nutritional status.

Methods

A panel of households from the Gaya and Nalanda districts of Bihar were surveyed: the first round in July and August 2019 (n = 2026 households) and the second round from December 2019 to January 2020 (n = 2001 households). Data were collected on household consumption, production, and sale of milk, as well as other foods. The study examines the consumption-production linkage of milk and the association of dietary diversity with consumption from own production, with households as the unit of analysis. Ordinary least square regression analysis of average monthly household milk consumption was used to identify factors associated with milk consumption, particularly milk production.

Results

The median (Quartile 1, Quartile 3) per capita milk consumption per day was 83.3 (41.6, 166.6) mL in the milk-consuming households. Average monthly household milk consumption in liters was higher in milk-producing households [β: 7.1; 95% confidence interval (CI): 6.1, 8.1] than households relying on market purchases. Household milk consumption was higher in the third tertile of milk production than the first tertile of production (β: 14.3 L/wk; 95% CI: 12.1, 17.2) and lower in the highest tertile of household sale quantity (β: -8.8 L/wk in tertile 3, 95% CI: -12.7, -5) than the first tertile of household sale quantity of milk.

Conclusions

The study provides evidence that consumption of milk in rural households is associated with own production such that households with higher production consume more. However, sale preferences restrict the quantity of milk consumed in milk-producing households.

Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study

BACKGROUND

School-based interventions have been implemented in resource-limited settings to promote healthy dietary habits, but their sustainability remains a challenge. This study identified positive deviants (PDs) and negative deviants (NDs) from the control and treatment groups in a nutrition-sensitive agricultural intervention in Nepal to identify factors associated with healthy dietary practices.

METHODS

This is an explanatory mixed methods study. Quantitative data come from the endline survey of a cluster randomized controlled trial of a school and home garden intervention in Nepal. Data were analyzed from 332 and 317 schoolchildren (grades 4 and 5) in the control and treatment group, respectively. From the control group, PDs were identified as schoolchildren with a minimum dietary diversity score (DDS) ≥ 4 and coming from low wealth index households. From the treatment group, NDs were identified as schoolchildren with a DDS < 4 and coming from high wealth index households. Logistic regression analyses were conducted to identify factors associated with PDs and NDs. Qualitative data were collected through in-depth phone interviews with nine pairs of parents and schoolchildren in each PD and ND group. Qualitative data were analyzed thematically and integrated with quantitative data in the analysis.

RESULTS

Twenty-three schoolchildren were identified as PDs, and 73 schoolchildren as NDs. Schoolchildren eating more frequently a day (AOR = 2.25; 95% CI:1.07-5.68) and whose parents had a higher agricultural knowledge level (AOR = 1.62; 95% CI:1.11-2.34) were more likely to be PDs. On the other hand, schoolchildren who consumed diverse types of vegetables (AOR = 0.56; 95% CI: 0.38-0.81), whose parents had higher vegetable preference (AOR = 0.72; 95% CI: 0.53-0.97) and bought food more often (AOR = 0.71; 95% CI: 0.56-0.88) were less likely to be NDs. Yet, schoolchildren from households with a grandmother (AOR = 1.98; 95% CI: 1.03-3.81) were more likely to be NDs. Integrated results identified four themes that influenced schoolchildren's DDS: the availability of diverse food, the involvement of children in meal preparation, parental procedural knowledge, and the grandmother's presence.

CONCLUSION

Healthy dietary habit can be promoted among schoolchildren in Nepal by encouraging parents to involve their children in meal preparation and increasing the awareness of family members.

Crop diversification and farm household food and nutrition security in Northern Ghana

Farm households in Africa adopt resource allocation tools such as crop diversification to minimize risk exposure and safeguard their food and nutrition security. This study uses primary data and an ordered probit model to examine how crop diversification impacts the food security outcomes of rural farmers in northern Ghana. The findings revealed that along with other factors like access to extension services and use of soil fertility management practices, crop diversification increased food access and reduced the food insecurity experience of households. As a result, policies targeted at improving the food and nutrition security of peasant households should promote adoption of diversified crop production and use of sustainable soil management practices like composting.

Effect of agricultural diversification on dietary diversity in rural households with children under 5 years of age in Zambia

Micronutrient deficiencies in low-income countries are associated with the monotonous consumption of nutrient-deficient crops, contributing to childhood stunting with far-reaching socioeconomic consequences. To promote nutrition sensitive agriculture, policy makers in such countries have embarked on policy initiatives that encourage agricultural diversification in smallholder farming systems. This paper investigates the link between agricultural diversification and two key indicators of food and nutrition security among children under 5 years in rural Zambia. Data from the 2015 Rural Agricultural Livelihoods Survey and regression models are used to explain household dietary diversity and months of inadequate household food provisioning among 7934 households. Factors associated with the key outcome variables include land cultivated, household size, total livestock units, household head education, households receiving extension information, and use of productivity-enhancing inputs such as fertilizers. Although the results demonstrate that agricultural diversification is positively associated with the household dietary diversity score, the relationship is not statistically significant. Further, the study findings illustrate that agricultural diversity is negatively associated with months of inadequate household food provisioning but that this relationship is also not statistically significant. The implication for policy is that other interventions such as productivity enhancement and behavioral change communication need to be scaled up.

Effective nutrition governance is correlated with better nutrition outcomes in Nepal

BACKGROUND

The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth.

METHODS

Data were collected from two nationwide studies in Nepal to determine the relationship between a metric of nutrition 'governance' (the Nutrition Governance Index), derived from interviews with 520 government and non-government officials responsible for policy implementation and anthropometry measured for 6815 children in 5556 households. We employed Generalized Estimating Equation (GEE) and multilevel regression models.

RESULTS

A higher NGI (more effective nutrition governance) is positively associated with height-for-age as well as weight-for-height in children over 2 years of age compared to younger children (HAZ; β = 0.02, p < 0.004, WHZ; β = 0.01, p < 0.37). Results from the hierarchical model show that a one-point increase in the NGI is significantly associated with a 12% increase in HAZ and a 4% increase in WHZ in older children (> 24 months old). Mothers' education, child's age, BMI and no fever in the past 30 days were also protective of stunting and wasting. Seven percent and 17% of the overall variance in HAZ and WHZ, respectively, are accounted for by variations across the 21 district locations in which sampled households were located. Mean HAZ differs considerably across districts (intercept = 0.116, p < 0.001).

CONCLUSIONS

These results highlight the importance of effective management of policy-based programming and resource use to bring about nutrition gains on the ground. The NGI explained a non-negligible amount of variation in HAZ and WHZ, which underscores the fundamental role that good governance plays in promoting child nutrition and growth, and the value of seeking to measure it to assist governments in moving policies from paper to practice.

Crop diversity is associated with higher child diet diversity in Ethiopia, particularly among low-income households, but not in Vietnam

OBJECTIVES

To examine associations of household crop diversity with school-aged child dietary diversity in Vietnam and Ethiopia and mechanisms underlying these associations.

DESIGN

We created a child diet diversity score (DDS) using data on seven food groups consumed in the last 24 h. Generalised estimating equations were used to model associations of household-level crop diversity, measured as a count of crop species richness (CSR) and of plant crop nutritional functional richness (CNFR), with DDS. We examined effect modification by household wealth and subsistence orientation, and mediation by the farm's market orientation.

SETTING

Two survey years of longitudinal data from the Young Lives cohort.

PARTICIPANTS

Children (aged 5 years in 2006 and 8 years in 2009) from rural farming households in Ethiopia (n 1012) and Vietnam (n 1083).

RESULTS

There was a small, positive association between household CNFR and DDS in Ethiopia (CNFR-DDS, β = 0·13; (95 % CI 0·07, 0·19)), but not in Vietnam. Associations of crop diversity and child diet diversity were strongest among poor households in Ethiopia and among subsistence-oriented households in Vietnam. Agricultural earnings positively mediated the crop diversity-diet diversity association in Ethiopia.

DISCUSSION

Children from households that are poorer and those that rely more on their own agricultural production for food may benefit most from increased crop diversity.

Factors influencing household pulse consumption in India: A multilevel model analysis

Pulses (also known as legumes) are important in achieving nutrient adequacy in India due to their quality protein content. This study compared district-level pulse production and consumption across India, and household and district-level determinants of pulse intake, including availability, accessibility and affordability, using multi-level models in nationally representative datasets for 2011-12. The per capita consumption was about 50% of recommended intake (80 g/day), even in high-producing districts. District-level pulse production was associated with household pulse intake (2.73 × 10^-8 [5.19 × 10^-9, 4.94 × 10^-8]) and market accessibility (-0.0077 [-0.0133, -0.0021]). Affordability (absolute price of pulse) was also associated with household intake. While agricultural policies relating to pulses have been oriented towards improving pulse output and productivity, forward-looking policies to improve pulse intake should focus on demand-side factors, such as improved market accessibility and the affordability of pulses relative to other foods.

Design of a collaborative monitoring and evaluation system for a community-based nutrition project in rural Bangladesh

Poor diet and undernutrition are common among children living in Bangladesh. To promote appropriate complementary feeding of young children, an economic development (ED) program involving income-generating asset transfer was implemented alongside a social and behavior change (SBC) program. This paper introduces a collaborative monitoring and evaluation (M&E) system in which diverse collaborators ("research group", "implementation team", and "coordinators") facilitate M&E data acquisition by leveraging their comparative advantages. The implementation team built a monitoring system to track the ED (n = 2960) and SBC participants (n=∼10,000) over 12 months. Based on the baseline design and the monitoring records, the collaborators planned an impact evaluation introducing a quasi-experimental design using two cross-sectional surveys and a prospective cohort survey of child feeding and nutritional status. Using various data sources generated from the M&E system, the collaborators will also reveal the program impact pathway through which each intervention component is delivered, received, and utilized alongside the context-specific facilitators and barriers, including the programs' uptake. The collaborative M&E system enables the sharing of program goals, strengthens collaborators' commitment to the program, and extends the understanding of the program's progress and evaluation activities.

"In the Past, the Seeds I Planted often Didn't Grow." A Mixed-Methods Feasibility Assessment of Integrating Agriculture and Nutrition Behaviour Change Interventions with Cash Transfers in Rural Bangladesh

Combining agriculture with behaviour change communication and other nutrition-sensitive interventions could improve feeding practices to reduce maternal and child undernutrition. Such integrated intervention requires rigorous design and an appropriate implementation strategy to generate an impact. We assessed feasibility and acceptability of an intervention package that combines nutrition counselling, counselling and support for home-gardening, and unconditional cash transfers delivered to women on a mobile platform for improving maternal and child nutrition behaviours among low-income families in rural Bangladesh. We used mixed-methods including in-depth interviews with women (20), key-informant interviews with project workers (6), and a cross sectional survey of women (60). Women well-accepted the intervention and reported to be benefited by acquiring new skills and information on home gardening and nutrition. They established homestead gardens of seasonal vegetables successfully and were able to find a solution for major challenges. All women received the cash transfer. Ninety-one percent of women spent the cash for buying foods, 20% spent it on purchasing seeds or fertilizers and 57% used it for medical and livelihood purchases. Project staff and mobile banking agent reported no difficulty in cash transfer. Combining nutrition-specific and -sensitive interventions is a feasible and acceptable approach. Using mobile technologies can provide additional benefits for the intervention to reach the disadvantage families in rural settings.

Agricultural and empowerment pathways from land ownership to women's nutrition in India

Land size is an important equity concern for the design of ‘nutrition‐sensitive’ agricultural interventions. We unpack some of the pathways between land and nutrition using a cross‐sectional baseline survey data set of 4,480 women from 148 clusters from the ‘Upscaling Participatory Action and Videos for Agriculture and Nutrition’ trial in Keonjhar district in Odisha, India. Variables used are household ln‐land size owned (exposure) and maternal dietary diversity score out of 10 food groups and body mass index (BMI; kg/m²) (outcomes); and mediators investigated are production diversity score, value of agricultural production, and indicators for women's empowerment (decision‐making in agriculture, group participation, work‐free time and land ownership). We assessed mediation using a non‐parametric potential outcomes framework method. Land size positively affects maternal dietary diversity scores [β 0.047; 95% confidence interval (CI) (0.011, 0.082)] but not BMI. Production diversity, but not value of production, accounts for 17.6% of total effect mediated. We observe suppression of the effect of land size on BMI, with no evidence of a direct effect for either of the agricultural mediators but indirect effects of β −0.031 [95% CI (−0.048, −0.017)] through production diversity and β −0.047 [95% CI (−0.075, −0.021)] through value of production. An increase in land size positively affects women's decision‐making, which in turn negatively affects maternal BMI. The positive effect of work‐free time on maternal BMI is suppressed by the negative effect of household land size on work‐free time. Agriculture interventions must consider land quality, women's decision‐making and implications for women's workload in their design.

Small-Scale Livestock Production in Nepal Is Directly Associated with Children's Increased Intakes of Eggs and Dairy, But Not Meat

Animal source foods (ASF) provide nutrients essential to child growth and development yet remain infrequently consumed in rural Nepal. Agriculture and nutrition programs aim to increase ASF intake among children through small-scale animal husbandry projects. The relationship between livestock ownership and children's consumption of ASF, however, is not well established. This study examined associations between livestock ownership and the frequency with which Nepali children consume eggs, dairy, and meat. We analyzed longitudinal 7-day food frequency data from sentinel surveillance sites of the Policy and Science of Health, Agriculture and Nutrition (PoSHAN) study. Data consisted of surveys from 485 Nepali farming households conducted twice per year for two years (a total of 1449 surveys). We used negative binomial regression analysis to examine the association between the number of cattle, poultry, and meat animals (small livestock) owned and children's weekly dairy, egg, and meat intakes, respectively, adjusting for household expenditure on each food type, mother's education level, caste/ethnicity, agroecological region, season, and child age and sex. We calculated predicted marginal values based on model estimates. Children consumed dairy 1.4 (95% CI 1.1-2.0), 2.3 (1.7-3.0) and 3.0 (2.1-4.2) more times per week in households owning 1, 2-4 and >4 cattle, respectively, compared to children in households without cattle. Children consumed eggs 2.8 (2.1-3.7) more times per week in households owning 1 or 2 chickens compared to children in households without chickens. Child intake of meat was higher only in households owning more than seven meat animals. Children's intakes of dairy, eggs, and meat rose with household expenditure on these foods. Small-scale animal production may be an effective strategy for increasing children's consumption of eggs and dairy, but not meat. Increasing household ability to access ASF via purchasing appears to be an important approach for raising children's intakes of all three food types.

Factors associated with dietary diversity and length-for-age z-score in rural Ethiopian children aged 6-23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation

Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length-for-age z-score (LAZ) in children 6-23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May-June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio-economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership. LAZ was positively associated with age, socio-economic status, maternal education, fruit and vegetable production, and land ownership.

First foods: Diet quality among infants aged 6-23 months in 42 countries

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.

Association of food security and other socio-economic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh

INTRODUCTION

Dietary diversity score (DDS) is a proxy indicator for measuring nutrient adequacy. In this study, we aimed to identify the nutritional statuses and current patterns of DDS among children between 6-59 months old and their associations with different individual and household level factors in rural Bangladesh.

METHODS

The Nobokoli programme of World Vision Bangladesh was implemented in Mymensingh, Sherpur, Rangpur, Dinajpur, Thakurgaon, Panchagar, and Nilphamari districts of Bangladesh between 2014 and 2017. A cross-sectional community household survey was administered between July and October 2014 to collect baseline data to evaluate the Nobokoli programme. A total of 6,468 children between 6-59 months old were included in the final analysis. Anthropometric data was collected following WHO guidelines on using wooden height and digital weight scales. We collected food intake information for the past 24 hours of the survey. The WHO's child growth standard medians were used to identify the nutritional indices of stunting, wasting, and underweight. Food items consumed were categorized into nine food groups and the DDS was constructed by counting the consumption of food items across these groups during the preceding 24 hour period. The association of DDS and nutritional status (stunting, wasting and underweight) with sociodemographic factors and household food security status were examined using multivariable models; linear regression and logistics regression respectively.

RESULTS

The prevalence of stunting, wasting and underweight among children aged 6-59months were 36.8%, 18.2% and 37.7% respectively. Our findings revealed that almost all children ate any form of starch followed by consumption of milk or milk products (76%) and fleshy meat /fish (61%) respectively. The mean DDS among children was 3.93(sd 1.47). Forty percent of the children obtained a DDS score less than 4. Multivariable analysis suggested that children whose mothers had higher educational attainment and are skilled workers had higher DDS (15% and 48% respectively) compared to their counterparts. The DDS showed strong positive association with household wealth status. Children from food secure households had 26% higher DDS compared to children from food insecure households. Similarly, increasing maternal education and household wealth were found to be protective against childhood stunting and undernutrition.

DISCUSSION

Our findings reiterate the need for improving household socioeconomic factors and household food security status for improving dietary diversity practices and nutritional status of children. Evidence-based solutions are needed to be implemented and expanded at scale to ensure appropriate dietary practices and improve nutritional status of the children in local context.

Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji

Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity.

Impacts of Caregivers’ Nutrition Knowledge and Food Market Accessibility on Preschool Children’s Dietary Diversity in Remote Communities in Southeast Nigeria

Empirical evidence is scanty on the nexus between caregivers’ nutrition knowledge, market accessibility, and preschool children’s dietary diversity in remote communities of Africa’s most populous country, Nigeria. To fill this gap, this study evaluated the effects of caregivers’ nutrition knowledge and access to food market on dietary diversity of preschool children. We used cross-sectional data from four hundred households selected from twenty remote communities in Southeast Nigeria. The study adopted instrumental variable regression to estimate the impacts of nutrition knowledge and food market access on preschool children’s dietary diversity. The findings show that in remote communities, caregivers’ nutrition knowledge and households’ closeness to the market improved preschool children’s dietary diversity. The study demonstrates the potential of improving preschool children’s nutrition outcomes through enhancing access to food market and the nutrition knowledge of the caregivers.

C. A, Manohar S, Shrestha B, Nonyane BAS, Neupane S, Bhandari S, Klemm RD, Webb P, West KP. Nutritional resilience in Nepal following the earthquake of 2015

Background

The 2015 earthquake in Nepal caused massive damages and triggered relief activities to minimize human suffering. The post-earthquake nutrition and food security situation in the hardest hit areas remains uncertain.

Methods

Two national cross-sectional surveys were conducted in 2014 and 2016 among households (HH) with pre-school aged children or newly married women. Of the 21 village development committees (VDCs) included in this sample, 7 fell within “earthquake-affected” areas. This paper presents data from 982 HH, 1015 women, and 883 children from 2014 and 1056 HH, 1083 women, and 998 children from 2016 living in these areas, with longitudinal overlap of about 55%. Prevalence estimates and 95% confidence intervals were calculated, and logistic regression was used to calculate p-values, both using robust estimates of standard errors to account for clustering.

Results

From 2014 to 2016, child wasting (weight-for-height z score <-2) fell from 4.5% (95% CI 3.3%– 6.1%) to 2.1% (1.4%– 3.1%) and food insecurity (assessed using the household food insecurity access scale) dropped from 17.6% (11.7%– 25.6%) to 12.4% (6.9%– 21.2%). Child stunting prevalence remained similar at both time-points. Improvements were also evident in dietary diversity and breastfeeding indicators.

Conclusions

Nutrition and food security conditions remained comparable or improved one year after the earthquake despite evidence of structural and other damage. Livelihood resilience to shocks and/or effective nutrition, food or health interventions may have helped buffer the impact on nutrition, although this hypothesis requires further exploration.

Seasonality of Consumption of Nonstaple Nutritious Foods among Young Children from Nepal's 3 Agroecological Zones

BACKGROUND

Children's dietary patterns vary seasonally, particularly in subsistence agriculture settings like Nepal, but the seasonality of nutritious nonstaple food consumption is not well explored in the literature.

OBJECTIVE

This study aimed to examine seasonal differences in children's consumption of provitamin A-rich fruit and vegetables, dairy, eggs, meat, and fish in Nepal's 3 agroecological zones, and to assess whether seasonal patterns vary by wealth and caste/ethnicity.

METHODS

Multivariable negative binomial regression models were used to analyze dietary data from 7-d food-frequency questionnaires, producing coefficient estimates in the form of incidence rate ratios (IRRs). Data were collected 3 times per year for 2 y from children aged 6-72 mo in Nepal's mountains (n = 226), hills (n = 168), and plains (n = 225).

RESULTS

There were significant seasonal differences in children's consumption of provitamin A-rich fruit and vegetables, dairy, meat, and fish that varied by agroecological zone. Adopting monsoon season as the referent for all comparisons, children in the mountains ate provitamin A-rich fruit and vegetables less frequently during the postmonsoon and winter seasons (IRRs: 0.5 and 0.7, respectively; both P < 0.004), whereas in the plains, children's consumption of these foods was lower only during the postmonsoon season (IRR: 0.2; P < 0.001). Children's dairy intake frequency increased during the winter in the mountains (IRR: 0.7; P < 0.004) and decreased during the winter in the hills (IRR: 1.5; P < 0.001). Only in the plains did children's meat and fish intakes vary seasonally, increasing during the postmonsoon season (IRR: 1.6; P < 0.004). Wealth and caste/ethnicity variability influenced children's consumption of each of these nutritious groups of foods, and moderated seasonal effects in some instances.

CONCLUSIONS

Children's diets varied differently by season within each agroecological zone of Nepal and in some cases across socioeconomic groups, revealing the importance of taking a season- and location-specific approach to assessing diets and tailoring dietary strategies.

Keragaman Pangan dengan Status Kadarzi Keluarga di Wilayah Kerja Posyandu Sidotopo, Surabaya

Background: Indonesia still facing some nutritional problems that hinder its economics development. The government itself has an effort to tackle nutritional problems by establishing  a program known as Keluarga Sadar Gizi (Kadarzi). The family expected to understand and overcome the nutritional problems affecting its members. One of Kadarzi’s five indicator is dietary diversity. Dietary divesity can reflected dietary quality. Therefore, dietary diversity assessment is influential to improve dietary quality. Objectives: The purpose of this study was to analyze the differences in dietary diversity scores among Kadarzi household. Method: The design of the study was cross sectional. Number of sample were 34 mothers who registered in Posyandu settled in Kelurahan Sidotopo, Kecamatan Semampir, Kota Surabaya. Samples were selected using simple random sampling technique. Kadarzi data were collected from KMS book. Dietary diversity was assessed using Individual Dietary Diversity Score (IDDS). The data were analyzed using independent T-test. Result: The result showed that most families were not meeting Kadarzi’s indicator (73%). There were 32.4% family categorized as low dietary diversity, 47.1% family categorized as medium dietary diversity, and 20.6% family categorized as high dietary diversity. There were a difference of dietary diversity score beetwen Kadarzi’s household nor Kadarzi’s household (p<0.001). In Kadarzi’s household the consumption of dark green leafy vegetables, other vitamin A rich fruits and vegetables, anf other fruits and vegetables are higher than non Kadarzi’s household. Conclusions: There was a significant difference in dietary diversity score beetwen Kadarzi’s household and nor Kadarzi’s household. The importance of eating diverse and some references of affordable food choice to meet dietary diversity were needed to share.ABSTRAKLatar belakang: Indonesia masih menghadapi beberapa masalah gizi yang menghambat perkembangan ekonomi. Namun pemerintah memiliki suatu upaya untuk mengatasi permasalahan gizi tersebut dengan membentuk program Keluarga Sadar Gizi (Kadarzi). Pada program ini keluarga diharapkan mampu mengerti dan mengatasi permasalahan gizi anggotanya. Salah dari lima perilaku Kadarzi adalah makan beragam. Makan beragam merupakan salah satu perilaku yang dapat menggambarkan kualitas diet individu. Oleh karena itu penilaian keragaman pangan perlu diketahui untuk mengetahui dan meningkatkan kualitas diet individu. Tujuan: Tujuan penelitian ini adalah untuk menganalisis perbedaan skor keragaman pangan pada keluarga sadar gizi. Metode: Penelitian observasional ini disusun dengan rancang bangun cross sectional. Sejumlah 34 sampel yang merupakan ibu balita yang terdaftar di Posyandu di wilayah Kelurahan Sidotopo, Kecamatan Semampir, Kota Surabaya dipilih menggunakan teknik simple random sampling. Data Kadarzi didapatkan dari observasi kartu menuju sehat (KMS). Keragaman pangan dinilai menggunakan instrumen Individual Dietary Diversity Score (IDDS). Data dianalisis menggunakan independent T-test. Hasil: Sebagian besar keluarga masih belum menerapkan perilaku Kadarzi (73%). Sebanyak 32,4% keluarga termasuk dalam kategori skor keragaman pangan rendah, 47,1% dalam kategori sedang, dan 20,6% dalam kategori tinggi. Terdapat perbedaan skor keragaman pangan antara keluarga yang menerapkan perilaku Kadarzi dan tidak menerapkan perilaku Kadarzi (p<0,001). Pada keluarga yang menerapkan perilaku Kadarzi konsumsi sayuran hijau, sayur dan buah vitamin A, sayur dan buah yang lain lebih tinggi daripada keluarga yang tidak menerapkan Kadarzi. Kesimpulan: Terdapat perbedaan skor keragaman pangan antara keluarga yang menerapkan perilaku Kadarzi dan tidak menerapkan perilaku Kadarzi. Diperlukan pemaparan informasi lebih lanjut mengenai pentingnya makan beragam dan pemilihan makanan yang terjangkau untuk dapat memenuhi konsumsi makan beragam.