Determinants of Inadequate Minimum Dietary Diversity Intake Among Children Aged 6-23 Months in Sub-Saharan Africa: Pooled Prevalence and Multilevel Analysis of Demographic and Health Survey in 33 Sub-Saharan African Countries

Multidimensional disparity in inadequate minimum dietary diversity between poor and non-poor children aged 6-23 months in Sub-Saharan Africa: a multivariate decomposition analysis

Background

Sustainable Development Goal (SDG) 2 aims to "end hunger, achieve food security, and improve nutrition" by 2030. However, the prevalence of inadequate Minimum Dietary Diversity (MDD) is on the rise in Sub-Saharan Africa (SSA). Therefore, this study aimed to assess the disparities between multidimensional poor and non-poor households in terms of inadequate MDD among children aged 6 to 23 months in SSA, using data from the 2018-2023 Demographic and Health Survey (DHS).

Methods

The study utilized data from a nationally representative weighted sample of 352,463 children aged 6 to 23 months, drawn from the latest rounds of the DHS in 18 SSA countries. A decomposition analysis was performed to assess the disparity in inadequate MDD between multidimensionally poor and non-poor Households. This analysis divided the disparity into two components: one related to differences in the levels of determinants (endowments) between the poor and non-poor, and the other concerning variations in the effects of the covariates.

Results

The overall prevalence of inadequate MDD among children in SSA was 89.05%. This prevalence was highest in Central Africa at 90.55% and lowest in South Africa at 87.8%. The difference in inadequate MDD between multidimensional poor and non-poor children was highest in East Africa at 6.15%, which was statistically significant. Factors such as women's education, husband's educational status, the employment status of both parents, household wealth index, place of residence, family size, and the number of children significantly contributed to the disparity in inadequate MDD among children from multidimensional poor and non-poor households in SSA.

Conclusion

The study highlights a concerningly high prevalence of inadequate MDD among children in SSA, with significant disparities observed between multidimensionally poor and non-poor households. The largest gap in inadequate MDD between poor and non-poor households was found in East Africa. Key factors contributing to these disparities include women's education, husband's educational status, the employment status of both parents, household wealth index, place of residence (urban vs. rural), family size, and the number of children. The findings underscore the urgent need for targeted interventions to address inadequate MDD among young children in SSA. Efforts should focus on reducing poverty, improving maternal education, and enhancing employment opportunities, particularly for women, by promoting equitable economic prospects. Addressing these underlying factors is essential to closing the gap in dietary diversity and improving the nutritional outcomes of children in the region.

What works for reducing stunting in low-income and middle-income countries? Cumulative learnings from the Global Stunting Exemplars Project

BACKGROUND

Impaired linear growth and stunting in children under 5 y is a marker of multiple deprivations in low-income and middle-income countries.

OBJECTIVES

We aimed to assess drivers and policies influencing improvements in linear growth and stunting reduction in 10 countries with annual rates of reduction in childhood stunting averaging 1.1% (range: 0.4%-1.7%) at national-level or subnational-level, and to improve a framework of action for other countries to follow.

METHODS

We used mixed methods to assess trends and patterns of improvement in linear growth in children under 5 y using available household-level data and in-depth analysis of programs and their implementation. We assessed patterns of change with multivariate regression analyses of risk factors driving stunting and affecting change. We compared results from the Oaxaca-Blinder decomposition analyses using a hierarchical approach and retrospectively assessed the appropriateness of a previously proposed 10-step process for country-level planning and implementation processes. Limited data precluded robust serial assessment of dietary intake at individual level for children and mothers.

RESULTS

Rapid reduction in childhood stunting is possible and findings across exemplar countries underscore the benefits of indirect and direct interventions in health and other social sectors. These include programs focusing on poverty alleviation; water, sanitation, and hygiene; promotion of girls' education and empowerment; and maternal nutrition. The potential benefits of family planning programs and factors contributing to gains in maternal nutrition were noted. In malarial endemic areas, malaria control programs were associated with improved childhood growth, and patterns of growth indicated continued benefits of childhood disease prevention and management strategies.

CONCLUSIONS

A systematic, evidence-informed approach to improve maternal and child health and nutrition is feasible and, with targeting, can accelerate reduction in linear growth faltering in childhood.

Utilization of long-acting contraceptive methods and associated factor among women of reproductive age in East Africa: A multi-level analysis of recent Demographic and Health Surveys

BACKGROUND

Comprehensive family planning is essential for reproductive health, allowing individuals to make informed choices about family size and enhancing maternal and child health. Long-acting contraceptives (LACs) are known for their high efficacy and consistent use. This study examines the prevalence and determinants of LAC utilization among women of reproductive-age in 11 East African countries.

METHODS

Secondary data from Demographic and Health Surveys (2015-2022) across 11 East African nations were pooled and analyzed. The study sample included 144,414 women aged 15-49. Bivariate and multivariate regression analyses were conducted using Stata 17 to explore factors associated with LAC utilization. Results are presented as adjusted odds ratios (AOR), with statistical significance at p <  0.05.

RESULTS

The prevalence of LAC utilization among reproductive-age women in East Africa is 14.87%. Women from middle-income households are 13% more likely to utilize LACs compared to those from poor households (AOR = 1.13, 95% CI: 1.08-1.18), while those from wealthy households are 15% more likely (AOR = 1.15, 95% CI: 1.11-1.20). Married women and those living with a partner are 42% more likely to utilize LACs than unmarried women (AOR = 1.42, 95% CI: 1.33-1.52). Educational attainment significantly impacts LAC utilization: women with primary education are 52% more likely (AOR = 1.52, 95% CI: 1.44-1.60), those with secondary education are 63% more likely (AOR = 1.63, 95% CI: 1.53-1.73), and women with higher education are twice as likely to utilize LACs (AOR = 2.00, 95% CI: 1.84-2.17).

CONCLUSIONS

LAC utilization remains relatively low in the studied East African countries. Factors positively associated with higher LAC utilization include being married, higher income, educational attainment, employment, and media exposure. Additionally, women with more than three children and those from countries with lower illiteracy and poverty rates also have higher LAC utilization. Conversely, a history of abortion, fewer health fieldworker visits, and later initiation of sexual activity and childbirth are associated with lower LAC utilization. These findings emphasize the need for targeted interventions to overcome barriers and promote LAC access and utilization.

Factors associated with concordance of mother-child (6-23 months) dietary diversity in Sub-Saharan Africa

BACKGROUND

Inadequate dietary diversity is a major contributor to undernutrition, and compromises the health of both mothers and children. Available evidence demonstrates a significant association between maternal and child dietary diversity. However, there is limited evidence about the factors influencing the concordance of mother-child dietary diversity in Sub-Saharan Africa (SSA). Therefore, we investigated the factors associated with the concordance of mother-child dietary diversity in SSA.

METHODS

A community-based cross-sectional study was conducted based on the recent Demographic and Health Surveys (DHS) data of eight Sub-Saharan African countries. A total weighted sample of 29,138 mother-child pairs within the five years preceding the survey was included. A mixed-effect binary logistic regression model was employed to identify factors associated with concordance between mother-child dietary diversity. Variable with p-value < 0.2 in the bivariable mixed-effect binary logistic regression analysis was considered for the multivariable analysis. In the multivariable mixed-effect binary logistic regression analysis, the Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI) were reported. The percentage of agreement between mothers and children with minimum dietary diversity was assessed using kappa statistics.

RESULTS

The concordance of dietary diversity between mother-child pairs in SSA was 74.48% (95% CI: 73.98, 74.98). A higher likelihood of mother-child dietary diversity concordance was significantly associated with mothers who had a primary level of education (AOR = 1.40, 95% CI: 1.31, 1.53) and those who were divorced or widowed (AOR = 1.54, 95% CI: 1.29, 1.84). Conversely, lower odds of concordance were observed among mothers with higher education (AOR = 0.75, 95% CI: 0.66, 0.85), those exposed to media (AOR = 0.78, 95% CI: 0.73, 0.83), and mothers belonging to poorer (AOR = 0.81, 95% CI: 0.74, 0.88), middle-income (AOR = 0.82, 95% CI: 0.75, 0.89), richer (AOR = 0.80, 95% CI: 0.73, 0.88), and richest (AOR = 0.75, 95% CI: 0.67, 0.83) households.

CONCLUSION

The findings highlight that the dietary diversity concordance between mother-child pairs in sub-Saharan Africa is moderate at 74.48%. However, the factors influencing concordance suggest socio-economic and educational disparities. Mothers with a primary education level and those who were divorced or widowed had higher concordance with their children's dietary diversity, indicating their potential prioritization of family dietary habits despite limited resources or support systems. On the other hand, lower concordance among mothers with higher education and those exposed to media suggest that these groups may adopt more individualized dietary practices. Furthermore, households with higher economic status, surprisingly, exhibited lower concordance, which may indicate resource allocation differences within wealthier families or greater dietary autonomy among children. Globally, one-fourth of children aged 6-23 months and two-thirds of women of reproductive age suffer from micronutrient deficiencies, primarily due to inadequate dietary diversity [1-3]. It is estimated that 50-70% of the global disease burden is associated with poor dietary patterns and malnutrition [4]. In Low- and Middle-income Countries (LMICs), where many impoverished and rural households depend on starchy staples due to limited access to diverse foods, only 20% of children meet minimum acceptable dietary standards, exacerbating malnutrition and related health challenges [5,6]. Dietary Diversity (DD) is recognized as a key indicator of a healthy diet, reflecting the variety of food groups consumed within 24 hours [7]. According to the World Health Organization (WHO), DD serves as a proxy for child feeding practices, with consumption from at least four different food groups indicating that the child likely consumed an animal-source food, a fruit or vegetable, and a staple food such as grains, roots, or tubers [8].

Optimizing minimum dietary diversity: examining appropriate complementary feeding practices and influencing factors among children aged 6-23 months in Ghana; a cross-sectional study

BACKGROUND

Inappropriate supplementary feeding techniques put children under the age of two in danger of malnutrition, illness, and death. However, only a few children receive nutritionally appropriate and diversified diets. It is noteworthy that achieving minimum dietary diversity plays a pivotal role in the attainment of Sustainable Development Goals. However, the double burden of malnutrition poses a significant threat to achieving these goals.

METHODS

A health facility-based cross-sectional study was conducted from April to July 2021. A multi-stage sampling technique was used to sample 422 study participants. Data were collected with a paper-based questionnaire, coded and entered into Epi-Data version 3.1. Data extraction was carried out in Excel Sheet for cleaning and then later exported into STATA for analysis. The dependent variable explored in the study was MDD. The independent variables considered in our estimation include; mothers' age (years), educational level, marital status, ethnicity, occupational status, religion, place of residence, sex of the child, age of the child (in months), and complementary feeding practices.

RESULTS

Out of the 422 participants, the majority of them 343 (81.0%) had good dietary practices. The prevalence of MDD among the children was 17.1%. On the other hand, educational level [aOR = 3.16 (95% CI: 0.75-13.29), p = 0.001] and ethnicity [aOR = 24.72 (1.43-15.64), p = 0.011] were statistically associated with children's high MDD.

CONCLUSION

The study concludes that while MDD was low among the children studied, breastfeeding was common but gaps existed in providing essential food groups, with significant influences from maternal education and ethnicity. The study highlights the need for targeted interventions to enhance dietary practices for children aged 6-23 months. Specifically, the study emphasized scaling up comprehensive public awareness campaigns to raise awareness about the importance of dietary diversity for child health and development.

Time to dietary diversity of complementary feeding improvements and its associated factors among infants aged 6-12 months in Ethiopia: evidence from performance monitoring for action

Background

Infant and Young Child Feeding significantly affect the health, development, and nutritional status of children under 2 years old, ultimately affecting their survival. The aim of this study is to determine the time to improvement in dietary diversity and associated factors in infants aged 6 to 12 months.

Methods

The study used secondary data from the PMA Ethiopia longitudinal panel survey, involving pregnant women from January to March 2024. The data management and analysis were performed using Stata version 17. The Kaplan-Meier survival curve (KM) and the log-rank test method were implemented. A Cox proportional-hazard regression model was used to explore the association between independent variables and the outcome variable. The strength of the association was indicated by the adjusted hazard ratio (AHR) with a 95% confidence interval. The threshold of p < 0.05 was applied to determine the significance of an association.

Results

The study found that the proportion of infants with improved dietary diversity aged 6-12 months was 22% (95% CI: 19.5, 25%). Factors associated with improved dietary diversity in infants aged 6 to 12 months were married women (AHR = 9.3, 95% CI = 1.19, 8.30), women with a secondary school (AHR = 1.9, 95% CI = 1.05, 3.51), women with technical and vocational (AHR = 2.0, 95% CI = 1.01, 4.05) and women with a university degree (AHR = 2.9, 95% CI = 1.51, 5.38). Moreover, women in the highest wealth quintile (AHR = 3.5, 95% CI = 1.31, 9.41), women visiting PNC (AHR = 1.7, 95% CI = 1.13, 2.62), women visiting ANC 1-3, and more than four times were (AHR = 2.4, 95% CI = 1.51, 3.74) and (AHR = 3.6, 95% CI = 2.28, 5.67) times higher for improving dietary diversity.

Conclusion

The findings of this study showed that the proportion of dietary diversity improvement was 22%. Which is relatively low. Marital status, educational status, wealth index, PNC, and ANC visits were identified as statistically significant factors associated with dietary diversity improvements. It suggests that public health interventions should focus on enhancing maternal knowledge and promoting regular healthcare visits to mitigate malnutrition and improve infant health outcomes in Ethiopia.

Prevalence and determinants of post-neonatal mortality in East Africa: a multilevel analysis of the recent demographic and health survey

Background

One of the most common measures of society's health is mortality among neonates. Developing and developed countries still differ significantly in neonatal mortality rates. While there are about 18 neonatal deaths worldwide for every 1,000 live births during the first month of life, less is known about neonatal mortality in developing countries, especially in East Africa. Understanding the extent of mortality during the post-neonatal period and its determinants is crucial for developing appropriate policies and strategies that could help solve the issue. Thus, the aim of this study was to identify the prevalence of post-neonatal mortality in East African countries and the factors that are associated with it.

Methods

Secondary data analysis was conducted using data from the most recent Demographic and Health Surveys, which included 11 East African countries between 2014 and 2022. A weighted sample of 225,635 live births had been used in the study. STATA/SE 14 was used for data analysis. The multilevel mixed-effects logistic regression model was applied to determine the factors associated with post-neonatal mortality. In the multilevel logistic regression model, significant factors were deemed to be associated with post-neonatal mortality at p-values <0.05. The data were interpreted using the adjusted odds ratio (AOR) and confidence interval (CI). The best-fit model has been found to be the one with the lowest deviance and highest logliklihood ratio.

Results

In East Africa, post-neonatal mortality was found to be 15 per 1,000 live births. Pregnancy type (AOR = 3.09, 95% CI: 2.30, 4.13), birth weight (AOR = 1.58, 95% CI: 1.25, 2.01), maternal age (AOR = 1.58, 95% CI: 1.32, 1.90), maternal education (AOR = 1.82, 95% CI: 1.14, 2.92), tetanus shots prior to delivery (AOR = 1.23; 95% CI: 1.06-1.42), birth order (AOR = 5.68, 95% CI: 4.48, 7.24), those born in Uganda (AOR = 1.33, 95% CI: 1.03, 1.73), and Burundi (AOR = 1.48, 95% CI: 1.11, 1.98) had the highest odds of post-neonatal death.

Conclusion

According to this study, post-neonatal mortality is higher in developing countries, particularly in East Africa. It was discovered that factors at the individual and community levels associated with post-neonatal mortality. Consequently, focus should be paid to babies born to mothers in the lowest age group, those born of multiple pregnancies, without formal educations, who did not receive tetanus shots prior to birth, and who were born in the first birth order.

Prevalence and determinants of unintended pregnancy among rural reproductive age women in Ethiopia

Despite growing utilization of family planning in Ethiopia, many pregnancies in rural areas are still unintended and unintended pregnancy remains a major global challenge in public and reproductive health, with devastating impact on women and child health, and the general public. Hence, this study was aimed to determine the prevalence and associated factors of unintended pregnancy in rural women of Ethiopia. This study used a 2016 Ethiopian Demography and Health Survey data. A total weighted samples of 974 reproductive-aged rural women were included in this analysis. Multilevel mixed logistic regression analysis was employed to consider the effect of hierarchal nature of EDHS data using Stata version 14 to determine individual and community level factors. Variables significantly associated with unintended pregnancy were declared at p-value < 0.05 with adjusted odds ratio and 95% confidence interval (CI). The prevalence of unintended pregnancy in rural women was 31.66% ( 95%CI 28.8%, 34.66%). Never had media exposure (AOR: 2.67, 95%CI 1.48, 4.83), don't have work (AOR: 0.33, 95%CI 0.21, 0.52), being from household size of one to three (AOR: 0.44 95%CI 0.2, 0.96), being primiparous (AOR: 0.41, 95%CI 0.17, 0.99), women from poor families (AOR: 2.4, 95%CI 1.24, 4.56), lacking the intention to use contraceptive (AOR: 0.24, 95%CI 0.14, 0.44) were individual-level factors significantly associated with unintended pregnancy. Women from large central region (AOR: 4.2, 95%CI 1.19, 14.62) and being from poor community wealth status (AOR: 4.3, 95%CI 1.85, 10.22) were community-level factors statistically associated with unintended pregnancy. The present study prevalence of unintended pregnancy in rural women was relatively high. Maternal occupation, household size, media exposure, parity, women wealth, intention to use contraceptive, region and community level wealth were factors statistically associated with unintended pregnancy. Hence, demographer and public health practitioners has to give great emphasis on designing an intervention with implementation strategies to increase accessibility of media for reproductive-age women's and improve women financial capacity, and strengthen maternal health services. These strategies helps to decrease adverse birth outcomes associated with unintended pregnancy in rural areas.

Determinants of animal source food consumption among children aged 6-23 months in sub-Saharan Africa: multilevel mixed effect model

A diversified diet in early childhood that comprises plant and animal source foods contributes to better health outcomes throughout the life course. However, inadequate infant and young child-feeding practices are serious public health problems in Africa. Evidence on the magnitude and determinants of inadequate animal source food consumption (ASF) in sub-Saharan Africa (SSA) is not yet well established. Hence, this study aimed to estimate the pooled magnitude and determinants of ASF consumption in SSA. A total weighted sample of 92,309 children aged 6-23 months from the Demographic and Health Survey dataset of 35 SSA countries was used for this study. A multilevel mixed-effect model was fitted. The intra-class correlation coefficient (ICC) and likelihood ratio (LR) tests were used to assess the presence of the clustering effect. The model comparison was made using deviance information criteria (DIC). A p-value of p < 0.05 was used to declare statistical significance. The pooled magnitude of ASF consumption among children aged 6-23 months in SSA was 23.7% (95% CI: 23.4, 23.9). Across the SSA regions, the Southern Africa region had the highest consumption of ASF (51.35%), and the lowest was from the Eastern Africa region (21.41%). Younger children aged 6-9 months (AOR = 3.39; 95% CI: 3.14, 3.65), mothers who had no formal education (AOR = 1.46; 95% CI: 1.37, 1.56), children from mothers with no media exposure (AOR = 1.17; 95% CI: 1.11, 1.24), children from the poorest households (AOR = 2.59; 95% CI: 2.36, 2.84), rural residence (AOR = 1.20; 95% CI: 1.12, 1.28), living in low-income countries (AOR = 2.43; 95% CI: 2.03, 2.90), and children from the East Africa region (AOR = 1.24; 95% CI: 1.14, 1.35) were among the significant predictors for not consuming ASF. In this study, ASF consumption was markedly low. Almost three-fourths of children aged 6-23 months in SSA did not consume ASF in the previous day. Age of the child, ANC visits, maternal educational status, maternal marital status, media exposure, and household wealth index were significant individual-level predictors of ASF consumption, whereas the place of residence, country's income level, and regions of SSA were found to be significant community-level predictors of ASF consumption. Thus, the study highlighted that policymakers, governments, and their partners should demonstrate rigorous efforts to improve dietary diversification with due consideration to the identified predictors of ASF.

Determinants of micronutrient supplementation during pregnancy among women in three sub-Saharan African countries: a multilevel logistic regression model

Background

Poor maternal nutrition during pregnancy is a common cause of poor maternal and infant outcomes. Micronutrient deficiencies are common among pregnant women in low- and middle-income countries, including sub-Saharan Africa. Pregnant women are recommended to take micronutrients like iron or folic acid and deworming medication during pregnancy. Therefore, this study was conducted to assess micronutrient intake and its associated factors among pregnant women in three countries using the most recent demographic and health survey.

Methods

We used data from the most recent demographic and health surveys, which were carried out between 2019 and 2022 in three sub-Saharan African countries. The study included a weighted sample of 13,568 reproductive-age women who had given birth within the five years prior to the survey. Utilizing multilevel logistic regression, the factors associated with the dependent variable were identified. Model comparison and fitness were assessed using the deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Ultimately, factors were deemed statistically significant if they had a p-value less than 0.05.

Results

The pooled prevalence of micronutrient intake among pregnant women during pregnancy of last birth was 77.56% (95% CI: 76.85%-78.25%). Factors like age [AOR = 1.78; 95% CI (1.14, 2.77)], educational status [AOR = 1.49; 95% CI (1.23, 1.79)], marital status [AOR = 0.66; 95% CI (0.58, 0.75)], working status [AOR = 1.17; 95% CI (1.01, 1.34)], media exposure [AOR = 1.20; 95% CI (1.05, 1.38)], preceding birth interval [AOR = 1.17; 95% CI (1.01, 1.34)], number of ANC visits [AOR = 1.65; 95% CI (1.29, 2.10)], and residence [AOR = 1.19; 95% CI (1.03, 1.37)] were significantly associated with micronutrient intake among pregnant women.

Conclusions

More than three-fourths of the study subjects were micronutrient supplemented during their pregnancy. Improving women's education, disseminating nutrition information through media, providing more attention to young pregnant women who live in rural areas, increasing the number of ANC visits, and women's empowerment are strongly recommended.

Maternal socio-economic status determines animal source food consumption of children aged 6-23 months in East African countries: a multilevel mixed-effects generalized linear model

Background

Nutrient deficiencies in Africa persist due to limited access to animal-source foods, causing a higher undernutrition prevalence, with 30.7% stunted children under five, which is higher than the global average of 22.0%. In African regions, there needs to be more information on access, consumption, and factors influencing children's animal-source food consumption. Therefore, we comprehensively analyse data from the Demographic and Health Surveys (DHS) to determine factors associated with children's (aged 6-23 months) consumption of animal-source foods (ASFs) in East African countries, which is crucial for policy and program development.

Methods

We utilized cross-sectional pooled DHS data from nine East African countries reported from 2015 to 2021. The sample size consisted of 18,686 weighted children aged 6-23 months who were included. The DHS data were collected from women (15-49 years old) from households in each enumeration area of each country. We calculated the pooled proportion of consumption of foods of animal origin using multi-level logistic regression analysis to determine factors of ASFs, and the strength of the association was measured by an adjusted odds ratio (AOR) with a 95% CI and a p-value < 0.05, which was declared as significant.

Result

The study found that 51.07% (95% CI: 50.26-51.88%) of infants and young children in East Africa consume ASFs, with variation across countries, of which 28.26% (95% CI: 26.31-30.29%) was the lowest in Burundi and 55.81% (95% CI: 53.39-58.21%) was the highest ASF consumption in Zimbabwe. The amount of ASF consumed grows with children's age and varies greatly between countries. In addition, children in the wealthiest quintile and with the highest educational attainment consume more ASFs. However, those who lived in rural areas consumed fewer ASFs.

Conclusion

The consumption of ASFs increased with the age of children, maternal education, and household wealth index. The government and non-government sectors should implement public health interventions targeting rural residents and poor households to increase access to and consumption of ASFs for children aged 6-23 months in East Africa.

The influence of minimum dietary diversity on undernutrition among children aged 6-23 months in Ethiopia: a multilevel mixed-effect analysis based on 2019 Ethiopian mini demographic and health survey

Background

Undernutrition persists as a critical issue in developing countries like Ethiopia due to poor feeding practices for infants and young children. The impact of dietary diversity on children's health in Ethiopia remains unclear, necessitating further investigation to develop effective prevention strategies.

Objective

To examine the association between minimum dietary diversity and undernutrition among children aged 6-23 months in Ethiopia.

Methods

Data from the 2019 Ethiopian Mini Demographic and Health Survey, including 1,501 women with children aged 6-23 months, were analyzed using STATA version 17 software. Child stunting, wasting, and underweight were assessed using Z-scores. Dietary diversity was measured using minimum dietary diversity. Multilevel logistic regression analysis determined associations, presenting results as crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI).

Results

Overall, 10.99% of children had adequate minimum dietary diversity, with Addis Ababa (44.57%) and Somalia (1.47%) showing the highest and lowest prevalences, respectively. The highest stunting prevalence was in the Amhara region (45.86%), while Addis Ababa had the lowest (9.78%). Wasting was lowest in Addis Ababa (1.09%) and highest in Tigray (17.07%). Underweight prevalence ranged from 2.17% in Addis Ababa to 33.33% in Tigray. Children with adequate minimum dietary diversity (MDD) had significantly lower odds of stunting (AOR = 0.68, 95% CI = 0.45, 0.96), underweight (AOR = 0.51, 95% CI = 0.27, 0.99), and wasting (AOR = 0.40, 95% CI = 0.17, 0.97) compared to those who had inadequate minimum dietary diversity (MDD).

Conclusion

This study highlights the association between minimum dietary diversity and stunting, wasting, and underweight among Ethiopian children aged 6-23 months. Urgent nutrition-specific interventions are needed, particularly in regions with high undernutrition rates and low dietary diversity. Targeted interventions focusing on promoting diverse and nutritious diets for children, along with improving access to essential healthcare services, are imperative to mitigate the burden of undernutrition and ensure the well-being of Ethiopia's youngest population and reinforcing existing programs is crucial to address this public health issue effectively.

Prevalence and determinants of inadequate dietary diversity among pregnant women in four Sub-Saharan Africa countries: a multilevel analysis of recent demographic and health surveys from 2021 to 2022

Background

Diversity in the mother's diet can have major effects on the developing fetus throughout pregnancy. Approximately 1 million neonates die on their first day of life as a result of inadequate nutrition, which also complicates the mother's pregnancy and has a negative impact on the delivery outcome. Dietary diversity during pregnancy is poorly recognized in developing countries, despite the fact that it is detrimental. As a result, this study aimed to assess the prevalence and associated factors of inadequate dietary diversity in Burkina Faso, Ghana, Kenya, and Tanzania among pregnant women.

Methods

Secondary data analysis was conducted using data from the most recent Demographic and Health Surveys, which included four countries in Sub-Saharan Africa between 2021 and 2022. A total of 80,083 pregnant women were included in this study. The women's dietary diversity was computed from 10 food categories. Based on the minimum diversity score, women were categorized as having inadequate dietary diversity if their diversity score was less than five food items and as having adequate dietary diversity if they took five or more food groups. A multilevel mixed-effects logistic regression model was used to identify the factors associated with inadequate dietary diversity. At p-values <0.05, significant factors correlated with inadequate diversity were identified. The result was interpreted using 95%CI and adjusted odds ratio. The best-fit model was determined to be the one with the lowest deviance and highest loglikelihood ratio.

Results

The prevalence of inadequate dietary diversity among pregnant women in Burkina Faso, Ghana, Kenya, and Tanzania was 94.46%. Factors such as no formal education (AOR = 3.39, 95% CI: 2.54, 4.54), distance to health facilities (AOR = 1.36, 95% CI: 1.16, 1.60), poor wealth quantiles (AOR = 2.97, 95% CI: 2.41, 3.65), no media exposure (AOR = 1.84, 95% CI: 1.45, 2.35), low community ANC utilization (AOR = 1.21, 95% CI: 1.16, 1.60), and reside Burkina Faso (AOR = 1.47, 95% CI: 1.09, 1.99) were among the factors associated with inadequate dietary diversity.

Conclusion

According to this study finding, pregnant women had a high percentage of inadequate dietary diversity. Factors at the individual and community levels contributed to the lack of diversity in nutrition. Thus, when developing policies and strategies, the health ministries of Burkina Faso, Kenya, Ghana, and Tanzania should to consider the women who underutilize antenatal care services, live in low wealth quantiles and who did not get formal education.

Low levels and determinants of appropriate complementary feeding practices among children aged 6-23 months from Tigray, Ethiopia: a community-based cross-sectional study

INTRODUCTION

Complementary feeding is considered appropriate when introduced timely at 6 months of age, and where it fulfils the minimum meal frequency, minimum dietary diversity and minimum acceptable diet. Sufficient evidence is available on the different individual indicators of appropriate complementary feeding.

OBJECTIVE

This study was conducted to assess the prevalence and determinants of appropriate complementary feeding practices among children aged 6-23 months in Tigray, Northern Ethiopia.

DESIGN AND SETTING

A community-based cross-sectional study was conducted in 52 districts of Tigray.

PARTICIPANTS

A total of 5321 children aged 6-23 months were included using stratified two-stage random sampling.

RESULTS

Approximately 19% of children received appropriate complementary feeding. Maternal residence in urban areas (adjusted OR (AOR) 1.26; 95% CI 1.062 to 1.489), maternal education (AOR 1.34; 95% CI 1.111 to 1.611), antenatal care (ANC) visits (AOR 1.75; 95% CI 1.343 to 2.281), household food security (AOR 2.81; 95% CI 2.367 to 3.330) and provision of colostrum to newborns (AOR 1.76; 95% CI 1.139 to 2.711) were found predictors of appropriate complementary feeding. Moreover, children in the 12-17 and 18-23 months age groups were 1.3 (AOR 1.30; 95% CI 1.083 to 1.551) and 1.7 (AOR 1.73; 95% CI 1.436 to 2.072) times more likely to receive appropriate complementary feeding respectively, compared with children aged 6-11 months.

CONCLUSIONS

Appropriate complementary feeding practices among children aged 6-23 months remain unacceptably low in Tigray. Recommendations to improve nutrition outcomes include counselling on age-appropriate complementary feeding, education for girls and women, targeting families through food security initiatives, provision of nutrition education on appropriate complementary feeding practices during ANC visits, supporting mothers to initiate breastfeeding within the first hour of delivery and crafting context-based messaging for rural families.

Dietary diversity and associated factors among infants and young children in three West African countries

Providing children healthy diversified diets is important for their optimal growth and development. The high prevalence of under-nourishment during the critical early life period is of serious concern in West Africa. We assessed the level of dietary diversity and associated factors for children aged 6-23 months in Côte d'Ivoire, Niger and Senegal. Prior 24 h dietary intake was assessed for 3,528 children (Côte d'Ivoire: N = 118; Niger: N = 763; Senegal: N = 2,647) using the Diet Quality Questionnaire survey tool administered to primary caregivers. Cluster random sampling was conducted for urban and rural areas in Niger and Senegal and simple random sampling was used in Côte d'Ivoire, where only rural households were selected. Survey data were analyzed to determine children's intake of items from eight food groups: breast milk; grains, roots, tubers and plantains; pulses, nuts and seeds; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum Dietary Diversity (MDD) was assessed based on the consumption of ≥5 of the 8 food groups. In all countries, the majority of children were ≥ 12 months of age and from rural households. Children from poor/very poor households ranged from 32.4 to 41.9%. MDD prevalence was 54.2% in Côte d'Ivoire, 33.3% in Niger and 30.8% in Senegal. In all three countries, children 12-23 months had significantly higher consumption of six of the food groups, compared to those 6-11 months, and children ≥12 months had a higher likelihood of MDD, compared to infants, in Niger (aOR = 4.25; 95% CI: 2.46, 7.36) and Senegal (aOR = 2.69; 95% CI: 2.15, 3.35). MDD prevalence was higher among children in urban, compared to rural, areas in Niger (p = 0.020) and Senegal (p < 0.001) and significantly higher in the wealthiest, compared to poorest, households. This study suggests most young children in Côte d'Ivoire, Niger and Senegal are not receiving an adequately diversified diet, with a reliance on starchy staples and lower intake of high-quality protein sources. Our results highlight socio-economic barriers to attaining dietary diversity in these settings and stress the urgent and continuing need for investments in strategies that support optimal complementary feeding practices.

Exploring minimum dietary diversity among cambodian children using four rounds of demographic and health survey

Dietary diversity among children is a crucial factor influencing their nutritional status; therefore, this paper uses data from four rounds of the Cambodia Demographic and Health Survey (CDHS) to examine the minimum dietary diversity among children aged 6-23 months. Multilevel binary regression is used to evaluate the variation in minimum dietary diversity at the cluster and province levels. The results show that nearly half of Cambodian children consistently lacked access to vitamin A-rich fruits and vegetables. Although the prevalence of inadequate minimum dietary diversity (MDD) among children significantly dropped from 76% in 2005 to 51% in 2021-2022, it is still high and needs attention. A decomposition analysis (Blinder-Oaxaca decomposition) was further used to understand the drivers of this temporal change in dietary diversity. The empirical results show that clusters represented the most significant source of geographic variation with respect to all eight food groups and MDD. Nutritional policy should improve education and awareness, reduce socio-economic disparities, leverage media, and promote full antenatal care to improve dietary diversity in Cambodia. Initiatives targeting the enhancement of insufficient minimum dietary diversity intake should encompass individual aspects and be customized to suit geographic and community settings.

Household- and community-level factors of zero vegetable or fruit consumption among children aged 6-23 months in East Africa

Introduction

The World Health Organization recommends that children aged 6-23 months should consume a diversified diet, including fruits and vegetables, during each meal. However, low consumption of fruits and vegetables contributes to 2.8% of child deaths globally. The literature review indicates limited research on factors that affect zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Therefore, this study aimed to investigate the household- and community-level factors determining zero vegetable or fruit consumption among children aged 6-23 months in East Africa.

Method

The study analyzed cross-sectional secondary data from the recent rounds of demographic and health surveys conducted in East Africa from 2015 to 2023. The weighted sample comprised 113,279 children aged 6-23 months. A multilevel mixed-effect analysis was used, measuring the random variation between the clusters based on the intra-cluster correction coefficient, median odds ratio, and proportional change variance. Adjusted odds ratio with a 95% confidence interval was reported while considering variables having a p < 0.05 as statistically significant.

Results

The overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa was 52.3%, with Ethiopia showing the highest prevalence (85.9%). The factors associated with zero vegetable or fruit consumption were maternal educational level, number of household members, short birth interval, multiple births, sex of the household head, household wealth index, community-level maternal literacy, community-level wealth index, and countries.

Conclusion

Considering the high overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa, overlooking this nutritional gap among children is a serious oversight. Therefore, efforts should be geared toward improving individual- and community-level maternal literacy. In particular, nutrition and public health organizations should support low-income communities to achieve vegetable or fruit consumption for infants and young children.

Level of dietary diversity score and its predictors among children aged 6-23 months: a linear mixed model analysis of the 2019 Ethiopian Mini Demographic Health Survey

Background

The dietary diversity score (DDS) of children is one of the indicators as part of infant and young child feeding practices. This study aimed to assess the level of DDS and its determinants among Ethiopian children aged 6-23 months.

Methods

This study analysed retrospective cross-sectional data on a weighted sample of 1511 children aged 6-23 months after extracting it from the Ethiopian Mini Demographic and Health Survey 2019. A a linear mixed model was fitted and expressed as adjusted beta coefficients with a 95% CI. Finally, predictors with a p value <0.05 were considered statistically significant. Measures of variation were explained by intraclass correlation coefficients (ICC), and model fitness was determined using the Akaike information criterion.

Result

The mean (±SD) DDS of children was 2.8 (±1.5). Only 56.3%, 13.4% and 11.6% of children met the minimum meal frequency (MMF), minimum dietary diversity score and minimum acceptable diet, respectively. The full model ICC was 0.266, which implied that 26.6% of the total variance of DDS among children was attributed to the differences between clusters. For a 1-month increase in the child's age, the DDS of children will increase by 0.016 units, holding all other variables constant. Also, for every 1-year increase in maternal education, a 0.057-unit increase in the DDS of children is predicted. Children from wealthy families, having mothers who have had media exposure, meeting MMF and taking fewer than 30 min to reach a nearby water supply have been proven to increase the DDS.

Conclusion

In Ethiopia, the DDS of children is very low. To improve DDS enhancing maternal literacy, revenue production activities, media exposure and access to water sources should be prioritised. The significance of feeding children regularly throughout the day should be emphasised.

Maternal employment status and child age are positive determinants of minimum dietary diversity among children aged 6-23 months in Sagnarigu municipality, Ghana: a cross-sectional study

BACKGROUND

Intake of a diversified diet is key to the prevention of malnutrition among children as it results in improved intake of energy and micronutrients, which are deemed critical for better nutritional status of children. This study assessed minimum dietary diversity (MDD) and its determinants among children aged 6-23 months in the Sagnarigu Municipality of Ghana.

METHODS

This was an analytical cross-sectional study, carried out in the Sagnarigu Municipality, Ghana and involved 369 mother-child pairs selected through a systematic random sampling. A semi-structured questionnaire was used to obtain respondents' socio-demographic characteristics, feeding practices, nutritional knowledge and anthropometry. MDD was assessed using a repeated 24-hour dietary recall method. Chi-square/Fisher exact test and binary logistic regression analysis were used to determine the factors associated with MDD.

RESULTS

The study found that 24.9% of the children were between the ages of 6-8 months and 75.1% were between the ages of 9-23 months. About 64.2% of the children met the MDD. Children of mothers who were self-employed were approximately 2 times more likely to meet the MDD as compared to children of mothers who were unemployed [Adjusted Odd Ratio (AOR): 1.93, 95% CI (1.13-3.31), P = 0.017]. Also, children aged 9-23 months were approximately 14 times more likely to meet MDD as compared to younger children aged 6-8 months [AOR: 13.98, 95% CI (7.54-25.91), P < 0.001].

CONCLUSION

Our study suggests that maternal empowerment may have positive effects on improving the MDD of infants and young children.

Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: a multilevel analysis of the recent demographic and health survey

INTRODUCTION

Malnutrition is a public health problem in sub-Saharan Africa with an increased morbidity and mortality rate than in other parts of the world. Poor complementary feeding practices are one of the major causes of malnutrition during the first two years of life. Therefore, this study aimed to determine the prevalence and associated factors of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries.

METHODS

A multilevel mixed-effect analysis was carried out using recent demographic health survey data from 19 sub-Saharan African countries, which were conducted between 2015 and 2020. A total weighted sample of 60,266 mothers of children aged 6 to 23 months were included in the study. The demographic health survey employs a stratified two-stage sampling technique. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with complementary feeding practice. Variables with a p-value less than 0.05 and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported as statistically significant variables associated with appropriate complementary feeding practices.

RESULTS

The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries was 13.02% (95% CI: 12.75-13.29%). Maternal educational level [AOR = 0.69, 95% CI (0.64, 0.74)] and [AOR = 0.52, 95% CI (0.47, 0.57)], marital status of the mother [AOR = 0.85, 95% CI (0.74, 0.96)], sex of household head [AOR = 1.78, 95% CI (1.09, 1.27)], total children ever born [AOR = 1.52, 95% CI (1.18, 1.96)], [AOR = 1.43, 95% CI (1.14, 1.81)], and [AOR = 1.31, 95% CI (1.04, 1.64)], media exposure [AOR = 0.74, 95% CI (0.69, 0.79)], ANC visits attended during pregnancy [AOR = 0.73, 95% CI (0.63, 0.80)] and [AOR = 0.67, 95% CI (0.62, 0.74)], place of delivery [AOR = 0.92, 95% CI (0.85, 0.98)], currently breastfeeding [AOR = 1.12, 95% CI (1.01, 1.23)], PNC checkup [AOR = 0.75, 95% CI (0.70, 0.80)], the current age of the child [AOR = 0.26, 95% CI (0.24, 0.28)] and [AOR = 0.14, 95% CI (0.13, 0.16)], birth order [AOR = 1.31, 95% CI (1.09, 1.58)], number of under 5 children in the household [AOR = 0.76, 95% CI (0.59, 0.97)], community illiteracy [AOR = 1.09, 95% CI (1.02, 1.18)], and country category [AOR = 1.62, 95% CI (1.18, 2.22)] were significantly associated with appropriate complementary feeding practices.

CONCLUSION

The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan Africa was relatively low. Higher maternal educational level, female household head, having media exposure, attending more ANC visits, health facility delivery, currently breastfeeding, having PNC follow-up, low community illiteracy, and living in the West Africa region increase the odds of appropriate complementary feeding practices. Women empowerment, increasing maternal health services accessibility, promoting breastfeeding behavior, increasing media exposure of the household, and improving the proportion of health facility delivery are strongly recommended.

Socio-economic inequalities in and factors associated with minimum dietary diversity among children aged 6-23 months in South Asia: a decomposition analysis

OBJECTIVE

This study aimed to determine the factors associated with minimum dietary diversity (MDD) and estimate the socioeconomic inequalities in MDD among children from five South Asian countries.

DESIGN

Cross-sectional.

SETTING

The study used the most recent round of secondary databases of Demographic Health Survey data of Bangladesh (2017-2018), India (2019-2021), Maldives (2016-2017), Nepal (2018) and Pakistan (2017-2018).

PARTICIPANTS

This study used information on MDD and other explanatory variables from a total of 136 980 (weighted) children aged 6-23 months.

METHODS

Multivariable logistic regression was employed to identify the factors associated with MDD and concentration index (CIX) and Lorenz curve were used to measure the socioeconomic inequalities in MDD.

RESULTS

The overall weighted prevalence of MDD in South Asia was 23.37%. The highest prevalence of MDD was found among children from Maldives (70.7%), while the lowest was in Pakistan (14.2%). Living in affluent versus poor households, having a mother who is employed versus a mother who is unemployed, exposure to various forms of media (newspapers and magazines), seeking antenatal care (ANC) more than four times compared with those who sought ANC less than four times and having children older than 4 years old are the most common significant factors associated with MDD deficiency. This study found the value of the CIX for MDD (MDD: CI=0.0352; p<0.001) among children with a higher socioeconomic status, suggesting inequality in MDD in favour of the more among well-off households.

CONCLUSION

Inequality in the prevalence of MDD favours the affluent. Health policy and intervention design should prioritise minimising socioeconomic inequalities concerning the MDD. In addition, policy-makers should prioritise the associated factors of MDD such as education, wealth status, employment, media exposure while designing intervention or policies.

Incorrect Feeding Practices, Dietary Diversity Determinants and Nutritional Status in Children Aged 6-23 Months: An Observational Study in Rural Angola

BACKGROUND

More than a quarter of children who are affected by severe acute undernutrition reside in Sub-Saharan Africa. Incorrect feeding practices have a negative impact on a child's health in both the short and the long term, and the interval from conception to two years is the most critical for the development of undernutrition-related complications. These first 1000 days of life also represent an "opportunity window" for early interventions, hence, having a clear insight into dietary habits and the determinants of diet quality is fundamental to improving nutritional counseling practices.

OBJECTIVES

To investigate incorrect feeding practices, dietary diversity determinants and nutritional status in children aged 6-23 months.

METHODS

Prospective quali-quantitative observational study conducted at the Missionary Catholic Hospital of Chiulo (Angola) from March to April 2023.

RESULTS

Of 250 children, global acute malnutrition affected 25.2% and was associated with starting complementary feeding at <4 months of age (p = 0.007) and not achieving the minimum meal frequency (p < 0.0001). Minimum dietary diversity was found in 11.2%, minimum meal frequency was experienced by 72.8%, and the minimum acceptable diet was found in 11.2% of participants. The minimum dietary diversity was reached only by households with access to food from five or more major food groups (p = 0.007) or the money to buy food from five or more major food groups (p = 0.008) and was higher in households where the householder had a higher educational level (p = 0.002). Regarding the determinants linked to family traditions and beliefs, the main religion-associated beliefs concerned the impurity of pork (n = 25) and fish (n = 8), while eggs (n = 19) and cow milk (n = 8) were the main food types that were deemed harmful for children.

CONCLUSIONS

Although some factors (economic and religious) may be difficult to overcome, other factors linked to erroneous beliefs (dangerous foods) or incorrect feeding practices (early weaning and an incorrect frequency of meals) can be targeted, to improve the effectiveness of nutritional counseling practices.

Home delivery among women who had optimal ANC follow-up in Sub-Saharan Africa: A multilevel analysis

BACKGROUND

Home deliveries, where most births take place, are significantly responsible for the majority of maternal mortality. In order to develop appropriate policies and methods that could aid in addressing the issue, it is important to understand the scope of home delivery and its determinants in developing countries. Therefore, this study aims to ascertain the prevalence and factors associated with home delivery among women who had optimal ANC follow up in the Sub-Saharan Africa countries.

METHODS

A population based cross-sectional study was conducted. Data from the most recent Demographic and Health Surveys, which covered 23 Sub-Saharan Africa countries from 2014 to 2020, were used. The study used a total of 180,551 women who had optimal ANC follow up weighted sample. Stata 14 was used to analyze the data. The determinants of home delivery were determined using a multilevel mixed-effects logistic regression model. Factors associated with home delivery in the multilevel logistic regression model were declared significant at p-values <0.05. The adjusted odds ratio and confidence interval were used to interpret the results.

RESULTS

In Sub-Saharan Africa, three in ten (30%) women who had optimal ANC follow-up gave birth at home. Individual-level variables such as maternal age (20 to 35 years) (AOR = 1.27, 95% CI: 1.10, 1.46), no formal education (AOR = 3.10, 95% CI: 2.68, 3.59), pregnancy complications (AOR = 0.74, 95% CI: 0.67, 0.82), distance to a health facility (AOR = 1.43, 95% CI: 1.30, 1.58), and poor wealth status (AOR = 2.71, 95% CI: 2.37, 3.10) had higher odds of home delivery. Community-level variables such as rural residence (AOR = 2.83, 95% CI: 2.48, 3.22), living in central Sub-Saharan Africa (AOR = 7.95, 95% CI: 5.81, 10.9), and eastern Sub-Saharan Africa (AOR = 2.74, 95% CI: 2.09, 3.59), were significantly associated with home delivery.

CONCLUSIONS AND RECOMMENDATION

This study concludes that home delivery in sub-Saharan Africa among women who had optimal ANC follow-up were high. The study identified that both individual and community-level variables were determinants of home delivery. Therefore, the Government and ministries of health in Sub-Saharan Africa countries should give attention to those women who reported distance as a big problem to health facilities and for rural resident women while designing policies and strategies targeting reducing home delivery in sub-Saharan Africa.

Spatial variation and determinants of inappropriate complementary feeding practice and its effect on the undernutrition of infants and young children aged 6 to 23 months in Ethiopia by using the Ethiopian Mini-demographic and health survey, 2019: spatial and multilevel analysis

Background

Inappropriate complementary feeding practices (IACFPs) are major public health issues in Ethiopia, which usually result in stunting and becoming an intergenerational cycle. However, the spatial patterns and determinants of IACFP and its effect on undernutrition are not well understood in Ethiopia. Therefore, the aim of this study was to explore the spatial patterns and determinants of IACFPs and their effects on the undernutrition of infants and young children (IYC) in Ethiopia.

Methods

This was a nationwide community-based survey study among 1,463 mothers of IYC aged 6-23 months in Ethiopia. The global spatial autocorrelation was assessed using the global Moran's-I to evaluate the spatial clustering of IACFPs. Significant clusters with high and low rates of IACFPs were explored. A multilevel mixed-effect logistic regression with cluster-level random effects was fitted to identify determinants of IACFPs with an AOR and 95% CI.

Results

The prevalence of IACFPs was 90.22%. The spatial pattern of IACFP in Ethiopia was clustered across regions (Global Moran's I = 0.63, Z-score = 12.77, value of p ≤0.001). Clusters with a high rate of IACFP were detected in southern, northwest, and eastern Ethiopia. Individual and community-level variables accounted for 63% of IACFP variation. Mothers with no education were 3.97 times (AOR = 3.97; 95% CI: 1.64-9.60) more likely to have IACFPs than those with higher education. The poorest HHs had 4.80 times the odds of having IACFPs as the richest HHs (AOR = 4.80, 95% CI: 1.23-18.71). The odds of having IACFPs were 2.18 times (AOR = 2.18; 95% CI: 1.28-3.72) higher among babies with no postnatal checkup. Non-breastfed IYC were 2.8 times (AOR = 2.80; 95% CI: 1.29-6.10) more likely to have IACFP when compared with breastfed ones. IYC with the inadequate introduction of solid, semi-solid, and soft foods, inadequate minimum dietary diversity, and inadequate minimum acceptable diet were more likely to have wasting, underweight, and stunting.

Conclusion

This study showed the prevalence of IACFPs was very high, which had an effect on undernutrition and showed spatial variation in Ethiopia. Therefore, the government of Ethiopia and stakeholders should focus on women with no education and the poorest HHs, encourage PNC checkups, and encourage breastfeeding in the hotspot areas to minimize IACFPs in Ethiopia.

The prevalence and multilevel analysis of minimum dietary diversity intake and its determinants among 6-23 months old infants in The Gambia: further analysis of the Gambian demographic and health survey data

BACKGROUND

Poor infant and young child feeding (IYCF) practices are a significant issue both globally and in developing nations, and they have a significant role in undernutrition, healthy growth, and development, particularly in the first 2 years of life. Improving children's general health and wellbeing requires recognizing and decreasing preventable drivers of malnutrition. Hence, this study aimed to assess the prevalence and possible determinants of minimum dietary diversity among 6-23 months old babies in the Gambia.

METHODS

Data from the 2019-2020 Gambia demographic and health survey were used. The study included a total of 2100 weighted 6-23 months old children. To identify characteristics significantly linked with minimum dietary diversity among infants, a multilevel fixed-effect analysis approach was used. After adjusting other confounding variables, variables with a p value of 0.25 were incorporated into a multivariable multilevel regression analysis to determine associated variables. An adjusted odds ratio with a 95% confidence interval was then applied.

RESULTS

Only 22.22% (95% CI 18.55, 21.99) of infants had received the minimum dietary diversity. Mothers, who had mass media exposure (aOR = 2.71, CI = (1.02, 6.21), wealthier (aOR = 1.70, CI = 1.02, 2.85), child age of (aOR = 4.14, CI = 2.98, 5.76), and (aOR = 4.97, CI = 3.54, 6.98), have shown a positive statistical association with the outcome variable, respectively. Regarding regions mothers who came from Kanifing (aOR = 0.49, CI = 0.25, 0.94), Janjanbureh (aOR = 0.38, CI = 0.18, 0.82), and Basse (aOR = 0.51, CI = 0.26, 0.99) had showed less likelihood odds to provide the minimum dietary diversity (MDD) for their babies compared to Banjul local government area, respectively.

CONCLUSION

The World Health Organization dietary evaluation tool suggests that the MDD value be extremely low, even though it might be slightly higher than the numbers for some nations. The country may need to take drastic measures to tackle child malnutrition.

Factors associated with diet diversity among infants and young children in the Eastern and Southern Africa region

This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6-23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6-11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin-A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.

Short birth interval and its predictors among reproductive age women in high fertility countries in sub-Saharan Africa: a multilevel analysis of recent Demographic and Health Surveys

BACKGROUND

In developing countries, short birth interval is one of the major public health issues. It is one of the leading cause's adverse birth outcomes in the worldwide. Despite the fact that ending maternal and perinatal morbidity and mortality is one of the Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including high fertility countries. Thus, this study aimed to determine the short birth interval and its predictors in ten high fertile sub-Saharan African countries.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys (DHS). A total of weighted sample of 303,979 women of childbearing age group (15- 49) who had at least two alive consecutive children was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the associated factors of short birth interval. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.

RESULTS

Overall prevalence of short birth interval in high fertile sub Saharan Africa was 58.74% (52.32%, 65.17%).The factors significantly associated with the short birth interval were women's educational status; primary education (AOR = 0.88; 95% CI: 0.86,0 .91), secondary and higher (AOR = 0.10; 95% CI: 0.09, 0.11), working (AOR = 0.91; 95% CI: 0.88, 0 .93), classified as rich wealth index level (AOR = 0.90; 95% CI: 0.88, 0.93),having six and above ideal number of children (AOR = 2.25; 95% CI: 2.22, 2.30), preferred waiting time two years and above to give birth (AOR = 0.83; 95% CI: 0.76, 0.89), contraceptive non users (AOR = 3.01; 95% CI: 2.93, 3.07), community level education (AOR = 1.97; 95% CI: 1.54, 2.08), rural residency (AOR = 2.17; 95% CI: 2.13, 2.22), and country Chad (AOR = 1.37; 95% CI: 1.22, 1.54).

CONCLUSION

The prevalence of short birth interval in the top ten high fertile sub Saharan African countries is still optimally high. Therefore, the government of each country should work on the access to family planning and education in rural parts of the countries.

Correlates of dietary diversity among children aged 6-23 months of head porters in Ghana

Objective

In many developing countries, most children cannot meet minimum dietary diversity (MDD), defined as the consumption of four or more of the seven food groups. In Ghana, only 35% of children met MDD nationwide in 2017, but rates are worse among the rural poor and resource-constrained individuals like Head Porters (HPs). The current study investigated the correlates of MDD in children of HPs aged 6-23 months old in Ghana.

Methods and materials

A cross-sectional survey was carried out in 2021 among 423 HPs selected purposively from eight market centers in two commercial cities. A multi-stage sampling method was used in obtaining the sample, while a structured interview guide was used to collect data from the caregivers. Stata version 15.1 and descriptive and inferential statistics like frequency, percentage, chi-square and logistic regression were used to analyze the data. All results were deemed significant if the p-value was < 0.05 and the odds ratios with a 95% confidence interval.

Results

The children had a mean age of 14.3 (±4.9) months, while half of the caregivers (48.2%) were between 15 and 25 years. Approximately 59% (251) had good knowledge of infant and young child feeding practices (IYCF). About 45% of the children consumed a diversified diet. The number of postnatal care (PNC) visits, delivery in a health facility, meeting minimum meal frequency (MMF), and the child's age was independently associated with MDD at the multivariate level.

Conclusion

Over a third of the caregivers had poor knowledge of IYCF practices. Furthermore, less than half of the children achieved MDD reflecting the need for more education by the stakeholders. Regular PNC visits and delivery in health facilities were independently associated with MDD; therefore, interventions to combat low MDD should prioritize the relevance of these predictors.