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

Maternal and household factors affecting the dietary diversity of preschool children in eastern Ethiopia: a cross-sectional study

OBJECTIVE

Investigate the association between the dietary diversity of preschool children and proximate factors including household food insecurity, maternal food choice, preferences, khat use, and levels of depressive symptoms.

DESIGN

Cross-sectional survey of randomly selected households.

SETTING

Haramaya Health and Demographic Surveillance site in Eastern Ethiopia, predominantly smallholder farming households.

PARTICIPANTS

678 preschool children (24-59 months) and their mothers.

METHODS

The key outcome, the adequacy of dietary diversity of preschool children, was calculated using a 24-hour parental dietary recall. Binary logistic regression was then used to identify maternal and household factors associated with dietary adequacy versus inadequacy.

RESULTS

The majority (80.53%) of surveyed children had low dietary diversity (mean Dietary Diversity (MDD)) score of 3.06±1.70 on a 7-point scale). Approximately 80% of households exhibited food insecurity. Households with greater food security (adjusted OR (AOR)=1.96, 95% CI 1.19 to 3.23), healthier maternal food choice (AOR=2.19, 95% CI 1.12 to 4.31) and broader maternal food preferences (AOR=4.95, 95% CI 1.11 to 21.95) were all associated with higher dietary diversity of their preschool children (p≤0.05). Other covariates associated with adequate child dietary diversity included improved household drinking water sources (AOR=1.84, 95% CI 1.16 to 2.92) and family planning use (AOR=1.69, 95% CI 1.00 to 2.86). Despite predictions, however, maternal depression and khat consumption were not identified as factors.

CONCLUSIONS

The dietary diversity of preschool children is extremely low-a pattern observed in both food-secure and food-insecure households. Key factors include maternal selection of food for convenience and ease, preferences that do not include animal protein or healthier food choices, and lack of access to improved drinking water sources. Interventions around maternal food choice and preferences could improve preschool children's nutritional health.

Concordance and determinants of mothers' and children's diets in Nigeria: an in-depth study of the 2018 Demographic and Health Survey

OBJECTIVES

Improving the diversity of the diets in young children 6-23 months is a policy priority in Nigeria and globally. Studying the relationship between maternal and child food group intake can provide valuable insights for stakeholders designing nutrition programmes in low-income and middle-income countries.

DESIGN

We examined the relationship between maternal and child dietary diversity among 8975 mother-child pairs using the Nigeria 2018 Demographic and Health Survey (DHS). We assessed concordance and discordance between maternal and child food group intake using the McNemar's χ² test, and the determinants of child minimum dietary diversity (MDD-C) including women MDD (MDD-W) using hierarchical multivariable probit regression modelling.

SETTING

Nigeria.

PARTICIPANTS

8975 mother-child pairs from the Nigeria DHS.

PRIMARY AND SECONDARY OUTCOME MEASURES

MDD-C, MDD-W, concordance and discordance in the food groups consumed by mothers and their children.

RESULTS

MDD increased with age for both children and mothers. Grains, roots and tubers had high concordance in mother-child dyads (90%); discordance was highest for legumes and nuts (36%), flesh foods (26%), and fruits and vegetables (39% for vitamin-A rich and 57% for other). Consumption of animal source food (dairy, flesh foods, eggs) was higher for dyads with older mothers, educated mothers and more wealthy mothers. Maternal MDD-W was the strongest predictor of MDD-C in multivariable analyses (coef 0.27; 95% CI 0.25 to 0.29, p<0.000); socioeconomic indicators including wealth (p<0.000), mother's education (p<0.000) were also statistically significant in multivariable analyses and rural residence (p<0.000) was statistically significant in bivariate analysis.

CONCLUSION

Programming to address child nutrition should be aimed at the mother-child dyad as their food consumption patterns are related and some food groups appear to be withheld from children. Stakeholders including governments, development partners, non-governmental organizations, donors and civil society can act on these findings in their efforts to address undernutrition in the global child population.

Women's empowerment and child nutrition in a context of shifting livelihoods in Eastern Oromia, Ethiopia

Agriculture, and particularly livestock and animal source foods, has been closely linked to improvements in human nutrition. Production, income, and women's empowerment improve household food security and child nutritional outcomes in interacting ways. Khat production in Eastern Ethiopia is changing the economic and livelihood landscape for communities that have traditionally relied upon small-scale mixed agriculture and livestock production. How this shifting livelihood landscape and the empowerment of women in these communities are affecting nutritional outcomes has not been investigated. Using cross-sectional data collected during formative research for the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project, we developed models to examine the roles of livelihood activities, including livestock production, staple crop production, and khat production, and women's empowerment in child nutrition outcomes. Survey participants were randomly selected mothers of children aged 10-15 months from Haramaya district, Eastern Hararghe, Oromia, Ethiopia. Nested logistic regression models were performed for each nutrition outcome: children's animal source food consumption, children's dietary diversity, and child stunting, wasting, and underweight. Explanatory variables included those for livelihood (tropical livestock unit, crop production, and khat production ladder) and women's empowerment (as indicated by domains of the Women's Empowerment in Agriculture Index), and covariates including child sex, mother's age, mother's education, assets, income, and kebele. Results indicated that khat production and tropical livestock units were not significantly associated with any of the child nutrition outcomes. However, results did indicate that the odds of reporting child animal source food consumption in households where the mother was empowered in the leadership domain was 3.33 times that in households where the mother wasn't (p < 0.05). In addition, the odds of having a stunted child in households where the mother was empowered in the time domain was 2.68 times that in households where the mother wasn't (p < 0.05). The results from this study both support and complicate the existing literature on the associations between women's empowerment in agriculture and child nutrition outcomes, underscoring the important role that livelihood, contextual factors, and location may have on the complex relationship between empowerment domains and nutritional outcomes.

Under-nutrition and its determinants among school-aged children in northwest Ethiopia

Background

Malnutrition among children has lifelong implications, its outcomes not only cover the whole life but also transfer from one generation to another generation. Most studies conducted before focused on undernutrition in pregnant mothers and children less than 5 years of age, whereas school-age children are often omitted from health and nutrition surveys or surveillance. In Northwest Ethiopia, particularly in the study area, the community levels nutritional status of school-age is not well studied and documented. Therefore, this study aimed to assess the prevalence and determinants of the under-nutritional status of school-age children in Gondar Zuria District, Northwest Ethiopia.

Methods

A community-based cross-sectional study design was employed with 364 respondents from January to April 2020. Data entered using Epi Data software version 3.1. Standard deviation scores were obtained by the world health organization Anthro Plus software to determine the nutritional status of children, and further analysis was done by using STATA version 14 software. Adjusted odds ratio with its corresponding 95 % confidence interval was used to declare statistically significant variables.

Results

The prevalence of overall under-nutrition was 71.98% (95%, CI: 67%–76%) from which, 43.13% (95%, CI: 38%–48%) were stunted, 40.93% (95%, CI: 35%–46%) were under-weight, and 35.44% (95%, CI: 30%–40%) were wasted. Child age [AOR = 0.30, 95% CI (0.13–0.68)], food insecurity [AOR = 2.24, 95% CI (1.03–4.83)], good knowledge of mother/care giver [AOR = 0.40, 95% CI (0.17–0.92)], having larger family size (Tzioumis and Adair, 2014; Wolde et al., 2015; Mohammed et al., 2019) [6-8] [AOR = 2.92, 95% CI (1.29–6.58)], and unprotected drinking water sources [AOR = 2.84, 95% CI (1.00–8.06)] were the predictors of under-nutrition.

Conclusion

According to the world health organization cut-offs, the prevalence of overall under-nutrition in the study area was very high. Child age, food insecurity, knowledge of mother/caregiver, having a larger family size, and unprotected drinking water sources were the predictors of under-nutrition. The district offices should give attention to the improvement of the food security status of the community, and give priority to the availability and accessibility of drinking water sources, particularly pipe water sources. Special attention to older age groups of children is important to control the prevalence of under-nutrition.

Farmers’ Preference and Willingness to Pay for Climate-Smart Rice Varieties in Uzo-Uwani Local Government Area of Enugu State, Nigeria

This paper examined farmers’ preference and willingness to pay (WTP) for climate-smart rice varieties in Uzo-Uwani Local Government Area of Enugu State, Nigeria. A total of 80 respondents were purposely selected from 5 major rice growing communities in the study area. Questionnaire was the main tool for data collection. Also, data on climate elements (such as temperature and rainfall volume) for a period of 35 years (1986–2020) were obtained from the Nigerian Meteorological Agency (NIMET). Multinomial logit model, ordinary least square (OLS) regression model, descriptive statistics and trend analysis were employed for data analysis. The results show that FARO 44 was preferred by 95% of the farmers for grain size, 100% of farmers preferred it for days to maturity, 76.2% preferred it for strength of grain to withstand breakage during processing, 98.75% preferred it for potential yield (tons) and plant height (cm) and 87.5% preferred it for its ecological adaptation. Farmers’ preference and willingness to pay for climate-smart rice varieties were influenced by attributes of these varieties and knowledge of such technologies, primary occupation, farm size, extension visits and access to media information and farm size. This study recommends that government should provide extension agents with the adequate resources to enable them carry out their duties more effectively.

Climate Change Perception and Uptake of Climate-Smart Agriculture in Rice Production in Ebonyi State, Nigeria

Rice production in Nigeria is vulnerable to climate risks and rice farmers over time have experienced the risks and their respective impacts on rice farming. Rice farmers have also responded to perceived climate risks with strategies believed to be climate-smart. Farmers’ perception of climate risks is an important first step of determining any action to be taken to counteract the negative effects of climate change on agriculture. Studies on the link between perceived climate risks and farmers’ response strategies are increasing. However, there are limited studies on the determinants of rice farmers’ perception of climate events. The paper therefore examined climate change perception and uptake of climate-smart agriculture in rice production in Ebonyi State, Nigeria using cross-sectional data from 347 rice farmers in an important rice-producing area in Nigeria. Principal component analysis, multivariate probit regression model and descriptive statistics were adopted for data analysis. Perceived climate events include increased rainfall intensity, prolonged dry seasons, frequent floods, rising temperature, severe windstorms, unpredictable rainfall pattern and distribution, late onset rain, and early cessation of rain. Farmers’ socioeconomic, farm and institutional characteristics influenced their perception of climate change. Additionally, rice farmers used a variety of climate-smart practices and technologies to respond to the perceived climate events. Such climate-smart practices include planting improved rice varieties, insurance, planting different crops, livelihood diversification, soil and water conservation techniques, adjusting planting and harvesting dates, irrigation, reliance on climate information and forecasts, planting on the nursery, appropriate application of fertilizer and efficient and effective use of pesticides. These climate-smart agricultural measures were further delineated into five broad packages using principal component analysis. These packages include crop and land management practices, climate-based services and irrigation, livelihood diversification and soil fertility management, efficient and effective use of pesticide and planting on the nursery. High fertilizer costs, lack of access to inputs, insufficient land, insufficient capital, pests and diseases, floods, scorching sun, high labour cost, insufficient climate information, and poor extension services were the barriers to uptake of climate-smart agriculture in rice production. Rice farmers should be supported to implement climate-smart agriculture in rice production in order to achieve the objectives of increased rice productivity and income, food security, climate resilience and mitigation.

A Review of Selected Studies on the Factors Associated with the Nutrition Status of Children Under the Age of Five Years in South Africa

Malnutrition is a considerable contributor to child mortality and morbidity. Child malnutrition further affects the country's economic development. Child malnutrition in South Africa is persistent, continuing to be an alarming burden. The nutritional status of kids under the age of five years is a critical indicator of the country's economic condition and health status. An understanding of the influencers of the nutritional status of children can act as a catalyst in combatting all forms of malnutrition. The purpose of this paper was to review selected studies concerning the factors that affect the nutritional status of children in South Africa. Studies were selected from electronic databases, which were PubMed, Google Scholar, Science Direct, Sabinet African Journals, and the University of Zululand library catalog. The keywords that were used to search studies and articles from the selected database were: risk factors, child nutritional status, children under the age of five years, South Africa, malnutrition, underweight, stunted, wasting, and over-nutrition. Studies and surveys published from 2010-2019 that reported on the factors influencing the nutritional status of children under the age of five years were included in this review. Twenty-seven articles met the inclusion criteria of the study. The 27 articles were made up of 21 cross-sectional articles and six longitudinal articles. The finding from this review highlights that there is a lack of studies conducted in urban areas. The results show that the nutritional status of children is affected by several factors. These include household food insecurity, low household income, illiterate caregivers, unemployment, inadequate dietary intake, low birth weight, consumption of monotonous diets, poor caregiver's nutritional knowledge, poor access to water and sanitation, poor weaning practices, age of the caregiver, and demographic characteristics of a child (age and gender). It is critical to have an understanding of the factors that affect the nutritional status of children. Such knowledge can significantly contribute to formulating policies that can enhance nutrition security and the country's economy. Moreover, insights into strategic interventions to eradicate all forms of malnutrition can be made.

Energy and Nutrient Intake and Associated Factors Among Pastoral Children in Southern Ethiopia

BACKGROUND

A better understanding of nutrient intakes and predicting factors will help in designing more effective programs that address the nutrition requirements of pastoral children.

METHODS

Dietary diversity score (DDS) and amounts of food items consumed were recorded for 538 children aged 6 to 59 months from August to October 2015. The nutrient contents per 100 grams of foods consumed by children were calculated. Median energy and nutrient intakes of children were calculated and compared with the World Health Organization (WHO) recommended nutrient intakes (RNI). The effects of various factors on the median energy adequacy ratio (EAR) and on nutrient adequacy ratio (NAR) were analyzed using logistic regression.

RESULTS

Children had low DDS (2.7) with diets dominated by dairy and cereal preparations. Thus, only a few children received the minimum DDS (11.7%) and minimum acceptable diet (5%). Most of the children had low intakes of energy, vitamins (C, B, A, folic acid), iron, and zinc. Autonomy of mothers in decision-making, nonpastoral incomes, crop cultivation, and keeping diverse livestock species had positive effects on nutrient intakes. Children living in villages closer to markets and those aged 6 to 23 months had better NAR than others. The median EAR was higher for children aged 6 to 23 months, when households possessing more animal species and engaged in crop cultivation compared to others.

CONCLUSION

Study children had lower DDS than WHO standards and intakes of several micronutrients were inadequate. Variables associated with median EAR and NAR point to those in need of improvement.

Predictive Insights for Improving the Resilience of Global Food Security Using Artificial Intelligence

Unabated pressures on food systems affect food security on a global scale. A human-centric artificial intelligence-based probabilistic approach is used in this paper to perform a unified analysis of data from the Global Food Security Index (GFSI). The significance of this intuitive probabilistic reasoning approach for predictive forecasting lies in its simplicity and user-friendliness to people who may not be trained in classical computer science or in software programming. In this approach, predictive modeling using a counterfactual probabilistic reasoning analysis of the GFSI dataset can be utilized to reveal the interplay and tensions between the variables that underlie food affordability, food availability, food quality and safety, and the resilience of natural resources. Exemplars are provided in this paper to illustrate how computational simulations can be used to produce forecasts of good and bad conditions in food security using multi-variant optimizations. The forecast of these future scenarios is useful for informing policy makers and stakeholders across domain verticals, so they can make decisions that are favorable to global food security.

Men's nutrition knowledge is important for women's and children's nutrition in Ethiopia

In an effort to address undernutrition among women and children in rural areas of low‐income countries, nutrition‐sensitive agriculture (NSA) and behaviour change communication (BCC) projects heavily focus on women as an entry point to effect nutritional outcomes. There is limited evidence on the role of men's contribution in improving household diets. In this Agriculture to Nutrition trial (Clinicaltrials.gov identifier: NCT03152227), we explored associations between men's and women's nutritional knowledge on households', children's and women's dietary diversity. At the midline evaluation conducted in July 2017, FAO's nutrition knowledge questionnaire was administered to male and female partners in 1396 households. There was a high degree of agreement (88%) on knowledge about exclusive breastfeeding between parents; however, only 56–66% of the households had agreement when comparing knowledge of dietary sources of vitamin A or iron. Factor analysis of knowledge dimensions resulted in identifying two domains, namely, ‘dietary’ and ‘vitamin’ knowledge. Dietary knowledge had a larger effect on women's and children's dietary diversities than vitamin knowledge. Men's dietary knowledge had strong positive associations with households' dietary diversity scores (0.24, P value = 0.001), children's dietary diversity (0.19, P value = 0.008) and women's dietary diversity (0.18, P value < 0.001). Distance to markets and men's education levels modified the effects of nutrition knowledge on dietary diversity. While previous NSA and BCC interventions predominantly focused on uptake among women, there is a large gap and strong potential for men’s engagement in improving household nutrition. Interventions that expand the role of men in NSA may synergistically improve household nutrition outcomes.

Impact of Poultry Farmers' Participation in Modern Food Retail Markets on Household Dietary Diversity: Lessons from Southeast Nigeria

Simple Summary

Developing countries’ food systems are experiencing rapid transformations led by modern food retail market (MFRM) channels such as supermarkets, fast food firms, hotels, and convenience stores. This paper analyzes the impact of these channels on farm households’ dietary diversity with survey data from Southeast Nigeria. Estimates from the instrumental variable model show that participation in MFRM is associated with a significant increase in dietary diversity. Furthermore, the linkages through which MFRM participation impacts dietary diversity are analyzed using seemingly unrelated regression. Poultry farm income, consumption of poultry products produced by the farmer, and area of vegetable cultivated using poultry droppings have positive association with dietary diversity, while male controlled poultry farm revenue has negative association with dietary quality. Our study provides useful insights that poultry farm managers would find helpful. It also serves as a potential source of information for policymakers for planning as it links smallholder poultry farmers’ participation in modern food retail markets to improved nutrition.

Abstract

This study analyzed the interrelationships between participation in MFRMs and dietary diversity of poultry farming households in Southeast Nigeria. We used cross-sectional data from poultry farmers in Southeast Nigeria and employed instrumental variable and seemingly unrelated regression models to estimate the impact of MFRM participation and major linkages to poultry farm households’ dietary diversity. The results show that participating in MFRMs, relative to traditional markets, improved poultry farmers’ dietary diversity. Moreover, dietary diversity was positively related to higher poultry farm incomes, higher value of own poultry products consumed, and larger area of vegetable cultivated using poultry droppings as manure. Furthermore, increased poultry farm income, higher value of own poultry products consumed, and larger area of vegetable land cultivated using poultry droppings as manure increased the dietary diversity of the farm households. In contrast, a higher share of poultry production revenue controlled by men reduced household dietary diversity. These findings make clear the potential of improving farming households’ nutrition outcomes by promoting participation in MFRMs and the major impact pathways.

Mother-Related Determinants of Children At-Home Fruit and Vegetable Dietary Patterns in a Polish National Sample

Fruit and vegetable intake is indicated among the features of sustainable diets, while children’s intake is strongly associated with the intake of their parents, as well as the availability of food products and their accessibility at home. The aim of the study was to analyze the mother-related determinants of children at-home fruit and vegetable dietary patterns in a Polish national sample of children aged 3–10 years. The random quota sampling (with quotas for age, education, and place of residence) was conducted to recruit the national representative sample of Polish mothers of children aged 3–10 years (n = 1200) who were interviewed using a Computer-Assisted Telephone Interviewing (CATI) method. They were asked about their children’s at-home fruit and vegetable dietary patterns, which were later compared in sub-groups that were stratified for age, educational background, marital status, place of residence, occupational status, and total net income in households. The indicated features, but not marital status, were indicated as determinants of children at-home fruit and vegetable dietary patterns. Children of younger mothers more often than others consumed fruits, whereas those of older mothers consumed vegetables. Children of mothers who had a lower level of education more commonly than others consumed fruits alone as a dish, and they had a higher preference for them, while those of mothers who had a higher level of education had a higher consumption of vegetables than others, although they had a medium preference for them. Children of mothers from villages had a lower consumption of vegetables and fruits than others, although they had a higher preference for fruits. Children of mothers with no professional job had a lower consumption of vegetables than others and more often consumed them processed, although they had a higher preference for fruits and vegetables. Children of mothers with low income had a lower consumption of vegetables than others and more often consumed fruits in a dish with other products, although they had a higher preference for fruits and vegetables. To summarize, an indication of a high preference for fruits and vegetables by mothers is not accompanied by the higher consumption and recommended dietary patterns for fruit and vegetable intake by their children. In particular, the sub-samples of mothers who had a low level of education, were from villages, did not have a professional job, and had low income may either overestimate the fruit and vegetable preference of their children or do not offer them sufficient amount of fruits and vegetables, although they indicate a higher preference. In order to encourage more sustainable diet following, in terms of the fruit and vegetable intake, it is essential to introduce actions toward the properly planned nutritional education for the indicated target groups.