Women's dietary diversity scores and childhood anthropometric measurements as indices of nutrition insecurity along the urban-rural continuum in Ouagadougou, Burkina Faso

Prevalence and determinants of minimum dietary diversity for women of reproductive age in Uganda

BACKGROUND

Globally, over a billion women of reproductive age (WRA) suffer from some kind of undernutrition micronutrient deficiencies, and/or anemia as a result of inadequate dietary diversity. This leads to poor maternal and child health outcomes, however, there is limited research on population level research on minimum dietary diversity for women (MDD-W). This study assessed the prevalence and predictors of MDD-W among WRA in Uganda.

METHODS

This study was a secondary analysis of data from the lot quality assurance sampling (LQAS) survey conducted across 55 Ugandan districts between May and September 2022. Women of various ages were interviewed across 5 study subgroups that this study used to construct its study population (WRA). Descriptive analyses, tests for outcome differences, and multilevel mixed-effects logistic regression were conducted at a 5% statistical significance level using STATA version 17. The results were reported using Adjusted Odds Ratios (aOR) as the measure of the outcome.

RESULTS

The study analyzed responses from 29,802 WRA with a mean age of 27.8 (± 6.8) years. Only 8.8% (95% CI 8.5-9.3) achieved the MDD-W, the least proportion was observed in the South-Central region (3.13%). In the adjusted analysis, WRA who were older than 25 years (aOR 1.1, 95% CI 1.1-1.3, p < 0.001), had secondary education (aOR = 1.4, 95% CI 1.1-1.7, p = 0.003) or above (aOR = 1.7, 95% CI 1.3-2.2, p < 0.001), and used modern contraceptives (aOR = 1.1, 95% CI 1.0-1.3, p = 0.01) were more likely to achieve the MDD-W. Conversely, WRA who travelled longer distances to the nearest household water source (aOR = 0.8, 95% CI 0.7-0.9, p = 0.002) and those residing in larger households (aOR = 0.9, 95% CI 0.8-1.0, p = 0.019) were less likely to achieve the MDD-W.

CONCLUSION

A low proportion of WRA met the MDD-W. Age, education level, household sizes and use of modern contraception were predictors of MDD-W among WRA in Uganda. MDD-W-related program efforts in Uganda should strengthen multisectoral collaboration with prioritization of younger women, education, household sizes and access to safe water sources.

Land tenure, food security, gender and urbanization in Northern Ghana

Links between land tenure and food and nutritional insecurity are receiving increased attention. Nevertheless, urban and periurban dwellers face challenges in accessing land to produce food for subsistence and sale. An ethnographic study and food and nutrition insecurity survey were conducted between October 2013 and November 2014 in Tamale, Northern Region of Ghana, to explore the dynamic and recursive links between land access, food access and the ability to maintain resources to meet long-term needs. Results showed that infrastructural development and agriculture compete for land. The shortage of land for agricultural purposes was pronounced in urban areas (20%) than in periurban areas (1.3%) and rural areas (0%). Food insecure households were more likely to name a lack of land than anything else as the primary reason for their inability to grow crops (Fisher's exact probability = 0.040). Urban and periurban dwellers cope with the constraints posed in the communal tenure system by using strategies such as urban-periurban-rural migrant farming and buffer zone cultivation. The role of women in providing nutritious soups is especially important, and they use various mechanisms to circumvent their lack of access to land and provide food for the household. Political, economic and cultural elements thus interact to constitute the link between land and food.

Effects of dietary diversification during pregnancy on birth outcomes in east Gojjam, northwest Ethiopia: A prospective cohort study

Introduction

Adequate nutrient intake during pregnancy is an important key factor affecting fetal growth and birth outcomes, as well as maternal health, as demonstrated by experimental animal studies. However, the few human studies available, especially those conducted in the least developed countries (LDCs), are much less consistent. Therefore, this study aimed to investigate the association between dietary diversification during pregnancy and birth outcomes in Gojjam, Ethiopia.

Methodology

A facility-based prospective cohort study was conducted on 416 pregnant mothers (exposed and non-exposed) from December 2019 to January 2020. Information about the Women's Dietary Diversity Score (WDDS) was collected using the Food and Agricultural Organization's guidelines. Data were collected through interviewer-administered questionnaires and measurements. Log-binomial regression analysis was performed to estimate the relative risk of adverse birth outcomes. Energy, macronutrient, and micronutrient amounts were calculated using the nutrition survey software version 2007. The differences between groups were noticed using analysis of variance. Eta squared was estimated in the current study.

Results

The overall magnitude of low birth weight, preterm birth, and stillbirth in the study area, respectively, was 41%, 38%, and 4%. After adjustment for baseline characteristics, this study revealed that pregnant women in the inadequate WDDS group were at increased risk of LBW (ARR = 6.4; 95% CI: 3.4, 12) and PTD (ARR = 6.3; 95% CI: 3.3, 11.95) as compared with their counterparts but no difference in the occurrence of stillbirth (ARR = 1.08; 95% CI: 0.20, 5.79).

Conclusion

Overall, this study found a large magnitude of low birth weight and preterm birth. Inadequate intake of dietary diversity during pregnancy significantly increased the rate of low birth weight and preterm birth. Thus, we recommend the concerned body to work on improving the feeding practices of pregnant mothers in the study area.

Household food insecurity is associated with child’s dietary diversity score among primary school children in two districts in Ghana

Background: Dietary diversity is generally considered as a good indicator of nutrient adequacy and is influenced by various factors at the national, household, and individual levels. Objective: The present study sought to determine the relationships between household food insecurity, primary caregivers’ nutrition knowledge, and dietary diversity of school-aged children in Ghana. Methods: This forms part of a longitudinal study conducted in the Ayawaso West Municipal district in Accra (urban setting) and the Upper Manya Krobo district (rural setting) in Ghana. Data were collected from a total of 116 caregiver-child dyads using 24-h dietary recall and a short version of the US 12-month Household Food Security Survey Module. Nutrition knowledge and sociodemographic data were obtained using a structured questionnaire. Multivariable logistic regression was used to check for factors associated with children’s dietary diversity. Results: Majority of households reported food insecurity, with a higher percentage of insecure households located in the rural area (88.9% vs. 46.5%, P ≤ 0.0001), compared to the urban setting. Diet diversity among the study children was low, with a mean (standard deviation [SD]) of 5.8 (2.1) out of 14 food groups. Children living in food insecure households were three times more likely to have received low diverse diet compared to those from food secure households (adjusted odds ratio [OR] =3.3, 95% confidence interval [CI]: 1.4–8.0). Caregivers’ nutrition knowledge was, however, not related to children’s dietary diversity. Discussion and conclusion: Household food insecurity was a main predictor of dietary diversity among school-age children in this study. Thus, caregiver knowledge in nutrition may not be enough, particularly in the presence of food insecurity to guarantee adequate nutrition for school-aged children.

Dietary diversity and associated factors among HIV-positive adults attending the anti-retroviral therapy clinic at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia: a cross-sectional study

The aim of the study was to assess dietary diversity (DD) and associated factors among human immune deficiency virus (HIV)-positive adults attending the anti-retroviral therapy (ART) clinic at Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Northwest Ethiopia. An institution-based cross-sectional study was conducted at FHCSH in 2019. A systematic random sampling technique was employed to select 352 study subjects. Data were collected using an interviewer-administered questionnaire and chart review. Statistical Package for the Social Science version 26 was used for analysis. A simple and multivariable binary logistic regression was used to determine associated factors. Two hundred and nine (59⋅4 %) adults had consumed a diversified diet. The mean individual DD score was 3⋅86 ± 1⋅18. Self-employment status (adjusted odd ratio (AOR): 4⋅60; 95 % confidence interval (CI): 1⋅72, 12⋅27), quintiles of wealth index (the second (AOR: 4⋅33; 95 % CI: 1⋅72, 10⋅89), middle (AOR: 4⋅40; 95 % CI: 1⋅71, 11⋅31), fourth (AOR: 6⋅60; 95 % CI: 2⋅36, 18⋅48) and the highest quintiles (AOR: 9⋅45: 95 % CI: 3⋅34, 26⋅77), the last CD4 count 200–349 cells/mm³ (AOR: 8⋅08; 95 % CI: 2⋅93, 22⋅23), those who took first-line ART regimen drugs (AOR: 4⋅49; 95 % CI: 2⋅19, 9⋅21), subjects who did not take co-trimoxazole prophylaxis (AOR: 6⋅36; 95 % CI: 2⋅54, 15⋅88), those who had nutritional counselling at a health institution (AOR: 2⋅36; 95 % CI: 1⋅08, 5⋅16), had no food preference (AOR: 2⋅42; 95 % CI: 1⋅14, 5⋅13) and a food-secure household (AOR: 3⋅51; 95 % CI: 1⋅85, 6⋅67) were associated factors of DD among adults on ART. This study exhibited that the DD status among adults attending the ART clinic was below two-thirds. Health institutions and health professionals working at ART clinics shall strengthen their efforts to sustain the nutritional counselling service and ART adherence at health institutions and encourage the patients to avoid food preference for their meal. It is vital to ensure the household food security of adults on ART.

Dietary Diversity and Micronutrients Adequacy in Women of Childbearing Age: Results from ELANS Study

Dietary diversity, an important component of diet quality, is associated with an increased probability of adequate micronutrient intake. Women of childbearing age (WCA) are particularly vulnerable to micronutrient inadequacy. The Minimum Dietary Diversity for Women (MDD-W) has been used widely as a proxy measurement of micronutrient adequacy. This study aimed to assess the association between MDD-W and nutrients adequacy among WCA of eight Latin American countries. Nutrient intakes from 3704 WCA were analyzed with two 24-hour dietary recalls. Dietary diversity was calculated based on ten food groups with a cut-off point of intake ≥5 groups. The mean dietary diversity score was 4.72 points, and 57.7% of WCA achieved MDD-W. Vitamin D and E showed a mean Nutrient Adequacy Ratio (NAR) of 0.03 and 0.38, respectively. WCA with a diverse diet (MDD-W > 5) reported a significantly higher intake of most micronutrients and healthy food groups with less consumption of red and processed meats and sugar-sweetened beverages. MDD-W was significantly associated with the mean adequacy ratio (MAR) of 18 micronutrients evaluated. Nevertheless, even those women with a diverse diet fell short of meeting the Estimated Average Requirements (EAR) for vitamins D and E. MDD-W is an appropriate tool to evaluate micronutrients adequacy in WCA from Latin America, showing that women who achieved the MDD-W reported higher adequacy ratios for most micronutrients and an overall healthier diet.

Single camera multi-view anthropometric measurement of human height and mid-upper arm circumference using linear regression

Background

Manually measured anthropometric quantities are used in many applications including human malnutrition assessment. Training is required to collect anthropometric measurements manually, which is not ideal in resource-constrained environments. Photogrammetric methods have been gaining attention in recent years, due to the availability and affordability of digital cameras.

Objective

The primary goal is to demonstrate that height and mid-upper arm circumference (MUAC)–indicators of malnutrition–can be accurately estimated by applying linear regression to distance measurements from photographs of participants taken from five views, and determine the optimal view combinations. A secondary goal is to observe the effect on estimate error of two approaches which reduce complexity of the setup, computational requirements and the expertise required of the observer.

Methods

Thirty-one participants (11 female, 20 male; 18–37 years) were photographed from five views. Distances were computed using both camera calibration and reference object techniques from manually annotated photos. To estimate height, linear regression was applied to the distances between the top of the participants head and the floor, as well as the height of a bounding box enclosing the participant’s silhouette which eliminates the need to identify the floor. To estimate MUAC, linear regression was applied to the mid-upper arm width. Estimates were computed for all view combinations and performance was compared to other photogrammetric methods from the literature—linear distance method for height, and shape models for MUAC.

Results

The mean absolute difference (MAD) between the linear regression estimates and manual measurements were smaller compared to other methods. For the optimal view combinations (smallest MAD), the technical error of measurement and coefficient of reliability also indicate the linear regression methods are more reliable. The optimal view combination was the front and side views. When estimating height by linear regression of the distance from the head to the floor, the mean MAD was 10.51 mm ± 6.52 mm SD, and when estimating height from the bounding box using the reference object, the mean MAD per participant was 11.53 mm ± 6.43 mm SD. When estimating MUAC from the mid-upper arm radius using the reference object, the mean MAD was 7.24 mm ± 4.79 mm SD. The mean MAD for all methods when using camera calibration was 2–3 mm smaller.

Conclusions

Applying linear regression to distance measurements from photos of adults taken from multiple view angles has been shown to accurately estimate height and MUAC to within the accuracy required for nutrition assessment. Future work will focus on automating the landmark detection, and validating the methods on populations that include undernourished adults and children of all nutrition statuses. These future works will improve the practicality of this method as a potential tool for nutrition assessment by novice users.

Vaccination and nutritional status of children in Karawari, East Sepik Province, Papua New Guinea

Delivery of health care services to rural and remote populations in Papua New Guinea (PNG) is problematic. This is mainly due to difficulties with transportation and communication. Hence, the children in this region of PNG are likely to be at risk of malnutrition compounded by inadequate vaccination that may predispose them to preventable diseases. This study was conducted to determine the vaccination and nutritional status of children less than 5 years old in the remote and rural Karawari area of PNG. 105 children were included in the study, of whom 55% were male and 45% female. The mean age of children included in the study was 32.6 months. Their age, height, and weight by gender was not significantly different. Overall, 85% of children had incomplete vaccination. However, children above the median age of 32 months (34%) were more likely to be fully vaccinated for their age, χ2 (1) = 23.294, p < 0.005. In addition, 25% of children were below the -1 SD (Z-scores) for weight-for—height, 33% below the -1 SD for weight-for-age, and 25.5% below the -1 SD for height-for-age compared to WHO standards.

A large proportion of children had poor nutrition status and lack protection from vaccine preventable diseases. This study recommends that the government should introduce a surveillance system for detecting issues of importance to the rural majority. We also recommend that the PNG government reopen the nearby health centre, and/ or establish new facilities within the region, with adequately trained and compensated staff.