Effect of nutrition education integrating the health belief model and theory of planned behavior on dietary diversity of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial

BACKGROUND

Maternal anemia, miscarriage, low birth weight (LBW), preterm birth (PTB), intrauterine growth restriction (IUGR), prenatal and infant mortality, morbidity, and the risk of chronic disease later in life are all increased by a lack of dietary diversity during pregnancy. However, evidence for the effect of nutrition education on the dietary diversity score (DDS) among pregnant women was sparse in Ethiopia, particularly in the study areas. This study aimed to assess the effect of nutrition education on dietary diversity among pregnant women in urban settings in Southeast Ethiopia.

METHODS

A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention group and 223 control group) at health facilities from February to December 2021. A multistage cluster sampling technique, followed by systematic sampling, was used to select the pregnant women. Pregnant women who participated in the interventions were given nutrition education starting at 16 weeks of gestation and continuing for 6 months. We used a pre-tested, interviewer-administered, structured questionnaire to collect the data. A 24-hour qualitative dietary recall was used to calculate the dietary diversity score (DDS). A multivariable generalized estimating equation (GEE) model was conducted to evaluate the intervention effect.

RESULTS

After the intervention, the proportion of adequate dietary diversity was 14.15% higher in the intervention arm compared to the control group (45.09% versus 30.94%, P = 0.002). The overall difference in adequate dietary diversity between the two groups was 8.5%. After adjusting for background characteristics, the multivariable GEE binary logistic model revealed that having received intervention [(AOR = 1.89, 95% CI: 1.27, 2.79)], being literate [(AOR = 3.41, 95% CI: 1.13, 10.23)], and having high wealth [(AOR = 1.60, 95% CI: 1.09, 2.35)] significantly improved adequate dietary diversity.

CONCLUSION

The findings indicated that having received the intervention, being literate, and having a high level of wealth significantly improved maternal dietary diversity. Efforts should be made to increase nutrition education using the health belief model (HBM) and the theory of planned behavior (TPB). Moreover, there is a need to improve literacy and economic empowerment through income-generating activities to enhance adequate dietary diversification during pregnancy.

TRIAL REGISTRATION

Clinicaltrials.gov (PACTR202201731802989, Retrospectively registered on 24 January 2022).

Correlates of minimum dietary diversity among pregnant women on antenatal care follow up at public health facility in Puntland, Somalia

In Somalia, where a poorly diversified diet is leading to adverse pregnancy and neonatal outcomes, there is a significant dearth of evidence that needs to be studied. Hence, this study was to identify factors associated with minimum dietary diversity among pregnant women in Somalia. A facility-based survey was conducted among 361 pregnant women attending antenatal care (ANC) using a structured questionnaire. Dietary diversity was measured using consumption of 10-food groups. Bivariable and multivariable binary logistic regression analyses were used, along with odds ratios and 95% confidence intervals. About 48.2% (42.9-53.5) of women had an inadequately diversified diet. The risk of having an inadequately diversified diet was higher among rural residents (AOR = 1.20; 0.30-4.75), multigravida (AOR = 2.85; 1.43-5.68), young women (AOR = 2.15; 0.82-5.61), extended families (AOR = 1.19; 0.68-2.10), with infrequent ANC visits (AOR = 4.12; 2.06-8.27), fewer frequent meals (AOR = 1.84; 1.09-3.10) and from food-insecure households (AOR = 3.84; 2.28-6.49) as compared to their counterparts. Consumption of poorly diversified diet was prevalent and associated with dietary diversity was prevalent among women which could be strongly predicted by parity, ante-natal care and food security, which needs to be targeted for interventions.

Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review

This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.

Immunonutrition: Diet Diversity, Gut Microbiome and Prevention of Allergic Diseases

Allergic diseases are increasing both in morbidity and mortality. Genetic, environmental, and dietary factors may all be involved in this increase. Nutrition during pregnancy, breastfeeding, and early life may play a particularly important role in preventing allergic diseases. Based on current systematic reviews, the intake of specific nutrients has failed to prevent allergic disease. Prevention strategies have shifted their focus to the overall diet which can be described using diet diversity. Infant and maternal diet diversity in pregnancy has been associated with reduced allergy outcomes in childhood. Overall, diet also seems to have a marked effect on the microbiome compared to single foods. Factors that may negate the allergy-preventative effect of overall diet diversity include the addition of emulsifiers, advanced glycation end-product content, and overuse of commercial baby foods. There is a need to perform randomized controlled trials using overall dietary intake to support international food allergy guidelines. These studies should ideally be conducted by multi-professional teams.

Mothers' dietary diversity and associated factors in megacity Dhaka, Bangladesh

Mothers in developing countries are nutritionally vulnerable due to an undiversified diet. Dietary diversity and healthy dietary patterns of mothers are necessary for the health and nutrition of both the mother and the child. Keeping these in mind, the study was designed to investigate the determinants of mothers' dietary diversity in the capital city (Dhaka) of Bangladesh. A total 613 mothers who had at least one child aged 6-59 months were surveyed in 2020. Dietary diversity (DD) was measured by 24 h recall period following the established guidelines. To explore the determinants of dietary diversity, a log linear regression model was employed. The findings revealed that the overall DD of mothers was low, with less than 15% of respondents consuming more than 5 of the 9 food groups. The study found that if a mother receives one more year of formal education, her DD, on average, would increase by 0.70%. Receiving antenatal care (ANC) for four or more times during pregnancy increases DD by 5.13% compared to mothers who receive ANC less than four times. The findings also showed that mothers with access to assets have 10.18% higher DD than mothers without access to assets. On the other hand, mothers' employment status was negatively associated with DD. Redistributing the household workload between mother and other household members can play a critical role in increasing mothers' DD. Providing care facilities and counseling to mothers about the nutritional value of consuming different food groups can substantially improve the situation.

Dietary vitamin A intake and its major food sources among rural pregnant women of South-West Bangladesh

The study aimed to estimate the dietary intake of vitamin A and its major food sources among rural pregnant women from the southwest region of Bangladesh. A multi-stage random cluster sampling method was used to select the respondents (N = 1012). A semi-structured questionnaire was used to collect the data, and statistical analysis was conducted using IBM SPSS 20.0. The mean age of the respondents was 23.27 ± 5.23 years, and the majority were in their second (48%) and third trimester (49%). The mean dietary intake of vitamin A was 392 ± 566 μg Retinol Activity Equivalent (RAE)/day (51% of Recommended Dietary Allowance). The contribution of β-carotene (plant source) and retinol (animal source) in vitamin A intake was about 60% and 40%, respectively. The major β-carotene contributing food groups were vegetables (dark and light) and tubers, and food items were colocasia, potato, beans, brinjal, and ripe tomatoes. On the other hand, the major retinol-contributing food groups were fish, eggs, and milk, and food items were small fish, Rui (carp) fish, and cow's milk. It was also observed that the consumption of food items from β-carotene and retinol-contributing food groups did not differ significantly among the three groups of respondents, but the variations in the amount of the different food items consumed were significant. Dietary vitamin A intake is low among pregnant women in the South-West region of Bangladesh. Hence, they are at a greater risk of adverse materno-fetal health outcomes associated with vitamin A deficiency.

Level and Predictors of Minimum Dietary Diversity Among Pregnant Women in Eastern Ethiopia: Evidence From Facility-Based Cross-sectional Survey

Low dietary diversity is one of the most serious public health issues in developing countries, resulting in poor nutritional status, particularly vitamin and mineral deficiencies in pregnant women. However, there is insufficient information on the current status of pregnant women's minimum dietary diversity in Eastern Ethiopia. The main aim of this study is to assess the level and predictors of minimum dietary diversity among pregnant women in Harar Town, Eastern Ethiopia. The study was conducted on 471 women using a health institution-based cross-sectional study design from January to March 2018. A systematic random sampling method was used to select the study participants. A pretested and structured questionnaire was used to collect data on the minimum dietary diversity. A logistic regression model was used to assess the relationship between the outcome variable and the independent variables. A P-value of .05 was used to indicate statistical significance. The proportion of pregnant women who had adequate minimum dietary diversity was 52.7% (95% CI: (47.9%, 57.6)). Urban residence [(AOR = 0.08, 95% CI: (0.02, 0.33)], smaller family size [(AOR = 7.28, 95% CI: (3.25, 16.28)], husband occupation [(AOR = 2.55, 95% CI: (1.39, 4.6)], husband support [(AOR = 3.85; 95% CI: (1.23, 12.02)], having more than 1 dwelling room [(AOR = 5.7, 95% CI: (2.32, 13.8) and medium wealth quantile [AOR = 1.93, 95% CI: (1.13.39)] were associated with adequate minimum dietary diversity. The level of minimum dietary diversity was low in the study area. It was linked to urban residency, smaller family sizes, husband employment, husband support, having more than 1 bedroom, and medium wealth quantile. Efforts should be made to improve husband support, wealth index, husband occupation, and food security status in order to boost mothers' minimal dietary diversity.

Micronutrient intake and associated factors among pregnant women in East Africa: Multilevel logistic regression analysis

BACKGROUND

Micronutrient deficiencies during pregnancy pose significant public health issues, considering the potential for negative consequences not only during pregnancy but also throughout life. Anemia in pregnant women is becoming a significant problem in developing countries, with scientific evidence indicating that 41.8 percent of women worldwide suffer from anemia. As a result, investigating the pooled prevalence and factors associated with micronutrient intake among pregnant women in East Africa is critical to alleviate the burden of micronutrient deficiency among pregnant women.

METHOD

The pooled prevalence of micronutrient intake with a 95% Confidence Interval (CI) was reported and presented in a forest plot for East Africa Countries using STATA version 14.1. Intra-class Correlation Coefficient (ICC), Likelihood Ratio (LR) test, Median Odds Ratio (MOR), and deviance (-2LLR) values were used for model comparison and fitness. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multilevel logistic model were used to declare significant factors associated with micronutrient intake.

RESULT

The pooled prevalence of micronutrient intake in East African countries was 36.07% (95% CI: 35.82%, 36.33%). In the multilevel logistic regression model, women from the highest wealth quintile were 1.06 [AOR = 1.09, 95%CI: 1.00, 1.11] more likely to take micronutrients compared to their counterparts. Mothers who attained primary education, secondary education, and tertiary education had 1.20 times [AOR = 1.20, 95% CI: 1.15, 1.26], 1.28 times [AOR = 1.28, 95% CI: 1.19, 1.36] and 1.22 times [AOR = 1.22, 95% CI: 1.07, 1.38] more likely take micronutrient compared to mothers who attained no education, respectively.

CONCLUSION

The overall prevalence of micronutrient intake in East Africa was low. Only 36% of the study participants had micronutrient intake practice. Socioeconomic factors (education level, and household wealth status) have been shown to influence micronutrient intake. Therefore, it is necessitates the continuation of ongoing projects as well as the development of fresh ones that concentrate on these variables and include effective treatments and programs, especially among underprivileged and vulnerable populations.

Determinants of minimum dietary diversity of lactating mothers in rural northern region of Bangladesh: A community-based cross-sectional study

Background

Breastfeeding requires additional diversified foods for the nutritional requirements of mothers and children, especially in preventing micronutrient deficiencies. The minimum dietary diversity for women (MDD-W) is a proxy indicator of micronutrient adequacy for women.

Objectives

This study aimed to identify the determinants associated with MDD in lactating women.

Methods

A community-based cross-sectional study was conducted among lactating mothers having at least one live birth in last three years from two districts of Bangladesh between 31^st May 2021 and 9^th June 2021. Dietary and socio-demographic information was obtained using a single 24-h recall and socio-economic status questionnaires. MDD was defined as at least four food groups consumed in the last 24 hours. In binary logistic regression, adjusted models were used to assess the relationship between MDD and socio-economic factors.

Results

The mean Dietary Diversity Score (DDS) was 3.9 ± 1.2. The MDD was met by 29.7% of women. Respondent's ages 20-24 years [Adjusted Odds Ratio (AOR) = 0.5; 95% CI: 0.3-0.9], 25-34 years [AOR = 0.5; 95% CI: 0.3-0.8], and 35-49 years [AOR = 0.5; 95% CI: 0.2-0.9], husband's academic qualifications more than 12 years [AOR = 1.9; 95% CI: 1.0-3.7], family income more than 15000 BDT per month [AOR = 2.3; 95% CI: 1.2-4.3], and husband's profession as a day labor [AOR = 0.5; 95% CI: 0.3-0.7] were significant factors to have MDD.

Conclusions

DDS and MDD were very poor among the mothers, whereas women's age, husband's education, and the family's monthly income were independent determinants of MDD. Special interventions may be needed to improve MDD.

Determinants of dietary practice among pregnant women at the public hospitals in Bench-Sheko and Kaffa Zones, Southwest Ethiopia

BACKGROUNDS

The frequency of poor dietary practice due to inappropriate dietary habits is higher during pregnancy compared to any other stage of the life cycle. Suboptimal dietary practices during pregnancy can increase the risk of intrauterine growth restriction, low birth weight, anemia, prenatal and infant mortality, and morbidity. Therefore, this study aimed to determine the dietary practice and associated factors among pregnant women at the public hospitals of Bench-Sheko and Kaffa zone.

METHODOLOGY

An institutional-based cross-sectional study design was conducted among 566 pregnant women who attended antenatal care at the public hospitals of the Bench-Sheko and Kaffa zones. A systematic random sampling technique was employed to select the study units. The data were entered into Epi Data 3.1 and exported to Statistical Package for Social Science (SPSS) version 21 software for further analysis. Both Binary and Multivariable logistic regression analyses were used to examine the association between dependent and independent variables. The Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) with 95% Confidence interval (CI) were calculated and the variable with P-value < 0.05 was considered statistically significant.

RESULT

According to this study, only 23.7% (95% CI: 20.1, 27.4) of the study participants had a good dietary practice. The urban residents (AOR = 2.64; 95% CI:1.18, 5.92), monthly income of > 2000ETB (AOR = 2.47; 95% CI: 1.31,4.65), having nutrition information (AOR = 2.5; 95% CI: 1.14,5.52), good dietary knowledge (AOR = 2.79; 95% CI: 1.48,5.27), mothers occupation of employer (AOR = 1.88; 95% CI: 1.04,3.42) and a family size < 5 (AOR = 3.37; 95% CI: 1.32,8.65) were determinate of dietary practice.

CONCLUSION

Generally, the prevalence of good dietary practice is suboptimal in the study area. Urban residency, monthly income > 2000ETB, good dietary knowledge, having nutrition information, family size < 5, and government employed mothers were the predictors of the good dietary practice in the Bench-Sheko and Kaffa zone. Therefore, providing in-service training for health professionals and assigning nutritionist to each public hospital should be done to provide health and nutrition education; and strengthen the existed nutrition counseling service for pregnant women. Moreover, the government should create sustainable income-generating activities for pregnant women.

Determinants of Dietary Diversity Practice among Pregnant Women in the Gurage Zone, Southern Ethiopia, 2021: Community-Based Cross-Sectional Study

Background

Dietary diversification is considered the proxy indicator of dietary quality and nutrient adequacy during pregnancy. Pregnant women have been considered susceptible to malnutrition because of their increased nutrient demands and thus consuming a variety of foods in their diet plays a lion's role in ensuring adequate nutrient intake. So understanding bottleneck factors associated with dietary diversity practice is very crucial to encouraging adequate dietary diversity practice. Therefore, this paper aimed to assess determinants of dietary diversity practice among pregnant women in the Gurage zone, Southwest Ethiopia.

Methods

A community-based cross-sectional analytical study was conducted among 726 pregnant women, 13 key informants, and 27 focus group discussion discussants in the Gurage zone, southwest Ethiopia, from 1 September to 1 November 2021. A face-to-face interviewer-administered questionnaire was used to collect the data. According to the Minimum Dietary Diversity Score for Women (MDD-W) tool, women who consumed more than or equal to 5 of 10 food groups in the previous 24 hours had a diverse diet. Epi data version 3.1 was used for data entry, while SPSSversion 26 was used for analysis. To determine factors associated with dietary diversity, bivariate and multivariable logistic regression models were used to obtain crude odds ratio (COR), adjusted odds ratios (AOR), and 95 percent confidence intervals (CIs). Statistical significance was determined using adjusted odds ratios (AORs) with 95 percent confidence intervals (CIs) and p values less than 0.05. In narrative form, qualitative results were triangulated with quantitative data.

Results

The overall prevalence of the adequate dietary diversity practice was found to be 42.1% with 95% CI (48.4–46.1%) and the mean dietary diversity score was 5.30 ± 1.49 standard deviation (SD). Multivariable analysis revealed that primary school level [AOR = 6.471 (2.905, 12.415)], secondary school level (9–12) [AOR = 7.169 (4.001, 12.846)], college and above level [AOR = 32.27 (15.044, 69.221)], women with higher empowerment [AOR = 3.497 (2.301, 5.315)], women with a favorable attitude toward dietary diversity [AOR = 1.665 (1.095, 2.529)], women from wealthier households [AOR = 2.025 (1.252, 3.278)], and having well-secured food status [AOR = 3.216 (1.003, 10.308)] were variables that influence dietary diversity practice. Three FGD and 13 key informant interviews were conducted, and the results of qualitative data generated three major themes.

Conclusion

The overall prevalence of adequate dietary diversity practice was found to be low in this study when compared to studies conducted in Ethiopia. Maternal educations, mothers' attitudes toward dietary diversity, women empowerment, food security status, and wealth index level of the household were determinant factors that influence dietary diversity practice in this study. Therefore, programs aimed to improve pregnant women's dietary diversity practice should focus on improving the socioeconomic status and creating a congenial environment to promote women's empowerment.

Dietary practice among cohort pregnant women who gave birth to neonates with and without neural tube defect: a comparative cross-sectional study

Despite the high burden of neural tube defects (NTD) in eastern Ethiopia, there is no evidence that it is related to maternal dietary practice. The aim of the present study was to compare dietary practice between women who gave birth to newborns with and without NTDs. A comparative cross-sectional study was performed on a total of 276 (138 in each group) mothers who delivered neonates with or without NTD. Study participants were selected from three hospitals found in the eastern part of Ethiopia. The dietary practice was determined using the indicators including meal frequency, dietary diversity score (DDS), food variety score (FVS) and consumption of animal source food (ASF) generated from the dietary data collected using validated and pre-tested Food Frequency Questionnaire (FFQ). A multivariable logistic regression model was fitted to isolate independent predictors of dietary practices. The prevalence of good dietary practice was 29 % (95 % CI 23·6 %, 34·3 %). There was a significant difference in dietary practices (P = 0·034), in FVS (P = 0·01), in DDS (P = 0·045) between the two groups. In multivariable logistic regression, independent predictors of having good dietary practice were: not being the mother of a newborn with NTDs [adjusted odds ratio (AOR) 2·1, 95 % CI 1·07, 4·1], being from a rural residence area (AOR 0·29, 95 % CI 0·1, 0·7) and being illiterate (AOR 0·16, 95 % CI 0·03, 0·8). The present study found that dietary practice is associated with the development of NTDs. Nutrition education, food fortification and supplementation are needed to address this issue, and further research is needed to explore the mechanism.

Household food insecurity and dietary diversity of women of reproductive age among smallholder farming households in northwest Bangladesh

Despite Bangladesh's remarkable progress in agricultural production over the past few decades, household food and nutrition insecurity persist, especially in rural areas. The nutrition security and dietary diversity are even more critical for women of reproductive age among smallholders. This study examined household food insecurity and dietary diversity of women of reproductive age in the rural areas of northwest Bangladesh. Using cross-sectional data collected from 252 smallholder households, we measured household food insecurity and dietary diversity of women of reproductive age by the Household Food Insecurity Access Scale and the Minimum Dietary Diversity for Women, respectively. Determinants of household food insecurity were examined, and associations between household food insecurity and low dietary diversity were determined. The majority of the households were mildly insecure (51.2%) followed by moderately insecure (27.4%). The households felt anxiety of food insecurity for more than six months a year (Food Security Index = 2.10 out of 4.00). The mean food group consumed by women was 4.63 indicating low dietary diversity and dominance of diets by grains and dark green leafy vegetables. The findings also indicate a significant and positive association between household food insecurity and low dietary diversity of women. Education of household heads, household size, access to information sources, access to credit support, and perceived impacts of climate change on crop production were identified as determinants of household food insecurity. The study recommends that appropriate interventions be formulated to improve the food and nutrition security in the study areas.

Diversified dietary intake and associated factors among pregnant mothers attending antenatal care follow-up in public health facilities of Dire Dawa, Eastern Ethiopia

Poor diversity dietary intake has great significance to women, pregnancy outcome and on her fetus or the growing and development of their baby collectively. Uncertainty of studies to examine whether pregnant women have been utilizing diversity dietary in their frequent intake and this has changed nutritional status. Therefore, this study aims to assess diversified dietary intake and associated factors among pregnant mothers attending antenatal care follow-up in public health facilities of Dire Dawa, Eastern Ethiopia. A facility-based cross-sectional study was conducted among 453 pregnant mothers randomly selected from the antenatal care unit at public health facilities from November 1-30/2020. Study subjects were selected with a systematic random sampling method from randomly selected antenatal care unity of health facilities in Dire Dawa Administration. A structured questionnaire and anthropometric measurements were used to collect data. Data were entered with kobo software and exported to Statistical Package for Social Science statistical software version 20 for analysis. Binary and multiple logistic regression models were used to declare the significance of independent variables at P<0.05. This study shows 55% (95% CI = (50-59.5) were inadequate diversified dietary intake. Having lower monthly income (Adjusted Odds Raito [AOR] = 4.4, Confident interval [95%CI] = 1.3-14.6), elementary educational status of mothers (AOR = 3.8, 95%CI = 1.5-9.9), consumption of two meals per day (AOR = 16.6, 95% CI = 2.04-135.8), didn't get antenatal care counseling (AOR = 2.2, 95% CI = 1.1-2.8) were significantly associated with diversified dietary. The result revealed that around 55% of respondents had inadequate dietary diversity. low household income, had less maternal education level and, consuming two meals per day, and no information about dietary diversity has contributed to inadequate dietary diversity. Accordingly, go forward in the right side of those variables were the core recommendation of this study.

Dietary behaviour and anthropometric parameters across the spectrum of pregnant and lactating mother, infant, young children, adolescent girls and reproductive age group females: An assessment of undernutrition among KOL tribe

Introduction

The Kol is an ancient tribal community, who resides in the backward Bundelkhand and Baghelkhand regions bordering UP and MP. Reports claim the high level of exploitation and marginalisation of them by feudal landed landlords. Due to the dearth of studies on Kol community their plight hasn't been addressed effectively so far. Thus, this study was undertaken to assess the dietary behaviour and anthropometric parameters across the spectrum of Maternal, Lactating, Infant, Young Children, Adolescent girls, and reproductive-age women (MIYC-AR) of Kol Community.

Methodology

It was a descriptive observational cross-sectional study, conducted over a period of 6 months; in hard to reach area of Manikpur block, Mangawa, in Chitrakoot district. Pregnant, lactating mothers, infant, young children, adolescent and reproductive age females who were found eligible, were included in the study. A total of 180 participants (30 from each group) were recruited by non-probability purposive sampling. A structured questionnaire was used to collect information regarding Iron folic acid and calcium intake, frequency of major meals and snacks, feeding history of infant and young child. Weight, height, head circumference and mid upper arm circumference were noted and the participants were classified accordingly. Statistical analysis was done using STATA version 13 software.

Results

Only 36% and 30% of the pregnant and lactating mother, respectively, consumed IFA and calcium. The mean diet diversity score was inadequate for all the groups. Maximum among adolescents (70%) and half of the reproductive age group female (50%) were underweight. More than half of the infants (57%) were found to be malnourished on MUAC measurement, while the similar proportion among young children were found to be normal (p < 0.001). Half of the young children had timely initiation of complimentary feeding. But, none among young children received Vitamin A syrup.

Conclusion

Significant higher prevalence of malnutrition was found among infants, adolescents, and reproductive age group females. Strengthening the public distribution system and rigorous supplementary nutrition services through ICDS are the priority intervention needed to address the poor nutritional status of tribe.

Dietary diversity (DD) and associated factors among Lactating women (LW) in Pawie district, Northwest, Ethiopia, 2019: community-based cross-sectional study

Background

Low Dietary Diversity (DD) result in severe problem among the vulnerable group in low-income countries (LICs), whose diets are predominantly starchy staples. Lactating Women (LW) from LICs are considered a nutritionally vulnerable group. It results in many consequences on the health and well-being of children, households, communities, and the nation. However, there is little empirical evidence on factors contributing to low DD among LW in Ethiopia and the proposed study site. Therefore, this study aimed at assessing the DD and associated factors among LW in Pawie district, Northwest Ethiopia.

Methods

A Community-based cross-sectional study was conducted among 806 LW from March to May 2019 G.C. DD assessed using 24 h dietary recall methods with structured questionnaires.

A mean dietary diversity score (DDS) was computed for ten food groups. Food insecurity measured using a 9-item Household Food Insecurity Access Scale (HFIAS). The multivariable logistic regression model was used to see the relevant associations. The variables which have a significant association with DD were identified based on AOR, P-value ≤ 0.05, and 95% Cl.

Results

A total of 806 LW aged 15–49 years were interviewed with a response rate of 100%. About two-third of LW had low DD (<5 food groups). Fathers occupation being daily laborer [AOR = 1.82, 95% CI (.339, 9.784)], birth interval less than 24 months [AOR = 3.7, 95 % CI (1.743, 7.885)], family size greater than six members [AOR = 1.55, 95 % CI (1.046, 2.313)] and food insecurity [AOR = 2.23, 95 % CI (1.626, 3.066)] were more likely associated with the low DD among LW compared to their counterpart.

Conclusion

The DD among LW was low. Low Dietary Diversity was statistically associated with low birth intervals, large family sizes, and food insecurity. Hence, attention should be paid to the identified factors of low DD of LW to improve their health, and that of their children as well as their family.

Prevalence and socio-economic determinants of inadequate dietary diversity among adolescent girls and boys in Bangladesh: findings from a nationwide cross-sectional survey

Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018-19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.

Maternal Dietary Patterns and Pregnancy Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Healthy maternal diets can lower the odds of developing pre-eclampsia, a direct and second leading cause of maternal death, globally. However, there is a research gap in low- and middle-income countries (LMIC), which bear a disproportionate burden of these deaths. The objectives of this systematic review were to: 1) evaluate the association between dietary patterns in pregnancy and hypertensive disorders, including pre-eclampsia for pregnant and postpartum women in LMIC, and 2) compile barriers and facilitators to an adequate maternal diet. A systematic search was performed on MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health, Web of Science, Cochrane Central Register of Controlled Trials, African Journals Online, the WHO Regional Databases, 2 trial registries, Google Scholar, and reference lists. Included in the analysis were primary research studies of dietary patterns during pregnancy, with pregnancy hypertension outcome(s), and conducted in LMIC. Included studies were assessed using ROBINS-I risk of bias. Thirteen studies were included, of which 5 studies were included in a meta-analysis (Review Manager 5). Lower odds of pre-eclampsia were associated with adequate (compared with no or low) consumption of vegetables (OR: 0.38; 95% CI: 0.18, 0.80; I2 = 85%; P = 0.01) and adequate (compared with no or low) consumption of fruit (OR: 0.42; 95% CI: 0.24, 0.71; I2 = 79%; P = 0.008). No firm conclusions could be drawn about the impact on pre-eclampsia odds of any of the following during pregnancy: high consumption of meat or grains; a "Western" diet; or alcohol consumption. More LMIC-based research is needed to explore whether the apparent beneficial effects of fruits and vegetables on pre-eclampsia incidence might be enhanced when maternal malnutrition is prevalent, and/or whether other sociodemographic factors might contribute.

Dietary Practice and Associated Factors Among Pregnant Women at Public Health Institution in Mizan-Aman Town, Southwest Ethiopia

Background:

A poor dietary intake of key macronutrients and micronutrients adversely affects pregnancy outcomes and neonatal health. The occurrence of dietary inadequacy during pregnancy is higher compared to any other stage of the life cycle. Therefore, this study aimed to assess dietary practice and associated factors among pregnant women.

Methods:

A facility-based cross-sectional study design was conducted among 378 pregnant women from March to May 2021 at the public health institution of Mizan-Aman town, southwest Ethiopia. A systematic random sampling technique was used to reach the study participants. The short food-frequency questionnaires and nutrition-behaviors checklist measurement were used to assess the dietary practice. Nine questions were applied to assess the dietary attitudes of the respondents. After the summation of the score, the respondent was categorized as favorable attitude if their score was > the median and unfavorable attitude if their score was ⩽ to the median of the score. The data were entered into Epi Data 3.1 and exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Variables of P-value <.25 during bivariate logistic regression analysis were considered for multivariate analysis. Finally variables with an adjusted odds ratio of P-value <.05 along with a 95% Confidence interval (CI) were declared statistically significant.

Results:

The overall magnitude of good dietary practice among pregnant women was 25.1% (95% CI: 20.9, 29.71%). In multivariate logistic regression analysis, the variables having television/radio (AOR = 4.2, 95% CI: 1.8, 10.2), household food security (AOR = 3.1, 95% CI: 1.0, 9.9), good dietary knowledge(AOR = 4.1, 95% CI: 1.98, 8.6), favorable dietary attitude (AOR = 4.34, 95% CI: 1.2, 8.7), monthly income of 1000 to 2000 Ethiopian birr (AOR = 3.7, 95% CI: 1.3,11.2) and >2000 Ethiopian birr (AOR = 7.0;95% CI: 3.3,15.4) were significantly associated with good dietary practice.

Conclusion:

The dietary practice among pregnant women was very low. The factors like having television/radio, good dietary knowledge, household food security, favorable dietary attitude, and monthly income of 1000 to 200 and greater than 2000 Ethiopian birr were significantly associated with the good dietary practice of pregnant women.

Level and predictors of dietary diversity among pregnant women in rural South-West Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the magnitude of dietary diversity and associated factors among pregnant women in the rural communities of Jimma Zone, south-west Ethiopia.

DESIGN

A community-based cross-sectional study was conducted from 1 June to 30 June 2020.

SETTINGS

The study was conducted in Seka Chekorsa and Mana districts. From a total of 63 listed kebeles, 21 were randomly selected.

PARTICIPANTS

Three hundred sixty first-trimester pregnant women have participated in this study. We used a systematic random sampling method to select the participants after a home-to-home census.

PRIMARY AND SECONDARY OUTCOMES

Dietary diversity was assessed using a 24 hours dietary recall method. Descriptive statistics were computed to describe the study subjects. Bivariate and multivariable logistic regression was run to control for all possible confounding effects and measure the strength of association between the outcome of interest and predictor.

RESULTS

The overall magnitude of adequate dietary diversity was found to be 186 (51.7%); 95% CI 46.1% to 56.4%). Having attended elementary education (adjusted OR (AOR)=2.45; 95% CI 1.33 to 4.51), completed grade 8 (AOR=6.05; 95% CI 2.65 to 13.80), attended high school (AOR=11.69; 95% CI 3.76 to 36.27), completed high school and above (AOR=2.92; 95% CI 1.16 to 7.32), husbands attended high school (AOR=2.92; 95% CI 1.15 to 7.47), family size of less than five (AOR=3.44; 95% CI to 1.77-6.66) were positively significantly associated with adequate dietary diversity. On the other hand, not had additional meal during pregnancy (AOR=0.42; 95% CI 0.21 to 0.83) was negatively associated with adequate dietary diversity.

CONCLUSIONS

We observed that the adequate dietary diversity score of pregnant women was low compared with the pooled proportion of dietary diversity conducted in Ethiopia. Therefore, strengthening and promoting female education through intersectoral collaborations and additional meal counselling during pregnancy is indispensable.

Dietary habits, diversity, and predictors among pregnant women attending primary health care centers for antenatal care in Lagos, Nigeria

Background and Aim:

Inadequate nutrition during fetal development resulting from poor dietary habits leads to reprogramming within fetal tissues and poses as a risk factor for non-communicable diseases in later life. This study was conducted to determine the dietary habits, diversity, and predictors among pregnant women in Lagos, Nigeria.

Methods:

A descriptive cross-sectional study was conducted using a structured interviewer-administered questionnaire to obtain data from pregnant women attending primary health care centers in Lagos, Nigeria. A multistage sampling method was used to select 350 pregnant women. A food frequency questionnaire was used to assess the dietary habits while dietary diversity was measured using non-quantifiable 24-hour recall. Data were analyzed using Epi-Info version 7.2 computer software. Chi-square and t-test were used to test for associations and P value < 0.05 was considered to be statistically significant.

Results:

Only 16.7% of respondents consumed five servings of fruits and vegetables daily while the rice was the most frequent meal taken (45.4%). Meat was the commonest animal protein (20.3%) and only 30.8% had a high dietary diversity score (DDS). High DDS was significantly associated with parity of 1–3, living in a duplex or detached house, completion of at least secondary school education, and highly skilled professionals.

Conclusion:

Healthy dietary habits and high DDS were low and associated with low parity and higher socio-economic status. Nutrition intervention that encourages higher dietary diversity is needed especially among women of higher parity and lower socioeconomic status in Lagos.

A Social Norms-Based Intervention Improves Dietary Diversity among Women in Rural India: The Reduction in Anemia through Normative Innovations (RANI) Project

Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization’s Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.

What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries

This paper draws on data from five sub-Sahara African countries; Uganda, Rwanda, Malawi, Zambia, and Mozambique consisting of 10,041 married women who were cohabitating with a male spouse. The study aim was to investigate the relationship between women's empowerment and women's dietary diversity and consumption of different food items. Women's empowerment was measured using the indicators in the five domains of Women's Empowerment in Agriculture index (WEAI) and women's dietary diversity and food consumption was examined using the women's dietary diversity score (WDDS) measure. OLS and LPM regressions were used and analyses were confirmed using marginal effects from Poisson and logistic regressions. Results suggest that three out of the 10 WEAI indicators of empowerment showed different magnitude and direction in significant associations with improved WDDS and varied associations were found in three out of the five countries examined. In addition, the three significant empowerment indicators were associated with the consumption of different food groups in three out of the five countries examined suggesting that diverse food groups account for the association between the WEAI and WDDS. Improved autonomy, and input in production were associated with improved likelihoods of consumption of dairy products, and fruits and vegetables including vitamin A-rich produce. Empowerment in public speaking was associated with improved consumption of other fruits and vegetables including vitamin A-rich produce. The varied nature of empowerment indicators towards improving women's dietary diversity and food consumption suggests that different empowerment strategies might confer different benefits towards the consumption of different food groups. Further, findings imply that interventions that seek to empower women should tailor their strategies on existing contextual factors that impact on women.

Factors associated with dietary diversity among pregnant women in the western hill region of Nepal: A community based cross-sectional study

BACKGROUND

Dietary diversity can play an important role in providing essential nutrients for both mother and fetus during pregnancy. This study aimed to assess the factors associated with dietary diversity during pregnancy in the western hill region of Nepal.

METHODS

A cross-sectional study of 327 pregnant women was conducted in an urban municipality of Baglung district in the western hill region of Nepal. A semi-structured questionnaire was used to collect information on household demographic and socioeconomic status, food taboos, household food security status, nutrition-related knowledge in pregnancy, and women's empowerment. Women consuming ≥5 of 10 food groups in the past 24 hours were defined as consuming a diverse diet using the Minimum Dietary Diversity Score for Women (MDD-W) tool. Bivariate and multivariate logistic regression was used to estimate crude odds ratio (cOR) and adjusted odds ratios (aOR) and 95% confidence intervals (CIs) to understand factors associated with dietary diversity.

RESULTS

Almost 45% (95% CI: 39.6-50.4) of the participants did not consume a diverse diet and the mean dietary diversity score was 4.76 ± 1.23. Multivariable analysis revealed that women with greater empowerment (aOR = 4.3, 95% CI: 1.9-9.9), from wealthier households (aOR = 5.1, 95% CI: 2.7-9.3), joint families (aOR = 2.7, 95% CI: 1.4-5.1), employment (aOR = 2.2, 95% CI: 1.2-4.1), and had adequate nutrition knowledge (aOR: 1.9, 95% CI 1.1-3.4) had higher odds of dietary diversity.

CONCLUSION

Along with socioeconomic status, women's empowerment and nutrition knowledge were modifiable risk factors that should be considered as targets for programs to improve women's health during pregnancy.

Household factors and gestational age predict diet quality of pregnant women

Adequate diet during pregnancy has positive effects on the mother and pregnancy outcome. Assessment of diet quality during pregnancy is particularly important in areas where household food security is suboptimal, to enable appropriate targeting and intervention. This study assessed diet quality and identified predicting factors among pregnant women in northern Ghana. A cross‐sectional study involving 403 pregnant women was conducted in May 2018. Pregnant women attending antenatal care clinics (ANC) were selected using simple random sampling technique. We assessed socio‐demographic characteristics, 24‐h recall and household food security. The minimum dietary diversity for women (MDD‐W) was used as a proxy measure for diet quality based on Food and Agricultural Organization (FAO) guidelines. Logistic regression models were fitted to determine the predictors of diet quality. The mean dietary diversity score (DDS) of 10 food groups was 4.4 ± 1.1 (95% CI: 4.3–4.5). Logistic regression showed that women of high educational level (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI] [1.21–4.84]; P = 0.01), women of high household wealth index (AOR = 1.78; 95% CI [1.14–2.77]; P = 0.01], none/mild household hunger (AOR = 2.71; 95% CI [1.26–5.82]; P = 0.01), medium household size (6–15 members) (AOR = 1.66; 95% CI [1.04–2.66]; P = 0.03) and women of gestational age 20–35 weeks (AOR = 1.89; 95% CI [1.05–3.40]; P = 0.03) were more likely to have quality diets after adjusting for potential confounding variables. Diet quality among pregnant women was low and was predicted by educational level, household wealth, gestational age and food security. Women education and improvements in household food security could impact diets of pregnant women in northern Ghana.

Umbilical Cord Blood Screening for the Detection of Common Deletional Mutations of α-Thalassemia in Bangladesh

α-Thalassemia (α-thal) is assumed to be very prevalent in Bangladesh. We aimed to assess the prevalence of the disease in the country and provide a model for α-thal newborn screening in Bangladesh. We collected umbilical cord blood (UCB) samples from 413 unrelated newborns in Bangladesh. Demographic information, blood indices, osmotic fragility, serum iron (Fe), and zinc (Zn) levels were evaluated for all the subjects. All subjects underwent a polymerase chain reaction (PCR)-based diagnosis for α-thal status, followed by a multiplex gap-PCR-based identification of the deletion type present. Sixty-seven subjects had at least one α-thal deletion (16.22%). We observed that -α^3.7 (rightward), - -^SEA (Southeast Asian), -α^4.2 (leftward), - -^MED (Mediterranean) and - -^THAI (Thailand) deletions were the most common α-globin deletions present in the country, with the -α^3.7 (n = 37) and - -^SEA (n = 18) being most prevalent. The osmotic fragility test (OFT) could predict the presence of α-thal deletions with over 98.0% sensitivity. Complete UCB count analysis revealed significant differences between healthy subjects and subjects with α-thal deletions. Although the iron level was almost the same (108.0 vs. 105.7 µg/dL), a reduced level of Zn (98.6 vs. 71.8 µg/dL, p < 0.01) was observed in the cord blood-derived serum of the subjects with α-thal deletions. Moreover, parental age at the time of delivery, gestational period, and birth weight was lower in the subjects with α-thal deletions. This study provides partial information on the epidemiology of α-thal in Bangladesh and describes a model for α-thal newborn screening in the country.

EAACI position paper on diet diversity in pregnancy, infancy and childhood: Novel concepts and implications for studies in allergy and asthma

To fully understand the role of diet diversity on allergy outcomes and to set standards for conducting research in this field, the European Academy of Allergy and Clinical Immunology Task Force on Diet and Immunomodulation has systematically explored the association between diet diversity and allergy outcomes. In addition, a detailed narrative review of information on diet quality and diet patterns as they pertain to allergic outcomes is presented. Overall, we recommend that infants of any risk category for allergic disease should have a diverse diet, given no evidence of harm and some potential association of benefit in the prevention of particular allergic outcomes. In order to harmonize methods for future data collection and reporting, the task force members propose relevant definitions and important factors for consideration, when measuring diet diversity in the context of allergy. Consensus was achieved on practice points through the Delphi method. It is hoped that the definitions and considerations described herein will also enable better comparison of future studies and improve mechanistic studies and pathway analysis to understand how diet diversity modulates allergic outcomes.

Dietary practices and associated factors among pregnant women in West Gojjam Zone, Northwest Ethiopia

Background

The optimal dietary practice is a critical requisite for maternal nutrition. However, the majority of Ethiopian pregnant women have inadequate nutrient intakes. These may be due to their poor dietary habits. Identifying factors affecting the dietary practices of pregnant women is crucial to design appropriate interventions. In this country, the dietary practices of pregnant women and determinants are not well studied. Therefore, the purpose of this study was to assess the dietary practices and associated factors among pregnant women in West Gojjam Zone, Northwest Ethiopia.

Methods

A community-based cross-sectional study was carried out among 712 pregnant women from May to August 2018. Quantitative data complemented with a qualitative method. Pregnant women were selected using a cluster sampling technique. Structured questionnaires were utilized for data collection. Data were entered into Epi-Info version 7.2.2 and exported to SPSS version 23 software for analysis. Data were described using frequencies and mean. A logistic regression analysis was done.

Three focus group discussions and 17 key-informant interviews were conducted for the qualitative data. Focus group discussion participants were mothers, husbands, and health professionals. Typical case and homogeneous sampling techniques were used for the key-informant interviews and focus group discussions, respectively. Thematic analysis was used for the qualitative data.

Results

Only 19.9% of respondents had appropriate dietary practices. On the multivariable logistic regression analyses, being food secure [AOR = 2.25, 95% CI: (1.1, 4.5)], having high edible crop production [AOR = 2.00, 95% CI: (1.2, 3.2)] and a favorable attitude [AOR = 1.69, 95% CI: (1.1, 2.6)] were significantly associated with the appropriate dietary practices of pregnant women. In the qualitative study, lack of knowledge on maternal diet, cultural prohibition, and knowledge gap of the professionals were barriers that interfere with dietary practices during pregnancy.

Conclusion

Pregnant women in the study area are found to have suboptimal dietary practices. Therefore, health professionals should give regular nutrition counseling using cards and role models for promoting diversified food production and consumption.

Dietary Quantity and Diversity among Anemic Pregnant Women in Madura Island, Indonesia

Dietary diversity and quantity are important for pregnant women, particularly anemic pregnant women. This study aimed to analyze the association between dietary quantity and diversity among anemic pregnant women. This cross-sectional study was conducted in 2017 at Madura Island, Indonesia, and involved 152 anemic pregnant women. Hemoglobin concentration was analyzed by the cyanmethemoglobin method. Dietary quantity was measured by the 2 × 24 h recall. Dietary diversity was determined by Minimum Dietary Diversity for Women of Reproductive Age (MDD-W). Spearman's rank association was performed to analyze the association between dietary diversity and quantity. The median of hemoglobin concentration was 10.1 g/dL, and 57.2% pregnant women had mild anemia. Most of the pregnant women had low adequacy levels of energy and macro- and micronutrients (except for iron). More than half (57.9%) of anemic pregnant women had reached minimum dietary diversity. Family size (p=0.048) and gestational age (p=0.004) had negative associations with dietary diversity. Dietary diversity had positive associations with energy (p=0.029), protein (p=0.003), vitamin A (p=0.001), vitamin C (p=0.004), and zinc (p=0.015) adequacy levels. Dietary diversity had no significant association with calcium (p=0.078) and iron adequacy level (p=0.206). High prevalence of mild and moderate anemia was found among pregnant women in their third trimester. Anemic pregnant women already consumed food with minimum dietary diversity but did not meet dietary quantity. Increasing dietary quantity is a priority for anemic pregnant women.

Association of breast milk gamma-linolenic acid with infant anthropometric outcomes in urban, low-income Bangladeshi families: a prospective, birth cohort study

Background/Objectives

Infant linear-growth faltering remains a major public health issue in low- and middle-income countries and suboptimal breast milk composition may be a local, population-specific risk factor. The relationship between early post-natal breast milk fatty acid (FA) composition and infant growth at 1 and 2 years of age was investigated prospectively in 563 families in Dhaka, Bangladesh.

Subjects/Methods

A maternal breast milk sample drawn before infant age 6 weeks was analyzed for percentage composition of 26 FAs, and infant length for age Z score (LAZ) was measured longitudinally to infant age 2 years. Individual FAs were tested as predictors of the infant growth outcomes.

Results

Of 26 tested FAs, %gamma-linolenic acid (%GLA) was mostly significantly associated with increase in LAZ from 6 to 52 weeks (ΔLAZ(52−6w)), and also to 104 weeks. The association was consistent over all breast milk stages with estimated effect size of +0.05 ΔLAZ(52−6w) per 20% change in %GLA (p value = 3 × 10⁻⁶), and stronger for ΔLAZ(104−6w) at +0.06 (p value = 8 × 10⁻⁷), explaining 1% of the outcome variance. Infant serum zinc measurements at 6 and 18 weeks of age were included in adjusted analyses, suggesting at least partial independence of infant zinc levels. The association was strongest in 417/563 (74.1%) families with %GLA <0.2%. Breast milk arachidonic acid fraction was within normal range with weaker evidence of association in early breast milk stages.

Conclusions

This study found that %GLA in breast milk was independently associated with infant linear growth, albeit with small effect size, in a predominantly slum-dwelling, low-income, Bangladeshi cohort.

Dietary patterns of >30,000 adolescents 9-15 years of age in rural Bangladesh

Little is known of the usual food intakes of rural adolescents in South Asia. This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. Latent class analysis was used to assign individuals to dietary patterns based on class membership probabilities. The following five dietary patterns (class membership probabilities) were identified: (1) “least diverse” (0.20); (2) “traditional” (0.28); (3) “low vegetable/low fish” (0.23), (4) “moderately high meat” (0.20); and (5) “most diverse” (0.09). The least diverse pattern had the lowest median consumption of most foods and traditional had a relatively higher intake of most vegetables and fish. The most diverse pattern consumed both healthy and processed foods much more often than other patterns. The two most diverse patterns (4 and 5) were associated with higher socioeconomic status, body mass index, height‐for‐age Z‐score, and male gender, and the least diverse pattern showed inverse associations with these characteristics. The most diverse pattern may represent an early wave of the nutrition transition in rural Bangladesh.

Maternal nutrition practices in Uttar Pradesh, India: Role of key influential demand and supply factors

Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change.

Maternal dietary diversity and micronutrient adequacy during pregnancy and related factors in East Gojjam Zone, Northwest Ethiopia, 2016

Background

Monotonous and less diversified diets are associated with micronutrient deficiency. Evidence on maternal dietary intakes during pregnancy is essential to achieve the 2025 global nutrition target and reduce maternal and child mortalities. This study assessed pregnant women’s dietary diversity and identified factors associated with inadequate dietary diversity in East Gojjam Zone.

Methods

We conducted a community-based cross-sectional study between April and June 2016. Eight hundred thirty-four pregnant women were randomly sampled. The Women Dietary Diversity Score tool developed by the Food and Agricultural Organization (FAO) and Food and Nutrition Technical Assistance (FANTA) was used. Data were entered into EpiData with double entry verification, and analysis was done using IBM SPSS version 20. Level of significance was set to P < 0.05 with 95% confidence interval (CI) to identify the independent factors associated with inadequate dietary diversity.

Results

The mean (±SD) dietary diversity score was 3.68 (±2.10). Inadequate dietary diversity was prevalent in 55% [95% CI (52.3–59.3%)] of pregnant women, or indirectly micronutrient was inadequate in more than half of the pregnant women. Commonly consumed dietary groups were legumes, nuts, and seeds (85.5%) followed by starchy staples (64.7%). Inadequate dietary diversity was higher among non-educated [Adjusted Odds Ratio (AOR) = 7.30, 95% CI (2.35–22.68)] compared to college and above completed women. Wealth index had significant association with dietary diversity, in which women in the poorest [AOR = 8.83, 95% CI, (1.60–48.61)], poorer [AOR = 6.34, 95% CI (1.16–34.65)], poor [AOR = 8.46, 95% CI (1.56–45.70)], and richer [AOR = 6.57, 95% CI (2.16–20.01)] had higher odds of inadequate dietary diversity. Those who had not received dietary counseling had three folds [AOR = 3.31, 95% CI (1.49–7.35)] of inadequate dietary diversity compared to their counterparts. Less likelihood of inadequate dietary diversity was among women with an increased meal frequency [AOR = 0.53, 95% CI (0.38–0.74)].

Conclusion

Consumption of less diversified food during pregnancy is common in the study area. Adequacy of micronutrients is insufficient for more than half of the studied pregnant women. We conclude that being non-educated affects pregnant women to depend on less diversified diet. Providing dietary counseling during pregnancy can improve nutritional practice for pregnant women.

Dietary diversity practice and associated factors among pregnant women in North East Ethiopia

Objective

Diversified food during pregnancy is the very important since it is known to affect pregnancy and birth outcomes. The aim of this study was to assess dietary diversity practice and associated factors among rural pregnant women in North East Ethiopia.

Result

A total of 647 pregnant women were participated with a response rate of 97.4%. The adequate dietary diversity practice of pregnant women was found to be 31.4% [95% confidence interval (CI) 27.8–35.2]. Cereals were the most commonly consumed food groups. Dietary diversity practice of pregnant women was associated with maternal education [Adjusted Odds Ratio (AOR) = 2.36, 95% CI 1.29, 4.32], wealth index (AOR = 1.85, 95% CI 1.21, 2.82), nutrition information (AOR = 2.51, 95% CI 1.05, 6.02) and Productive safety net program beneficiary (PSNP) (AOR = 1.7, 95% CI 1.16, 2.50). The dietary diversity practice of pregnant women was found to be low in the study area. Maternal education, wealth status, having nutrition information and PSNP beneficiary were the determinant factors.

Orange Fanta versus orange fruit: A novel measure of nutrition knowledge in Malawi

This paper introduces a novel survey instrument to identify distinct components of nutrition knowledge and test for links between knowledge and dietary choices in Southern Malawi. Our first aim is to distinguish respondents' familiarity with recommended behaviours, such as when to start breastfeeding or introduce solid foods, from respondents' factual knowledge about mechanisms, such as whether biscuits or papaya and orange fruit or orange Fanta contribute more to future health. We find knowledge of nutrition behaviours to be strongly associated with more schooling, older age, and being female, whereas knowledge of mechanisms is associated only with training and employment as a health professional. We then test whether this expanded definition of nutrition knowledge is associated with dietary intake when controlling for other factors and find no significant links in these data. Results point to the need for knowledge surveys and public health behaviour-change campaigns to address the kinds of information that might have the most influence on actual behaviour, potentially including the mechanisms involved in food composition, food safety, and disease transmission.

Household food insecurity is associated with low dietary diversity among pregnant and lactating women in rural Malawi

OBJECTIVE

To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0-9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.

DESIGN

Cross-sectional study.

SETTING

Two rural districts in Central Malawi.

SUBJECTS

Pregnant (n 589) and lactating (n 641) women.

RESULTS

Of surveyed pregnant and lactating women, 66·7 and 68·6 %, respectively, experienced moderate or severe food insecurity and only 32·4 and 28·1 %, respectively, met MDD. Compared with food-secure pregnant women, those who reported severe food insecurity had a 0·36 lower DDS (P&lt;0·05) and more than threefold higher risk (OR; 95 % CI) of not consuming meat/fish (3·19; CI 1·68, 6·03). The risk of not consuming eggs (3·77; 1·04, 13·7) was higher among moderately food-insecure pregnant women. Compared with food-secure lactating women, those who reported mild, moderate and severe food insecurity showed a 0·36, 0·44 and 0·62 lower DDS, respectively (all P&lt;0·05). The risk of not achieving MDD was higher among moderately (1·95; 1·06, 3·59) and severely (2·82; 1·53, 5·22) food-insecure lactating women. The risk of not consuming meat/fish and eggs increased in a dose-response manner among lactating women experiencing mild (1·75; 1·01, 3·03 and 2·81; 1·09, 7·25), moderate (2·66; 1·47, 4·82 and 3·75; 1·40, 10·0) and severe (5·33; 2·63, 10·8 and 3·47; 1·19, 10·1) food insecurity.

CONCLUSIONS

Addressing food insecurity during and after pregnancy needs to be considered when designing nutrition programmes aiming to increase dietary diversity in rural Malawi.

Factors associated with nutritional status and dietary practices of Bangladeshi adolescents in early pregnancy

Bangladesh has a high prevalence of adolescent pregnancy, but little is known about the nutritional status and dietary practices of Bangladeshi adolescents in early pregnancy or associated factors. We used the baseline data of 1552 pregnant adolescents from a longitudinal, cluster-randomized effectiveness trial conducted in northwest Bangladesh. Forty-four percent of the adolescents were short for their age, 36% had low body mass index, 28% were anemic, 10% had iron deficiency, and 32% had vitamin A deficiency. The mean consumption of animal-source foods was 10.3 times/week. In multivariate analysis, socioeconomic status, education, and food security were generally positively associated with anthropometric indicators and dietary practices but not with iron or vitamin A status. Our findings confirm that there is a high burden of undernutrition among these Bangladeshi adolescents in early pregnancy. Understanding factors related to undernutrition can help to identify adolescent pregnant women at higher risk and provide appropriate counseling and care.

Effects of dietary advice on insulin-like growth factors among healthy newborns

OBJECTIVES

In fetal life, insulin, insulin-like growth factor (IGF) 1, IGF 2 and IGF-binding protein (IGFBP) 3 are essential growth factors. The purpose of this study is to investigate the effects of dietary intervention on insulin-like growth factors in the cord blood of neonates.

METHODS

The study involved 52 pregnant women who were followed up in Gazi University Medical School Hospital at Ankara, Turkey. They were randomly divided into two groups: The experimental group was involved in nutrition education. We measured IGF 1, IGF 2 and IGFBP 3 concentrations in cord blood from 52 neonates.

RESULTS

In the experimental group, cord serum levels of IGF 1, IGF 2 were observed to be higher than that of control group.

CONCLUSION

Dietary advice had positive effects on the cord serum IGF 1 and IGF 2 concentrations. Dietary advice during pregnancy proved to be effective in fetal development.