PREDICTORS OF HOUSEHOLD DIETARY DIVERSITY IN ETHIOPIA: ANALYSIS OF [PDF]

SLIDE 1

Abdulhalik Workicho, Garumma Tolu, Beyene Wondafrash, Shibani Ghosh, Jennifer Coates October,2014 Adama, Ethiopia PREDICTORS OF HOUSEHOLD DIETARY DIVERSITY IN ETHIOPIA: ANALYSIS OF THE 2011 WELFARE MONITORING SURVEY (WMS) DATA,

1

SLIDE 2

Background

An adequate supply of nutrients is needed to maintain all the

functions

f

human body and daily activities at maximum efficiency, thus ensuring healthy living [Edris M., 2004].

Dietary diversity, a simple count of food items or food groups used

in the household or by the individual over a certain time period, has been considered a potential ‘proxy’ indicator to reflect nutrient adequacy [Ruel MT, 2002].

In developing countries where people often share food from a

common bowl [Hudson GJ,1995], dietary diversity, food variety and consumption of animal source foods are indicators commonly used to assess dietary intake [Hop LT 2003]

2

SLIDE 3

Contd’…

Studies demonstrated that dietary diversity scores are useful

proxy indicators of adequate intake across a range of key micronutrients[Kenedy G, 2009].

It has also been indicated that both Food variety Score (FVS)

and Dietary Diversity Score (DDS) had a positive correlation with mean adequacy ratio (MAR).

Thus, food diversity patterns and their determinants need to be

examined in

rder

to carry

ut

tailored nutritional interventions.

3

SLIDE 4

Objectives

To identify the variety of foods consumed at house hold level
To determine house hold level Dietary Diversity Score (DDS)
To identify the determinants of house hold level dietary

Diversity

4

SLIDE 5

Methods

A secondary data from 27,695 HHs, sourced from welfare monitoring

survey (WMS) data set was analyzed.

The sample was allocated based on a probability proportional to size.
The participants were drawn from urban and rural areas of the country.
Structured questionnaire was used to collect socio demographic, economic

and dietary data.

The respondents were asked to report number of days in the past week they

consumed the food items listed on the food frequency questionnaire.

5

SLIDE 6

Consumers of a food item were defined if they had consumed

the food item at least once in the past week [Kant AIL, 1997 ].

The food items [table 1] were grouped into six groups

[cereals/vegetables/fruits/dairy/protein foods/oils] [Table 2] according to the My Pyramid classification for healthy eating [Mirmiran P, et al, 2006].

A Dietary Diversity Score (DDS) was constructed by counting

the intake of the food groups in the reference period (one week) [19] based on the definition that it is the sum of food groups consumed over the reference period.

Contd’…

6

SLIDE 7

The DDS was converted into tertile and the highest tertile was

used to define ‘‘high’’ household dietary diversity score, while the two lower tertile were combined and labeled as ‘‘low’’ household dietary diversity score.

Mean DDS was reported and logistic regression analysis was

used to identify determinants for HHDD. The statistical significance was determined by using a P value < 0.05 as a cutoff point.

All the analysis was performed with SPSS version 20.

Contd’…

7

SLIDE 8

Result and Discussion

Individual food items frequency of consumption in a week

A total of 27,695 households were involved in the study out of

the selected 28,032 households giving a response rate of 99.8%.

The mean HH size was 4.77+2.26.
while 75% of the HH heads were males.
Overall, a total of 19016 (67.9%) of the households have low

DDS.

8

SLIDE 9

Contd’…

9

SLIDE 10

Description of food groups consumed

Six food groups were constructed from the individual food

items based on My pyramid food group classification.

Cereals were consumed daily by 95.1% of the household.
It was found that, the mean consumption per week was highest

for cereals (6.8+1) and lowest for fruits (0.8+1.6). (Table 2)

10

SLIDE 11

Contd’…

11

SLIDE 12

Regional distribution

Low HHDDS was recorded in more than 70% of

households in Benishangul Gumuz while more than 60 % of households in Harari region categorized under the high HHDDS.

Only 11.4% of the households in Addis Ababa had

high HHDDS while majority of its households (47%) ranking in low HDDS.

12

SLIDE 13

10 20 30 40 50 60 70 80 percent region Low Mediun High

Contd’…

13

SLIDE 14

A multiple logistic regression analysis showed that, wealth

index of the middle and higher category, engaging in farming activity, were positively associated with higher HHDDS.

Experience of shortage of food, experience of shock, residence

in large cities and towns, were negatively associated with having higher DDS.

14

SLIDE 15

Multiple logistic regression analysis

15

SLIDE 16

Summary

68% of HHs have low DDS
Low HHDDS in (70%) and high HHDDS (60%)

were exhibited in Benishangul and Harari respectively

Only 11% of HH in AA with High DDS
Fruits were less consumed food groups.
Higher income and engaging in farming activity were

positively related to having high HHDDS

16

SLIDE 17

Recommendation

Educating the public more about benefits of consuming

fruits alongside increasing the availability of the products is important

strengthening strategies that help HHs increase their

income will also have a direct effect to help people diversify their diet.

Multi-sectoral collaboration to prevent and build up the

capacity of the HHs to withstand different calamities.

17

SLIDE 18

Acknowledgment

We are extremely thankful for Ethiopian CSA for providing

the data and

USAID/ENGINE funding the data analysis.
We also are grateful for Professor Tefera Belachew for his

technical support.

18

SLIDE 19

References

1. Edris M. Nutrition for health extension workers. Debub University: November 2004. 2. Kennedy ET, Ohls F, Carlson S & Fleming K.The healthy eating index: design and applications. J. Am Diet. Assoc, 1995; 95: 1103– 108. 3. Haines PS, Siega-Riz AM & Popkin BM. The diet quality index revised: a measurement instrument for populations. J. Am

Diet. Assoc, 1999; 99: 697–704.

4. Stookey JD, Wang K, Ge K, Lin H & Popkin BM. Measuring diet quality in China: the INFH-UNC-CH Diet Quality Index. Eur.

J. Clin. Nutr, 2000; 54: 811–821.

5. Ruel MT. Is dietary diversity an indicator of food security or dietary quality? A review of measurement issues and research

needs. FCND Discussion Paper 140. Washington DC: International

Food Policy Research Institute,2002

19

SLIDE 20

6. Hudson GJ (1995) Food intake in a West African village: estimation
f food intake from a shared bowl. Br J Nutr; 73(4):551–569.
7. Kennedy G, Fanou-Fogny N, Seghieri C, Arimond M, Koreissi Y, et
al. (2010) Food groups associated with a composite measure of

probability of adequate intake of 11 micronutrients in the diets of women in urban Mali. J Nutr ;140 (11):2070S–8S. 8. Kennedy GL, Pedro MR, Seghieri C, Nantel G, Brouwer ID (2007) Dietary diversity is a useful indicator of micronutrient intake in non-breastfeeding Filipino children. J Nutr ; 137(2):472–7.

9. Arimond M, Wiesmann D, Becquey E, Carriquiry A, Daniels MC, et

al. (2010) Simple food group diversity indicators predict micronutrient adequacy of women’s diets in 5 diverse, resource- poor settings. J Nutr; 140(11):2059S–69S.

20

SLIDE 21

10. Ogle BM, Hung PH, Tuyet HT (2001) Significance of wild vegetables

in micronutrient intakes of women in Vietnam: an analysis of food

variety. Asia Pac J Clin Nutr; 10(1):21–30.
11. Marshall TA, Stumbo PJ, Warren JJ, Xie XJ(2001) Inadequate nutrient

intakes are common and are associated with low diet variety in rural, communitydwelling elderly. J Nutr ;131(8):2192–6.

12. Allen LH (2003) Interventions for micronutrient deficiency control in

developing countries: past, present and future. J Nutr; 133(11 Suppl 2):3875S–3878S.

13. Neumann C, Harrisa DM, Rogers LM (2002) Contribution of animal

source foods in improving diet quality and function in children in the developing world. Nutrition Research; 22(1):193–220.

14. Hop LT (2003) Programs to improve production and consumption of

animal source foods and malnutrition in Vietnam. J Nutr; 133(11 Suppl 2):4006S– 4009S.

21

SLIDE 22

15. Kennedy, G, Nadia F, Chiara S and Inge D. B. Dietary Diversity

as a Measure of the Micronutrient Adequacy of Women’s Diets: Results from Bamako, Mali Site. Washington, DC: Food and Nutrition Technical Assistance II Project, Academy for Educational Development, 2009.

16. Kant AIL, Thompson FE (1997) Measures of overall diet quality

from a food frequency questionnaire: National Health Interview Survey, 1992. Nutr Res;17(9): 1443–1456.

17. Mirmiran P, Azadbakht L, and Azizi F. (2006). Dietary Diversity

within Food Groups: An Indicator of Specific Nutrient Adequacy in Tehranian Women Journal of the American College of Nutrition, 2006; 25 (4): 354–361

22

SLIDE 23

Thank you

23