PREDICTORS OF HOUSEHOLD DIETARY DIVERSITY IN ETHIOPIA: ANALYSIS OF THE 2011 WELFARE MONITORING SURVEY (WMS) DATA, Abdulhalik Workicho, Garumma Tolu, Beyene Wondafrash, Shibani Ghosh, Jennifer Coates October,2014 Adama, Ethiopia 1
Background • An adequate supply of nutrients is needed to maintain all the functions of 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
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 order to carry out tailored nutritional interventions. 3
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
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
Contd’… • 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. 6
Contd’… • 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. 7
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
Contd’… 9
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
Contd’… 11
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
Contd’… 80 70 60 50 percent 40 30 Low 20 Mediun 10 High 0 region 13
• 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
Multiple logistic regression analysis 15
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
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
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
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6. Hudson GJ (1995) Food intake in a West African village: estimation of 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
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
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
Thank you 23
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