Objective: Malnutrition because of poor dietary diversity contributing to child morbidity and mortality. Two-thirds of child mortality occurs within the first 2 years. However, there is limited data related to dietary diversity among children aged 6 to 23 months in Ethiopia. Thus, this study aimed to assess dietary diversity and factors among children aged 6 to 23 months in the study setting. Methods: A community-based cross-sectional study conducted on 438 children aged 6 to 23 months in Dire Dawa, 1-30/02/2019. Simple random sampling was used to select study subjects. Data collected using a structured and pretested interview administered questionnaire. Data entered using EpiData 4.2 and analyzed with SPSS Version 22. Multivariable logistic regression was used to examine associated factors. Adjusted odd-ratio with 95% confidence interval (CI) used, and P-value <.05 considered statistically significant. Results: The overall minimum dietary diversity practice was 24.4% (95% CI: 20.3, 28.5). Maternal education [AOR 2.20; 95% CI: 1.08, 4.52], decision-making [AOR = 2.5; 95% CI: 1.19, 5.29], antenatal care [AOR = 2.19; 95% CI: 1.20, 3.99], postnatal care [AOR = 6.4; 95% CI: 2.78, 14.94] and facility delivery [AOR = 2.66; 95% CI: 1.35, 5.25] were maternal factors. Moreover, child’s age [AOR = 2.84; 95% CI: 1.39, 5.83], and child’s sex [AOR = 2.85; 95% CI: 1.64, 4.94] were infant factors. Conclusion: One-fourth of children practiced minimum dietary diversity. Child’s age, birth interval, postnatal care, antenatal care, child’s sex, mothers’ decision-making, mothers’ education, and place of delivery were significant predictors. Therefore, maternal education, empowering women, and improve maternal service utilization are crucial to improving dietary diversity.
We conducted this in Dire Dawa city Administration from February 1 to 30, 2019. The city is located 515 km away from Addis Ababa, the capital city of Ethiopia. According to the 2019 population projection, Dire Dawa Administration has 493 000 total populations with 49% males and 51% females.19 The city administration achieved 100% primary health care geographic access. It has 6 hospitals, 8 health centers that provide health services to the residents for the 9 urban kebeles (The smallest administration unit). A community-based cross-sectional study was employed. All mothers of infants 6 to 23 months in randomly selected kebeles in the city administration were included. However, we had excluded mother-infant pairs whose house was closed after a minimum of 3 visits every other day. The sample size was determined using a single population proportion formula with an assumption of 95% confidence level, 4.5% margin of error, 10% non-response rate, and taking 68.4% of the proportion of minimum Dietary diversity of children in Bale Zone.20 Thus, the final sample size was 451 mothers of infants’ 6 to 23 months. We had selected 4 from the 9 urban kebeles and using the simple random sampling method. A total of 1420 infants and young children aged 6 to 23 months are living in the selected kebeles according to data obtained from the kebele information desk. Moreover, proportional allocation to the sample size was performed to estimate the number of children that participate in the selected kebeles. The list of mothers with infants and young children aged 6 to 23 months residing in the selected kebeles of the city were taken from health extension workers and then the sampling frame was constructed. Finally, the simple random sampling technique was employed to select the study subjects. The data were collected using a face-to-face interviewer-administered questionnaire among mothers having children aged 6 to 23 months by allowing them to recall food items that feed their children in the last 24-hours. The questionnaire adapted from the different previous published studies, and the world health organization (WHO).21-26 The questionnaire included socio-demographic characteristics of infants and young children, mothers, maternal health, obstetric history, and health service utilization related variables, and infant and young child feeding practices. Minimum dietary diversity score is defined as the proportion of infants and young children aged 6 to 23 months who received at least 4 food groups out of 7 food groups in the previous 24-hours (grain, legumes, dairy products, egg, meat, fruits, and vegetables) recommended by the world health organization.26 First, the questionnaire prepared in English was translated to the local languages and then translated back to English to check for consistency. To ensure the quality of the data, the data collectors and supervisors were trained for 3 days. The interview was conducted through a home-to-home visit. We had conducted a pre-test on 5% (23 participants) of the sample size out of the selected kebeles. Modifications of the questionnaire were carried out accordingly. The supervisors and investigators closely supervised the data collection process. Finally, to ensure the quality of the data, 2 independent data clerks performed double data entry. The data entered and cleaned using EpiData version 4.2, and then exported to SPSS version 24 statistical software for analysis. Descriptive summary measures such as mean and frequency used and presented using texts, tables, and graphs. The association between the outcome variable and independent variables analyzed using a binary logistic regression model. Variables with a P-value <.25 were retained and entered into the multivariable logistic regression analysis. The model fitness was tested by the Hosmer-Lemeshow goodness of fit test. The direction and the strength of statistical associations were measured by the odds ratio with 95% CI. The Adjusted Odds Ratio (AOR) along with 95% CI was estimated to identify the associated factors for minimum dietary diversity practices. Finally, statistical significance was declared at P-value <.05.
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