Minimum Dietary Diversity Practice and Associated Factors among Children Aged 6 to 23 Months in Dire Dawa City, Eastern Ethiopia: A Community-Based Cross-Sectional Study

  • Global Pediatric Health, Volume 8, Year 2021

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Study Justification:
This study aimed to assess the dietary diversity and associated factors among children aged 6 to 23 months in Dire Dawa City, Eastern Ethiopia. The justification for this study is that malnutrition due to poor dietary diversity contributes to child morbidity and mortality, with two-thirds of child mortality occurring within the first 2 years. However, there is limited data on dietary diversity among children in this age group in Ethiopia. Understanding the factors influencing dietary diversity is crucial for developing effective interventions to improve child nutrition and reduce child mortality.
Highlights:
– The overall minimum dietary diversity practice among children aged 6 to 23 months in Dire Dawa City was found to be 24.4%.
– Maternal education, decision-making, antenatal care, postnatal care, and facility delivery were significant factors associated with dietary diversity.
– Child’s age and sex were also found to be significant factors.
– The study emphasizes the importance of maternal education, empowering women, and improving maternal service utilization to improve dietary diversity among children.
Recommendations for Lay Reader:
– Encourage mothers to prioritize their education, as it has been shown to positively impact dietary diversity among children.
– Promote shared decision-making within families to ensure that children receive a diverse and nutritious diet.
– Advocate for increased access to antenatal and postnatal care services, as they are associated with improved dietary diversity.
– Support facility delivery to ensure that mothers and infants receive appropriate care and guidance on infant feeding practices.
– Recognize the importance of considering the age and sex of the child when promoting dietary diversity.
Recommendations for Policy Maker:
– Invest in programs and initiatives that promote maternal education, as it has a significant impact on child nutrition.
– Implement policies that support women’s empowerment and decision-making within families, as it can positively influence dietary diversity among children.
– Strengthen antenatal and postnatal care services to ensure that mothers receive adequate guidance and support for optimal infant feeding practices.
– Improve access to facility delivery services to ensure that mothers and infants receive appropriate care and counseling on infant feeding.
– Consider age and sex-specific interventions to address the factors influencing dietary diversity among children.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies and programs related to maternal and child health, including nutrition.
– Local Government Authorities: Responsible for coordinating and implementing interventions at the community level, including health education and awareness campaigns.
– Health Extension Workers: Responsible for providing health education and counseling to mothers and families at the community level.
– Non-Governmental Organizations (NGOs): Involved in implementing nutrition programs and interventions, providing support and resources to improve dietary diversity among children.
Cost Items for Planning Recommendations:
– Education and Training: Budget for training programs to enhance the knowledge and skills of health workers, including health extension workers, on maternal and child nutrition.
– Awareness Campaigns: Budget for developing and implementing health education campaigns targeting mothers and families to promote dietary diversity.
– Infrastructure and Equipment: Budget for improving the infrastructure and equipment in health facilities to support antenatal and postnatal care services.
– Monitoring and Evaluation: Budget for establishing a system to monitor and evaluate the implementation and impact of interventions aimed at improving dietary diversity.
– Collaboration and Coordination: Budget for facilitating collaboration and coordination among key stakeholders, including government agencies and NGOs, to ensure effective implementation of interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is a community-based cross-sectional study, which provides valuable information about the dietary diversity among children aged 6 to 23 months in Dire Dawa City, Eastern Ethiopia. The sample size was determined using a single population proportion formula, and simple random sampling was used to select study subjects. Data collection was done using a structured and pretested interview-administered questionnaire. Data analysis was performed using appropriate statistical methods. The results show that the overall minimum dietary diversity practice was 24.4%, and several factors were identified as significant predictors. However, there are a few areas for improvement. First, the abstract does not provide information about the response rate, which is important to assess the representativeness of the sample. Second, the abstract does not mention any limitations of the study, which would be helpful for interpreting the results. Finally, the abstract could provide more details about the implications of the findings and potential recommendations for improving dietary diversity among children. To improve the evidence, it would be beneficial to include the response rate, discuss the limitations of the study, and provide more specific recommendations based on the findings.

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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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and resources related to maternal health, including dietary diversity. These apps could provide educational content, reminders for prenatal and postnatal care visits, and tips for improving dietary diversity.

2. Community Health Workers: Train and deploy community health workers who can visit households and provide education and support to mothers regarding maternal health, including the importance of dietary diversity. These workers can also help connect mothers to healthcare facilities and services.

3. Telemedicine: Establish telemedicine services that allow mothers to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide access to expert advice on maternal health, including dietary recommendations.

4. Maternal Health Clinics: Set up dedicated maternal health clinics within healthcare facilities that focus on providing comprehensive care and support to pregnant women and new mothers. These clinics can offer specialized services, including nutrition counseling and support for improving dietary diversity.

5. Maternal Health Education Programs: Develop and implement targeted education programs that aim to raise awareness about the importance of dietary diversity during pregnancy and postpartum. These programs can be conducted in community settings, healthcare facilities, and through digital platforms.

6. Incentives for Facility Delivery: Implement incentives, such as financial or non-financial rewards, to encourage women to deliver their babies in healthcare facilities. This can help ensure access to skilled birth attendants and postnatal care, which are important for promoting maternal and child health.

7. Public-Private Partnerships: Foster collaborations between public and private sectors to improve access to maternal health services. This can involve leveraging private sector resources and expertise to enhance the availability and quality of maternal healthcare, including nutrition support.

It is important to note that these recommendations are general and may need to be tailored to the specific context and needs of Dire Dawa City, Eastern Ethiopia.
AI Innovations Description
Based on the study conducted in Dire Dawa City, Eastern Ethiopia, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Maternal Education: Implement programs that focus on improving maternal education, as it was found to be a significant factor associated with minimum dietary diversity practice. This can be done through community-based education initiatives, adult literacy programs, and partnerships with local schools and educational institutions.

2. Empowering Women: Empower women by providing them with the necessary knowledge and skills to make informed decisions regarding their own health and the health of their children. This can be achieved through women’s empowerment programs that focus on enhancing decision-making abilities, providing access to resources, and promoting gender equality.

3. Improve Maternal Service Utilization: Enhance access to antenatal care, postnatal care, and facility delivery services. This can be done by strengthening the healthcare system, increasing the number of healthcare facilities, improving transportation infrastructure, and providing financial incentives or subsidies for maternal health services.

4. Community-Based Interventions: Implement community-based interventions that promote and support minimum dietary diversity practices among mothers and caregivers. This can include nutrition education programs, cooking demonstrations, and the establishment of community gardens or food cooperatives to ensure the availability of diverse and nutritious food options.

5. Mobile Health (mHealth) Solutions: Utilize mobile health technologies to improve access to maternal health information and services. This can include mobile apps or SMS-based platforms that provide educational resources, appointment reminders, and access to healthcare professionals for remote consultations.

By implementing these recommendations, it is possible to improve access to maternal health and enhance dietary diversity practices among children aged 6 to 23 months, ultimately reducing child morbidity and mortality rates.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase maternal education: Promote and provide opportunities for women to receive education, particularly in areas related to maternal and child health. This can empower women to make informed decisions regarding their own health and the health of their children.

2. Enhance decision-making power of mothers: Encourage and support women in having a say in decisions related to their own health and the health of their children. This can be achieved through education, awareness campaigns, and community engagement.

3. Improve antenatal and postnatal care: Strengthen the availability and accessibility of antenatal and postnatal care services. This includes ensuring that pregnant women and new mothers have access to regular check-ups, counseling, and support for proper nutrition and care.

4. Promote facility delivery: Encourage and facilitate deliveries to take place in healthcare facilities, where skilled healthcare professionals can provide necessary care and interventions. This can be achieved through awareness campaigns, improving infrastructure, and addressing barriers such as transportation and cost.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of women receiving antenatal care, the percentage of facility deliveries, or the percentage of women with adequate postnatal care.

2. Collect baseline data: Gather data on the current status of the selected indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Implement the recommendations: Introduce the recommended interventions, such as increasing maternal education, enhancing decision-making power, improving antenatal and postnatal care, and promoting facility delivery.

4. Monitor and collect data: Continuously monitor the implementation of the interventions and collect data on the selected indicators. This can involve regular surveys, interviews, or data collection from healthcare facilities.

5. Analyze the data: Analyze the collected data to assess the impact of the interventions on the selected indicators. This can be done using statistical methods, such as comparing pre- and post-intervention data or conducting regression analyses.

6. Evaluate the impact: Evaluate the impact of the interventions on access to maternal health by comparing the post-intervention data with the baseline data. Assess whether the recommended interventions have led to improvements in the selected indicators.

7. Adjust and refine: Based on the evaluation results, make adjustments and refinements to the interventions as needed. This can involve scaling up successful interventions, addressing any challenges or barriers identified, and continuously monitoring and evaluating the impact.

By following this methodology, it is possible to simulate the impact of the recommended interventions on improving access to maternal health and make evidence-based decisions for further improvements.

Statistics:
Citations: 7
Authors: 10
Identifiers:
DOI: 10.1177/2333794X21996630
Research Areas:
Community Interventions, Disparities, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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