Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean

Abstract

Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (β = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (−0.52 (95% CIs −0.91, −0.12)) and rural residence (−0.46 (−0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.

Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya

“…Because this previous study investigated individual food security rather than household food insecurity and did not adjust for potential confounders of the association, it may not be directly comparable to our current study; nonetheless, the previous study identified an association between food source and food security [ 32 ]. Our observation of an association of food source with dietary diversity is consistent with other existing studies [ 29 , 33 , 34 , 35 , 36 ]. However, the specific food sources investigated were not always commensurate with those in this study, likely due to country differences, food outlet classification and the prevalence of use of different food sources in different study samples.…”

“…This dietary diversity indicator presents minimum dietary diversity ‘as a proxy to micronutrient adequacy’ for women of reproductive age [ 28 ]. Precedent for the use of MDD-W as a pragmatic approach to assess dietary diversity in adults in low resource settings can be found in a recent study [ 29 ].…”

A Typology of Food Environments in the Pacific Region and Their Relationship to Diet Quality in Solomon Islands

“…We then applied this typology to analysis of a large nationally representative survey of food acquisition in Solomon Islands to quantify, for the first time, the reliance of different population groups on different FEs and the role they play in contributing to diet quality. This is a significant contribution to the literature as there are few studies that examine the relationship between FE types and diet quality in the Pacific region (e.g., [26,42]) and no studies to our knowledge that examine this relationship across all the relevant FEs presented here. The cultivated FE is by far the most important source of food in Solomon Islands providing 60% of the quantity and 33% of the value of food acquired nationally.…”

“…In order to describe the sources of food acquisition in the Pacific region, we adapt existing conceptual frameworks of FEs [12,14,26] to the Pacific context. The framework by Turner et al [12] distinguishes between the 'external' and 'personal' FE whereby the external domain includes characteristics such as food availability, prices and vendor properties, whilst the personal FE is determined by individual level factors that interact with the external FE such as accessibility, affordability and desirability.…”

“…However, they do not describe personal or community relationships, nor do they describe food aid, as sources of food. Haynes et al [26] present food sources relevant in two small case study communities from small island states including one in the Pacific region, again, building on existing typologies, and focusing on the exchange mechanism (purchase, own production, etc.) as a distinguishing feature.…”