Promoting dietary diversity to improve child growth in less‐resourced rural settings in Uganda

Kabahenda, Margaret; Andress, Elizabeth L.; Nickols, Sharon Y.; Kabonesa, Consolata; Mullis, Rebecca

doi:10.1111/jhn.12056

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…The dietary diversity score (DDS) is one of the a priori defined dietary indices used to assess overall diet quality [ 9 ]. Dietary diversity has been known as a key index of high diet quality in various populations [ 10 – 12 ]. Nevertheless, the association between dietary diversity and obesity remains controversial across different cultures.…”

Section: Introductionmentioning

confidence: 99%

Diet diversity and nutritional status among adults in southwest China

et al. 2017

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BackgroundWith rapid urbanization in the past decades, diet diversity continues to increase in China. The present cross-sectional study aims to explore the association between dietary diversity and nutritional status among adults in southwest China.MethodsThis study used data from 2011–2012 National Nutritional Survey in Yunnan Province, southwest China (N = 1105).Data of three consecutive 24-hour dietary recalls were used to calculate dietary diversity scores (DDS) and nutrient adequacy ratio (NAR). Body mass index and waist circumference were used to determine nutritional status. Surveylogistic procedure of SAS 9.2 software was used to examine the association between DDS and obesity by estimating odds ratio (OR) and 95% confidence intervals (CI).ResultsThe mean DDS was 5.2 (SD 1.1) out of nine points. Being female, younger age, belonging to Han ethnicity, having higher educational level and household income were positively associated with DDS (all P<0.05). As DDS increased, consumption also increased in most food groups except grains and vegetables. People with medium and high DDS (DDS = 5 and DDS ≥6, respectively) ingested more energy than the recommended quantity(NAR = 1.1 and 1.2, respectively). However, the intakes of Calcium and Vitamin A were seriously inadequate even for people with high DDS (NAR≤0.5). With potential confounders adjusted, people with medium and high DDS were at higher risk of general and central obesity than people with DDS ≤4 (OR = 1.4–1.9, P<0.01).ConclusionsOur data indicated that high DDS was associated with excessive energy intake and obesity among adults in southwest China. Although dietary diversity is widely recommended, public health messages should give less emphasis on dietary diversity.

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Section: Introductionmentioning

confidence: 99%

Diet diversity and nutritional status among adults in southwest China

et al. 2017

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“…Food consumption is one of the most important factors in the aetiology of nutritional anaemia and iron deficiency (ID) in school-aged children (4,5) . The intake of a great variety of foods across and within the various food groups is needed to meet nutrient requirements and may help to alleviate multiple micronutrient deficiencies and reduce the risk of nutritional anaemia (6)(7)(8) . In low-and middleincome countries, including South Africa, the diets of the majority of children lack variety and consist mainly of plant-based foods (predominantly cereals, roots and tubers), with limited consumption of animal-source foods (ASF), fruits and vegetables (6,(9)(10)(11) .…”

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confidence: 99%

Associations of dietary diversity with anaemia and iron status among 5- to 12-year-old schoolchildren in South Africa

Visser

Zyl

Hanekom

et al. 2020

Public Health Nutr.

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Abstract Objective: To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa. Design: An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status. Setting: KwaZulu-Natal and North West provinces, South Africa. Participants: Children (n 578) 5- to 12-year-old. Results: A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of ‘vegetables and fruits other than vitamin A-rich’ and ‘animal-source foods (ASF)’ was associated with lower odds of being anaemic (both P = 0·002), and ‘organ meats’ with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of ‘meat, chicken and fish’ was associated with lower odds of being anaemic (P = 0·045), and ‘vegetables and fruits other than vitamin A-rich’, ‘legumes, nuts and seeds’ and ‘ASF’ with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively). Conclusion: In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.

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“…The key messages adapted to support the food guide were designed to address information gaps identified in a needs assessment study reported by Nankumbi et al [7]. Age appropriate IYCF cards [19], which are the standard tool for educating caregivers of young children in Uganda, were used as the reference in developing the nutrition education messages. 2 provides an outline of key messages communicated using the cards.…”

Section: Description Of the Nutrition Education Interventionsmentioning

confidence: 99%

“…This indicates that the Food Guide group adapted better child-feeding practices than caregivers in the IYCF group and the control. The similarity between the IYCF group and the control may be attributed to the likely use of IYCF counselling cards during the well-child visits (mainly immunization days) in public health facilities to educate caregivers on appropriate child-feeding practices in both the IYCF cards and control group since use of IYCF cards is the standard practice [19]. This indicates that community level nutrition education that utilizes the current IYCF counselling cards is likely not to have added much advantage in improving overall child-feeding practices compared to ongoing IYCF education efforts in public health facilities.…”

Section: Socio-demographic Characteristics Of the Participantsmentioning

confidence: 99%

“…In Uganda, Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards) [19] has for long been the standard package used by the Ministry of Health to educate caregivers on appropriate child-feeding practices. These counselling cards are used in both health facilities and community settings across the country; however, little is known about their effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Improving caregivers’ infant and young child-feeding practices using a three-group food guide: A randomized intervention study in central Uganda

Kansiime¹,

Kabahenda²,

Bonsi³

2021

AJFAND

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Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30yearsremained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%,respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples,there is need to improve the population’s awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards)that were developed by United Nations Children’s Fund (UNICEF), are currently the standard package used in Uganda’s health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards.A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a three-foodgroup guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status.At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores,which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p =0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-for-age (p = 0.03) Z-scores.These findings,therefore,indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards.Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth.

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Promoting dietary diversity to improve child growth in less‐resourced rural settings in Uganda

Abstract: Educating caregivers has the potential to improve young children's nutritional status and growth, especially among less literate populations where households subsist on what they produce.

Cited by 6 publications

References 29 publications

Diet diversity and nutritional status among adults in southwest China

Diet diversity and nutritional status among adults in southwest China

Associations of dietary diversity with anaemia and iron status among 5- to 12-year-old schoolchildren in South Africa

Improving caregivers’ infant and young child-feeding practices using a three-group food guide: A randomized intervention study in central Uganda

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