Factors Associated with Dietary Diversity among Children of Agro Pastoral Households in Afar Regional State, Northeastern Ethiopia
Misgan Legesse Liben1*, Taye Abuhay2 and Yohannes Haile3
1Department of Public Health, College of Medical and Health Sciences, Samara University, Afar, Ethiopia
2Department of Statistics, Bahir Dar University, Ethiopia
3 Department of Statistics, College of Natural and Computational Science, Samara University, Ethiopia
Submission: April 29, 2017; Published: July 31, 2017
*Corresponding author: Misgan Legesse Liben, Department of Public Health, College of Medical and Health Sciences, Samara University, Afar, Ethiopia.
How to cite this article: Misgan L L, Taye A, Yohannes H. Factors Associated with Dietary Diversity among Children of Agro Pastoral Households in Afar
Regional State, Northeastern Ethiopia. Acad J Ped Neonatol. 2017; 5(2): 555715. DOI: 10.19080/AJPN.2017.05.555715
Introduction: Dietary diversity has been consistently associated with child nutritional status and growth in developing countries. Therefore, this study was aimed to identify the factors affecting dietary diversity among children of agro pastoral households in northeastern Ethiopia.
Methods: A community-based cross sectional study was employed in Afambo district on 370 mother-child pairs. Binary and multivariable logistic regression analyses were used to identify the factors associated with dietary diversity. Variables with a p-value < 0.05 were identified as statistically significant.
Results: Overall 30.8% (95% CI: 26.1, 35.5%) of children aged 6-59 months achieved the minimum dietary diversity score (DDS) with mean score of 2.73. Mothers who got counseling on proper child feeding practices at postnatal checkup [AOR=3.7(1.45, 9.28)] and mothers who fed colostrum to their children were independent positive predictors of meeting minimum dietary diversity. The factor associated with decreased odds of meeting minimum dietary diversity was moderate to severe household hunger scale [AOR=0.24(0.10, 0.57)].
Conclusion: This study showed that nearly three children in every ten achieved the minimum DDS. Therefore, sound and culturally appropriate child feeding counseling during postnatal care should be given to mothers of young children so that they can make the possible use of locally available foods. In addition, expansion of social programs that might contribute to the earning capacity of poor households is also vital to ensure the dietary diversity.
Dietary diversity is a qualitative measure of food consumption that reflects household access to a variety of foods. It provides a more rapid, user-friendly and cost-effective approach to measure changes in dietary quality at individual level [1,2]. Dietary diversity is essential to ensure access to local foods that will adequately meet the energy and nutrient needs of a growing child [3,4].
Dietary diversity has been consistently associated with child nutritional status and growth in a variety of studies in the developing countries. It was associated with lower prevalence of childhood stunting [5-9], underweight  and wasting [10,11]. Moreover, appropriate complementary feeding is important to
tackle child mortality. In developing countries, about six percent of all deaths among children aged less than five years can be prevented by recommended dietary diversity and meal frequency practices [12-14].
Despite this fact, limited studies are conducted on dietary diversity among agro pastorals in Afar Regional State. Therefore, this study was aimed to identify the factors affecting dietary diversity among children of agro pastoral households in northeastern Ethiopia. The findings may help policy makers and program managers to design intervention strategies that possibly might improve child dietary diversity.
A community based cross sectional study was conducted
on 370 mother-child pairs in Afambo district from January 21
to February 05/2015. Based on the 2007 census population
projection, the district has a total population of 29,399, of which
2,639 are estimated to be children aged 6-59 months. There are
seven kebeles (the smallest administrative units next to district in
Ethiopia) in the district.
Firstly, Afambo district was selected purposively. Secondly, of
the seven kebeles in the district, four were randomly selected by
lottery. To give equal chance in the selection of mother-child pairs,
proportional allocation technique was employed across each
selected kebeles. Finally, systematic random sampling technique
was applied to select the study participants. If there was more than
one mother-child pair in one household unit, one mother with the
youngest child was selected. The detailed sampling procedure is
found elsewhere .
Data were collected using a pretested-interviewer
administered structured questionnaire. The questionnaire was
prepared first in English and translated into Afar’af (the local
language), then back to English to check for consistency. The
Afar’af version of the questionnaire was used to collect the data.
Eight high school graduates who can speak the local language
were recruited as data collectors. The questionnaire was pretested
on two kebeles which were not included in the study. Then, the
pretest amendments on the questionnaire were made accordingly.
Dietary diversity score (DDS), the outcome variable in this
study, was defined as the total count of different food groups
irrespective of the amount consumed by children in the 24 hour
period preceding the survey. It was created based on the mother’s
recall of the child’s consumption of food groups in the 24 hours
preceding the survey. The mother reported whether or not the
child consumed the following food groups: 1) Grains, roots and
tubers; 2) Legumes and nuts; 3) Dairy products (milk, yogurt,
cheese); 4) Flesh foods (meat, fish, poultry and liver/organ
meats); 5) Eggs; 6) Vitamin-A rich fruits and vegetables; 7) Other
fruits and vegetables. The response options were ‘yes, consumed’
(score 1) and ‘no, not consumed’ (score 0). These were summed
up to create the child DDS, which ranged from 0 to7.
Then, as recommended by World Health Organization 
child DDS was categorized into two; children with four or more
dietary diversity score were classified as “meeting the minimum
dietary diversity (MDD)”while those with less than four as “not
meeting the MDD”. Finally, those children who meet the minimum
dietary diversity score were coded as “1” and those who did not
meet the minimum dietary diversity score were coded as “0” for
The independent variables were maternal characteristics (age,
occupation, educational status, marital status, ethnicity, religion),
household characteristics (family size, income, household head,
household hanger scale), paternal education status, maternal
health services (history of antenatal care (ANC), place of delivery,
history of postnatal care (PNC), mode of delivery, child feeding
counseling at ANC and PNC checkups), child characteristics ( sex
and age) and child feeding practices (bottle feeding in the 24 hours
preceding the survey, complementary feeding initiation time,
prelacteal feeding and colostrum feeding). In this study household
hanger scale was categorized into three levels based on the FANTA
Data were checked for completeness and consistencies.
It was also cleaned, coded and entered into Epi Data version
3.02, then exported to SPSS version 20 for analysis. In binary
logistic regression analysis, the crude odds ratio (COR) with
95% confidence interval was estimated to assess the association
between each independent variables and the outcome variable.
Then, variables with p-value <0.3 in the binary analysis were
considered in the multivariable logistic regression analysis. The
Hosmer-Lemeshow goodness-of-fit with enter procedure was
used to test for model fitness. Adjusted odds ratio (AOR) with
95% confidence interval was estimated to assess the strength of
the association. Variables with p-value <0.05 in the multivariable
logistic regression analysis were considered as significant and
independent predictors of dietary diversity score.
The study was approved by Ethical Review Committee
(ERC) of Samara University. An official letter was written from
Samara University to Afambo district administration office.
Then, permission and support letter was written to each selected
kebeles. The participants enrolled in the study were informed
about the study objectives, expected outcomes, benefits and the
risks associated with it. A written consent was taken from the
participants before the interview. Confidentiality of responses
was maintained throughout the study.
About 65% of the study children consumed dairy products and
18.6%consumed egg in the 24 hour recall period. Overall 30.8%
(95% CI: 26.1, 35.5%) of children aged 6-59 months achieved
the minimum dietary diversity score (Table 1). The mean dietary
diversity score of the study participants was 2.73.
Binary logistic regression analysis showed that religion,
child age, antennal care attendance, child feeding counseling at postnatal care, complementary feeding initiation at 6 months
and household hunger scale were significantly associated with
minimum dietary diversity score at p<0.05. In the multivariable
logistic regression analysis child feeding counseling at postnatal
care, colostrum feeding and household hunger scale remained
statistically significant at p <0.05.
Mothers who got counseling on proper child feeding practices
at postnatal check up were [AOR=3.7(1.45, 9.28)] 3.7 times more
likely to fed their children with diversified food compared to
mothers who lack counseling. Compared to children who deprived
of colostrum, children who fed on colostrum were [AOR=2.7(1.18,
6.42)] more likely to get diversified food. Children from households
with moderate to severe hunger were [AOR=0.24(0.10, 0.57)]
less likely to receive diversified food compared to children from
households of little to no hunger (Table 2).
This study showed that 30.8% of mothers fed their child
with the recommended dietary diversity score by World Health
Organization. This is lower than the finding at Areka town of
Wolaita Zone . However, it is higher than the findings at
Southern  and Eastern Ethiopia. This might be due to the
reason that a significant proportion of children in the Ethiopia
lowlands receive adequate dietary diversity compared to the
midland agro-ecological zones .
Child feeding counseling during the postnatal checkups was
the positive predictor for dietary diversity. Mothers who had given
counseling on proper child feeding practices at postnatal checkup
were 3.7 times more likely to feed their children with diversified
food compared to mothers who lack counseling. In line with this study, in Nepal absence of postnatal care checkup was negatively
associated with infant and child feeding index . This might
be due to the fact that mothers who got counseling at postnatal
checkup may be encouraged by health professionals to practice
optimal feeding practices.
Compared to the study children who deprived of colostrum,
children who fed on colostrum were about three times more
likely to get diversified food. In Raya Kobo district, mothers who
fed their children with colostrum were more likely to practice
proper infant and young child feedingas compared to those who
discarded colostrum . This could be explained in such a way
that mothers who fed their children with colostrum might have
positive attitude and knowledge on the advantage of optimal child
Children of households in moderate to severe hunger were
76%less likely to receive diversified food compared to children
from households of little to no hunger. Likewise, in Ghana ,
Ethiopia , and rural Bangladesh  households in the highest
wealth quintiles have higher odds of achieving higher dietary
diversity compared to those in the lowest wealth quintiles. Similar
finding was reported in Kenya .
The study shares the limitation of cross sectional study
design. However, due attention was given to the study procedures;
including the process of training and close supervision throughout
the study period.
Colostrum feeding and counseling on proper child feeding
practices at postnatal checkups are independent positive
predictors of minimum dietary diversity score. However, there
is negative association between household hunger scale and
minimum dietary diversity score. Therefore, sound and culturally
appropriate child feeding counseling during postnatal care should
be strengthen to mothers of young children so that they can make
the possible use of locally available foods. In addition, expansion
of social programs that might contribute to the earning capacity of
poor households is also vital to ensure the dietary diversity.