Determinants of dietary diversity among pregnant women in Laikipia County, Kenya: a cross-sectional study

BACKGROUND: Dietary diversity has continued to gain widespread attention among the population since it has evidently been associated with nutrient adequacy. A diverse diet has been shown to reflect nutrient adequacy since no one food can meet the nutritional requirement of a person. Pregnant women have been considered vulnerable to malnutrition due to their increased nutrient requirement and therefore a variety of foods in their diet is considered imperative in ensuring adequate nutrient intake. To promote dietary diversity, it is important to understand the factors associated with it. This paper therefore assessed the determinants of dietary diversity among pregnant women in Laikipia County, Kenya. METHODS: The study was a cross-sectional analytical study consisting of 254 pregnant women attending antenatal clinic at Nanyuki Teaching and Referral Hospital in Laikipia County, Kenya. RESULTS: The mean Dietary Diversity Score (DDS) was 6.84 ± 1.46 Standard Deviation (SD), with cereals being the most (99%) commonly consumed food group. Adjusted Logistic Regression (AOR) analyses revealed education level (AOR = 2.78; (95% Confidence Interval (CI) 1.06, 5.32; p < 0.001), employment status (AOR = 2.29; CI 1.18, 4.14; p = 0.003), monthly income (AOR = 2.08; CI 1.32, 3.03; p < 0.001), household assets (AOR = 1.93; CI 0.73, 6.90; p = 0.030), land ownership (AOR = 0.64; CI 0.44, 2.25; p = 0.040), and morbidity (AOR = 0.78; CI 0.36, 2.34; p = 0.010) among the pregnant women as the variables that influenced their dietary diversity. CONCLUSION: Socioeconomic factors (education level, employment status, monthly income, household assets and land ownership) have been shown to influence dietary diversity in this study. New policies and intervention programmes targeting these determinants of dietary diversity should therefore be enacted, while the existing ones should be supported and monitored particularly among the vulnerable populations. Such policies and programmes among pregnant women will ensure improved dietary diversity and adequate nutrient intake. Similarly, since morbidity incidence among pregnant women have been shown to significantly influence dietary diversity, public health awareness campaign on the importance of early detection and timely treatment of diseases among pregnant women should be launched by the relevant stakeholders

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

Background: Previous reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD. Methods: We conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equationmodels (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD. Results: Out of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts. Conclusions: Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status