DIETARY DIVERSITY AND ITS ASSOCIATED FACTORS AMONG PREGNANT WOMEN IN

BAGLUNG MUNICIPALITY, BAGLUNG

Vintuna Shrestha

MPHN, BSc Nursing

1

Outline of the presentation

• Background

• Objectives

• Methodology

• Results and discussion

• Conclusion

2

Background Pregnancy

One of the crucial period within the 1000 days window of opportunity ("Why 1,000 days," 2010)

Nutritionally vulnerable period (King, 2000)

Dietary diversity

Number of different food groups consumed over a specific reference period (Ruel, 2002)

An essential element of diet quality which signifies micronutrient adequacy (Food Agriculture Organization and FHI 360, 2016)

3

Background…

Lack in diversity in diet (Hamosh, 1996 & Arimond et al., 2010)

Monotonous diet with inadequate intake of micronutrient from animal source food, fruits and vegetables (Lee, Talegawkar, Merialdi, & Caulfield, 2013)

Maternal micronutrient deficiency

4

Background…

• For a positive pregnancy experience dietary diversity is highly prioritized (World Health Organization, 2016)

• Poor dietary diversity a factor associated with maternal under-nutrition (Nepal Government, 2014)

• MDD-W is endorsed by the international community for monitoring progress in global frameworks and it is proposed to be included as indicator for diet quality in the SDG framework (UN Standing Committee on nutrition, 2015)

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Objectives

General objective

To determine the dietary diversity and its associated factors among the pregnant women at Baglung Municipality.

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Objectives…

Specific objective• To assess the dietary diversity

• To estimate the nutrient intake by pregnant women and how these match the Recommended Dietary Allowance

• To identify the socio-demographic and economic factors and household food security and their association with dietary diversity in pregnancy

• To identify knowledge on appropriate nutrition and food taboos during pregnancy and their association with dietary diversity among pregnant women

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Objectives…

• To assess pregnant women health related information and its association with dietary diversity among pregnant women

• To measure the status of women empowerment and its association with dietary diversity among pregnant women

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Variables

Dependent Variable Dietary Diversity

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Variables…

Independent Variables

Socio-demographic and economic factors

Age

Ethnicity

Religion

Family type

Husband’s education

Husband’s employment

Wealth quintile index

Household head

Nutrient intake( carbohydrate, protein, fat, calcium and iron)

Food taboos

House hold food insecurity

Knowledge on appropriate nutrition during pregnancy

10

Variables…

Independent Variables

Pregnant women health related factors

• Gestational age

• Gravida

• Trimester

• Number of ANC visits

• Timing of first ANC visits

Women empowerment

Involvement in household decision-making.

• Health care

• Major household purchases

• Visit to her family and relatives

Membership in community groups

Cash earning

Ownership of house/land

Educational level 11

Methodology

Study design Descriptive cross sectional

Study type Quantitative

Study period July 2018 to April 2019

Study Site Baglung municipality, Baglung district, Province 4, Nepal

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Methodology…

Sample size 327

Sampling Technique Simple random sampling

Exclusion CriteriaHistory of chronic disease like hypertension, diabetes and

HIV/AIDS

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Methodology…

Data collection technique

- Structured questionnaire

- Face to face interview

Tools

- 24hrs dietary recall

- Photo atlas

14

Methodology…

15

Methodology…

Data collection tools- NDHS questionnaire for wealth quintile index and women

empowerment

- Food Agriculture Organization of the United Nation, KAP manual, Guidelines for assessing nutrition-related Knowledge, Attitudes and Practices

- Extensive Literature review on food taboos related to diet during pregnancy

- Household Food Insecurity Access Scale developed by FANTA, USAID

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Methodology…

Data analysis

• Data entry: Epi Data 3.1 version

• Data analysis: IBM Statistical Package for Social Sciences,Version 21.

• Diet plan 7 software for analyzing nutrient content

• Wealth quintile: Principle component analysis

• Bivariate analysis: Chi-square test

• Logistic regression analysis

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19%

27%54%

Ethnicity Dalit/ Non-dalit terai/ Religious minority

Janjati

Upper caste

Result and discussion

40

287

0

50

100

150

200

250

300

350

<20 years >= 2o years

Age

Socio-demographic characteristics

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Result and discussion

26%

74%

Family type

Nuclear

Joint/ Extended

31%

69%

Household head

Female

Male

Socio-demographic characteristics

19

Result and discussion

38

78

3525

118

33

0

20

40

60

80

100

120

140

Occupation of participants husband

5626

8 2

235

0

50

100

150

200

250

Occupation of participants

Socioeconomic Characteristics

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Result and discussion

Health related factors

56.643.4

6.441.3

52.3

0 20 40 60

GravidaPrimi gravidaMultigravida

TrimesterFirst

SecondThird

Percentage

Mean Gestational age ±SD (in weeks) 25.6 ± 7.8

21

Result and discussion

22

Food taboo

s during preg…Yes

28%

No72%

Food taboos during pregnancy

Result and discussion

96.6

2.4

0.9

55.4

44.6

6.4

68.8

24.8

0 20 40 60 80 100 120

Household food security status

Food secure

Mildly food insecure

Moderately food insecure

Knowledge on appropriate…

Inadequate knowledge

Adequate knowledge

Women empowerment level

Low

Moderate

High

Percentage23

Result and discussion

55.04

44.95

Diverse

Not diverse

Mean DD =4.76SD= 1.23

Dietary diversity

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Result and discussion

100 98.5

3.1

61.2

14.125.7

46.2

7.6

70.3

49.8

0

20

40

60

80

100

120

Pe

rce

nta

ge

Diet Characteristics

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Result and discussion

Nutrients Average SD Median RDA Value% of RDA

Value

Energy, Kcal/day 1745.8 320.3 1741.5 2525 68

Protein, g/day 42.8 9.3 41.15 78 55

Fat, g/day 51.3 19.51 52.8 30 171

Calcium, mg/day 377.7 155.4 342 1000 31

Iron, mg/day 7.3 2.4 6.9 35 21

Nutrient intake

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Result and discussion

Characteristics Dietary Diversity (DD) COR (95% CI) AOR (95% CI)

n (%)

Diverse Not diverse

Family type

Nuclear 37 (43.0) 49 (57.0) REF REF

Joint/ Extended 143 (59.3) 98 (40.7) 1.93(1.17-3.18) 2.08 (1.56-6.05)

Earning status of the participant

Not Paid 143 (50.0) 143 (50.0) REF REF

Paid 37 (90.2) 4 (9.8) 9.25 (3.21-26.62) 4.83 (1.48-15.76)

Wealth quintile

Lowest 22 (33.8) 43 (66.2) REF REF

Second 26 (39.4) 40 (60.6) 1.41(.70-2.84) 1.15 (0.51-2.55)

Middle 36 (55.4) 29 (44.6) 1.13(.56-2.29) 0.94 (0.41-2.14)

Fourth 45 (68.2) 21 (31.8) 4.26(2.04-8.91) 3.19 (1.38-7.40)

Highest 51 (78.5) 14 (21.5) 4.90(2.30-10.41) 3.27 (1.92- 8.17)27

Multivariate analysis

Result and discussion

Characteristics Dietary Diversity (DD) COR (95% CI) AOR (95% CI)

n (%)

Diverse Not diverse

Knowledge on appropriate nutrition during pregnancy

Inadequate knowledge 80 (44.2) 101 (55.8) REF REF

Adequate knowledge 100 (68.5) 46 (31.5) 2.74(1.73-4.30) 1.87 (1.08-3.26)

Women empowerment level

Low 6 (28.6) 15 (71.4) REF REF

Moderate 108 (48.0) 117 (52.0) 2.30(.86-6.16) 1.94 (0.60-6.30)

Highest 66 (81.5) 15 (18.5) 11.00(3.66-33.05) 7.17 (1.90-27.11)

Multivariate analysis

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Conclusion

• Dietary diversity of pregnant women in Baglung municipality is low

• Pregnant women had inadequate nutrient intake except for fat intake

• About half of the pregnant women met the minimum dietary diversity criteria

• Earning status of pregnant women, family type, wealth quintile, knowledge and women empowerment level

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