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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)
5
Objectives
General objective
To determine the dietary diversity and its associated factors among the pregnant women at Baglung Municipality.
6
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
7
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
8
Variables
Dependent Variable Dietary Diversity
9
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
12
Methodology…
Sample size 327
Sampling Technique Simple random sampling
Exclusion CriteriaHistory of chronic disease like hypertension, diabetes and
HIV/AIDS
13
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
16
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
17
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
18
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
20
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
24
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
25
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
28
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
29
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