Dietary practices and nutritional status of children aged 0-24 months and their mothers in the rural ensete-monoculture dominated Sidama region, Ethiopia

Abstract

Underernæring og mangelfullt næringsinntak er vanlige problemer i mange lavinntektsland slik som Etiopia. I disse områdene er de fleste studiene fra bynære strøk på grunn av nærhet til infrastruktur og helsesystemer. Det er derimot nokså få som studerer ernæring i svært rurale og perifere strøk. Denne studien ble gjort i Sidama regionen, kjent for dyrkningen og bruk av Ensete planten (ensete ventricosum). Denne planten kalles også «psaudo-banan» eller «flask banan» og var svært dominerende i regionen for flere tiår tilbake. Doktorarbeidet inkluderte 985 hushold med mor-barn par der barna var under to år. Det ble gjort antropometriske målinger, kostholdsintervju og måling av hemoglobin. 39% av barna hadde mangelfull lengdevekst (stunting) og 61% var anemiske. Det var 13 prosent av mødrene som var anemiske og også samme antall som var undervektige. Nærmere 40% av barna og mødrene hadde utilstrekkelig variert diett. Det var svært lav bruk av animalske kilder. 75% av husholdene var matvareusikre og bruken av Ensete var svært minimal. Analytiske statistiske metoder fant at alder, kjønn og hemoglobin påvirket lengdeveksten hos barn. Mors ernæringsstatus var påvirket av utdanning og diettvariasjonen. Det er behov for umiddelbare og langsiktige tiltak for å bedre ernæringsstatusen hos kvinner og barn på landsbygda i Sidama, Etiopia. Bruk av gamle tilgjengelige metoder, slik som Ensete kan kompensere noe for matvareusikkerhet. Kvinners utdanning og diettvariasjon må styrkes.

Background: Ethiopia is a low-income country with a high burden of child and maternal undernutrition. Although overnutrition is on the rise among different groups of the population, undernutrition is still dominant in many rural and less privileged parts of the country. Sub-optimal dietary intakes are among the common factors associated with undernutrition. Most studies in Ethiopia focus on urban and semi-urban areas with relatively better access to transportation and health facilities. However, few studies exist from rural and less privileged areas. The dietary aspects of the rural ensete-monoculture dominated Sidama region were assessed a few decades ago. The background to this thesis was understanding the current dietary aspects of this rural community, particularly for young children and mothers. Objectives: The aim of this thesis is to describe the dietary practices and nutritional status of young children and mothers in the rural ensete-monoculture dominated Sidama region, Ethiopia. It also aims to analyse the dietary and non-dietary risk factors for undernutrition among children below the age of two and their mothers. It also investigates the consumption of animal-source foods among children and mothers. Method: A total of 985 households with children under the age of two and their mothers aged between 15 and 49 were randomly selected from seven rural kebeles. Data on sociodemographic characteristics, anthropometric measurements, haemoglobin level assessments and dietary recalls was obtained. Household food access was also assessed, using the household food insecurity access scale tool. Animal-source food consumption frequencies among children and mothers were also assessed and analysed in relation to household livestock ownership. EpiData version 3.1 was used to double-enter and validate the data. SPSS version 25 was used to clean and describe the data. SPSS version 25 and STATA version 15 were used for further analysis. Multilevel linear regression was used for Paper I and Paper II, and ordinal logistic regression was used for Paper III. Result: In Paper I, we found that stunting among children aged 0-24 months was 39.5% and that the majority of the children (61.7%) were anaemic. The prevalence of household food insecurity was 74.9%. Age, sex, haemoglobin level of the child and household food insecurity were significant factors associated with faltering linear growth among children younger than 24 months. In Paper II, the prevalence of anaemia and underweight among mothers were 12.8% and 12.6%, respectively. Determinants of mothers’ haemoglobin levels were weight, dietary diversity score and educational status. Household wealth and the dietary diversity scores of the mothers were also factors positively associated with the mother’s anthropometric status. The minimum dietary diversity prevalence among children was 39.1% (Paper I) and that of the mothers was 38% (Paper II). In Paper III, we described animal-source food consumption frequencies among children and mothers during a month prior to our study. Any dairy consumption among children was 91.8%, and 96% among mothers. While egg consumption among children was 83%, it was 50% among mothers. Meat consumption was reported for 26.2% of the children and for 34% of the mothers. Nearly, three-quarters (631 out of 851 households) owned cows and a quarter (213 out of 851 households) kept goats or sheep. Conclusion: We found that child undernutrition, anaemia and stunting were major problems in the rural area. Anaemia was a mild public health problem, while being underweight was a medium public health problem among mothers with children below the age of two, according to the WHO classification criteria [1, 2]. We also described low-diversified diets among children and mothers and high food insecurity. Planning and implementing short-term and long-term strategies to improve access to nutritious foods and sustainable food security require consideration.