Dietary Diversity of Children 6–23 months Is Limited by Age Related Complementary Feeding Practices as well as Household Dietary Diversity in Peru, Bangladesh and Sierra Leone
Authors: Robert Rebecca C. , Creed‐Kanashiro Hilary M. , Penny Mary E. , Marin Margot , Cottrell Bethann 
Published: November 2023

BackgroundComplementary feeding of infants and young children (IYC) 6–23 months is a critical factor for healthy growth and development. Dietary diversity (DD)‐‐the number of different food groups consumed‐‐is a proxy for micronutrient adequacy; minimum dietary diversity (MDD) is a WHO indicator used to assess the adequacy of complementary feeding in an IYC population. DD at the household level provides a measure of the food groups consumed in the home and thus potentially available for children. The comparison of household with child DD permits exploration of whether inadequate child DD is due to lack of availability in the home or intra‐household distribution to the child. Although a number of factors have been described in relation to child DD, the literature is limited regarding its relation with household DD.ObjectivesThis study examined firstly, the association between household and child DD in poor, mostly rural areas of 3 diverse countries: Peru—a middle income country, Bangladesh and Sierra Leone—both low‐income countries; and secondly, this same association across three IYC age groups (6–8 months, 9–11 months, 12–23 months) in each country.MethodsData were collected as part of the endline surveys following implementation of CARE's Window of Opportunity intervention which aimed to improve the diet and growth of children 0–23 months. Randomly sampled households in the intervention districts were selected (Peru n=402, Bangladesh n=1905, Sierra Leone n=585). DD was derived from 24 hour dietary recalls of the child's intake and HH food group consumption. The foods consumed in each case were assigned to 7 food groups (WHO): cereals/tubers/roots, flesh foods, eggs, dairy, legumes, vitamin A fruits/vegetables and other fruits/vegetables. Household and IYC consumption were compared in bivariate analysis. Generalized linear modeling (GLM) was used to examine MDD (a dichotomous variable)—which was met when IYC consumed 4 or more of the 7 groups.ResultsMDD was met by 89% of children in Peru, 61% in Bangladesh, and 53% in Sierra Leone. For each food group, with the exception of dairy, more households than IYC consumed them in all 3 countries. A clear and steep increase in consumption of each food group was seen by child's age group in all countries; youngest children had the lowest frequency of consumption (Table 1). In country specific GLM models, increasing household DD was significantly associated with meeting MDD (Odds Ratio (OR) range 2.0 to 3.0), controlling for mother's education, household food security and child's age group. In these same models, compared to IYC 6–8 months, older children had strong, independent associations with meeting MDD; 9–11 months (OR range 3.2 to 5.3), and 12–23 months (OR range 6.0 to 10.7).ConclusionsInfants 6–8 months were at significantly greater risk for not meeting MDD compared to children 9–11 and 12–23 months. While greater household DD decreased IYC risk for not meeting MDD, the comparison of foods consumed in the household versus the child's diet suggests that household DD, representing availability of foods, was not necessarily the main limiting factor. The variety of available food groups within the household, intra‐household distribution and/or caregiver selection of foods may all limit IYC DD. Future work should focus on understanding the barriers and facilitators for providing children with the full range of foods available so that DD among IYC, especially those in the youngest age group, can be improved.Support or Funding InformationCARE USA; The Catholic University of America
Household and Child Consumption of Food Groups in 3 Countries
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