Gudrun B. Keding

Relating dietary diversity and food variety scores to vegetable production and socio-economic status of women in rural Tanzania

The objective of the present study was to measure diversity in nutrition with dietary scores, and to assess their relationship to vegetable production and the socio-economic status of women in rural Tanzania. A dietary diversity score (DDS) and a food variety score (FVS) were created from data gathered with three semi-quantitative 24-h recalls performed during three non-consecutive seasons during 2006/2007. Data on vegetable production, selling and buying and socio-economic data was gathered with a semi-quantitative questionnaire. A total of 252 randomly selected women from three districts of north-eastern and central Tanzania participated. The median DDS of 6 and the mean FVS of 8.3 were low, suggesting an overall poor dietary quality, with about one third of participants having an alarmingly low DDS of only two to four food groups per day. These women consumed a very basic diet consisting mainly of cereals and vegetables. Differences among districts were pronounced while those among seasons were less distinct. The DDS and FVS were both significantly associated with ethnicity, occupation and status within the household of participants. As a more varied diet is not necessarily healthier, integration of both quantity and quality in the scores is proposed for future studies. This can be achieved, for example, by weighing food types according to their importance in the diet. As both scores are linked to the production, selling and buying of vegetables, the promotion of homestead food production may be a good way to improve dietary diversity.

Dietary Patterns and Nutritional Health of Women: The Nutrition Transition in Rural Tanzania

Background Many developing countries are experiencing a rapid nutrition transition in urban areas. Objective To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania. Methods A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006–2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns. Results The five dietary patterns were “traditional-coast,” characterized by fruits, nuts, starchy plants, and fish; “traditional-inland,” characterized by cereals, oils and fats, and vegetables; “purchase,” characterized by bread and cakes (usually fried in oil), sugar, and black tea; “pulses,” characterized mainly by pulses, with few or no vegetables; and “animal products,” characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (ρ = 0.192, p = .005) and between the animal products pattern and wealth (ρ = 0.168, p = .002). Conclusions Differences between traditional and modern nutritional food patterns were evident. This study found the “traditional-inland” pattern to be the most healthy, while the “purchase” food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.

Obesity as a public health problem among adult women in rural Tanzania

Even in rural areas of Tanzania, an early stage of the nutrition transition is underway: 3 times as many women were overweight or obese than were undernourished. Overweight and obese women mainly follow a diet characterized by high consumption of bread and cakes (usually fried or baked in oil), sugar, and black tea. Even in rural areas of Tanzania, an early stage of the nutrition transition is underway: 3 times as many women were overweight or obese than were undernourished. Overweight and obese women mainly follow a diet characterized by high consumption of bread and cakes (usually fried or baked in oil), sugar, and black tea. ABSTRACT Background: For many developing countries, obesity and its sequelae have become a challenge of a magnitude similar to hunger and undernutrition. The main objective of this study was, therefore, to investigate the weight status of women in rural Tanzania with reference to season as well as the link between womens weight, food consumption, and attitudes toward obesity. Methods: Three cross-sectional surveys in 3 different seasons within 1 year interviewed the same 210 women, ages 17–45 years, from 3 rural districts of northeastern and central Tanzania. These surveys assessed body mass index (BMI), food intake, and dietary diversity through 24-hour recalls, womens attitudes toward obesity, vegetable production, and socioeconomic status. Results: Although 71% of the women had a normal BMI, 7% were underweight, 16% overweight, and 6% obese. The BMI was correlated with the Dietary Diversity Score (DDS), the Food Variety Score (FVS), with the consumption of foods from the food groups “bread/cakes,” “sugar,” and “tea,” and with the production of exotic vegetables. In a multiple regression model, FVS was directly associated with BMI. When asked to describe the typical characteristics of an obese person, women mentioned more negative than positive characteristics. Conclusion: The prevalence of overweight and obesity was 3 times higher than that of underweight. Apparently, even in rural areas of Tanzania, a nutrition transition is underway. No direct association was identified between vegetable consumption and BMI. Although this study did not assess behavioral factors, such behavioral factors as activity levels as well as attitudes need to be considered, even in rural settings, to address all facets of malnutrition.

Production and processing of foods as core aspects of nutrition-sensitive agriculture and sustainable diets

Some forms of malnutrition are partly due to agriculture not having nutrient outputs as an explicit goal. A better understanding of what is required from agricultural production and food processing for healthy and sustainable diets is needed. Besides nutritional quality or nutrient output, important factors are: water, soil, health hazards, agrobiodiversity and seasonality. Therefore, possible interactions among constituents of the food chain – human health, the environment, knowledge and education – should be considered from a systemic perspective. Nutrition-sensitive agriculture needs to consider and understand the role of biodiversity in improving dietary quality and dietary diversity as well as seasonality in food supply. Apart from improving agricultural systems in order to close the nutrition gap, efficient storage and food processing technologies to prolong shelf-life are required. If processing is poor, high food losses can cause food insecurity or increase the risk of producing unsafe and unhealthy food. Food storage and processing technologies, particularly at household level, are challenging and often not applicable to traditional crops. In order to achieve the aims of nutrition-sensitive agriculture, it is necessary to comprehend its complexity and the factors that influence it. This will require a trans-disciplinary approach, which will include the three sectors agriculture, nutrition and health at research, extension and political levels. Ensuring that farmers are knowledgeable about production systems, which sustainably provide adequate amounts of nutritious food while conserving the environment is an essential part of nutrition-sensitive agriculture. At the same time, for the benefits of nutrition-sensitive agriculture to be realized, educated consumers are required who understand what constitutes a healthy and sustainable diet.

Variability of On-Farm Food Plant Diversity and Its Contribution to Food Security: A Case Study of Smallholder Farming Households in Western Kenya

Traditional mixed agroforestry farms are regarded as sustainable agroecological systems contributing to agrobiodiversity conservation and household food and nutrition security in sub-Saharan Africa. However, in Kenya little is known on the level of agrobiodiversity of these mixed farms and its contribution to food and nutrition security. A case study was conducted to assess food plant and livestock diversity and to identify the biophysical and socioeconomic factors influencing food plant diversity in 30 smallholder farms in Western Kenya. The survey identified six livestock species and 59 food plant species. Higher food plant species richness was found on farms managed by wealthier households and older household heads. However, households with high on-farm food plant richness and diversity were not more food secure than households managing species-poor farms. The nonsignificant relationship between food security and agrobiodiversity during the time of this case study may have resulted from the fact that the surveyed 30 families sourced significant proportions of their food from markets and did not fully depend on their farms for food, particularly for spices and condiments, fruits, and animal source foods. Therefore, we suggest a diversification of farms through livestock and fruit tree farming for improving dietary diversity and incomes of the surveyed households.

Influence of Seasonal On-Farm Diversity on Dietary Diversity: A Case Study of Smallholder Farming Households in Western Kenya

ABSTRACT This study explored the associations between dietary patterns and farm diversity as well as socioeconomic variables during two seasons in rural Western Kenya. As a mean of two surveys, the average dietary diversity scores (DDS) of households and women were low, implying low household economic access to food and low women’s dietary quality. The Food Consumption Score (FCS) showed that acceptable levels of food consumption were realized over seven consecutive days in the 2014 survey by the majority of households (83%) and women (90%). While there was no strong association between the food scores and seven farm diversity indicators, both food scores were significantly associated with the household’s wealth status, ethnicity of both the household head and the spouse, and the education level of the spouse. For holistic household food and nutrition security approaches, we suggest a shift from a focus on farm production factors to incorporating easily overlooked socioeconomic factors such as household decision-making power and ethnicity.

Introduction of Fruits and Vegetables into Children's Diets in the Iringa Region, Tanzania

Introduction of Fruits and Vegetables into Children’sDiets in the Iringa Region, TanzaniaUndernutrition is still a major problem among chil-dren under the age of 5 years in developing countries[1], often occurring during the weaning period, whichis recommended by World Health Organization tostart after 6 months of exclusive breastfeeding[2, 3]. However, little is known about the introduc-tion time and consumption frequency of complemen-tary foods in Tanzania. Therefore, an explorativestudy was conducted in the Iringa Region ofTanzania’s Southern Highlands during the dryseason in August and September 2008. Participantswere recruited by a systematic sampling procedureconsisting of 124 rural and urban mothers and heryoungest child between the age of 6 months and5 years. Mothers were interviewed with structuredand open-ended questionnaires. Children’s dietaryintakes were assessed using a single 24-h dietaryrecall [4], of which a dietary diversity score (DDS)[5] and a food variety score (FVS) according toDrewnowski et al. [6] were calculated. Children’sheights and weights were measured with a portablewooden stadiometer (Shorr Productions ofMaryland, USA) and a digital scale (Seca 862, SecaGmbH & Co KG, Hamburg, Germany), respectively.ENA-software using WHO Child Growth Standards2005 [7] was applied to determine the nutritionalstatus. Data of nine children were incomplete andexcluded of the statistical analysis [SPSS version17.0 (SPSS Inc., Chicago, IL, USA)]. The medianchild’s age was 19 months (Table 1). Children wereintroduced to grain-based complementary foods,fruits and vegetables at a median age of4.0 (0.1/12), 6.0 (1/17) and 8.0 (2/24) months, respect-ively, with no statistical differences between the ruraland urban area. A total of 76% of children wereintroduced to complementary foods earlier than thefirst 6 months of life. Notably, the introduction wasstill later than in other developing and developedcountries [8–13]. However, 51% were given solidsbefore reaching the age of 4 months, increasingtheir risk of diarrhoea. Regarding vegetables,30% of children were not given any before reachingthe age of 12 months increasing their risk of develop-ing micronutrient deficiencies. The mean DDS was5 while children were primarily fed starchy foods,such as maize, plain rice, cassava and sweet potatoes(Fig. 1). Regarding vegetables, they ate traditionalvegetables adapted to local agricultural conditionsand incorporated into the family’s diet. The medianand mean FVS was 11 and higher than the mean FVSof 5.5 found in a South African study [14], but com-parable to the mean value of 10 found amongGuatemalan infants [15]. The observed stunting rateof 41% was similar to the rate of 38% found by theTanzanian Demographic and Health Survey 2004–05(TDHS) [16]. Both weights and heights of childrenwere positively correlated with the number of fruitand vegetable types consumed as well as DDSand FVS. These findings indicate that a higher foodvariety has positive impacts on weight andheight development of children, although thisimpact is not fully understood. Conclusively, furtherinvestigations on the impact of young children’sdiets on their growth, health and development areneeded.C

Contribution of Nutrient Diversity and Food Perceptions to Food and Nutrition Security Among Smallholder Farming Households in Western Kenya: A Case Study

Background: Sub-Saharan Africa is the only region in the world where hunger is prevalent in over one-third of the population, with smallholder farming households, producers of over 80% of Africa’s food, facing both calorie and micronutrient deficiencies. With agricultural systems serving as the main source of all nutrients, little is known about the extent to which agricultural diversity in different seasons can meet macro- and micronutrient needs in rural Africa. Objective: Linkages between nutrient diversity and food species were investigated. Methods: A case study was conducted in Western Kenya to assess the seasonal nutrient diversity, seasonal nutrient accessibility levels, and food perceptions in 30 smallholder farms, 7 markets, and among 97 focus group discussion participants, respectively. All present food plant and animal species were inventoried and assigned to 1 of the 7 major Food and Agriculture Organization–defined food groups. Based on 2 macronutrients and 5 micronutrients, dendrogram-based nutrient functional diversity metrics were calculated. Results: On-farm and market food species offered all 7 macro- and micronutrients under investigation, regardless of seasonal variation in species numbers. Although there were varying seasonal nutrient accessibility levels in markets, farms were especially effective in readily availing 4 of the 7 nutrients. However, the main food shortage months coincided only with maize shortage, but a diversity of local foods, deemed to be of low cultural and culinary preferences, were available. Conclusions: Nutrition education on the importance of a diversity of local foods in meeting dietary needs, thus stimulating the demand side, can contribute to achieving year-round household food security.