ABSTRACT
The aim of the study was to assess dietary diversity score and nutritional status of market women in Aba-North Local Government Area Abia State. A sample of 242 women was selected using systematic random sampling. Anthropometric characteristics were measured, while socio demographic information, market activities, dietary habits and 24-hour dietary recall were assessed using a questionnaire. Information on dietary diversity representing the number of foods groups consumed over 24 hour period was obtained using Women dietary diversity questionnaire (WDDQ) and the household dietary score (WDDS) was calculated based on nine food groups for the market women. Data were analyzed using descriptive and chi square with SPSS version 20.0. From the result, about 24% of the market women skipped breakfast. The prevalence of overweight and obesity were 39.8% and 12%, respectively. Total dietary diversity score was 4.45 ± 1.17 with their diets predominantly composed cereals, white tubers and roots (0.87±0.25) and dark green vegetables (0.66±0.41). About (50.4%) of the women had low DDS. No relationship was observed between DDS and WC (X2=2.077; p=0.354), WHR (X2=0.988; p=0.610), BMI (X2=6.880; p=0.550) and MUAC (X2=0.113; p=0.945) (p>0.05). Some of the socio-demographic variables tested such as level of education and religion of the women was significantly related with dietary diversity (p<0.05). Dietary diversification and nutrition education should be emphasized to promote good dietary habits through proper combination of the different food groups.
TABLE OF CONTENTS
TITTLE
PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE
OF CONTENTS v
LIST
OF TABLES ix
ABSTRACT x
CHAPTER
1
INTRODUCTION
1.1
Statement of problem 7
1.2
Objectives 9
1.2.1 General
objectives
9
1.2.2 Specific
objectives 9
1.3
Significance of the study
10
CHAPTER
2
LITERATURE REVIEW 11
2.1 Dietary diversity 11
2.1.1 Measurement
of dietary diversity 12
2.1.2 Importance
and relevance of dietary diversity 15
2.2 Health and nutritional status of women 17
2.3 Roles
and workload of women in society 20
2.4 Implications
of workload and time constraints on nutrition and health of women 24
2.5 Nutritional
assessment for the nutritional status of women 26
2.5.1 Anthropometrics 26
2.5.2 Biochemical
data 26
2.5.3 Clinical
data 26
2.5.4 Dietary
data 27
CHAPTER
3
MATERIALS AND METHODS
3.1 Study
design 29
3.2 Area of
study 29
3.3 Population
of study 29
3.4 Sampling
and sampling techniques 30
3.4.1 Sample
size determination 30
3.4.2 Sampling
procedure 31
3.5 Preliminary
activities 32
3.5.1 Preliminary
visits 32
3.5.2 Training
of research assistants 32
3.5.3 Pretesting
and validation of questionnaire 32
3.6 Data
collection 33
3.6.1 Questionnaire
administration 33
3.6.2 Anthropometric measurements 33
3.6.3 Dietary intake assessment 34
3.7 Data
analysis 35
3.8 Statistical
analysis 37
CHAPTER
4
RESULTS AND DISCUSSION
4.1 Socio-Demographic Data of the Market
Women 38
4.2 Market Activities of the Women 41
4.3 Dietary Habits of the Market Women 44
4.4
Dietary Diversity of the Market Women 48
4.4
b Mean Dietary Diversity of the Market Women 50
4.5 Qualitative 24 Hour Dietary
Recall of the Market Women 52
4.6 Mean Anthropometric Measurement
of the Market Women 55
4.7 Nutritional Indicators of the Market
Women 56
4.8
Relationship between Dietary Diversity Score, Socio-Demographic Characteristics
And
Nutritional Status 59
CHAPTER
5
CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 66
5.2 Recommendations 66
REFERENCES 68
APPENDIX I 81
APPENDIX II 82
LIST OF TABLES
Table
3.1 Cut-off points for BMI 35
Table
4.1a Socio-demographic data of the market women 38
Table
4.1b Socio-demographic characteristics of the market women 40
Table
4.2a Market activities of the women 42
Table
4.2b Market activities of the women 44
Table
4.3a Dietary habits of the market women 45
Table
4.3b Dietary habits of the market women 47
Table
4.4a Dietary diversity score of the market women 50
Table 4.4b Mean dietary diversity of
the market women 51
Table 4.5a Qualitative 24 hour
dietary recall of the market women for breakfast 53
Table 4.5b Qualitative 24 hour
dietary recall of the market women for Dinner 54
Table 4.6 Mean anthropometric
measurement of the market women 56
Table
4.7 Nutritional indicators of the market women 58
Table 4.8a Relationship
between dietary diversity score and nutritional status indicators 61
Table
4.8bi Relationship between dietary diversity score and socio-demographic
Characteristics 63
Table 4.8bii Relationship between
dietary diversity score and socio-demographic
characteristics 64
CHAPTER
1
INTRODUCTION
Malnutrition
is severe, affecting lives of millions of people worldwide, mostly children and
women (IFPRI, 2014). Malnutrition is an abnormal physiological condition caused
by inadequate, unbalanced or excessive consumption of macronutrients and/or
micronutrients; it includes undernutrition and overnutrition as well as
micronutrient deficiencies (FAO et al.,
2013). Over 2 billion people are affected by micronutrient deficiency, also
referred to as hidden hunger (FAO et al.,
2013). On the other hand, more than 805 million people do not consume enough
calories (FAO et al., 2014).
According to the 2014 Global Nutrition report (IFPRI, 2014), 2-3 billion people
are malnourished, diagnosed as undernourished, overweight or obese, or
deficient in micronutrients.
In
most developing countries, micronutrient malnutrition is still a major threat
of public health attention (Kennedy et al., 2007). This problem has
been attributed to the intake of monotonous cereal based diets that are lacking
in diversity. Diets in some countries lack fruits, vegetables and animal source
foods (Kennedy et al., 2007 and Daniels 2009). Regrettably, women of
reproductive age are most vulnerable due to their increased nutrients needs (Lee et
al., 2013). Due to this, inadequate nutrient intake among women and
other micronutrient deficiencies has remained prevalent in developing countries
(Allen, 2014).The scientific community has long been interested in the overall
quality of diets owing to the fact that it is important for each individual’s
health to meet his/her needs for different nutrients through a healthy, varied
and balanced diet (Savy et al.,
2005).
Dietary
diversity that is, the number of foods consumed across and within food groups
over a reference period is widely recognized as being a key element of diet
quality (Sedodo et al., 2014). There
is less evidence from developing countries where monotonous diets, relying
mostly on a few plant-based staple foods, are typical (Kennedy et al., 2009). Even fewer studies from
developing countries have aimed to confirm the association between dietary
diversity and nutrient adequacy specifically among adult women (Wiesmann et al., 2009). Dietary diversity score
is needed to provide information on specific food groups of interest (FAO,
2011). The few available studies have supported the association between
diversity and nutrient adequacy (Ogle et
al., 2001; Torheim et al., 2003).
It reflects the concept that increasing the variety of foods and food groups in
the diet helps to ensure adequate intake of essential nutrients and promotes
good health (Arimond et al., 2011).
There is ample evidence from developed countries showing that dietary diversity
is indeed strongly associated with nutrient adequacy and thus is an essential
element of diet quality (Sedodo et al.,
2014).
Dietary
diversity score is viewed at individual and house levels. Household Dietary
Diversity Score (HDDS) is meant to reflect, in a snapshot form, the economic
ability of a household to access a variety of foods. Studies have shown that an
increase in dietary diversity is associated with socio-economic status and
household food security (household energy availability) (Hatloy et al., 2000; Hoddienot and Yohannes,
2002). Individual / Women Dietary Diversity Scores (IDDS/WDDS) aim to reflect
nutrient adequacy (FAO, 2007). Studies in different age groups have shown that
an increase in individual dietary diversity score is related to increased
nutrient adequacy of the diet (FAO, 2010). Dietary diversity scores have been
validated for several age/sex groups as proxy measures for macro and/or
micronutrient adequacy of the diet. Scores have been positively correlated with
adequate micronutrient density of complementary foods for infants and young
children (FANTA, 2006), and macronutrient and micronutrient adequacy of the
diet for non breast-fed children (Hatloy et al., 1998; Ruel et al., 2004;
Steyn et al., 2006; Kennedy et al., 2007), adolescents (Mirmiran et
al., 2004) and adults (Ogle et al., 2001; Foote et al., 2004;
Arimond et al., 2010). Women’s dietary diversity scores (WDDSs)
have been proven to be a good measure of household macronutrient adequacy and
household nutrition insecurity (FAO, 2011). The WDDSs are based on a 24-h
recall period and the number of food groups consumed and reflect the
probability of micronutrient adequacy of the diet (FAO, 2011). A study proposed
the use of the following indicators in the post-2015 framework: prevalence of
overweight/obesity, prevalence of anaemia among women and the dietary diversity
of women (FAO et al., 2014). These
indicators were proposed with the goal of ending all forms of malnutrition (FAO
et al., 2014). The FAO post-2015
framework was aimed at defining the global development framework, referred to
as Sustainable Development Goals (SDGs) that succeeded the Millennium
Development Goals (MDGs). Although, many studies have reported different
measurements and prevalence of malnutrition in Burkina Faso (Savy et al., 2007), little is known about
differences in malnutrition along the urban-rural continuum.
Dietary
diversity scores have been validated for several age/sex groups as proxy
measures for macro and/or micro nutrient adequacy of the diet (FANTA, 2006).
There is less evidence from developing countries where monotonous diets,
relying mostly on a few plant-based staple foods, are typical (Kennedy et al., 2009). Even fewer studies from
developing countries have aimed to confirm the association between dietary
diversity and nutrient adequacy specifically among adult women (Wiesmann et al., 2009). However, the few
available studies have also supported the association between diversity and
nutrient adequacy (Ogle et al., 2001;
Torheim et al., 2004). Scores have
been positively correlated with adequate micronutrient density for adults (Ogle
et al., 2001; Foote et al., 2004; Arimond et al., 2010).
Dietary diversity is important
as different foods and food groups are good sources for various macro- and
micronutrients, so a diverse diet best ensures nutrient adequacy (FANTA, 2016).
The principle of dietary diversity is embedded in evidence-based healthy diet
patterns, such as the Mediterranean diet and the “DASH” diet (Dietary
Approaches to Stop Hypertension), and is affirmed in all national food-based
dietary guidelines (FANTA, 2016). The World Health Organization (WHO) notes
that a healthy diet contains fruits,
vegetables, legumes, nuts and whole grains (FANTA, 2016).
A
diverse diet is most likely to meet both known and as yet unknown needs for
human health. In addition to our knowledge of protein, essential fatty acid,
vitamin and mineral requirements, new knowledge about health effects of a wider
range of bioactive compounds continues to grow. According to the FAO guidelines
for measuring Household and Individual dietary diversity, the questionnaire
contains 16 food group, where twelve food groups are proposed for HDDS while
nine food groups are proposed for WDDS (FAO, 2011).
Nutritional
status is the condition of the body in those respects influenced by the diet;
the levels of nutrients in the body and the ability of those levels to maintain
normal metabolic integrity (Bender, 2005). For adults, general adequacy is
assessed by measuring weight and height; the result is commonly expressed as
the body mass index, the ratio of weight (kg) to height (m2)
(Bender, 2005). Body fat may also be estimated by measuring skinfold thickness
and muscle diameter as well. Status with respect to individual vitamins and
minerals is normally determined by laboratory tests, either measuring the blood
and urine concentration of the nutrients and their metabolites or by testing
for specific metabolic responses (Bender, 2005).
A
market woman is a woman who sells, or works in
a market (Useful English Dictionary, 2012). Women constitute the greatest
percentage of traders found in various markets where they stay from dawn to
dusk (Ukegbu et al., 2015). Their
dietary habits may lead to poor and even dangerous lifestyle. Their market
activities may influence lifestyle or determine the lifestyle which may
eventually affect their nutritional status (Ukegbu et al., 2015). The market place is an occupational environment that
can predispose individuals to obesity, mainly due to the sedentary nature and
enhanced access to food (Afolabi et al.,
2004). The nutritional status of a
market woman is a critical part of their overall health status. It is related
to among other things food intake during their lifetime, the nourishment they
received before birth, their energy output and workload, their market activities,
their power over resources for household food security and their roles in the
food chain (Hanson, 2000). Poor diet, frequent acute and chronic infections,
repeated pregnancies, prolonged lactation and a heavy burden of work may all
contribute to serious physiological depletion and sometimes to overt
malnutrition (Hanson, 2000).
A study of traders across various parts of Nigeria
revealed prevalence of obesity to be 16.3% in Ibadan (Balogun and Owoaje,
2007), 12.3% in Lagos (Odugbemi et al.,
2012) and 28.1% in Sokoto (Awosan et al.,
2014), in Tanzania, cereals contribute more
than half (51%)
to the total
dietary energy supply,
followed by starchy roots
(19%) (Kinabo et al., 2006).Therefore, the dietary
diversification index, i.e. the contribution of food groups other than cereals
and starchy roots is very low (Kinabo et
al., 2006).
Research
on six states in Nigeria (Bornu, Taraba, Osun, Akwa ibom, Kaduna, Kwara) among
women showed that 16.5%
scored low, 83.3% scored average and 0.2% scored high DDS
which indicates that dietary diversity is poor in Nigeria (Sanusi, 2010). Also research from
Ouagadouguo, Cameroun found that relative proportions of the nutrition indices
such as stunting, wasting and underweight varied across the urban rural
continuum. Rural households (15%) had the highest relative proportion of WDDS
compared with urban households (11%) and periurban households (8%)(Takemore et al., 2016).
For
women in Burkina Faso, when
controlling for socio-demographic and
economic characteristics, there
remained a significant difference between
percent of women
underweight in the
lowest dietary diversity tertile (22.8%) compared to the highest dietary diversity tertile (9.8%)
(Savy et al., 2005). Hence, this
study is aimed at knowing the dietary diversity score and the nutritional
status of market women in Aba north L. G. A. of Abia state.
1.1
Statement
of problem
In
developing countries, great interest has been paid to a balanced and
diversified diet especially in relation to problems caused by nutritional
deficiencies and the consequences in women (WHO/FAO, 2008). It has been clearly
stated that a non-diversified diet can have negative consequences on
individual’s health, well-being and development, mainly by reducing physical
capacities and resistance to infection and also impairing cognitive
development, reproductive and even social capacities (Underwood, 2002). Diets
in some countries lack fruits, vegetables and animal source foods (Kennedy et
al., 2007 and Daniels 2009). Regrettably, women of reproductive age
are most vulnerable due to their increased nutrients needs (Lee et
al., 2013). The problem of
non-diversified diet has been attributed to the intake of monotonous cereal
based diets that are lacking in diversity. Diets like fruits, vegetables and
animal source foods are lacking (Kennedy
et al., 2007 and Daniels 2009).
Maternal malnutrition is
a major predisposing
factor for morbidity and
mortality among African
women (Lartey, 2008), some
of the causative
factors are inadequate food
intake, poor diet
quality and frequent infections. In
addition, it is well known that in developing countries, the nutritional status
of women in urban areas is generally better than that in rural areas, one of
the explanations for this difference being, a more diversified diet in urban
areas (Popkin and Bisgrove, 2004), though access to more diverse foods
sometimes leads to diets higher in fats and can result in other health problems
(Drewnowski and Popkin, 2007).
Dietary
problems may be primarily quantitative in the most underprivileged areas such
as, rural areas during seasonal food shortages or urban areas under acute
poverty (Savy et al., 2005). Compared
with men, women – and particularly women of reproductive age require diets that
are higher in nutrient density (nutrients per 100 calories) (FANTA, 2016). Research
on six states in Nigeria which are Akwa Ibom, Bornu, Kaduna, Kwara, Osun, and
Taraba showed prevalence of low dietary diversity score among women as 16.5%
(Sanusi, 2010). Also research from Ouagadouguo found that relative proportions
of the nutrition indices such as stunting, wasting and underweight varied
across the urban rural continuum (Takemore et
al., 2016). Rural households (15%) had the highest relative proportion of
low DDS compared with urban households (11%) and periurban households (8%) (Takemore
et al., 2016).
This
makes them vulnerable to micronutrient deficiencies (FANTA, 2016).
Micronutrient deficiencies impair women’s health and the health of their
children. In some settings, women may be disadvantaged in intra-household
distribution of nutrient-dense foods (for example, animal-source foods).
Improved dietary diversity is one of several strategies for improving
micronutrient intakes for women of reproductive age. As
a result, the dietary deficiency then appears to be chiefly energy related.
However, there is need for the assessment of dietary diversity and nutritional
status of market women in Aba north in order to counsel these women who take
care of their homes.
1.2 Objectives of the
Study
1.2.1 General objectives
The
general objective of this study is to assess the dietary diversity scores and
the nutritional status of market women in Aba-North.
1.2.2 Specific objectives
The
specific objectives are to:
i.
describe dietary habits
of the market women.
ii.
determine their dietary
diversity by using Women Dietary Diversity Scores (WDDS).
iii.
assess the nutritional
status of market women using anthropometric measurement.
iv.
identify
socio-demographic determinants of dietary diversity
v.
evaluate the relationship
between dietary diversity score, socio-demographic characteristics and
nutritional status.
1.3 Significance of the
study
This
study will reveal the importance of diversification of diet for women and also
give more understanding on the relationship between dietary diversity and
nutritional status of market women.
The
information that is gotten from this research work can be important for
planning and conducting intervention programmes for women both in the urban and
rural areas by nutritionists or other health workers.
This
study will also help to advice market women on the need for consumption of
adequate diets to improve their nutritional status.
This
study will aid other researchers for further research in this area.
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