Dietary Practices, Maternal Nutritional Status and Child Stunting: Comparative and Intervention Studies in Pulse and Non-Pulse Growing Rural Communities in Ethiopia

Abstract

Maternal and child undernutrition is a significant problem globally, particularly in low- and middle-income countries, such as Ethiopia. In 2008, Ethiopia began a National Nutrition Program (NNP) which prioritized maternal and child undernutrition. Ethiopia remains largely an agricultural economy; hence, improvements in the nutrition of women and children relies on agriculture (e.g. types of crops, productivity, consumption). Pulses are important crops, second to cereals; however, whether pulse agriculture translates to health benefits has not been well documented. This research aimed to document evidence of pulse agriculture translating to nutrition health benefits through: Characterizing the nutrition/food security situation and associated risk-factors of mothers and young children from both pulse and cereal growing communities; comparing the diets and health measures of mothers-children in pulse versus cereal communities; and, implementing a nutrition education intervention in a pulse growing rural community. Mixed method approaches, both quantitative and qualitative, were used in cross-sectional and intervention designs. Participants were mothers and their <5y of age children from two rural pulse-growing communities of Halaba and one cereal growing community from Zeway, Ethiopia. Data gathered included socioeconomic and demographic, household food security, dietary and anthropometric information using a semi-structured survey questionnaire, weighed food records, and anthropometric measurements. A six-month nutrition education program, involving interactive monthly community meetings and home-visits, was offered to one of the pulse communities and the other served as a control. Focus group discussions (FGD) were also conducted with male farmers to obtain their perspective on issues surrounding pulses. Very high levels of stunting among children <5y of age (54% in Halaba, 42% in Zeway) were found, as well as moderate to high levels of maternal undernutrition in Zeway (14%) and Halaba (22%) communities, respectively. Gender and household structure variables such as empowerment imbalance, access to land by women, household size and physiological density associated with maternal and or child stunting. In addition, many of the World Health Organization recommended infant and young child feeding (IYCF) practices were suboptimal, especially where complementary foods were below the estimated needs for energy and nutrients. The study also found unacceptably high levels of household food insecurity and hunger, particularly in Halaba communities with supply related factors (i.e., women’s access to land, work burden, land size, frequency of production) having greater influence than demand factors. Median energy and nutrient intakes for mothers, but not children, were significantly higher in the pulse communities than those in the cereal community. Dietary Diversity Scores (DDS) were low (3 food groups) in both mothers and children independent of the communities studied. Pulse consumption was low in both communities. Child stunting and underweight, and maternal undernutrition were worse in the pulse than cereal communities. Pulses were mostly sold for income and women had limited control over use (e.g. consumption) and knowledge of the nutrition benefits of pulses was lower among mothers in pulse-growing communities. The intervention study in the pulse communities showed significant improvements in the intervention group for knowledge, attitudes and practice (KAP) of pulses among mothers. The median DDS, as well as pulse and animal source food consumption indexes, improved for both mothers and children. The mean body-mass index-for-age z-score increased and wasting decreased in the children. Farmers in the FGD expressed intention to produce and retain more pulses for home consumption. No such changes were found in the comparison community. Overall, this research showed high levels of child stunting and maternal undernutrition, suboptimal IYCF practices, and high household food insecurity and hunger which all indicate the need to strengthen government’s nutrition service delivery to women and children. Mothers-children in the pulse communities did not have better nutrition status indicating pulse production does not necessarily translate to nutrition benefits unless bridging efforts, such as providing nutrition education, addressing gender disparities in access/control of resources (e.g. land, pulses) are in place. Community-based nutrition education interventions could be effective in improving mothers’ knowledge of pulses and consumption frequency. Such interventions can lead to increasing DDS in mothers and their children, and decreasing underweight and wasting in rural Ethiopia.