Food and nutrition knowledge, attitudes and practices among children in public primary school with canteens in southern Benin: a case study.

BACKGROUND: Food and nutrition notion among schoolchildren in Benin is still less documented. Few studies have examined the determinants of food and nutrition among schoolchildren while others have attempted to link knowledge, attitudes and practices to diet. The present study aims to evaluate food and nutrition knowledge, attitudes and practices among schoolchildren enrolled in public primary schools canteens in Cotonou and its surroundings. METHODS: A diagnostic study was conducted in twelve public primary schools with canteens. A structured interview questionnaire was used to collect data from 861 schoolchildren aged 7 to 14 years. Three scores were used to assess the level of knowledge, attitude and practice. The overall score was the total of correct responses. The maximum score for all the three parameters was 15, 6 and 4 respectively for knowledge, attitude and practices. Data were analyzed using STATA 16. Logistic regression was performed to identify the relationship between food and nutrition practices and knowledge and attitude. Pearson goodness of fit test was performed to verify the adequacy of the model. A P-value of less than 0.05 (P < 0.05) was considered significant at 95% confidence interval. RESULTS: schoolchildren's nutrition knowledge was low (mean score 2.52 ± 1.33) while attitude and practices were acceptable (mean score 4.08 ± 1.39 and 2.84 ± 0.77). Only 18.2% of schoolchildren knew the different food groups and 3.4% knew that they should eat at least five fruits and vegetables a day. Most of the schoolchildren (93.6%) were favorable to eat at least five fruits and vegetables and 86.8% were willing to eat more than 3 times a day. Among all practices, snacking between meals and eating breakfast were poorly observed by the schoolchildren. Nutrition knowledge was associated with practices observed among schoolchildren but not with attitudes. However, a significant positive association was observed (p < 0.05) between attitudes and practices. CONCLUSION: Knowledge on food and nutrition among schoolchildren from public primary schools with canteen was low. This study suggests implementation of nutritional education to improve schoolchildren's knowledge and attitudes towards healthy diets and nutrition.

Mainstreaming traditional fruits, vegetables and pulses for nutrition, income, and sustainability in sub-Saharan Africa: the case for Kenya and Ethiopia.

This study documented existing knowledge on traditional fruits, vegetables and pulses in Kenya and Ethiopia. The aim was to identify neglected and underutilized species with high potential for food security, for their economic value and contribution to sustainable agriculture, based on a literature review and confirmation of existing data by local experts. In order of priority, the top 5 fruit species in Kenya are Tamarindus indica L., Adansonia digitata L., Sclerocarya birrea (A.Rich.) Hochst, Balanites aegyptiaca (L.) Delile, and Ziziphus mauritiana Lam., for vegetables are Amaranthus spp., Vigna unguiculata (L.) Walp., Solanum spp., and Cleome gynandra L. Top fruits in Ethiopia are Balanites aegyptiaca (L.) Delile, Ziziphus spina-christi (L.) Desf., Cordeauxia edulis Hemsl., Cordia africana Lam., and Mimusops kummel A. DC., for vegetables are Brassica carinata A. Braun, Cucurbita pepo L., and Amaranthus spp. In both countries, priority pulse species (no ranking) are Phaseolus lunatus L., Sphenostylis stenocarpa (A.Rich.) Harms, Mucuna pruriens (L.) DC., Lablab purpureus (L.) Sweet, and Cajanus cajan (L.) Millsp. Generally, these priority species are good sources of key nutrients known for their inadequate dietary intakes in sub-Saharan Africa, represent a safety net for household income, and contribute positively to ecosystem resilience in existing agricultural systems. Complete, accurate and reliable nutrient composition data are needed to raise consumer awareness about their nutritional and health benefits. Since women play a central role in traditional food systems, their empowerment, and hence resilience, increase the positive impact they can have on the households' dietary diversity. In particular, introducing small-scale processing techniques and marketing strategies could enhance their supply and consumption.

Qualitative analysis of the perceptions of rural communities about the use of awareness-raising videos in nutrition and health programs in Benin.

This cross-sectional study aims at analyzing the perceptions of mothers, community leaders, and nutrition/health care workers (NHCWs) about using videos in nutrition and health programs compared to posters. In total, we recruited 42 mothers, 39 community leaders, and 30 NHCWs from villages and local organizations in two rural districts in South Benin, Bopa, and Houéyogbé. Learning sessions on Dietary diversity and Hygiene and deworming were organized using posters and videos. Participants' opinions on pros and cons of videos and posters were collected using individual semi-structured interviews with NHCWs and focus group discussions with mothers and community leaders, then analyzed thematically. Results showed that videos were perceived as more adapted to rural communities than posters because they were in local languages, self-explanatory, appealing, and captivating. Videos also enabled the dissemination of standardized messages. Globally, participants better-understood messages from videos than from posters, especially when dealing with dynamic processes. However, the speed of video sequences allowed limited time for self-reflection and assimilation of certain messages. The absence of electricity and lack of equipment to play videos in villages are also major constraints on the use of videos in such settings. While videos are innovant communication tools that should be promoted to improve motivation and compliance in learnings, they should be preferably used as complements to traditional posters for optimized assimilation of messages.

Indigenous communities' perceptions reveal threats and management options of wild edible plants in semiarid lands of northwestern Kenya.

BACKGROUND: Understanding how local communities perceive threats and management options of wild edible plants (WEPs) is essential in developing their conservation strategies and action plans. Due to their multiple use values, including nutrition, medicinal, construction, and cultural as well as biotic and abiotic pressures, WEPs are exposed to overexploitation, especially within arid and semiarid lands, and hence the need to manage and conserve them. We demonstrate how an understanding of indigenous communities' perceptions could be achieved through an integrated participatory approach involving focus group discussions (FGDs) and field plot surveys. METHODS: We conducted three FGDs between October 2020 and April 2021 within three community units in northwestern Kenya with different socioeconomic and environmental characteristics. We subsequently surveyed 240 field plots of size 1 ha each to assess threats facing WEPs within a 5 km buffer radius in every study community. We compared ranks of threats and management options across community units. RESULTS: Rankings of threats and management options differed across the three study communities. We obtained strong positive linear relationships between field and FGD rankings of threats facing WEPs. Climate change, overstocking, overharvesting, and invasive species were the highest-ranked threats. Mitigation of climate change, local knowledge preservation, selection, propagation, processing, and marketing of WEPs ranked high among possible management options irrespective of the socioeconomic and environmental characteristics of the community unit. CONCLUSIONS: Our approach emphasizes the relevance of leveraging indigenous communities' perceptions and conducting field plot surveys to assess threats and management options for WEPs. Evaluating the effectiveness and cost-benefit implications of implementing the highly ranked management options could help determine potentially suitable habitats of the WEPs for conservation and management purposes, especially for priority WEPs.

Dietary Diversity Predicts the Adequacy of Micronutrient Intake in 6- to 23-Month-Old Children Regardless of the Season in Rural Southern Benin.

BACKGROUND: The Infants and Young Children Dietary Diversity Score (IYC-DDS-7) has been validated to assess dietary quality in children. However, its applicability to predict the adequacy of micronutrient intake remains a challenge in all contexts. DESIGN AND METHODS: A 24-hour dietary recall assessment was conducted on a sample of 628 children aged 6 to 23 months in the plenty season (PS) as well as in the lean season (LS). The IYC-DDS-7 was calculated based on 7 food groups, whereas the mean micronutrient density adequacy (MMDA) for 11 micronutrients. The ß regression models were used to assess the relationship between IYC-DDS and MMDA and differences in nutrient intake between the 2 seasons. A receiver-operating characteristic curve analysis was also performed to determine IYC-DDS-7 cutoff levels that maximized sensitivity and specificity in assessing dietary quality and predicting MMDA below- or above-selected cutoff levels. RESULTS: Participating children's MMDA was 56.9% ± 12.8% versus 61.9% ± 8.6% and IYC-DDS-7 was 3.43 ± 1.5 versus 3.77 ± 1.0 in the PS and LS. The IYC-DDS-7 had a positive correlation with MMDA, irrespective of the season. For a 1-unit increase in IYC-DDS-7, MMDA increased by a mean of 10.7% (CI, 8.3%-13.1%; P < .001). The minimum threshold of the 4 food groups corresponded to a sensitivity of 76% and 61% and a specificity of 75% and 70% for the prediction of inadequate diet in the PS and LS, respectively. CONCLUSIONS: The IYC-DDS-7 predicted MMDA, regardless of seasons for infants and young children. The IYC-DDS-7 cutoff of 4 groups performed well in classifying children with low-diet quality.

Traditional Individual and Environmental Determinants of Healthy Eating in Vihiga County, Western Kenya.

Traditional ethnic groups in Kenya are unlikely to eat a healthy and diversified diet due to many individual and environmental factors, which may result in poor health status. Therefore, the determinants of eating behavior need to be identified prior to any public health action. For this study, focus group discussions (15 in total) in a double-layer design were conducted, comprising adult men and women from 5 villages of Vihiga County. Questions explored knowledge; barriers and cues to action toward eating a healthy diet containing a variety of foods; including indigenous food species. We found that healthy eating concepts are known; however, several taboos that restrict food consumption reduce local diet quality in terms of diversity. Nutrition education is a cue to action. We identified several individual and environmental determinants of eating behavior in the studied communities. Public health action should focus on supporting healthy eating behaviors and refining some taboos' beliefs.

Transforming food systems with trees and forests.

The global food system is failing to deliver sufficient and nutritious food to all, while damaging the earth and unsustainably drawing down its resources. We argue that trees and forests are essential to solving these challenges. We outline the current contributions of trees and forests to the global food system and present recommendations to leverage these contributions as part of the efforts to reshape food systems to better support healthy diets and environmental sustainability. Trees and forests provide nutrient-rich foods, incomes for food security, ecosystem services for food production, and add resilience to food systems. At the same time, trees and forests protect biodiversity and mitigate climate change through carbon sequestration. We recommend four approaches to realise the full potential of trees and forests to contribute to healthy and sustainable food systems: scaling up current tree-based food production, reorientating some agricultural investments towards nutrient-dense food production, repurposing production incentives from support of calorie-rich but nutrient-poor foods to support nutrient-dense foods, and integrate nutrition objectives into forest conservation and restoration programmes. Trees and forests have important roles to play in the transformation of our food systems, but more needs to be done to ensure that these roles are realised.

Nutrient composition of Parkia biglobosa pulp, raw and fermented seeds: a systematic review.

There is increasing evidence that nutrient differences observed among crop varieties or animal breeds belonging to the same species are sometimes greater than differences between species. Parkia biglobosa is an important tree species that provides edible products and income to rural households in West Africa. To better understand intra-species nutrient variability of P. biglobosa edible products, a review on the nutrient content of its pulp and seeds (raw and fermented) was conducted. Google scholar and the keywords "P. biglobosa" AND "nutrition" were used to screen the available literature from 1980 onwards, and the Zotero software was used to manage references. A step-wise assessment of titles, abstracts and full papers, led to a selection of 69 papers from which data were retrieved following FAO INFOODS guidelines. After data harmonization and quality checks, 42 papers were retained and used to extract data to populate a nutrient database. Despite an apparent abundance of nutrient analyses focused on P. biglobosa's edible products, the quality of data available was poor and very few authors presented additional information, such as soil characteristics, climate, maturity at harvest, etc. that could influence the nutritional content of the products. Many data gaps remain. The present study will stimulate further investigations into nutrient composition of P. biglobosa products and ultimately will contribute to selecting nutritionally "+" trees for multiplication and/or domestication of the species.

Determining factors associated with breastfeeding and complementary feeding practices in rural Southern Benin.

This study aimed at characterizing breastfeeding and complementary feeding practices in a food-insecure area of Benin and identifying factors associated with these practices. A cross-sectional study was conducted in the districts of Bopa and Houéyogbé among n = 360 mother-child pairs. Children aged 0-17 months were considered. Socioeconomic characteristics among children and mothers, Breastfeeding on demand, Breastfeeding frequency during children illness, and Positioning and Attachment of children while breastfeeding were assessed using semi-structured interviews and observations. Qualitative 24-hr recalls were administered to mothers to compute WHO recommended complementary feeding practices indicators namely minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) among 6-17 months old children (n = 232). Associations between each feeding practice and mothers' socioeconomic characteristics were tested using multivariate generalized linear models. Breastfeeding on demand and good positioning and attachment for breastfeeding rates were 59% and 66%, respectively. Only 26% of mothers used to increase breastfeeding frequency when their children were ill. The proportions of children who met MDD, MMF, and MAD were 51%, 75%, and 44%, respectively. Children living in Houéyogbé were less likely to be breastfed on demand compared with those living in Bopa; however, they had better breastfeeding frequency during illness and meal frequency. Socioeconomic factors with significant association with breastfeeding practices were children age and sex and mothers' education, ethnicity, and employment status. Complementary feeding practices were positively associated with children's age but not with other socioeconomic characteristics. Breastfeeding and complementary feeding practices were almost suboptimal or medium and still need to be improved through well designed nutrition intervention program including nutrition education.

Pathways to Diverse Diets-a Retrospective Analysis of a Participatory Nutrition-Sensitive Project in Kenya.

BACKGROUND: There is a current need for better understanding the impact of nutrition-sensitive agriculture interventions. This study is based on a community-based participatory project that diversified diets of women and children by making use of local food biodiversity. This retrospective impact pathway analysis aims at explaining why and how impact was reached. OBJECTIVES: This study aimed to understand how a nutrition-sensitive agriculture project improved people's diets by analyzing the pathways from agriculture to nutrition. It also aimed to test theoretical pathways by comparing the documented pathways with those from a widely used framework from the literature. METHODS: A qualitative study was conducted in 2019 through 10 semistructured focus group discussions with community members engaging in the project and 5 key informant interviews with local authorities that worked with these communities during the project. Summative content analysis was used to identify pathways through which the project affected diets of beneficiaries. The defined pathways were compared with the pathways of the widely used Tackling the Agriculture-Nutrition Disconnect in India (TANDI) framework from the literature. RESULTS: Out of the agriculture-nutrition pathways that are presented in the literature, 3 were found in the responses: 1) food from own production; 2) income from sale of foods produced; and 3) women's empowerment through access to and control over resources. In addition, 5 other pathways were identified and indicated spillover effects from the intervention to the control participants, increased nutrition knowledge, improved health, savings, and empowerment and harmony in the household. CONCLUSIONS: Pathway analysis in nutrition-sensitive agriculture can provide valuable understanding on how and why dietary improvements have been achieved in an intervention. The approach can hence be instrumental in addressing the current demand within the field on understanding the progress and impact of interventions. Pathway analysis also helps to address knowledge gaps regarding theoretical frameworks, as in the present study, concerning women empowerment pathways.

Born to Eat Wild: An Integrated Conservation Approach to Secure Wild Food Plants for Food Security and Nutrition.

Overlooked in national reports and in conservation programs, wild food plants (WFPs) have been a vital component of food and nutrition security for centuries. Recently, several countries have reported on the widespread and regular consumption of WFPs, particularly by rural and indigenous communities but also in urban contexts. They are reported as critical for livelihood resilience and for providing essential micronutrients to people enduring food shortages or other emergency situations. However, threats derived from changes in land use and climate, overexploitation and urbanization are reducing the availability of these biological resources in the wild and contributing to the loss of traditional knowledge associated with their use. Meanwhile, few policy measures are in place explicitly targeting their conservation and sustainable use. This can be partially attributed to a lack of scientific evidence and awareness among policymakers and relevant stakeholders of the untapped potential of WFPs, accompanied by market and non-market barriers limiting their use. This paper reviews recent efforts being undertaken in several countries to build evidence of the importance of WFPs, while providing examples of cross-sectoral cooperation and multi-stakeholder approaches that are contributing to advance their conservation and sustainable use. An integrated conservation approach is proposed contributing to secure their availability for future generations.

The Impact of Local Agrobiodiversity and Food Interventions on Cost, Nutritional Adequacy, and Affordability of Women and Children's Diet in Northern Kenya: A Modeling Exercise.

Wild plant species are often excellent sources of micronutrients and have the potential to promote healthy living, yet they are under-exploited. Distribution of micronutrient powders as diet supplements can play an effective role in reducing micronutrient deficiencies among infants and young children. However, assessing their effects in ensuring a nutritious diet at low cost have been limited. This study assessed the impact of including wild plant species and micronutrient powders in modeled optimized lowest-cost diets for women and children in rural Kenya. Market surveys, focus group discussions in six villages and a 24-h dietary intake recall were used to collect data that were subsequently entered in the cost of diet linear programming tool to model lowest-cost nutritious diets for women and children in Turkana County, Kenya. Three wild vegetables, three wild fruits, and micronutrient powder were added to the models to assess their impact on the cost and the nutrient adequacy of the diets. A locally adapted cost optimized nutritious diet without any intervention costs between 50 and 119 Kenyan shillings (KES) daily ($0.5 to $1.2) for children between 6 and 23 months and 173 to 305 KES ($1.8 to $2.9) for women. Addition of the three wild vegetables resulted in cost reductions between 30 and 71% as well as making up for iron and zinc gaps. The micronutrient powder had an insignificant effect on diet cost and filling nutrient gaps. Edible wild plant species, specifically wild vegetables, can reduce diet costs in considerable proportions while filling nutrient gaps year-round. However, affordability of a nutritious diet remains a major challenge in Turkana County, irrespective of the wealth group.

Variation in the Factors Associated With Diet Quality of Children Aged 6 to 23 Months in Low and High Agroecological Zones of Rongai Subcounty, Kenya.

BACKGROUND: Adequate quality complementary diets and appropriate feeding practices are important for proper growth and development of young children. OBJECTIVE: To assess factors associated with diet diversity, meal frequency, and acceptable diet of children aged 6 to 23 months in two agroecological zones of Rongai subcounty, Kenya. METHODS: A cross-sectional study was conducted among 384 mothers/caregivers with children aged 6 to 23 months. A structured questionnaire was used to assess sociodemographic characteristics and child feeding practices. Diet diversity, meal frequency, and acceptable diet were derived from a 24-hour recall of child's food intake. Factors associated with diet quality were determined using binary logistic regression. RESULTS: Mean child diet diversity score was 3.54 ± 1.0 of 7 food groups, with 56.8% of the children achieving minimum dietary diversity. A majority of the children (81.8%) received minimum meal frequency (MMF), with significant (P < .05) difference between low (91.1%) and high (75.2%) agricultural potential areas. Children who received minimum acceptable diet (MAD) were only 34.1%. Mother/caregiver education level positively (P < .05) associated with minimum diet diversity in low potential area (adjusted odds ratio [AOR] = 3.79, 95% CI: 1.47-9.75) and with MAD in high potential area (AOR = 1.87, 95% CI: 1.01-3.46). Other factors associated with MDD, MMF, and MAD included household income and slow feeding in low potential area, and child gender and active feeding in high potential area. CONCLUSION: There is a variation in factors associated with diet quality and child feeding practices in different agroecological zones. Therefore, nutrition education and behavior change communication interventions aimed at improving child nutrition should be context-specific.

Identification and frequency of consumption of wild edible plants over a year in central Tunisia: a mixed-methods approach.

OBJECTIVE: To identify wild plants used as food and assess their frequency of consumption over a year in a region of Tunisia where agriculture is undergoing a major transformation from smallholder farming to an intensive high-input agricultural system. DESIGN: Qualitative ethnobotanical study followed by a survey of women's frequency of consumption of wild plants conducted using FFQ at quarterly intervals. SETTING: Sidi Bouzid governorate of central Tunisia. PARTICIPANTS: Mixed-gender group of key informants (n 14) and focus group participants (n 43). Survey sample of women aged 20-49 years, representative at governorate level (n 584). RESULTS: Ethnobotanical study: thirty folk species of wild edible plants corresponding to thirty-five taxa were identified by key informants, while twenty folk species (twenty-five taxa) were described by focus groups as commonly eaten. Population-based survey: 98 % of women had consumed a wild plant over the year, with a median frequency of 2 d/month. Wild and semi-domesticated fennel (Foeniculum vulgare Mill. and Anethum graveolens) was the most frequently consumed folk species. Women in the upper tertile of wild plant consumption frequency were more likely to be in their 30s, to live in an urban area, to have non-monetary access to foods from their extended family and to belong to wealthier households. CONCLUSIONS: In this population, wild edible plants, predominantly leafy vegetables, are appreciated but consumed infrequently. Their favourable perception, however, offers an opportunity for promoting their consumption which could play a role in providing healthy diets and mitigating the obesity epidemic that is affecting the Tunisian population.

Exploring agrobiodiversity for nutrition: Household on-farm agrobiodiversity is associated with improved quality of diet of young children in Vihiga, Kenya.

Due to their limited access to the external productive inputs and the dependency on rain-fed agricultural production, small scale farmers in sub-Saharan Africa have continued to face undernutrition despite the significant advancements in agriculture. They however often live in areas endowed with high agrobiodiversity which could contribute, if explored, to improved diets and nutrition. Few studies have linked the contribution of agrobiodiversity to the micronutrient adequacy of the diets of young children among smallholder farmers. The study explored this relationship and contributes to the growing body of literature linking agrobiodiversity to nutrition of young children. Two cross-sectional surveys were conducted as part of baseline assessment for an intervention study, one in the lean and a second in the plenty season in Vihiga county, Kenya. Household level interviews were administered to 634 households with children 12-23 months. Agrobiodiversity was defined as the number of crop species cultivated or harvested from the wild and the number of livestock maintained by the household across two agricultural seasons. Dietary data were collected using two-non-consecutive quantitative 24-hour recalls and analyzed using Lucille software. Diet quality was assessed using dietary diversity score based on seven food groups and mean probability of micronutrient adequacy computed for eleven micronutrients. A total of 80 species were maintained or harvested from the wild by the households. Mean household species richness was 9.9 ± 4.3. One in every four children did not meet the minimum dietary diversity score. The average mean probability of micronutrient adequacy was 68.11 ± 16.08 in plenty season compared to 56.37± 19.5% in the lean season. Iron, zinc and calcium were most limiting micronutrients in the diet, with less than 30% average probability of adequacy in both seasons. Household agrobiodiversity was positively associated with both dietary diversity score (r = 0.09, p = 0.029) and micronutrient adequacy (r = 0.15, p<0.000) in the pooled sample. One unit increase in species diversity was associated with 12.7% improvement in micronutrient adequacy. Despite the rich agrobiodiversity in the study area the diets were low in diversity and there is an unrealized opportunity to improve micronutrient intake through greater promotion and consumption of locally available agrobiodiversity.

Participatory farm diversification and nutrition education increase dietary diversity in Western Kenya.

Our study assessed the effectiveness of a community-based participatory approach in increasing micronutrient adequacy of diets of women and young children through agricultural activities and nutrition education in Vihiga County, Western Kenya. Outcome indicators include the mean dietary diversity score (DDS), the percentage of women and children reaching minimum dietary diversity (MDD), and micronutrient adequacy (mean adequacy ratio). The project consisted of(a) a diagnostic survey covering agrobiodiversity and nutrition, (b) participatory development of activities to improve nutrition, (c) a baseline survey covering dietary intakes, (d) participatory implementation of the developed activities, and (e) an endline survey covering dietary intakes. The diagnostic survey was conducted in 10 sublocations of Vihiga County, which were pair-matched and split into five intervention and five control sublocations. The intervention sublocations developed activities towards improving nutrition. Before implementation, a baseline survey collected the dietary intake data of 330 women-child pairs in the intervention and control sublocations. To support the activities, communities received agriculture and nutrition training. After 1 year of implementation, an endline survey collected dietary intake data from 444 women-child pairs in the intervention and control sublocations. Impact was assessed using the difference-in-difference technique. Highly significant positive impacts on children's mean DDS (treatment effect = 0.7, p < 0.001) and on the share of children reaching MDD (treatment effect = 0.2, p < 0.001) were shown. Higher dietary diversity can be explained by the development of subsistence and income-generating pathways and increased nutrition knowledge. Participatory farm diversification and nutrition education were shown to significantly increase dietary diversity of young children in Western Kenya.

Determinants of dietary diversity among women of reproductive age in two different agro-ecological zones of Rongai Sub-County, Nakuru, Kenya.

BACKGROUND: Empirical evidence on the link between agrobiodiversity and dietary diversity appears to be inconclusive. Thus, there arises a need to determine other factors that could significantly influence dietary diversity in different agro-ecological zones, as factors may vary from region to region. OBJECTIVE: The objective of this study was to document the status of agrobiodiversity and dietary diversity and to assess the determinants of dietary diversity among women of reproductive age in two different agro-ecological zones of Rongai Sub-County in Kenya. DESIGN: A cross-sectional study of 384 women aged 18-49 years was conducted. Agrobiodiversity was measured using the Shannon-Wiener index, species richness (count) and production diversity score. A 24-hour dietary recall was used to determine minimum dietary diversity for women (MDD-W) of reproductive age. RESULTS: Although the level of agrobiodiversity was different between the low and high agro-ecological zones (using Shannon-Wiener index); the women's dietary diversity was not different (p > 0.05) between low (3.78 ± 0.99) and high potential areas (3.84 ± 1.05). In multivariate logistic regression, there was no association (p > 0.05) between agrobiodiversity indicators and dietary diversity across the two agricultural zones. Factors influencing MDD-W in two agricultural zones were different. In low potential areas, woman's education level positively determined dietary diversity, while in high potential areas household gender, woman's education level, woman's age and family size influenced MDD-W. CONCLUSION: The proportion of women who met minimum dietary diversity was low. Although agrobiodiversity was different in the two agro-ecological zones, women's dietary diversity scores were similar. In low agricultural potential areas, only education level influenced women's dietary diversity while household gender, education level, age and family size were the important determinants in high agricultural potential areas. Therefore, it is recommended that nutrition interventions focusing on lessening malnutrition and improving dietary quality should pay special attention to differences in agro-ecological zones to develop region-specific interventions instead of generalizing interventions.

Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets.

Smallholder farmers dependent on rain-fed agriculture experience seasonal variations in food and nutrient availability occasioned by seasonality of production patterns. This results in periods of nutrient abundance in the plenty seasons followed closely by periods of nutrient inadequacies and malnutrition. This pattern contributes to a cycle of deteriorating health and nutrition status and deprives children of their ability to realize full developmental potential. This study investigates the role of caregiver's nutritional knowledge and attitudes in mediating effects of seasonality on children's diets. Repeated cross-sectional surveys were conducted on 151 randomly selected households in the plenty and lean seasons to collect dietary data using two non-consecutive quantitative 24-hr recalls and caregiver's nutritional knowledge and attitudes assessed using interviewer administered questionnaire. Sixty-five percent of the caregivers had attained a primary level education or less. There was a positive modest correlation between caregivers' nutritional knowledge and their attitudes (r = 0.3, P < 0.000, α = 0.01). Children's mean adequacy ratio was significantly higher in the plenty season than in the lean season (0.84 vs. 0.80, P < 0.000). A two-block hierarchical regression to predict the seasonal changes in dietary quality of children using caregiver's nutritional knowledge and attitude scores while controlling for the effect of sociodemographics and mean adequacy ratio at first season (plenty) found that caregiver's nutritional knowledge (ß = -0.007, SE = 0.003, P = 0.027, 95% CI [-0.013, -0.001] ŋ2  = 0.034) but not attitudes had significant contribution to the prediction. Maternal nutritional knowledge mediates seasonal variation in child nutrient intakes.

Dietary species richness as a measure of food biodiversity and nutritional quality of diets.

Biodiversity is key for human and environmental health. Available dietary and ecological indicators are not designed to assess the intricate relationship between food biodiversity and diet quality. We applied biodiversity indicators to dietary intake data from and assessed associations with diet quality of women and young children. Data from 24-hour diet recalls (55% in the wet season) of n = 6,226 participants (34% women) in rural areas from seven low- and middle-income countries were analyzed. Mean adequacies of vitamin A, vitamin C, folate, calcium, iron, and zinc and diet diversity score (DDS) were used to assess diet quality. Associations of biodiversity indicators with nutrient adequacy were quantified using multilevel models, receiver operating characteristic curves, and test sensitivity and specificity. A total of 234 different species were consumed, of which <30% were consumed in more than one country. Nine species were consumed in all countries and provided, on average, 61% of total energy intake and a significant contribution of micronutrients in the wet season. Compared with Simpson's index of diversity and functional diversity, species richness (SR) showed stronger associations and better diagnostic properties with micronutrient adequacy. For every additional species consumed, dietary nutrient adequacy increased by 0.03 (P < 0.001). Diets with higher nutrient adequacy were mostly obtained when both SR and DDS were maximal. Adding SR to the minimum cutoff for minimum diet diversity improved the ability to detect diets with higher micronutrient adequacy in women but not in children. Dietary SR is recommended as the most appropriate measure of food biodiversity in diets.

Barriers to Eating Traditional Foods Vary by Age Group in Ecuador With Biodiversity Loss as a Key Issue.

OBJECTIVE: To document the perceptions of indigenous peoples for the sustainable management of natural resources against malnutrition. DESIGN: Initially 4 and then 12 interviews were conducted with 4 different age groups. SETTING: Eight rural villages in Guasaganda, central Ecuador, were studied in 2011-2012. PARTICIPANTS: A total of 75 people (22 children, 18 adolescents, 20 adults, and 15 elders). MAIN OUTCOME MEASURES: Benefits, severity, susceptibility, barriers, cues to action, and self-efficacy of eating traditional foods. ANALYSIS: Qualitative content analysis was completed using NVivo software. Initial analysis was inductive, followed by a content analysis directed by the Health Belief Model. Coding was completed independently by 2 researchers and kappa statistics (κ ≥ 0.65) were used to evaluate agreement. RESULTS: Healthy perceptions toward traditional foods existed and differed by age. Local young people ate traditional foods for their health benefits and good taste; adults cultivated traditional foods that had an economic benefit. Traditional knowledge used for consumption and cultivation of traditional foods was present but needs to be disseminated. CONCLUSIONS AND IMPLICATIONS: Nutrition education in schools is needed that supports traditional knowledge in younger groups and prevents dietary changes toward unhealthy eating. Increased production of traditional food is needed to address current economic realities.