Household Dietary Diversity is a Strong Predictor of Average Nutrient Adequacy in Ethiopia


by Daniel Mekonnen | August 27, 2020

Over the past two decades, Ethiopia has made significant progress in reducing child undernutrition and increasing average caloric consumption per capita. However, this progress does not seem to be matched by a corresponding reduction in micronutrient malnutrition, commonly known as hidden hunger. Low dietary diversity and nutritional inadequacy remain widely prevalent in Ethiopia. Starchy staples including cereals, root crops (potatoes, sweet potatoes, cassava, and other root crops), and enset/kocho make up more than 75 percent of total calorie intakes, while the recommendation is that calories from staples should not be more than 60 percent. With such a small percentage of the diet made up of nutrient-rich foods such as fruits, vegetables, and animal-source foods, iron, zinc and vitamin A deficiencies are mild-to-moderate public health problems in the country. According to WHO, major health consequences of deficiency in these nutrients include poor pregnancy outcome, impaired physical and cognitive development, increased risk of blindness and morbidity in children and reduced work productivity in adults.

To better understand the problems of diets and nutrition and identify potential interventions, there is need for repeated national food consumption surveys that take a food systems perspective. A food systems approach understands food as a “system” and may help identify the problem areas in the context of nutrient acquisition as well as enabling innovations, interactions and dynamics among the different components of food systems. This is because food systems affect human and planetary health, influence producers’ decisions and consumers’ food choices, and vice versa. However, these surveys are not often undertaken in Ethiopia because they are more costly, and when they are available, they often lack information on important parts of the food system, including production, processing, distribution, trade, food environments and consumer behavior, preventing researchers, policy makers, and other stakeholders from getting a full system perspective.

In a paper recently published in Food Security, researchers at Wageningen University & Research, working as part of A4NH’s Food Systems for Healthier Diets research flagship, examined how the various components of food systems may explain household dietary diversity (HDDS) and nutrient adequacies in Ethiopia. Dietary diversity is one of the proxies for diet quality and previous studies have shown that individual (in some studies household) dietary diversity is associated with nutrient adequacy. Using the 2015-2016 Ethiopia Living Standards Measurement Study - Integrated Surveys on Agriculture (LSMS-ISA), we found that households who live closer to a city or large population center, or those with access to health and transport services, reach higher HDDS than their counterparts with limited or no access to such services. We also found that the average nutrient consumption varies by place of residence and income profile, where households in urban areas and those in the higher income quintiles tend to have greater nutrient intake than those in rural areas or with lower incomes.

Attaining household nutrient adequacy may require consumption of a broad number of food groups. Hence, we examined the associations between HDDS and the mean probability of nutrient adequacy (MPA), and the potential threshold effects of household dietary diversity score in Ethiopia. This revealed several interesting findings:

  1. Econometric results showed that HDDS is indeed strongly associated with a household’s MPA. We found that a standard deviation increase in HDDS is associated with about a 15 percent increase over the MPA.
  2. Based on a household’s food consumption over seven days, results showed that an HDDS of 10 is the minimum threshold at which HDDS may improve household MPA in Ethiopia. Even though there is no universally accepted HDDS threshold that would indicate sufficiency to improve household MPA, a threshold of 10 out of 12 food groups seems to be high. This seems to suggest that at least some of the food groups are consumed in insufficient quantities. Further research examining the contribution of each food group to MPA may help identify food groups with higher potential to improving the MPA.

In the context of research on dietary diversity and nutrient adequacy, the LSMS or Household Consumption Expenditure surveys (HCES) have major limitations. For example, the recall period is longer – seven days instead of 24 hours – raising concern about reliability. Also, dietary information is about the household’s consumption instead of the individual’s dietary intake, while the amounts of food consumed during the recall period is estimated by the respondent and not weighed and food items are recalled from fixed list and with insufficient detail to make exact matches between the food items in the list and a food composition database. Moreover, information on the out-of-home consumption is insufficient to be included in calculations.

Despite these limitations, our estimates of the prevalence of inadequacies of iron, zinc and vitamin A in the country are comparable to that of a previous national food consumption survey in Ethiopia. This adds evidence to Coates et al. (2017) and Sununtnasuk and Fiedler (2017) which show the potential of HCES/LSMS to help draw policy-relevant information in the absence of national food consumption surveys. These surveys are large in size, nationally representative, and collected every three to five years, allowing for analysis of trends and progresses. These surveys often include a wide range of indicators including household food consumption, socio-demographic characteristics, and food system components, allowing for various analytical options.

Given the caveats, results of our study provide suggestive evidence that policies and interventions targeting HDDS may improve household nutrient adequacy or reduce hidden hunger in Ethiopia. Our study showed that a systems approach that improves household incomes, together with the improvement of access to health and transport services may be beneficial.

Daniel Mekonnen is a researcher at Wageningen University & Research. 


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