Department of Statistics, Shahjalal University of Science & Technology, Sylhet, Bangladesh.
Team Leader of 5th Year Annual Evaluation of JANO Project, Sylhet, Bangladesh.
PLoS One. 2024 Oct 3;19(10):e0309213. doi: 10.1371/journal.pone.0309213. eCollection 2024.
Maternal and child health, which is integral to public health, depends on maintaining a healthy diet during pregnancy and lactation to achieve optimal outcomes. This study aimed to investigate the prevalence and determinants of minimum dietary diversity (MDD) among pregnant and lactating women (PLW) in this particular context.
A stratified cluster sampling approach was employed, encompassing intervention areas (Rangpur and Nilphamari in Bangladesh) as strata, with 30 clusters. The study included 631 pregnant and lactating women (PLW) aged 15 to 49 years, focusing on their consumption of a minimally diverse diet. The outcome variable was binary: MDD (1 = if they consumed ≥ 5 food items from a basket of 10 food groups, indicating they met the MDD; 0 = if they consumed < 5 items, indicating they did not meet the MDD), assessed based on ten food groups over a 24-hour period. The data were analyzed using a binary logistic regression model.
The study found that 51.19% of PLW met MDD criteria, indicating positive dietary practices. Those aged 21-49 years had significantly lower odds of meeting MDD than those aged 15-20 years. Education played a key role, with completion of primary (p = 0.029) and secondary incomplete education (p = 0.055) associated with higher odds of meeting MDD. Other identified predictors included climate-smart techniques for agriculture, women's empowerment, food security, producing legume, nut and seeds and negative impact on family expenditure due to increase in commodity prices, especially food prices. Employing climate-smart agriculture increased odds by 1.58 times (p = 0.028), empowered women had 2.31 times higher odds (p < 0.001), and food security played a crucial role (p = 0.006). Moreover, producing legumes, nuts, or seeds was significantly associated with higher odds of meeting MDD (OR = 1.55, p = 0.039), while experiencing negative economic impacts lowered the odds (OR = 0.63, p = 0.034).
The study provides insights into factors influencing MDD among PLW in northern Bangladesh. Empowering women and promoting climate-smart techniques for agriculture emerged as pivotal determinants, alongside enhancing education levels, increasing food security, and addressing economic barriers. Implementing multifaceted interventions that consider socio-demographic diversity, economic disparities, and dietary preferences is crucial for enhancing dietary diversity and improving health outcomes in this vulnerable population.
母婴健康是公共卫生的重要组成部分，这取决于孕妇和哺乳期妇女（PLW）在妊娠和哺乳期保持健康饮食，以实现最佳结果。本研究旨在调查这一特定背景下孕妇和哺乳期妇女（PLW）最低饮食多样性（MDD）的流行情况和决定因素。
采用分层聚类抽样方法，将干预地区（孟加拉国的朗布尔和尼拉帕尔）作为分层，共 30 个聚类。研究纳入了 631 名 15 至 49 岁的孕妇和哺乳期妇女（PLW），重点关注她们从十种食物组的篮子中摄入最低限度多样化的饮食。因变量是二元的：MDD（1=如果她们摄入≥5 种食物来自十种食物组的篮子，表明她们符合 MDD；0=如果她们摄入<5 种食物，表明她们不符合 MDD），根据 24 小时内摄入的十种食物进行评估。数据采用二元逻辑回归模型进行分析。
研究发现，51.19%的 PLW 符合 MDD 标准，表明饮食行为良好。21-49 岁的 PLW 与 15-20 岁的 PLW 相比，达到 MDD 的可能性显著降低。教育是一个关键因素，完成小学（p=0.029）和未完成中学教育（p=0.055）与更高的达到 MDD 的可能性相关。其他确定的预测因素包括农业气候智能技术、增强妇女权能、粮食安全、生产豆类、坚果和种子，以及由于商品价格上涨特别是食品价格上涨对家庭支出产生负面影响。采用气候智能农业使可能性增加了 1.58 倍（p=0.028），增强妇女权能使可能性增加了 2.31 倍（p<0.001），粮食安全发挥了关键作用（p=0.006）。此外，生产豆类、坚果或种子与达到 MDD 的可能性显著相关（OR=1.55，p=0.039），而经历经济负面影响则降低了可能性（OR=0.63，p=0.034）。
本研究提供了有关孟加拉国北部 PLW 最低饮食多样性（MDD）影响因素的见解。增强妇女权能和推广农业气候智能技术是关键决定因素，同时还需要提高教育水平、增加粮食安全并解决经济障碍。实施考虑社会人口多样性、经济差距和饮食偏好的多方面干预措施，对于提高这一脆弱人群的饮食多样性和改善健康结果至关重要。
