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Research Detail

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Andrew L. Thorne-Lyman
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115

Natalie Valpiani
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111;

Kai Sun
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205

Richard D. Semba
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205

Christine L. Klotz
Nutrition Service, Policy, Strategy and Programme Support Division, World Food Programme, 00148 Rome, Italy;

Klaus Kraemer
Sight and Life, 4002 Basel, Switzerland

Nasima Akhter
Helen Keller International Asia Pacific, Dhaka 1212, Bangladesh

Saskia de Pee
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111; 7 Nutrition Service, Policy, Strategy and Programme Support Division, World Food Programme, 00148 Rome, Italy

Regina Moench-Pfanner
10 Global Alliance for Improved Nutrition, 1202 Geneva, Switzerland;

Mayang Sari
Helen Keller International, New York, NY 10010

Martin W. Bloem
Nutrition Service, Policy, Strategy and Programme Support Division, World Food Programme, 00148 Rome, Italy; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205

In Bangladesh, rice prices are known to be positively associated with the prevalence of child underweight and inversely associated with household non grain food expenditures, an indicator of dietary quality. The collection of reliable data on household expenditures is relatively time consuming and requires extensive training. Simple dietary diversity scores are increasingly used as measures of food security and as proxies for nutrient adequacy. This study examines associations between a simple dietary diversity score and commonly used indicators of socioeconomic status in Bangladesh. Data representative of rural Bangladesh was collected from 188,835 households over 18 rounds of bi-monthly data collection from 2003–2005. A simple household dietary diversity score was developed by summing the number of days each household consumed an item from each of 7 food groups over a 7-d period. The dietary diversity score was associated with per capita non grain food expenditures (r = 0.415), total food expenditures (r = 0.327), and total household expenditures (r = 0.332) using Spearman correlations (all P , 0.0001). The frequency of meat and egg consumption showed greater variation across quintiles of total monthly expenditure than other items contributing to the dietary diversity score. After controlling for other measures of socioeconomic status in multiple linear regression models, the dietary diversity score was significantly associated with monthly per capita food and total expenditures. Low dietary diversity during the period prior to major food price increases indicates potential risk for worsening of micronutrient deficiencies and child malnutrition in Bangladesh.

  Household Dietary Diversity, Food Expenditures, Closely Linked in Rural Bangladesh, Increasing the Risk of Malnutrition, Financial Crisis1
  Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet, and the Chittagong Hill Tracts
  
  
  Socio-economic and Policy
  Income generation

This analysis adds to the literature supporting the use of dietary diversity measures as indicators that may be particularly useful in settings where more in-depth tools may not be easily applied.

Sampling Data were collected from 188,835 households that participated in the Nutritional Surveillance Project (NSP) of Bangladesh in 2003–2005. The NSP was established in 1989 by Helen Keller International and the Institute of Public Health Nutrition of the Government of Bangladesh. A stratified multistage cluster design was used and indicators were chosen based on the United Nations Children’s Fund’s conceptual framework of the causes of malnutrition. Rural households were selected from 4 sub districts in each of the 6 divisions of Bangladesh: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet, and the Chittagong Hill Tracts. Sampling was designed to statistically represent each of the divisions as well as the entire country of Bangladesh. Data collection Two-person field teams, trained by Helen Keller International, collected data every 2 mo coinciding with the different seasons of Bangladesh, resulting in a total of 18 rounds of data collection over the 3 y covered in this paper. A new cross-sectional sample was drawn each round. Quality control was ensured by refresher trainings before each round of data collection and by random supervisor visits with repeated collection of a subsample of the data within 24 h of the initial data collection. A structured coded questionnaire was used to collect data. The household head or another adult household member provided information on the household’s composition, weekly expenditures, land ownership, parental education, and other socioeconomic and health indicators. Each household was asked to report expenditures from the previous 7 d on rice, wheat, eggs, pulses, fish, vegetables, fruits, meat, poultry, milk, sweet biscuits, snacks, spices, sugar, cooking oil, and other foods. Data were collected on the following nonfood expenditures for the previous month: medical care, education, housing, agricultural inputs and livestock purchases, electricity, fuel, taxes, loan payments, and other household items. Expenditure variables were collected in Bangladeshi taka. A 7-d recall was used to collect information on the number of days each household consumed typical foods commonly available in rural Bangladesh, including yellow/orange fruits and vegetables, green leafy vegetables (shak), meat, chicken, fish, eggs, or pulses (dal). Data analysis A simple household dietary diversity score was created from the non grain food groups described above. The score was calculated as the unweighted sum of the number of days in the previous week households consumed at least one item from each of the 7 food groups described above. The range of possible scores was 0–49. In keeping with our interest in the validity of simple measures, the proxies used in this analysis for food security and household wealth are straightforward. In the absence of data on energy availability at the household level, we use household expenditures as our comparison measures for food security. Household level food consumption and food expenditure data were collected in the NSP using a 7-d recall. Though we consider dietary diversity and food security at the household level, we created per capita expenditure variables for use in the analysis to control for the effects of household size on spending. Monthly per capita non grain food expenditure represents the sum of reported 7-d expenditure on the food categories given in the expanded list above, except rice and wheat, multiplied by the mean number of weeks per month (4.34 wk/mo). Because few of the poorest households purchase large amounts of rice, a monetary value for in-kind rice was included in total food expenditure calculations (21). Rice produced on a household’s land, received as in-kind payment for labor, and received as a gift was reported in kilograms and assigned a monetary value determined by the daily market price of rice recorded at the time of the survey. This monetary value was summed with cash expenditure on grain and non grain foods and divided by household size to calculate monthly per capita total food expenditure. Extreme outliers of total food expenditure were identified and removed during data cleaning. Nonfood expenditures, collected using a 1-mo recall period, were summed and divided by household size. The result was added to per capita total food expenditure to arrive at an estimate of monthly per capita total expenditure, a proxy for household income. The amount of cultivable land owned by the household, another important socioeconomic indicator in Bangladesh, was reported in decimals. For analysis, we first calculated the hectare (ha) equivalent of the decimals owned and then created a categorical land ownership variable using cutoff values consistent with previous research in Bangladesh (2,22). Households owning 0 ha were categorized as landless. Land ownership fell into the following categories: marginal, which included any land up to 0.2 ha; small, from 0.201 to 1.0 ha; medium, from 1.01 to 2.0 ha; and large, which included any land .2 ha. The area of the main dwelling, in square meters, was calculated by multiplying the reported length and width. For both maternal and paternal education, values .12 were recoded as 12 y of education because of the small sample size of individuals with more than a high school level education. Statistical analyses were performed using SAS Survey (SAS Institute). To represent the rural population of Bangladesh, analyses were weighted according to the population of each of the 7 divisions of Bangladesh and adjusted for the multi-stage cluster design of the NSP. The unit of analysis was the household and those with multiple children were counted only once. Spearman correlation tests were used to examine associations between dietary diversity score and expenditure variables, parental education variables, amount of cultivable land owned by household, the area of the main dwelling, sex of household head, and number of members in household. Differences in mean dietary diversity score between quintiles of total expenditure and food expenditure were examined using 1-way ANOVA with multiple comparison tests undertaken using the Tukey-Kramer adjustment (P , 0.05). ANOVA models were also used to compare mean weekly household food expenditures, non grain food expenditures, and expenditures on each individual food group by quintile of dietary diversity score. Multiple linear regression models were used to test associations between each expenditure variable and the score, controlling for land ownership, parent education, number of household members, and area of main dwelling. Values in the text are means 6 SD.

  J. Nutr. 140: 182S–188S, 2010.
  
Funding Source:
1.   Budget:  
  

In conclusion, the significant differences in non grain food spending and consumption between poorer and wealthier households in the present analysis draw attention to the need to consider a broad definition of food security, particularly when developing policy responses to food crises. Indeed, analysis of data from Bangladesh has consistently shown that the percentage of underweight children was lower in households who spent more on non rice foods (6,26). While the findings presented here reinforce the idea that lowering the price of rice will enable households to diversify their diets, the fact that even those in the upper quintile of expenditures consume animal source foods infrequently suggests the need for interventions that specifically address micronutrient deficiencies to be part of the response to food crises.

  Journal
  


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