Study design, setting and subjects
A cross-sectional study designed was used to assess dietary diversity in under-fives. It was conducted in Ekumfi Narkwa, a sub-district of Ekumfi in the Central region of Ghana. The sample consisted of two hundred and fifty (250) children between six to fifty-nine (6–59) months who had started complementary food and their caregivers. Children were identified from the four (4) suburbs in the community namely Asemasa- Esikado, Ahenbrom, Kokodo and Adukrom. A selection based on proportionate to size was used to select respondents from communities. A minimum of forty-five (45) subjects were selected form each suburb using the modified random walk.
In the modified random walk, key land marks in the community such as private and public schools, churches, mosque, Community- based Health Planning Services (CHPS) compound, community information centre and the taxi rank were listed. One of the major landmarks in the suburb was randomly selected. The first house closest to the landmark was chosen as the first house from which subjects were selected. The selection continued from there in a clockwise direction till the required sample size for the suburb was obtained. For Asemaasa-Esikado, Ahemrom, Kokodo, and Adukrom suburbs the following key landmarks were selected the Methodist church, Ahembrom, the information centre, the child welfare clinic site and the Methodist Primary school respectively.
Caregivers with children under-five years were identified by asking the residents. In a house with several households, one child aged 6–59 months from each of the different households was eligible to participate. The study was explained to the caregivers of these children and they were taken through the consent procedure if they agreed to take part. In households where a mother had two children under-five years, one of the children was randomly select by a simple ballot process using folded pieces of paper with the child’s name on it. The child whose name was picked by the mother, was automatically selected to be part of the study.
Participation in the study was based on willingness of the caregiver to give full consent and the availability of the child during the study period.
Assessment of nutrient intake
Data collection was done by trained local field workers with a pre-tested questionnaire in the homes of the subjects. Data collected included; the background characteristics of respondents and children, dietary intake of the children. A pre-tested dietary diversity questionnaire adopted from the Food And Nutrition Technical Assistance (FANTA) project, [18] was used to capture information of dietary consumption over a period of seven (7) days. The reference period was chosen according to Food and Agriculture Organization (FAO) guidelines for measuring household and individual dietary diversity [11]. The caregivers were asked whether; the children had eaten foods from the seven (7) main food groups over the past seven days and the number of days they had consumed foods from each food group. Data gathered were recorded accordingly.
The food groups assessed were;
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a.
Grains, roots or tubers and plantain
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b.
Vitamin A-rich plant foods
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c.
Other fruits and vegetables
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d.
Flesh foods (Meat, poultry, fish and seafood)
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e.
Eggs
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f.
Pulses, legumes or nuts
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g.
Milk and milk products
Foods consumed from the sugary food group (sweets, pastries and drinks), were also recorded. However, it was excluded from the analysis because they are known to have poor bioavailability of micronutrients [19].
The individual dietary diversity score (IDDS), was calculated for each subject. It was calculated as follows; every child who had consumed foods from a particular food group for more than five days in the past week was scored 1. The total number of 1 score each child had gotten was added up, as their individual dietary diversity score. The highest dietary diversity score was 7. However, sugary foods were not added to the scoring. The average dietary diversity score of the subjects was also calculated.
The minimum dietary diversity of the children in the community was calculated using the formula
$$ \frac{\mathrm{Number}\ \mathrm{of}\ \mathrm{children}\ \left(6\hbox{-} 59\ \mathrm{months}\right)\mathrm{who}\ \mathrm{recieved}\ \mathrm{food}\ \mathrm{from}\ \mathrm{four}(4)\ \mathrm{or}\ \mathrm{more}\ \mathrm{food}\ \mathrm{groups}\ \mathrm{in}\ \mathrm{the}\ \mathrm{past}\ \mathrm{seven}\ \mathrm{days}}{\mathrm{Number}\ \mathrm{of}\ \mathrm{children}\ \left(6\hbox{-} 59\ \mathrm{months}\right)}\kern0.75em \times 100\% $$
Modified from [20]
The minimum dietary diversity for the various age groups was also calculated. Data collected on demographic characteristics and their general practices were presented in tables as frequencies and percentages.
