Status of household dietary diversity and associated factors among rural and urban households of Northern Uganda.
Date
2023
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Nature
Abstract
Background In Northern Uganda, 21 and 52.4% of children under five are underweight and stunted, respectively
while 32.9% of pregnant women are anemic. This demographic situation suggests among other issues, a lack of die
tary diversity among households. Good nutrition practices that confer dietary quality such as dietary diversity are
known to depend on nutrition knowledge and attitude and are shaped by sociodemographic and cultural factors.
However, there is a paucity of empirical evidence to support this assertion for the variably malnourished population
of Northern Uganda.
Methods A cross-sectional nutrition survey was conducted among 364 household caregivers (182 from two loca
tions in Northern Uganda; Gulu District (the rural) and Gulu City (the urban), selected through a multistage sampling
approach. The aim was to determine the status of dietary diversity and its associated factors between rural and urban
households of Northern Uganda. The household dietary diversity questionnaire and the food frequency questionnaire
on a 7-day reference period were used to collect data on household dietary diversity whereas multiple choice ques
tions and the five points Likert Scale were used to determine knowledge and attitude toward dietary diversity. Con
sumption of ≤ 5 food groups were regarded as low in dietary diversity, 6–8 food groups as medium and ≥ 9 as high
dietary diversity score using the FAO 12 food groups. An Independent two-sample t-test was used to differentiate
the status of dietary diversity between the urban and rural areas. The Pearson Chi-square Test was used to determine
the status of knowledge and attitude while Poisson regression was used to predict dietary diversity based on caregiv
ers’ nutritional knowledge and attitude and their associated factors.
Results The 7-day dietary recall period revealed that dietary diversity was 22% higher in urban (Gulu City) than in the
rural area (Gulu District) with rural and urban households achieving medium (score of 8.76 ± 1.37) and high (score
of 9.57 ± 1.44) dietary diversity status, respectively. Diets in both locations were dominated by starchy cereals
and tubers while animal-source foods and fruits and vegetables were the least consumed. A higher proportion
(51.65%) of urban respondents had good nutrition knowledge toward dietary diversity compared to their rural
counterparts (23.08%) and a significantly higher proportion (87.91%) of the former exhibited positive attitude
towards dietary diversity than the rural counterparts (72.53%). Application of the Poisson regression shows that nutri
tional knowledge was a positive predictor of dietary diversity in the rural (β = 0.114; ρ = 0.000) than in the urban areas
(β = -0.008; ρ = 0.551). Caregivers attitude had no significant effect across locations. In terms of associated factors,
marital status is a positive predictor of dietary diversity in the urban (β = 1.700; ρ = 0.001) than the other location (β = -2.541; ρ = 0.008). Whereas education level of household caregiver and household food expenditure show nega
tive effects across the two locations, the educational level of the household head is an outlier as it positively predicted
dietary diversity in the rural (β = 0.003; ρ = 0.002) when compared to urban area (β = -0.002; ρ = -0.011).
Conclusion Rural households in Northern Uganda have medium-level dietary diversity with urban households hav
ing high dietary diversity. Diets in both locations are dominated by starchy cereals and roots and tubers. The urban
rural food divide can be harmonized through nutrition education and outreach, specifically focusing on the FAO 12
food groups. Attitude toward consumption of fruits and vegetables which are seasonally abundant would improve
dietary diversity and nutritional outcomes in the study area.
Description
Keywords
Attitude, Dietary diversity, Gulu district, Knowledge, Rural, Urban
Citation
Kolliesuah, N. P., Olum, S., & Ongeng, D. (2023). Status of household dietary diversity and associated factors among rural and urban households of Northern Uganda. BMC nutrition, 9(1), 83.