Market food diversity mitigates the effect of environment on women's dietary diversity in the Agriculture to Nutrition (ATONU) study, Ethiopia

Abstract

Objective: In Ethiopia, women's dietary diversity is low, primarily due to poor food availability and access, both at home and market level. The present study aimed to describe market access using a new definition called market food diversity (MFD) and estimate the impact of MFD, crop and livestock diversity on dietary diversity among women enrolled in the Agriculture to Nutrition (ATONU) trial.

Design: Baseline cross-sectional data collected from November 2016 to January 2017 were used for the analysis. Availability of foods in markets was assessed at the village level and categorized into nine food groups similar to the dietary diversity index for women. Bivariate and multivariate mixed-effects regression analyses were conducted, adjusted for clustering at the village level.

Setting: Chicken-producing farmers in rural Ethiopia.ParticipantsWomen (n 2117) aged 15-49 years.

Results: Overall, less than 6 % of women met the minimum dietary diversity (≥5 food groups) and the most commonly consumed food groups were staples and legumes. Median MFD was 4 food groups (interquartile range: 2-8). Multivariate models indicated that women's dietary diversity differed by livestock diversity, food crop diversity and agroecology, with significant interaction effects between agroecology and MFD.

Conclusions: Women's dietary diversity is poor in Ethiopia. Local markets are variable in food availability across seasons and agroecological zones. The MFD indicator captures this variability, and women who have access to higher MFD in the highland agroecological zone have better dietary diversity. Thus, MFD has the potential to mitigate the effects of environment on women's dietary diversity.

Keywords: Agriculture; Farm diversity; Livestock diversity; Market food diversity; Nutrition.

Fig. 1

Proportion reporting market food availability (as indicated by two key informants in each village) by agroecological zone: (a) lowland, (b) midland and (c) highland; Agriculture to Nutrition (ATONU) study, rural Ethiopia, November 2016–January 2017. Green colour or density of 1·0 denotes that all markets assessed in the particular zone and month have availability of the selected foods, while light purple and grey (density of 0·0) denotes very low availability. Food items are ordered by overall availability, where maize was nearly universally available in markets and pumpkin was the least available. Blanks represent no availability; for example, carrots are not found in the month of July among markets in the lowland agroecological zone

Fig. 2

Relationship between women’s dietary diversity in the previous 24h and (a) market food diversity in November 2017, (b) livestock diversity, (c) food crop diversity in Meher season and (d) food crop diversity in Belg season; Agriculture to Nutrition (ATONU) study, rural Ethiopia, November 2016–January 2017. Values are means (), with their standard errors represented by vertical bars; represent the range of dietary diversity scores. Slope and P value from bivariate models adjusted for kebele: (a) slope=–0·02, P=0·286; (b) slope=0·10, P<0·001; (c) slope=0·13, P<0·001; (d) slope=0·05, P=0·179

Fig. 3

Regression results from models examining the effect of market food, food crop and livestock diversity, region and agroecological zone on women’s dietary diversity; Agriculture to Nutrition (ATONU) study, rural Ethiopia, November 2016–January 2017. Values are regression coefficients, with their 95 % CI represented by horizontal bars, from bivariate models (), multivariate models without interaction terms () and multivariate models with interaction terms (). Multivariate models adjusted for region, education, women’s education, wealth quintiles, woman’s age, age of the household head, household size, access to improved water and sanitation, and kebele-level clustering (SNNPR, Southern Nations, Nationalities and Peoples’ Region). Other coefficients are presented in the online supplementary material, Supplemental Table 3

Fig. 4

Predicted women’s dietary diversity score, with 95 % confidence interval represented by shaded band, from the adjusted multivariate model that includes interaction between agroecology (, , lowland; , , midland; , , highland) and market food diversity; Agriculture to Nutrition (ATONU) study, rural Ethiopia, November 2016–January 2017. Highland agroecological zone × market food diversity has estimated slope=0·18 and P=0·001