Prevalence and associated factors of meeting minimum dietary diversity for women among pregnant and non-pregnant women of reproductive age in three sub-Saharan African countries

Abstract

Introduction: Food insecurity and undernutrition persist in much of sub-Saharan Africa. Women of reproductive age (WRA) who fail to meet the minimum dietary diversity (MDD-W) have inadequate nutrient intakes and increased risk of adverse pregnancy outcomes. This study assessed MDD-W in The Gambia, Kenya, and Mozambique and identified determinants. Methods: A food list-based 24-hour recall was conducted within the PRECISE Network, a prospective cohort study with pregnant and non-pregnant WRA in The Gambia, Kenya, and Mozambique. We descriptively summarized dietary diversity scores and rates of MDD-W ([≥]5 out of 10 food groups) and very low dietary diversity ([≤]2 food groups). We evaluated associated factors (demographic/household characteristics, socio-economic status, womens autonomy), using multivariable regression models performed on R Studio (version 4.2.3). Results: Dietary intake data from 7,715 women (1,846 from The Gambia, 3,209 from Kenya, 2,660 from Mozambique) showed that 47.7% met MDD-W (65.1% The Gambia, 45.0% Kenya, 39.2% Mozambique). Pregnant women had a slightly higher rate of meeting MDD-W compared with non-pregnant WRA (48.4% pregnant vs 45.6% non-pregnant [aOR 1.65, 95% CI: 1.40, 1.95]). Higher educational attainment, professional and small business occupations, pregnancy status, parity, household size, marital status and being from The Gambia were protective factors for meeting MDD-W. Poverty and living alone were risk factors for unmet MDD-W. Poverty and country of residence (Mozambique), were risk factors for very low dietary diversity. Conclusion: A majority of the PRECISE cohort did not meet MDD-W, including both pregnant and non-pregnant WRA, suggesting inadequate micronutrient status before pregnancy and limited dietary diversity improvement during pregnancy. Socio-economic indicators are key determinants of adequate dietary diversity, but local contextualisation is essential. Our study highlights the importance of nutrition-specific and -sensitive interventions in women and girls across the lifespan.