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Social Stratification of Children's Diet and Nutrition: Understanding Women's Situation in Addis Ababa
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Background: Childhood undernutrition is the cause of nearly half of all deaths in under-five children. In sub-Saharan African countries, this problem is further complicated by the rising prevalence of overweight. Mothers play a key role in child care and nutrition, however, in cities that are undergoing rapid social and economic changes, little is known about their lived experiences and challenges. Moreover, little is known about the influence of the neighbourhood food environment and family socio-economic conditions of food acquisition and intake in sub-Saharan Africa. Therefore, the study aims to understand the nexus between mothers’ child care and feeding experiences, neighbourhood food environment, diet diversity, and family socioeconomic status. Methods: A mixed qualitative and quantitative study design was used. The qualitative component involved thirty-six in-depth interviews with mothers who had children under the age of five years. A thematic analysis approach was used to analyse verbatim transcripts. For the quantitative component, two rounds of cross-sectional household surveys were conducted. The sample was drawn from all districts of Addis Ababa; a total of 5467 households with mother-child pairs. Data were analysed using a generalised estimating equation (GEE) and mixed-effect logistic regression model. Results: Urban mothers are under pressure to ensure their child gets adequate care and food; the changes in their environment owing to the reconstruction of city and migration further limit their ability to do so. Mothers expressed that their decision of what to feed their children is influenced by children’s preferences, perceived safety of the food, familiarity with the food, and affordability.

Children receiving the recommended minimum diet diversity totaled 59.9% (58.5–61.3). Having an adequately diverse diet was associated with having an educated mother, and being from the wealthier and more food-secure households. Animal source and vitamin-A-rich food groups are the least affordable and consumed food groups in the study settings. Families with uneducated mothers, in the lowest wealth group and those who perceived food groups to be unaffordable, consumed a less diverse diet.

The prevalence of stunting was 19.6% (18.5–20.6) and that of over-weight/obesity was 11.4% (10.6–12.2). Maternal education level was associated with both forms of malnutrition; children with uneducated mothers were more likely to be stunted (AOR: 1.8; 1.4–2.2) and less likely to be overweight/obese (AOR: 0.61; 0.44–0.84), while being from the highest wealth household and from a severely food insecure household were associated with a higher likelihood of obesity and stunting, respectively. Conclusion: Child nutritional outcomes and diet quality vary by the socioeconomic status of the family; particularly that of mothers. Therefore, efforts to improve diet and nutritional outcomes of children need to consider mechanisms to strongly support mothers.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. , p. 60
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1662
Keywords [en]
malnutrition, urban mothers, diet diversity, preschool children, social stratification, affordability, Addis Ababa, Ethiopia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-407952ISBN: 978-91-513-0932-3 (print)OAI: oai:DiVA.org:uu-407952DiVA, id: diva2:1420971
Public defence
2020-09-28, Rudbeckssalen, Rudbeck C11 ground floor, Dag Hammarskjölds väg 20, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2020-05-19 Created: 2020-04-01 Last updated: 2020-05-19
List of papers
1. Mixed blessings:: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia
Open this publication in new window or tab >>Mixed blessings:: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207685Article in journal (Refereed) Published
Abstract [en]

Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-369725 (URN)10.1371/journal.pone.0207685 (DOI)000450775300036 ()30458024 (PubMedID)
Funder
Swedish Research Council Formas
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2020-04-01Bibliographically approved
2. What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia
Open this publication in new window or tab >>What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia
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2018 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 9, article id 1142Article in journal (Refereed) Published
Abstract [en]

Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.

Keywords
Ethiopia, child feeding/nutrition, qualitative methods, urban mothers
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-364627 (URN)10.3390/nu10091142 (DOI)000448659900015 ()30135354 (PubMedID)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2020-04-01Bibliographically approved
3. Social Stratification, Diet Diversity and Malnutrition among Preschoolers: A Survey of Addis Ababa, Ethiopia.
Open this publication in new window or tab >>Social Stratification, Diet Diversity and Malnutrition among Preschoolers: A Survey of Addis Ababa, Ethiopia.
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2020 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 12, no 3, article id E712Article in journal (Refereed) Published
Abstract [en]

In Sub-Saharan Africa, being overweight in childhood is rapidly rising while stunting is still remaining at unacceptable levels. A key contributor to this double burden of malnutrition is dietary changes associated with nutrition transition. Although the importance of socio-economic drivers is known, there is limited knowledge about their stratification and relative importance to diet and to different forms of malnutrition. The aim of this study was to assess diet diversity and malnutrition in preschoolers and evaluate the relative importance of socioeconomic resources. Households with children under five (5467) were enrolled using a multi-stage sampling procedure. Standardized tools and procedures were used to collect data on diet, anthropometry and socio-economic factors. Multivariable analysis with cluster adjustment was performed. The prevalence of stunting was 19.6% (18.5-20.6), wasting 3.2% (2.8-3.7), and overweight/obesity 11.4% (10.6-12.2). Stunting, overweight, wasting and limited diet diversity was present in all social strata. Low maternal education was associated with an increased risk of stunting (Adjusted odds ratio (AOR): 1.8; 1.4-2.2), limited diet diversity (AOR: 0.33; 0.26-0.42) and reduced odds of being overweight (AOR: 0.61; 0.44-0.84). Preschoolers in Addis Ababa have limited quality diets and suffer from both under- and over-nutrition. Maternal education was an important explanatory factor for stunting and being overweight. Interventions that promote diet quality for the undernourished whilst also addressing the burgeoning problem of being overweight are needed.

Keywords
Ethiopia, diet diversity, malnutrition, pre-school children, social stratification, urban
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-407667 (URN)10.3390/nu12030712 (DOI)32156006 (PubMedID)
Available from: 2020-03-27 Created: 2020-03-27 Last updated: 2020-04-01
4. Availability, affordability and consumption of family food:-the social stratification in Addis Ababa, the EAT Addis Study in Ethiopia
Open this publication in new window or tab >>Availability, affordability and consumption of family food:-the social stratification in Addis Ababa, the EAT Addis Study in Ethiopia
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-407951 (URN)
Available from: 2020-04-01 Created: 2020-04-01 Last updated: 2020-04-01

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