Postwar dietary diversity among children aged 6-23 months in northern Ethiopia

Introduction: Conflict exacerbates poor complementary feeding and reduces
dietary diversity. Before the 2020–2022 war in northern Ethiopia, around
74% of children aged 6–23 months failed to meet minimum dietary diversity
(MDD) and post-war prevalence was unknown. This study aims to assess MDD
prevalence and associated factors among children aged 6–23 months in a
town in northern Ethiopia two years after the ceasefire. Methodology: A
health facility-based cross-sectional study of 584 participants was
conducted in a town in northern Ethiopia. Sociodemographic and dietary
data were collected using a 24-hour dietary recall questionnaire and
analyzed in STATA ® version 15. Pre-war dietary diversity was estimated
using data from the 2016 and 2019 Ethiopian Demographic and Health
Surveys. Results: MDD declined from 33.2% pre-war period to 25.2% (95% CI:
21.6-28.7) in the post-war period. Children aged 18–23 months were 3.2
times more likely to achieve MDD than those aged 6–11 months (p = 0.001).
Middle- and high-income households had 6.13-fold and 13.58-fold higher
odds of meeting MDD, respectively (both p < 0.001). Households with
5–8 members had 3.6-fold higher odds of providing MDD compared to those
with 1–3 members (p = 0.017). Children of mothers aged 26–35 years (AOR =
0.48, p = 0.026) and 36–42 years (AOR = 0.29, p = 0.017) had lower odds of
meeting MDD. Higher paternal education (AOR = 2.58, p = 0.031) and
paternal occupation as a merchant (AOR = 3.17, p = 0.001) were positively
associated with MDD. Post-war, grain (77.5% to 92.1%) and legume (33.9% to
69.3%) consumption increased significantly, while flesh foods (20.9% to
7.2%) and vitamin A-rich foods 46.8% to 26%) declined. Conclusion:
Post-war dietary diversity in remains low, influenced by socioeconomic and
demographic factors. Significant reductions in nutrient-dense foods
highlight critical gaps in child nutrition. Targeted nutrition education
for caregivers and interventions promoting dietary diversity are essential
in conflict-affected settings.

引言：冲突会加剧不良辅食喂养行为，并降低膳食多样性。埃塞俄比亚北部2020-2022年战争爆发前，约74%的6~23月龄儿童未达到最低膳食多样性（Minimum Dietary Diversity, MDD）标准，且战后的相关患病率尚不明确。本研究旨在停战两年后，对埃塞俄比亚北部某城镇的6~23月龄儿童的MDD患病率及其相关影响因素进行评估。
研究方法：本研究在埃塞俄比亚北部某城镇开展，采用基于医疗机构的横断面研究设计，共纳入584名研究对象。研究人员通过24小时膳食回顾问卷收集社会人口学及膳食摄入数据，并采用STATA®15.0软件进行数据分析。本研究利用2016年与2019年埃塞俄比亚人口与健康调查（Ethiopian Demographic and Health Surveys, EDHS）的数据估算战前膳食多样性水平。
结果：战后MDD达标率从战前的33.2%下降至25.2%（95%置信区间：21.6~28.7）。18~23月龄儿童达到MDD标准的概率是6~11月龄儿童的3.2倍（p = 0.001）。中等收入与高收入家庭的儿童达到MDD标准的比值比分别为6.13倍与13.58倍（均p < 0.001）。家庭规模为5~8人的家庭，其儿童达到MDD标准的比值比是1~3人家庭的3.6倍（p = 0.017）。母亲年龄为26~35岁（调整后比值比（Adjusted Odds Ratio, AOR）= 0.48, p = 0.026）与36~42岁（AOR = 0.29, p = 0.017）的儿童，达到MDD标准的概率更低。父亲受教育程度更高（AOR = 2.58, p = 0.031）以及父亲职业为商人（AOR = 3.17, p = 0.001）与儿童达到MDD标准呈正相关。战后，谷物（摄入占比从77.5%升至92.1%）与豆类（从33.9%升至69.3%）的摄入占比显著上升，而肉类食物（从20.9%降至7.2%）与富含维生素A的食物（从46.8%降至26%）的摄入占比有所下降。
结论：战后儿童膳食多样性水平仍处于低位，且受社会经济与人口统计学因素的影响。富含营养的食物摄入占比大幅下降，暴露出儿童营养保障方面存在的显著短板。在受冲突影响的地区，针对照护者的针对性营养教育以及推广膳食多样性的干预措施至关重要。