Introduction
Child undernutrition, the damaging result of poor nutrition during the first 1000 days of life, puts children in a physical and cognitive disadvantage [
1]. Globally, 149 million under 5 children were estimated to be stunted in 2018 [
2]. Undernutrition has been known as an underlying cause for reduced cognitive skills, lower school performance, morbidities, poverty, and nearly half of under-five deaths [
3]. Standard infant and young child feeding recommendations have been established as ways to improve nutrition outcomes [
4]. At 6 months of age, infants should start complementary feeding without stopping to breastfeed. A highly diversified complementary diet increases energy and nutrients intakes, and hence improves the nutritional status of children [
5].
Animal-source foods (ASFs) are important components of nutritious diets and play a significant role in minimizing the risk of undernutrition among vulnerable groups [
6]. Consumption of such foods by older infants and young children has been found to increase dietary diversity. High Dietary diversity has been shown to strongly contribute to improved nutritional results in children [
7]. According to a systematic review of studies done in food-insecure areas, consumption or provision of additional complementary foods has been effective at reducing undernutrition. However, to get better results, this should be combined with education [
8,
9]. Dairy products (milk, yogurt, cheese), flesh foods (meat, fish, poultry and organ meats), and eggs are the three ASFs that make-up the eight food groups illustrated by the World health organization (WHO) to determine optimal dietary diversity [
10].
Animal source foods (ASFs) are energy-dense foods that contain the highest quality proteins yielding all the essential amino acids in amounts and forms human beings require. They are also efficient sources of bioavailable micronutrients including iron, zinc, vitamin A, vitamin B12, riboflavin, and calcium, which are of utmost concern globally when addressing food insecurity [
11,
12]. Besides, they contain lower levels of anti-nutritional factors compared to plant source foods [
13].
Although the stunting reduction rate Ethiopia has achieved is outstanding, the problem remains a major challenge, with approximately two out of five under 5 children are stunted (short for their age). Moreover, micronutrient deficiencies, especially of iron, vitamin A, iodine and zinc, are common among children. Annually, such problems of undernutrition cost the country 4.7 billion USD or 16% of its Gross domestic product (GDP). To tackle such problems of undernutrition, Ethiopia developed and applied different approaches like the National Nutrition Program [
14] and a recent Food and Nutrition Policy [
15].
In low and middle-income countries like Ethiopia, access to and availability of ASFs is usually limited for many children. According to the Ethiopian demographic and health survey (EDHS), only 14% of children aged 6–23 months meet the minimum dietary diversity requirements. This report noted that only 8% of children consumed meat, fish, or poultry. It also showed that about 17 and 25% of children aged 6–23 months reported consumption of eggs and dairy products, respectively [
16]. A study conducted in Tigray region also found that only 13% of the children 6–23 months old meet the WHO recommended dietary diversity [
17]. One reason for the diets being extremely monotonous could be poor consumption of ASFs.
Various factors may influence the availability and consumption of ASFs by children. Factors that were associated with increased ASF consumption include increased child age, pastoral livelihood, Muslim religion, and participation in a Productive Safety Net Program [
18]. Besides, villages in forested areas with wild animal populations, observing a large number of ceremonies of long duration, households with a greater number of small livestock, and women’s autonomy on decisions about livestock assets also were related to increased ASF intake [
19].
Information regarding the magnitude and determinants of ASF consumption among children is inadequate at national level. Ethiopia is a country with diverse livelihoods, religions, and cultures that can affect consumption of ASFs among children. In an area with such socioeconomic and cultural diversity, much research on this topic is necessary to provide more conclusive information to establish effective interventions to improve dietary diversity and reduce stunting.
Therefore, with this study, we aimed to fill the gap of information regarding the consumption of ASF and the factors associated with it at the national level. The objective of this study was to determine the magnitude and factors associated with ASF consumption among children aged 6 to 23 months in Ethiopia.
Discussion
In this secondary analysis of the 2016 EDHS, which included a total of 2861 children aged 6–23 months, 46.5% reported consuming any type of ASF in the day prior to the survey. This is similar to a recent survey in Ethiopia that found a slightly higher magnitude (51%) of ASF consumption [
18]. A survey in Kenya reported that less than 30 and 10% of children consumed flesh foods and eggs, respectively [
21]. The lower magnitude in the latter study could be due to the absence of information on dairy consumption.
Religion, number of household assets, number of livestock owned by a household, ownership of land usable for agriculture, and child age are the five variables that were significantly associated with the outcome variable.
Children from orthodox family had lower odds of ASF consumption compared to children from other religions. Not differently, a study that assessed ASF consumption by children from four regions of Ethiopia found a 30% lower consumption in children from Orthodox households than children from Muslim households [
18]. Throughout the year, Ethiopian Orthodox Christians have seven official fasting periods; All Wednesday and Fridays, except for the 50 days after Easter, the Lenten fast of 55 days, the Nineveh fast of 3 days, the vigils, or gahad of Christmas and epiphany, the 14–44 days fast of the apostles, the 43 days of the fast of the prophets, and the 15 days fast of the assumption in august. The average person may fast about 180 days, refraining from consuming ASF including meat, eggs, and milk [
22]. During these extended time periods, a person is expected not to consume any food of animal origin. Although children are not supposed to fast, the limited availability of ASFs in the households they live during such periods may affect their consumption of those foods. The other reason that could affect ASF consumption by children is fear of contamination of cooking utensils and violation of religious rules and procedures by caregivers [
23]. Notwithstanding the above explanations, a recent report by Alive and Thrive on IYCF practices, beliefs, and influences in Tigray region discussed that some mothers reported unaffordability and unavailability of meat and chicken in the market in fasting periods [
24]. This could be due to the fact that ASFs especially meat are scarce and more expensive particularly during long periods of fasting like Lent in Orthodox communities because fasting adults are unwilling to slaughter animals [
25].
Besides, children from households with higher numbers of livestock showed higher ASF consumption. Other studies found similar findings. Compared to households that did not own a particular livestock group, consumption of ASF during the 30 days before the survey was found to be significantly higher in households that owned the livestock group from which the food was derived [
26]. Besides, according to a study in rural Uganda, promoting (small) livestock ownership significantly increased dairy consumption [
27]. Moreover, in a study in rural Nepal, even low levels of poultry and cattle ownership were respectively associated with higher consumption of eggs and dairy among young children [
28]. Ownership of livestock is also a positive facilitator of child dietary diversity [
29]. These findings support the argument that households are utilizing livestock for own consumption. Therefore, such a positive association between livestock ownership and ASF consumption should be maintained by addressing socio-cultural norms and practices towards motives of livestock keeping, promoting good livestock rearing practices, improving market access, and filling gaps on nutrition importance of ASFs [
30]. This is especially important in Ethiopia, a country known as one of the owners of huge number of livestock in the world [
31].
In contrast to the findings in our study, a study by Kobina et al. noted that household ownership of any livestock, but not poultry, was associated with decreased consumption of ASFs [
32]. The reason for this difference could be the higher ownership of free-range poultry compared to other livestock and the relatively very low sample size in the Kobina et al. study. Similarly, a study in Luangwa Valley, Zambia, found no significant association between livestock ownership and ASF consumption [
33].
In this presented study, ASF consumption increased by nearly 20% with a unit increase in the number of household assets. This is similar to a study done in Indonesia in which increased value of household assets was significantly associated with ASF consumption [
34]. Economic capability of households possesses a great role in determining the likelihood of ASF consumption [
35]. Households with a higher number of assets (electricity, a television, a radio, mobile/non-mobile telephone, a refrigerator, a table, a chair, a bed with a mattress (cotton/sponge/spring), an electric mitad (a grill or cooktop used for preparing injera or bread), and a kerosene lamp/pressure lamp) may have a better opportunity to prepare and present ASFs on their table for consumption.
This study showed higher odds of ASF consumption among children in higher age categories. Similarly, in their study about ASF and child stunting, Headey et al. witnessed that consumption of any ASF and only dairy (consumption of meat, eggs, and fish were similar across age groups) increased with age [
36]. The reason could be that as age is increasing, it is more likely feeding skills are improved and caloric needs are increased.
Nevertheless, children from households that own land usable for agriculture showed lower ASF consumption. This is challenged by a recent report by food and agriculture organization which states that the ownership, including its quality, of agricultural land is a major positive determinant of the relationship between crop and livestock production [
37]. The reason for this negative association could be the fact that more than 72% of households that own land usable for agriculture in this study lie within the three lowest wealth quintles (middle, poorer, and poorest). These households are more likely to sell and/or exchange any of their livestock for other necessary goods than using for own consumption. In such households, ASFs are considered as luxury foods and usually are only consumed during holidays and special events.
Strengths and limitations of the study
The main strength of this study is that it utilized a large sample size and that the sampling technique (especially the use of sampling weights) allowed every household to have equal probability of inclusion. The larger sample size proved important in maintaining the internal validity of the study by helping provide precise descriptive and analytic findings. The other strength is that the data in this study were collected from all the regions in Ethiopia, which makes generalizability of the findings forward.
The crosssectional design of this study means it doesn’t show any cause and effect relationship between the outcome variable and the explanatory variables. Additionally, lack of information on possible explanatory variables like food insecurity status of the households may have changed the picture of the current associations between the variables. Therefore, incorporating a household food insecurity access score in future studies can be crucial in identifying other unseen associations. Another possible limitation is that this study did not provide information on the amount and frequency of ASF consumption. The use of 24-h dietary recalls may not perefectly tell about the usual diets (i.e., by creating within-person error) leading to an attenuation bias [
38]. Therefore, future similar studies should consider and try to address the points raised.
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