Dietary diversity and adequacy of women caregivers in a peri-urban informal settlement in South Africa

Abstract

Objective

Simple measures reflecting dietary quality are preferred for assessment of dietary intakes in low-income communities, e.g. dietary diversity that reflects a healthy, varied, nutritious diet, associated with nutrient adequacy. A strong association between household income and food access suggests dietary diversity assessment as one of the indicators of household food security. The aim of this study was to assess the food security situation of black women in an informal settlement by exploring their food access capabilities through dietary diversity measures and the coping strategies they employ to cope with poverty and hunger.

Methods

A randomly selected sample of black women living in an informal settlement completed a pretested socio-demographic questionnaire (socio-economic circumstances) and validated questionnaires (1-wk quantified food frequency questionnaire: diversity measures; 24-h recall: nutrient intake; Cornell Hunger Scale: coping strategies). Food variety scores and food group diversity scores were calculated from frequency analyses for all foods and food groups. Nutrient adequacy ratios for various nutrients and the mean adequacy ratio for their diet were calculated. Relationships between dietary diversity and nutritional adequacy were investigated with Pearson correlations. Food variety score cut points were tested for sensitivity and specificity against nutritional adequacy.

Results

Intakes were deficient for all nutrients except carbohydrates. Individual mean ± SD nutrient adequacy ratios ranging between 0.15 ± 0.18 and 0.95 ± 0.19 confirmed the poor dietary quality. Zero to 40 individual foods were consumed, but the mean ± SD food variety score was only 3.17 ± 1.21, indicating low food diversity, as did the low dietary diversity score (2.82 ± 0.99) using 0 to 6 food groups.

Conclusions

Limited food access and food variety in poor households resulted in inadequate nutrient intakes (low nutrient adequacy ratios), confirmed by poor dietary diversity (food variety score and food group diversity score). Dietary diversity assessment can successfully replace traditional dietary assessment tools in poverty-stricken or low-income communities where quick assessments are often required to assess the greatest need.

Introduction

Intakes from a variety of foods within and across food groups are thought to improve intakes of a variety of nutrients and promote good health [1], [2]. The focus is, therefore, on overall dietary quality rather than on intakes of individual foods and nutrients [2], [3], [4], [5]. Although one of the Food-Based Dietary Guidelines in South Africa (SA) states the importance of eating a variety of foods daily, few studies have assessed the effect of dietary variety on the quality of total food intake in SA. Household food security is considered an important measure of health and well-being and is universally used to design nutrition interventions in rural and/or low-income areas [6], [7]. Globally and nationally, at the household level, both availability and access to food from household or community sources are implied compared to utilization or consumption of available food or accessed food within the household at the individual level [8], [9]. Simple measures to determine dietary quality at individual and household level are needed to assess the access dimension of household food security [6], [7]. Dietary diversity is a measure of diet quality and is quantified as food variety (the number of individual food item types consumed) or food group variety (the number of food groups utilized) [3], [6], [7], [8], [9]. Poor populations suffer most in achieving a diverse diet as they consume a typically monotonous diet based on starchy staple foods containing little or no animal products, dairy foods, and few fruits and vegetables, resulting in multiple nutrient deficiencies [5]. Household food security, nutrition security, and dietary diversity cannot be achieved by reliance on just one staple food being consumed as this will be deficient in a range of micronutrients, apart from being relatively poor in protein quality. Dietary variety is thus essential to achieve healthful eating patterns [2].

In SA, only two studies have been published on dietary diversity. Both concluded that dietary diversity and the analysis of food variety within the food groups can identify children [10] and the elderly [11] with dietary inadequacies and thus poor health. This research project focused on dietary diversification in women residing in an informal settlement in the Vaal region, a peri-urban area in SA with a population of 794 599 people of which 47.9% are unemployed and 46.1% of households live in poverty [12]. Dietary diversification can also be used as proxy measure for measuring household food access and thus food security [13]. The aim of this research study was to determine---by proxy---the household food security situation of the black women (N = 1261) living in an informal settlement in SA by exploring their food access capabilities through (1) dietary diversity measures (number of individual foods and food groups consumed), and (2) the coping strategies they employ.