Embed Size (px)
Citation preview
Identification of food environmental factors hindering dietary diversification
A mixed methods study in rural south India
Archana Konapur, Madhavan Nair Krishnapillai, Balakrishna Nagalla, SubbaRao M Gavaravarapu
Session 8B: Food Environments & Drivers of Food ChoiceANH Academy Week
28th June ‘19
Presenting author :
• Food environments (FE)physical, economic, policy and socio-cultural context that influencespeople’s consumption choices andnutritional status
• Widely studied in developedcountries
• Lacunae of studies in India – FE andDiet Diversity
• Assessment - objective, but alsosubjective
• Need - A multi-dimensionalcomprehensive approach
Micronutrient Malnutrition
Dietary Diversification
Food Environment
Background
To measure five dimensions of food environment (i)availability(ii)accessibility (iii)affordability (iv)acceptability and(v)accommodation of a diverse food and its influence on diet diversityof children in rural middle income households
Objective
FE Availability Accommodation
Accessibility Affordability Acceptability
Stakeholder
Vendor & Caregiver
Vendor & Caregiver
Caregiver Caregiver Caregiver
Study Area
Ghatkesar (15 villages)Telangana State
Ghatkesar(Sub District)
Mixedmethods
Quantitative Method
QualitativeMethod
Inclusion Criteria• Village with >500 HH• 3-5 family size• 6-10 Y old child• SLI >24• Literate mother
Villages Sub-urban Urban
On-going Nutrition Communication Intervention project – aims to promote consumption ofmicronutrient rich foods – sample size (n=160) (CTRI Reg. No CTRI/2015/06/005836)
All of the villages are comparable with respect to target population
Typical Grocery Shop
MOPED
Push-cart
TROLLEY
Weekly Market
HAWKERS
Only semi-perishable food item are sold
Few grocery shops - Perishable food item are also sold
Measuring Availability
Type of shop
Number of shop
Variety of food
Observation
Checklist*
Interview vendor
*14 food groups;197 food items. Prepared using Indian Food Composition Tables, 2017
Measuring Accessibility
Distance Perception
Interview
Questionnaire
Variable
Method
Material
Variable
Method
Material ArcGIS
Buffer†
METHODOLOGY
Perception
Questionnaire
Interview caregiver
† Buffer zone created was 50m, 100m, 150m and 200m
Measuring Affordability & Acceptability
Perception
Questionnaire
Measuring Accommodation
No. of hours
Questionnaire
Interview
Variable
Method
Material
Variable
Method
Material
Interviewcaregiver
Measuring Diet Diversity of 6-10 y children
Questionnaire*
Interview
Practice
M
E
T
H
O
D
O
L
O
G
Y
*A validated diet diversity score (DDS) specific to 6-10 y children was administered among caregivers
No. of days Meet demand
100
6154 53
58
0
20
40
60
80
100
120
Food List AS PS KS CG
Availability of semi-perishable foods (%) RESULTS
n=54 n=53n=58 n=83 n=48
AS:Aushapur; PS:Pratapasingaram; KS: Kachwanisingaram; CG: Chowdaryguda
Villages
Ghatkesar(Sub District)
AS
CG
PSKS
semi-perishable foods: cereals, millets, pulses, oil, fat, spices, condiments
100
46 43 4863
0
20
40
60
80
100
120
FOOD LIST AS KS PS CG
n=77n=59n=53n=124 n=56
AS PS KS CG
Availability of perishable foods
Actual availability 46% 43% 48% 63%
Perceived availability (caregiver)
94% 91% 68% 100%
22
6
88
11
3 3
58
3733 33
70
0
10
20
30
40
50
60
70
80
90
100
GLV Othervegetables
Fruits Fish
PS AS CG KS
Perceived non-availability by caregivers Actual Availability of perishable foods (%)
AS:Aushapur; PS:Pratapasingaram; KS: kachwanisingaram; CG: Chowdaryguda
What matters?Actual availability or perceived availability!
Weekly market in Chowdaryguda
Fruits
Grocery shops (n=42)
Flesh foods shop (n=10)
HawkersWeekly market
Shop open time
6.00 a.m to 9:00 p.m
9.00a.m to 9 p.
1 h in the morning or evening
5.30 p.m to
8.30 p.m
Duration 12 h 10 h 1 h 3 h
Number of days in a week
Daily Daily Twice/thrice a week
Once a week
Satisfyingconsumer demand
Yes Yes limited foodvariety is sold
Yes
(Demand
Driven)
Satisfied by the vendor service
Yes Yes limited foodvariety is sold
No
Perceived Accommodation of Foods
“It will be good if the fruits and vegetables markets are set up at least on alternate days in a week” – caregivers in KS,PS,AS
“As consumers do not consume bacchalikura(GLV) we do not get them. We bring only those items consumed by people here” – Vendor (PS)
ChowdarigudaKachwanisingaram
Pratapasingaram Aushapur
ACCESSIBILITY TO SHOPS (<200m)
AS PS KS CG
Accessibility
Actual distance 200m 200m 200m 200m
Caregiver(semi-perishable)
Accessible distance
Accessible distance
Accessible distance
Accessible distance
15.6 15.6
50.0
62.5
5.6
0.0
13.9
27.8
2.47.1
19.0
31.0
14.0 14.0
2.3
44.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
GLV other veg. fruits fish
PS
AS
CG
KS
Perceived accessibility to perishables by caregivers (n=160)N
on
-acc
ess
ible
Paradox
Though it is a problem,
Habituated to go to neighboring town
(2-3 km)
Need to increase
the availability
0
20
40
60
80
100
120
AS KS CG PS
Number of food groups consumed by the 6-10 year old children (n=160)
AS:Aushapur (DDS 8.5); KS:Kachwanisinagaram (DDS 8.7); PS: Pratapasingaram (DDS 8.9); CG:Chowdariguda (DDS 8.2)
1 2 3 4 5 6 7 8 9 10 11 12 13
96
2
1621
29
21
AS PS KS CG
Milk & milk products
Costly Dislike
2 32
9
6
3
AS PS KS CG
Other Vegetables
Not Available Costly Dislike
11
3
11
4
2018
11 1318
24
34
15
AS PS KS CG
Fleshfoods/Pulses/Egg
Not Available Costly Dislike
20
44
6 61
6171
91 89
AS PS KS CG
Green Leafy Vegetables
Not Available Dislike
2735 37
1923
15
365
1217
6
AS PS KS CG
Fruits Not Available Costly DislikeFactors hindering diet diversification
Middle income
families too are not
able to diversify
because of cost
-Promote locally
grown perishables
Educate – ways
and means to
incorporate the
foods in the
menu
availability with help of
the local stakeholder
Conclusion
Conclusions cannot be generalized as this observation requires replication of the study across the spectrum of various economic groups
and education background
Limitation
