Dietary Diversity and Nutritional Status among

women of reproductive age in a selected rural area

Dr. Rabeya Khatun

Roll no: 22021
Session: 2022-2023
Masters of Public Health (Community Nutrition)
Department of Nutrition & Biochemistry

National Institute of Preventive and Social Medicine

(NIPSOM)
 Introduction
• Proper nutrition is essential for the health and well-being
of individuals, particularly women of reproductive age
who play a critical role in the development of their
children.

• Bangladesh has made significant progress in improving

the health and nutrition status of its population, however,
malnutrition remains a major public health concern, with
more than one-third (36.1%) of the adult population being
undernourished (Global Nutrition Report 2020).
 Introduction
• Women of reproductive age (15-49 years) in Bangladesh are at
risk of poor nutrition due to several factors, including poverty,
limited access to healthcare, and cultural beliefs and practices.

• 22% of women of reproductive age are underweight, 10% are

overweight or obese, and 29% have anemia. These poor
nutritional outcomes can have negative consequences for
maternal and child health, including increased risk of maternal
mortality, poor fetal growth, and low birth weight (Bangladesh
Demographic and Health Survey 2017-18)
 Justification

• Bangladesh is a developing country with a high prevalence of malnutrition

among women of reproductive age group. It is estimated that 36.4% of women
aged 15-49 years are undernourished, and 9.7% are overweight or obese.
(BDHS-2017-18)

• Malnutrition, particularly among women of reproductive age, is a major public

health concern in Bangladesh.

• It is well established that poor dietary diversity leads to poor nutritional status,
and poor nutritional status has serious consequences for both mothers and their
children.
 Justification
• The nutritional status of women of reproductive age is critical for their
own health as well as that of their children.

• Dietary diversity directly related to the nutritional status. It continues the

intergenerational cycle of malnutrition, where poor nutrition in mothers
can lead to malnourished babies, and ultimately malnourished
adolescents.

• By promoting dietary diversity, it may be possible to break this cycle and

improve the nutritional status of future generations. The link between
dietary diversity and nutritional status is also acknowledged, indicating
that dietary diversity can directly impact a person's health and reduce the
risk of various diseases.
 Research Question

• What is the state of dietary diversity and

nutritional status of women of reproductive age in
a selected rural area?
 General Objective

• To assess the level of dietary diversity and

nutritional status of women of reproductive age in
rural area.
 Specific Objectives

• To assess the dietary diversity among women of reproductive age

group by using dietary diversity score (DDS).

• To assess the nutritional status of women of reproductive age by

using anthropometric measurement.

• To determine the sociodemographic characteristics of the

respondents.
 Operational Definition

• Dietary Diversity : Is defined as the variety or the number of

different food groups people eat over the time given.

Dietary Diversity Score (DDS):

• DDS is calculated by assigning scores to each food group
consumed over a period of 24 hours. Scores are then summed
up to get a final score. According to FAO Minimum Dietary
Diversity for Women guide (2016):
• Lowest dietary diversity: ≤ 3 food group
• Medium dietary diversity: 4 and 5 food group
• High dietary diversity: ≥ 6 food group
 Operational Definition
• Nutritional Status: Refers to the overall health status of
women of reproductive age group as assessed by
anthropometric measurements such as body mass index
(BMI) .

• Normal BMI: 18.5-24.9 according to WHO criteria.

• Normal BMI: 18.5-22.9 according to Asian criteria
established by the WHO Expert Consultation in 2002.

• Reproductive age group: women between the ages of 15 and

49 years will be considered as the reproductive age group.
 List of Variables
Dependent variables:
Nutritional status: BMI

Independent variables:
Dietary diversity score (DDS).
 Variables…Continued
Variables related to Socio demographic characteristics:

• Age

• Marital status

• Educational status

• Number of family member

• Number of child

• Income

• Occupation

• Household assets
 Conceptual Framework
Variables related to
Dietary diversity
Socio demographic Score (DDS):
variables
Nine Food Groups
• Age, (According to FAO):
• Marital status, Nutritional status
• Educational of reproductive • Starchy staples
status, Women • Vitamin A rich
• Number of fruits & vegetables
family member, • Height • Legume & nuts
• Number of child • Weight • Fats & oils
• Income • BMI • Meat, Poultry, Fish
• Occupation • Other Fruits
• Household • Other Vegetables
asset • Milk & milk
products
• Eggs
 Methodology
Study design :
• cross-sectional study.

Study place:

• Nagarkanda Upazilla, Faridpur.

Study period:

• 1st January 2023 to 31st December 2023.

Study population:
• Women aged15-49 years.
 Methodology…..Continued
Selection criteria:
Inclusion Criteria
• Women of reproductive age (15-49 years) who reside in
nagarkanda upazila.
• Women who are willing to participate in the study and
will give consent.
Exclusion Criteria
• Women who are pregnant or lactating during the study
period.
• Women who are severely ill.
 Methodology…..Continued
• Sample Size : n=z²pq/d²
Here,
n = (Z^2 * P * Q) / d^2
Where, n = sample size
Z = the standard normal value at the desired level of confidence
(e.g., 1.96 for 95% confidence interval)
P = Expected proportion of the respondent consumed lowest dietary
diversified food 30% (Syeda et al.2018).
Q = 1-P
d = the margin of error (e.g., 5% or 0.05)
Lowest dietary diversified food 30% , a margin of error of 5%, and a
confidence interval of 95%, the sample size will be
n = (1.96^2 * 0.3 * 0.7) / 0.05^2
n = 345
 Methodology…..Continued

Sampling technique:
Convenience sampling technique

Data collection instruments:

• Pretested semi-structured questionnaire

Data collection technique:

• Face to face interview
• Anthropometric measurement
Pre-testing: The developed questionnaire will be first
pre-tested and modification will be done accordingly
and the questionnaire will be finalized.
 Methodology…..Continued
Data Management Plan:
 Initially data will be checked for completeness and correctness
in order to exclude missing or inconsistent data.
 Then data will be entered into the computer using Statistical
Package for Social Science(SPSS).
Data Analysis Plan:
 Then data will be analyzed by using the Statistical Package for
Social Science(SPSS).
 Descriptive data will be analyzed by simple frequency
distribution ( mean , standard deviation, percentage).
 Data will be presented using frequency table, graph and chart.
 Ethical Issues

• The protocol will be approved by protocol approval

committee of NIPSOM.
• Ethical clearance of the study will be obtained from the
Institutional Review Board (IRB) of NIPSOM.
• Informed written consent will be taken from each and
every participant.
• Privacy and confidentiality will be maintained strictly.
• Participants will have all rights to withdraw from the
study.
• They will be assured that there would be no harm to them
during study as there is no invasive procedure will be
applied.
 References
• National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2017-18: Key Indicators. Dhaka,
Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF
International, 2019.

• Rahman, A. S. M. M., Akter, S., Islam, M. S., & Ferdousi, S. (2020). Association between
dietary diversity and nutritional status among women of reproductive age in rural
Bangladesh. BMC Public Health, 20(1), 1-10.

• Islam, M. M., & Alam, M. M. (2017). Association between dietary diversity and nutritional
status among adolescent girls in rural Bangladesh. South East Asia Journal of Public Health,
7(2), 39-42.

• Alam, S.S., Rahman, M.N., Mia, M.A., Haque, M.M. and Islam, K. (2018) Dietary
Diversity and Nutritional Status of Adolescent Girls in Selected Urban Slum of Dhaka
City in Bangladesh. Journal of Nutrition and Health Sciences, 7(3), pp.1-10.
• FAO (2016) Minimum Dietary Diversity for Women: A Guide for Measurement. Rome,
Italy: FAO. Available at: http://www.fao.org/3/a-i5486e.pdf

• World Health Organization (WHO). (2021).

Thank you