1. King Edward Medical University, Lahore, Pakistan; dua90zahra@gmail.com
2. Sunsari Technical College, Nepal; parshuram@gmail.com

*             Correspondence: parshuram@gmail.com

Keywords: nutrition, variability, domestic food safety, rural community, urban community

1. INTRODUCTION

In order for everyone in the household to have access to enough food that is both sufficient and nourishing—a prerequisite for maintaining an active and healthy lifestyle—food security is essential. According to the Food and Agriculture Organisation (FAO), food security is the state in which every individual has physical, social, and economic access to healthful food that meets their dietary needs and preferences. The term “dietary diversity” refers to the range of food options available to family members. Rising inflation has been a major cause of malnutrition and a decline in nutritional diversity in recent years, particularly in low-socioeconomic countries. Pakistan also has other challenges, such as an unsteady economy, a rapidly growing population, and a lack of awareness regarding the importance of consuming a diverse diet to meet nutritional needs. Women in rural areas often prioritise the nutritional needs of their families over their own, which leads to a lack of attention to their own dietary requirements. Lack of family planning and a high birth rate among rural women due to inadequate awareness both have a major impact on food insecurity. Numerous social determinants, including low socioeconomic status, ignorance, and maternal illiteracy, have been linked to significant effects on food security, according to earlier research [1, 2]. Approximately half of Pakistan’s population lives in rural and semi-urban areas, where the country’s food insecurity rate is highest. In Pakistan, 27.3% of women of reproductive age had a vitamin A deficiency, and 42% of women with iron-insufficiency anaemia [3, 4]. Additionally, studies show that only 1.7% of women have a diversified diet that includes foods from at least five different food categories. Variables like as women’s educational attainment, gestational status, socioeconomic position, gender of the head of household, family size, religion, site of residence, and land ownership have all been linked to appropriate dietary diversity [5].  Interestingly, moms report less dietary diversity than their children do, which may be related to a desire to lose weight. Conversely, 80% of children were considered to be of normal weight, while 70% of mothers were classified as overweight or obese. There is a pressing need for study on food security and dietary diversity, but none has been done in Punjab’s rural regions. There is currently a dearth of research on the connection between food security and the availability of a wide range of food items in rural areas. These remote communities typically have a high male population, limited access to healthful food, and a low regard for women’s rights. Working women make a substantial contribution to food security in these rural areas when compared to housewives. Reducing the population’s risk of food scarcity and nutritional deficiencies requires assessing the prevalence of food shortage and food security variables. Furthermore, research on the connection between dietary diversity and household socioeconomic status can be utilised to establish personalised dietary requirements and develop public health intervention strategies. The primary goals of the study were to look at the range of diets that women in these areas might choose from and to perform a preliminary survey of the rural population to find out if food insecurity occurred in homes. The study’s objective was to provide planning and management teams with accurate information so they could ensure food security for rural women and boost dietary diversity.

2. MATERIALS AND METHODS

90 rural Pakistani households’ worth of data were gathered for this study in 2022. Women between the ages of 15 and 45 gave written agreement, and qualified experts used a structured survey to collect data in the local language. Swindle and Bilinsky’s guidelines6 were adhered to in order to evaluate family dietary diversity, and a list of 45 distinct foods from 12 food groups was used. Based on consumption during the previous 24 hours, each of the individual food groups received a score of 1 or 0, and the overall score varied from 0 to 12. A modified HFIAS7 scoring system was used in the study to assess the food security status of households during the previous 30 days. Based on values ranging from 0-27, homes were classified as food secure, mildly insecure, moderately insecure, or severely insecure. Due to a lack of participants in each of the three categories (mild, moderate, and severe food insecurity), the categories were combined into a single group (food insecure) (ordinal logistic regression model). For the purpose of data analysis, SPSS Statistics V22.0 was used. Descriptive statistics, such as mean with standard deviation, frequencies, and percentages, were used to outline the study variables. ANOVA (Analysis of Variance) was performed for continuous variables and the Chi-square test was utilised for categorical variables to determine any significant differences between the food insecurity groups. A linear regression analysis was performed to look at the relationship between the score for dietary diversity and food insecurity. In order to determine the relationship between dietary diversity and food insecurity, a binary logistic regression was also performed, using the food secure category as a reference for the binary dependent variables.

3. RESULTS AND DISCUSSION

Following data in Table 1 regarding dietary diversity score was obtained that showed how many households were obtained given the number of food groups.

Table 1: Frequency of Food groups and household groups

With a standard deviation of 2.58, the average dietary diversity score for all households in Figure 2 was 7.85. The question of whether a household’s food is sufficiently diverse is not answered by a set criterion or objective. Nonetheless, there are two ways to use this signal in a performance evaluation context, according to FANTA (Food and Nutrition Technical Association). As a reference, one can look at the dietary diversity pattern of wealthier households (the top 33%). This first approach makes the assumption that when money rises, less wealthy individuals will diversify their diets more. The second approach sets a standard of 33% of households with the highest level of food diversification. We made use of the latter. With a standard deviation of 1.27, the average dietary diversity count for 33% of the households with the highest diversity was 10.53. As a result, the population under study’s average dietary variety score was found to be 2.68 odds lower than that of 33% of the households with the highest diversity, based on food security status. 38% of those polled (n = 34) reported being food secure, 21% reported being mildly insecure (n = 19), 23% reported being highly insecure (n = 21), and 18% reported being severely insecure (n = 16). We combined the mild, moderate, and severe food insecurity categories into a single category named “Food Insecure” (Ordinal Regression) in order to assure statistical validity and streamline the analysis. The mean dietary diversity scores for the four classed categories were as follows. In Figure 3, the food secure group obtained a mean Dietary Diversity Score of 9.12 (with a standard deviation of 2.33), 2.03 odds higher than the food insecure group (whose mean Dietary Diversity Score was 7.09 with a standard deviation of 2.43), all while taking into consideration our classification. According to the data collected from the population, women’s food security status grew as the average monthly income of the household climbed, whereas the average income of food insecure groups decreased.

Figure 1: Household dietary diversity score

Figure 2: Classification in view

Women’s dietary diversity was consistently found to be negatively correlated with household food insecurity in this typical rural region of Pakistan, both before and after controlling for a number of potential confounders. This is the first study to discover a correlation between an independently evaluated indicator of family food insecurity and women’s nutritional intakes, which were measured on a regular basis. This study showed a clear connection between dietary diversity, food security, and the danger of consuming insufficient amounts of nutrient-dense foods. The best explanation for this dietary risk pattern was provided by a calculated “wealth index,” which showed the local level of living [8]. Other variables, including the percentage of female literacy, were much less instructive. Poverty and poor female literacy rates are known to be significant causal factors impacting nutrition quality, and they frequently coexist in different homes [9]. Our findings indicate that poor dietary diversity is mostly caused by poverty, a conclusion that is corroborated by other research conducted in low-income nations that demonstrate an inverse relationship between household food insecurity and overall food expenditures [10]. Furthermore, the size of the household—especially the number of children—was adversely influencing the diversity of diets. This suggests that households with more dependents could have to choose food quantity over quality, which would result in a less varied diet. It should be noted that the scope of our study was limited to a particular rural location in Pakistan and may not be generalizable to other areas or nations. To improve dietary diversity and lessen food insecurity in households, the results emphasize the significance of tackling poverty and raising socioeconomic status. A few examples of these interventions would be focused social safety net initiatives, job and education possibilities, and initiatives to promote agriculture. Several methodological concerns may restrict the generalizability of our results. For example, we chose to gather data mostly from easily approachable houses. It was not possible to get the data from far locations. Recall bias is another potential constraint, as it may influence the accuracy and precision of recollections of previous dietary practices. Despite this, we were able to reduce the communication gap between the researchers and the research participants since the researchers knew the local language and culture. Even Nevertheless, individuals may have given false information because they were reluctant to respond to delicate inquiries on food intake. Notwithstanding these drawbacks, our study provides a number of advantages. Initially, data were gathered by researchers who were conversant with the language and culture of the subjects. Second, we included a long list of food items in our inquiries regarding the food consumed during the previous 24 hours, which further strengthens the validity of our data.

4. CONCLUSION

According to the study, smaller families, higher levels of dietary diversity, and higher household income were all associated with improved food security. It is advised that regional health authorities continue to give priority to initiatives that target dietary diversity and household income in order to achieve better health outcomes.

REFERENCES

1. Akbar M, Niaz R, Amjad M. Determinants of households’ food insecurity with severity dimensions in Pakistan: Varying estimates using partial proportional odds model. Health Soc Care Community. 2020;28(5):1698-709
2. Akhtar S. Malnutrition in South Asia-A Critical Reappraisal. Crit Rev Food Sci Nutr. 2016;56 (14):2320-30.
3. National Nutrition Survey 2018 – Key Findings Report [Internet] National nutrition survey short report; 2018 [cited 2022 June 11]. Available from: https://www.unicef.- org/pakistan/reports/national-nutrition-survey-2018-key-findingsreport.
4. Sheikh S, Iqbal R, Qureshi R, Azam I, Barolia R. Adolescent food insecurity in rural Sindh, Pakistan: a cross-sectional survey. BMC Nutr. 2020;6(1):1–9.
5. Vijay J, Kumar Patel K. Recommendations to scale up dietary diversity data at household and individual level in India. Diabetes Metab Syndr. 2021;15(6):102310.
6. Swindale A, Bilinsky P. Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide (Version 2). 2006.
7. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide: Version 3. 2007.
8. Gunnsteinsson S, Labrique AB, West KP Jr, Christian P, Mehra S, Shamim AA, et al. Constructing indices of rural living standards in Northwestern Bangladesh. J Health Popul Nutr. 2010;28(2):509–19.
9. Rashid DA, Smith LC, Rahman T. Determinants of dietary quality: evidence from Bangladesh. World Development. 2011;39 (2):2221–31
10. Melgar-Quinonez HR, Zubieta AC, MkNelly B, Nteziyaremye A, Gerardo MF, Dunford C. Household food insecurity and food expenditure in Bolivia, Burkina Faso, and the Philippines. J Nutr. 2006;136(Suppl):1431.
11. Maryam Majeed, Rubab Ali, Umm-e-Aimen & Aqsa Jabeen. Medical Staff, Workplace Bullying and Its Effects on the Performance. Dinkum Journal of Medical Innovations, 2(04):120-125.
12. Marie Diack. Factors Influencing Relational Violence in Nepali Married Relationships. Dinkum Journal of Medical Innovations, 2(04):126-133.
13. Gul Rukh Malik, Rubab Zahra & Tahir Rana. Autism Spectrum Disorders Frequency in Asian Countries. Dinkum Journal of Medical Innovations, 2(04):134-139.
14. Parshu Ram Chaudhary, Asbin Bandhari & Parshu Kirby. Aeroallergens and Significant Environmental Pollutants: Aeroallergen Sensitivity Symptoms. Dinkum Journal of Medical Innovations, 2(04):140-149.
15. Imran Mehfooz Khan, Aron Kumar & Pradeep Sahejpal. Extensive Management Medical Incidents Provided to Gallbladder Cancer Using Cholecystectomy Specimen. Dinkum Journal of Medical Innovations, 2(04):150-156.