The Relationship Between Maternal and Infant Diets and Nutritional Outcomes in Sub-Saharan Africa

Abstract

Globally, 149 million children under 5 years are stunted, 13.5% are underweight, and 49 million wasted, 17 million of them severely. Low birth weight (LBW), preterm birth and small for gestational age (SGA) are also prevalent, affecting 10-15 % of all births globally, the majority in low and middle income counties (LMICs). These outcomes are significant causes of infant and child mortality, weakened immunity, increased infections, long term developmental delays and increase risk of overweight and obesity and related chronic diseases in later life. The importance of maternal and child diets in first 1000 days of life, from conception to the first 2 years of life, and its effects on child growth and development is not well explored. This dissertation examines the role of maternal and child diet quality in preventing poor birth and child growth outcomes in LMICs countries. Chapter 1 examines the association of child dietary diversity with nutritional recovery, hospitalization, death, and weight and height gain among children treated for uncomplicated severe acute malnutrition (SAM), using binomial and linear regression methods. We found that eggs may be important for recovery from SAM and did not find associations with recovery or response to treatment.

Chapter 2 evaluates the association of prenatal Minimum Diet Diversity for Women (MDD-W) and the Prime Diet Quality Score (PDQS) with birth outcomes in Tanzania, using binomial regression models. We found the PDQS was associated with lower risk of preterm, very preterm, LBW, very low birth weight (VLBW) and fetal loss and the MDD-W was protective against SGA. Chapter 3 examines the association of the MDD-W during pregnancy with child growth outcomes of stunting, wasting and underweight from 3 to 12 months using Cox regression models, in a Ugandan birth cohort. We found that diversified prenatal maternal diets were associated with fewer incidences of underweight. We did not find an association with stunting and wasting. This dissertation supports that maternal and child diet quality may be modifiable factors to improve birth and child growth outcomes in LMICs. Additional research is required to evaluate these associations, using various tools for assessing diets, in varied locations.