A typical household in the project region
In the Maritime region, the average household (n=440; table A, p.183) (comprising all households, better-off and undernourished) has 5.7 members and is headed by a male (96 %). 67 % of the adults in this household live in a monogamous relationship. The average mother is 30 years old and went to school for 2.4 years.
Statistically, she is likely to receive counselling on childcare (70 %) and nutrition (65 %). The average household has access to land (92 %), and 21 % engage in horticultural production. The sources of income generation are diverse and include the marketing of crops (78 %), the sale of l livestock (56 %) and other business activities (60 %), such as petty trade. Occasional labour (22 %) and remittances (22 %) only play a minor role. The average household lacks access to adequate drinking water sources (78 %), probably contributing to the fact that 48 % of the children suffered from diarrhoea in the two weeks prior to the survey.
In contrast, the multiple regression analysis reveals that the typical undernourished household is larger than the average household. The results indicate that the mother’s education has a slightly positive effect on dietary diversity. Various indicators stress the positive effect of financial resources and (additional) income sources on food and nutrition security. Income from crops improves the indicators MAD and HFIES, and income from remittances and sale of livestock increase the likeliness to improve indicators MAD and WMDD.
Interrelations between food and nutrition security indicators
As in Zambia, the three indicators of undernourishment (MAD, WMDD, and HFIES) are interrelated (see Table “Undernourished HH Togo”, p. 185) and stress the multidimensionality of food and nutrition security. Mothers eating a diverse diet are more likely to have children who meet the MAD intake; Mothers who do not meet the Minimum Dietary Diversity Score (WMDD) are significantly more likely to have children that suffer from diarrhoea. As for the number of clinic visits for
children under 5 (“under- 5 clinic visits”), the picture is inconclusive: Children who are undernourished have few under-5 clinic visits, while households with severe or moderate food insecurity show numerous under-5 clinic visits. This inconclusive finding might be since under-5 clinic visits can be a consequence of undernourishment as well as a treatment for it. Nutrition counselling has a positive impact on the minimum acceptable diet of children.
Table 36 shows the factors (positively or negatively) associated with food and nutrition security. The regression analysis (see p. 196) uses the explanatory variables to analyse the determinants of IDDS-CH (row 1 and 2), minimum meal frequency (MMF), MAD for children (row 3 and 4) and IDDS-W (row 5 and 6).
Table 36: Associated factors regarding FNS
Dependent variables Statistically significant independent variables IDDS-CH (regression
includes HFIES)
Sale of animal products (++), Receiving remittances (++), nutrition counselling through health services (++) and media (++),
education of mother (+), caretaking support through siblings (++), household size (-), moderate and severe household food
insecurity (--), other caretaking support (-)
MMF Breastfeeding of children (++), sale of crops (++), sale of animal products (++), income of business / petty trade (++), caretaking support of siblings (++), polygamous family (-)
MAD Sale of animal products (++), Receiving remittances (++), household size (--), Moderate and severe household food insecurity (--), Nutrition counselling through health services (++) and through media (+), Siblings support caretaking (++)
IDDS-W (regression includes HFIES)
Sale of animal products (++), income from remittances (++), household size (--), moderate and severe household food insecurity (--)
Source: Results based on quantitative statistical analysis of the GIZ nutrition baseline survey in Eastern Province (2015) and Maritime (2016).
Positive and large positive associations are indicated by (+) and (++), respectively. Negative and large negative associations are indicated by (-) and (- -), respectively.
Determinants of undernutrition: Dietary diversity of children
As Haddad et al. (1994) point out, large households logically have a higher demand of food than households with less members (Haddad et al., 1994). The regression analysis shows that household size has a negative effect on children’s dietary diversity score (IDDS-CH). As shown in columns (1) and (2), the negative effect of household size decreases if one adds the Household food insecurity variable (HFIES), indicating that the household size reflects the overall poverty level of the household. The age of the mother has no influence on dietary diversity.
Additional income sources are positively associated with the children dietary diversity score. The sale of animal products reflects an increased supply of animal products. Remittances contribute to a larger overall income, and, by “smoothing”
income, positively affect food and nutrition security (Thow et. al, 2016). The findings also show that nutrition counselling (i.e. health services, media) has a positive effect on the dietary diversity of children.
The positive effects of economic (e.g. remittances) and behavioural factors (e.g.
nutrition counselling) on children’s nutritional status is not contradictory nor exclusive. While high income does not automatically mean good nutritional status, both variables are positively associated. Economic endowments (i.e. money, labour, time, land) determine the range of possible behaviours, and thus individual and household eating patterns. In this set of possible eating behaviours, nutrition counselling helps prioritize eating patterns which are most healthy for children and therefore positively influence their nutritional status. On the other hand, a change of behaviour might also positively affect economic endowments by e.g. influencing household health.
Brothers and sisters who actively take part in childcare have a positive impact on the dietary diversity of their younger siblings. The help of the child’s grandmother or grandmother-in-law, on the other hand, does not seem to affect undernutrition.
The effect of the mother’s support is not significant, either.
Minimum acceptable diet and minimum meal frequency
Income sources play a key role for meal frequency. In particular, income from crops, animals and businesses increase the likelihood of children meeting the minimum requirements. This might be due to the increased income from selling surplus or due to edible produce provided by crops and animals. Childcare support from siblings also has a positive impact on children’s Minimum Meal Frequency, highlighting the important role of siblings as secondary caretakers.
Dietary diversity of women
The sale of animal products and remittances also have a positive impact on the dietary diversity of women. Women living in a polygamous relation have slightly lower dietary diversity scores compared with women living in monogamous relationships. The negative effects of household size in terms of dietary insecurity are greater for women than for children, which indicates that mothers effectively shield their children from negative external effects (many mothers mentioned such efforts in the interviews).
When the Household Food Insecurity Experience Scale (HFIES) is added to the column (5) of the regression analysis table, the negative impact of having a home garden on dietary diversity is eliminated. An explanation could be that vegetable cultivation is only practiced by relatively disadvantaged groups that do not have the means to buy vegetables. This suggests that household food insecurity and home gardening are adversely related.