Data were collected through face-to-face interviews, anthropometric measurement, and serum ferritin analysis by trained research assistants. The questionnaire contained data on socio-economic, obstetric, maternal perception, food consumption, dietary diversity, knowledge, attitude, and practices of pregnant women. In addition, mid-upper arm circumference (MUAC) and maternal height measurements were taken. The nutritional status of the pregnant women was measured with non-stretchable MUAC tape and the reading value was taken to the nearest 0.1-cm. All measurements were performed threefold and the average value of two concordant readings was considered as the ultimate value. Pregnant women with average MUAC measurements of less than 23 cm were categorized as having “undernutrition” otherwise normal [25 , 26 (link)]. The questionnaire was initially prepared in English and translated to the local language (Afan Oromo) by individuals with good command of both languages. It was also pre-tested on 10% of the samples in Kersa District before actual implementation. Women’s hemoglobin concentration (in g/dL) was measured at each study site by well-trained medical technologists using HemoCue® Hb 301 system, according to the manufacturer’s instructions (HemoCue AB Ängelholm Sweden) which is a gold standard for fieldwork. A prick was done on the tip of the middle finger after the site was cleaned with disinfectant. The first drop of blood was cleaned off and the second drop was collected to fill the microcuvette which is then placed in the cuvette holder of the device for measuring hemoglobin concentration. Hemoglobin values were adjusted for altitude as per the Center for Disease Prevention and Control (CDC) recommendation [27 ].
As the detailed description has been given elsewhere in a previous papers [23 (link), 24 (link)], the formerly validated food frequency questionnaire (FFQ) containing 27 of the most common lists of food items consumed by the district community was used to assess the dietary diversity of the study participants [28 –33 ]. The food items in the FFQ were grouped into ten food groups, including cereal, white roots and tubers, pulse and legumes, nuts and seeds, dark green leafy vegetables, other vitamin A-rich fruits and vegetables, meat, fish and poultry, dairy and dairy product, egg, other vegetables, and other fruits. The sum of each food group pregnant women consumed over seven days was calculated to analyze the dietary diversity scores (DDS) [32 (link)]. Furthermore, the dietary diversity score was converted into tertiles, with the highest tertile labeled as a "high dietary diversity score" whereas both lower tertiles combined were defined as a “low dietary diversity score". The food variety score (FVS) is the frequency of individual food items consumed during the reference period. Therefore, it was estimated by calculating each individual’s intake of the 27 food items over seven days.
As the detailed description has been given elsewhere in a previous papers [23 (link), 24 (link)], the formerly validated food frequency questionnaire (FFQ) containing 27 of the most common lists of food items consumed by the district community was used to assess the dietary diversity of the study participants [28 –33 ]. The food items in the FFQ were grouped into ten food groups, including cereal, white roots and tubers, pulse and legumes, nuts and seeds, dark green leafy vegetables, other vitamin A-rich fruits and vegetables, meat, fish and poultry, dairy and dairy product, egg, other vegetables, and other fruits. The sum of each food group pregnant women consumed over seven days was calculated to analyze the dietary diversity scores (DDS) [32 (link)]. Furthermore, the dietary diversity score was converted into tertiles, with the highest tertile labeled as a "high dietary diversity score" whereas both lower tertiles combined were defined as a “low dietary diversity score". The food variety score (FVS) is the frequency of individual food items consumed during the reference period. Therefore, it was estimated by calculating each individual’s intake of the 27 food items over seven days.
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