Minimum Dietary Diversity - Children (MDD)
English: % of children 6-23 months of age who received foods from ≥ 5 food groups the previous day or night
French: % d'enfants âgés de 6 à 23 mois ayant consommé des aliments appartenant à au moins 5 groupes d’aliments distincts le jour ou la nuit précédents
Portuguese: % de crianças entre 6 - 23 meses de idade que receberam alimentos de ≥ 5 grupos alimentares no dia ou noite anteriores
Czech: % dětí ve věku 6-23 měsíců, které v uplynulém dni a noci konzumovaly jídlo z alespoň 5 potravinových skupin
What is its purpose?
MDD assesses the proportion of children 6-23 months of age who have consumed at least five out of eight pre-defined food groups the previous day or night. It is an indicator of a diet's micronutrient adequacy, an important dimension of its quality.
How to Collect and Analyse the Required Data
Collect the following data by conducting individual interviews with the primary caretakers of a representative sample of children aged 6-23 months.
1) Check whether yesterday was a special day (religious festival or celebration) when the child (aged 6-23 months) ate an unusually varied or limited diet - if so, do not proceed with collecting dietary data as it is likely that they will not reflect a typical diet.
2) List all meals which the child ate in the previous day in the Recording Meals Form (see link below).
3) Double check the meals' composition (e.g. porridge with or without milk).
4) Check for any snacks (including fruits) which were not mentioned.
5) Ask whether the child was breastfed during the previous day or night: "Yesterday, during the day or at night, was [baby's name] given any breast milk?"
6) Only then record in the questionnaire which food groups were eaten. Double check with the respondent regarding which foods the child ate from groups that were not mentioned (for example: "Did s/he yesterday eat any eggs?")
7) Count the number of consumed food groups for the given child - see their list included in the guidance below (incl. the new, 8th food group breastmilk).
8) Count the number of children whose diet consisted of at least 5 food groups (i.e. reached Minimum Dietary Diversity).
9) Calculate the indicator's value by dividing the number of children whose diet consisted of at least 5 food groups by the total number of surveyed children. Multiply the result by 100 to convert it to percentages.
Disaggregate the data by gender, wealth and age group.
1) Note that the original WHO 2010 guidance provided below works with 7 food groups for children 6-23 months of age; however, based on a June 2017 expert consultation it has been updated to reflect the inclusion of breast milk as an 8th food group (see WHO/UNICEF Operational Guidance provided below; revised full guidance has not been published yet). Among the advantages of including breast milk as another food group is that the data can be compared across breastfed and non-breastfed groups of children. When interpreting the indicator data, pay attention to the extent to which changes to dietary diversity are happening due to children receiving more (or less) diverse food versus due to more (or fewer) children being breastfed.
2) Dietary diversity is prone to seasonal differences. Do your best to collect baseline and endline data in the same period of a year; otherwise, it is very likely that they will not be comparable. Do not collect data during the fasting periods (such as pre-Easter time or Ramadan) and during the fasting days.
3) This indicator relies on accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the data collectors should always verify the child’s age. This can be done by reviewing the child’s birth certificate, vaccination card or another document; however, since many caregivers do not have such documents (and since they can include mistakes), it is essential that your data collectors are able to verify the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors in their correct use.
4) Record food groups in the questionnaire only after all meals were listed in the Recording Meals Form – do not record it straightaway as it is very likely that the number of food groups consumed will be under-reported.
5) When training your data collectors, practice extensively which meals belong to which food group (allocate at least 3 hours full of examples and exercises). For example, while pumpkin flesh belongs to Vitamin A Rich Foods, pumpkin leaves belong to Dark Green Leafy Vegetables (see more examples in the FAO Guidelines below). If your questionnaire includes examples of different foods per each group, adjust them to the local context.
6) Do not record foods in quantities lower than one teaspoon (for example, a small amount of fish powder added for flavouring).
7) Well-designed, long-term (3 years or more) projects have a chance to increase the average dietary diversity by 1 "point"; for short-term projects, an increase by 0.5 "point" is a realistic maximum you can achieve.
8) Based on the number of meals included in the Recording Meals Form, you can also assess the meal frequency. Combination of MDD + meal frequency data enables you to determine the percentage of children which consume a Minimum Acceptable Diet (see separate page on MAD indicator).
9) Take advantage of the very useful guidelines provided below.
Access Additional Guidance
- FAO (2013) Guidelines for Measuring Household and Individual Dietary Diversity (.pdf)
- WHO (2008) Indicators for Assessing IYCF Practices Part 1: Definitions (English version) (.pdf)
- WHO (2008) Indicators for Assessing IYCF Practices Part 1: Definitions (French version) (.pdf)
- PIN (2015) Practical Checklist for Conducting Nutrition Surveys (.pdf)
- WHO (2010) Indicators for Assessing IYCF Practices Part 2: Measurement (French version) (.pdf)
- WHO (2010) Indicators for Assessing IYCF Practices Part 2: Measurement (English version) (.pdf)
- WHO/UNICEF (2017) Global Nutrition Monitoring Framework: Operational Guidance (.pdf)