Minimum Dietary Diversity - Children

Outcome

% of children 6 - 23 months of age who consumed foods and beverages from at least five out of eight defined food groups during the previous day and night

The minimum dietary diversity indicator assesses the proportion of children aged 6–23 months who consumed foods and beverages from at least five out of eight defined food groups during the previous day and night. It is a population-level indicator of dietary diversity that is associated with micronutrient adequacy; it does not directly measure nutrient intake, food quantity or overall diet quality.

Collect the following data from a representative sample of children aged 6–23 months by interviewing, for each child, the caregiver who knows most about what the child consumed during the previous day and night.

 

1) The enumerators should administer the current breastfeeding question, the “Liquids questionnaire” and the “Open Recall Questionnaire for Foods” available in the WHO/UNICEF guidance (see below, pages 25–30). Breast milk counts as one of the eight food groups, so breastfeeding during the previous day and night must be recorded.

As the WHO/UNICEF guidance explains, the enumerator should ask about all foods the child ate during the previous day and night, starting from when the child woke and proceeding through the day and night. For mixed dishes, ask about the main ingredients if these are not clear (e.g. porridge with or without milk).

Once all foods have been recorded, ask whether the child ate any snacks or small meals that may have been forgotten. Then ask about each food category that was not mentioned. For example, if the respondent did not mention eggs, ask: ‘Just to make sure, did [child’s name] eat any eggs yesterday during the day or the night?’ This helps reduce the risk of foods being forgotten.

2) Convert the food categories used in the questionnaires into the eight food groups used by the Minimum Dietary Diversity indicator. Annex 8 of the WHO/UNICEF guidance (see below) explains how the questionnaire categories correspond to these eight food groups.

3) For each child, count the number of food groups consumed during the previous day and night. If information for a food group is missing or recorded as ‘don’t know’, do not count that food group as consumed. A child meets Minimum Dietary Diversity if they consumed foods and beverages from at least 5 of the 8 food groups.

4) To calculate the indicator’s value, divide the number of children aged 6–23 months who consumed foods and beverages from at least 5 food groups by the total number of surveyed children aged 6–23 months. Multiply the result by 100 to convert it to a percentage.

This data can be disaggregated by sex of the child and age group, and, if relevant and feasible, also by household wealth, geographic area, and programme exposure.

1) An alternative approach to collecting the necessary data is using the list-based recall method. In this method, an enumerator reads a standardized list of food items to the child's caregiver. For each item, the caregiver indicates whether or not the child consumed it during the previous day and night. For more information about this method, read the WHO/UNICEF guidance provided below.

2) According to WHO/UNICEF (see guidance below), consumption of any amount of a qualifying food or beverage from a food group is sufficient to “count” – i.e. there is no minimum quantity. However, ingredients used only in small amounts to add flavour to a mixed dish should not be counted. Follow the WHO/UNICEF guidance when identifying the main ingredients of mixed dishes.

 

3) The enumerators should not exclude or revisit a child solely because the previous day was a celebration, feast, illness day or otherwise unusual for that child. Such individual-level variation is part of population dietary intake. If intake is likely to be highly unusual for a large share of the survey population, for example during Ramadan, avoid fielding the survey during that period where feasible or interpret the results accordingly.

4) Dietary diversity can vary by season. Where seasonality is likely to affect diets, collect baseline and endline data in the same season. Comparisons between survey rounds or areas surveyed in different seasons should be interpreted cautiously.

5) During training, practise classifying locally common foods and mixed dishes into the questionnaire categories and then mapping these categories to the eight MDD food groups. Use the training guidance and food-group mapping in the WHO/UNICEF publication below.

6) This indicator relies on accurate age assessment. Use a reliable record of the child’s date of birth where available. If the date of birth is not documented or known, estimate the child’s month and year of birth using a locally adapted events calendar. See FAO’s Guidelines below for guidance on developing and using local events calendars.

7) When households are sampled, collect data for all children aged 6–23 months in each sampled household. If children are sampled directly as the primary sampling units, collect data only for the sampled child.

8) The data collected for this indicator can also be used to calculate the proportion of children who consumed foods from a specific food group during the previous day and night. For example, you can calculate the percentage of children aged 6–23 months who consumed vitamin A-rich fruits and vegetables / flesh foods / eggs / dairy products / or pulses, nuts and seeds. Such food-group-specific results can be useful when a programme aims to increase the consumption of particular types of nutritious foods.

10) Because the indicator is based on a single previous-day recall, it should be interpreted as a population-level prevalence measure, not as a measure of an individual child’s usual diet or of the quantity of food consumed.

 

11) The indicator was revised in 2017 by adding breast milk as an eighth food group and increasing the cut-off from 4 out of 7 to 5 out of 8 food groups. This removed the previous advantage given to formula-fed children, as infant formula counted as a food group while breast milk did not. Values calculated using the former 4-out-of-7 definition should not be directly compared with values calculated using the current 5-out-of-8 definition unless the earlier data can be recalculated. When interpreting changes in MDD, consider whether they reflect changes in the diversity of foods consumed, breastfeeding, or both.

  

12) The same eight-food-group dietary diversity score can also be presented using UNICEF’s child food poverty categories. According to UNICEF’s report (see below), if children are fed:

• 0–2 food groups/day, they are living in severe child food poverty

• 3–4 food groups/day, they are living in moderate child food poverty

• 5 or more food groups/day, they are not living in child food poverty

Also consider using the following indicators:

• Minimum Meal Frequency (captures feeding frequency, a complementary dimension not measured by dietary diversity)

• Minimum Acceptable Diet (combines dietary diversity and feeding frequency into a broader IYCF measure)

• Egg and/or Flesh Food Consumption by Children (shows whether nutrient-dense animal-source foods contribute to the child's diet)

• Sweet Beverage Consumption By Children (captures an unhealthy diet dimension that MDD does not penalise)

• Unhealthy Food Consumption by Children (captures unhealthy foods that can coexist with apparently adequate dietary diversity)