Zero Vegetable / Fruit Consumption by Children

Outcome

% of children 6 - 23 months of age who did not consume any vegetables or fruits during the previous day

WHO recommends that children aged 6–23 months consume fruits and vegetables daily. This indicator assesses the proportion of children in this age group who did not consume any qualifying vegetables or fruits during the previous day. It is a population-level indicator of an unhealthy feeding practice and does not measure the amount consumed or an individual child’s usual diet.

There are two main ways to determine the indicator’s value. Both require conducting individual interviews with caregivers of a representative sample of children aged 6-23 months:

 

1) Using Data from Minimum Dietary Diversity

When measuring Minimum Dietary Diversity for Children, the WHO/UNICEF questionnaire (see below) also records the data required for this indicator. Use Question 7C on vitamin A-rich yellow or orange vegetables, Question 7E on dark green leafy vegetables, Question 7F on other vegetables, Question 7G on vitamin A-rich fruits and Question 7H on other fruits. In the WHO/UNICEF 2021 guidance (see below), these questions are on page 29 of the open-recall questionnaire and pages 30-31 of the list-based questionnaire. Do not include Question 7D on plantains and white/pale starchy roots and tubers, as these foods do not count towards this indicator.

  

2) Asking Only About Fruits and Vegetables

If you do not need to administer the full WHO/UNICEF food questionnaire, ask only the five questions below. Before data collection, adapt the examples to foods commonly consumed in the survey area. Use the food lists in Annex 6 of the WHO/UNICEF guidance available below to identify appropriate examples. Use a small number of locally common and easily recognised examples from each relevant group rather than attempting to list every possible food. Ask respondents to consider foods eaten at home or elsewhere, including snacks and the main ingredients in mixed dishes.

Q1: Yesterday, during the day or at night, did [child’s name] eat any vegetables, such as [provide examples of locally common vitamin A-rich yellow or orange vegetables]?

Q2: Yesterday, during the day or at night, did [child’s name] eat any vegetables, such as [provide examples of locally common dark green leafy vegetables]?

Q3: Yesterday, during the day or at night, did [child’s name] eat any other vegetables, such as [provide examples of locally common other vegetables]?

Q4: Yesterday, during the day or at night, did [child’s name] eat any fruits, such as [provide examples of locally common vitamin A-rich fruits]?

Q5: Yesterday, during the day or at night, did [child’s name] eat any other fruits, such as [provide examples of locally common other fruits]?

A1-A5: yes / no / does not know

To calculate the indicator’s value, divide the number of children aged 6–23 months who did not consume any of the five qualifying vegetable or fruit categories during the previous day by the total number of surveyed children aged 6–23 months. Multiply the result by 100 to convert it to a percentage.

Count a child as having zero vegetable or fruit consumption only if all five relevant food categories are recorded as “no”. If ‘does not know’ is recorded or a response is missing for any of these categories, keep the child in the total number of surveyed children but do not count them as having zero vegetable or fruit consumption.

Disaggregate the data by gender, age group and household wealth. 

1) The examples of vegetables and fruits in the questionnaire should be adapted to foods commonly consumed in the survey area. General guidance on adapting the food groups is provided on page 43 of the WHO/UNICEF guide. More detailed examples are provided in Annex 6, particularly Table A6.3 (page 74), Table A6.5 (page 77), Table A6.6 (page 79), and Tables A6.7–A6.8 (from page 81).

2) Only foods belonging to the WHO/UNICEF vitamin A-rich fruit and vegetable and other fruit and vegetable groups count towards this indicator. Plantains and starchy roots or tubers, such as white potatoes, white yams and cassava/manioc, do not count. During questionnaire adaptation and enumerator training, identify locally common foods belonging to each category and use a manageable set of locally understood examples.

3) Fruit and vegetable consumption can vary by season. Where seasonality is likely to affect diets, conduct survey rounds in the same season where feasible. Do not exclude an individual child’s data solely because the previous day was unusual, for example because of illness, a celebration or a feast. If feeding practices are likely to be unusual for a large share of the survey population, such as during Ramadan, avoid fielding the survey at that time where feasible.

 

4) 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.

 

5) 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 it using a standardised approach; a locally adapted events calendar can help caregivers recall the child’s approximate date of birth. Read FAO’s Guidelines (see below) for guidance on preparing and using local events calendars.

Also consider using the following indicators:

• Minimum Dietary Diversity - Children (provides broader dietary diversity information and uses the same food recall)

• Sweet Beverage Consumption By Children (captures an important unhealthy beverage dimension of young children’s diets)

• Unhealthy Food Consumption by Children (captures unhealthy foods that can coexist with low fruit and vegetable consumption)

• Egg and/or Flesh Food Consumption by Children (adds a complementary positive measure of nutrient-dense food consumption)