Abstract
BACKGROUND: Women's diet diversity is a proxy indicator of micronutrient adequacy. Low diet diversity affects the health of pregnant women and their offspring, eventually hindering productivity and economic development. Despite its significant influence on nutrition, the food environment has been considered to a lesser extent in international research and advocacy. Currently, influencing the food environment and increasing nutritional sensitivity are emerging strategies for addressing nutritional challenges. Therefore, this study aimed to assess diet diversity and associated factors, with a special focus on the food environment, among pregnant women in the Kilteawlaelo district, Tigray, northern Ethiopia. METHODS: A mixed cross-sectional study design was used. The quantitative part of the study consisted of a total of 423 randomly selected pregnant women. Seven focus group discussions and seven in-depth interviews were also conducted in the qualitative study. Quantitative data were analyzed using SPSS version 21. The maternal diet diversity score was defined as adequate if it was greater than or equal to five food groups. Bivariate and multivariable binary logistic regressions were used to analyze the data. Qualitative data were transcribed and entered into the Atlas Ti version 7.5 software for coding, and inductive thematic analysis was used. RESULTS: Only 48.2% (95% CI: 43.00, 52.70) of pregnant women had adequate diet diversity. Being a farmer (p = 0.010), having low food availability perceptions (p = 0.003), and having only one local market day (p = 0.013) were associated with low diet diversity. Pregnant women reported in their group discussions that foods were not available at home in sufficient quantities, were not affordable in the market, and they had to travel far to reach the local food markets. CONCLUSION: A large number of pregnant women had inadequate dietary diversity scores, which can imply micronutrient deficiencies. While occupation, perceived food availability, and number of market days in a week had significant effects on diet diversity, food desirability, convenience, and market accessibility were not associated with it. Improving the food environment by increasing the availability of food and expanding local food markets and the number of market days can lower the prevalence of inadequate diet diversity among pregnant women.