Dietary diversity and associated factors among women of reproductive age in Jeldu District, West Shoa Zone, Oromia Ethiopia

Gudisa Merga; Samson Mideksa; Nagasa Dida; Gina Kennedy

doi:10.1371/journal.pone.0279223

. 2022 Dec 19;17(12):e0279223. doi: 10.1371/journal.pone.0279223

Dietary diversity and associated factors among women of reproductive age in Jeldu District, West Shoa Zone, Oromia Ethiopia

Gudisa Merga ¹, Samson Mideksa ², Nagasa Dida ^3,^*, Gina Kennedy ⁴

Editor: Amene Abebe Kerbo⁵

PMCID: PMC9762567 PMID: 36534691

Abstract

Background

Women of reproductive age are at a higher risk of insufficient micronutrient intake due to their low dietary diversity which has an impact on child growth and development, anemia and low birth weight. However, there are no information from the study area. Hence, the study aimed to assess dietary diversity and associated factors among reproductive-age women in Jeldu District, West Shoa Zone, Oromia Region, Ethiopia, 2018.

Methods

A community-based cross-sectional study was undertaken among 634 women of reproductive age. The study participants were recruited using a systematic sampling method. The data were collected using a structured questionnaire based on 24-hour dietary recalls. The data were checked, coded, and entered into EpiData version 3.1 before being exported to SPSS Version 21 for analysis. Descriptive statistics like frequency standard deviation, mean and proportions were computed., both binary and multivariable logistic regressions were run at 95 percent confidence intervals. A P-value of <0.05 was used to declare a statistically significant association between dietary diversity and explanatory variables.

Results

The proportions of women who consumed greater than or equal to five food groups were 81.9%. Agro-ecological zone of highland (AOR = 7.71: 95% CI: 3.72, 15.99), women who have a radio (AOR; 1.87: 95% CI; 1.17, 2.99) and women’s decision-making power to purchase food for household (AOR; 3.93:95% CI; 2.3, 6.71) and having own mobile phone (AOR: 1.92 (1.74, 3.16)) were statistically associated with food dietary diversity.

Conclusion

The proportion of women who met the minimal standard for dietary variety requirements was high. The presence of radios, mobile phones, women’s purchasing decision power, as well as possessing large cattle, and the agroecological zone of the participants were all important predictors of dietary variety among reproductive-age women. The local media, agriculture office, health office, and women, youth, and children office all need to pay more attention to the determinants of dietary variety in women.

Background

Dietary diversity refers to the variety of foods consumed across and within food categories within a certain period, as well as a rise in the range of foods available across and within food groups that can ensure optimal intake of key nutrients for good health [1].

Dietary diversity is typically measured by adding up how many different foods were taken over some time or, more commonly, by counting how many different food groups were consumed [2, 3]. The proportion of women aged 15 to 49 who consume at least 5 out of 10 food groups is known as minimum dietary diversity for women (MDD-W). It is an indicator of women’s diet quality with a focus on micronutrient sufficiency and a measure of household access to a diet high in micronutrients [4, 5].

All people must consume a variety of foods to meet their nutritional needs; a diverse diet is important and helps to ensure optimal intake of micronutrients; No one food has all the nutrients; The possibility of fulfilling nutrient needs is higher when more food types are consumed daily [2, 5, 6]. Low dietary intakes and unfair intra-household food distribution are the leading causes of undernutrition, and food taboos and misconceptions contribute significantly to the high levels of undernutrition among vulnerable groups [7–10].

Most monotonous staple meals are deficient in important micronutrients, resulting in micronutrient deficits in susceptible groups (especially women of reproductive age) [11]. Many people in underdeveloped nations lack the resources to cultivate or purchase micronutrient-dense foods like meat, fish, poultry, eggs, milk, and dairy products, and their diets are based on nutrient-deficient staples like rice and maize [12].

In underdeveloped nations such as Africa, Asia, Latin America, and the Caribbean, pregnant and breastfeeding women who ate mostly plant-based diets had insufficient micronutrient intakes and minimal dietary diversification [13]. Micronutrient deficiency, also known as hidden hunger, affects more than two billion people worldwide. Key micronutrient deficiencies, such as iron, iodine, vitamin A, folate, vitamin D, and zinc, can have serious health consequences in young children, adolescent girls, pregnant, and lactating women [14].

Annually, maternal malnutrition causes 800,000 neonatal deaths;, stunting, wasting, and maternal micronutrient deficiencies cause approximately 3.1 million child deaths [15, 16]; all forms of malnutrition are caused by poor diets, insufficient knowledge and resources, and unhealthy environments; if current trends continue, one person in two will be malnourished by 2030 [17]; poor maternal nutrition is directly associated with mothers’ lack of resistance to infection and wasting; poor maternal nutrition is directly associated with mothers’ lack of resistance [18]. Due to their poor dietary diversity, Ethiopian women of reproductive age are at a higher risk of micronutrient deficiency [19]. But, there is no information on dietary divericity practice among reprocuttive age women of Jeldu District. As a result, this study assessed dietary diversity practice and its associated variables among women of reproductive age in Jeldu district, West Shoa zone, Oromia Ethiopia, in 2018.

Method and materials

Study design and setting

A community-based cross-sectional study was conducted from March to April 2018 in Jeldu district, West Shoa zone, Oromia Ethiopia.

A single population proportion formula was used to estimate the sample size. The sample size was calculated using the following assumptions: 50% as prevalence of adequate dietary diversity among women of reproductive age, 95% confidence level, 1.5 design effects, 10% nonresponse rate, and 5% degree of precision. Finally, a sample size of 634 was achieved.

The district was stratified into agroecological zones and then ten sub-districts (the smallest administration units) were selected by simple random sampling from the total thirty subdistricts by lottery method.

Sample size and sampling technique

Households were selected using systematic random sampling; a community health information system (CHIS) was used as a sampling frame. Then six hundred thirty-four (634) samples were proportionally allocated for each selected subdistrict. Finally, one woman was selected using a lottery method if more than one woman presents in a household. Tool and Data Collection Methods: Regarding data collection semi-structured questionnaire was used to collect data tool was adapted after reviewing different literatures, food and Agriculture Organization (FAO); FHI 360 (1, 4). Minimum Dietary Diversity for Women and health survey reports. First, the tool was prepared in English and translated to Afan Oromo, and re-translated to English by language experts to check the consistency of the questionnaire.

Thirteen (13) data collectors who speak the Afan Oromo language were trained for two days before the actual data collection on interviewing approach, data collection technique, objectives of the study, participant’s rights, techniques of data collection, and completeness of the data. The questionnaire was pretested among thirty-two households out of the study area (Edensa Gelan).

The outcome, dietary diversity, was assessed using Food and Agricultural Organization to measure women’s dietary diversity. Food consumed by women of reproductive age was assessed through the 24-hour recall method (food consumed in one day from the time of interview back) and then food items were categorized into ten food groups. Dietary Diversity Score (DDS) was created as a summary measure of dietary intake, accordingly, participants who had DDS of five and above were considered as having adequate dietary diversity, whereas inadequate DDS was determined when they had less than five DDS [4, 21].

Operational definition

In this study, large-Livestock mean animal like—cattle, horses, donkey, goats, and sheep; whereas small livestock is animals like hen and cock; Adequate dietary diversity was assessed using the ten FANTA food groups. Inadequate dietary diversity: when women of reproductive age consumed less than five of ten food groups within 24 hours; Adequate dietary diversity: when reproductive women age consumed at least five of ten food groups within 24 hours.

Data management and analysis

Epi-Data 3.1 was used for data entry and exported to SPSS Version 21 window for analysis. Descriptive statistics like frequency and percentage for the categorical variables, and mean and standard deviation for continuous variables were applied. Binary logistic regression analysis was done to identify candidate variables for multivariable logistic regression model and variables having a p ≤ 0.20 were candidates for multivariable logistic regression and entered into multivariable logistic regression model. Variables with less than (p ≤ 0.05) were declared statistically significant at 95% of the confidence interval.

Ethics approval and consent to participate

This study was approved by the ethical review board of the College of Medicine and Health Sciences, Ambo University. The ethical review board also approved its ethical issues as there was no procedure that affects the study subject and the data is used only for research purpose. Hierarchically all administrative bodies were communicated and permission was secured. Informed consent to participate in the study was obtained from all participants after explaining objectives and procedures of the study and their right to participate or to withdraw at any time in between of the interview. For this purpose, a one-page consent letter was attached to the cover-page of each questionnaire stating about the general purpose of the study and issues of confidentiality which was discussed by data collectors before proceeding to the interview. Lastly, we confirm that this study was conducted in accordance with the Declaration of Helsinki.

Results

Socio-demographic economic and characteristics

A total of 634 women of reproductive age participated in this study, making a response rate of 100% with a mean age of (30.55) years and a standard deviation of 7.628. About 44.2% of participants were from the Highlands, 36.9% from the Midlands, and 18.9% from the Lowlands. More than (53.6%) of the respondents were protestant in religion, about 83% were married, and 55.2% of the participants had no formal education. 57.1% of respondents were farmers, and 50.6% of participants lived with less than five family members (Table 1).

Table 1. Socio-demographic characteristics of reproductive women in Jeldu district West Shoa zone, Oromia, Ethiopia, March 25 –April 15, 2018.

Variables	Category	Frequency	Percentage
Age	15–24	135	21.3
	25–34	282	44.2
	35–44	188	29.7
	≥45	29	4.6
Agro-ecological Zone	Highland	280	44.2
	Midland	234	36.9
	Lowland	120	18.9
Marital status	Single	81	12.8
	Married	526	83
	Divorce	17	2.7
	Widowed	10	1.6
Religion	Orthodox	244	38.5
	Waqefta	50	7.9
	Protestant	340	53.6
Educational status	No formal education	350	55.2
	Primary	241	40.1
	Secondary and above	43	6.8
Family size	<5	321	50.6
Family size	≥5	313	49.4
Occupational status	House wife	141	22.2
	Farmers	362	57.1
	Students	89	14
	^*Others	42	6.6

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*Merchant: government employments and daily labors.

Regarding average monthly income, more than half (62.1%) of women earned 501–1500 Ethiopian birr (Average exchange rate in 2018:1$ = 27.6677 ETB). More than three-fourth (77%) women were doing home gardening and about 83% households had farmland. Regarding the communication material, more than half (56.9%) and two-thirds (73%) of participants had radio and mobile phone, respectively (Table 2).

Table 2. Socio-economic characteristics in Jeldu district West Shoa zone, Oromia, Ethiopia, March 25 –April 15, 2018.

Variables	Category	Frequency	Percent
Head of household(n = 634)	Male	538	84.9
Head of household(n = 634)	Female	96	15.1
HH member have saving account at any bank	Yes	171	27
HH member have saving account at any bank	No	463	73
Average monthly Income (Ethiopian birr)	≤500	123	19.4
	501–1500	394	62.1
	≥1501	117	18.5
Production grow on farmland(n = 526)	Wheat	349	66.3
	Teff	327	62.2
	Barely	251	47.7
	Sorghum	173	32.9
	Maize	255	48.5
	Onion	60	11.4
	Chickpea	73	13.9
	Potatoes	331	62.9
	Bean	44	8.4
	Peas	20	3.8
Having mass media or having electronics device in the HH	Having radio	361	56.9
	Having mobile	463	73
	Having TV	59	9.3

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Food dietary diversity and associated factors

Overall, 81.9% (95% CI: 78.9–84.9) women had adequate dietary diversity. Moreover, the mean dietary diversity score of participants was 5.98 (SD± 1.86). The majority (99.8%) of women consumed starchy staples (grains, roots, and tubers). However, only 24.1%ate dark green leafy vegetables (Fig 1).

Using bivariable logistic regression analysis, the variables identified at a p-value of < 0.2 for the final model were age, agro-ecological zone, marital status, having a bank account at any bank, having home gardening, having farmland, having small animals, having large animal, average monthly income, radio usage, mobile phone usage, food exchange, main source of food from market, main source of food own production, women’s decision making to purchase food, and animal used as means of transportation. In multivariable logistic regression, variables like women’s decision-making power to purchase food for the household, Agro-ecological zone, having large livestock, having a radio, and having a mobile phone were significantly associated with dietary diversity. Women in the highland were 7.71 (AOR = 7.71; 95% CI: 3.72–15.99) more likely to consume adequate dietary diversity than women of reproductive age in the lowlands. Women who had radio were 1.87 times more likely to have adequate diversified food (AOR = 1.87; 95%; CI: 1.17–2.99) compared to their counterparts. Women with purchasing power for household food were 3.93 times more likely to consume diversified food (AOR = 3.93; 95% CI:2.3–6.71) as compared to women with no purchasing power., Women who had large livestock were 2.67 times more likely to have adequate diversified food compared to those who women who had no large livestock (AOR; 2.67: 95% CI: 1.4–5.08) and women who had mobile phones were 1.92 times more likely to consume adequate dietary diversity (AOR = 1.92; 95% CI: 1.74–3.16,) compared to their counterparts (Table 3).

Table 3. Binary and multivariable logistic regression model showing socio demographic, socio economic and personal food environment factors associated with dietary diversity among reproductive age women in Jeldu district West Shoa zone, Oromia, Ethiopia, March 25 –April 15, 2018.

Variables	Category	WRA dietary diversity		COR(95%CI)	AOR(95%CI)	p-value
Variables	Category	Adequate	Inadequate	COR(95%CI)	AOR(95%CI)	p-value
Age	15–24	111(82.2%)	24(17.8%)	2.83(1.18–6.75)	2.07(0.75–5.73)	0.158
	25–34	131(81.9%)	51(18.1%)	2.77(1.23–6.22)	2.18(0.85–5.65)	0.106
	35–44	159(84.6%)	29(15.4%)	3.35(1.44–7.82)	2.75(1.02–7.4)	0.045
	≥45	18(62.1%)	11(37.9%)	1	1
Agro ecology	Highland	264(94.3)	16(5.7%)	5.258(2.73–10.13)	7.71(3.72–15.99)	<0.001
	Midland	164(70.1%)	70(29.9%)	0.747(0.45–1.24)	1.017(0.57–1.8)	0.955
	Lowland	91(91.5%)	29(24.5%)	1	1
Marital status	Single	60(74.1%)	21(25.9%)	2.857(0.75–10.86)	1.01(0.81–5.68)	0.987
	Married	440(83.7%)	86(16.3%)	5.116(1.45–18.05)	1.53(0.31–7.8)	0.608
	Divorced	14(82.4%)	3(17.6%)	4.667(0.804–23)	1.95(0.28–16.05)	0.53
	Widowed	5(50%)	5(50%)	1	1
Bank account	Yes	151(88.3%)	20(117%)	1.29 (0.73–2.29)	0.648(0.363–1.16)	0.142
Bank account	No	368(79.5%)	95(20.5%)	1	1
Radio	Yes	316(87.5%)	45(12.5%)	2.42(1.60–3.66)	1.87(1.17–2.99)	0.009
Radio	No	203(74.4%)	70(24.6%)	1	1
Mobile phone	Yes	391(84.1%)	72(15.6%)	1.82(1.19–2.29)	1.92(1.74–3.16)	0.01
Mobile phone	No	128(74.9%)	43(25.1%)	1	1
Home gardening	Yes	405(83%)	83(17%)	1.37(0.87–2.17)	0.612(0.332–1.16)	0.134
Home gardening	No	114(78.1%)	32(21.9%)	1	1
farm land	Yes	439(83.5%)	87(16.5%)	1.766(1.08–2.88)	0.66(0.29–1.5)	0.322
farm land	No	80(74.1%)	28(25.9%)	1	1
Small livestock	Yes	275(84.1%)	52(15.9%)	1.37(0.91–2.05)	1.38(0.85–2.24)	0.19
Small livestock	No	244(79.5%)	63(20.5%)	1	1
large livestock	Yes	471(84.1%)	89(15.9%)	1.77(1.08–2.88)	2.67(1.4–5.08)	0.009
large livestock	No	48(64.9%)	26(35.1%)	1	1
Average monthly income (ETB)^*	≤500	98(97.7%)	25(20.3%)	0.37(0.17–0.80)	0.517(0.21–1.25)	0.144
	501–1500	314(79.7%)	80(20.3%)	0.37(0.18–0.22)	0.55(0.26–1.19)	0.133
	≥1501	107(91.5%)	10(8.5%)	1	1
Food exchange	Yes	489(82.6%)	103(17.4%)	1.90(0.94–3.8)	1.62(0.68–3.86)	0.28
Food exchange	No	30(71.4%)	12(28.6%)	1	1
Animal transport	Yes	90(87.4%)	13(12.6%)	1.65(0.89–3.06)	0.79(0.39–1.6)	0.5
Animal transport	No	429(80.8%)	102(19.2%)	1	1
Food own farm land	Yes	483(84%)	92(16%)	3.4(1.9–5.9)	1.8(0.85–3.82)	0.25
Food own farm land	No	36(61%)	23(39%)	1	1
Food from market	Yes	469(83.3%)	94(16.7%)	0.477(0.27–0.83)	0.1.178(0.69–3.13)	0.317
Food from market	No	50(70.4%)	21(29.6%)	1	1
Women’s decision-making power to purchase food for household	Yes	426(85.2%)	74(14.8%)	3.026(1.92–4.75)	3.93 (2.3–6.71)	<0.001
	No	78(65.5%)	41(34.5%)	1	1

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* Average exchange rate in 2018:1$ = 27.6677 ETB.

Discussion

This study was conducted among reproductive age women of Jeldu District to determine ditery divercity practice and its associated factors. Accordingly, this study revealed that more than three-fourths (81.9%) of women consumed the minimum recommended food groups or has got adequate dietary diversity. Compared to other study findings, it is higher than the findings of: South Africa 25% [20], India, 46.2% to 76.6% [21, 22], Algeria, 32% [23], Bangladesh 65% [24] and studies in other part of Ethiopia, 28% to 50.7% [25–27] however it is lower than the study conducted in Zambia 87.5% [28]. The high proportion of adequate dietary diversity in this study might be due to the nature of the study, i.e, the study period. Moreover, the study area is known district of tuber and grain producers. This study also confirmed that almost all (99.8%) women consumed grains, roots, and tubers. This result was supported by the study conducted in Ghana, Zambia; in Kenya and other area of Ethiopia [28–30].

The result of multivariable logistic regression analysis showed that women who were living in the highlands were 7.71 times more likely to consume adequate dietary diversity when compared with those who were living in the lowlands. This result agreed with the study conducted in the Limu district of Hadiya Zone, Southern Ethiopia [31]. The similarity could be due to the high production of different grains and tubers in the highlands and the availability of varieties of crops in the highland, moreover presence of many market days and shops could avail availability of healthier diets like vegetables and fruits in both studies, and almost all in highland areas vegetables like potatoes exist and are consumed throughout the year. But inconsistent with the study conducted in Raya Alamata, Southern Tigray, Ethiopia [18, 32].

The difference is due to availability of the production, and socio-cultural determinants which might need further concerns. The community accessibility to market supplies that population resides near to market could have better access to a variety of foods and the agro-ecological zone could play great role for the place where these market exit.,; these could be risk factors for a reduction in agricultural productivity when a variety of products are not available an individual cannot consume varieties of food groups. Women who had radio were 1.87 times more likely to consume adequate dietary diversity when compared with their counterparts. This result is consistent with a study conducted in Ethiopia [33, 34].

The similarity is due to access to information through broadcasts of nutrition and health messages as a means of advocacy, and it is related to their economic status; women with higher monthly income can buy mobile and radio services and receive nutrition massages. Women who owned large livestock were 2.67 times more likely to consume adequate dietary diversity. Studies in rural Bangladesh and other parts of Ethiopia are congruent with this findings [35, 36]. This consistent association suggests that households that own large livestock are more likely to move from inadequate dietary diversity to adequate dietary diversity and are easy to keep, trade, and contain foods that may provide micro- and macronutrients when their products are consumed, and also used as income. Lastly, women who have the decision-making power to purchase food for their household were 3.93 times more likely to consume adequate dietary diversity, which is consistent with the study in Nepal and the Netherlands, Bangladesh, Ghana, and Ethiopia [29, 33, 37–41].

The study tried to show the dietary diversity of one of the most vulnerable groups of the population on behalf of the Jeldu district, West Shoa, Oromia Ethiopia and, but some of the limitations of this study should be taken into consideration. This study did not consider the quantity of food consumed by women of reproductive age and a single twenty-four-hour recall did not indicate the normal dietary routine of women. There might be social desirability bias and recall bias during data collection which do not show cause and effects. The study period would not represent reality exist in the community across the year. Moreover, it would have been good if the study was supported by qualitative study to address different social-cultural food taboos in the community.

Conclusion

The proportion of adequate dietary diversity is high in the sampled population of the Jeldu district, West Shoa zone, Oromia, Ethiopia. Women’s making decisions, Agroecological zones, having large livestock, having a radio, and having mobile phones were the predictors of women’s dietary diversity. So health extension workers who are working at the grass root level of the community, district health office, and other concerned bodies should give special attention to the predictors of dietary diversity among women of reproductive age because it improves their dietary diversity.

Supporting information

S1 Dataset. Dataset–SPSS.

(SAV)

Click here for additional data file.^{(150.5KB, sav)}

Acknowledgments

The authors would like to thank all respondents for their willingness to participate in the study. They are also grateful to Ambo University College of Medicine Health Sciences, department of Public Health, for material support.

Abbreviations

AOR: Adjusted Odds Ratio
CGIAR: Consultative Group on International Agricultural Research
CI: Confidence Interval
COR: Crud Odds Ratio
DDS: Dietary Diversity Score
FAO: Food and Agriculture Organization
MDD-W: minimum dietary diversity for women
SPSS: Statistical Package for Social Sciences
WRA: women of reproductive age

Data Availability

All relevant data are within the article and its Supporting Information files.

Funding Statement

Consultative Group on International Agricultural Research (CGIAR) from a Research Program on Agriculture for Nutrition and Health (A4NH) under the flagship of Food Systems for Healthier Diets (FSHD).

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PLoS One. doi: 10.1371/journal.pone.0279223.r001

Decision Letter 0

Amene Abebe Kerbo

10 Jul 2022

PONE-D-22-08826Dietary Diversity and Associated Factors among Reproductive Age Women in Jeldu District, West Shoa Zone, Oromia EthiopiaPLOS ONE

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Reviewer #1: Manuscript Number: PONE-D-22-08826

Full Title of the Title of paper: Dietary Diversity and Associated Factors among Reproductive Age Women in Jeldu, District, West Shoa Zone, Oromia Ethiopia.

Comments forwarded by the reviewer

The title and abstract cover the main aspect of the work but some issues should be included

� Good if the title had time frame

1. Abstract section

1.2 Methods: good to indicate P value used to declare statistical significance.

1.3 Results part of the abstract: equal to or greater or equal to five food shows repetitions of words (need correction of words). It should be relevant to the reader and contain the proportion of reproductive age women who had an overall good/ adequate dietary variety practice, rather than reporting the proportion of reproductive age women who obtained >=5 categories. It's also crucial to present the minimum dietary diversity score as a mean (SD). Furthermore, there is no need to interpret the results in the abstract section; instead, it is preferable to describe the predictor factors that have a significant association with their AOR and 95 percent CI.

1.3 Conclusions part of the abstract: inconsistency (mobile phones and possession of large cattle) It wasn't stated whether or not relevant predictors are present in the abstract's result section, however it did appear in the abstract's conclusion section.

2. Background: the introduction provides background and information relevant to the study, but some issues should be corrected/explained.

Line 63: While defining Dietary diversity it says, the number of foods consumed but it should be the number of food groups consumed not the number of food consumed.

Line 84-89: To relate to the outcome variables, the Author indicated the following target groups: pregnant and breastfeeding women, young children, adolescent females, pregnant, and lactating women. However, they should, in my opinion, keep (specifically) to the target audience specified in the headline (so need consistency). Because the aforementioned groups require a unique study strategy and specific consideration when dealing with dietary diversity.

The authors did not provide a clear magnitude on the problem (at least in the study area), instead focusing on malnutrition. While dietary diversity is a proxy indication of nutritional status, it is good to focus on dietary diversity (specific to title) rather than malnutrition. For example, what is the magnitude/prevalence of reproductive-age women consuming five or more food groups from the list? Or, in Ethiopia, what percentage of reproductive-age women ate a diet that was less varied or monotonous? It should also detail the variables (related factors) that may have contributed to the target group's poor or good dietary diversity practices.

3.Method: Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail?

In my opinion Authors, tries to do their best, but to be clear and replicable, the methods need certain explanation

Line 104: P (prevalence) Authors used were 50% (i.e. 50% of women of reproductive age obtained adequate dietary diversity. It should be supported with reference.

Line 107: According the Authors report, ten kebeles were selected by lottery method. But it is not clear that from how many Kebeles these 10 kebeles were selected? And what was the assumption to select the given number of Kbeles?

Data collection tools and procedures should be clearly described.

Line 108-109: As a sampling frame, the community health information system (CHIS) was used. Why not use simple random sampling instead of systematic random sampling, which is the most recommended method, if there is a sample frame?

Line 115The authors noted that the questionnaire was written in English, translated into Afan Oromo, and then re-translated into English to ensure consistency. But who is responsible for translating the tools? It should be clarified that this should be done by a language expert.

How will the women's privacy be respected during the interview? What was the location of the interview and how was it conducted? Other family members, for example, did not have free access to the interview location because safeguarding the women's privacy is vital.

Do the Authors have supervisor(s)? If so should be mentioned, the number, their discipline and their activities.

The reader will be able to identify/ capture the relevant independent (predictors) variables that the Authors employed in this study and how those factors were measured to assess the main outcome variable if the major components (or contents) of the questionnaire (or instrument) are provided. This section, in my opinion, should be well stated, as it determines the quality of the research.

Line 121-127: the authors used ten different food groups recommended by the Food and Agricultural Organization to measure DDS. Food groups were assessed using a 24-hour recall method, created as a summary measure of dietary intake, and dichotomized into DDS of (less than five and five and above) to determine whether women had adequate or inadequate dietary diversity. That was the list of good points, but in addition to that, good if

1. The authors should list the ten food groups that were utilized to assess DDS.

2. Make clear whether the authors validated the questionnaire/tool after conducting the assessment of locally available foodstuffs with the mentioned ten food groups according to FAO

3. Specify whether the Authors are evaluating/asking about food just or beverages and/or snacks as well.

4. Make it obvious whether the interviewers are probing the respondents for any food varieties that they may have forgotten.

5. It should be clarified what the authors did if the foods mentioned by the respondents were not in the predetermined list..

Line 128 -132: In Data processing and analysis, I missed the descriptive statistics like mean and Standard Deviation for (continuous variable) and frequency and percentage for (categorical data).

4. Results: The study presents the results of primary scientific research? The research finding produces contribution to the specific vulnerable group. But need clarification in certain areas.

Line 145-146 the authors mentioned that mean of DDS was used, good to include the SD (standard deviation as well). That is (mean ±SD).

Good to give clues for factors which shows significant association with dietary diversity at bivariate analysis and those variables adjusted for. Each variable which shows significant association at multivariate binary logistic regression should be re written again to be self-explanatory.

Example, reproductive age women who were living in highland were 7.71 times more likely to consume a diversified diet compared to their counter parts/or women living in lowland areas [(AOR =7.71; 95% CI: 3.72, 15.99)] and etc.

5. Conclusions: are presented in an appropriate fashion and are supported by the data.

Yes

Results reported have not been published elsewhere? In my understanding not published anywhere

6. Discussions:

160-161: The authors state that the study's nature explains the high proportion of adequate dietary diversity in the study area (i.e. study period). But how certain is this to be the case? It would be better, in my opinion, to rewrite because the likely reason could be a study period. However, that is not the only explanation; there could be others. It's also worth noting if there are any research findings from other study locations that show a higher proportion of adequate DDs than the Jaldu district in Ethiopia.

Line 194: This study's limitation is social desirability bias and recall bias during data collection, which is a reasonable concern raised by the authors, but what the authors did to minimize social desirability bias, particularly recall bias. To reduce recall bias, it is now advised to use a multiple pass 24 hour recall method with good probing techniques.

Line 199: To enhance dietary diversity among reproductive women of reproductive age, the authors suggested that the relevant body pay special attention to predictors of dietary diversity. However, because this is a general recommendation, the relevant entity should be designated and a specific task should be assigned to take action.

7. The article is presented in an intelligible fashion and is written in Standard English?

The manuscript needs language and grammar editions.

8. The research meets all applicable standards for the ethics of experimentation and research integrity?

Yes

Reviewer #2: I would like to thank the authors for the nice work entitled “Dietary Diversity and Associated Factors among Reproductive Age Women in Jeldu District, West Shoa Zone, Oromia Ethiopia” aimed to assess dietary diversity and associated factors among reproductive age women. The clarity in the methodology and the result section were interesting. I have listed my concerns as follows:

1. Methods L 115- Here you have described to have used a tool after reviewing different document, can you please include the references including for the FAO document.

2. Methods L 115- You have mentioned the data collection tool is translated, can you please be specific with the translation process, if it’s translated by a certified language expert.

3. Methods L 123- You have stated that you used a 24-h recall method to assess the food consumed but you have not mention for how many days you implemented the technique. Please include the number of days.

4. Results L140- You have mentioned the average income of the participants to be about between 500-1500 birr. In my opinion it would sound better if you put this amount in USD, for ease of understanding to the readers. In what category of income is this amount considered in the Ethiopian context? Is it a Low, Middle or High income?

5. Results L 149-50- You have included the results for Women’s making decision, Agro ecological zone, having large livestock, having radio and mobile phone. Yet, in the methods section you have not described the justification for choosing these factors are considered appropriate for measuring/determining/ dietary diversity. Please provide your justification for including these factors instead of other possible options.

6. Result L150- You have used terms like ‘large livestock’ is large referring to number or size of the animals. Please define terms before using them.

7. Discussion L161- Your justification for adequate DD is the study period. Primarily, study period is a vague phrase is it the season or the length of your study duration? Secondly how about the effect of other factors such as access to the market, availability of food varieties in the area, tradition of the society under study, the feeding practices and trends etc.? Please try to consider the possible social, economic or environmental factors in your discussion.

8. Discussion L161- The results of this study indicated that the highlanders consume adequate DD is 7.7 more likely than lowlanders. But when referring to the inconsistency with a study in South Tigray you have stated it’s because of the mountainous topography, I am afraid to say but the topography of Southern Tigray is not just mountains but a plain and fertile land and the agricultural products in there ranges from crops to fruits. I believe you can cite other possible reason for that the difference such as variety of crops in the areas or the income level or the access to roads and market or education or any other factor? Or you can cite a reference for your justification.

9. Discussion L176- You have mentioned that women possessing radio/mobile are more likely to attain adequate DD and you have related it to high income. This will be a more interesting discussion if you could include the income level (500-1500 birr) you have stated in the result section to support your justification.

10. Discussion L190- You claimed to have focused on the most vulnerable group. Can you please elaborate on this by rewriting it as ‘…the most vulnerable group such as …’ since it is open to interpretations. The vulnerable group can be attributed to age (children, aged), sex, physical and economic condition etc.

11. Conclusion: Your conclusion is weak and it requires writing it very well.

Minor

1. Abstract L41- Please remove the repeated word.. reproductive “…undertaken among 634 reproductive women of reproductive age.” scientific names should be italicized

2. Abstract L48- re write the sentence “Women those who were living…” as Women who were living

3. Background L95- In the sentence “…mothers' lack of resistance to” please either complete the sentence or remove the ‘to’ at the end.

4. Methods L 111- Typo error, change If to if

5. Methods L 1120- I am not sure if this is a standard abbreviation ‘32hh’ or you should write it in full at first as ‘32 household’

6. I have observed that throughout the manuscript you have capitalized the word women ‘Women’. I didn’t find it appropriate please check it.

7. The grammatical problem is quite high, for instance read the lines between L149-L155 in the last paragraph of the result section. In my opinion your manuscript need professional editing to solve the language issues.

Reviewer #3: Comments to and questions authors

Question1. What is the difference between your study populations, I.e. reproductive age Women and adolescents and pregnant women? As there are, multiple studies conducted in your locality on the mentioned topics what is the contribution of your study to scientific record?

https://doi.org/10.1186/s40985-020-00137-2

https://doi.orgi /10.1186/s40795-017-0148-0

https://doi.org/10.1155/2019/3916864

and others more:

Line 4 - Reproductive women of reproductive age? Do you mean those who gave birth?

Line 104- As you use 50% of proportion, site the literature, If simple consideration why?

Line 105- why design effect? Make it clear

Line 131-make your terms consistent (multivariable logistic regression, multiple logistic regression and multivariate)

Line 132-indicate your level of confidence

General comment;

1. as you developed your questionnaire, the Validity of your question would have checked, but you did not said anything, so I think your tool miss validity

2. There are numerous punctuation problems (spacing, full stop, comma… You need to read detail and correct), long and jargon sentences, check and rewrite it

3. Use standard English language

Reviewer #4: • There are a lot of typographical errors in this manuscript. The language and logic flow of ides should be maintained

• If all the comments are incorporated , I belief the article is of great importance in contributing to scientific evidence

Reviewer #5: Dietary Diversity and Associated Factors among Reproductive Age Women

Manuscript Number: PONE-D-22-08826

1. Please avoid bold letters in abstract section of your Manuscript.

2. I suggest rather than saying study subject use study participants.

3. General comment on Introduction part. This part needs rewriting. In this part you have to write the magnitude, and severity of problem related to poor dietary diversity among Reproductive Age Women starting globally to Ethiopian case. E.g, what problems among Reproductive Age Women due to poor dietary diversity seen in the world it might be in terms of heath problem, growth impairment, loss of productivity or death? What has been done to alleviate the situation and what is not done? This part has to show clear part of the identified gap in available evidences. You can then put your objectives in the study context by justifying its originality and importance. .

4. In line 107, ten kebeles were selected. Please define kebeles for research communities, If it is a population ward, a village or else?

5. Why did you stratified the district into agro-ecological zone? Was the population heterogeneous?

6. You have selected households using systematic random sampling by having sampling frame from community health information system (CHIS). How can you justify that under result section your response rate was 100%?

7. In line 122-127, you have stated that Food consumed by women of reproductive age was assessed through 24-h recall method and then food items were categorized into ten food groups and adequacy of dietary diversity was calculated by summation. I am in doubt if you have you considered the amount or size of food consumed as it was recall method.

8. Where is the operational definition for Adequate Dietary diversity? I suggest if you added it to your manuscript.

9. Reference please for this citation: food and Agriculture Organization (FAO); FHI 360. Minimum Dietary Diversity for Women in line 113.

10. Mention the reference for the statement in line 130 “ variables those having a p ≤0.20 were candidate for multiple logistic regression.

11. In line 216, what was the reason for taking Verbal consent from study subjects aged eighteen years and up?

12. Under result section, only fig.1 uploaded. But you mentioned as table 1, 2, 3. You must upload or remove from referencing in the manuscript.

13. Under your discussion part you said that “This study also confirmed that almost all (99.8%) women consumed grains, root and tubers and this result was supported with the study conducted in Ghana, Zambia; In Kenya and Ethiopia.” Can you analyse the factors associated for this opportunity from your findings as well as others previous studies?

14. Women who owning large livestock were 2.67 times more likely consumed adequate dietary diversity as stated in line 182. By saying large livestock, do you mean size or number? Clarify or operationalize!

15. Regarding average monthly income in Ethiopian birr in line 140, how did you calculated and is it standard for international researchers?

16. In line 152, you mentioned that Women who making decision had adequate dietary diversity. It was better to describe it in terms of household purchase, seeking health service and visiting relatives, who are educated, have a regular earning, owns household or land singly or jointly.

17. In conclusion section, you must reveal the findings of sampled population of the Jeldu district rather than the whole district. Rewrite it!

The end

Thank you very much!

Reviewer #6: Reviewer 1

Comments to the Author

The topic for this article is an interesting and important one. It presents information on dietary diversity and associated factors among children aged 6 - 23 months in Ethiopia. This is useful information; however, the reviewers have raised some important issues that deserve attention.

I suggest the authors identify the gap in the current literature a little bit more clearly, even for Ethiopia since a number of studies are already available. Furthermore, the generalizability of the present study to other populations is a question. It should become clear what is the added value of this study beyond Ethiopia, especially considering that the type of study is not very innovative. Likewise, your results could be compared to other parts of the world.

The manuscript does not bring any novelty to the field, and it uses incorrect terms, making it difficult to understand the study. Hence justify for the above sentence?

Comments

1. In abstract…p value: for binary and multivariate should be sated

2. In abstract-

-Under result, is there highland and highland place in Jaldu district which is stated by CSA Ethiopia? If yes, could u show for us the reference?

Your result in abstract is different from the factor associate witten under line 149-155 ’’- The logistic regression output showed that Women’s making decision, Agro ecological zone having large livestock, having radio and mobile phone significantly associated with dietary diversity women who were living in highland were 7.71 (AOR =7.71; 95% CI: 3.72,15.99) , women who have radio were1.87(AOR= 1.87;95% ;1.17,2.99), Women who making decision were 3.93(AOR =3.93 ; 95% CI: 3.93,2.3,6.71) , women who had large livestock were 2.67( 154 AOR;2.67: 95% CI;1.4,5.08) and women who have mobile phone1.92 (AOR=1.92:95% 155 CI;1.74,3.16,) had adequate dietary diversity (Table 3).’’ Could you justify or correct this thing?

3. Is it reference -1 is book or report or article? Could revise its citation?

4. I think the bracket of PLOS citation according to plos guideline is like= [ ]

Methods

5. Change to methods=method and materials….line 100

6. Write subtitle under method and materials like=Study design, setting, and population….etc until quality control

7. How 10 kebeles were selected? And from how many kebeles?

8. Why you want to use 1.5 design effects as far as u want to generalize your finding for one district or Jaldu district, not west shoa zone.

9. Correct capital to small letter “If” ….line 111

Result

10. Break a sentence in to two and make a sense…. from 134-137

11. There is no variables in table 1, which you wrote here under result ‘’More than (53.6%) of the respondents were protestant in religion, about 83% were 138 married, 55.2% participants, were had no formal education. 57.1% respondents were farmers 139 and 50.6% participants living with less than five family member(table.1).”

12. Make a subtitles under result(socio demographic,factors associated….)

13. On table three under age category(35—44) it shows as it was associated(AOR;2.75(1.02,7.4),P= 0.045),Hence why u did not discussed?

Discussion

14. One line 161 ‘’ The high proportion of adequate dietary diversity in this study is due to the nature of the study i.e study period’’. Justify deeply with citation why the prevalence was high?

15. On line 172-176, ’’The difference is due to agro ecological zone, production availability and socio cultural determinants, most of the highland areas are in Tigray Ethiopia are mountainous and prone to soil erosion and degradation; these could be risk factors for a reduction in agricultural productivity when variety of production are not existing an individual cannot consumed varieties of food groups’’, the question here is, justfy how your study period got high food diversity at highland than lowland as far as most of the highland areas are in Tigray Ethiopia are mountainous and prone to soil erosion and degradation; these could be risk factors for a reduction in agricultural productivity?

**********

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Reviewer #1: No

Reviewer #2: Yes: Mohammed Hussen Bule

Reviewer #3: No

Reviewer #4: Yes: Elias Teferi Bala

Reviewer #5: No

Reviewer #6: No

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PLoS One. 2022 Dec 19;17(12):e0279223. doi: 10.1371/journal.pone.0279223.r002

Author response to Decision Letter 0

28 Sep 2022

Author's response to Reviewers Comments

PONE-D-22-08826

Title of Manuscript: Dietary Diversity and Associated Factors among Reproductive Age Women in Jeldu District, West Shoa Zone, Oromia Ethiopia

Authors:

1. Gudisa Merga: gudisamerga2017@gmail.com

2. Samson Mideksa: samkmwmtj@gmail.com

3. Nagasa Dida: nadibefe@yahoo.com

Generally, in manuscript we have used track change to incorporate or address the reviewers’ comments.

A Point by point response

Response to Reviewer #1:

RESPONSE TO SPECIFIC COMMENTS:

The title and abstract cover the main aspect of the work but some issues should be included

Good if the title had time frame

Response from the authors: As suggested by the reviewer, time frame is added to the title.

1. Abstract section

1.2 Methods: good to indicate P value used to declare statistical significance.

Response from the authors: We have indicated as suggested by the reviewer.

1.3 Results part of the abstract: equal to or greater or equal to five food shows repetitions of words (need correction of words).

Response from the authors: Corrected

It should be relevant to the reader and contain the proportion of reproductive age women who had an overall good/ adequate dietary variety practice, rather than reporting the proportion of reproductive age women who obtained >=5 categories.

Response from the authors: ??

It's also crucial to present the minimum dietary diversity score as a mean (SD). Furthermore, there is no need to interpret the results in the abstract section; instead, it is preferable to describe the predictor factors that have a significant association with their AOR and 95 percent CI.

Response from the authors: corrected.

Response from the authors: In the result section of the abstract having mobile phone is incorporated as one predictor variable

2. Background: the introduction provides background and information relevant to the study, but some issues should be corrected/explained.

Response from the authors:

Line 63: While defining Dietary diversity it says, the number of foods consumed but it should be the number of food groups consumed not the number of food consumed.

Response from the authors: Corrected to food groups

Response from the authors: food dietary diversity study among pregnant women was not done before and other area Ethiopia, that is why we use even a proportion of 50% to determine the sample size!

3.Method: Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail?

In my opinion Authors, tries to do their best, but to be clear and replicable, the methods need certain explanation.

Response from the authors:

Line 104: P (prevalence) Authors used were 50% (i.e. 50% of women of reproductive age obtained adequate dietary diversity. It should be supported with reference.

Response from the authors: If there is no study done on the same population, statistically we are forced to use an assumption of the proportion of 50% because it gives the maximum sample.

Response from the authors: Total number of the kebles in the districts are included into the abstract and 10 of them were selected with the assumption that at least 30% of the kebeles must be addressed.

Data collection tools and procedures should be clearly described.

Response from the authors: We made revision as indicated in the manuscript using track change.

Response from the authors: Actually right. If there is sampling frame simple random sampling has to be applied. But, for simplicity and to overcame difficult topography of the district we applied systematic random sampling.

Response from the authors: We have used two language experts who translated to English by the first person and re-translated the back to English by the second person.

Do the Authors have supervisor(s)? If so should be mentioned, the number, their discipline and their activities.

1. The authors should list the ten food groups that were utilized to assess DDS.

Response from the authors: We have put the references that clearly show and list those ten food groups. Moreover, in the result section under Fig. 1 we have listed the ten food groups with their result.

2. Make clear whether the authors validated the questionnaire/tool after conducting the assessment of locally available foodstuffs with the mentioned ten food groups according to FAO

Response from the authors: From the very beginning we have used the standard tool -FAO 2016. So, we assumed validating the questionnaire is not important.

3. Specify whether the Authors are evaluating/asking about food just or beverages and/or snacks as well.

Response from the authors: Of course, As far as the study concerned with the 24 hr recall, the food they used in 24 hours including snacks were evaluated.

4. Make it obvious whether the interviewers are probing the respondents for any food varieties that they may have forgotten.

Response from the authors: Perfectly, the respondents were propped for the any food varieties. See the questionnaire we have used.

5. It should be clarified what the authors did if the foods mentioned by the respondents were not in the predetermined list…

Response from the authors: The ten food groups can handle any food, and we haven’t encountered any. But, if we encountered we had been excluded.

Line 128 -132: In Data processing and analysis, I missed the descriptive statistics like mean and Standard Deviation for (continuous variable) and frequency and percentage for (categorical data).

Response from the authors: incorporated as suggested.

4. Results: The study presents the results of primary scientific research? The research finding produces contribution to the specific vulnerable group. But need clarification in certain areas.

Response from the authors: We have indicated that the data were directly collected from the respondents, so that the study is an Original research.

Line 145-146 the authors mentioned that mean of DDS was used, good to include the SD (standard deviation as well). That is (mean ±SD).

Response from the authors: SD is included as suggested by the reviewer.

Good to give clues for factors which shows significant association with dietary diversity at bivariate analysis and those variables adjusted for.

Response from the authors: list of those variables identified by the bivariable binary logistic regression for the final model were included as indicated using track change.

Each variable which shows significant association at multivariate binary logistic regression should be re written again to be self-explanatory.

Response from the authors:

5. Conclusions: are presented in an appropriate fashion and are supported by the data.

Yes

Results reported have not been published elsewhere? In my understanding not published anywhere

6. Discussions:

Response from the authors:

Response from the authors: To void the social desirable bias, the data collector informed the respondents about the objective of the stud; by calling the possible time of food consumption time (breakfast, snack, lunch and dinner) in a day the recall bias was minimized as much as possible.

Response from the authors: corrected by making it specific.

7. The article is presented in an intelligible fashion and is written in Standard English?

The manuscript needs language and grammar editions.

Response from the authors: Revision has made throughout the whole document.

8. The research meets all applicable standards for the ethics of experimentation and research integrity?

Yes

Response to Reviewer #2 comments

1. Methods L 115- Here you have described to have used a tool after reviewing different document, can you please include the references including for the FAO document.

Response from the authors: There references from which tool is adopted is included.

2. Methods L 115- You have mentioned the data collection tool is translated, can you please be specific with the translation process, if it’s translated by a certified language expert.

Response from the authors: It is alright that the translation was made by the language experts, and we have incorporated it.

Response from the authors: included as suggested by the reviewer.

Response from the authors: the currency exchange of Birr in dollar during the study period is incorporated.

Response from the authors:

6. Result L150- You have used terms like ‘large livestock’ is large referring to number or size of the animals. Please define terms before using them.

Response from the authors: add under the operational definition.

Response from the authors: In this study the term study period refers to the time of data collection and the other points are considered.

Response from the authors:

Response from the authors: Unfortunately, the average monthly income of the household didn’t show association with the study variable, that is why we haven’t consider for the discussion.

Response from the authors: The vulnerable group to be addressed in this section is to mean the pregnant women, not about the other vulnerable group.

11. Conclusion: Your conclusion is weak and it requires writing it very well.

Response from the authors: Revision has made

Minor

1. Abstract L41- Please remove the repeated word.. reproductive “…undertaken among 634 reproductive women of reproductive age.” scientific names should be italicized

Response from the authors: Removed as indicated.

2. Abstract L48- re write the sentence “Women those who were living…” as Women who were living

Response from the authors: Revised

3. Background L95- In the sentence “…mothers' lack of resistance to” please either complete the sentence or remove the ‘to’ at the end.

Response from the authors: ‘to’ is removed.

4. Methods L 111- Typo error, change If to if

Response from the authors: changed!

5. Methods L 1120- I am not sure if this is a standard abbreviation ‘32hh’ or you should write it in full at first as ‘32 household’

Response from the authors: Right you are it is not standard abbreviation, we have changed hh to household throughout the document

6. I have observed that throughout the manuscript you have capitalized the word women ‘Women’. I didn’t find it appropriate please check it.

Response from the authors: Corrected, except at the beginning of the sentence i.e. if the sentence begin with ‘women’ we have used the upper case.

Response from the authors: Revision has made across the whole document.

Response to Reviewer #2 comments

Reviewer #3: Comments to and questions authors

https://doi.org/10.1186/s40985-020-00137-2

https://doi.orgi /10.1186/s40795-017-0148-0

https://doi.org/10.1155/2019/3916864

and others more:

Response from the authors: As we all know; reproductive age women are those women who are in the age group of 15 to 49 years; whereas the pregnant women are those women in reproductive age women and pregnant as well. Hence, even if they are in the same age range the population in our case is vast a bit. But, adolescents are those aged from 10 -19 years which need special attention because of physiological development change. Moreover, local information is also valuable for the scientific contribution.

Line 4 - Reproductive women of reproductive age? Do you mean those who gave birth?

Response from the authors: Corrected, the first reproductive is deleted.

Line 104- As you use 50% of proportion, site the literature, If simple consideration why?

Response from the authors: If there is no study done on the same population, statistically we are forced to use an assumption of the proportion of 50% because it gives the maximum sample.

Line 105- why design effect? Make it clear

Response from the authors: In sampling procedure; there is stratification and more than sampling techniques is used to select the kebeles (sub-district) and the households; hence, the design effect was used.

Line 131-make your terms consistent (multivariable logistic regression, multiple logistic regression and multivariate)

Response from the authors: corrected.

Line 132-indicate your level of confidence

Response from the authors: Indicated

General comment;

1. as you developed your questionnaire, the Validity of your question would have checked, but you did not said anything, so I think your tool miss validity

Response from the authors: Actually, the questionnaire was adapted not developed and to check whether applicable to our context it was pretested. So, we have corrected the term developed to adapted.

2. There are numerous punctuation problems (spacing, full stop, comma… You need to read detail and correct), long and jargon sentences, check and rewrite it

Response from the authors: Done, revision has mad across the whole document.

3. Use standard English language

Response to Reviewer #2 comments

Reviewer #4: • There are a lot of typographical errors in this manuscript. The language and logic flow of ides should be maintained.

Response from the authors: Revision has made as indicated using the track change.

• If all the comments are incorporated , I belief the article is of great importance in contributing to scientific evidence

Reviewer #5: Dietary Diversity and Associated Factors among Reproductive Age Women

Manuscript Number: PONE-D-22-08826

1. Please avoid bold letters in abstract section of your Manuscript.

Response from the authors: Avoided.

2. I suggest rather than saying study subject use study participants.

Response from the authors: Corrected.

Response from the authors: revised

4. In line 107, ten kebeles were selected. Please define kebeles for research communities, If it is a population ward, a village or else?

Response from the authors: It means subdistrict – the smallest administration unit; so we have replaced the kebele with sub-district.

5. Why did you stratified the district into agro-ecological zone? Was the population heterogeneous?

Response from the authors: Right, the population at these different ecological zones harvest different crops, cereals, vegetables and fruit. That means the population have different access to variety of foods. That is why we have stratified the district into ecological zone.

Response from the authors: One, in the rural area mothers are available at home most of the time unless there is special case. Second, when the target is not available revisit was made. Lastly, the data collection was done out of market day and special events.

Response from the authors: you are right, we haven’t assessed the amount. Because Fanta food groups tool doesn’t assess the amount, rather the variety.

8. Where is the operational definition for Adequate Dietary diversity? I suggest if you added it to your manuscript.

Response from the authors: Operational definition is included.

9. Reference please for this citation: food and Agriculture Organization (FAO); FHI 360. Minimum Dietary Diversity for Women in line 113.

Response from the authors: Included.

10. Mention the reference for the statement in line 130 “ variables those having a p ≤0.20 were candidate for multiple logistic regression.

Response from the authors:

11. In line 216, what was the reason for taking Verbal consent from study subjects aged eighteen years and up?

Response from the authors: All information they provided are verbal and there is no any specimen taken from the study participants.

12. Under result section, only fig.1 uploaded. But you mentioned as table 1, 2, 3. You must upload or remove from referencing in the manuscript.

Response from the authors: All table are in word document.

Response from the authors: ????

Response from the authors: what large and small mean in this study is included in the definition.

15. Regarding average monthly income in Ethiopian birr in line 140, how did you calculated and is it standard for international researchers?

Response from the authors: the currency exchange of Birr in dollar during the study period is incorporated.

Response from the authors: Corrected.

17. In conclusion section, you must reveal the findings of sampled population of the Jeldu district rather than the whole district. Rewrite it!

Response from the authors: Corrected; revision has also made.

Reviewer #6: Reviewer 1

Comments to the Author

The manuscript does not bring any novelty to the field, and it uses incorrect terms, making it difficult to understand the study. Hence justify for the above sentence?

Response from the authors: Corrected.

Comments

1. In abstract…p value: for binary and multivariate should be sate

Response from the authors: stated.

2. In abstract-

-Under result, is there highland and highland place in Jaldu district which is stated by CSA Ethiopia? If yes, could u show for us the reference?

Response from the authors:

Response from the authors: Corrected.

3. Is it reference -1 is book or report or article? Could revise its citation?

Response from the authors: As indicated under the reference, it is a five site study result summary and it is recommended to site as ‘Mary Arimond, et al. Dietary Diversity as a Measure of the Micronutrient Adequacy of Women’s Diets In Resource-Poor Areas: Summary of Results from Five Sites. Washington, DC: FANTA-2 Bridge, FHI 360, 2011.’

4. I think the bracket of PLOS citation according to plos guideline is like= [ ]

Response from the authors: Corrected.

Methods

5. Change to methods=method and materials….line 100

Response from the authors: changed.

6. Write subtitle under method and materials like=Study design, setting, and population….etc until quality control

Response from the authors: subtitle are give as suggested by the reviewer..

7. How 10 kebeles were selected? And from how many kebeles?

Response from the authors: indicated.

8. Why you want to use 1.5 design effects as far as u want to generalize your finding for one district or Jaldu district, not west shoa zone.

9. Correct capital to small letter “If” ….line 111

Response from the authors: Corrected.

Result

10. Break a sentence in to two and make a sense…. from 134-137

Response from the authors: Separated.

Response from the authors: Table was missed form the table list, the socio-demographic factor table is added.

12. Make a subtitles under result (socio demographic factors associated….)

Response from the authors: Subtitle are given.

13. On table three under age category (35—44) it shows as it was associated (AOR;2.75(1.02,7.4), P= 0.045), Hence why u did not discussed?

Response from the authors: Discussed.

Discussion

Response from the authors: Justified as indicated on the manuscript using the track change.

Response from the authors: Revision has made.

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PLoS One. doi: 10.1371/journal.pone.0279223.r003

Decision Letter 1

Amene Abebe Kerbo

3 Oct 2022

PONE-D-22-08826R1Dietary Diversity and Associated Factors among Reproductive Age Women in Jeldu District, West Shoa Zone, Oromia Ethiopia, 2018PLOS ONE

Dear Dr. Dida,

Please submit your revised manuscript by Nov 17 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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PLoS One. 2022 Dec 19;17(12):e0279223. doi: 10.1371/journal.pone.0279223.r004

Author response to Decision Letter 1

2 Dec 2022

We have no words for the reviewers, the have made us. The comments they have provided are very valuable and we have learnt a lot from it. Many thanks to all of them.

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PLoS One. doi: 10.1371/journal.pone.0279223.r005

Decision Letter 2

Amene Abebe Kerbo

5 Dec 2022

Dietary Diversity and Associated Factors among Women of Reproductive Age in Jeldu District, West Shoa Zone, Oromia Ethiopia

PONE-D-22-08826R2

Dear Mr Negasa

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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PLoS One. doi: 10.1371/journal.pone.0279223.r006

Acceptance letter

Amene Abebe Kerbo

8 Dec 2022

PONE-D-22-08826R2

Dietary Diversity and Associated Factors among Women of Reproductive Age in Jeldu District, West Shoa Zone, Oromia Ethiopia

Dear Dr. Dida:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

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Data Availability Statement

All relevant data are within the article and its Supporting Information files.

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Dietary diversity and associated factors among women of reproductive age in Jeldu District, West Shoa Zone, Oromia Ethiopia

Gudisa Merga

Samson Mideksa

Nagasa Dida

Gina Kennedy

Roles

Abstract

Background

Methods

Results

Conclusion

Background

Method and materials

Study design and setting

Sample size and sampling technique

Operational definition

Data management and analysis

Ethics approval and consent to participate

Results

Socio-demographic economic and characteristics

Table 1. Socio-demographic characteristics of reproductive women in Jeldu district West Shoa zone, Oromia, Ethiopia, March 25 –April 15, 2018.

Table 2. Socio-economic characteristics in Jeldu district West Shoa zone, Oromia, Ethiopia, March 25 –April 15, 2018.

Food dietary diversity and associated factors

Fig 1. Food groups consumed among women reproductive age in Jeldu West Shoa Zone Ethiopia, 2018.

Table 3. Binary and multivariable logistic regression model showing socio demographic, socio economic and personal food environment factors associated with dietary diversity among reproductive age women in Jeldu district West Shoa zone, Oromia, Ethiopia, March 25 –April 15, 2018.

Discussion

Conclusion

Supporting information

Acknowledgments

Abbreviations

Data Availability

Funding Statement

References

Decision Letter 0

Amene Abebe Kerbo

Roles

Author response to Decision Letter 0

Decision Letter 1

Amene Abebe Kerbo

Roles

Author response to Decision Letter 1

Decision Letter 2

Amene Abebe Kerbo

Roles

Acceptance letter

Amene Abebe Kerbo

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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