Knowledge of dietary diversity and its determinants among pregnant women attending antenatal care in Zanzibar: A cross-sectional study
Chukwuma J. Okafor, Islam H. Mwita, Rodolfo Isidro Bosch Bayard, Theresa BernadiniBackground
Dietary diversity is a key proxy indicator of micronutrient adequacy among pregnant women, yet remains suboptimal in many low- and middle-income settings. Limited evidence exists on dietary diversity knowledge and its determinants in Zanzibar.
Objective
To assess knowledge of dietary diversity and identify associated factors among pregnant women attending antenatal care (ANC) at Mpendae Health Centre, Zanzibar.
Design
Facility-based analytical cross-sectional study.
Methods
A facility-based analytical cross-sectional study was conducted among 245 pregnant women attending ANC services using a consecutive sampling approach (March–April 2025). Data were collected using a structured, pretested questionnaire comprising 32 items. Knowledge of dietary diversity was assessed using 9 binary items (Cronbach’s α = 0.74) and categorized as adequate (score ≥6/9) or inadequate. Multivariable logistic regression was used to identify independent predictors, with crude odds ratios (CORs), adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p-values reported .
Results
Overall, 75.9% of participants had adequate knowledge of dietary diversity. In multivariable analysis, marital status and education were significant predictors. Women who were not married had significantly lower odds of adequate knowledge compared to married women (AOR = 0.28; 95% CI: 0.14–0.56; p < 0.001), while those with secondary or higher education were more likely to have adequate knowledge (AOR = 2.15; 95% CI: 1.18–3.91; p = 0.012). Women at ≥28 weeks gestation had higher odds of adequate knowledge (AOR = 3.42; 95% CI: 1.85–6.32; p < 0.001), and those attending ≥4 ANC visits were four times more likely to be knowledgeable (AOR = 4.11; 95% CI: 2.05–8.24; p < 0.001). Women who did not receive nutrition counselling had significantly lower odds of adequate knowledge (AOR = 0.31; 95% CI: 0.14–0.69; p = 0.004).
Conclusion
Dietary diversity knowledge was relatively high but unequally distributed. ANC-related factors, particularly visit frequency and nutrition counselling, were key determinants, highlighting the need to strengthen structured nutrition education throughout pregnancy.