The role of child nutrition counselling, gender dynamics, and intra-household feeding decision-making on child dietary diversity in semi-arid northern Ghana

Every child has the right to proper nutrition. As such, child nutrition counselling is recommended to improve child dietary diversity and reduce malnutrition. However, there is limited empirical evidence on how child nutrition counselling, gender dynamics, and intra-household feeding decisions play a role and translate to child dietary diversity in rural contexts. Informed by theoretical conceptions from Health Belief Model (HBM) and Gender and Development (GAD) framework, we analyzed cross-sectional data from 517 smallholder households in Ghana's semi-arid Upper West Region to investigate the relationship between child nutrition counselling, gender dynamics, intra-household feeding decision-making, and their impact on child dietary diversity. Results from ordered logistic regression show that households that received child nutrition counselling reported higher child dietary diversity. Joint intra-household feeding decisions were associated with higher child dietary diversity. Households with good self-rated childcare, engaged in home gardening, and higher wealth, as well as those in the Waala ethnic group, were more likely to have high child dietary diversity. A decrease in household head age was linked to increased high child dietary diversity. On the other hand, female-headed households, Brifo ethnic groups, and those in the Wa East and Wa West districts were less likely to experience high child dietary diversity. Implementing interventions and policies prioritizing nutrition education in the Upper West Region and similar sub-Saharan African contexts is recommended. Strategies like scaling up child nutrition counselling, food demonstrations, mother-to-mother support nutrition outreach, and mobile nutrition clinics can empower women and improve children's well-being.