Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets.

Smallholder farmers dependent on rain-fed agriculture experience seasonal variations in food and nutrient availability occasioned by seasonality of production patterns. This results in periods of nutrient abundance in the plenty seasons followed closely by periods of nutrient inadequacies and malnutrition. This pattern contributes to a cycle of deteriorating health and nutrition status and deprives children of their ability to realize full developmental potential. This study investigates the role of caregiver's nutritional knowledge and attitudes in mediating effects of seasonality on children's diets. Repeated cross-sectional surveys were conducted on 151 randomly selected households in the plenty and lean seasons to collect dietary data using two non-consecutive quantitative 24-hr recalls and caregiver's nutritional knowledge and attitudes assessed using interviewer administered questionnaire. Sixty-five percent of the caregivers had attained a primary level education or less. There was a positive modest correlation between caregivers' nutritional knowledge and their attitudes (r = 0.3, P < 0.000, α = 0.01). Children's mean adequacy ratio was significantly higher in the plenty season than in the lean season (0.84 vs. 0.80, P < 0.000). A two-block hierarchical regression to predict the seasonal changes in dietary quality of children using caregiver's nutritional knowledge and attitude scores while controlling for the effect of sociodemographics and mean adequacy ratio at first season (plenty) found that caregiver's nutritional knowledge (ß = -0.007, SE = 0.003, P = 0.027, 95% CI [-0.013, -0.001] ŋ2  = 0.034) but not attitudes had significant contribution to the prediction. Maternal nutritional knowledge mediates seasonal variation in child nutrient intakes.