The influence of the food environment on dietary quality and nutrient adequacy in Ethiopia
| dc.contributor.advisor | Thornhill, Stephen | |
| dc.contributor.advisor | Lahiff, Edward | |
| dc.contributor.author | Hailu, Andinet Abera | en |
| dc.contributor.funder | Ethiopian Public Health Institute (EPHI) | |
| dc.date.accessioned | 2026-09-17T13:23:47Z | |
| dc.date.available | 2026-09-17T13:23:47Z | |
| dc.date.issued | 2026-06-22 | en |
| dc.date.submitted | 2026-06-22 | |
| dc.description.abstract | Improving dietary quality and micronutrient adequacy remains a critical public health challenge in Ethiopia, where food insecurity, seasonal shortages, and limited market access constrain nutritional outcomes. This thesis examines how the food environment (FE) shapes dietary quality and micronutrient adequacy, with a particular focus on women and children. Using a mixed-methods approach, the study integrates household survey data, qualitative insights from focus groups and key informant interviews, and Cost of the Diet modeling to provide a comprehensive understanding of how the food environment influences dietary quality. A novel composite food environment score was developed to capture the various dimensions of the FE, including availability, market diversity, affordability, and infrastructure, and was strongly and consistently associated with all analyzed dietary quality measures. This study shows that households with more favourable food environments achieve higher dietary diversity and micronutrient adequacy, although pronounced spatial and socioeconomic disparities persist across the study regions. Production diversity and seasonality further enhance micronutrient intake and buffer households against seasonal food shortages. For example, greater on-farm crop diversity—such as the cultivation of cereals, legumes, fruits, and vegetables—was associated with improved dietary diversity and micronutrient intake. Households producing a wider range of food groups (high production diversity) had significantly higher Women’s Dietary Diversity Scores (WDDS) and Food Variety Scores (FVS). In addition, the study highlights the role of policies and programs, including agricultural extension services, nutrition-sensitive agriculture initiatives, and market access interventions, in enhancing the availability and accessibility of diverse, nutrient-rich foods. These findings underscore the importance of integrating crop diversification strategies with supportive food and nutrition policies to improve dietary outcomes. However, economic pressures and market incentives often limit the translation of diverse production into actual consumption. Cost of the Diet analyses indicate that nutrient-adequate diets cost three to six times more than calorie-only diets, and only a minority of households can afford them. Interventions such as agricultural diversification, food fortification, and low-cost nutrient-dense substitutes can lower diet costs, but persistent infrastructure and governance constraints continue to limit access to nutritious foods. Qualitative findings show that sociocultural norms, including religious fasting, gendered power dynamics, and perceptions of affordability, shape food choices, underscoring that improving physical or economic access alone is insufficient. This thesis shows that Ethiopia’s poor dietary quality and nutrient gaps are driven by concrete barriers in the food environment, including unreliable markets, high prices for nutritious foods, limited on‑farm diversity, and gendered constraints that shape household food choices. Addressing these gaps requires integrated solutions that expand diverse production, lower the cost of nutritious foods, improve market access, and support women’s decision‑making. By synthesizing quantitative and qualitative evidence, this work provides clear, actionable guidance for designing more effective nutrition policies and programs. | en |
| dc.description.status | Not peer reviewed | en |
| dc.description.version | Accepted Version | en |
| dc.format.mimetype | application/pdf | en |
| dc.identifier.citation | Hailu, A. A. 2026. The influence of the food environment on dietary quality and nutrient adequacy in Ethiopia. PhD Thesis, University College Cork. | |
| dc.identifier.endpage | 310 | |
| dc.identifier.uri | https://hdl.handle.net/10468/19279 | |
| dc.language.iso | en | en |
| dc.publisher | University College Cork | en |
| dc.rights | © 2026, Andinet Hailu. | |
| dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject | Food environment | en |
| dc.subject | Dietary quality | en |
| dc.subject | Micronutrient adequacy | en |
| dc.subject | Ethiopia | en |
| dc.title | The influence of the food environment on dietary quality and nutrient adequacy in Ethiopia | |
| dc.type | Doctoral thesis | en |
| dc.type.qualificationlevel | Doctoral | en |
| dc.type.qualificationname | PhD - Doctor of Philosophy | en |
