Exploring reasons for poor dietary diversity in Karnataka, India - a mixed-methods study

Abstract Background More than a third of the world's malnourished population resides in India, and micronutrient deficiency is a common cause of malnutrition in India. Over 80% of India's population suffer from this condition, especially due to inadequate intakes of riboflavin, folate, vitamins B6 and B12. In this study, we aimed to gain a better understanding of the reasons for poor dietary diversity in Karnataka, India. Methods From March to October 2024, 28 community health workers were trained and deployed across rural and peri-urban (around Bangalore) communities in Karnataka. During the initial engagement, information on resident demographics and dietary patterns over the past 24 hours were collected using a proprietary eHealth platform, then residents were educated on the importance of a balanced diet and eating diverse food groups. Selected residents were interviewed 2-4months later to assess dietary changes and their motivations. Study was done in collaboration with Bayer. Results 47,423 residents were engaged in Karnataka (43% in peri-urban areas). In total, 87% had poor dietary diversity - although this was poorer in peri-urban (99.6%) compared to rural areas (78%). This was attributed to the availability of fresh, local foods in rural areas, and the easier accessibility of processed foods in peri-urban areas. 959 residents were interviewed post-engagement, and found that only 6% and 1% of residents with poor dietary diversity showed improvements in their dietary patterns post-engagement in rural and peri-urban areas respectively. This was explained by the mismatch between actual and perceived dietary adequacy - suggesting a significant knowledge gap amongst residents. Dietary changes were also hindered by economic constraints, availability, and dietary habits Conclusions Addressing micronutrient deficiency in Karnataka requires a multi-pronged approach that targets individual knowledge, behaviour change, and systemic structures that hinder improvements. Key messages • Effective nutrition education programmes need to be explored in Karnataka. • Systemic solutions that address farmers and food retailers are needed to improve micronutrient deficiency in Karnataka.