Household Food-Related Assessment Using an Innovative Passive Dietary Assessment Device in Ghana

Abstract Objectives Traditional dietary assessment methods in low-middle income countries (LMICs) have considerable limitations. the objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of households in a LMIC setting. Methods Data from households in Mampong-Akuapem (n = 5), a semi-rural community, and Kweiman (n = 7), a peri-urban community, in the Eastern and Greater Accra Regions of Ghana, respectively, were evaluated. The AIM was used to monitor household activities for one day. Within each household, the primary caregiver (mother) wore the AIM during waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. Mothers also responded to a socio-demographic questionnaire and evaluated their perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom-designed software. Time spent in major household related activities around food are described. Results Households had 1.9 ± 0.3 adults and 2.8 ± 1.6 children (mean ± SD). Primary caregivers were 30.5 ± 5.2 years of age, all were married (1 separated), and had a median of 9 years of formal education. Two mothers were breastfeeding at data collection, but only 1 household had an infant <1 year. Total AIM wear time was 8 h, 19 min ± 2 h, 11 min, representing 58% of waking hours. All members of each household consumed the same prepared meals, and all meals were captured by the AIM. Among mothers, time spent cooking varied widely (2 h, 19 min ± 1 h, 42 min), ranging from 0.5 to 6 h. Time spent eating and drinking was 41 ± 15 min. Most of the mothers (n = 10) spent time feeding children (17 ± 23 min, including breastfeeding), with 6 mothers feeding younger children (11 ± 10 min), 5 feeding older children (7 ± 4 min), and 2 breastfeeding (53 ± 25 min). The AIM was generally accepted by the primary caregivers and household members although they would prefer a smaller size version. Conclusions In this pilot study, the AIM successfully captured household food related activities and practices that are associated with dietary intake and nutritional health in LMIC. Funding Sources The Bill and Melinda Gates Foundation.

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Development of a Screening Tool to Estimate Vitamin A Intake and Comparison with Detailed Dietary Assessment Methods

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_033 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 182-182

Author(s):

Reina Engle-Stone ◽

Jody Miller ◽

Ame Stormer ◽

Dolly Reario ◽

Mario Capanzana ◽

...

Keyword(s):

Vitamin A ◽

Screening Tool ◽

Dietary Assessment ◽

Food Composition ◽

Funding Sources ◽

Dietary Assessment Methods ◽

Usual Intake ◽

Filipino Children ◽

Gates Foundation ◽

Weighed Record

Abstract Objectives We aimed to develop and validate a tool to estimate vitamin A (VA) intake and identify children at risk of intake above the tolerable upper intake level (UL). Methods We developed, pilot-tested, and refined a screening tool to estimate VA intake among Filipino children 12–18 mo of age. Data were entered into tablets with pre-loaded food composition data to calculate VA intake immediately. The screening tool was used to identify children likely to have “adequate” (one group: 200–500 µg retinol activity equivalents, RAE/d) or “high” (two groups: >600 µg retinol/d) intake. Interviewers administered four 24-h recalls, one 12-h observed weighed record with 12-h recall, and a 30-d supplement questionnaire. Breastmilk intake and VA concentration were measured among breastfeeding children. We compared the screening tool and detailed dietary assessment (DDA) results for primary VA sources, group mean usual intake, and prevalence of intakes above the UL. Results Major VA sources were similar between methods: fortified milk powders, multivitamin supplements, and breastmilk; contributions from intervention programs (e.g., micronutrient powders, fortified staple foods) were low. Mean usual retinol intakes for the high groups (n = 47 and 39, respectively) were 1218 and 1313 µg/d by screening tool vs. 1096 and 931 by DDA; 70 and 77% had usual intake above 600 µg/d. In the adequate group (n = 37), mean total VA intake was 375 and 559 µg RAE/d by screening and DDA, respectively. Conclusions This screening tool provides a reasonably good rapid estimate of VA intake among Filipino children and can be useful for identifying groups with adequate to excessive intakes. Funding Sources Bill & Melinda Gates Foundation.

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A Case Study of Household Food-Related Assessment Using an Innovative Passive Dietary Assessment Device in Mampong-Akuapem, Ghana (FS17-03-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.fs17-03-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Alex Anderson ◽

Megan McCrory ◽

Matilda Steiner-Asiedu ◽

Richard Ansong ◽

Clara Lewis ◽

...

Keyword(s):

Elementary Education ◽

Formal Education ◽

Dietary Assessment ◽

Daily Activities ◽

Eastern Region ◽

Wake Time ◽

Wear Time ◽

Household Food ◽

Total Wear ◽

Low Middle Income Countries

Abstract Objectives Traditional dietary assessment methods in low-middle income countries (LMICs) have significant limitations. The objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of a household in a LMIC setting. Methods This is a case of an 8-member household from Mampong-Akuapem, a semi-rural community in the Eastern Region of Ghana. The household was made up of mother (35 years), father (37 years), and six children (ages 17 years, 13 years [twins], 8 years, 5 years, and 18 months). Mother has no formal education and works as a cook, whereas the father has elementary education and is a farmer/construction worker. All members of the household consume the same prepared meals. The AIM was used to monitor household activities for a day. The primary food preparer (mother) wore the AIM during all waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. The mother also responded to a socio-demographic questionnaire and evaluated her perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom software. Major household related activities around food are reported. Results Overall, a total wear time of 776 minutes (12.9 hr; 76.1% of usual wake time) was recorded with images spanning a total of 681 minutes (11.4 hr; 87.8% of total wear time). Cooking and food preparation (four different meals) accounted for 47.9%, shopping 1.5%, breastfeeding and other child feeding 5.1%, and eating 5.4% (communal 4.9% and non-communal 0.5%), and other daily activities 40.1% of usual wake time. Three main meals captured on the AIM were breakfast (rice porridge - boiled watery rice with added sugar, milk and bread), lunch (fufu - pounded boiled cassava and plantain, and chicken soup), and dinner (kelewele - fried spiced yellow plantains). The AIM was generally accepted by the participant and household members although they preferred a smaller size version. Conclusions The AIM has the potential of capturing household food related activities and practices that affect dietary intake and nutritional health in LMIC. Funding Sources Funded by the Bill & Melinda Gates Foundation.

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Pediatric critical COVID-19 and mortality in a multinational cohort

10.1101/2021.08.20.21262122 ◽

2021 ◽

Author(s):

Sebastian Gonzalez-Dambrauskas ◽

Pablo Vasquez-Hoyos ◽

Anna Camporesi ◽

Edwin Mauricio Cantillano ◽

Samantha Dallefeld ◽

...

Keyword(s):

Hospital Mortality ◽

Latin American ◽

Lower Mortality ◽

Older Children ◽

Middle Income ◽

Middle Income Countries ◽

Disease Patterns ◽

Age Related ◽

Low Middle Income Countries ◽

International Multicenter Study

AbstractObjectivesTo understand the international epidemiology of critical pediatric COVID-19 and compare presentation, treatments, and outcomes of younger (<2 years) and older (>2 years) children.DesignProspective, observational study from April 1 to December 31, 2020SettingInternational multicenter study from 55 sites from North America, Latin America, and Europe.ParticipantsPatients <19 years old hospitalized with critical COVID-19InterventionsnoneMain outcomes measuredClinical course, treatments, and outcomes were compared between younger and older children. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) for hospital mortality.Results557 subjects (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Younger children had more respiratory findings (56% vs 44%), viral pneumonia (45% vs 29%), and treatment with invasive ventilation (50% vs 37). Gastrointestinal (28% vs 69%) or mucocutaneous (16% vs 44%) findings, vasopressor requirement (44% vs 60%), and MIS-C (15% vs 40%) were less common in younger children. Hospital mortality was 10% overall but 15% in younger children (odds ratio 1.89 [95%CI 1.05-3.39]). When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2.6; 95%CI 1.07-6.31) or pulmonary comorbidities (aOR 4.4; 95%CI 1.68-11.5), admission hypoxemia (aOR 2.33; 95%CI 1.24-4.37), and lower respiratory symptoms (aOR 2.83; 95%CI 1.49-5.39). Gastrointestinal (aOR 0.49; 95%CI 0.26-0.92) or mucocutaneous symptoms (aOR 0.31; 95%CI 0.15-0.64), treatment with intravenous immune globulin (aOR 0.33; 95%CI 0.17-0.65), and MIS-C (aOR 0.26; 95%CI 0.11-0.64) were associated with lower mortality.ConclusionsWe identified age-related differences in presentation and mortality for critical pediatric COVID-19 that should prompt more attention to improving management in younger children, especially in developing countries.Table of Contents SummaryThis is a multinational study describing critical pediatric COVID-19 clinical spectrum and related mortality in high and low-middle income countries during 2020.What’s known on this subjectPediatric critical illness due to COVID-19 is uncommon and have lower mortality compared to adults when hospitalized. While larger cohorts are from high-income countries (HICs), studies including data from low-middle-income countries (LMICs) remain scarce.What this study addsIn our multinational cohort of critical pediatric COVID-19, we identified higher mortality than previously reported and age-related disease patterns. Children <2 years old had more respiratory disease and higher mortality, and older children had more non-pulmonary disease and better outcomes.

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Assessment of Vitamin A (VA) Total Body Stores (TBS) Using Dried Derum Spots (DSS)

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_066 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 861-861

Author(s):

Georg Lietz ◽

Anthony Oxley ◽

Reina Engle-Stone ◽

Jody Miller ◽

Dolly Reario ◽

...

Keyword(s):

Current Method ◽

Cold Chain ◽

Isotope Dilution Method ◽

Dilution Method ◽

Serum Samples ◽

Retinyl Acetate ◽

Middle Income ◽

Funding Sources ◽

Filipino Children ◽

Gates Foundation

Abstract Objectives The retinol isotope dilution method has been successfully applied to assess the efficacy of VA interventions in low and middle-income countries. However, the current method is limited in its applicability because it relies on keeping serum samples in the cold chain. To overcome that limitation, we assessed the feasibility of using DSS for assessing TBS in Filipino children 12–18 months of age. Methods Serum (40 µL) from Filipino children, who had received an oral dose of [,13C10]-retinyl acetate was spotted and dried on Whatman 903 cards then stored at −20°C before shipment at room temperature; aliquots of liquid serum were kept frozen at −80°C until analysis. DSS and liquid serum were extracted by established methods and then analysed by LC-MS/MS to quantify the [,13C]/[,12C] retinol ratio and TBS. Results Mean ± SD TBS of 57 Filipino infants aged 12–18 mo were 507.6 ± 185.8 µmol and 495.5 ± 170.1 µmol from either serum or DSS samples, respectively. Comparison of methods using Bland-Altman analysis indicated agreement between both methods with an intra-individual mean difference for TBS of 22.1 µmol (4.5%). Conclusions TBS can be determined using serum spot samples in field settings, thus reducing the costs and limitations of shipping serum samples on dry ice and reducing the need for −80C storage in field stations. Funding Sources Medical Research Council UK; Bill and Melinda Gates Foundation.

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Enteric Function as a Determinant of Nutritional and Clinical Recovery from Acute Illness Among Children in Kenya and Pakistan

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_121 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 916-916

Author(s):

Kirkby Tickell ◽

Donna Denno ◽

Ali Saleem ◽

Zaubina Kazi ◽

Barbra Richardson ◽

...

Keyword(s):

High Performance ◽

A Priori ◽

Infection Prevalence ◽

Hiv Status ◽

Post Discharge ◽

Middle Income ◽

Funding Sources ◽

Gates Foundation ◽

Poor Outcomes ◽

Discharge From Hospital

Abstract Objectives In low- and middle-income countries (LMICs), acutely ill undernourished children remain at high risk of mortality for months following discharge from hospital. Community-based studies suggest that enteric dysfunction (ED), including permeability and impaired absorption, is associated with poor outcomes. We used the lactulose rhamnose ratio (L: R) test, which provides a functional assessment of gut integrity, to determine if ED influences clinical and nutritional recovery in the post-discharge period. Methods Children aged 2–24 months without diarrhea were recruited from Civil Hospital Karachi, Pakistan and Migori County Referral Hospital, Kenya. L: R tests were administered after children were clinically stable (oral feeds, not dehydrated, no oxygen needs) and pre-discharge. Similarly aged children were pseudo-randomly selected from homes near those of children being discharged and were also tested. Prior to administration of sugars, urine was collected to detect background levels, followed by a two-hour collection. Samples were analyzed by high-performance chromatography mass spectroscopy. Crude L: R distributions were compared using the Mann-Whitney test. A priori determined confounders (age, mid-upper arm circumference [MUAC], HIV status, site) were adjusted for in linear regression of log-transformed L: R. Results 156 hospitalized and 91 community children were recruited. Median age was nine months in each group. Hospitalized children had lower median MUAC (12.4 vs 13.5 cm) and higher HIV infection prevalence (5% vs 1%). Both sugars were largely undetectable in pre-dose samples. Urinary median L: R among children being discharged (0.36 (interquartile range [IQR] 0.20–0.87)) was significantly higher compared to community peers (0.30 (IQR: 0.17–0.48, P = 0.038)). This difference remained significant in the adjusted model (p: 0.008). Conclusions Children at discharge from hospital in LMICs appear to have worse enteric function than community peers, and this difference does not appear to be attributable to young age or nutritional or HIV status. This analysis will be expanded to include L: R association with mortality, morbidity and growth outcomes prior to the conference. Funding Sources Thrasher Research Foundation 14,466, the Bill & Melinda Gates Foundation OPP 1,131,320.

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Dietary Diversity Measures Derived from Food Frequency Methods Are Weak Proxies for Anthropometric Indicators of Child Nutrition in East Africa (P11-111-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-111-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Lucas Gosdin ◽

Usha Ramakrishnan ◽

Amy Webb Girard

Keyword(s):

Child Nutrition ◽

Dietary Diversity ◽

Child Feeding ◽

Middle Income ◽

Food Frequency ◽

Anthropometric Indicators ◽

Young Child Feeding ◽

Child Undernutrition ◽

Funding Sources ◽

Low Middle Income Countries

Abstract Objectives The 7-item child dietary diversity score (DDS) is used widely as a metric of dietary diversity (DD) for infant and young child feeding (IYCF) in low-middle income countries. Validation of the DDS was based on mean micronutrient density adequacy and not other measures of child nutrition. We aimed to develop a measure of DD more strongly associated with anthropometric indicators of child nutrition. Methods We used data from two Tanzanian surveys, IMMANA (n = 88; ages 6–23 mo.) and the Demographic and Health Survey (DHS) (n = 9,156; ages 6–59 mo.), and two Kenyan surveys, MAMA SASHA (n = 384; age 6–12 mo.) and DHS (n = 17,509; ages 6–59 mo.). For each survey, we calculated the DDS, minimum DD, a score using all 15 items found in the standard DHS, and a yes/no indicator of animal source food (ASF) consumption. In IMMANA and MAMA SASHA, we also used a count of all unique food items consumed and based each measure on both 24-hr and 7-day recall periods. Outcome indicators were stunting, wasting, and underweight as defined by WHO. We evaluated the performance of each DD measure in identifying child undernutrition by comparing the area under the ROC curve (AUC), and estimating odds ratios using logistic regression methods. AUC = 50% is no better than random assignment. Complex survey procedures were used in all analyses and alpha was set at 0.05. Results In the DHS and MAMA SASHA data, all measures of DD had similar AUC values that did not exceed 61% when compared to the anthropometric indicators. In the IMMANA data, no measure exceeded 70% AUC for wasting, 64% for underweight, or 58% for stunting. For most DD measures, increasing the recall period to 7 days marginally improved its AUC (< 3%), while it decreased the AUC for wasting in the IMMANA data. The ASF indicator had a similar AUC to the DDS. In the Tanzania DHS, a higher DD, by all four measures, was associated with decreased odds of stunting, wasting, and underweight. In contrast, no measure of DD was associated with growth indicators for Kenya. The DD indicators based on the 15-item list and the count of unique foods were negatively associated with odds of wasting in the IMMANA data. Conclusions In two east African settings, measures of DD derived from existing food frequency questionnaires were weak proxies for measures of child undernutrition based on anthropometry. Funding Sources Innovative Methods and Metrics for Agriculture and Nutrition Actions.

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Dietary Assessment of Shared Plate Eating: A Missing Link

Nutrients ◽

10.3390/nu11040789 ◽

2019 ◽

Vol 11 (4) ◽

pp. 789 ◽

Cited By ~ 8

Author(s):

Tracy Burrows ◽

Clare Collins ◽

Marc Adam ◽

Kerith Duncanson ◽

Megan Rollo

Keyword(s):

Food Intake ◽

Carrying Capacity ◽

Dietary Assessment ◽

Portion Size ◽

Development Work ◽

Middle Income ◽

Line Drawings ◽

Middle Income Countries ◽

Dietary Assessment Methods ◽

Use Of Technology

Shared plate eating is a defining feature of the way food is consumed in some countries and cultures. Food may be portioned to another serving vessel or directly consumed into the mouth from a centralised dish rather than served individually onto a discrete plate for each person. Shared plate eating is common in some low- and lower-middle income countries (LLMIC). The aim of this narrative review was to synthesise research that has reported on the assessment of dietary intake from shared plate eating, investigate specific aspects such as individual portion size or consumption from shared plates and use of technology in order to guide future development work in this area. Variations of shared plate eating that were identified in this review included foods consumed directly from a central dish or shared plate food, served onto additional plates shared by two or more people. In some settings, a hierarchical sharing structure was reported whereby different family members eat in turn from the shared plate. A range of dietary assessment methods have been used in studies assessing shared plate eating with the most common being 24-h recalls. The tools reported as being used to assist in the quantification of food intake from shared plate eating included food photographs, portion size images, line drawings, and the carrying capacity of bread, which is often used rather than utensils. Overall few studies were identified that have assessed and reported on methods to assess shared plate eating, highlighting the identified gap in an area of research that is important in improving understanding of, and redressing dietary inadequacies in LLMIC.

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The Impact of Covid 19 on Pregnant Women and Child Health

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3645 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1367-1373

Author(s):

Nikhil Sanjay Mujbaile ◽

Smita Damke

Keyword(s):

Social Issues ◽

Middle Income ◽

Web Based ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

The Social ◽

Social Separation ◽

The Impact ◽

And Child Health ◽

General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools.

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