Gender and age differences in meal structures, food away from home, chrono-nutrition, and nutrition intakes among adults and children in Tanzania using newly developed tablet-based 24-hour recall tool

Authors: AMBIKAPATHI, RAMYA - Purdue University; IREMA, IMANI - Public Health - Tanzania; LYATUU, ISAAC - Public Health - Tanzania; Caswell, Bess; MOSHA, DOMINIC - Public Health - Tanzania; NYAMSANGIA, STELLA - Public Health - Tanzania; GALVIN, LAUREN - Public Health - Tanzania; MANGARA, ALLY - Muhimbili University; BONCYK, MORGAN - Purdue University; FROESE, SAVANNAH - Purdue University; VERSSIMO, CRISTIANA - Purdue University; ITATIRO, JULEITH - Ministry Of Health And Social Welfare; KARIATHI, VICTORIA - Ministry Of Health And Social Welfare; KAZONDA, PATRICK - Muhimbili University; WANDELLA, MEDINA - Ministry Of Health And Social Welfare; FAWZI, WAFAIE - Harvard School Of Public Health; KILLEWO, JAPHET - Muhimbili University; MWANYIKA-SANDO, MARY - Public Health - Tanzania; PRAYGOD, GEORGE - Tsetse Research Institute; LEYNA, GERMANA - Muhimbili University; PATIL, CRYSTAL - University Of Illinois; GUNARATNA, NILUPA - Purdue University

Submitted to: Current Developments in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/25/2022
Publication Date: 2/8/2022
Citation: Ambikapathi, R., Irema, I., Lyatuu, I., Caswell, B.L., Mosha, D., Nyamsangia, S., Galvin, L., Mangara, A., Boncyk, M., Froese, S., Verssimo, C., Itatiro, J., Kariathi, V., Kazonda, P., Wandella, M., Fawzi, W., Killewo, J., Mwanyika-Sando, M., Praygod, G., Leyna, G., Patil, C., Gunaratna, N.S. 2022. Gender and age differences in meal structures, food away from home, chrono-nutrition, and nutrition intakes among adults and children in Tanzania using newly developed tablet-based 24-hour recall tool. Current Developments in Nutrition. 6/3. https://doi.org/10.1093/cdn/nzac015.
DOI: https://doi.org/10.1093/cdn/nzac015

Interpretive Summary: Detailed, quantitative dietary intake data are critical for assessment of population dietary status, nutrition research and evaluation of diet-related programs and policies. However, such data are costly and labor-intensive to collect using paper-based dietary recall surveys. We developed a tool that can be used on Android tablets to collect detailed dietary intake data following an established method for conducting 24-hour dietary recalls. The use of tablets eliminates the time-consuming and costly step of entering data from paper forms into and database and can reduce data errors or missingness. This tablet tool was developed for use in rural Tanzania and customized to the local context using meal terms, food and ingredient lists, recipe recording and portion measurements that match local customs. Through this customized, tablet-based system, the data on foods and drinks consumed were readily linked to the nutrient composition data for rapid review and analysis. The tool was used to collect over 10,000 dietary records among Tanzanian adults and children participating in two different studies of nutrition, health and food environment. Use of tablets with this 24-hour recall tool was practical for field implementation of nutrition-related research and user-friendly for study staff. The data collected with this tool can be used to assess multiple dimensions of dietary intakes and practices, including dietary patterns, food and nutrient intakes, consumption of processed foods, child feeding practices, timing and source of meals, and dietary differences by age and gender. This tablet dietary recall tool is available freely for research purposes and can be adapted to other contexts in East Africa. The development and sharing of this tool can expand the availability of detailed dietary data for many types of nutrition-related studies.

Technical Abstract: Background: In many regions of the world, little is known about meal structures, meal patterns, and nutrient intake because the collection of quantitative dietary intake is expensive and labor-intensive. Objectives: We describe the development and field-feasibility of a tablet-based Tanzania-24-hour recall tool (TZ-24hr-DR), and dietary intakes collected from adults and children in rural and urban settings. Methods: Using the Tanzanian food composition table, the TZ-24hr-DR tool was developed on an Android platform using Open Data Kit. The module provides food lists, meal lists, ingredient lists, quantity and amount consumed, breastfeeding frequency, and a recipe feature. Similar to the USDA Automated Multiple Pass Method, this TZ-24hr-DR contains review features such as time in between meals, a summary of meals, and portion sizes. Results: Using this new tool, we collected dietary intake among (1) 845 children 0-18 months of age enrolled in the EFFECTS trial (ClinicalTrials.gov Identifier: NCT03759821) in Mara, Tanzania, and (2) 312 adult families from the DECIDE study in peri-urban Dar es Salaam. Data collectors were trained on paper-based methods with food models and tablet-based collection. Conversion to nutrient intake was readily linked and accessible, enabling rapid review and analysis. Overall, 2,158 and 8,197 dietary meal records were collected from DECIDE study and EFFECTS trial. Among adults, 63% of men and 92% of women report eating at home. Food consumed outside the home typically occurs for the first two meals. Children’s intake of nutrients increased with age; however, median micronutrient intakes for calcium, iron, zinc, and vitamin A remained below recommended nutrient intakes. Conclusions: TZ-24hr-DR is a field- and user-friendly tool that can collect large samples of dietary intakes. Further validation with paper-based or weighted 24-hour recall is needed. The tool is available freely for research purposes and can be further adapted to other contexts in East Africa.