Feasibility of the Automatic Ingestion Monitor (AIM-2) for infant feeding assessment: A pilot study among breastfeeding mothers from Ghana

Authors: CERMINARO, CAROLINE - University Of Georgia; SAZONOV, EDWARD - University Of Alabama; MCCRORY, MEGAN - Boston University; STEINER-ASIEDU, MATILDA - University Of Ghana; BHASKAR, VIPRAV - University Of Alabama; GALLO, SINA - University Of Georgia; LAING, EMMA - University Of Georgia; JIA, WENYAN - University Of Pittsburgh; SUN, MINGUI - University Of Pittsburgh; BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC); FROST, GARY - Imperial College; LO, BENNY - Imperial College; KOJO ANDERSON, ALEX - University Of Georgia

Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/10/2022
Publication Date: 5/26/2022
Citation: Cerminaro, C., Sazonov, E., McCrory, M., Steiner-Asiedu, M., Bhaskar, V., Gallo, S., Laing, E., Jia, W., Sun, M., Baranowski, T., Frost, G., Lo, B., Kojo Anderson, A. 2022. Feasibility of the Automatic Ingestion Monitor (AIM-2) for infant feeding assessment: A pilot study among breastfeeding mothers from Ghana. Public Health Nutrition. https://doi.org/10.1017/S1368980022001264.
DOI: https://doi.org/10.1017/S1368980022001264

Interpretive Summary: While breast feeding is important for the health of infants, self report of frequency and duration of breastfeeding is highly inaccurate. Passive, wearable sensors can be used to obtain objective information about infant feeding, but their use has not been tested. This report compared assessment of infant feeding (frequency, duration, duration and cues) by self-report and that of the Automatic Ingestion Monitor-2 (AIM-2), a camera attached to eye-glass frames. A cross-sectional pilot study was conducted in Ghana. Mothers wore the AIM-2 on eyeglasses for one day during waking hours; the images were automatically captured by the device every 15 seconds. Participants were breastfeeding mothers of infants. Compliance with wearing the AIM-2 was high, suggesting low user burden. Maternal report differed from the AIM-2 data, such that mothers reported higher mean breastfeeding frequency (11 vs. 8 times) and duration (18.5 vs 10 minutes) during waking hours. Thus, AIM-2 is a feasible tool for the assessment of infant feeding among mothers in Ghana. Future studies using the AIM-2 are warranted to establish validity.

Technical Abstract: Passive, wearable sensors can be used to obtain objective information in infant feeding, but their use has not been tested. Our objective was to compare assessment of infant feeding (frequency, duration, duration and cues) by self-report and that of the Automatic Ingestion Monitor-2 (AIM-2). A cross-sectional pilot study was conducted in rural and urban communities in Ghana. Mothers wore the AIM-2 on eyeglasses for 1 day during waking hours to assess infant feeding using images automatically captured by the device every 15 seconds. Feasibility was assessed using compliance with wearing the device. Infant feeding practices collected by the AIM-2 images were annotated by a trained evaluator and compared with maternal self-report via interviewer-administered questionnaire. Participants were 38 (18 rural, and 20 urban) breastfeeding mothers of infants (child age <=7 months. Twenty-five mothers reported exclusive breastfeeding, which was common among those <30 years of age (n=15, 60%) and those residing in urban communities (n=14, 70%). Compliance with wearing the AIM-2 was high (83% of wake-time), suggesting low user burden. Maternal report differed from the AIM-2 data, such that mothers reported higher mean breastfeeding frequency (11 vs. 8 times, p=0.041) and duration (18.5 vs 10 minutes, p=0.007) during waking hours. The AIM-2 was a feasible tool for the assessment of infant feeding among mothers in Ghana as a passive, objective method and identified over-estimation of self-reported breastfeeding frequency and duration. Future studies using the AIM-2 are warranted to determine validity on a larger scale.