Objective: To examine the association between nutrient adequacy and dietary diversity, and to assess and compare the determinants for the two constructs in an adult population in rural Mali. Design: Cross-sectional study assessing food intake by a validated 7-day quantitative food frequency questionnaire. Two different dietary diversity indexes were created: food variety score (FVS), a simple count of food items, and diet diversity score (DDS) a count of food groups. Mean adequacy ratio, the mean ratio of intake to recommended intake (each truncated at one) of energy and nine nutrients, was calculated as an indicator of nutrient adequacy. Information on household and individual characteristics, including demography, socioeconomic conditions and food production strategies was obtained using precoded questionnaires. Setting: Bafoulabé district, Kayes region, Western Mali. Subjects: In total, 502 subjects (55% women) aged 15-45 y from 319 different households. Results: Both FVS and DDS had a positive correlation with mean adequacy ratio (MAR). Multivariate analysis (linear regression)showed that the most important factors explaining MAR was the number of milk products, vegetables and green leaves consumed, as well as sex and the number of crops produced in the household. Dietary diversity was associated with socioeconomic status, residence and age. Conclusion: Dietary diversity is useful as an indicator of nutrient adequacy. It is important to examine how various food groups contribute to the nutrient adequacy of the diet in an area. Sponsorship: The Norwegian Research Council and The Strmme Foundation funded the project.

Objective: To assess the validity of two diet quality indexesFfood variety score (FVS) and diet diversity score (DDS) in Western Mali. Design: In two separate studies (A and B), FVS and DDS were derived from a food frequency questionnaire (FFQ) and were compared with the same scores and with measures of nutrient adequacy derived from 2-day weighed records (WR). Setting: Two rural, adjacent villages in Mali, West Africa. Subjects: In study A (1996), 48 women and 27 men (15-59 y) participated. Study B (1999) included 34 women and 36 men (15-45 y). Results: Spearman's correlation coefficients between FVS from the FFQ and WR for men were 0.5 in study A and 0.4 in study B. The corresponding correlations for DDS were 0.2 and 0.4, respectively. Correlations for women were lower, especially in study B. Classification into quartiles was also best for men. Correlations for the two diet variety scores from the FFQ with nutrient adequacy from the WR in study A were about 0.3 for men, but lower for women. In study B, these correlations were around 0.5 for men, whereas for women there was no association. Conclusion: FVS and DDS can be assessed by our FFQ. The two diet variety scores reflect diet quality and are simple tools that can be used for monitoring. The validation study gave better results for men than for women, which has implications for further use of these instruments. Sponsorship: The Norwegian Research Council and The Stromme Foundation funded the project.

Objective: To assess the effect on the haemoglobin concentrations of schoolchildren of weekly iron tablets administered by teachers. Design: Sixty schools were randomly assigned to two groups: in 30 schools children were given weekly for 10 weeks a tablet providing 65 mg of iron and 0.25 mg of folic acid; in the other 30 schools no iron tablets were given. All children were dewormed and given vitamin A before the study began. The haemoglobin concentration of up to 20 randomly selected children in each school was estimated before and 2 weeks after the end of treatment. Setting: Rural community schools in Kolondieba district of Mali.

Objective: To assess the relative validity of the second version of a quantitative foodfrequency questionnaire (QFFQ), designed to measure the habitual food and nutrient intake in one season in rural populations in Western Mali, West Africa. Design: The dietary intake during the previous week was assessed with the 164-item QFFQ administered by interview. This was compared with the intake from a 2-day weighed record (WR) with weighed recipes. Setting: The village of Ouassala in the Kayes region, Western Mali. Subjects: Thirty-four women and 36 men aged 15 -45 years, from 29 households. Results: The QFFQ gave a lower intake of lunch and dinner and a higher intake of snacks than the WR. The discrepancies were larger for women than for men. The median proportion of subjects classified in the same quartile of intake was 29% for food groups and 36% for energy and nutrients. For classification into extreme opposite quartiles, the median proportion was 6% for food groups and 7% for energy and nutrients. Spearman's rank correlation for energy and nutrients ranged from 0.16 (% energy from protein) to 0.62 (retinol equivalents). Conclusions: The second version of the QFFQ tends to underestimate total food weight. The methods used for estimating food portion size should therefore be applied with caution. The changes made from the first version had little effect. The ability to rank subjects according to dietary intake is similar with both versions. The improved layout of the new QFFQ makes it a more user-friendly tool for comparing dietary intake between population groups and for measuring changes over time. The food-frequency questionnaire (FFQ) is often the most feasible method for collecting data on regular dietary intake from large population samples. Its advantages include quicker administration and processing, and subsequently lower costs and participant burden than alternative methods such as diet history or repeated 24-hour recalls. Although the FFQ has traditionally been used in epidemiological studies 1,2 , it can also be used to assess and monitor nutrition situations, and as a basis for policy planning 3 . The FFQ is a simple tool for ranking individuals according to dietary intake, but its ability to provide accurate quantitative measures of intake is generally limited 4 . Furthermore, FFQs should be developed and validated in the local setting to ensure that the method is adapted to the target population and culturally sensitive 5 . A number of recently published studies report the use of FFQs in various populations in South Africa 6 -12 . However, the application of FFQs in other African countries appears much more limited 13 -16 . To our knowledge, very few studies have been done on the development and validation of FFQs in African population groups 3,17 -20 , indicating a need for further development of quantitative methods for assessing their dietary intake. This paper describes the relative validity of the second version of a quantitative food-frequency questionnaire (QFFQ), designed to m...

Objectives: To assess vitamin A supplementation (VAS) coverage of children aged 6 -59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali. Design: Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed. Setting: Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas. Subjects: Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders. Results: At least 80% of the children received the supplement. More 'traditional' communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson x 2 ¼ 5.03; P ¼ 0.025) and fathers' education (Pearson x 2 ¼ 19.02; P , 0.001), possession of a radio (Pearson x 2 ¼ 8.93; P ¼ 0.003) and listening to it (Pearson x 2 ¼ 7.62; P ¼ 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P ¼ 0.004), 'traditional channels' (P ¼ 0.02) and fathers' education (P ¼ 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general. Conclusion: National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6-59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers. Keywords Vitamin A supplementationChild survival National Nutrition Weeks MaliVitamin A repletion was shown to reduce the mortality of children aged 6-59 months by 23-34% in areas where vitamin A deficiency (VAD) is prevalent 1 -4 . In sub-Saharan Africa, it is estimated that 42% of children under 5 years of age are at risk of VAD and that adequately controlling this deficiency can avert over 645 000 child deaths per year in the region . This prevalence is higher than the cut-off point of 5%, indicating that VAD is a public health problem in a population 7 . In order to tackle this situation, Mali developed and applied strategies q The Authors 2007