Assessing Child Nutrient Intakes Using a Tablet-Based 24-Hour Recall Tool in Rural Zambia

Abstract

Background: Detailed dietary intake data in low-income populations are needed for research and program evaluation. However, collection of such data by paper-based 24-hour recall imposes substantial demands for staff time and expertise, training, materials, and data entry. Objective: To describe our development and use of a tablet-based 24-hour recall tool for conducting dietary intake surveys in remote settings. Methods: We designed a 24-hour recall tool using Open Data Kit software on an Android tablet platform. The tool contains a list of local foods, questions on portion size, cooking method, ingredients, and food source and prompts to guide interviewers. We used this tool to interview caregivers on dietary intakes of children participating in an efficacy trial of provitamin A-biofortified maize conducted in Mkushi, a rural district in central Zambia. Participants were children aged 4 to 8 years not yet enrolled in school (n ¼ 938). Dietary intake data were converted to nutrient intakes using local food composition and recipe tables. Results: We developed a tablet-based 24-hour recall tool and used it to collect dietary data among 928 children. The majority of foods consumed were maize, leafy vegetable, or small fish dishes. Median daily energy intake was 6416 kJ (1469 kcal). Conclusions: Food and nutrient intakes assessed using the tablet-based tool were consistent with those reported in prior research. The tool was easily used by interviewers without prior nutrition training or computing experience. Challenges remain to improve programming, but the tool is an innovation that enables efficient collection of 24-hour recall data in remote settings.

Overcoming Dietary Assessment Challenges in Low-Income Countries: Technological Solutions Proposed by the International Dietary Data Expansion (INDDEX) Project

“…Yet, nearly all existing electronic 24HR data collection platforms were designed for use in high-income countries [19,20]. Though a handful of automated data collection tools have been used to collect dietary data in resource constrained contexts, for example, in India and Zambia, these were designed for specific research purposes and settings only, and cannot be adapted to other geographic locations [21,22]. …”

Smartphone tool to collect repeated 24 h dietary recall data in Nepal

“…However, in low-income countries, these benefits have rarely been realised for the collection of dietary data, such as 24 h dietary recalls or weighed food records (4)(5)(6) . Dietary intake assessment is well known to be error-prone (7,8) , so near-instant access to digitised data could facilitate improvements in data quality and precision of intake estimates, particularly for studies with large sample sizes.…”

Within-person, between-person and seasonal variance in nutrient intakes among 4- to 8-year-old rural Zambian children

“…One explanation for this result is that in this population drawn from a single, rural district, children have similar dietsregardless of socio-economic status or peri-urban residencewith meals typically consisting of stiff maize porridge accompanied by a small range of vegetable, fish or meat dishes. A second possible explanation for the low between-person variance is use of portion size photographs and standardised recipes in our tablet-based 24-h recall tool (22,23) . Though portion size estimates were adjusted for food density, constraining participants to indicate one of five depicted portion sizes rather than indicating portion by food models may have contributed to the low between-person variance.…”

“…Dietary intake data were collected by intervieweradministered, tablet-based 24-h recall. The recall was developed for use in the present study, as previously described by Caswell et al (23) . The primary caregiver of each enrolled child was asked to describe all foods and beverages the child consumed between waking the previous morning and waking the morning of the interview.…”