Validation of the CIMI-Ethiopia Program and Seasonal Variation in Maternal Nutrient Intake in Enset (False Banana) Growing Areas of Southern Ethiopia

Abstract

Background: Tools for the rapid and accurate analysis of nutrient intakes from diets of individuals in Southern Ethiopia are lacking. The Calculator of Inadequate Micronutrient Intake program for Ethiopia (CIMI-Ethiopia) has been developed to overcome this problem. CIMI-Ethiopia also computes protein and energy intakes from the diet. The objectives of the current study were to validate CIMI-Ethiopia for the dietary pattern of Southern Ethiopia, and assess the nutrient intakes in postharvest dry and lean wet seasons. Methods: 24-h dietary recall (24HR) data was collected from 578 women of a reproductive age in postharvest dry and lean wet seasons in 2017. For analysis, 24HR data was entered into NutriSurvey (NS), which was the reference nutrition software, and then into CIMI-Ethiopia. For validation, the mean and standard deviation (SD) of the difference between CIMI-Ethiopia and NS were computed. The percentage of participants with an inadequate intake was calculated. The correlation between CIMI-Ethiopia and NS results was determined. The nutrient intakes in postharvest dry and lean seasons were compared. Results: Among the nutrients, pantothenic acid, vitamin B1, and protein showed a very high accuracy in CIMI-Ethiopia calculation (|difference (D)| < 5.0% of the NS result). Nutrients with a good accuracy (|D| = 5%–15%) were iron, zinc, magnesium, vitamin B12, vitamin B6, and energy. The accuracy for calcium, niacin, and vitamin A was moderate (|D| = 15%–30%). The intakes calculated by CIMI-Ethiopia and NS of iron, zinc, magnesium, calcium, B-complex vitamins, vitamin A, protein, and energy were highly correlated (r = 0.85–0.97, p < 0.001). NS analysis identified a significant reduction in the mean intake of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season; however, calcium and vitamin A intake increased. Conclusions: It has been found that CIMI-Ethiopia is a valid tool for estimating nutrient intakes at an individual level in Southern Ethiopia. The study demonstrated a decline in intakes of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season. This result provides some hint for fortification and supplementation programs that aim to combat maternal malnutrition in rural Southern Ethiopia.

Calculator for inadequate micronutrient intake for Ethiopia (CIMI‐Ethiopia): Validation of the software for lactating mothers and their children under 2 years

“…Most of the average nutrient and energy intake calculated by CIMI‐Ethiopia and NS were comparable, except for vitamin A, both for children and lactating mothers, and vitamin C in the lactating mothers. These slight variations of the vitamin A intake calculated by CIMI‐Ethiopia and NS are in line with the results observed in the concurrent validation study conducted in Ethiopia, and CIMI validation studies conducted in Indonesia and Tanzania (Bosha, Lambert, et al., 2019; Jati et al., 2014; Lambert et al., 2018). The reason for the variation in the vitamin A calculated by the two software in the present study is mainly that the maximum selectable amount in the “butter and oils” group of the CIMI‐Ethiopia is 30 g unlike in the NS, in which an unlimited amount can be entered (data not shown).…”

“…Accordingly, the average mean differences of each nutrient intake were calculated as an average of the mean difference results obtained by subtracting the results produced by NS results from CIMI‐Ethiopia of the participants included in the study, and the average mean difference % for each nutrient was calculated as the average mean difference divided by the average nutrient result produced by NS and then multiplying the dividend by 100 (Appendix S1, Equation a and b). Then, the percentage mean difference was used to categorize the accuracy of the results of energy and nutrient intake produced by CIMI‐Ethiopia as very high (±0 < 5%), good (±5%–15%), moderate (±15%–30%), and low (±>30%) (Bosha, Desalegn, et al., 2019; Bosha, Lambert, et al., 2019; Lambert et al., 2018).…”

“…Then, these data will be available and can be used for both individual‐ and population‐level dietary consumption interpretation using different dietary reference recommendations. Besides these, CIMI is designed to calculate nutrient intake from an individual diet using a 24‐h dietary assessment method (Bosha, Desalegn, et al., 2019; Bosha, Lambert, et al., 2019; Jati et al., 2014; Lambert et al., 2018; Wald et al., 2019).…”

“…Cereals and root‐ and tuber‐based foods are staples for Ethiopians; thus, considering this for its full usage of CIMI‐Ethiopia is important, but it needs to evaluate the validity of the results generated by the software in the two contexts. Accordingly, CIMI‐Ethiopia was validated using dietary intake data collected from women of reproductive age, in southern Ethiopia, where root‐ and tuber‐based diets are staples in the community (Bosha, Desalegn, et al., 2019; Bosha, Lambert, et al., 2019). The study revealed that CIMI‐Ethiopia precisely calculates nutrient intake for women of reproductive age in southern Ethiopia.…”

“…Yet, it is not known, where CIMI‐Ethiopia produces valid results in terms of calculating the nutrient intake and also identifying the inadequate intake of specific nutrients from individual dietary information. Moreover, the validation study in southern Ethiopia was based on data collected during different agricultural seasons, unlike in northern Ethiopia, in which the dietary pattern is profoundly affected by religious fasting (Bosha, Desalegn, et al., 2019; Bosha, Lambert, et al., 2019; Desalegn et al, 2018; Desalegn et al., 2019). Besides this, the validity of CIMI‐Ethiopia for its ability to calculate the precise results based on children's data is not assessed.…”