Gender and Age Differences in Meal Structures, Food Away from Home, Chrono-Nutrition, and Nutrition Intakes among Adults and Children in Tanzania Using a Newly Developed Tablet-Based 24-Hour Recall Tool

Ramya Ambikapathi, Imani Irema, Isaac Lyatuu, Bess Caswell, Dominic Mosha, Stella Nyamsangia, Lauren Galvin, Ally Mangara, Morgan Boncyk, Savannah L Froese, Cristiana K Verissimo, Julieth Itatiro, Victoria Kariathi, Patrick Kazonda, Medina Wandella, Wafaie Fawzi, Japhet Killewo, Mary Mwanyika-Sando, George PrayGod, Germana Leyna, Crystal Patil, Nilupa S Gunaratna, Ramya Ambikapathi, Imani Irema, Isaac Lyatuu, Bess Caswell, Dominic Mosha, Stella Nyamsangia, Lauren Galvin, Ally Mangara, Morgan Boncyk, Savannah L Froese, Cristiana K Verissimo, Julieth Itatiro, Victoria Kariathi, Patrick Kazonda, Medina Wandella, Wafaie Fawzi, Japhet Killewo, Mary Mwanyika-Sando, George PrayGod, Germana Leyna, Crystal Patil, Nilupa S Gunaratna

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-h 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 the 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: Dietary intake using TZ-24hr-DR was collected among 1) 845 children 0-18 mo of age enrolled in the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) trial (ClinicalTrials.gov identifier: NCT03759821) in Mara, Tanzania, and 2) 312 adult families from the Diet, Environment, and Choices of positive living (DECIDE) observational study in peri-urban Dar es Salaam. Interviewers 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, 2158 and 8197 dietary meal records were collected from the DECIDE study and EFFECTS trial, respectively. Among adults, 63% of men and 92% of women reported eating at home, and there were differences in protein, fat, and zinc. Food consumed outside the home typically occurs for the first 2 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: The TZ-24hr-DR is a field- and user-friendly tool that can collect large samples of dietary intakes. Further validation is needed. The tool is available freely for research purposes and can be further adapted to other contexts in East Africa.

Keywords: Tanzania; adults; children; dietary data; diets; nutrient intakes; open data kit; tablet.

© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Flow of TZ-24hr-DR tool from demographics, food consumption, ingredient information, and recipe information. Asterisks indicate there were many choices. TZ-24hr-DR, Tanzania 24-h recall tool.
FIGURE 2
FIGURE 2
Sample individual dietary profiles were created daily based on uploaded data (top panel: DECIDE study; bottom panel: EFFECTS Trial). DECIDE, Diet, Environment, and Choices of positive living; EFFECTS, Engaging Fathers for Effective Child Nutrition and Development in Tanzania. EP refers to edible portion.
FIGURE 4
FIGURE 4
Mean energy intake by the meal of the day by gender from the DECIDE study (PLHIV adults). DECIDE, Diet, Environment, and Choices of positive living; PLHIV, persons living with HIV.
FIGURE 3
FIGURE 3
Timing of meals in DECIDE study (PLHIV adults; top panel) and EFFECTS trial (children 

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