Evaluating pictorial charts as a means of collecting participant-recorded data on household dietary diversity in low-literacy communities in Tanzania.

Innovative methods to collect dietary data at multiple times across the year are needed to better understand seasonal or temporal changes in household diets and measure the impact of nutrition-sensitive agricultural programmes in low-income countries. The present study aims to validate a picture-based research tool for participants to self-record their household's dietary diversity each month in villages of Manyoni District, Tanzania. Pictorial record charts were developed to reflect local food resources. In 113 randomly selected households, the person responsible for food preparation was trained to mark all items consumed by any household member within the home, or prepared for consumption outside the home, for a single recording day. The next day, an interview-based household 24-h food recall (H24HR) was collected for the same period. Separate analyses tested agreement (a) between picture charts and H24HR and (b) between H24HR following chart completion and on an alternative day. Concordance between methods differed between food groups and items but was high to very high for all cereals, vegetables, pulses, legumes and nuts and almost all fruits. Recording of ten items (including non-cultivated fruits and ingredients of mixed dishes) differed significantly between H24HR assessments, all of which were reported by more households in interviews following chart completion. Results suggest potential for visual prompts and the contemporaneous nature of data collection to improve the accuracy of interview-based recall. With adequate investment in developing and implementing context-adapted tools, pictorial charts may also offer an effective standalone method for use at multiple time-points in agricultural programmes.

Food composition tables in resource-poor settings: exploring current limitations and opportunities, with a focus on animal-source foods in sub-Saharan Africa.

Animal-source foods (ASF) have the potential to enhance the nutritional adequacy of cereal-based diets in low- and middle-income countries, through the provision of high-quality protein and bioavailable micronutrients. The development of guidelines for including ASF in local diets requires an understanding of the nutrient content of available resources. This article reviews food composition tables (FCT) used in sub-Saharan Africa, examining the spectrum of ASF reported and exploring data sources for each reference. Compositional data are shown to be derived from a small number of existing data sets from analyses conducted largely in high-income nations, often many decades previously. There are limitations in using such values, which represent the products of intensively raised animals of commercial breeds, as a reference in resource-poor settings where indigenous breed livestock are commonly reared in low-input production systems, on mineral-deficient soils and not receiving nutritionally balanced feed. The FCT examined also revealed a lack of data on the full spectrum of ASF, including offal and wild foods, which correspond to local food preferences and represent valuable dietary resources in food-deficient settings. Using poultry products as an example, comparisons are made between compositional data from three high-income nations, and potential implications of differences in the published values for micronutrients of public health significance, including Fe, folate and vitamin A, are discussed. It is important that those working on nutritional interventions and on developing dietary recommendations for resource-poor settings understand the limitations of current food composition data and that opportunities to improve existing resources are more actively explored and supported.

Validation of a Food Knowledge Questionnaire on Tanzanian Women of Childbearing Age.

The present manuscript describes the validation of a food knowledge questionnaire (FKQ) for Tanzanian childbearing age women. The FKQ was derived from the Ugandan version and was adapted according to Tanzanian culture and food habits, including 114 closed-ended questions, divided into five different sections. The FKQ was administered to 671 Tanzanian childbearing-age women who were eligible if they: (i) were aged between 14 and 49 years old, (ii) had not been diagnosed with any disease and (iii) lived in the urban or peri-urban area of the Arusha and Morogoro region. The validation process of the FKQ was conducted in Tanzania and the recruitment occurred between August and October 2020. The final version of the validated questionnaire was characterized by a total of 88 questions, divided into ten different sections; each section aimed to investigate a different aspect of food knowledge, except for section A, which collected information related to the social and demographic characteristics of the respondent. The food knowledge questionnaire showed good construct validity and content validity to assess knowledge and food practices in Tanzanian women of childbearing age and could be used in future studies to identify women at higher risk of unhealthy eating habits and food choices.

Dietary patterns and nutritional health of women: the nutrition transition in rural Tanzania.

BACKGROUND: Many developing countries are experiencing a rapid nutrition transition in urban areas. OBJECTIVE: To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania. METHODS: A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006-2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns. RESULTS: The five dietary patterns were "traditional-coast," characterized by fruits, nuts, starchy plants, and fish; "traditional-inland," characterized by cereals, oils and fats, and vegetables; "purchase," characterized by bread and cakes (usually fried in oil), sugar, and black tea; "pulses," characterized mainly by pulses, with few or no vegetables; and "animal products," characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (p = 0.192, p = .005) and between the animal products pattern and wealth (p = 0.168, p = .002). CONCLUSIONS: Differences between traditional and modern nutritional food patterns were evident. This study found the"traditional-inland" pattern to be the most healthy, while the "purchase" food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.

Indigenous vegetables: a sustainable approach to improve micronutrient adequacy in Tanzanian women of childbearing age.

BACKGROUND/OBJECTIVES: Increasing dietary diversity is a viable strategy for addressing micronutrient malnutrition in women of childbearing age (WCA) from low-income countries. Recently, it has been demonstrated that some indigenous vegetables (IV) with high nutrient density may help to ameliorate micronutrient's intake. The Minimum Dietary Diversity index for Women (MDD-W) could be considered as a proxy to describe one important dimension of women's diet quality. This cross-sectional study aimed at exploring aspects contributing to micronutrients adequacy in Tanzanian WCA, with a focus on IV consumption and other socio-demographic factors. SUBJECTS/METHODS: Data collection was conducted among urban and peri-urban women in Arusha city, Tanzania. Socio-demographic factors were collected using a structured interview. Information on IV consumption and MDD-W calculation were obtained using a 24-h recall. RESULTS: One-hundred and forty-one women aged 14-49 years were interviewed. Sixteen per cent of the sample consumed at least one portion of IV/day. The total median MDD-W was 4.0 (IQR. 3.0-5.0) and it was adequate in the 44% of the sample. Women who consumed IV had MDD-W 0.66 points (95% CI: 0.02-1.30, p = 0.046) higher than those who did not; consuming IV had an odds ratio of more than three times concerning women not consuming IV (OR: 3.30, 95% CI: 1.24-8.81, p = 0.017). CONCLUSIONS: The IV consumption is positively associated with micronutrient adequacy and its absence from the diet can be an indicator of micronutrient deficiencies in vulnerable people such as WCA. For that reason, this study suggests that IV consumption may improve micronutrient deficiency in WCA.

Adequacy of macro and micronutrients in infants and young children's diets in Zanzibar, Tanzania.

BACKGROUND: A study was conducted in Zanzibar using ProPAN software to assess nutrient adequacy of foods given to infants and children aged 6-23 months old in Zanzibar. METHODOLOGY: The 24-hr dietary recall method embedded in ProPAN software was used to determine the adequacy of energy, protein, iron, calcium, zinc and vitamin A in foods consumed by children. Sample of 200 mothers/caretakers with children aged 6-23 months were interviewed. RESULTS: Most frequent foods given to infants and children were tea, bread, white rice and fish. Key nutrients such as iron, zinc and vitamin A were below the recommended levels except for vitamin C from the diets consumed by children aged 11-23 months. Energy and protein were considered to be adequate as more than 90% of the children received enough of these nutrients. Mean age of introduction of complementary foods was four months. CONCLUSION: Children diets were limited in fruits and vegetables that caused micronutrients of nutritional importance such as iron, zinc and vitamin A to be supplied below recommended level. Equally, fat intake was below recommended level. Nutrition education on appropriate complementary foods should be given to caregivers. Promotion of consumption of diversified diets and locally available nutrient dense foods should be emphasized so as to achieve adequate intake of nutrients to infants and young children.

Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania.

BACKGROUND: Measures of quality of care in low- and middle-income countries (LMICs) rarely include experience of care. This gap in service quality metrics may be driven by a lack of understanding of client and provider perspectives. Understanding these perspectives is a critical first step in not only improving metrics, but also in improving service delivery. This study identifies the items antenatal care (ANC) clients and health care providers in Tanzania associate with a quality ANC service and explores the experience of care domain from both client and provider perspectives. METHODS: We conducted semi-structured interviews with15 providers and 35 clients in Tanzania that included a free-listing activity to elicit items clients and providers associate with quality ANC services. We analyzed the free-listing for rank order and frequency to identify the most salient items, which were included in the second phase of data collection. We then conducted semi-structured interviews with a pile sort activity with the same 15 providers and 32 new clients to understand the importance of the items identified in the free-listing. We used a thematic analysis driven by the framework approach to analyze interview data. RESULTS: Both clients and providers perceived quality of ANC as being comprised of items related to experience of care, provision of care, and cross-cutting essential physical and human resources. The free-listing findings illuminated that the experience of care was equally important to clients and providers as the availability of physical and human resources and the content of the care delivered. In addition, clients and providers perceived that a positive patient care experience - marked by good communication, active listening, keeping confidentiality, and being spoken to politely - increased utilization of health services and improved health outcomes. CONCLUSIONS: The experience of care in LMICs is an overlooked, yet critically important topic. Understanding the experience of care from those who receive and deliver services is key to measuring and improving the quality of ANC. Our research highlights the importance of incorporating experience of care into future quality improvement activities and quality measures. By doing so, we identify barriers and facilitating factors of practical use to policy-makers and governments in LMICs.

Rich Food Biodiversity Amid Low Consumption of Food Items in Kilosa District, Tanzania.

BACKGROUND: Indigenous foods, which contribute largely to the majority of the households' food basket in rural Tanzanian communities, have not been fully characterized or documented. OBJECTIVES: The study aimed to document foods available and consumed in Kilosa District, Tanzania, in an attempt to promote, revive use, and build evidence for sustainable utilization of the rich local biodiversity. METHODS: Data were collected from 307 households in 3 agroecological zones in Kilosa District during the beginning of the rainy season (February-May) and immediately after harvest (September-October). A list of food items was generated, and 24-hour recall was performed. Descriptive statistics were calculated and a student t test statistic was used to compare the means of the Food Biodiversity Score between the agricultural seasons. RESULTS: A total of 183 edible food items were reported by households with more reported in the rainy season (n = 82) compared to harvest season (n = 64). The mean number of food items consumed per day during the rainy season was 4.7 (95% CI: 4.5-5.0) compared to 5.9 (95% CI: 5.7-6.1) during harvest season. About 50% of the households mentioned that wild edible foods were less accepted by household members. CONCLUSION: Despite the rich local food biodiversity, households relied on few food items which may be due to limited awareness and knowledge about the biodiversity of foods in the community. It is important to educate communities on the rich and affordable food base available locally to improve their food diversity, income, and nutritional status.

Dietary patterns and household food insecurity in rural populations of Kilosa district, Tanzania.

INTRODUCTION: Few studies have investigated the relationship between dietary pattern and household food insecurity. The objective of the present analysis was to describe the food consumption patterns and to relate these with the prevalence of food insecurity in the context of a rural community. METHODOLOGY: Three hundred and seven (307) randomly selected households in Kilosa district participated in the study. Data were collected during the rainy season (February-May) and post harvest season (September-October) in the year 2011. Food consumption pattern was determined using a 24-h dietary recall method. Food insecurity data were based on the 30 day recall experience to food insecurity in the household. Factor analysis method using Principal Components extraction function was used to derive the dietary patterns and correlation analysis was used to establish the existing relationship between household food insecurity and dietary patterns factor score. RESULTS: Four food consumption patterns namely (I) Meat and milk; (II) Pulses, legumes, nuts and cooking oils; (III) fish (and other sea foods), roots and tubers; (IV) Cereals, vegetables and fruits consumption patterns were identified during harvest season. Dietary patterns identified during the rainy season were as follows: (I) Fruits, cooking oils, fats, roots and tubers (II) Eggs, meat, milk and milk products (III) Fish, other sea foods, vegetables, roots and tubers and (IV) Pulses, legumes, nuts, cereals and vegetables. Household food insecurity was 80% and 69% during rainy and harvest-seasons, respectively (P = 0.01). Household food insecurity access scale score was negatively correlated with the factor scores on household dietary diversity. CONCLUSION: Food consumption patterns and food insecurity varied by seasons with worst scenarios most prevalent during the rainy season. The risk for inadequate dietary diversity was higher among food insecure households compared to food secure households. Effort geared at alleviating household food insecurity could contribute to consumption of a wide range of food items at the household level.

Obesity as a public health problem among adult women in rural Tanzania.

BACKGROUND: For many developing countries, obesity and its sequelae have become a challenge of a magnitude similar to hunger and undernutrition. The main objective of this study was, therefore, to investigate the weight status of women in rural Tanzania with reference to season as well as the link between women's weight, food consumption, and attitudes toward obesity. METHODS: Three cross-sectional surveys in 3 different seasons within 1 year interviewed the same 210 women, ages 17-45 years, from 3 rural districts of northeastern and central Tanzania. These surveys assessed body mass index (BMI), food intake, and dietary diversity through 24-hour recalls, women's attitudes toward obesity, vegetable production, and socioeconomic status. RESULTS: Although 71% of the women had a normal BMI, 7% were underweight, 16% overweight, and 6% obese. The BMI was correlated with the Dietary Diversity Score (DDS), the Food Variety Score (FVS), with the consumption of foods from the food groups "bread/cakes," "sugar," and "tea," and with the production of exotic vegetables. In a multiple regression model, FVS was directly associated with BMI. When asked to describe the typical characteristics of an obese person, women mentioned more negative than positive characteristics. CONCLUSION: The prevalence of overweight and obesity was 3 times higher than that of underweight. Apparently, even in rural areas of Tanzania, a nutrition transition is underway. No direct association was identified between vegetable consumption and BMI. Although this study did not assess behavioral factors, such behavioral factors as activity levels as well as attitudes need to be considered, even in rural settings, to address all facets of malnutrition.

Nutritional vulnerability of older persons living in urban areas of Lake Victoria Basin in East Africa: a cross sectional survey.

The aim of this study was to (1) determine the prevalence of malnutrition and (2) investigate factors affecting nutritional status of older persons living in urban areas of Lake Victoria Basin. The prevalence of underweight was 16.5%, with men (24.1%) being significantly more likely to be underweight (P < 0.05) than women (12.3%). Overall, 61.2% had normal body mass indices, 13.2% were overweight, and 9.1% were obese. Energy intake was low (1596.3-1630.5 Kcal), with only 22% and 38% of men and women, respectively, meeting their daily requirements. Protein intake was adequate in more than half of men and women. Vitamin A, iron, and zinc intakes were moderate, while calcium intake was low (P < 0.05). Inadequate food access, poor health, living arrangements, and poor eating patterns were the main nutritional risk factors. There is a need to plan nutrition programs that can improve living conditions, health, and nutritional status of older adults in these urban areas of the Lake Victoria Basin.