Project 6, output 2Project 6, output 2

24 hour recall method to 24 hour recall method to assess change in OFSP assess change in OFSP

consumption – results from consumption – results from the REU baseline survey inthe REU baseline survey in

MozambiqueMozambique

Jan Low for Cornelia LoechlJan Low for Cornelia Loechl

Output 2

• The value of orange fleshed sweetpotato as a component of food-based approaches to improved nutrition is demonstrated by 2010. Impact assessment of REU project

• Target for 2008: Role of OFSP in diets and nutrient intake of children under 5 years of age and their mothers established in Mozambique and Uganda, with emphasis on intake in vitamin A/carotenoids. REU baseline surveys in Mozambique and

Uganda; (Mozambique survey report available; Uganda survey data currently being analyzed)

Impact assessment of REU

• IFPRI (International Food Policy Research Institute, Washington DC) is collaborating with CIP and HarvestPlus

• 24 hour recall method used to assess role of OFSP in the diet and changes in consumption of OFSP over time as part of REU impact measurement

Objective and outcomes of impact assessment of REU

• Objective: identify impact and cost effectiveness of REU models

Demonstrate effectiveness of models by examining a series of production, dietary, and health outcomes along the pathway toward improved vitamin A status for target groups (children and women of childbearing age)

• Intermediate outcomes on which to measure impact– OFSP adoption rates, SP yields– Farm profitability, commercialization– OFSP and vitamin A dietary intake– change in serum retinol concentrations in target groups

(Uganda)– will consider impacts on morbidity and child growth

Design of impact assessment of REU

Control Model 1 Model 2

Model 2Model 1Control

Baseline

Follow up

InterventionNo intervention

Prospective (before-after), randomized evaluation design

Impact survey will examine changes in intervention communities relative to changes in control communities

Mozambique: 11-12/2006

Uganda: 06-08/2007

Both countries: mid-2009

Attributable impact along the pathway toward improved

health status

Med

iati

ng f

acto

rsAdoption

Consumption

Health Welfare

Vitamin A intakes

Dietary assessment…1

• CIP is taking the lead role in the dietary assessment

• Objective: To measure changes in OFSP and vitamin A intakes

• Method: 24 hour recall at baseline and two years later

• Record individual food intakes of mothers and children over the period of the previous day

Dietary assessment…2

Specific objectives: To provide information about types of

foods and drinks consumed over the period of one day

To determine amounts of foods and drinks consumed by making portion size estimates; various tools are used to help participants show us how much food was eaten

To calculate the intakes of energy and nutrients from the foods and beverages consumed

24 hour recall method…1

Modified 24 hour-recall method is used:

Interactive, multiple-pass

24 hour-recall

(adopted from Gibson and Ferguson, 1999)

Enhanced visual impression of the foods consumedReduced memory lapsesImproved estimation of portion sizes consumed

24 hour recall method…2

Why interactive?

Training of mothers before first recording day

• Mothers will be given a bowl and a plate for the child and for herself and asked to use them for their food on the next day to assist in the recall (enhanced visual impression).

• Mothers will also be shown how to complete a picture chart on the next day of what they eat and another of what their child eats (reduced memory lapses).

24 hour recall method…3

Why multiple passes?

Uses four “passes” to enhance recall of foods and beverages consumed by one individual (mother and child are questioned separately)

• First pass: all foods and beverages are listed and when they were consumed by the mother or child.

• Second pass: use of standard and specific “prompts” to obtain more details about each food or drink listed in the “first” pass. During this pass information of the type and amount of each ingredient used in the mixed dishes is collected on a special recipe form.

24 hour recall method…4

Third pass: enumerator helps the mother to remember and estimate the amount of each food or drink that she or her child actually ate.

24 hour recall method…5

Methods to quantify foods/ ingredients and portion sizes:

Direct weighing of actual foods whenever food is available

Aids in quantifying portion sizes consumed (improved estimation of portion sizes):

1. Use salted replicas of some of the main meals (e.g. chima): mothers are asked to serve a portion of a salted sample of actual foods consumed identical in size into their own dishes, using their own utensil

2. Determine volume equivalent of food consumed (using rice)3. Use life-sized graduated photographs of foods (e.g. mangos,

bananas, etc.) to estimate size of food consumed4. Determine length of fish consumed5. Model play dough identical in shape and size to food/portion size

consumed and record volume6. Estimate proportions and record the fraction of food

used/consumed

24 hour recall method…6

Fourth pass: all the information collected is read back to the mother and she is asked to verify it. It is checked that everything has been recorded correctly and the descriptions of each food item are complete and legible. Any unrecorded items or details are corrected. The foods eaten are compared with those checked on the picture chart for the mother/child .

Processing dietary data

• Collection and calculation of nutrient composition of standard recipes to reduce the number of household-level recipes to collect (and thus reduce burden on enumerators and respondents)

• Collection and calculation of conversion factors to translate from measured/estimated quantities to grams of food or ingredient eaten by the individual

• Compiling food composition table specifically for foods consumed in Mozambique based on nutrient values from a number of sources

Analyzing dietary data

• Adjustment of observed nutrient intake distributions to remove the variability introduced by day-to-day variations in nutrient intakes with an individual (i.e.,within-subject variation; repeat observation was collected in a subset of households) usual intakes

• Calculation of median intakes of nutrients

• Assessment of probability of adequacy of selected micronutrients (including vitamin A) by comparing estimated usual intake distributions to distributions of requirements

• Probability of adequacy was assessed for non-breastfed children, and for women aged 19-50; probability, averaged across individuals, is equivalent to the prevalence of adequacy at group level

Results Mozambique baseline survey…1

Nutrient intakes of children and probability of adequacy:

• Prevalence of adequacy highest for vitamin C and B6; very low for vitamin B12 and near zero for zinc

• 50% had adequate intakes of vitamin A

Results Mozambique baseline survey…2

Mean probability of nutrient adequacy for non-breastfed children

0.00 0.20 0.40 0.60 0.80 1.00

Vitamin A

Thiamin

Riboflavin

Niacin

Vitamin B6

Folate

Vitamin B12

Vitamin C

Zinc

Nu

trie

nts

Prevalence of adequacy

Results Mozambique baseline survey…3

Macronutrients and proportion of energy intake for children:

– High proportion of total energy intake from carbohydrate: 84% (acceptable range: 45-65%)

– Low fat intake: 7% of energy from fat (acceptable range: 30-40%)

– Protein: 12% of energy from protein (acceptable range: 5-20%)

Unbalanced diets of children

Results Mozambique baseline survey…4

Main vitamin A sources of children:• Mango (account for 63% of vitamin A consumed)

• DGLV (account for 10% of vitamin A consumed)

Adequate intakes of vitamin A largely due to widespread availability (in season during data collection) and consumption of mango

Consumption of SP:• 11% of children consumed SP – almost

exclusively WFSP

• Average intake: 132 grams

Challenges dietary assessment

• Seasonality: Follow-up survey in Mozambique will be conducted in 2009 in different season – Mango will not be widespread available

• Complexity of data collection: skilled enumerators; extensive training; two visits of households

• Time-consuming processing of data: availability of conversion factors, standard recipe data and FCT

Challenges limit widespread use of method to demonstrate impact on OFSP intakes (for example for SP Commodity Initiative)

Thank You