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To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country.
Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEA in a randomized order.
Two urban and two rural communities in southern Malawi.
Women (n 300) aged 18–45 years, equally divided by urban/rural residence and years of education (≤4 years and ≥5 years).
Responses for digital and printed PSEA were highly correlated (>91 % agreement for all foods, Cohen’s κw = 0·78–0·93). Overall, at the individual level, digital and actual-food PSEA had a similar level of agreement with the weighed meal record. At the group level, the proportion of participants who estimated within 20 % of the weighed grams of food consumed ranged by type of food from 30 to 45 % for digital PSEA and 40–56 % for actual-food PSEA. Digital PSEA consistently underestimated grams and nutrients across foods, whereas actual-food PSEA provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level.
Digital PSEA require further testing in low-income settings to improve accuracy of estimations.
To investigate preferences for and ease-of-use perceptions of different aspects of printed and digitally displayed photographic portion-size estimation aids (PSEA) in a low-resource setting and to document accuracy of portion-size selections using PSEA with different visual characteristics.
A convergent mixed-methods design and stepwise approach were used to assess characteristics of interest in isolation. Participants served themselves food and water, which were weighed before and after consumption to measure leftovers and quantity consumed. Thirty minutes later, data collectors administered a meal recall using a PSEA and then a semi-structured interview.
Blantyre and Chikwawa Districts in the southern region of Malawi.
Ninety-six women, aged 18–45 years.
Preferences and ease-of-use perceptions favoured photographs rather than drawings of shapes, three and five portion-size options rather than three with four virtual portion-size options, a 45° rather than a 90° photograph angle, and simultaneous rather than sequential presentation of portion-size options. Approximately half to three-quarters of participants found the portion-size options represented appropriate amounts of foods or water consumed. Photographs with three portion sizes resulted in more accurate portion-size selections (closest to measured consumption) than other format and number of portion-size option combinations. A 45° angle and simultaneous presentation were more accurate than a 90° angle and sequential presentation of images.
Results from testing PSEA visual characteristics separately can be used to generate optimal PSEA, which can improve participants’ experiences during meal recalls.
Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight.
We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers’ experiences with testing recommended practices.
An urban district and a rural district in Rwanda.
Caregivers with an under- or overweight child from 6 to 59 months of age (n 136).
We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child’s health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others.
These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.
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