Utilization of respondent-driven sampling among a population of child workers in the diamond-mining sector of Sierra Leone.

This article describes the implementation of respondent driven sampling (RDS) in a study conducted in Kono District, Sierra Leone. RDS was used to identify children, under the age of 18 years old, working in the diamond sector of Sierra Leone. This includes children working directly as diamond miners as well as children working in the informal sector connected to the diamond field. The article seeks to postulate that RDS is a suitable method for a rapid approach to a population that is unidentified in size and demonstrate how RDS can reach a study population within a limited period.

Snacks are important for fat and vitamin intakes among rural African women: a cross-sectional study from Malawi.

OBJECTIVE: To estimate the contribution of energy and selected nutrients from foods eaten as snacks and as meals. SUBJECTS AND METHODS: Forty-four nonpregnant women in the reproductive age, of whom 20 were lactating, participated in this study. Women from rural households were randomly selected and energy and nutrient intakes were estimated using 2 days' observed weighed food record. Snacks eaten between meals were estimated by weighed food record as well as recall, thrice per day. RESULTS: The largest proportions (mean+/-s.e.) of fat (33+/-3.6%), vitamin C (36+/-4.1%) and a large proportion of vitamin A (30+/-4.4%) intakes were from snacks. Furthermore, snacks provided 20% of the energy intakes. CONCLUSION: Snacks are important for energy and nutrient intakes and adequacies in rural African women and have the potential to combat energy and nutrient deficiencies in low-income countries.

Nutrient adequacy and dietary diversity in rural Mali: association and determinants.

OBJECTIVE: To examine the association between nutrient adequacy and dietary diversity, and to assess and compare the determinants for the two constructs in an adult population in rural Mali. DESIGN: Cross-sectional study assessing food intake by a validated 7-day quantitative food frequency questionnaire. Two different dietary diversity indexes were created: food variety score (FVS), a simple count of food items, and diet diversity score (DDS) a count of food groups. Mean adequacy ratio, the mean ratio of intake to recommended intake (each truncated at one) of energy and nine nutrients, was calculated as an indicator of nutrient adequacy. Information on household and individual characteristics, including demography, socioeconomic conditions and food production strategies was obtained using precoded questionnaires. SETTING: Bafoulabé district, Kayes region, Western Mali. SUBJECTS: In total, 502 subjects (55% women) aged 15-45 y from 319 different households. RESULTS: Both FVS and DDS had a positive correlation with mean adequacy ratio (MAR). Multivariate analysis (linear regression) showed that the most important factors explaining MAR was the number of milk products, vegetables and green leaves consumed, as well as sex and the number of crops produced in the household. Dietary diversity was associated with socioeconomic status, residence and age. CONCLUSION: Dietary diversity is useful as an indicator of nutrient adequacy. It is important to examine how various food groups contribute to the nutrient adequacy of the diet in an area.

Validation of food variety as an indicator of diet quality assessed with a food frequency questionnaire for Western Mali.

OBJECTIVE: To assess the validity of two diet quality indexes-food variety score (FVS) and diet diversity score (DDS) in Western Mali. DESIGN: In two separate studies (A and B), FVS and DDS were derived from a food frequency questionnaire (FFQ) and were compared with the same scores and with measures of nutrient adequacy derived from 2-day weighed records (WR). SETTING: Two rural, adjacent villages in Mali, West Africa. SUBJECTS: In study A (1996), 48 women and 27 men (15-59 y) participated. Study B (1999) included 34 women and 36 men (15-45 y). RESULTS: Spearman's correlation coefficients between FVS from the FFQ and WR for men were 0.5 in study A and 0.4 in study B. The corresponding correlations for DDS were 0.2 and 0.4, respectively. Correlations for women were lower, especially in study B. Classification into quartiles was also best for men. Correlations for the two diet variety scores from the FFQ with nutrient adequacy from the WR in study A were about 0.3 for men, but lower for women. In study B, these correlations were around 0.5 for men, whereas for women there was no association. CONCLUSION: FVS and DDS can be assessed by our FFQ. The two diet variety scores reflect diet quality and are simple tools that can be used for monitoring. The validation study gave better results for men than for women, which has implications for further use of these instruments.

Validation of a quantitative food-frequency questionnaire for use in Western Mali.

OBJECTIVE: The purpose of this study was to validate a quantitative food-frequency questionnaire (QFFQ) created for assessing the usual intake of foods and nutrients in the prevailing season in Western Mali. DESIGN: Intake of foods and nutrients over the week preceding the interview was measured with a 69-item QFFQ. Intakes were compared with intakes as measured with 2-day combined weighed and recalled diet records. SETTING: A rural village in Western Mali, West Africa. SUBJECTS: Twenty-seven men and 48 women (15-59 years of age) representing 18 households. RESULTS: Spearman rank correlations between intake of food groups from the QFFQ and the diet record ranged from 0.09 (meat/fish) to 0.58 (tea/coffee). Median coefficient was 0.37. Median Spearman correlation coefficient for nutrient intake was 0.40. Men had higher median correlation coefficients than did women. The proportion of subjects being classified into the same quartile of food intake was on median 33%, while a median of 7% was misclassified into extreme quartiles. Correct classification into the same quartile for intake of nutrients was on median 34% while a median of 4% was grossly misclassified. Intakes of most food groups and nutrients as measured by the QFFQ were higher than those measured by the diet records. However, while men had higher estimated intakes for foods eaten in-between meals, women in general had higher intake of foods eaten in the main meals. CONCLUSION: This QFFQ can be used for comparing the intake of foods and nutrients between groups within this study population. It therefore represents a useful tool in the surveillance of food intake in the population, both in identifying vulnerable groups and for tracking food intake over time. The differences between men and women in overestimating food intake need to be taken into account when using the method.

Food variety, socioeconomic status and nutritional status in urban and rural areas in Koutiala (Mali).

OBJECTIVE: The purpose of this study was to analyse the associations between the food variety score (FVS), dietary diversity score (DDS) and nutritional status of children, and to assess the associations between FVS, DDS and socioeconomic status (SES) on a household level. The study also assessed urban and rural differences in FVS and DDS. DESIGN: Cross-sectional studies in 1994/95, including a simplified food frequency questionnaire on food items used in the household the previous day. A socioeconomic score was generated, based on possessions in the households. Weight and height were measured for all children aged 6-59 months in the households, and anthropometric indices were generated. SUBJECTS AND SETTING: Three hundred and twenty-nine urban and 488 rural households with 526 urban and 1789 rural children aged 6-59 months in Koutiala County, Sikasso Region, Mali. RESULTS: Children from urban households with a low FVS or DDS had a doubled risk (OR>2) for being stunted and underweight. Those relations were not found in the rural area. There was an association between SES and both FVS and DDS on the household level in both areas. The FVS and DDS in urban households with the lowest SES were higher than the FVS and DDS among the rural households with the highest SES. CONCLUSIONS: Food variety and dietary diversity seem to be associated with nutritional status (weight/age and height/age) of children in heterogeneous communities, as our data from urban areas showed. In rural areas, however, this association could not be shown. Socioeconomic factors seem to be important determinants for FVS and DDS both in urban and rural areas. FVS and DDS are useful variables in assessing the nutritional situation of households, particular in urban areas.

Dental fluorosis and nutritional status of 6- to 11-year-old children living in rural areas of Paraíba, Brazil.

The aim of this study was to investigate the relationship between nutritional status and dental fluorosis in areas with fluoride in the drinking water in Paraíba, Brazil. Rural villages of comparable low socio-economic status and stable water fluoride levels were selected. Lifelong residents (6-11 years old, n = 650) were examined for nutritional status (height-for-age index; WHO methods) and dental fluorosis of central incisors and first molars (TF index). The sample was divided into three groups according to fluoride levels in the drinking water: low (below 0.7 ppm F, n = 164), medium (between 0.7 and 1.0 ppm F, n = 360) and high (above 1.0 ppm F, n = 126). Dental fluorosis was observed in 30.5, 61.1 and 71.4% of the children in these F groups, respectively. The prevalence was significantly related to the water F concentrations (chi2 = 59.93, d. f. = 2, p<0.001). The severity of dental fluorosis ranged from TF 1 to 3 in the low F group and up to 7 in the others. Malnutrition prevalence was approximately 20% in all F groups, but was unrelated to dental fluorosis. The fairly high prevalence of dental fluorosis observed suggests that other factors may be operating.

Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa.

OBJECTIVE: This study assesses whether a simple count of food items and food groups can predict the nutritional adequacy of the diet in an economically poor country. DESIGN: A three-day weighed record of children. SETTING: Koutiala town, in Southeastern Mali. SUBJECTS: Seventy-seven children, 13-58 months of age. One child was excluded owing to an extraordinarily low food variety. INTERVENTION: The study was conducted in April August 1995. Data from this study were used to create two different indices: Food Variety Score (FVS), a simple count of food items, and Dietary Diversity Score (DDS), a count of food groups. Mean Adequacy Ratio (MAR) was calculated as an indicator for nutrient adequacy, and used to validate FVS and DDS. RESULTS: Mean (s.d.) FVS was 20.5 (3.8) and mean (s.d.) DDS was 5.8 (1.1). A positive correlation was found both between FVS and MAR (Pearson 0.33, P < 0.001) and DDS and MAR (Pearson 0.39, P < 0.001). With cut-off points for FVS at 23 and for DDS at 6, the indices have high ability to identify those with a nutritionally inadequate diet. MAR increased with increasing FVS and DDS. FVS needs to be at least 15 or DDS at least 5 to give a satisfactory MAR. CONCLUSION: Although a simple count of food items or food groups cannot give a full picture of the adequacy of the nutrient intake, the results from this study show that the food scores can give a fairly good assessment of the nutritional adequacy of the diet, particularly if combined. Such indicators are important for identification of vulnerable groups in areas where people normally eat from a shared bowl, which makes detailed dietary intake studies difficult, time consuming and expensive.

Human milk: an invisible food resource.

Human milk is an invaluable food resource for infants and young children in Sub-Saharan Africa. Statistics on production of human milk at local and national levels are lacking. In this article, estimates of the quantity of human milk production in Mali, Senegal, Nigeria, and Zimbabwe were calculated. Annual production in the urban and rural areas in Mali was 13 and 17 kg per capita, respectively. National annual median production ranged from 93,000 (Zimbabwe) to 1.3 million metric tons (Nigeria), and from 9 (Zimbabwe) to 15 kg per capita (Mali). Given a value of (US)$1 per liter, inclusion of human milk in calculations of the gross national product (GNP) for these countries would increase this value by more than 5% for Mali, and nearly 2% for Senegal. Human milk is a significant food source to children in this region and should be included in national food statistics due to its nutritional and economic importance.

Nutrient composition and nutritional importance of green leaves and wild food resources in an agricultural district, Koutiala, in southern Mali.

This paper discusses the nutrient composition and the nutritional importance of green leaves and wild gathered foods in an area with surplus food production in Mali. In this West African country, there is little information about the nutrient composition and the nutritional quality of foods in general, and of wild gathered foods in particular. Food frequency was collected in two cross-sectional surveys. Focus group discussions with women in the area were used to collect information about seasonality, availability and preparation of various foods. Selected food samples were collected for chemical analysis of nutrient composition. The food samples of green leaves (Adansonia digitata, Amaranthus viridis, Tamarindus indica, Allium cepa), seeds and flour (Parkia biglobosa) and fruits (Tamarindus indica) were analysed for water, energy, fat, protein, minerals, amino acids and carotenoids. Availability and use of the foods varied with seasons. In the rainy season, wild gathered foods (e.g. A. digitata) were used as much as fresh cultivated foods (e.g., A. viridis and A. cepa). The wild food resources were more frequently used in rural than in urban areas, with A. digitata as the dominating green leaves. Green leaves were rich in energy, protein and minerals (calcium, iron). Leaves of A. viridis were, in particular, rich in beta-carotene (3290 micrograms/100 g). Chemical score in dried green leaves varied from 47 (A. cepa) to 81 (A. digitata), with lysine as the first limiting amino acid. P. biglobosa fermented seeds, with 35% fat and 37% protein were a complementary source of lysine in the diet. Based on the seasonality, the frequency of use and the nutrient contents of selected green leaves and wild gathered foods in Koutiala district, it is concluded that these traditional and locally produced foods are valuable and important nutrient contributors in the diet both in rural and urban areas, but most important in rural areas.

Problems and pitfalls in the use of estimated age in anthropometric measurements of children from 6 to 60 months of age: a case from Mali.

Estimates of the age of children are often used uncritically in anthropometric measures. This study shows that even with construction of calendars for use of determination of age, substantial training, a careful follow-up in the field by research assistants, and control of all questionnaires immediately after the interviews of the caretakers and weighing of the children, errors remain in estimating the age of children. Such errors may affect the results substantially, leading to errors in the estimation of age-based measures of nutritional status. In the case of Northern Mali, the effect was most likely an underestimation of malnutrition by perhaps as much as 10 to 30 percentage points. The biases in age estimation in many cases are not constant across subgroups of a population. Therefore age estimation problems may lead to wrong decisions regarding policy formulation, planning of development programs and activities, identification of target groups, and, in particular, evaluation of programs and activities. In situations where age has to be estimated, anthropometric measurements that are less influenced by errors in age estimation are recommended.