A Mixed-Method Study Exploring Experiences and Perceptions of Nutritionists Regarding Use of an Image-Based Dietary Assessment System in Tanzania.

Due to global advances in technology, image-based food record methods have emerged as an alternative to traditional assessment methods. The use of image-based food records in low and lower-middle income countries such as Tanzania is limited, with countries still using traditional methods. The current study aimed to determine the feasibility of using a new voice and image-based dietary assessment system (VISIDA) in Dar es Salaam, Tanzania. This mixed-method study recruited 18 nutritionists as participants who collected image-based records of food and drinks they consumed using the VISIDA smartphone app. Participants viewed an online demonstration of the VISIDA web platform and the analysis process for intake data collected using the VISIDA app. Then, participants completed an online survey and were interviewed about the VISIDA app and web platform for food and nutrient intake analysis. The method was reported as being acceptable and was found to be easy to use, although technical challenges were experienced by some participants. Most participants indicated a willingness to use the VISIDA app again for one week or longer and were interested in using the VISIDA system in their current role. Participants acknowledged that the VISIDA web platform would simplify some aspects of their current job. Image-based food records could potentially be used in Tanzania to improve the assessment of dietary intake by nutritionists in urban areas. Participants recommended adding sound-on notifications, using the VISIDA app in both Apple and Android phones, enabling installation from the app store, and improving the quality of the fiducial markers.

Contents of nutrition care services among pregnant women attending antenatal clinic: An Exit interview.

BACKGROUND: Focused antenatal care currently implemented in Tanzania recommends that women receive nutrition care during routine clinic visits. However, little detail is documented in regard to the nutrition information provided to pregnant women during these visits. The present study aimed to investigate whether pregnant women recalled nutrition information or support provided and, if so, who provided this during routine antenatal clinic visits. The secondary aim was to determine how pregnant women intended to implement the information and what mode of delivery was preferred for receiving nutrition information. METHODS: An exploratory cross-sectional study comprising exit interviews was conducted with 50 pregnant women attending antenatal clinics in three regional referral hospitals in Dar es Salaam, Tanzania. RESULTS: All participants (n = 50) reported receiving nutrition care from healthcare workers in regard to; haemoglobin checks (79% of participants), iron and folic acid supplementation (70%), weight measurement (70%), eating advice (60%), and dietary intake assessment (38%). However, the information recalled on each category was inconsistent. For 60% of participants, nurses were reported as the source of nutrition care during pregnancy, followed by medical doctors (22%). The most preferable mode for receiving nutrition information was reported as individual face-to-face sessions with health practitioners, followed by mobile phone. All of the participants who received nutrition information indicated that they intended to implement. CONCLUSIONS: Nurses were the main source of nutrition information for pregnant women attending antenatal clinics, followed by medical doctors. However, the content of nutrition information recalled by participants was inconsistent. Healthcare facilities need to implement strategies to ensure pregnant women understand and can implement nutrition information provided by healthcare workers during routine antenatal care.

Nutrition services offered to pregnant women attending antenatal clinics in Dar es Salaam, Tanzania: A qualitative study.

OBJECTIVES: To provide an overview of the qualifications of nurses working in antenatal clinics, and to identify current nutrition services and information provided to pregnant women. To explore barriers and enablers to the provision of nutrition services by nurses to pregnant women attending antenatal clinics mapped against the Theoretical Domains Framework. DESIGN AND SETTING: Cross-sectional qualitative study, conducted in three municipal hospitals (Temeke, Mwananyamala and Ilala) in Dar es Salaam, Tanzania. PARTICIPANTS: Fourteen nurses currently providing health services to pregnant women, with at least two months' work experience within in the selected facility were purposively selected. METHOD: In-depth interviews were carried out with the participants by three trained research assistants using guides prepared in Swahili. Transcripts were translated into English and imported to NVivo 12 software. Data was analysed using qualitative content analysis principles. RESULTS: Five nutrition services commonly provided to pregnant women at antenatal clinics were nutrition education, iron and folic acid supplementation, weight measurements, dietary assessment and haemoglobin level monitoring. Domains included knowledge, skills, beliefs about capabilities, in addition to memory, attention and decision processes, and the environmental context and resources domains had both barriers and enablers identified by participants. The three remaining domains of the social/professional role and identity, optimism, and beliefs about consequences had only enablers reported. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Nurses deliver nutrition care to pregnant women during routine antenatal clinic visits. However, the information delivered to pregnant women varied among nurses, and a number of barriers and enablers to provision of nutrition care to pregnant women were identified. This data can inform future improvement to strategies for implementing nutrition services to pregnant women attending antenatal clinics. In-service training to nurses working with pregnant women and availability of tailored nutrition education materials, such as a food guide in these health facilities could improve nutrition care during this important period.

mHealth interventions targeting pregnancy intakes in low and lower-middle income countries: Systematic review.

Dietary intake during pregnancy plays a vital role in determining the health of both mother and baby. Maternal undernutrition affects a large proportion of women in low and lower middle income countries (LLMIC) likely influencing high maternal, infant, and child mortality in these countries. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This paper reviews the literature to evaluate the effectiveness of mHealth interventions on improving dietary/nutrients intake of pregnant women in LLMIC. Eight electronic databases were searched from inception up to April 2018, including the MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science, Scopus, Global Index Medicus, and Maternity and Infant Care. Using Covidence, two reviewers assessed articles for inclusion, assessed study quality and extracted data. Only studies published in English language were included. Data were summarised narratively. In total, 6,778 were identified of which four were included, with three randomised controlled trials and one prepost experimental study. Studies were conducted in India (n = 2), Indonesia (n = 1), and Kenya (n = 1). All articles evaluated the use of nutrient supplements; iron supplements (n = 1), vitamin supplements (composition not mentioned; n = 1), or calcium supplements (n = 1). This review suggests that mHealth interventions can be used to improve intake of micronutrient supplementation and nutritional status of pregnant women in LLMIC. Further studies are needed to address the limited evidence base related to mHealth nutrition interventions targeting dietary intakes of pregnant women in LLMIC.

Multivitamin and iron supplementation to prevent periconceptional anemia in rural tanzanian women: a randomized, controlled trial.

OBJECTIVE: Women's nutritional status during conception and early pregnancy can influence maternal and infant outcomes. This study examined the efficacy of pre-pregnancy supplementation with iron and multivitamins to reduce the prevalence of anemia during the periconceptional period among rural Tanzanian women and adolescent girls. DESIGN: A double-blind, randomized controlled trial was conducted in which participants were individually randomized to receive daily oral supplements of folic acid alone, folic acid and iron, or folic acid, iron, and vitamins A, B-complex, C, and E at approximately single recommended dietary allowance (RDA) doses for six months. SETTING: Rural Rufiji District, Tanzania. SUBJECTS: Non-pregnant women and adolescent girls aged 15-29 years (n = 802). RESULTS: The study arms were comparable in demographic and socioeconomic characteristics, food security, nutritional status, pregnancy history, and compliance with the regimen (p>0.05). In total, 561 participants (70%) completed the study and were included in the intention-to-treat analysis. Hemoglobin levels were not different across treatments (median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65). However, compared with the folic acid arm (28%), there was a significant reduction in the risk of hypochromic microcytic anemia in the folic acid and iron arm (17%, RR: 0.61, 95% CI: 0.42-0.90, p = 0.01) and the folic acid, iron, and multivitamin arm (19%, RR: 0.66, 95% CI: 0.45-0.96, p = 0.03). Inverse probability of treatment weighting (IPTW) to adjust for potential selection bias due to loss to follow-up did not materially change these results. The effect of the regimens was not modified by frequency of household meat consumption, baseline underweight status, parity, breastfeeding status, or level of compliance (in all cases, p for interaction>0.2). CONCLUSIONS: Daily oral supplementation with iron and folic acid among women and adolescents prior to pregnancy reduces risk of anemia. The potential benefits of supplementation on the risk of periconceptional anemia and adverse pregnancy outcomes warrant investigation in larger studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT01183572.

Weight status and iron deficiency among urban Malian women of reproductive age.

The present study investigated the association between weight status and Fe deficiency (ID) among urban Malian women of reproductive age. Height, weight, serum ferritin (SF), soluble transferrin receptor (sTfR) and C-reactive protein (CRP) concentrations were measured in sixty apparently healthy women aged 15-49 years old in Bamako, Mali. Prevalences of overweight and obese were 19 and 9 %, respectively. SF was non-significantly different between overweight (84 µg/l) and normal-weight women (52 µg/l). The prevalence of ID (SF < 12 µg/l) was 9 % in the overweight group and no true ID (sTfR>8·3 mg/l) cases were recorded in the overweight and obese groups. The prevalence OR of ID (SF < 12 µg/l) in the overweight group was NS (OR = 0·3; P = 0·363). Conversely, the chronic energy deficiency group was at a significantly higher risk of ID than the normal-weight group, adjusting or not for CRP (OR = 7·7; 95 % CI 1·49, 39·96; P = 0·015). The lack of association between overweight and ID in the present study could be due to the fact that the excess of body fat of the women might not be critical to induce chronic inflammation related to reduced Fe absorption. Future research based on a larger convenience sample should be designed to further investigate associations between overweight, obesity and ID in developing countries.