Evaluation of acceptability, functionality, and validity of a passive image-based dietary intake assessment method in adults and children of Ghanaian and Kenyan origin living in London, UK

BACKGROUND: Accurate estimation of dietary intake is challenging. However, whilst some progress has been made in high-income countries, low- and middle-income countries (LMICs) remain behind, contributing to critical nutritional data gaps. This study aimed to validate an objective, passive image-based dietary intake assessment method against weighed food records in London, UK, for onward deployment to LMICs. METHODS: Wearable camera devices were used to capture food intake on eating occasions in 18 adults and 17 children of Ghanaian and Kenyan origin living in London. Participants were provided pre-weighed meals of Ghanaian and Kenyan cuisine and camera devices to automatically capture images of the eating occasions. Food images were assessed for portion size, energy, nutrient intake, and the relative validity of the method compared to the weighed food records. RESULTS: The Pearson and Intraclass correlation coefficients of estimates of intakes of food, energy, and 19 nutrients ranged from 0.60 to 0.95 and 0.67 to 0.90, respectively. Bland-Altman analysis showed good agreement between the image-based method and the weighed food record. Under-estimation of dietary intake by the image-based method ranged from 4 to 23%. CONCLUSIONS: Passive food image capture and analysis provides an objective assessment of dietary intake comparable to weighed food records

Paediatric Bronchiectasis in a Resource-Constrained Centre: A Case Series

Bronchiectasis denotes fixed and often irreversible dilatation of the bronchial wall caused by persistent inflammation and infection. Children with bronchiectasis in developing countries suffer recurrent hospitalisation and poor quality of life and usually succumb to the condition. These children are poorly recognised, misdiagnosed, and under-reported. We report five cases of computerised tomography-diagnosed paediatric bronchiectasis managed at the Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia. The ages of the children at presentation ranged from 3 to 14 years, and they all had recurrent chest infections. Four out of the five cases had Pulmonary Tuberculosis, among whom two cases had HIV/TB co-infections, and the only non-TB, non-HIV case had features of Down syndrome with congenital heart lesions. All the cases had growth impairment; digital clubbing was observed in four, and low peripheral oxygen saturation in room air in three of the five children. These cases are reported to increase the index of suspicion among clinicians working in resource-limited settings to consider the diagnosis of bronchiectasis in children with recurrent chest infections. Early diagnosis and prompt management, including appropriate follow-up care, will improve the quality of life of these children and ensure better management outcomes

The effect of delay in collection and processing on RNA integrity in human placenta: experiences from rural Africa.

This paper examines the relationship between time to processing and RNA quality in placentas collected from women in a field setting in rural Gambia. Placental samples were collected from the villages and transferred to the laboratory. RNA was extracted using Trizol and integrity assessed using the RNA integrity number (RIN). Values were inversely correlated with delay in processing. Expression levels of candidate genes increased with decreasing RIN. Normalising to a housekeeper gene removed this artefact. We propose a cut-off point of 90 min from delivery, after which samples cannot be used for gene expression analysis

Methodology for objective, passive, image- and sensor-based assessment of dietary intake, meal-timing, and food-related activity in Ghana and Kenya (P13-028-19).

Objectives: Herein we describe a new system we have developed for assessment of dietary intake, meal timing, and food-related activities, adapted for use in low- and middle-income countries. Methods: System components include one or more wearable cameras (the Automatic Ingestion Monitor-2 (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera; ear-worn camera; the eButton, a camera attached to clothes; and eHat, a camera attached to a visor worn by the mother when feeding infants and toddlers), and custom software for evaluation of dietary intake from food-based images and sensor-detected food intake. General protocol: The primary caregiver of the family uses one or more wearable cameras during all waking hours. The cameras aim directly in front of the participant and capture images every few seconds, thereby providing multiple images of all food-related activities throughout the day. The camera may be temporarily removed for short periods to preserve privacy, such as during bathing and personal care. For analysis, images and sensor signals are processed by the study team in custom software. The images are time-stamped, arranged in chronological order, and linked with sensor-detected eating occasions. The software also incorporates food composition databases of choice such as the West African Foods Database, a Kenyan Foods Database, and the USDA Food Composition Database, allowing for image-based dietary assessment by trained nutritionists. Images can be linked with nutritional analysis and tagged with an activity label (e.g., food shopping, child feeding, cooking, eating). Assessment of food-related activities such as food-shopping, food gathering from gardens, cooking, and feeding of other family members by the primary caregiver can help provide context for dietary intake and additional information to increase accuracy of dietary assessment and analysis of eating behavior. Examples of the latter include assessment of specific ingredients in prepared dishes, the source of these ingredients, cooking method, and how, where, and when food is consumed. Results: N/A. Conclusions: Pilot- and feasibility-testing is underway. The system will be tested for accuracy of dietary intake assessment versus weighed food intake in urban and rural settings around Accra, Ghana and Nairobi, Kenya. Funding Sources: [Funded by the Bill & Melinda Gates Foundation]

Development and validation of objective, passive dietary assessment Method for estimating food and nutrient intake in households in Low and Middle-Income Countries (LMICs): a study protocol

Malnutrition is a major concern in low- and middle-income countries (LMIC), but the full extent of nutritional deficiencies remains unknown largely due to lack of accurate assessment methods. This study seeks to develop and validate an objective, passive method of estimating food and nutrient intake in households in Ghana and Uganda. Household members (including under-5s and adolescents) are assigned a wearable camera device to capture images of their food intake during waking hours. Using custom software, images captured are then used to estimate an individual's food and nutrient (i.e., protein, fat, carbohydrate, energy, and micronutrients) intake. Passive food image capture and assessment provides an objective measure of food and nutrient intake in real time, minimizing some of the limitations associated with self-reported dietary intake methods. Its use in LMIC could potentially increase the understanding of a population's nutritional status, and the contribution of household food intake to the malnutrition burden. This project is registered at clinicaltrials.gov (NCT03723460)

Chronic T cell-mediated enteropathy in rural west African children: relationship with nutritional status and small bowel function

Previous studies from The Gambia have shown that poor childhood growth is resistant to all but the most intense nutritional intervention and highly dependent on small bowel permeability related to enteropathy. We thus aimed to characterize the mucosal inflammatory response in rural Gambian children in relation to intestinal permeability and nutritional status. Small bowel biopsies were taken from 38 rural Gambian children (age, 0.5-3 y) with a range of nutritional and clinical states (median weight z score, -4.6; range, 0.5 to -6.4), 75% of whom had diarrhea. Morphometry was performed with immunohistochemical analysis for a range of lineage and activation markers, including proinflammatory and regulatory cytokines, and related to current clinical status and gut permeability. Comparison was made with 19 age-matched U.K. controls. All Gambian children, regardless of nutritional status, had evidence of chronic cell-mediated enteropathy with crypt hyperplasia, villous stunting, and high numbers of intraepithelial lymphocytes. CD25+ cells were 20-fold higher than in U.K. controls. Although small bowel architecture was independent of nutritional status, T cell numbers rose and B cell numbers fell with worsening nutrition, and mucosal cytokine production became biased toward a proinflammatory response, with progressive decrease of transforming growth factor-ß expression. Tropical enteropathy predates the onset of marasmus and is characterized by a cell-mediated TH1 response. Protein-energy malnutrition is associated with reduction of regulatory immune responses in the mucosal microenvironment, potentially impairing the mechanisms of oral tolerance