ICTs for Nutrition, Agriculture, and Time Use: Can we do better than 24-hour recall by using “innovative methods” of nutrition data collection?
In the over fifty years in which explicit efforts have been made to improve nutrition, there have been countless achievements in global understanding of the causes and consequences of malnutrition, and the actions required to change outcomes for women and children. In these same fifty years, technological advances have changed the modern world. We communicate with friends and family everywhere instantaneously on hand-held devices, and track our location, heart rate, and calories burned real-time. The confluence of smartphones with high resolution cameras and widespread access to social media outlets have made first-person photography ubiquitous.
Limitations of traditional methods. However, in this time, the methods to evaluate nutrition and key drivers of nutrition status, such as women’s time use patterns, have changed relatively little. The most widely used method for collecting data on diet quality and women’s time use is the 24-hour recall. Errors and biases introduced by the methodology are known to compromise data quality and pose a challenge to nutrition research. Direct observation, which is the gold standard, is resource intensive, imposes a serious burden on the participant, and likely influences their behavior. It is impractical for the purposes of programmatic evaluation.
Research aims and methods. The objective of the IMMANA-funded[1] ‘Using Information Communication Technologies (ICTs) to understand the relationships between labour- saving agricultural innovations, women’s time use and maternal and child nutrition outcomes’ study is to develop, validate and apply innovative methods to more accurately measure women’s time allocation and maternal and infant dietary diversity in rural Uganda. A multi-disciplinary team from the London School of Hygiene and Tropical Medicine, the Natural Resources Institute (NRI) of the University of Greenwich, and the Africa Innovations Institute (AfrII) set out in eastern Uganda to evaluate new tools and methods to capture maternal and child diet diversity and maternal time use data.
Can you collect nutrition and time use data as reliably (or more reliably) using a wearable camera, GPS logger, and automated interactive voice response (IVR) calls every 4 hours (asking about activities and diet) compared to other methods, and in a more cost-effective and less invasive manner? Over two hundred mothers are participating in a 5-day intensive study, including one 15-hour observation day, one 24-hour diet and time use recall, and two days of “innovative methods”. Dietary diversity scores for mothers and children, and calculations of women’s time allocation across key categories using the ICTs will be validated against results from direct observation, in comparison to the same validation for 24-hour recalls versus direct observation. The feasibility and acceptability of the method will also be assessed.
Early lessons learnt. The ICTs are easily available, inexpensive, and already being used for research in high income country contexts. However, devising a method for rural women with low education and literacy, limited access to electricity, limited exposure to TV or mobile phones, etc. to use photos on a tablet to recall their day posed some unexpected challenges, requiring many iterations of the protocol. It was difficult, for example, for some mothers to orient to a first-person perspective of the photos from their wearable camera – that is, to conceptualize where they were relative to the objects, people, and places in the photos. It was also challenging to devise a method that was both effective and rapid, that struck the right balance between enumerator-driven verses participant-driven interpretation of the photos, and to get enumerators and participants to see the photos as a series of activities rather than discrete snapshots.
Next steps. Conclusions from recent studies of the evidence for the role of maternal time allocation on maternal and child nutrition are limited and mixed, in part due to methodological limitations. A viable alternative to recall methods for diet and time use data collection in rural LICs has the potential to be a game-changer for the field of nutrition, and in particular the field of nutrition-sensitive agriculture. We need high quality impact evaluation data to know what works to improve nutrition. With better evidence provided by shrewd deployment of cost-efficient “innovative methods” – with a lower burden on participants and enumerators than traditional methods – we can design better and more cost-effective interventions to improve nutrition outcomes for women and children globally. The team is wrapping up data collection in early 2018; preliminary results are expected by the end of the year.
Supplementary materials:
- [INATU-pic1] Mother wearing the wearable camera and receiving her first automated IVR call while working in the sugarcane field. Key objectives of pilot testing were to rapidly assess the feasibility and acceptability of the suite of innovative tools.
- [INATU-pic2] IMMANA enumerators “code” wearable camera data before heading to the field the review the photos with mother participants.
- [INATU-pic3] This mother uses photos from her previous day (with the wearable camera) on a tablet to help her remember her activities and foods she and her child ate.
[1] Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA) (http://immana.lcirah.ac.uk/) is a research initiative funded by the UK Department for International Development (DFID) and coordinated by the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH). IMMANA aims to accelerate the development of a robust scientific evidence base needed to guide changes in global agriculture and food systems to feed the world’s population in a way that is both healthy and sustainable.
Written by Andrea L. Spray, World Bank Nutrition Consultant and PhD Candidate at LSHTM, with Gwen Varley[1], Jan Priebe1, Joweria Nambooze[2], Elaine Ferguson[3], and Kate Wellard1
[1] Natural Resources Institute (NRI), University of Greenwich (https://www.nri.org/news/2017/innovative-nri-projects-measure-up-tools-for-improved-nutrition)
[2] Africa Innovations Institute (AfrII) (https://www.afrii.org/)
[3] London School of Hygiene & Tropical Medicine (LSHTM) (https://www.lshtm.ac.uk/)
Reaping big from cassava farming
Mr. Okiror Gilbert a Cassava Seed Entrepreneur (CSE) from Koloin in Ngora District, with his bags of packaged clean cassava stem cuttings he intends to sell to fellow farmers to boost multiplication of clean cassava seed.
Mr. Okiror recently made sales on cassava cuttings / stems worth about 2.5 million Uganda Shillings from clean planting materials of the NaSE 19 variety that he accessed from AfrII through the Cassava Seed Systems Project in collaboration with the CAVA II Project, both implemented by AfrII.
Through the two projects, farmers like Mr. Okiror have readily accessed certified and high yielding disease tolerant varieties of NaROCASS I, NaSE 14, and NaSE 19 of cassava seed for planting, to increase yield production.
He commends AfrII for enabling him access clean seed for multiplication and also for availing him skills and Knowledge in good agronomic practices including practicing row planting of the cassava seed, and timely weeding among others to boost high yield production.
In the photos:AfrII Zonal Manager, Mr. Anthony Ijala (In stripped shirt with black jacket),CAVA II Uganda Country Manager-Mr Francis Alacho (white shirt) and Mr. Okiror Gilbert, a CSE.
Cassava farming saves farmers from trekking miles to access water
The Awuco family, 77-year-old Victor and 57-year-old Phoebe Awuco, cassava farmers of Alito sub county in Kole District, Northern Uganda are enjoying the benefits of investing in value addition of the cassava crop and have recently constructed an underground water tank from earnings they saved from cassava production. The couple has been travelling a distance of 2 Kilo meters to fetch / access water for use during the processing of cassava.
They delightfully shared their moment of bliss of their new innovation “We spent nearly 1 million Uganda Shillings of our savings from cassava to construct this water tank and we are content with this new development for we no longer have to walk many kilo meters to get water with which to use to wash the fresh cassava roots, as well as rinse and soak the roots before processing them to obtain HQCC and flour. The water for all this is now right in our back yard” (Both smile)
Mr. Awuco then adds “It has not been a smooth road but we have managed, my wife is very supportive in each step of the way”
Blessed with 3 children of their own and 8 grandchildren, the Awuco family is greatly benefitting from farming cassava and have also realized the benefits of conducting business in cassava processing following the successes that have come along with this.
The couple’s first achievement from cassava farming and processing was a motorcycle they purchased back in 2014. The motorcycle has since eased their transportation challenges to easily access the market where they sell their cassava flour, and also purchase other household requirements like food stuffs.
The Awuco’s have also been able to finance the education of their grandchildren to as far as university level through cassava farming “Cassava has greatly improved our household livelihoods. We are able to buy food, cater for medical expenses and also take our grandchildren to school. Our eldest grandson has been admitted to Kyambogo University this year 2016 to study electrical engineering. This is great for us as a family” Mr. Awuco recounts.
The couple has been farming cassava for 3 years and in May 2016 this season, they set up a 1acre demonstration garden of the Narocass1 cassava seed variety. They have been growing the Nase14 cassava variety since 2013.
The couple is also a member of Alito Cassava Farmer Growers Association and Community Processing Group (CPG) that is supported by AfrII under the CAVA II project. The Alito cassava processing site was commissioned in 2014 by the Africa Innovations Institute (AfrII) at the commencement of the second phase of the Cassava: Adding Value for Africa (CAVA II) project.
The Awuco’s acknowledged CAVA II Uganda for the support extended ‘We are grateful to CAVA II for their contribution and also appreciate the work they are extending to us at the community through the CAVA II project in as far as providing us access to new technologies aimed to promote cassava production”
The Cassava: Adding Value for Africa Phase Two (CAVA II) Project supports value addition in cassava and commercialization of cassava in Africa. In Uganda, the CAVA II project has successfully developed value chains for High Quality Cassava Flour (HQCF) by supporting investors to establish HQCF processing sites in Eastern, Northern and Central Uganda. The project beneficiaries include among others, small holder farmers, Small and Medium Enterprises and selected actors working on cassava value chains.
CAVA II’s purpose is to increase the incomes of 23,010 Small Holder Framers (SHFs) and community processors through participation in profitable and sustainable value added cassava chains in Uganda and is being implemented in 18 districts of Pallisa, Kibuku, Budaka, Bukedea, Kumi, Soroti, Ngora, Serere, Dokolo, Nakaseke, Nakasongola, Lira, Apac, Otuke, Oyam, Kole and Alebtong.
The project is also being implemented in 4 other African countries of Nigeria, Ghana, Tanzania, and Malawi.
