The Development of a Quantified Food Frequency Questionnaire for Assessing Iron Nutrition in Schoolchildren from Resource-Limited Settings in Cape Town, South Africa

ABSTRACT

Children are vulnerable to developing iron deficiency anemia, especially in resource-limited settings. Information on habitual dietary intake informs dietary interventions aimed at improving iron deficiency. Dietary assessment in school-aged children is challenging and requires concerted efforts to mitigate the pitfalls of long complex methods. Nested within an intervention trial, we aimed to obtain dietary intake information to assess iron nutrition in 8 to 13-year-old children from resource-limited settings in Cape Town, South Africa. Following careful consideration of the study objective, participant characteristics, research setting, available resources, and features of the different dietary intake assessment methods, we identified an iron quantified food frequency questionnaire (QFFQ) as the best method to obtain the information. The QFFQ reflected the study population’s habitual intake and the nutrients of interest (protein, iron, vitamin A, vitamin C, calcium, zinc, and fiber). In addition, strategies such as interview-administration of the QFFQ, interviewing the child participant and caregiver together, simplifying frequency reporting, a strategic food list order and a variety of interesting portion size estimation aids collectively supported dietary intake assessment in this young study population. Using a methodical, multiphase approach and strategies that promote participant engagement, we developed the QFFQ, achieved interview success, and obtained comparable data.

KEYWORDS:

• Iron
• diet
• food frequency questionnaire
• schoolchildren
• South Africa

Acknowlegements

We thank the expert panel; the community representatives who partook in the consultations or pilot; the staff at the Family Centre for Research with Ubuntu (FAMCRU); and all study participants and their caregivers for their willingness, commitment, and contribution to the success of this study.

Author contributions

CG and RB conceptualized and designed the study. CG led the development process, implemented the QFFQ, performed the data management and statistical analyses, and wrote the manuscript. RB acted as supervisor and critically reviewed the manuscript.

Conflict of Interest

The authors declare no conflict of interest. 

Additional information

Funding

This research was supported by the Thrasher Research Fund (14199), the L’Oréal-UNESCO For Women in Science Sub-Saharan Africa Fellowship Programme and the Ernst and Ethel Eriksen Trust. The work reported herein was also made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Bongani Mayosi National Health Scholars Programme from funding received from the South African National Treasury. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of the SAMRC or the funders.