We study the relationship between the food environment (FE) and the food purchase patterns, dietary intakes, and nutritional status of individuals in peri-urban Tanzania. In Africa, the prevailing high density of informal vendors creates challenges to characterizing the FE. We present a protocol and tool developed as part of the Diet, Environment, and Choices of positive living (DECIDE) study to measure characteristics of the FE. We mapped 6627 food vendors in a peri-urban settlement of Dar es Salaam, of which over 60% were semi-formal and informal (mobile) vendors. We compute and compare four FE metrics inspired by landscape ecology—density, dispersion, diversity, and dominance—to better understand how the informal food environment relates to food purchase patterns, diets, and nutritional status among households with persons living with human immunodeficiency virus (PLHIV).

Background A nutritious diet is critical to minimizing disease progression of human immunodeficiency virus (HIV) and maximizing treatment efficacy. In low resource settings, meeting the food preference needs of people living with the HIV (PLHIV) can be achieved with a supportive food environment when HIV status is disclosed. However, less is known about family-level strategies related to building a supportive food environment. The Diet, Environment, and Choices of positive living (DECIDE), a mixed-methods observational study conducted in peri-urban Dar es Salaam, Tanzania, explored food preferences as influenced by the personal, family, and external food domains. Methods We completed a qualitative analysis of data generated from 40 interviews (n = 20 PLHIV and n = 20 family members) aimed at exploring the dynamics of food choice for using a family perspective. We expanded on Turner’s food environment framework and drew on Giddens’ structuration theory to guide our data collection and analysis. Interviews were audio recorded, transcribed, translated from Kiswahili to English, coded, and organized into themes. Results We found PLHIV personal food preferences were influenced by organoleptic properties, medications, disease stage, and gender norms. Family members were knowledgeable about the importance of nutritious food for HIV treatment and prioritized these needs to avoid HIV-related stigma and fulfill family obligations. With high prices of nutritious foods (animal source foods, fruits), family members strategized to secure preferred foods for the PLHIV by, 1) forgoing their own food preferences; 2) reallocating food within the household; 3)making food substitutions; and 4) leveraging external networks. These strategies were increasingly employed as the disease progressed. Conclusion The use of this expanded framework that included a family perspective on PLHIV food choice illuminated the various households decision-making dynamics that took place in this low resource community. Family members of PLHIV tried to buffer the limitations imposed by the external food environment, especially as the disease progressed. In the context of HIV status disclosure, integrating a family perspective into HIV nutrition interventions and programs has the potential to influence health outcomes and slow disease progression.

Background In many regions of the world, little is known about meal structures, meal patterns, and nutrient intake because the collection of quantitative dietary intake is expensive and labor-intensive. Objectives We describe the development and field-feasibility of a tablet-based Tanzania-24-hour recall tool (TZ-24hr-DR), and dietary intakes collected from adults and children in rural and urban settings. Methods Using the Tanzanian food composition table, the TZ-24hr-DR tool was developed on an Android platform using Open Data Kit. The module provides food lists, meal lists, ingredient lists, quantity and amount consumed, breastfeeding frequency, and a recipe feature. Similar to the USDA Automated Multiple Pass Method, this TZ-24hr-DR contains review features such as time in between meals, a summary of meals, and portion sizes. Results Dietary intake using TZ-24hr-DR was collected among 1) 845 children 0–18 months of age enrolled in the EFFECTS trial (ClinicalTrials.gov Identifier: NCT03759821) in Mara, Tanzania, and 2) 312 adult families from the DECIDE observational study in peri-urban Dar es Salaam. Interviewers were trained on paper-based methods with food models and tablet-based collection. Conversion to nutrient intake was readily linked and accessible, enabling rapid review and analysis. Overall, 2158 and 8197 dietary meal records were collected from DECIDE study and EFFECTS trial. Among adults, 63% of men and 92% of women report eating at home, and there were differences in protein, fat and zinc. Food consumed outside the home typically occurs for the first two meals. Children's intake of nutrients increased with age; however, median micronutrient intakes for calcium, iron, zinc, and vitamin A remained below recommended nutrient intakes. Conclusions TZ-24hr-DR is a field- and user-friendly tool that can collect large samples of dietary intakes. Further validation is needed. The tool is available freely for research purposes and can be further adapted to other contexts in East Africa.

Objectives The COVID-19 pandemic is worsening food insecurity and exacerbating social disparities. This study investigated the pandemic's impact on food insecurity, disparities, and determinants among graduate students at Purdue University, a public research university. Methods Purdue University graduate students completed a Graduate Student Experience in the Research University Survey (gradSERU) in Apr-Jun 2019 and the Fostering Food Security, Health, and Resilience in Graduate Education (FORGE) survey in Nov-Dec 2020, which assessed students’ food security, mental and physical health, and academic performance. A validated two-question tool measured food insecurity based on worry over or experience of running out of food without the ability to purchase more. Analyses using logistic regressions were performed in StataSE16. Results Food insecurity among graduate students doubled from spring 2019 (17%) to fall 2020 (36%, P < 0.001), increasing for all races, genders. Odds of food insecurity in 2020 were higher among students who were African American (OR: 5.7, 95% CI 3.2–10.1), Asian (OR 3.1 [2.1–4.8]), Hispanic or Latino (OR 3.0 [1.8–4.0]), international (OR 1.5 [1.2–1.8]), LGBTQ+ (OR 1.9 [1.4–2.6]), caregiving for adults (OR 2.7 [1.9–3.6]), or funded through fellowships or assistantships (vs. personally funded, OR 1.5 [1.1–2.0]). Food insecure students faced greater stress (OR 3.5 [3.0–4.2]) and reduced ability (OR 0.6 [0.5–0.8]) to attain a healthy diet, with reduced access to stores with fruits and vegetables (OR 0.7 [0.6–0.9]) or considered good quality (OR 0.4 [0.3–0.5]). Food insecure students were more likely (OR 6.7 [5.2–8.6]) or vegetables (OR 8.1 [6.1–10.9]) due to cost. Lack of time (52%), culturally desired foods (11%), and transportation (10%) were limitations to a healthy diet. Conclusions Graduate student food insecurity increased significantly during the COVID-19 pandemic, particularly among international, minority, and LGBTQ + students, and coincided with lower likelihood of purchasing nutritious foods. Universities should implement policies and services to address persistent and increasing food insecurity and disparities among graduate students. Funding Sources Protect Purdue Innovations Faculty Grant.

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