 Hello everybody, welcome very much to our seminar, the file webinar on the design and analysis of the first national food consumption service in St. Kitts and Nevis in 2020. And I would like to welcome everybody who is in this webinar, we have more than 400, we have more than 100 people registered and we have a very many very interesting presentations in front of us. So I would like to say that the first one will be Renata Klake to do the welcome and introduction. Then Dolores Staffelen-Haris will do a welcome. Then Sharon Hatt-Chinson will do an overview of the survey and the role of the collaborators. Dr. Bauer will talk about the opportunities and challenges in the preparation of the MyFood 24 data collection and software. I myself, Ruch Armandier, will speak about the Caribbean photo book with household measures for photos and standard portions. Latoya Matjodukan and Katrin Kargilwana will talk about the experience and lessons learned from the data collection, design and implementation. Sandra Christman about the preliminary results and methodological issues in analyzing the survey data before Bridget will conclude to say what espouse commitment to dietary data and dissemination. And thereafter we will have a session of question and answers. So please, Renata, you have the floor. Thank you, Ruth. I'm really happy to be here this morning, not only to welcome you, but to join you. I really want to hear what you. Sorry about that. It's been a long and difficult road, a lot of hard work by many people to bring us here. Food security and nutrition and promoting healthy diets has always been an important part of FAO's program in the Caribbean. But we haven't really seen the sort of impact that we would have hoped for over the years. When I say that we would have hoped for or that countries themselves would have hoped for. And we're, it's very worrisome looking at the trends in female obesity and also childhood obesity in particular in the Caribbean over the years. You know, we all like to quote Einstein. So here I am. You know, Einstein says that the definition of insanity is doing the same thing over and over again and expecting a different result. So we really did want a different result. So we figured we have to do something different. And we really worked hard to find funding to do this. We did a research study to see if we can bring better data, if we bring better data into the process, better information, will we end up with better policies and more power in our advocacy. So here we are. The next person is, or I should say there's a heavy weight on the shoulders of St. Kitts and Nevis, because we worked so hard to get these resources. We need to demonstrate that it was worth it, and maybe getting the next resources to continue this work will be less difficult. So there's a big focus on what happens next, what does St. Kitts and Nevis do with the data to demonstrate that this is an important part to the development of good policies and strong programs and the ability to monitor impact. You know, we all get so accustomed to doing things without bothering to analyze whether it's worked. And this needs to change. So I did say it was a long and difficult path. And the difficulty, as we all know, was very much linked to COVID. The team had to keep reinventing ways of doing things just to get to move forward. And I really would like once again to recognize the hard work of everyone who was on the, who was part of this team, because there was challenge after challenge to overcome. While at the same time, of course, as with all funding sources, we can't say, okay, we'll wait a while. No, if we didn't meet our deadlines, the money would have vanished and the opportunity would have been lost. So I have said that I do know that this is the work of many, but I do want to single out two people who were there from the start. I'm sure that there will be plenty of opportunity for to recognize everyone else. And the first person I would like to recognize is Ruth Sharon Gehr. She's really been the mother of this process from the beginning. She, she has monitored, she has prodded, she has pushed, she has congratulated, she has supported and when necessary, she has chastised. She's done whatever was needed to keep this going forward in a way that was acceptable to her, according to the standards that FAO has established for this process. The second person that I'd like to to recognize is Latoya. You know, I met Latoya in St. Kitts and Nevis on my very first mission. I should say my first and only mission because COVID came. I have not been back to St. Kitts and Nevis and it was her energy that convinced me that we had a strong national counterpart and that you know this is always critical in work in the field that when hard times hit, there's somebody there that's going to help you find solutions. So many other people have joined the team. The UE team has been incredible. I know Ruth has brought many other partners into the process. We've worked very closely with the headquarters team and everyone has worked hard. With that, I look forward to listening to you and understanding what has happened and understanding what's next. So welcome and we look forward to the discussion. Thank you, Renata, for your very nice words and introduction and it's true it has been really, it was difficult but nice journey together. May I give the floor to Dr. Harris, the PS from St. Kitts and Nevis. Good morning to all. Good morning. Is everybody here with her clearly? Perfectly clear. Perfect then. Perfect way to start and to welcome all of you very warmly to this very important webinar seminar. However, whatever we want to call it, the important thing is that it is dissemination of the findings of a very important survey. I want to thank all of you for coming. I also want on behalf of the Ministry of Health to thank all of you who have been involved in the survey and the project from the conceptualization of it to the participation and to the facilitation. I want to particularly recognize Dr. Clarke, Dr. Hutchinson, Dr. Charandeer, and our local person on the ground, Latoya, Matthew Duncan, who I concur with you, Dr. Clarke, is very energetic and she knows what she wants. And when she is assigned a project, she knows and goes about it in a very firm and convincing manner. So I want to thank all of you. I want to thank all the other stakeholders who are engaging in the meeting. And I want to say also that I am very excited about this morning's engagement because I am informed that the findings of the individual food consumption survey and analysis which was done in San Kitsune will be revealed. And it is very interesting because this survey of course we recognize was done in a very challenging time. In the course of the coronavirus pandemic. But we are a resilient people and the pandemic has taught us much. And so I am pleased that we were able to complete the project within the deadline and that the resources move well in utilize. The survey was of immense in significance to San Kitsune this because currently within the federation. There is a high number of persons with non communicable diseases. In cities has become a scourge and approximately 85% of our populations. Death and mobility would be formed non communicable diseases. Therefore I find that the findings will provide the critical evidence to augment the federation's effort to mitigate against the incidents of non communicable diseases. And accelerate our progress toward our target goals, which include relevant food and national programs and policies. Having recognized that poor and unhealthy diet are causing micronutrient deficiencies, malnutrition on both sides, too much and too little. Moreover, our society is willing from an unfolding obesity epidemic, a key contributing factor of the associated non communicable diseases. The Ministry of Health is grateful for the survey as one of its strategic priorities to assist the federation in tracking its progress. Because despite the critical importance of healthy diets to our health and well being, we are challenged in getting reliable data on what our citizens and residents are eating at the individual level. I therefore wish to take this opportunity to commend the Food and Agriculture Organization for this initiative and to thank the University of the West Indies for its collaborative support. And to thank all the pushers and the shakers of the survey that propelled the survey to completion. Once again, I look forward to the outcomes, the findings and the outcomes of the survey that of course would assist us in policy and program formulation. Thank you all and I wish the session very good outcomes. Thank you. It's my pleasure to be part of this opening session. Thank you. Thank you so much, Dr Harris, who is the PS in St. Kitts and Nevis. May I give the floor to Sharon to give the overview of the survey. Thank you, Ruth. And hello to all the participants. Sharon Hutchinson, the responsible officer for the University of the West Indies, and I am presenting on behalf of Dr Isabella Grondesum, the principal investigator and the wider team at the university as well as at the University of Parania, the Ministry of Health, it's St. Kitts and Nevis and FVO. The PS just alluded to the major rise in non communicable diseases in the Caribbean, which includes things like diabetes, high blood pressure, stroke, and specifically the high incidences of obesity and overweight, particularly among women in the Caribbean. So based on this background, the survey is trying to determine food consumption patterns for persons between 18 and 65 years old who reside in St. Kitts and Nevis and collect empirical data that can be used to develop very good nutrition policies and programs for this country and we hope by extension we provide the Caribbean. In addition, this survey is aimed at increasing capacity at the University of the West Indies and also at the Ministry of Health in St. Kitts and Nevis as we all learn how to conduct these kinds of national level surveys. Specifically, the food consumption survey would like to collect data on the amount of food and nutrient intake for the population, the different food groups that are being used, especially as it relates to the German divide and across the two islands. It will also be getting information on the energy intake of the population, the nutrient intake, and the percentage of the population that meets the dietary recommendations of the Caribbean. We are also interested in looking at the use of imported versus locally produced food. As you are aware St. Kitts and Nevis is one of the small, win-win islands in the Caribbean, just located here in the Caribbean Sea, with a population of just over 50,000 persons. Nevis, which is the smaller island, has about 23% of the population, and so we really wanted to know if food consumption was varying geographically. Now there are a number of steps that were taken to get this survey implemented, and first we started with developing the 24 record questionnaire, a number of the world forms that contain socioeconomic data that we wanted to collect. We obtained ethics approval from the University of the West Indies as well as from St. Kitts and Nevis, and then we interviewed various software vendors to determine which software would be most suitable for this survey. Once this was done, we had to engage with the software company to get our training for our staff in terms of how to use the software, how to import the data, etc. At the same time, we had to prepare recipes in order to determine food quantification and determine various estimates such as yield factors. And while all this is going on, we had to develop our sampling procedure and also develop manuals for work by the field supervisors and the data collectors on the ground. Many different things were happening at the same time, so even while the sampling procedure was being developed, we had to at the same time develop food and recipes, which required us to get staff and support personnel from the Ministry of Health to actually go into the supermarkets to get some brand names for foods as responsible. And this led to the development of a comprehensive food database that included various factors such as preparation methods and household measures that are used. We also sought to develop a photo book from scratch, and this will be dealt with later on in the webinar, where we had to take pictures of the foods, established portion sizes and household measures. We also engage independent consultants to create a compilation of nutrient values for the Caribbean, and while this was not necessary in implementing the survey, this is critical in doing the data analysis. Once the food database was created, it was uploaded into the My Food 24 software, which I also show a picture of here. And then this 24 recall was linked to our Google form where we are collecting our social economic data. We had to test the software and then use it in training our field staff via a pilot survey initially, and then the full load of the survey. Now, there are several variables that we wish to collect, which included several socioeconomic data such as gender, age, marital status, ethnicity, etc. We also wanted to get an estimate of smoking status in the population and the level of physical activity. We asked persons about where their food is food, whether they are out and in certain restaurants, etc. We asked persons to start report height and width so that we can calculate their BMI. We asked about supplement take on a daily basis, as well as what they ate, when they ate a particular meal or snack, and where it was eaten more than home or at a restaurant, etc. We collected data for 16 food groups, including foods for particularly nutritional uses and composited dishes, as well as several macronutrients and vitamins and minerals of which are just sample are given here and later in the webinar, they will completely be provided. We worked very closely with the central statistical organizations in Kitsunebis to get a list of the number of households and the gender distribution sorted by their 260 enumeration districts. That was our sampling frame and from there, we did a sample run, a simple random sample of 156 of these 260 enumeration districts. From there, we selected a geographic reference point from which households were randomly collected. Once all eligible persons in each household was identified, we used a cache method to determine which person in the household will participate in the survey. We conducted face-to-face interviews only and the sampling was done every day of the week. In all, 960 persons were sampled. We got the first recall from all 960 and then we planned to have a second recall for half of that sample site. This really required a lot of resources. We had 13 tablets that had to be Wi-Fi enabled. There was significant logistics management in terms of getting all the field supervisors and data collectors on the ground in the plan that we had prepared because we had to ensure that the sampling was taking place on a particular reason or to meet our deadlines. We relied heavily on the country coordinator, Mrs. Latoya Masti-Dahal, and she coordinated the work on the ground for 20 data collectors and six field supervisors. When data was collected, we had research assistants review the data on a daily basis to give feedback for any gaps that were there or any information that needed to be clarified. All of this was working within a constant quality control by the advisory team and periodic retraining of the field staff. The team was again a huge collaboration here with the University of Watson-Days as a service provider and linking with the Ministry of Health in St. Kitts and Nevers, together with our international consultant Dr. Quispring, who also lives with researchers at Federal University of Paranoia to provide research support, as well as the affiliate advisory team led by Dr. Sharon Nye. And now we have on board Dr. Holmes to work through the various roles because we have the coordinates amongst all the technical staff, we had several research assistants working on each of the various components. We had to monitor the data entry and provide feedback to later quality control. We also engage in data cleaning, analysis, budgeting, and reporting. So I'm just giving you here the tip of the iceberg just for you to recognize that this was a huge team of support staff as well needed. This endeavor span two L.A. ways with a budget of approximately 300,000 U.S. dollars. And each of the main steps took a lot of time, so the average approval alone took about five months. Most of the time spent with developing the food list and the rest of the list on the database for upload, the planning for the survey and training, and so it took about three months, and then the implementation alone took about three months. And now we end this data analysis, we're wrapping this up now to get into the validation stage. So at this point, there's a huge effort, and I would certainly like to thank all persons who participated. The work that I said is funded by the FAO under these two L.A. ways. And I particularly would like to thank Ms. Victoria Martin for helping again the country coordinator. Thank you, everyone. This is an overview of our work. Thank you, Sharon, for this wonderful introduction of the survey, which helps to understand the rest. May I give the floor to Dr. Bauer. Dr. Bauer, you are still on mute. Thank you so much, Ruth. And I would like to thank all for coming and for me to share my presentation with you entitled opportunities and challenges in the preparation of my food 24 data collection software. And of course this presentation is made on behalf of the staff of FAO who are involved in this work as well as staff from the University of Parana, Brazil, and of course the University of the West Indies. Now, why did we choose... Dr. Bauer, would you mind sharing your screen? Can you now see it? Hello, can you see the screen now? Hello. Yes, now we can see the screen. All right, all right. All right, so once again, thank all the participants for coming to this webinar. And I'm glad to share with you my presentation entitled opportunities and challenges in the preparation of my food 24 data collection software. So why did we choose this dietary assessment 24-hour record? As you are all aware, the dietary assessment methods chosen for inclusion of the individual food consumption survey is the multipliers at 24-hour record. Multipliers in the sense that step-by-steps it enables the participants to vividly remember what he or she had ate and drunk the previous day. And the 24-hour record has been recognized as one of the best methodologies for monitoring dietary index of individuals and populations as compared to food frequency questionnaire. And the use of online software has become more and more popular and is replacing the so-called paper-based 24-hour dietary record, which you all know has many drawbacks because sometimes you cannot even read what has been written. And sometimes it's been, in fact, the figures cannot totally be seen. Therefore, we decided to choose the software My Food 24. And what are some of the reasons why we chose this type of software? Well, originally, this software was developed to be used among UK populations in adolescence and adults, and then, of course, later some countries decided to use it and tailored it to their database. It comes with the UK database, so any country buying this software either has to create its own database or has to tailor it in order to use it. So once again, it's the ability to create new version of the Caribbean food pattern that made us choose this. This allows the multiple past 24-hour record, as I mentioned earlier, and includes the breakdown of recipes during interviews, partial use of yield factors, and allows detailed food description, detailed, different portion size options and images. And of course, these images are to enable the participant to clearly state the portion of the food he or she has consumed. And export of results on food and nutrient intake level per subject broken down by eating vocation, so it could be breakfast, lunch, dinner, and so on. So developing my food 24 for use in St. Kitts and Nebis, it involved many steps, but the major two steps are creating a country-specific, detailed food list for St. Kitts and Nebis, as well as St. Vincent and the Grenadines and other parts of the Caribbean. So about 30,000 food items were included in this database, which is following the logic of global diet and old software for dietary assessment. And of course, detailed description and allowing always to choose unknown, because sometimes you ask individuals what they exactly consumed, despite the fact that you showed them different options, they still don't remember exactly what the kind of food was or how the preparation was. Therefore, we had this version of unknown. And the completion of all additional files, quantification, food composition, and linking, probing foods, and of course, food groups. So five interlinked tables were prepared. So at the food table, where information such as food names, brands, and nutrient values were inputted, and of course, food accompaniments. So these items popped up whenever a participant selected a certain entry in the diary. For example, if they select bread, then butter, margarine could pop up or jam, means things that are usually consumed with the bread. So once again, the food accompaniments, as I earlier mentioned, then the portion sizes, individual entries were made. For example, ready to eat meals, or some can share entries if they have the same portion sizes. For example, there were multiple types of honey, all with five grams of teaspoon portion size. And portion groups, this is to help for the identification of at least one portion for a product, and groups of multiple portions together. For example, a teaspoon, a tablespoon, half a cup, a cup, and so on. So it was really extensive. So the food list file incorporated a comprehensive and extensive food description system, as you can see here, food source, cow, goat, chicken, and so on. A preparation method fried, baked, cooked, and so on. The physical status, so liquid, powder, and other forms. The color of fruits and vegetables, which is very important as you are all aware. The color indicates a different fight and nutrients that have been fighting non-communicable disorders. And type of production, homemade or commercial, and type of added fad, butter, vegetable oil, spray, and so on. Type of added liquid, and synonyms, for example, regional variations, which of course, you know, in the Caribbean, sometimes one food cold in Trinidad, it would be entirely different name in Jamaica. For example, if you talk about Kalalu, Kalalu in Trinidad is a kind of mixture of vegetables cooked and mashed up together with all the killed vitamins, unfortunately. And of course, in Jamaica, if you say Kalalu, they mean the African spinach. So we took all these into consideration. And of course, brand names. The food quantification file included the following options. Household measurements, right? So the cup, the teaspoon, the table, table spoons, and what is really a heat table spoon, what is a level table spoon. We were really very precise in the identification of these identifications. And of course, the result of what we've done, development of the Caribbean database, this I mean, my food now, my food 24 is now fully tailored for use in the Caribbean. And the pain by an appropriate database to reflect index in the area of more than 30,000 generic and branded foods, and that includes local dishes and recipes. So you can see these are the food groups, 16 food groups as Dr. Hutchison had in her presentation that we used. So you can see the number, quite, quite extensive, quite a large number of them, as well as the number of the quantifications, really very huge. So you could see that it was really challenging to do this work. And recipe data collection and calculation of nutrient composition, so frequently consumed mixed dishes were collected from St. Kitts and Nibbis as well as St. Vincent and the Grenadines. Recipe information were collected and approved by the countries, and approximately 120 recipes were cooked at the UWI, and the weights of the ingredients were collected before cooking and well described as the final weight of the recipe. And the nutrient composition of all recipes were calculated using mixed recipe method. And when it comes to nutrient composition, a team of food composition experts from different parts of the world, Australia, Brazil, were really involved in creating the nutrient composition as well as research assistants from both universities, University of Parania in Brazil and the University of the West Indies. And for all food entries to food composition data in food composition table, and all had, I mean, missing values were taken into consideration. And this collection of course of food composition data can be the basis for a future development of food composition table for the Caribbean. And what we had the strength, some of the strengths of the Caribbean version of my food 24, there are many strengths, but it's not, I don't have enough time to talk about all of them. So some of them include frequently consumed foods and recipes from St. Kitts and Nebis, St. Vincent and the Grenadines, and other Caribbean countries. And that collaborative efforts, as mentioned, two universities were involved and you have experts from FAO, right, led by Roots. And of course, then you have the development of the comprehensive food list and recipes. So just look at the example, how deep we went in. If you have yam, we had to mention all the different colors of the yams, as I mentioned earlier, because they have different phytonutrients. And then we had to say whether it was, the yam was dry or fresh. And then the cooking method, was it fried, was it cooked, and then the type of food and the type of fat, which was really used. And of course, local recipes that were used. So these are some of the strengths of our survey. So challenges. Yeah, it was really time consuming to develop the Caribbean version, about seven months, right. And when you could see why seven months, a huge number of the items in the food list, a huge number of the quantifications and availability of trained personnel in food database preparation. So it was kind of a challenging for us, right. So we, I mean, we needed some kind of training as nobody has ever done such an extensive or comprehensive food list and recipe. The IT support was needed for my food 24. At the beginning, we thought that I mean it was an easy software to use, but unfortunately we came to realize that no, and lack of information from the Caribbean to prepare food database, databases, the recipes, factors, brand names and food amounts. And of course, but due to the capacity building, right, as I said, we had to be trained. And now of course we are able to do what we have done. And of course, COVID-19, as was earlier mentioned, was one of the drawbacks. And support from my food team was a times challenging. You had to wait, I mean sometimes 48 hours for response from them. So in trying to conclude, I'm sure I must have extended my time, exceeded my time. This survey has clearly demonstrated that it is feasible to use my food 24 for individual food consumption survey in other Caribbean countries. And that although the preparation of the Caribbean version of my food 24 was successful, one should bear in mind that future adaptations requires extra effort, money and human resources, including new foods. For example, we excluded insects, giraffes and their products. And if in the future we want to carry out study in IT, right, they eat lots of insects and giraffes, so you have to bring in this new food and it's going to be also kind of challenging. And the compilation of food composition data could be the basis for future development of the Caribbean food composition table. And capacity building here is quite important. Now we know how to do it, how to do it, thanks to Ruth and her colleagues there, right. So I mean it will be easier now to do any individual food survey in other parts of the Caribbean country. And that team, the team and of course the country. So I would once again thank you very much for your patience listening to me as a slow speaker and waiting for questions. Thank you so much. Thank you so much, Dr. Bauer for this wonderful presentation on the preparation of my food 24. I would like to say to the participants you have two possibilities to share your comments or your questions. We have at the bottom we have two possibilities, either the chat or question and answers where you are invited to post your questions and comments, because we will have a session at the end where we will discuss and answer all of your comments and questions. And next, I will do a presentation on the photo book that we were preparing for the survey in San Quince and Neves. So, and again, I am presenting it on behalf of many people who have contributed, and they are the same as in the other presentations that we have seen so far. So the important steps in a food consumption survey are three building blocks. It's the collecting data on food intakes, the appropriate use of relevant food composition data for calculating nutrient intakes, and then statistically converting observed to usual intakes for evaluation of nutrient adequacy and relations between foods and nutrients and health outcomes. And in this first building block, we have the methods that you choose, and this was very well described by Sharon, the instrument, the food list and the quantification method. And the quantification method, it's really one of the most important elements of this collecting data, because with the quantification people have most of the difficulties, not in identifying the foods, but to quantify it. And therefore, we choose to have the photo book instead of models or printed or digital photo. And why did we do that? Because we know that, as I said earlier, the largest source of errors is in the estimation of the food intake from the self reporting from the different participants. So we have to help them as much as we can to identify the portion size that they have chosen. Sometimes they also have a poor willingness or memory to estimate the portion sizes or a limited quantitative skills or a limited photo literacy to be able to relate what they see on the photo on to what they have eaten. And the other building block of error is the interviewers. If the interviewers is using the portion size estimations incorrectly, then we have the problem. And this is why Sharon explained we have had really expensive training. And also for the foods, there are some foods which are easier to quantify and others are more difficult. So the large areas of food are in those where we have a high value but a low weight, for example, for leaves, or depending on the shape of the food. So the best to identify is really the single unit solid food much more than the amorphous food. So why did we choose a photo book instead of photo models? So it's much easier to be carried by the interviewers, less volume and weight. And there is the possibility to display it in the software that we use. And in our case, it's a mindful 24 and to show it into the computer. And we can have a much wider range of quantification possibilities. In addition, we have the possibility of the household measures where we not only can see I have had one glass but what is half a glass or one force of the glass. And it is also much cheaper. So how did we develop this photo book? So we took the photographs and always in the same standard way. The size and number of the portion sizes were between four and six. The order of the presentation, it's always increasing. It's always the same angle to take the photographs, always the same background, always the same reference objects for scale. And between the different portion sizes, there must be a visible difference so that people can easily say I have had portion two or portion three. And the other thing was as well is to choose the fraction of each portion size. So instead of saying I have had the portion number two of the photo X or Y, I could say I have had three quarters of this photo. And all this what we have done is based on the guidelines which are published by IA and Dr. Christen is the first author. So how did we do it? First of all, we defined the food list and the recipe list and of them we decided for which we will need a photo and for which one we want. So we came up with 225 common foods including 25 recipes for which we would need that photo. And because we choose 121, it is obvious that some of the foods can be estimated using the same photos. We got the permission from the Brazilian photo book to take some of their photos series as and we have had the rest be photographed in some kids and now most of them and some of the photos did not come out that well so we needed to reduce them in new. Then we defined the food groups into which we will put the photos and we prepared the photo book including the editing and the layout and we printed some 20 books to be used in the survey. So what is the content? First of all, there is the background and then there is the objective. First, our first objective obviously it was that we use it in the individual food consumption service and send kids and nets. Then we included it in the MyFood24 version and it can then be also used in other Caribbean countries. So when they decide to do a survey and we thought it's not only useful for the survey but also for nutrition educators to teach individuals about the portion size and to have a better idea of how much they can eat or what. Then the next part is the description of the development of the photo book then instruction how to use it in a survey as well as in nutrition education. Then we have the photo index and the photos as well as the weight or volume of each of the photo and at the very end we have the plate size in real dimension. So the content, so we have three types of photos. One, the first part is the household measurements with the fractions, they are 37. Then a series of portions as I said before between four and six and then we have food portion standards which is for example different types of apples or coconut dumplings. And on the pages with the household measurements we also have a real size meter in centimeters and all the photos are grouped into eight food groups. And here are some examples. So you can see these are the different glasses that are frequently used in San Kits and Nevis but also in the Caribbean. So and you can see that for each of the glasses we have the fractions and you can see how many centimeters they are and it's the same with the spoons. And here is the meter that I was talking about and at the annex you will see that for every glass what is the volume and in this case every household measurement is only in volume and you can use the found inputs density database to convert then the volume to the weight of the food and as you know where the weight of the foods are different. This is why we said we only have the volumes here. So here it's the same for all the spoons we have the volume. And here are some of the portions with the photos with the portions and I would like to invite you to have a mental exercise. So in your point of view if you would like to choose 250 grams so which is the closest one to 250 gram of the Caribbean fish soup or of the Kupia. I give you a second to decide. And here is the answer. So I think it is not always obvious how much gram it is and you can see that the portion two or here the portion four has close to 250 gram. So and I think many people are not really knowledgeable about this qualification and this shows really the importance of having this portable. And here are some of the examples of the portion food portion units. And again here we have them together with the different ways. So and when people are asked to choose they should not choose according to the color but the size of the apple. And here you can choose of how much margarine or butter or butter is on the bread. And again you have the weight. There we also have some which are complex. So on one plate you have different biscuit types and again for each of them we have the weight. The conclusion is that this is an excellent quantification aid for future food consumption surveys and it showed really very useful. Here in when we did the survey in St. Kitts and Nevis. It will be a file publication and globally available free of charge like all the publication of FAO. And it and so it can be useful not only in St. Kitts and Nevis but also in the other Caribbean countries because we really did it in the thinking that it should include the foods for food. So all the Caribbean countries. So and the volumes and the weights are very helpful to to know how to translate the photo the amount on the photo. Yes. And with this one I would like to close and. And give the floor to Catherine and to Latoya to explain about the field experience. Thank you doctor. Good morning everyone. My name is Latoya Matthew Duncan country coordinator for the food consumption individual food consumption survey and this morning. Along with my doctor Catherine Cargill Wano will be presenting on the experiencing and the experiences and lessons from the data collection and design and implementation. Next week's outline. Our presentation will focus on the following equipment of field staff, field equipment use, sampling steps, data collection, field experiences, lessons learned, conclusion and implications for further studies. Enumerators were selected from various departments within the Ministry of Health as well as pooled a pool of experience interviewers and unemployed citizens with computer literacy in St. Kitts and Nevis. 85% of the enumerators were involved in involved in previous government surveys. 10% were involved in surveys of similar nature. Most recent survey was the community health and nutrition household survey conducted in 2012 under the farm to park project. The final team comprised of 20 enumerators who took part in a week training held in October 2020. Six field supervisors were selected to assist with the survey for supervisors from Senkets and two from Nevis. These supervisors came with a wealth of experience and knowledge. Three came from the ministries in Senkets and Nevis and three came from the statistics department in Senkets and Nevis. Prior to the start of data collection, the following survey material were issued to field interviewers. The field supervisor was responsible for ensuring that the field interviewers had adequate supplies of the materials needed during the time in the field. And here we have the list as you can see of field equipment that was distributed to the enumerators to ensure the success of this survey. Here we have the multi-stage sampling design that was used in step one, which is location as you know it was held in Senkets and Nevis. We have in step one selection of enumeration district as well as random sampling. In this step in Senkets a total of six participants were chosen from each enumeration district and they were selected randomly. This was done similarly in Nevis, however, eight participants were selected from each ED in Nevis. In step two, selection of households, systematic random sampling. In this step, the selection of households was the responsibility of the field supervisors using systematic random sampling. And the final step, which is step three, selection of individuals as well as the kish method. Using the kish grid, once a household was selected by the field supervisor, the field supervisor created a listing of all the persons in the household that are eligible for the interview process. From that listing, the grid is used to identify the individual who would be interviewed. The field supervisor is then responsible for obtaining consent from that individual who was selected from that particular household and the field supervisor additionally schedules an appointment for the interview, which will be carried out by the enumerator interviewer. Data collection, the duration of data collection, we started in November and complete November 2020 and completed data collection in January 2021. Data was collected every day of the week. We did a representative sample, both islander were done separately. We also looked at gender and food consumed on the days of the week. A data monitoring firm was used to track our data activities. Dr. Cargill will now continue with the rest of the presentation. Good morning everyone. Okay, to continue from my colleague, the field experiences will be presented according to technology, food 24, field staff and key challenges. So this survey was another one to think it's unneeded because as a result of the COVID-19 pandemic, technology played a vital role in data collection during this time. Tablets were used and as a result, it made data monitoring easier and it allowed for remote access so that errors and outliers could be detected and corrected on a daily basis. It's also helped with identifying any additional training needed as the data collection progressed. For example, it was identified that interviewers had some difficulty entering recipes, so additional training was provided. With regards to the Caribbean version of my food 24, again, this was a new concept for collecting and entering food data, which was complemented by the photo book, as it gave the participants an opportunity to visualize their portions or quantities of the foods consumed. However, the one week training provided was found to be insufferable as a survey was noted that our training was required to allow the staff to become more familiar with the photo book, the complex food lists that comprise of 16 food groups with one food having several variations, as mentioned in Dr. Farrer's presentation. Then there's also the cultural diversity, whereby the same foods have different names across the regions. For example, a popular one was hello in Trinidad would be called hookup instinct is unneeded, as well as food preparation and cooking methods used. Something to note with my food 24, being a UK based company, there were time zone differences which affected the rates generated initially, and so we had to bring to their attention so that it could be adjusted. In addition to that, the company upgraded the software during data collection, resulting in format change, which caused glitches. A few stuff displayed limited understanding of the foods as they were not familiar with certain food names, cooking methods, etc. So the complex food list is slowed down identification of food items and proved time consuming for them at first. Also, we found that initially there was insufficient prompting of participants to get details, for example, something like a participant having a cup of tea, for them to ask, did they put sugar in the tea, did they put cream in the tea, was it milk? Did they have a full cup of tea or a half or a quarter? There were instances of inaccurate selection of food items. Cooking methods and portion services, for example, so because of this additional editing and monitoring was required for the 24 hour recalls. I would just like to highlight some key challenges experienced. One challenge was that there was a need to provide field staff with individual coaching and support to maintain their motivation and to improve data quality. Also, field staff had no access to edit recalls after submission and so they had to keep written notes, you know, if they had anything that they wanted to change or any mistakes that they made in order to facilitate data editing. There were also technical challenges in the field due to mobile data coverage on both islands. As a result, some people or recalls were collected on paper and data inputted and or a question with this is that inputting data collected on a previous day would change the item added date and dairy date and in turn affect data analysis. In addition, we experienced an island wide blackout that stopped data collection over a few days. Another challenge was that over and under sampling of the days of the week and gender had to be very closely monitored. However, despite limitations, accuracy and data quality improved. One last challenge was that the pandemic delayed staff enumeration which impacted morale. So what are some lessons learned from this survey? So on the technology, firstly, that there was a need for trained staff with a good understanding of tablet use and familiarity in navigating my book 24 as well as there should be IT personnel on standby. We also learned that only having or only doing online training is suboptimal due to limited participation and feedback mechanisms and that adequate logistics are necessary for training sessions. In addition, ongoing training is necessary to improve and maintain quality of data. Furthermore, adequate training when adequate planning when using technology is vital as we learn from our experiences that we have to ensure that appropriate time zones are selected before starting and that program upgrades should not be scheduled during collection. And for situations involving unplanned technical issues, for example, an island wide blackout, a paper based questionnaire may be useful, but only enough. We learned that appropriate training in the area of food could have enhanced data collection and reduced errors. Also trained field supervisors could have been provided with access to the data submitted and in turn assist in monitoring and co-aging on an individual basis. Additionally, daily monitoring of collected 24 hour recalls by UAE and feedback to the field staff improved understanding and quality. We learned that flexibility is needed for unplanned staff dropouts and reorganization of field staff, field work, and the importance of plan for the unexpected in regards to staff remuneration. Also, the role of the country coordinator was key to assure that instructions were understood and followed by field staff. So in conclusion, due to COVID-19, travel to St. Kitts and Nevis was not possible, which impacted on training and supervision quality. The use of technology to collect food consumption data was useful during this time, as data was easily accessed and monitored. Overall, with appropriate coaching and support, data quality improved. Implications for future studies. Future food consumption surveys in the Caribbean and Latin America may profit from the MyFood 24 version produced, the photo book compiled, the training material developed, and experiences and lessons learned from the survey planning and implementation. Overall, using technology is the way forward, giving consideration to cost and human resources. Thank you. Thanks a lot for this insight in how it really worked on the ground and about all the lessons learned, which are many more than this one. And as Sharon said, you know, it's only the tip of the iceberg. So we are now looking forward to the preliminary results. Sandra, you have the floor. Thank you very much. So it's my pleasure to share with you the preliminary results, the methodological issues, some of the methodological issues in analyzing the survey data from St. Kitts and Nevis. So just a snapshot of what you have heard, we had a three months of data collection, and that's important to say that was done during a pandemic period, and that no collection was performed between Christmas and New Year's celebration. We initially had to collect the data from 960 adults with expected proportions between the two islands and from men and women, and actually we achieved 1,500 adults in the final sample size. And this is because we had the challenge of getting the right proportions for men and women in the two islands. So both this number has both information from 24-hour calls and general questionnaire. From a 40% of the sample, we also have a second 24-hour call, which will allow us to adjust for within-person availability, taking into account the day-to-day variation that we know is important in dietary service to estimate usual intakes. I would also like to highlight at this point that the number of quality controls were performed on a weekly basis as well. So apart from the individual quality controls case we mentioned, we had weekly reports to see how the data collection was going on, and that actually made us to drop some individuals, even before the survey was finished, and we placed them by new subjects. This minimized certainly the number of implausible values at the end of the survey. So in terms of sample characteristics, we have a proportion of 74% of the sample coming from some kids in 26 from babies, which was expected. Age mean of 42 years old, 59% of them being women, 95% African descent, 79.4% were employed, and about 62% had a high secondary school completed. The other proportions were divided between low-educated individuals and higher-educated individuals higher than secondary school. The number of persons in the household were on average almost three persons per household. And in terms of household model income, we had a distribution among low incomes and higher incomes, going down when income was a bit higher, if you can see in the ranges of $3,000 and $5,000. About 32% of the sample size did not wish to provide disinformation or did not know. When you look in the health and lifestyle habits, you will see that about 6% of the sample declared to SMOKE, 38% declared to be supplemented users. In terms of physical activity, 47.7% reported having mild physical activity, about 20% moderate and about 25% vigorous physical activity. Then an important result of our survey so far is the high BMI status values that we encountered. If you see here the yellow and the gray parts, we ended up to 65% of excess by weight, so considering overweight and obese proportions. And this is what's expected, but it's a high proportion that will be served. And it's also important to acknowledge that this is coming from self reported data. As also expected, the proportions were a bit higher for women as compared to men. When you look in the food purchasing habits, this is an important aspect that we wish to say more apart from the 24 hour recalls, because we're not sure how we will be able to gather, collect good quality information about this from 24 hour recalls, considering that people may not know how the food was produced or sold to them. We ask then if they were purchasing local produced food, generally speaking, and 96.5% said that yes. And the types of purchase local produced food were above about 90% for foods, vegetables, vegetables provisions in a less proportion and also meat, poultry and catching fish. Can you hear me well because I just got a message here that my internet is on time. So you were lost a little bit, but we saw what you were talking about. Okay. So this is an information about the local production. We also asked if you are buying food from the supermarket just to make sure and as expected 95% said yes, and a little proportional. Now going into the details of the 24 hour recall assessment. I just would like to mention a few aspects of the pre analysis of the data. Again, after the collection was finished, a number of other party controls were performed to was performed to identify extreme values and access the possibility of the data. Just as an example. Here we have excluded seven recalls with no justification because of low reports and no recalls war. We're cannibalized it to present more than 4000 kilocalories. Another aspect that I would like to highlight that we have just finished and will be considering in our future analysis is the recipe desegregation, because although my food had the possibility of desegregation foods are to build recipes during the data collection, we had a number of standard recipes that needs to be broken down after the collection was finished or need to be ready for data analysis. And the procedure was developed for allowing proportion of ingredients, including water, which is often underestimated to be measured with the reported data. And this will allow us to have better assessments of the food group level. In addition to the processing, this assessment, this merging of data between consumption composition that was already mentioned, was performed by food consumption composition specialist following FAO in food standards. And I'd like to acknowledge that that although the number was very high, about 30,000 food items. In a very quality controls in a very good manner. And one step when something that was done during this merging was to allow for grading the matching quality between consumption composition being one exact match to best available in three calculated. And when we look into these numbers coming from 13 food composition tables. We see that we observe the 63 exact match between the consumption composition data, 21% best available in 16 was calculated, mostly for recipes. And this is because when we look into that number of foods that were actually reported in the survey, that's of course much less than 30,000 is 2,106 to one. We see that we found that very good match for 84.3% of the survey, which is higher than the total table total compilation in about 16% of this matching is considered to be of less quality. But it means that we have life certainty about it. So, talking about the distributions of the day of the week, we are aiming to have a more balanced representation but was very challenging to actually get the proportions of man of the islands. In all other aspects we needed and at the end, we have an underrepresentation from Thursday to Saturday, which needs to be taken into account during the data analysis. Also important to show this result about the Goldberg cutoff analysis at the population level. Since this is more applicable or more, the word is now, it's more useful for population on nutritional service. When we compare the energy intake with the basal metabolic page that is strong, could be translating the energy requirements. So we calculated this figure which we call fuel to see the degree of under overestimation of the data. This lower confidence interval and upper confidence interval give us the idea of what we should expect between this ratio. And in fact, we see a lower fuel leading to the conclusion that underestimation of the reported food consumption exists in this survey at the population level. This is expected. We were not expecting an exact that there would be no underestimation because we are talking about to infer our recalls. But this is low. It's a bit lower. And it's important to consider that a high prevalence of overweight and obesity is present in this population. And we know that they tended to underestimate in takes even more. And another aspect that we also should not rule out is that the economic impact because of COVID pandemic situation may have led to lower in takes, indeed, apart from their energy requirements. Another methodological choices of this assessment that I would like to highlight with you that we are doing adjustments following the NSAI method, the adjustments of the within perseverability. And these user intakes are being adjusted for survey weight effect of the day of the week and sequence of two and four recalls using different models, considering the nature of the dietary components. And we will be reporting 25 dietary components, including energy, micronutrients and also vitamins and minerals. And perhaps not everything will be presented today, but that's our intention for the whole data analysis. And the last consideration here is that when you look at the food composition data coverage, consider that we always see some missing values in in these compilations, we found above 98.5% of completeness of the data. Actually just sugar wise 98.5 and the rest was above 99%, which is very good. And the last methodological consideration that I would like to bring is that we wish to compare the information nutrient values with the recommended dietary allowances for the Caribbean. But it's important to recognize that this this recommendation is a bit old and is focusing on the RDA, which is more appropriate for the individual assessment. And because we are looking at the population of assessment, we'll be considering this other references here is to the sign define the child this choice. But so far, that's what we have been considering. So now looking to the sum of the results of the transfer recalls. You'll see that about 93% of the sample population reported having breakfast, which is something good. And then we have high proportions for lunch and dinner. 37% are snacking between the meals. And this is a meal occasion that my food brings as an option in 64% were reporting having drinks. When you look at the energy intake on average or looking at the median total sample. We see a low intake as we already have expected from the code for values, about 1400 kilocalories. This is comparable between the islands in terms of median. And of course, we observe a higher consumption for me and as compared to women. And then if you look at the contribution of macro nutrients to this energy intake, we will see a high proportion of energy coming from fat, about 30% for both men and women, and also for total sugar, which is about 20%. This is slightly higher for women. And this is possibly a target for policies and programs in the area that could be focused. Looking to the reduction of these numbers. If you look at the food consumption occasions to the intake of energy and nutrients, you will see that most of the contribution for energy macro nutrients will be coming from breakfast, lunch and dinner. But we have this important result here that's adding to 20% of energy coming from total sugars, which if you're looking to a bit more in close to which foods are actually contributing to this total sugar intake. You will see that fruits and beverage drinks and here excluding natural fruits and juices are contributing to 40% added sugar in beverages are contributing to 25% soft drinks, alcoholic drinks coming also to a certain degree. And we know that high consumption of sugar sweetened beverage are a public health concern. And again, this could be a possibility for policies and programs targets to the total sugar intake. Similar contributions will be seen from vitamins and minerals in relation to food occasions, mostly coming from breakfast, lunch and dinner, but then some variations here considering let's say vitamin C, which is also coming from drinks. The last result would like to share with you. And here I'm not presenting figures yet because we still have a long way to validate the numbers with the workshops Sharon has mentioned before, but we have vitamin B3 and B12 as being adequate for most of the population. And for a number of vitamins and minerals, we have observed low intakes, at least for part of the population of our subgroups of the population. At this moment, this is of no concrete indication that these low intakes are of concern from a public health point of view, but we certainly need further evaluations and monitoring which this data will allow us to do now. And a preliminary finding considerations to finalize my presentation is that expressive self-report of lower weight in obesity was observed in the sub-population. Main meals are the most important sources of dietary intake in the population, as expected. A high contribution for fat and total sugar intakes was observed in this is a possibility for targeted policies and programs. A low consumption low intake was observed in the pandemic period, and this is an important aspect to be considered. It may partially justify the results, but we still need to look into that into more detail. And I guess it's also important to acknowledge that the underestimation of food consumption should not be neglected in the evaluation, especially based on the Goldberg Cut-off Evaluation Points, which has showed us that. And I would like to remember and highlight especially that this is a photography of the food consumption, is the first monitoring of the country, and certainly this will allow us to monitor and confirm the present results over the years. Future analysis will be performed to confirm the observed nutrient values and its inadequacies. So far, we also have not looked into much on the food group assessment, but we wish to assess the food sources of nutrient intakes and also compare food groups with guideline comparisons such as the national guideline from the country. Exploration of the data cross-educational and income levels will be performed. And further insights on the consumption of food according to local production, especially considering that for some food groups, not all, we have descriptors available to give us some information on locally produced production or homemade production and industrial production. Other data explorations will be disseminated to scientific publications. And to finalize, I would like to acknowledge the assistance or some help at a certain point from intake organization, megagitular and joint arsenal, Maximilucian and Soziakami-wise physicians, and also Deborah Frizzi, who certainly helped me, helped us a lot with the data analysis of the survey. Thank you very much. Thank you so much, Sandra, for giving us an insight of the preliminary results of this exciting survey. May I give now the floor to Bridget? And may I remind everybody that you can, if you have any questions or comments, please put them into the chat or the Q&A. Thanks very much, Ruth. Sandra, would you mind just stopping the sharing of the screen, please? Yeah, let me try. Oh, now I've helped. Very. Thank you. Thank you. Okay. Good morning. Good afternoon. Good evening to all. So I'd like to start by thanking Ruth very much for the kind invitation to present today and thank you all for your attendance and especially staying to the end of this webinar. I'd also like to thank the St. Kitts and Nevis project team for welcoming me recently to the project team. So my name is Bridget Holmes and I'm a nutrition and food systems officer and leader for the nutrition assessment team in FAO HQ in Rome. And I'll be presenting today about our commitment to dietary data sharing and dissemination. I'd like to just start by extending a special thank you to the nutrition assessment team, in particular those working on the sharing of dietary data, so Victoria and Jessica, Rita and Theresa, some of whom are attending the webinar today and a bit of background before I get into the nitty gritty of the presentation. So a bit of context related to dietary data. So when I refer to dietary data I'm referring to data about what people eat, so food consumption, what nutrients are in food, so food composition and how adequate the diet is so adequacy quality and diversity. And we know it's well recognized that there is a lack of dietary data, especially in low and middle income countries. So my name of the nutrition assessment team in FAO to accelerate data sharing, maximize data use and create a robust global evidence base on which to develop policies and improve nutrition. So we've heard already in the different presentations about why dietary data is needed and the relevance for St. Kitts and Nevis. So I'm going to give you a summary of some of the reasons why it might be needed. So first of all, simply to understand about why people, what people eat and drink, and understand the context that they eat and drink so when they eat where they eat with whom they eat and meal patterns and habits. But we can also look at differences in dietary intakes by factors like age, sex, type of area income or family size. And provide evidence on energy and nutrient intakes. We're also able to use this type of data to understand nutrients in food and the sources of nutrients in the diet and understand how particularly local foods or wild foods might contribute to adequate diets. We're able to look at diet quality and diet diversity and identify areas of concern in the diet or those population groups of concern. We're also able to research healthy and less healthy dietary patterns and investigate the link between diet and health. So for example, looking at non communicable diseases which we understand is particularly important in this region. We can also use this data to evaluate and consider the need for food fortification programs, but also to monitor and inform national food policies guidelines and health education programs and track progress towards the SDGs. And as Sandra was just mentioning, we can we can also use the data to monitor dietary trends and shifts. For example, looking at trends over time or particular towards particular types of foods. And finally, we can look at things like the sustainability or the implications of food choice and use the data to monitor and inform food safety policies and agricultural policies. So with these reasons in mind, I'd like to share with you some information about the global individual food consumption data tool or gift. And this is developed by FAO in collaboration with the World Health Organization together with other international partners and is funded by the Bill and Melinda Gates Foundation. This tool serves as a platform to make global individual quantitative food consumption data publicly available, accessible from all countries around the world, collected through both large nationwide surveys and small scale surveys. So there's different types of data that we can include in this platform, but we focus on data that is collected using 24 hour recalls, which was the method of choice for the St Kitts and Nevis survey or food records. But we only include dietary data that was quantitative so where information was collected on on amounts and covering the whole diet so where we have information on all foods and beverages consumed. The data that we include must already be matched to food composition data and amounts and nutrients reported as consumed. We also ask that the data for recipes is normally disaggregated into single ingredients. And we have a limit of at least 100 subjects in a survey. But we do include data sets from national subnational or small scale data sets depending on the country. There's several possible outputs that you can obtain from the platform. The platform essentially provides food based indicators for nutrition and food safety, infographics and visual representations of the data, and these are particularly adapted for non specialized users. We also share metadata summary statistics and micro data is available for download and further analysis with a particular focus on low and middle income countries. So the example screenshots you can see here are just illustrating the kinds of outputs you can achieve from the platform. For example, you can look at very high intakes which are relevant for food safety. You can also understand more simply contribution to the daily diet from different food groups. And another example here, for example, we can use the platform to look at the sources of micronutrients and macronutrients in the diet and this illustration is just to show you how that would look. So to date we have metadata available on nearly 300 surveys worldwide and micro data available for 24 surveys, as you can see from this map taken from the platform. In order to be to share these types of infographics, there's several steps that need to be followed. And this slide illustrates those steps. So the first step for us is to identify the existing data through our networks and through searches. We then validate the eligibility criteria, for example, the sample size and the method of dietary assessment used. Once data owners agree to share their data, we undertake a comprehensive data harmonization process which involves coding the data using a system called FoodX2 developed by EFSA. This allows the classification and description of foods using a common language across databases worldwide. Sometimes this type of FoodX2 coding is carried out by the data owner after training by FAO and checking by the team. In other cases, this is carried out by the team themselves, but for both scenarios, there's a lot of interaction between the data owners on this. And then at the end of the process, the data can be shared through the platform. So just to highlight where we are now with this development of the platform, we're hoping to expand the work that we've been doing. And we aim to disseminate microdata for at least 50 data sets in total by the end of next year. And we're continuously working to expand the metadata inventory of surveys. We're also working to create new infographics on dietary adequacy, diversity, food safety and environmental impact. And this will further maximize the use of dietary data. We're working on developing methodological protocols to share and improve the platform technology. And additionally, we undertake regular capacity development activities, including extensive training, giving to key stakeholders in countries on the use of their dietary data, and training on data harmonization for data managers. And we've trained over 200 data managers to date. So with this data sharing in mind, I want to just share a few considerations with you. Data sharing is not always straightforward and we often face challenges. So for example, the sharing of microdata, there's often difficulties accessing the data owners themselves and the willingness of data owners to share their data. The timing of the sharing is often critical versus other survey deliverables. And there's, there's legal issues and privacy, privacy laws that we need to take into account. We also need to consider carefully the quality of the data. So understand precisely the method of assessment, the method description, the portion methods, etc. And for this we cannot stress enough the importance of keeping clear protocols to document methods used. Some considerations in the, in the data use, including clear communication to platform units and transparency regarding data limitations. Regarding sharing of metadata, we often lack sufficient details and publications. And of course we see a time lag between data collection, publication, and then entry onto the inventory map. And with these considerations in mind, it's really key to stress how important partnerships and collaboration with data owners is. So just to summarize, we really see that there's huge opportunities in the collection sharing and use of data to improve global nutrition. And the first step towards having effective intervention is having reliable data on which to base programs and policies. The core of this data need is reliable information on what people eat and drink, what nutrients are in food, and how adequate the diet is. Despite this data needs, there is currently a huge knowledge gap. And it's the FAO nutrition assessment team will be aiming to focus on bridging this knowledge gap and accelerating data sharing and maximizing data use to create a robust global evidence base. If you know of a survey that is not included in our map, or you have dietary data to share, please do get in touch. With this in mind, I'd really like to share some good news with you that the survey that you've been hearing about today, the St Kitts and Nevis National Individual Food Consumption Survey will be shared soon on the platform. I'm pleased with kind agreement from the Ministry of Health, and I'm really delighted that this data will form part of the platform and I thank the ministry and the project team. So that's it from me. Thank you very much and back over to you, Ruth. Thank you so much. So, I think we have now seen the data flow from the very beginning to where it could end up. So in the FAO double weight show gift platform. So thank you so much. And I would really like to thank each of the presenters for to be in time. Very interesting. And, and really, I hope motivating for others to do the same. So we are now in the section of question and answers and we have some questions. So one of the first one is, will the presentations be available. This webinar is recorded so and it will be published on the FAO website. So where you can find it, we will not share the presentations as such, but only the recording of this webinar. And then we have a lot of questions on on regarding of my food 24. So as an NGO, would I have access to my food 24. And if so, how much would it cost. Who would like to answer probably Sharon. Thank you. We paid over 15,000 pounds UK pounds to be able to use the platform, but we were putting in data for two countries. Okay. And so it will be, you will have to interact with my food 24 to get a precise code for your use. So I can just share our experience. Thank you. So it was very expensive. I want to add this not a small amount of money and then there's the annual license to be able to continue to access the data. But you do have the ability to download all your data at the end and use it as you see fit in country. Thank you. Thank you. So we have a question from Europe line. Would you do you think that we could use the Caribbean my food 24 version in Europe line. Well, I think Ruth you are in the best position to answer this question but I would say yes. It could it could be possible to use it in that country. But they need to add the specific local foods that that would not be present in the current Caribbean food and drink database so maybe you can add more to that. Sure. So Sandra, you have you are raising your hand. Yeah, I would just like to say that an important aspect we consider is the language that can be adapted within my food 24 but as your guys speaks Spanish. The whole database behind I believe in terms of food description needs to be adapted. It could be translated and also adapted to the local food pattern that we mean extra work, but it could be a beginning a start point for for your for building our database. So and probably to add something on it so other my food 24 so they have between probably 2000 3000 food entries we have 30,000. So it means that we are much more detailed and it is very likely that if you want to adjust our version to yours so that you will find the food already entered into the system. So which will be a big advantage but as Sandra said it's if you require is in Spanish, you need to translate everything into Spanish, and probably also use different photos and photo books for the local food that you have so add some and dismiss others. Where is the Caribbean my food toasted is it toasted in UV or in the UK. It's posted in the UK coming out of my food 24 they maintain the platform, but only information is resides on what we're in a position to do is download the data. Once it's collected in the field is immediately translated online. And so that we could get that immediate recovery of data. So it's posted in the UK, but accessible to the data owners and in our case as you say the providers and so on, when getting my food 24 it's available to us, but we do not host it at the week. Thank you. Yes. So how many people worked on the preparation of my food 24. Well, I think the responsible officer Dr. Hutchison is in the best position. All I can say is, most likely, taking into consideration the senior technical experts, the junior technical expert, people from FAO and our consultant research assistants from Brazil as well as well as at UV. I would say about 20 but for precision, I would like to ask Dr. Hutchison to entertain that question. Okay, so I put an answer in the in the Q&A area just for the development of the information that went into my food 24 to allow us to have the survey implemented. We utilized six experts for support persons including IT and approximately 10 research assistants to help with the data entry. However, the additional components of the work that is needed for analysis, such as the compilation of nutrients for the Caribbean, that took three experts and four research assistants. Data analysis required additional experts such as the statistician to data experts, etc. So that I depended on it depends on which aspect of the work you are talking about. As I mentioned, there are many different activities were taking place simultaneously and we've brought an additional expertise to work with us as we went along. I would say that for the just for getting the survey implemented those 20% but for the entire work. It would be at least nine experts and 27 people on the ground in St. Kitts and Nevers, plus more than 15 research assistants engage in various activities at different times. Just to give you an idea of the scope of the team that was needed to execute this work. Thank you. Thank you. Ruth, can I say one thing? There is Janet. Janet has written something. Can you see it Ruth? Yes, let me. So to answer also the question to from Uruguay, so Janet Kate, who is the, while I don't know the mother of my food 24. She said that they are developing a new tool for in Peru in Spanish so that could be helpful as well. For the others. The other question is, did you ask if COVID impacted on food intake? Was there a specific question in the questionnaire about that? I know that Sharon has already answered something in the chat or in the Q&A answer box. The data analysis point of view from what we could see in the data. Well, first of all, we did not have any question related to that. So we could have asked something specific but we missed that opportunity. But I do like to say that spontaneously we had a few feedbacks from the participants saying that pandemic was affecting their lives. There was no high number but it called our attention during the analysis and that's why we are making these considerations. I made these considerations in the presentation because otherwise spontaneously said if we have asked perhaps we would have more feedback on this type of information. But also as Sharon has pointed out, the IANA has not been affected a lot by the lockdown it seems, although through is an ES. I guess we need more time to talk to the country to validate all this information to be able to say what's the implication of this, the results we are presenting. It's something to be considered but it's hard to affirm without having been asked. Yes. Then there is another question on the trace values in the food composition table. How that one was translated into values. I may try to answer this question. In the inputs power guidelines, we say that trace elements should be recorded as a value half of the LOQ. So as the standards of power inputs were followed, I guess this is what was taking place. Then we have some other questions about countries who would like to use it. To use myFood24 or to ask for assistance to do the same like what was done in some kids' names in other countries. So this is not to us to comment on because this will depend on the country where you are in. And if there is somebody like Latoya in St. Kitts and Davies who has all the energy and is able to convince the power representative to say, you know, yes, this is something that we need in our country. So POW is a very good agency to help us in doing so why don't we collaborate and do it. So this is really depending on the country, depending on the urgency that every country sees if they want or not to do a food consumption service and then with whom. Then then I have a lot of comments from our participants saying really very nice presentation, great. Thank you so much. And so just to add the Peruvian myFood24 version will feature an offline function too, which might be useful if you would like more information contact the myFood24 team. So please look at the internet myFood24 and contact them. With this one, if we don't have many more, if we don't have any additional questions, which I don't see for the moment, there is one, I'm leading a national dietary intake survey to take place in July November in South Africa. We are concerned about the impact of COVID on dietary intake as unemployment increases and we had several hard lockdowns and there will be, and there is another way. So if COVID is always the last year, I think COVID has had implications a lot for the whole world and even for the dietary assessment. So it's for sure it will impact but we will only know in the future how it impacted and to which extent. Ruth, may I just say a few words to this question from South Africa. I would suggest that the food security assessment could be performed along with the national survey. This is something we do in Brazil with a scale that is easy to answer with a few questions that will not add a lot of burden in the assessment. We have not considered that for some kids because we did not expect at that point that food security would be a problem at that level. But thinking now about the pandemic and that some countries are doing that, I would highly suggest to include this kind of assessment, which is about 14 extra questions in the real result in the degree of food security in the country. Yes, that is a very good suggestion and FAU is also working with Anna Herstvolch on the dietary diversity questions, which are about 25 questions and which take more or less five minutes to answer. So probably this would be also an additional tool to allow additional and different analysis of the food impact of the people. So before closing, I would like to give the floor to everybody to give a final comment. May I start with Sharon? So what would you like to say as to close before closing? Thank you, Ruth. I would just like to say that it really takes very close relationships, a lot of relationship building between the country, the service provider and the funder to ensure that the goals are met in a timely way. Notwithstanding any challenges and I am very pleased that we have an excellent team of persons working with us and I was happy that we were able to keep focused and keep moving forward every step of the way. So that team building and team management is a critical part of this kind of process. Thank you. Yes, I would just mention that the Caribbean version of the My Food 24 we developed is accessible and can be applied, as we mentioned earlier, not only in other parts of the Caribbean but also in Latin America. And of course, as Francine has written here, there is some cost to be here and you just have to contact My Food 24 and ask about the cost. That's all I have to say. Thank you. Thank you. Sandra. Oh no, sorry. Latoya and Katrin. Let's go. Good day again everyone. My final comments would be as relates to the experience of this survey overall. Firstly, I would like to thank FAO and their team, Dr. Shandria especially. For the early work and dedication as well as being one of the joint forces to ensure that this survey was a success to the participants, I must say, just looking from the preliminary data. I think it's a needless, we can agree that the data, a majority of it is a representation of what is currently happening in Senkitsa and Nibis and the ground. And I think it would be highly beneficial if we could get some other countries to be able to have data like this to look at the current situation and the ground as well as the nutrition. Being in the field of nutrition quite often, we are on the look sometime by some of our peers. So extremely good for that we know have this data and that we were able to complete a survey like this here in Senkitsa and Nibis which looks at a lot of the indicators as it relates to the nutritional situation of the population here in Senkitsa and Nibis. I want to thank the team again for involving me as well as follow up to what Dr. Hutchinson said about the dynamics of the group members as we need to be actively a part of the managing process of this survey. Thank you. Well, to add to what Latoya said, I would just say that for me, the experience was wonderful working with Senkitsa and the team there, you know, collecting data, it might seem challenging, but it was so rewarding to get good data at the end. Right. Isabella, would you like to say something? Okay, so good morning to the panelists as well as to the participants. Working on the individual food consumption survey has been a wonderful experience as well as a learning one. And the point at which we are at in the survey, I mean, it's when you look back, you wonder whether or not you were really involved in the amount of work that was done to get us where we are at. You know, how important the collaborations with each and everyone, the camaraderie with everyone as well. Yes, there were moments. However, you know, you bypass those moments, and we know that there was this goal that we had to achieve. And we got it done. So today's webinar to me has really put things in the context and it has brought us to that it's not the climaxes yet, because we are still working on other things. But I think it was just a wonderful experience and sitting and listening even made it a lot better. So thank you to Ruth and the team. Thank you, Isabella. Richard. Yeah, thanks Ruth. Maybe just the last word to say, you know, collecting any dietary data is challenging at the best of times, but really having learned about what the project team have done is, you know, I really want to just extend my congratulations to all the challenges that they've managed to overcome. And, yeah, look forward to further analysis of this data and really getting the most out of it as possible. So many thanks. Thank you. So, and I would like to join everybody else and saying, you know, it was a wonderful experience. It was really hard at times. And, and sometimes I think everybody of us was thinking, will we really manage to do it in the short time available and and to do everything that we did in one month, one year and three months. It's amazing. It's amazing. And, and it really shows that how everybody really everybody everybody on the ground in the team in the wider team has put all their efforts and hard into it and and making it real. And today, you know, I think it's really rewarding to see how the preliminary data comes through and that we can present it and we can be all proud of it. And I hope that this seminar was able to, to motivate other countries to go the same course. It is, it is painful at times, but it is so rewarding and we really need this data so that future policies and and programs are not just based on an an estimation of something but on real data. I see Sandra would like to add something. Yeah, because I'm, I think I didn't have the opportunity to say a few last words after Latoya and catering. I just want to add because actually everything that has been said, I agree and I confirm what I just would like to highlight is that how proud we should be or how proud the country should be with the first national food consumption survey from St. Kitties and Avis. In Brazil, we are always remembering the first survey we are always referring to that as the landmark for for what's going on with the country, if it thinks increase it, again, got worse. And now, I think it's an Avis will have that opportunity to monitor what's going on with their population in terms of dietary intake. Yes, I just missed that. Thank you for reminding. And yes, and I hope that when you have data or you think to do data to collect the data and that you will also share it with the gift platform because any data that is just in a drawer or in a report and not being used else how it's it's, it's a nice academic exercise, but it could be so much more useful and data sharing today is is key is key to bring the research questions up to and to answer some of them. So, having said so, I would really like to thank everybody of the presenters for their really wonderful presentations and insights and and to the participants for their questions and participation and patients to stay so long with us. And hopefully, we will have more dietary data in the future and not only dietary data, but the corresponding food composition data as well. Okay, thank you so much. And have a wonderful day and see you soon.