Supervisory team
LSHTM
Nagasaki University
- Miho Sato ([email protected])
American University of Beirut (AUB)
- Shady Elbassuoni ([email protected])
Project
Background
Acute malnutrition remains a major cause of morbidity and mortality among children under five in low-resource and humanitarian settings, affecting more than 45 million children globally. Despite extensive efforts, early detection and prevention remain constrained by methodological and operational challenges in existing surveillance systems. Traditional dietary assessment tools such as 24-hour recalls and food frequency questionnaires are limited by recall bias, intensive training needs, and logistical barriers in emergency contexts. While anthropometric monitoring is vital for identifying malnutrition, it primarily captures downstream nutritional outcomes rather than the upstream dietary and behavioral determinants that precede them. Furthermore, in situations where physical access to populations is restricted or impossible such as active conflict zones or besieged areas, we lack timely data on both nutritional status and dietary intake.
Mobile health technologies offer promising solutions to these challenges, enabling more frequent, less burdensome data collection that can inform timely interventions and improve targeting of nutrition assistance in crisis-affected populations.
Proposed project
This doctoral research aims to develop, validate, and operationalize a mobile-based dietary data collection tool that enhances early detection of nutritional risks and informs preventive strategies in humanitarian settings. The tool will leverage smartphone-based image recognition technologies to capture dietary intake information efficiently in low-resource contexts.
The study will be implemented in three phases:
Phase 1: Formative Research
A review will examine the validity and reliability of mobile-based dietary assessment methods in low-resource settings. Key informant interviews with humanitarian nutrition practitioners and UNRWA health staff will identify operational barriers, user requirements, and ethical considerations for technology-based data collection among vulnerable populations.
Phase 2: Tool Design and Development
Building on Phase 1 findings, the researcher will co-design a mobile dietary assessment tool tailored to the Palestinian humanitarian context. The tool will incorporate image recognition, simplified portion size estimation, and culturally appropriate food databases. Participatory design approaches with caregivers and health workers will optimize acceptability and usability.
Phase 3: Validation Study
A cross-sectional validation study involving 200–400 children aged 6–59 months and their caregivers will be conducted in UNRWA health facilities in Lebanon and Somalia. The mobile tool will be validated against gold-standard methods (weighed food records and multiple-pass 24-hour recalls), assessing accuracy, reliability, acceptability, and feasibility for integration into routine humanitarian nutrition surveillance.
References
- Gelli A, Nwabuikwu O, Bannerman B, Ador G, Atadze V, Asante M, Bempong S, McCloskey P, Nguyen PH, Hughes D, Folson G. Computer vision–assisted dietary assessment through mobile phones in female youth in urban Ghana: validity against weighed records and comparison with 24-h recalls. The American Journal of Clinical Nutrition. 2024 Nov 1;120(5):1105-13.
- Hattab S, Badrasawi M, Anabtawi O, Zidan S. Development and validation of a smartphone image-based app for dietary intake assessment among Palestinian undergraduates. Scientific Reports. 2022 Sep 14;12(1):15467.
- Elbassuoni S, Ghattas H, El Ati J, Zoughby Y, Semaan A, Akl C, Trabelsi T, Talhouk R, Ben Gharbia H, Shmayssani Z, Mourad A. Capturing children food exposure using wearable cameras and deep learning. PLOS Digital Health. 2023 Mar 27;2(3):e0000211.
The role of LSHTM and NU in this collaborative project
The collaboration leverages complementary expertise:
• LSHTM: Humanitarian nutrition, epidemiological modeling, famine early warning systems, regional partnerships
• NU: Food environment assessment, participatory qualitative methods, mobile health technologies, dietary tool validation
LSHTM will lead the project. Dr Zeina Jamaluddine, with a background in nutritional epidemiology in refugee and Middle Eastern contexts, will supervise the study design and field implementation. Professor Francesco Checchi will provide guidance on humanitarian health research and nutrition surveillance. Dr. Miho Sato will supervise the qualitative components, focusing on tool feasibility, user acceptability, and ethical considerations.
Particular prior educational requirements for a student undertaking this project
- Master's degree in nutrition, dietetics, public health nutrition, or nutritional epidemiology.
- Demonstrated experience with statistical analysis and epidemiological methods.
- Fluency in spoken and written Arabic (primary data collection will occur in Arabic-speaking population).
- Prior field research experience in low-resource settings, humanitarian contexts, refugee populations, or the Middle East regions.
- Understanding of young child feeding practices.
- Experience conducting ethical research with vulnerable populations.
Skills we expect a student to develop/acquire whilst pursuing this project
- Advanced dietary assessment methodologies and validation techniques.
- Mobile health technology applications for nutrition surveillance.
- Understanding of infant and young child feeding practices in humanitarian contexts.
- Survey design and questionnaire development for humanitarian settings.
- Conducting ethical research with vulnerable populations in humanitarian contexts.