Abstract

IntroductionPoor recall during investigations of foodborne outbreaks may lead to misclassifications in exposure ascertainment. We conducted a simulation study to assess the frequency and determinants of recall errors.MethodsLunch visitors in a cafeteria using exclusively cashless payment reported their consumption of 13 food servings available daily in the three preceding weeks using a self-administered paper-questionnaire. We validated this information using electronic payment information. We calculated associated factors on misclassification of recall according to time, age, sex, education level, dietary habits and type of servings.ResultsWe included 145/226 (64%) respondents who reported 27,095 consumed food items. Sensitivity of recall was 73%, specificity 96%. In multivariable analysis, for each additional day of recall period, the adjusted chance for false-negative recall increased by 8% (OR: 1.1;95%-CI: 1.06, 1.1), for false-positive recall by 3% (OR: 1.03;95%-CI: 1.02, 1.05), for indecisive recall by 12% (OR: 1.1;95%-CI: 1.08, 1.15). Sex and education-level had minor effects.DiscussionForgetting to report consumed foods is more frequent than reporting food-items actually not consumed. Bad recall is strongly enhanced by delay of interviews and may make hypothesis generation and testing very challenging. Side dishes are more easily missed than main courses. If available, electronic payment data can improve food-history information.

Highlights

  • Poor recall during investigations of foodborne outbreaks may lead to misclassifications in exposure ascertainment

  • Our results show that earliness of interviews of patients during foodborne outbreaks is essential, when the pathogen and disease have long incubation periods

  • Table A: False-negative food recalls by different groups for reported food selections, Berlin, Germany, 2013

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Summary

Methods

Lunch visitors in a cafeteria using exclusively cashless payment reported their consumption of 13 food servings available daily in the three preceding weeks using a self-administered paper-questionnaire. We validated this information using electronic payment information. We calculated associated factors on misclassification of recall according to time, age, sex, education level, dietary habits and type of servings

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