Validation of Mini Nutritional Assessment Tool for Ethiopian Old Age People
Authors: Seid Ahmed Muhye , Babbel Netsanet Fentahun 
Published: March 2023

Abstract
Background: The health status older people is usually overlooked in many low-income countries like Ethiopia. Appropriate nutritional assessment improves the health of old age people. The use of validated tools improves the accuracy of the data obtained, the capacity to compare findings across research, and improves a study's potential to find connections with other modifying factors like eating habits. In addition, high-quality data can positively affect policies and services, as well as resource efficiency.
The Mini Nutritional Assessment tool is a noninvasive and cheap practical evaluation tool that provides a simple and quick method of evaluating the nutritional status of old age people. The tool has multiple versions of confirmed validity in diverse languages, except in Amharic. Furthermore, the tool has still not been properly validated for Ethiopian old age people.
Objective: The purpose of this study was to translate Mini Nutritional Assessment tool into the Amharic language and validate it among old age people in Bahir Dar City.
Methods: This tool translation and validation study followed normal COSMIN Study design and reporting guidelines. The study was conducted in three stepwise phases from January 16 to March 13, 2021. The first phase was reviewing and selecting nutritional assessment tools for old age people. In the second phase, the selected Mini Nutritional Assessment tool was translated and reviewed by experts. Using the heterogenous purposive sample, ten healthcare specialists with professional experience in the care of old age people were chosen for this step. The experts examined the face and content validity of the Amharic version of the instrument in two rounds of the Delphi technique.
Finally, after incorporating the experts’ suggestions and comments, a cross-sectional study was conducted among old age people for psychometric validation. The participant-to-variables ratio of the 10:1 rule of thumb was followed for the minimum sample size. Since the Mini Nutritional Assessment tool has 18 items, 180 community-dwelling old age people were selected in multistage cluster sampling from Belay Zeleke, one of the sub-cities of Bahir Dar City. Principal component analysis was used to measure construct validity while Cronbach's alpha was employed to assess internal consistency reliability.
Results: The majority of the experts were males between the ages of 25 and 34 years and had more than two years of working experience. As experts reviewed, all items in the translated tool are socially acceptable and have no taboo or sensitive words. The translated tool's content validity ratio was 0.93, and its scale validities (S-CVI/Ave and S-CVI/AU) were 0.97 and 0.83, respectively. Moreover, 180 community-dwelling old age people aged 60 to 90 years old participated in a psychometric evaluation study. Construct validity of the tool was confirmed with factor loadings ranging from 0.47 to 0.89 with a Cronbach’s alpha of 0.65. The tool had a sensitivity and specificity of 97% and 83%, respectively.
Conclusion: The Amharic version of the Mini Nutritional Assessment tool showed good cross-cultural adaption, internal consistency reliability, and construct validity in Bahir Dar community-dwelling old age people. The tool can be used in regular care activities for aged people.