Learning from the Community to Predict Nutrition Status of Children Aged 6-24 Months in Gulu District, Northern Uganda: A Case Control Study.

The feeding and caring practices of infants and young children are critical to children's nutrition status and development milestones. Most nutrition studies have focused on unfavorable factors that contribute to malnutrition rather than favorable factors that promote good nutrition status among children. This study aimed at identifying predictors of normal nutrition status among children aged 6-24 months in Gulu District, Northern Uganda. A matched case-control study was conducted on a sample of 300 (i.e., 100 cases and 200 controls) purposively selected children during October-December 2021. Controls were children that had normal nutrition status, whereas cases with undernourished children had at least one type of undernutrition. Logistic regression was used to determine the predictors of good nutrition status using odds ratios (ORs). The mean age of the cases and controls was 15 months (SD ± 6) and 13 months (SD ± 5), respectively. At multivariable analysis, breastfeeding in the first hour of the child's life (AOR = 3.31 95% CI. 1.52-7.23), use of family planning (AOR = 2.21 95% CI. 1.25-3.90), number of under-fives in the household (AOR = 0.31 95% CI. 0.13-0.73) and hand washing with soap (AOR = 3.63 95% CI. 1.76-7.49) were significantly independently associated with a child's good nutrition status. Interventions that can improve children's nutrition status include breastfeeding in the first hour of child's life, use of family planning methods, child spacing and hand washing with soap.

Malaria reduction drives childhood stunting decline in Uganda: a mixed-methods country case study.

BACKGROUND: Uganda has achieved a considerable reduction in childhood stunting over the past 2 decades, although accelerated action will be needed to achieve 2030 targets. OBJECTIVES: This study assessed the national, community, household, and individual-level drivers of stunting decline since 2000, along with direct and indirect nutrition policies and programs that have contributed to nutrition change in Uganda. METHODS: This mixed-methods study used 4 different approaches to determine the drivers of stunting change over time: 1) a scoping literature review; 2) quantitative data analyses, including Oaxaca-Blinder decomposition and difference-in-difference multivariable hierarchical modeling; 3) national- and community-level qualitative data collection and analysis; and 4) analysis of key direct and indirect nutrition policies, programs, and initiatives. RESULTS: Stunting prevalence declined by 14% points from 2000 to 2016, although geographical, wealth, urban/rural, and education-based inequalities persist. Child growth curves demonstrated substantial improvements in child height-for-age z-scores (HAZs) at birth, reflecting improved maternal nutrition and intrauterine growth. The decomposition analysis explained 82% of HAZ change, with increased coverage of insecticide-treated mosquito nets (ITNs; 35%), better maternal nutrition (19%), improved maternal education (14%), and improved maternal and newborn healthcare (11%) being the most critical factors. The qualitative analysis supported these findings, and also pointed to wealth, women's empowerment, cultural norms, water and sanitation, dietary intake/diversity, and reduced childhood illness as important. The 2011 Uganda Nutrition Action Plan was an essential multisectoral strategy that shifted nutrition out of health and mainstreamed it across related sectors. CONCLUSIONS: Uganda's success in stunting reduction was multifactorial, but driven largely through indirect nutrition strategies delivered outside of health. To further improve stunting, it will be critical to prioritize malaria-control strategies, including ITN distribution campaigns and prevention/treatment approaches for mothers and children, and deliberately target the poor, least educated, and rural populations along with high-burden districts.

Using dietary serving scores to assess adequacy of dietary intake and associated factors among adult patients with type 2 diabetes in Kampala: a cross-sectional study.

BACKGROUND/OBJECTIVES: Adequate dietary intake for type 2 diabetes mellitus (T2DM) patients is central in preventing or delaying onset of diabetes related complications. This study used dietary serving scores (DSS) to determine the adequacy of dietary intake and associated factors among patients with T2DM in Kampala. SUBJECTS/METHODS: A facility based cross-sectional study among adult T2DM patients attending diabetes clinics attached to health care facilities in Kampala was conducted. Semi structured demographic and 7-day Food Frequency Questionnaires (FFQ) were used to collect data on sociodemographic characteristics, environmental factors and dietary intake respectively. Dietary intake was computed using Dietary Serving Scores (DSS) and was grouped into two: "adequate dietary intake (DSS of 78 and above)" and "inadequate dietary intake (DSS below 78)". Multiple linear regression was used to assess correlates of dietary intake. RESULTS: Out of the 400 participants, only 49 (12.25%; 95% CI: 9.04, 15.46) were classified as having adequate dietary intake. After adjusting for potential confounders, unmarried individuals (ß = -2.367; p = 0.024) and those who are salaried (ß = -3.162; p = 0.012) or self-employed (ß = -4.214; p = 0.001) had significantly lower mean DSS compared to their respective counterparts. T2DM patients who attended Nsambya hospital diabetes clinic had significantly higher mean DSS (ß = 3.698; p = 0.022) compared to those who receive treatment in Lubaga hospital. CONCLUSIONS: The prevalence of adequate dietary intake among patients with T2DM attending health facilities in Kampala is very low. More efforts are needed to educate patients on better dietary choices aligned with disease management.

Effect of Nutrition Education on Knowledge, Complementary Feeding, and Hygiene Practices of Mothers With Moderate Acutely Malnourished Children in Uganda.

BACKGROUND: Inappropriate infant and young child complementary feeding practices related to a lack of maternal knowledge contributes to an increased risk of malnutrition, morbidity, and mortality. There is a lack of data regarding the effect of nutrition education on maternal knowledge, feeding, and hygiene practices as part of a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition in low-income countries like Uganda. OBJECTIVE: To determine whether nutrition education improves knowledge, feeding, and hygiene practices of mothers with infants and young children diagnosed with moderate acute malnutrition. METHODS: A cross-sequential study using a pretest-posttest design included 204 mother-infant pairs conveniently sampled across 24 randomly selected clusters. Weekly nutrition education sessions were embedded in a supplementary porridge intervention for 3 months. Mean scores and proportions for knowledge, feeding, and hygiene practices were determined at baseline and end line. The difference between mean scores at the 2 time points were calculated with the paired t test analysis, while the proportions between baseline and end line were calculated using a z test analysis. RESULTS: Mean scores for knowledge, dietary diversity, and meal frequency were higher at end line compared to baseline (P < .001). Handwashing did not improve significantly (P = .183), while boiling water to enhance water quality improved (P < .001). CONCLUSION: Nutrition education in conjunction with a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition improved meal frequency, dietary diversity and water quality.

Physical Activity Levels Among Adults in Uganda: Findings From a Countrywide Cross-Sectional Survey.

BACKGROUND: Being physically active is associated with lower risk of many noncommunicable diseases (NCDs). We analyzed physical activity (PA) data collected as part of Uganda's countrywide NCD risk factor survey conducted in 2014, to describe PA levels in Uganda. METHODS: PA data were collected on the domains of work, travel and leisure. We calculated the percentage of participants meeting the World Health Organization (WHO) PA recommendations, and the types of intense-specific duration of PA. Prevalence ratios (PR) were used to identify factors associated with meeting WHO PA recommendations. RESULTS: Of the 3987 participants, 3758 (94.3%) met the WHO PA recommendations. Work-related PA of moderate intensity, and travel-related PA contributed most to participants' overall weekly duration of PA, each contributing 49.6% and 25.2% respectively. The median weekly duration of all moderate-intensity PA was 1470 minutes (interquartile range [IQR] = 540 to 2460). Weekly duration of all vigorous-intensity PA was low with a median of 0 minutes (IQR = 0 to 1080). The median daily sedentary time was 120 minutes (IQR = 60 to 240). Factors significantly associated with meeting WHO PA recommendations were body mass index and level of education. CONCLUSIONS: PA levels in Uganda are high, mostly achieved through travel and work-related activities of moderate intensity.

Nutritional status, feeding practices and state of other related indicators at onset of a multi-model community nutrition intervention program in Mpigi District, Uganda.

INTRODUCTION: In Uganda, malnutrition level has persistently remained high among the under-fives and this has led NGOs like World Vision, Uganda into finding innovative ways for intervention. This paper presents an assessment of nutrition status and values of related indicators at onset of a community intervention program in four sub-counties of Mpigi district in Central Uganda. METHODS: This was a cross-sectional study to provide baseline information for a nutrition intervention. The study units were index children aged 6-59 months from 818 households. Face to face interviews were conducted using semi-structured questionnaires. Values of key indicators were computed and compared between designated control and intervention areas. RESULTS: Stunting level was 32% while wasting was 3% and underweight at 10%. Most of the index children (78%) started breastfeeding within the first hour of birth. Nearly a third of the households visited had a kitchen garden and this did not differ by intervention status. CONCLUSION: Like at regional level, nutrition status and feeding practices in the study area were poor. The values of these indicators did not significantly change by designated intervention status. Much effort was needed to realize a difference in nutrition and feeding practices in designated intervention areas.

The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey.

BACKGROUND: Hypertension is an important contributor to global burden of disease and mortality, and is a growing public health problem in sub-Saharan Africa. However, most sub-Saharan African countries lack detailed countrywide data on hypertension and other non-communicable diseases (NCD) risk factors that would provide benchmark information for design of appropriate interventions. We analyzed blood pressure data from Uganda's nationwide NCD risk factor survey conducted in 2014, to describe the prevalence and distribution of hypertension in the Ugandan population, and to identify the associated factors. METHODS: The NCD risk factor survey drew a countrywide sample stratified by the four regions of the country, and with separate estimates for rural and urban areas. The World Health Organization's STEPs tool was used to collect data on demographic and behavioral characteristics, and physical and biochemical measurements. Prevalence rate ratios (PRR) using modified Poison regression modelling was used to identify factors associated with hypertension. RESULTS: Of the 3906 participants, 1033 were classified as hypertensive, giving an overall prevalence of 26.4%. Prevalence was highest in the central region at 28.5%, followed by the eastern region at 26.4%, western region at 26.3%, and northern region at 23.3%. Prevalence in urban areas was 28.9%, and 25.8% in rural areas. The differences between regions, and between rural-urban areas were not statistically significant. Only 7.7% of participants with hypertension were aware of their high blood pressure. The prevalence of pre-hypertension was also high at 36.9%. The only modifiable factor found to be associated with hypertension was higher body mass index (BMI). Compared to participants with BMI less than 25 kg/m2, prevalence was significantly higher among participants with BMI between 25 to 29.9 kg/m2 with an adjusted PRR = 1.46 [95% CI = 1.25-1.71], and even higher among obese participants (BMI ≥ 30 kg/m2) with an adjusted PRR = 1.60 [95% CI = 1.29-1.99]. The un-modifiable factor found to be associated with hypertension was older age with an adjusted PRR of 1.02 [95% CI = 1.02-1.03] per yearly increase in age. CONCLUSIONS: The prevalence of hypertension in Uganda is high, with no significant differences in distribution by geographical location. Only 7.7% of persons with hypertension were aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure. Thus a big percentage of persons with hypertension are at high risk of hypertension-related cardiovascular NCDs.