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.

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.