Cure rate and associated factors for children 6-59 months with severe acute malnutrition under the out patient therapeutic care programme in the health centres of Kabale District in Southwestern Uganda: a cross sectional study.

BACKGROUND: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality among children below five years with sub-Saharan Africa being the most affected. In Kabale district, SAM affects 2.9% children under the age of five. Uganda government introduced Outpatient therapeutic care (OTC) programme in all health centre level III and IV of Kabale. However, there was limited information about the cure rate and its associated factors among children under the programme hence the cause for the study. METHODS: A retrospective cross-sectional study was carried out on records of children 6-59 months (n = 637), presenting with SAM on OTC programme in the health centres of Kabale between 2013 and 2015. Data on cure rate (outcome) and other independent factors were collected, cleaned in excel and then exported into STATA 12 for analysis. Univariate, bivariate and logistic regression analysis was run to generate frequencies and factors associated. RESULTS: The cure rate was 36.3% (n = 231 cases) with a median recovery time of 21 days. The default rate was 58.6% (n = 373 cases) while the non-response and death rate were 0.6% (n = 4) and 1.1% (n = 7) respectively. Source at admission (Adjusted Odds Ratio [AOR] = 0.1, 95% CI 0.0, 0.7, p = 0.012), Weight at admission (AOR = 0.5, 95% CI 0.0, 0.9, p = 0.014) and Number of visits to the program (AOR = 14.9, 95% CI 9.3, 24.2, p = 0.040) were positively associated with cure rate of SAM children on OTC programme in Kabale. CONCLUSION: Overall the cure and default rate for children on OTC programme in Kabale were significantly higher than national and international standards making the findings quite alarming. However, the weight of the child at admission, the number of visits to the programme to receive services and the source where the child was coming from were very important determinants of cure rate. To improve the cure rates of SAM children in Kabale, there is need for policy makers and programme implementers to think about a community based management of severe acute malnutrition program approach.

Production of nutrient-enhanced millet-based composite flour using skimmed milk powder and vegetables.

The aim of this study was to develop a nutrient-enhanced millet-based composite flour incorporating skimmed milk powder and vegetables for children aged 6-59 months. Two processing methods were tested to optimize nutrient content and quality of millet-based composite flour, namely germination for 0, 24 and 48 hr and roasting at 80, 100, and 140°C. The amount of ingredients in the formulation was determined using Nutri-survey software. Germinating millet grains for 48 hr at room temperature significantly (p < 0.05) increased protein content (9.3%-10.6%), protein digestibility (22.3%-65.5%), and total sugars (2.2%-5.5%), while phytate content (3.9-3.7 mg/g) decreased significantly (p < 0.05). Roasting millet grains at 140°C significantly (p < 0.05) increased the protein digestibility (22.3%-60.1%) and reduced protein (9.3%-7.8%), phytate (3.9-3.6 mg/g), and total sugar content (2.2%-1.9%). Germinating millet grains at room temperature for 48 hr resulted in millet flour with the best nutritional quality and was adopted for the production of millet-based composite flour. Addition of vegetables and skimmed milk powder to germinated millet flour significantly (p < 0.05) increased the macro- and micronutrient contents and the functional properties of millet-based composite flour. The study demonstrated that the use of skimmed milk powder and vegetables greatly improves the protein quality and micronutrient profile of millet-based complementary foods. The product has the potential to make a significant contribution to the improvement of nutrition of children in developing countries.

Effect of skimmed milk and vegetable powders on shelf stability of millet-based composite flour.

BACKGROUND: Millet porridge is a major complementary food used in Uganda but it is limited in protein and micronutrients such as zinc and beta-carotene. Addition of milk and vegetable powders are known to greatly improve the nutrient content of millet flour. However, there was limited information on the shelf stability of the resultant composite flour. This study aimed at assessing the effect of milk and vegetable powders on the shelf stability of millet-based composite flour. RESULTS: There was a general increase in the moisture content, peroxide value (PV), free fatty acids (FFA), thiobaturic acid (TBA) and total plate count (TPC) of both composite and millet flours over the eight weeks storage period. However, higher moisture content, PV, FFA, TBA and TPC values were recorded in the composite flour compared to millet flour (control) at each sampling interval. Sensory evaluation results revealed that panelists preferred porridges prepared from millet only compared to those from composite flour. The degree of liking of porridges from both composite and millet flours generally decreased over the storage period. However, both porridges were deemed as acceptable by the end of the storage period. The TPC also remained below 105 cfu g-1 which is the maximum limit recommended by the Uganda National Bureau of Standards (UNBS). CONCLUSION: The study findings indicated that the addition of milk and vegetable powders negatively affected the stability of the composite flour. We recommend further studies to stabilize the product during storage. © 2018 The Authors. Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Modelling the impact of stunting on child survival in a rural Ugandan setting.

BACKGROUND: Uganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting. This study was conducted to model the impact of stunting on child mortality in the southwest region of Uganda where the prevalence of stunting and child mortality are of great public health concern. METHODS: The study was conducted in Buhweju district in the southwest region of Uganda. The study was cross-sectional involving use of a structured household questionnaire, focus group discussions and interviews with key informants in order to gather relevant information on infant and young child feeding (IYCF) and coverage of antenatal care (ANC) and vaccination programs. The survey of stunting, vaccination and ANC services covered 221 children aged 6-59 months while the assessment of IYCF practices covered 83 children aged 0-23. The Lives Saved Tool (LiST) was used to estimate the impact of stunting on child mortality and cases of stunting averted. RESULTS: The study findings indicated that only 33% of the mothers had knowledge of optimal IYCF and 39% of the sampled children were exclusively breastfed. The majority of the mothers (57%) breastfed their children for less than 2 years and only 31% of the mothers practiced appropriate introduction of complementary foods at 6 months. Only 17% of the 0-23-month-olds received a good standard of IYCF. Only 37% of the mothers reportedly attended ANC 4 times or more during pregnancy and among children aged 6-59 months, only 28% were fully vaccinated. The high impact LiST model estimated that 1297 children under 5 years would be saved and 24,850 cases of stunting averted in the study district. CONCLUSIONS: The study concludes that IYCF practices and coverage of expanded programme on immunization (EPI) and ANC in the study population are sub-optimal thus the high prevalence of stunting and child mortality in the region. LiST demonstrated that prevention of stunting would reduce child mortality in rural Uganda. Therefore, increased investment in cost-effective child survival interventions targeting rural areas of Uganda would have a significant impact on stunting and child mortality.

Predictors of Stunting in Children Aged 6 to 59 Months: A Case-Control Study in Southwest Uganda.

BACKGROUND: Stunting affects close to 2.4 million children in Uganda, and it is among the major contributors to the annual loss in productivity of the equivalent of US$899 million. OBJECTIVE: This study sought to identify the key underlying causes of the persistently high stunting rates in a region of Uganda known to have low poverty rates and a high agricultural output. METHODS: A matched case-control study was conducted in Buhweju district, southwest Uganda to compare prior exposures between stunted children (cases) and nonstunted children (controls). RESULTS: The sample comprised 56 cases and 112 controls, totaling 168 children aged 6 to 59 months. There were almost equal numbers of boys and girls in the sample. Boys were significantly more likely to be stunted compared to girls (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1-4.2; P < .05). Stunted children were significantly less likely to be introduced to complementary foods at an appropriate age and their primary caregivers lacked knowledge about stunting. The odds of stunting were 2.4 times greater for children in food-insecure households compared to those in food-secure households (OR: 2.4, 95% CI: 1.1-5.0; P < .05) and 4.5 times greater among children who resided in poor quality houses (OR: 4.5, 95% CI: 1.4-13.0; P < .05). CONCLUSION: Low access to appropriate complementary diets, sex of child, food insecurity, poor socioeconomic status, and low knowledge about stunting were the main predictors of childhood stunting in the study population.