Browsing by Author "Prudence, Atukunda"

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The association between dietary diversity and development among children under 24 months in rural Uganda: analysis of a cluster-randomised maternal education trial
(Public health nutrition, 2021-03) Paul, Kakwangire; Cami, Moss; Nicholas, Matovu; Prudence, Atukunda; Ane, C Westerberg; Per, O Iversen; Grace, Muhoozi
Objective: To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children. Design: A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6–8 months with child development domains (communication, fine motor, gross motor, personal–social and problem solving) at 20–24 months of age. Setting: Rural areas in Kabale and Kisoro districts of south-western Uganda. Participants: Children under 24 months. Results: After multivariable analysis, DDS at 6–8 months were positively associated with normal fine motor skills development at 20–24 months (AOR = 1·18; 95 % CI 1·01, 1·37; P = 0·02). No significant association was found between DDS and other development domains. Children who were not ill at 6–8 months had higher odds of developing normal communication (AOR = 1·73; 95 % CI 1·08, 2·77) and gross motor (AOR = 1·91; 95 % CI 1·09, 3·36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0·58; 95 % CI 0·33, 0·98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0·05). Conclusions: We found an association between child DDS at 6–8 months and improvement in fine motor skills development at 20–24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20–24 months.
The association of urine markers of iodine intake with development and growth among children in rural Uganda: a secondary analysis of a randomised education trial
(Public health nutrition, 2020-07) Prudence, Atukunda; Grace, KM Muhoozi; Lien, M Diep; Jens, P Berg; Ane, C Westerberg; Per, O Iversen
Objective: We examined associations of urine iodide excretion, proxy for iodine intake, with child development and growth. Design: This is a secondary analysis of a 1:1 cluster-randomised trial with a 6-month nutrition/stimulation/hygiene education intervention among mothers of children aged 6–8 months to improve child development and growth. Development was assessed using Bayley Scales of Infant and Toddler Development–III (BSID-III) and Ages and Stages Questionnaire (ASQ), whereas anthropometry was used to assess growth. Urine iodide concentration (UIC) and urine iodide/creatinine ratio (ICR) were measured. Setting: The current study was conducted in southern Uganda. Participants: We randomly selected 155 children from the 511 enrolled into the original trial and analysed data when they were aged 20–24 and 36 months. Results: Median UIC for both study groups at 20–24 and 36 months were similar (P > 0·05) and within the normal range of 100–199 μg/l (0·79–1·60 μmol/l), whereas the intervention group had significantly higher ICR at 20–24 months. The BSID-III cognitive score was positively associated (P = 0·028) with ICR at 20–24 months in the intervention group. The ASQ gross motor score was negatively associated (P = 0·020) with ICR at 20–24 months among the controls. ICR was not significantly associated with anthropometry in the two study groups at either time-point. Conclusions: Following the intervention, a positive association was noted between ICR and child’s cognitive score at 20–24 months, whereas no positive association with ICR and growth was detected. Iodine sufficiency may be important for child’s cognitive development in this setting.
Cognitive development among children in a low-income setting: Cost-effectiveness analysis of a maternal nutrition education intervention in rural Uganda
(Plos one, 2023-08) Montasir, Ahmed; Grace, K. M. Muhoozi; Prudence, Atukunda; Ane, C. Westerberg; Per, O. Iversen; Knut, R. Wangen
Inadequate nutrition and insufficient stimulation in early childhood can lead to long-term defcits in cognitive and social development. Evidence for policy and decision-making regarding the cost of delivering nutrition education is lacking in low and middle-income countries (LMIC). In rural Uganda, we conducted a cluster-randomized controlled trial (RCT) examining the effect of a maternal nutrition education intervention on developmental outcomes among children aged 6–8 months. This intervention led to significantly improved cognitive scores when the children reached the age of 20–24 months. When considering the potential for this intervention’s future implementation, the desired effects should be weighed against the increased costs. This study therefore aimed to assess the cost-effectiveness of this education intervention compared with current practice. Health outcome data were based on the RCT. Cost data were initially identified by reviewing publications from the RCT, while more detailed information was obtained by interviewing researchers involved in processing the intervention. This study considered a healthcare provider perspective for an 18-months’ time horizon. The control group was considered as the current practice for the future large-scale implementation of this intervention. A cost-effectiveness analysis was performed, including calculations of incremental cost-effectiveness ratios (ICERs). In addition, uncertainty in the results was characterized using one-way and probabilistic sensitivity analyses. The ICER for the education intervention compared with current practice was USD ($) 16.50 per cognitive composite score gained, with an incremental cost of $265.79 and an incremental cognitive composite score of 16.11. The sensitivity analyses indicated the robustness of these results. The ICER was sensitive to changes in cognitive composite score and the cost of personnel. The education intervention can be considered cost-effective compared with the current practice. The outcome of this study, including the cost analysis, health outcome, cost-effectiveness, and sensitivity analysis, can be useful to inform policymakers and stake- holders about effective resource allocation processes in Uganda and possibly other LMIC.
Long-term effects on depressive symptoms among Ugandan mothers – Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting
(Journal of Affective Disorders, 2024-04) Paul, Kakwangire; Prudence, Atukunda; Moses, Ngari; Ane, C. Westerberg; Per, O. Iversen; Grace, Muhoozi
Introduction Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda. Methods The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESsingle bondD). Results For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference − 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference − 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESsingle bondD. We did not find any baseline characteristics associated with maternal depression. Limitations The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms. Conclusion Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.
Longitudinal assessments of child growth: a six-year follow-up of a cluster-randomized maternal education trial
(Elsevier, 2021-08) Prudence, Atukunda; Moses, Ngari; Xi, Chen; Ane, C. Westerberg; Per, O. Iversen; Grace, Muhoozi
Background & aims: Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60e72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6e8 months old with data collection at 20e24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation. Methods: We measured growth using anthropometry converted to z-scores according to WHO guide- lines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care). Results: Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60e72 months, except that children in the intervention group had lower (P ¼ 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60e72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60 e72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings. Conclusion: In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition.