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Prevalence and risk factors of nutritional anaemia among female school children in Masindi district, western Uganda
(African Journal of Food, Agriculture, Nutrition and Development, 2013-07-01) Barugahara, EI; Kikafunda, J; Gakenia, WM
Anaemia is the most widespread nutrition related public health problem world-wide and yet in Uganda, there is little national data on anaemia and its likely causes amongst school children. The aim of this study was to assess the prevalence, dietary and health risk factors of nutritional anaemia amongst 11-14 year old girls attending primary schools in Masindi District of Western Uganda. Two schools, one urban and the other rural, were selected for this cross-sectional study. A total of 109 girls from the upper primary section were randomly selected from both schools. The Lovibond comparator was used to assay Hemoglobin (Hb) level in the whole blood after conversion of Hb to oxyhemoglobin by ammonia. Pre-tested structured questionnaires were used to collect data. Incidences of malaria were self reported. The dietary intake of iron, protein, folate, riboflavin, energy, vitamin C, dietary fibre and vitamin A was estimated from the East African food composition table used to analyze the 24-hour dietary recalls. Associations between anaemia and factors under investigation were examined using Pearsonfs chi-square test and Pearsonfs correlation coefficient analysis. Statistical significance was considered at p< 0.05. The overall prevalence of anaemia was 46%. It was twice as high in the urban school (61%) compared to the rural school (31%). There was a high intake of plant . based diets; majority of the school children with excess intake of fibre, inadequate intake of iron, protein, folate, riboflavin, energy and vitamin A were anaemic (p . 0.001). Malaria incidences were many and though de-worming was common in schools, it was not consistent. Performance of de-worming by nurses had more impact than that of the teachers. Anaemia was positively correlated with inadequate dietary intake (r = 0.61, p < 0.001), malaria incidences (r = 0.54, p = 0.02) and improper de-worming (r = 0.51, p = 0.04). A high prevalence of anaemia was found amongst the girls, particularly in the urban school. Improper de-worming, malaria incidences and poor feeding were the risk factors of nutritional anaemia. There is, therefore, an urgent need for a national anaemia assessment among this age group and the strengthening of the current School Health Program to address aspects of health and feeding in schools in Masindi district and Uganda as a whole.
Food as a human right during disasters in Uganda
(Elsevier: Food Policy, 2014-12) Rukundo, Peter Milton; Iversen, Per Ole; Oshaug, Arne; Omuajuanfo, Lovise Ribe; Rukooko, Byaruhanga; Kikafunda, Joyce; Andreassen, Bård Anders
Natural and human induced disasters are a threat to food security, economic progress and livelihoods in Uganda. However, we have limited knowledge regarding the putative role of the human rights dimension to the impact and management of such tragedies. In this article we assessed the present policies, legislation and institutional capabilities to ascertain whether they could assure the right to adequate food during disaster situations in Uganda. Using purposive sampling, 52 duty bearers working in institutions deemed relevant to food security, nutrition and disaster management were interviewed using a semi-structured guide. Relevant provisions from policy, legislation, institutional budgets and records of Parliament provided the context for analysis. The most important concern coming from the analyses of the information retrieved were inadequate preparedness mechanisms and capabilities. Whereas Uganda’s Constitution proclaims the right to adequate food, and the need to establish a contingencies fund and commission responsible for disaster preparedness and management, they had not been instituted. Implementation of relevant policies appeared slow, especially with regard to assuring adequate relief food as a State obligation. Legislation to guarantee funding and institutionalisation of necessary disaster preparedness and management capabilities was not in place. An ambitious 5-year Uganda Nutrition Action Plan adopted in 2011 had not yet been funded by mid-2013, implying a reality gap in nutrition programming. Budget architecture and financing to disaster management have in effect fallen short of assuring adequate relief food as a human right. Due to capacity constraints, an approach of humanitarian relief may be entrenched in contradiction of State obligations to respect, protect and fulfil human rights. To stay ahead of the potential threats, the Government with support of the Parliament and relevant partners need to enact legislation to appropriate budget resources needed to institute a mechanism of capabilities to implement the constitutional and policy provisions on the right to adequate food and disaster management.
Perceptions on the right to adequate food after a major landslide disaster: a cross-sectional survey of two districts in Uganda
(BMC International Health and Human Rights volume, 2015-04-25) Rukundo, Peter M; Iversen, Per O; Andreassen, Bård A; Oshaug, Arne; Kikafunda, Joyce; Rukooko, Byaruhanga
Despite the instruments on the right to adequate food adopted by the United Nations, there exists limited information on how this right is perceived. Following a major 2010 landslide disaster in the Bududa district of Eastern Uganda and the resettlement of some affected households into the Kiryandongo district in Western Uganda, we surveyed both districts to explore perceptions about the right to adequate food among households with different experiences; disaster-affected and controls. Methods: We deployed qualitative and quantitative techniques to a cross-sectional survey. The index respondent was the head of each randomly selected household from the landslide affected communities and controls from a bordering sub-county. Data was collected by interviews and focus group discussions (FGDs). Structured entries were tested statistically to report associations using Pearson’s Chi-square at the 95% CI. Information from FGDs was transcribed, coded, sequenced and patterned. Findings from both techniques were triangulated to facilitate interpretations. Results: Analysis included 1,078 interview entries and 12 FGDs. Significant differences between the affected and control households (P < 0.05) were observed with: age; education level; religious affiliation; existence of assets that complement food source; and having received relief food. Analysis between groups showed differences in responses on: whether everyone has a right to adequate food; who was supposed to supply relief food; whether relief food was adequate; and preferred choice on the means to ensure the right to adequate food. FGDs emphasized that access to land was the most important means to food and income. Affected households desired remedial interventions especially alternative land for livelihood. Despite the provision of adequate relief food being a state’s obligation, there was no opportunity to exercise choice and preference. Comprehension and awareness of accountability and transparency issues was also low. Conclusion: Though a significant proportion of participants affirmed they have a right to adequate food, relief food was largely perceived as insufficient. Given the high regard for land as a preferred remedy, a resettlement policy is of the essence to streamline post-landslide displacement and resettlement. Information materials need to be assembled and disseminated to stimulate awareness and debate on the right to adequate food.
Food variety consumption and household food insecurity coping strategies after the 2010 landslide disaster : the case of Uganda
(Cambridge University Press: Public Health Nutrition, 2016-06-09) Rukundo, Peter M; Oshaug, Arne; Andreassen, Bård A; Kikafunda, Joyce; Rukooko, Byaruhanga; Iversen, Per O
To evaluate the nutritional situation of the victims of the 2010 landslide disaster in Uganda, food varieties consumed and coping strategies were assessed. Design Cross-sectional. Food variety scores (FVS) were obtained as the total of food items eaten over the last week while an index was based on severity weighting of household food insecurity coping strategies. We included 545 affected and 533 control households. Setting Victims in the affected Bududa district in Eastern Uganda and those victims resettled in the Kiryandongo district, Western Uganda. Results Adjusted for covariates, in Bududa significantly higher mean FVS were observed among: affected than controls; farmers than others; and relief food recipients. Control households scored higher means (SE) on severity of coping: 28·6 (1·3) v. 19·2 (1·2; P<0·01). In Kiryandongo, significantly higher FVS were observed among: control households; household heads educated above primary school; those with assets that complement food source; and recipients of relief food. Severity of coping was significantly higher among affected households and non-recipients of relief food. Affected households had a higher likelihood to skip a day without eating a household meal in Bududa (OR=2·31; 95 % CI 1·62, 3·29; P<0·01) and Kiryandongo (OR=1·77; 95 % CI 1·23, 2·57; P<0·01). Conclusions Whereas FVS and severity of coping showed opposite trends in the two districts, resettlement into Kiryandongo led to severe coping experiences. Administrative measures that provide a combination of relief food, social protection and resettlement integration may offset undesirable coping strategies affecting diet.
Socioeconomic and Demographic Factors Influencing Feeding Practices, Morbidity Status, and Dietary Intakes of Children Aged 7–24 Months in Rural Uganda
(Ecology of Food and Nutrition, 2016-11-14) Barugahara, Evyline Isingoma; Mbugua, Samuel; Karuri, Edward; Maina, Gakenia Wamuyu
The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7–24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.
Realization of the right to adequate food and the nutritional status of land evictees: a case for mothers/caregivers and their children in rural Central Uganda
(BMC International Health and Human Rights, 2018-05-24) Nahalomo, Aziiza; Iversen, Per Ole; Rukundo, Peter Milton; Kaaya, Archileo; Kikafunda, Joyce; Eide, Wenche Barth; Marais, Maritha; Wamala, Edward; Kabahenda, Margaret
In developing countries like Uganda, the human right to adequate food (RtAF) is inextricably linked to access to land for households to feed themselves directly through production or means for its procurement. Whether RtAF is enjoyed among Ugandan land evictees, is unknown. We therefore explored this among land evictees (rights-holders) in Wakiso and Mpigi districts in rural Central Uganda. We assessed food accessibility and related coping strategies, diet quality and nutritional status of children 6–59 months old, and their caregivers. Effectiveness of the complaint and redress mechanisms in addressing RtAF violations was also explored. Methods: In this cross-sectional study, quantitative data was collected using a structured questionnaire, with food security and nutritional assessment methods from a total of 215 land evictees including 187 children aged 6–59 months. Qualitative data was collected by reviewing selected national and international documents on the RtAF and key informant interviews with 15 purposively sampled duty-bearers. These included individuals or representatives of the Uganda Human Rights Commission, Resident District Commissioner, Sub-county Chiefs, and local Council leaders. Results: We found that 78% of land evictees had insufficient access to food while 69.4% had consumed a less diversified diet. A majority of evictees (85.2%) relied on borrowing food or help from others to cope with food shortages. Of the 187 children assessed, 9.6% were wasted, 18.2% were underweight and 34.2% were stunted. Small, but significant associations, were found between food accessibility, diet quality, food insecurity coping strategies; and the nutritional status of evictees. We observed that administrative, quasi-judicial and judicial mechanisms to provide adequate legal remedies regarding violations of the RtAF among evictees in Uganda are in place, but not effective in doing so. Conclusion: Land eviction without adequate legal remedies is a contributor to food insecurity and undernutrition in rural Central Uganda. It is essential that the Government strengthens and enforces the policy and legal environment to ensure adequate and timely compensation of evictees in order to reduce their vulnerability to food insecurity.
Nutritional status of children 7–36 months old from millet consuming communities of Masindi District, Western Uganda
(BMC nutrition, 2019) Evyline, Isingoma Barugahara; Samuel, Kuria Mbugua; Gichohi, Karuri Edward
Background Several national reports have indicated poor nutritional status among children from Western Uganda where millet porridge is a predominant complementary food. However, little is known about the nutritional status of 7–36 months old children from millet consuming communities of Western Uganda. Methods A cross-sectional study was conducted in Bujenje County of Masindi District. A total of 636 children from 23 villages within Bwijanga and Budongo sub counties were randomly selected. Anthropometric measurements of children were taken. Data on demographic and socioeconomic characteristics of children’s households, their dietary practices and morbidity patterns was collected using a self-administered questionnaire. A statistical Package for the Social Sciences (SPSS) version 20 and Emergency Nutritional Assessment (ENA) Software Version 2010 were used for analysing data. The relationship between demographic and socioeconomic characteristics of households and children’s nutritional status was determined using Chi-square tests. Pearson’s correlation coefficient was used to determine the association between children’s nutritional status and the amount of millet porridge consumed. A p-value of < 0.05 indicated statistical significance. Results A proportion of 30.5% children were stunted, 11.6% underweight and 7.4% wasted. Underweight and wasting were significantly high in Budongo sub county at p = 0.044 and p = 0.005 respectively. Stunting and underweight were highest between 12 and 23 months at p = 0.005 and 0.020 respectively. Although millet porridges formed the bulk of children’s meals, they could only cater for < 60% of the recommended daily nutrient intake. Children with diarrhoea were 1.4 and 2 times likely to become stunted and underweight at p = 0.025 and 0.007 respectively. Feeding practices for children with diarrhoea were contrary to World Health Organisation’s recommendations in more than 50% of the studied children. There was a significant association between Height-for-Age Z scores, Weight-for-Height Z scores and the amount of millet porridge consumed by children (r = − 0.20, p < 0.001 and r = 0.14, p < 0.001 respectively). Conclusions Results showed slightly higher percentages of stunted, underweight and wasted children compared to national figures. This was attributed to high incidences of diarrhoea and inadequate feeding practices especially for children 12–36 months old.
Malnutrition and associated risk factors among children 6–59 months old in the landslide-prone Bududa District, Eastern Uganda: a cohort study
(Current Developments in Nutrition : American Society for Nutrition, 2022-01-18) Nahalomo, Aziiza; Iversen, Per Ole; Andreassen, Bård Anders; Kaaya, Archileo Natigo; Rukooko, Archangel Byaruhanga; Tushabe, Gerald; Nateme, Nancy Catherine; Rukundo, Peter Milton
Background The United Nations Sustainable Development Goal 2.2 calls for an end to all forms of malnutrition. This might be derailed due to persistent landslide disasters in low-income countries like Uganda. Objectives The prevalence of malnutrition and the impact of seasonal variations and associated factors were assessed among children aged 6–59 mo in the landslide-affected households in Bududa District, eastern Uganda. Methods A prospective cohort study using a 2-stage simple random technique was applied to select 422 households including 392 children during May–August (food-plenty season) 2019. After 6 mo, in January–March (food-poor season) 2020, 388 households and 366 children were assessed. Socioeconomic and demographic data were collected using structured questionnaires. Child malnutrition outcomes were defined according to WHO criteria. Factors associated with malnutrition outcomes were identified by bivariate and multivariate logistic regression.
Child saliva microbiota and caries: a randomized controlled maternal education trial in rural Uganda
(Scientific Reports, 2022-05-12) Muhoozi, Grace K. M.; Li, Kelvin.; Atukunda, Prudence.; Skaare, Anne B.; Willumsen, Tiril.; Enersen, Morten.; Westerberg, Ane C.; Morris, Alison.; Vieira, Alexandre R.; Iversen, Per O.; Methé, Barbara A.
Undernutrition is a public health challenge in sub-Saharan countries, including Uganda. In a previous randomized controlled trial (RCT) with a nutrition, hygiene and stimulation education intervention among mothers of 6 months’ old children, we found less caries in the intervention group when the children were 36 months of age. We now examined the effects of (i) the intervention on the microbiota, (ii) microbiota on caries, and (iii) the intervention and microbiota on caries. The original RCT comprised 511 mother/child pairs whereas in the current study we had access to data from 344/511 (67%) children aged 36 months. The saliva microbiota was determined using 16S rRNA gene sequencing. Carious lesions (a proxy for dental health) were identified using close-up intra-oral photographs of the upper front teeth. Statistical models were used to determine host-microbiota associations. The intervention had a significant effect on the microbiota, e.g. an increase in Streptococcus abundance and decreases in Alloprevotella and Tannerella. Significant associations between the microbiota and dental caries were identified: Positive associations of Capnocytophaga and Tannerella suggest that these taxa may be deleterious to dental health while negative associations of Granulicatella, Fusobacterium, and Abiotrophia suggest taxa potentially beneficial or benign contributors to dental health. Based on taxonomic profiles, the effects of the intervention and microbiota on dental health may be independent of one another. Educational interventions with emphasis on nutrition and oral hygiene may provide a feasible strategy to decrease progression of childhood caries in low-resource settings.
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.
A pragmatic randomized trial to examine the effect of combining healthy diet with mindfulness cognitive therapy to reduce depressive symptoms among university students in a low-resource setting: protocol for the NutriMind Project
(BMC Psychiatry, 2024-09-11) Kardel, Kristin Reimers; Iversen, Per Ole; Kaaya, Archileo Natigo; Muhoozi, Grace; Veierød, Marit B.; Wangen, Knut Reidar; Børøsund, Elin; Atukunda, Prudence Friberg
Background Mental health disorders still rank as leading causes of morbidity worldwide despite increasing awareness and improvements in treatment. Notably, low- and middle-income countries like Uganda, are disproportionately affected by such disorders. The burden of depressive symptoms in these countries is particularly high among students, aggravated by poverty, malnutrition, and inadequate public health governance, yet it is clearly under-researched, making it hard to achieve several of UN Sustainability Development Goals. Current treatment options are insufficient to tackle the increased burden of depressive disease. This is more challenging for low-resource regions especially in Sub-Saharan Africa, suggesting the need for alternative treatments that can swiftly be applied if proven effective. The main aim of this randomized controlled trial (RCT) is therefore to examine if a low-cost healthy diet (based on local Ugandan foods) combined with easy-to access mindfulness cognitive therapy can reduce depressive symptoms among university students in Uganda. Methods We will recruit female and male students at Makerere University, the largest public university in Uganda, to an open, intention-to-treat, two-armed RCT. Those who score above a predefined threshold on a self-reported assessment of depressive symptoms, measured by the Center for Epidemiological Studies – Depression score (CES-D), are eligible for study inclusion and will be randomized to either an intervention (n = 125) or a control (n = 125) group. The intervention group will receive educational group-based sessions on how to prepare a Mediterranean-type of healthy diet and how to adhere to the principles of mindfulness-based cognitive therapy. Outcome measures include self-reported depression symptoms, quality of life, and dietary intakes. In addition we will perform a cost-effectiveness analysis. The RCT intervention will last 9 months, followed by additional 15 months with regular data collections. Discussion We here describe a novel approach to treat depressive symptoms among university students living in resource constraint settings, by combining a healthy diet with low threshold psychotherapy. If this intervention succeeds, our project can be viewed as a step towards evidence-based behavior practices for young adults with a common mental disorder (depression) that are beneficial to public mental health initiatives and management. Trial registration The RCT is registered in ClinicalTrials.gov (ID: NCT05848973). The date of registration was August 14, 2023. Keywords Depression, Diet, Mindfulness-based cognitive therapy (MBCT), Mental health, Randomized trial, Uganda, University students

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