Journal Articles
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Item Associations between sociodemographic exposures, growth and development during infancy with development at the age of eight years among children: Analysis of a maternal education trial in rural Uganda(Journal of Global Health, 2024-12-06) Kakwangire, Paul; Ngari, Moses; Muhoozi, Grace; Ane, Cecilie Westerberg; Atukunda, Prudence; Per, Ole IversenBackground: Links between early life exposures and child development later in life are not sufficiently explored in low- and middle-income countries. We studied associations between sociodemographic variables, growth and development at six to eight months with developmental outcomes at eight years. Methods: We used data from a maternal education trial which included 511 mother-infant pairs at children's age of six to eight months (baseline). In this follow-up study, data from 361 mother-child pairs were available. Questionnaires were used to collect sociodemographic variables. Growth (anthropometry) was measured by study personnel and converted to z-scores according to the World Health Organization (WHO) growth reference. Child development (cognitive, motor and language) at baseline was assessed using Bayley Scales of Infant and Todler Development, third edition (BSID-III). Development at eight years was measured using two neuropsychological tools: Kaufman Assessment Battery for Children Second Edition (KABC-II) and Test of Variables of Attention (TOVA). Results: Higher weight-for-age z-scores (adjusted odds ratio (aOR) = 0.74; 95% confidence interval (CI) = 0.53, 0.98; P = 0.04), better maternal education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03). and better household head education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03) at six to eight months of age were associated with lower odds of scoring below average on KABC-II categorical scores at eight years of age. Motor composite scores and maternal parity at six to eight months of age were positively associated with auditory and visual TOVA scores (all P-values <0.05) at eight years. Cognitive composite scores at six to eight months of age were positively associated with visual TOVA scores (P < 0.05). In contrast, weight-for-length z-scores and household head age were negatively associated with both auditory and visual TOVA scores (P < 0.05). Being a female child was associated with lower auditory and visual TOVA scores (P < 0.05). Conclusions: At six to eight months of age, growth and development, gender, maternal education and parity, and household head age and education were associated with child development at eight years. Interventions emphasising improved growth and development in infancy, as well as parental educational attainment, may improve long-term developmental outcomes.Item Dietary practices and nutritional status of elderlypersons in post-conflict: A cross-sectional study ofNorthern Uganda(Research square, 2024-07-24) Ocaya, Dennis; Ndagire, Regina; Namboze, Joweria; Kyeyune, Jemimah; Atim, FionaMalnutrition remains a problem in older populations globally. Most older persons do not meet therequired dietary intake with the majority consuming more of carbohydrate-based foods and vegetables.The current study therefore aimed at assessing the dietary practices, nutritional status and associatedfactors among elderly persons in the post-war setting of Gulu district. This was a cross-sectional study among elderly persons ≥ 60 years residing in Bungatira Sub-County,Aswa County-Gulu District. The study used a multi-stage sampling procedure. Nutritional status wasmeasured using the Mini Nutrition Assessment – Short Form (MNA-SF) Analysis was done in STATA 16using modifi ed Poisson regression model. Variables with a p-value of 0.05 at multivariable analysis wereconsidered as factors associated with malnutrition.Item Differential COVID-19 vaccination uptake and associated factors among the slum and estate communities in Uganda: a cross-sectional population-based survey(MDPI, 2023-02) Joseph, Kawuki; Joweria, Nambooze; Paul, Shing-fong Chan; Siyu, Chen; Xue, Liang; Phoenix, K. H. Mo; Zixin, WangVaccination against COVID-19 remains one of the ultimate solutions to the ongoing pandemic. This study examined and compared the completion of primary COVID-19 vaccination series and associated factors in the slum and estate communities of Uganda. This was a cross-sectional survey conducted among 1025 slum and estate residents. Logistic regression models were fitted. Of the 1025 participants, 511 were slum residents and 514 were estate residents. Completion of COVID-19 vaccination was 43.8% in the slum community and 39.9% in the estate community (p = 0.03). Having more knowledge about COVID-19 was positively associated with completing COVID-19 vaccination in both communities. Perceived benefits and cues to action also had a positive association, but only among the slum residents. However, perceiving people infected with COVID-19 as having a high death rate, perceived barriers such as serious side effects and long distances, and depressive symptoms had negative associations with vaccine uptake among the slum community, but not in the estate community. Addressing barriers to vaccination, strengthening and utilizing the various cues to action, engagement of religious and cultural leaders, and continued community education and sensitization tailored to the needs of each community are potentially vital strategies in raising vaccination rates. Consideration of socioeconomic impact-alleviation strategies, especially among the urban poor, would also be beneficial.Item Differential practice and associated factors of COVID-19 personal preventive measures among the slum and estate communities of Uganda: A community-based cross-sectional survey(Journal of Global Health, 2023-09) Joseph, Kawuki; Joweria, Nambooze; Paul, Shing-fong Chan; Siyu, Chen; Xue, Liang; Phoenix, K H Mo; Zixin, WangBackground Compliance with personal preventive measures (PPMs) remains essential in the prevention and control of the coronavirus disease 2019 (COVID-19) pandemic and future infectious disease outbreaks. This study aimed at examining and compar- ing the practice of COVID-19 PPMs and associated factors in selected slum and estate communities of Uganda. Methods This was a cross-sectional survey conducted among 1025 slum and estate residents in Uganda. The outcome variable was compliance with COVID-19 PPMs, including face mask use, hand washing / hygiene, and social distancing. Logistic re- gression models were fitted to assess the associated factors, using SPSS (version 26). Results Of the 1025 participants, 511 and 514 were slum and estate residents, respec- tively. Compliance with PPMs was as follows; face mask use (slum 45.0% vs. estate 49.6%; P = 0.27), hand washing/ hygiene (slum 38.4% vs. estate 44.9%; P = 0.04) and social distancing (slum 19.4% vs. estate 36.0%; P < 0.001). Compared to estate residents, slum residents had more knowledge related to COVID-19, perceived COVID-19 would have a longer timeline and larger impact on their life, had more depression and anxiety symptoms, and faced more difficulties to access information. Illness perceptions, in- fection risk, and severity perceptions were associated with higher odds of PPMs com- pliance in both groups, except for perceiving a high chance of contracting COVID-19, which was associated with lower odds of social distancing in the slum community. Depression and anxiety symptoms were associated with higher odds of PPMs com- pliance in both groups. Frequent exposure to COVID-19 information through health care workers and family members and friends was associated with higher odds of all the PPMs in both communities. Moreover, getting COVID-19 information from local channels was significantly associated with higher odds of mask use and hand hygiene, but only in the estate community. Conclusions Our findings provided implications to improve PPMs compliance in future infectious disease outbreaks. To improve PPMs compliance rates, redesigning community education to focus on fostering positive perceptions and addressing the water and sanitation needs of slum communities are essential. Moreover, designing programs that provide free or subsidised face masks and soap to the most vulnerable and engaging religious leaders are also vital strategies.Item Automated wearable cameras for improving recall of diet and time use in Uganda: a cross-sectional feasibility study(Nutrition journal, 2023-01) Andrea, L. S. Bulungu; Luigi, Palla; Joweria, Nambooze; Jan, Priebe; Lora, Forsythe; Pamela, Katic; Gwen, Varley; Bernice, D. Galinda; Sarah, Nakimuli; Kate, Wellard; Elaine, L. FergusonBackground Traditional recall approaches of data collection for assessing dietary intake and time use are prone to recall bias. Studies in high- and middle-income countries show that automated wearable cameras are a promising method for collecting objective health behavior data and may improve study participants’ recall of foods consumed and daily activities performed. This study aimed to evaluate the feasibility of using automated wearable cameras in rural Eastern Ugandan to collect dietary and time use data. Methods Mothers of young children (n = 211) wore an automated wearable camera on 2 non-consecutive days while continuing their usual activities. The day after wearing the camera, participants’ dietary diversity and time use was assessed using an image-assisted recall. Their experiences of the method were assessed via a questionnaire. Results Most study participants reported their experiences with the automated wearable camera and image-assisted recall to be good (36%) or very good (56%) and would participate in a similar study in the future (97%). None of the eight study withdrawals could be definitively attributed to the camera. Fifteen percent of data was lost due to device malfunction, and twelve percent of the images were "uncodable" due to insufficient lighting. Processing and analyzing the images were labor-intensive, time-consuming, and prone to human error. Half (53%) of participants had difficulty interpreting the images captured by the camera. Conclusions Using an automated wearable camera in rural Eastern Uganda was feasible, although improvements are needed to overcome the challenges common to rural, low-income country contexts and reduce the burdens posed on both participants and researchers. To improve the quality of data obtained, future automated wearable camera-based image assisted recall studies should use a structured data format to reduce image coding time; electronically code the data in the field, as an output of the image review process, to eliminate ex post facto data entry; and, ideally, use computer-assisted personal interviews software to ensure completion and reduce errors. In-depth formative work in partnership with key local stakeholders (e.g., researchers from low-income countries, representatives from government and/or other institutional review boards, and community representatives and local leaders) is also needed to identify practical approaches to ensuring that the ethical rights of automated wearable camera study participants in low-income countries are adequately protected.Item A comparative study on the role of microcredit on agricultural production improvement among resource-poor rural women.(2023-03) Faith, Muyonga Mayanja Namayengo; Johan, A. C. van Ophem; Gerrit, AntonidesThe objective of the study was to compare agricultural investment and agricultural production of rural agrarian women in Uganda that had received microcredit to those that had not. A quasi-experimental was used to assess differences between performance indicators of agricultural enterprises for existing and incoming borrowers of Bangladesh Rural and Advancement Committee (BRAC) microfinance. Propensity score matching was used to ensure the comparability of the groups and to assess differences between existing borrowers and in- coming borrowers, before they received their first loan. Results indicated that the major reason for borrowing was education of children. There was no difference in investment in agricultural production between the study groups. The existing borrowers had lower monetary value of all harvested crops and for maize and beans than the in-coming borrowers. Total number of animals owned, types of animals kept and reported monetary value for goats and local cattle were also less for existing borrowers than for in-coming borrowers. It was observed that the loan repayment protocols did not match income from agriculture. The results reveal a need to modify loan repayment protocols to address the latent period between agricultural investment and output.Item Socio-demographic predictors of obesity among women in Mukono Central Division in Central Uganda: a cross-sectional study(BMC Women's Health, 2023-11) Justine, Athieno; Georgina, Seera; Faith, Muyonga Mayanja Namayengo; Joweria, Nambooze Galabuzi; Mariam, NamasabaAbstract Background There is a steadily increasing trend in obesity globally and in Sub-Saharan Africa that disproportionately affects women in most places. This is not different in Uganda, where the Uganda Demographic and Health Survey indicated an increase in obesity among women of reproductive age as measured by the body mass index (BMI). However, studies on the predictors of obesity in women are still limited. Particularly, studies using specific indicators of body fat are scant. This study explored the socio-demographic predictors of obesity as indicated by total body fat percentage among women in the age range of 18 to 69 years old living in Mukono Central Division in Central Uganda. Methods A cross sectional study design using quantitative methods was employed. A total of 384 women between 18 and 69 years old from Mukono Central Division in Central Uganda were randomly recruited. A structured questionnaire was used to collect socio-demographic data including age, level of education, marital status, childbearing status, household expenditure, household size and employment status. Total body fat percentage, the indicator for obesity was measured using the body composition meter from TANITA. The data was analyzed using multinomial logistic regression analysis using SPSS version 20. Results 155 women, nearly two fifths (40.4% CI 95% 38.4–42.4) were classified as obese. Age, marital status, childbearing status, and employment status were the factors that were associated with obesity among these women. Employment status was the only variable that remained significantly associated with obesity among the women after adjusting for other factors. Unemployed women were nearly two times more likely to be obese than the employed women (AOR 1.9; 95% CI 1.1–3.1). The prevalence of obesity among the unemployed and employed women was 48.2% and 34.4% respectively. Conclusions Obesity in women was predicted by employment status. An in-depth study on factors that predispose unemployed women to obesity, will be instrumental in guiding interventions to curb the emerging obesity epidemic in Uganda. In the same vein, strategies to reduce levels of unemployment among women living in urban Uganda are essential for protecting public health from the dimension of reducing obesity levels.Item 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, MuhooziObjective: 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.Item 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 IversenObjective: 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.