Diet and socio-economic factors and their association with the nutritional status of pre-school children in a low income suburb of Kampala city, Uganda

No Abstract.The East African Medical Journal Vol. 83 (10) 2006: pp. 565-57

Production and use of a shelf-stable bovine blood powder for food fortification as a food-based strategy to combat iron deficiency anaemia in subsaharan Africa

Iron deficiency anaemia (IDA) is the most widespread micro-nutrient deficiency  disease world-wide, particularly in developing countries. Although there are several strategies to combat IDA, food-based strategies are the most sustainable and yet little research has been carried out in this area. The study aimed at developing a technology for processing and preserving bovine blood into a shelf-stable powder, which would easily be utilised in fortifying commonly consumed food items, as a food-based strategy in the fight against iron deficiency anaemia. A shelf-stable  powder was processed from fresh bovine blood and the physical, chemical,  microbiological and shelf-life characteristics assessed using conventional methods. The results of the chemical analysis showed that bovine blood powder has a very high concentration of haeme iron at 195.46 mg/100g of powder. This is more than ten times the level of iron in bovine liver, one of the most commonly used food source of haeme iron whose iron content is only 17 mg/100gm of liver. Although microbiological tests carried out on the freshly processed blood powder and on the same powder after one and three months of storage at room temperature found a significant rise in yeast, mould and total plate counts, these values were low and within safe limits. The blood powder was used to fortify a bean sauce. Sensory analysis panellists considered the fortified bean sauce moderately acceptable with a mean score of 4.667 (like slightly) compared to a mean score of 2.333 (like very much) for the non-fortified sauce, on a nine point Hedonic scale. These findings show that processed bovine blood powder has very high levels of haeme iron and  thus has great potential as a food-based strategy to combat iron-deficiency  anaemia in resource-poor developing countries, particularly those in sub-Saharan Africa. However, more research is needed to improve the microbiological and  sensory characteristics of the blood powder.Key Words: Bovine blood, Iron  deficiency anaemia, Sub-saharan Afric

FACTORS AFFECTING THE VITAMIN A AND ß-CAROTENE CONTENTS OF MILK

The factors affecting the vitamin A and s-carotene contents of milk were investigated. A series of short- and long-term experiments were conducted using the University of Saskatchewan dairy herd and Saskatoon commercial fluid milk, respectively. The vitamin A potency of the milk was significantly influenced by cow-to-cow variations when the experimental cows were receiving high levels (87,600 IU/kg feed) of vitamin A supplementation. The day-to-day variations significantly affected the vitamin A content of milk when early lactation cows received low levels (8,200 IU/kg feed) of vitamin A supplementation. The milk of cows in late lactation contained more vitamin A per 100 ml but the milk of cows in early lactation contained more vitamin A per gm butter fat. Pronounced seasonal variations were observed in Saskatoon market milks. The spring milk contained 28.87%, 20.09%, and 8.33% more vitamin A potency than that of winter, fall and summer milk, respectively. Overall, spring and summer milk had significantly more vitamin A (1.17 times) than that of winter and fall milk. Supplementation of feeds with about 10 times the RDA of vitamin A increased the vitamin A content of the milk by 24% but did not affect either the milk yield or the B.F.% of the milk. Dietary hay suppressed, but dietary silage promoted, the recovery of dietary vitamin A in milk of cows fed the above forages, each supplemented with 250,000 and 600,000 IU vitamin A/cow/day. High levels of vitamin A intake depressed the milk and blood levels of s-carotene. Dietary levels of the vitamin A did not affect the concentration of the vitamin in the blood of the experimental animals. Pasteurization of milk had no deleterious effects on the vitamin A potency of milk. Skimming significantly reduced the vitamin A content of whole milk by 85.0% and 26.5% for skim and 2% B.F. milk, respectively. Fortification, at the processing plant, increased the vitamin A content of the low fat milk to above average levels. Maximal photodegradation of vitamin A occurred between 340 to 440 nm. s-carotene significantly protected vitamin A from photodegradation. Storage stability of vitamin A in processed milks (skim, 2% B.F. and homogenized milk) was found to be much less than that of whole, raw milk. The results from the study indicated that the vitamin A potency of milk can be optimized by fortification of winter feeds, particularly silage, with vitamin A. Once the milk has been produced, the vitamin A levels can be optimized by proper fortification of low fat milk and by proper packaging and storage of processed milk

Malnutrition amidst plenty: An assessment of factors responsible for persistent high levels of childhood stunting in food secure western Uganda

In spite of favourable natural and human resource capacity, malnutrition remains an important health and welfare problem in Uganda especially among children below 5 years. Western Uganda has persistently registered highest levels of childhood malnutrition despite being referred to as gthe food basketh of the country. This study sought to establish the causes of persistent child undernutrition to guide design of effective nutritional  policies and interventions. This was a cross-sectional study that used both quantitative and qualitative methods. Multistage random sampling and stratified sampling were used to select study areas and households with children 6.59 months, respectively. Stunting levels were determined using anthropometric measurements of height-for-age using the US National Center for Health Statistics (NCHS) Reference Standards, which were  approved for use in developing countries by the World Health Organization (WHO). The main causes of malnutrition were determined by logistic regression analysis. Almost half (46%) of children below 5 years were stunted, which is comparable to national prevalence of 47.8% for Western Uganda and this is unacceptably high. The major causes of stunting at (p .0.05) were improper health and sanitation, poor child feeding practices, poor access to appropriate knowledge for health and nutrition, poor socio-economic variables of access to food, type of employment, distance to main roads and markets, housing facility, income flow regime, gender disparities and access to fuel for cooking. Overall, there is low intake of animal protein and generally constrained access to adequate amount of food required for normal growth and development. At multivariate level, the main risk factors included; lack of information on child health feeding, socio-economic capacity of household, poor hygiene practices, and preparation of special foods for children. Results suggest that more emphasis needs to be put on community nutrition and health education with a focus on diet, hygiene, sanitation, social-economic and livelihood programs, improvement of health care services and diversification of interventions especially into poverty alleviation programs with a nutrition focus.Key words: Stunting, young children, nutrition, Ugand

Utilization of indigenous food plants in Uganda: A case study of south-western Uganda

The purpose of the study was to document and establish the traditional processin methods of indigenous food plants in Rukungiri district. In order to establish the status and level of utilization and processing of indigenous food plants in southwestern Uganda, a baseline survey was carried out using a participatory method of data collection. Respondents in Rukungiri district cited a total of 94 plants that were used for food. Some of the food plants were classified as indigenous to the area, while others were classified as exotic. The food types generally fell into five broad categories, namely; vegetables, fruits, roots/tubers, pulses and cereals. Vegetables and fruits were the most commonly used food plants and the Amaranths species were found to be the most popular vegetables, whereas wild plums (Carissa edulis) and gooseberries (Physalis minima) were cited among thepreferred fruit species. In spite of the fact that indigenous/traditional food plants have always ensured food security at the household level, the process of collecting them from the wild, their production,consumption and domestication was found to be on the decline in this area. This decline can be attributed to limited available knowledge on their nutritional content and to the emphasis that is placed on commercial, high yielding exotic plants by both the agricultural extension officers and farmers. The majority of farmers are only interested in the cultivation of crops from which they can earn an income, and because no one has cultivated indigenous food plants with the intention of earning an income from them, the plants have not proved their worth. Although the methods of utilization, especially food preparation, varied from one household to another, boiling, steaming and frying were very common and cross-cutting almost all the households. The principal mode of food preservation cited by households, especially for seeds, wassun drying

Roles and capacity of duty bearers in the realization of the human right to adequate food in Uganda

The right to adequate food recognised under international law provides a strong foundation for eradicating hunger and malnutrition in all nations. Uganda ratified the International Covenant on Economic, Social, and Cultural Rights (ICESCR) in 1987 and thereby committed itself to ensure the realization of the right to adequate food recognised under Article 11 of the Covenant. This study analysed the roles and capacity of duty bearers in the realization of the right to adequate food in Uganda. Structured interviews were held with purposefully selected duty bearers from 11 districts in the country between February and July 2007. Districts were selected by criterion based sampling. Relevant policies, budgets, and legislation were also reviewed, particularly with state obligations on human rights, and capacity of duty bearers in mind. Although this right is expressly recognised in the Food and Nutrition Policy of 2003 in which a multi-sectoral approach is proposed, sector-specific roles are not explicitly defined in Uganda’s institutional and policy framework. Most duty bearer (63%) considered the Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) as being responsible for the delays in implementing the relevant actions for the right to food. The Uganda Human Rights Commission (UHRC) reported receiving inadequate budget resources to support the right to food. Only 20% of duty bearers had knowledge of the General Comment 12, which is an important United Nations instrument that defines and elaborates on the human right to adequate food. Duty bearer’s knowledge of the right to food in the national Constitution had a significant (X2 = 0.003; P<0.05) positive correlation (R=0.283) with membership status to an adhoc Uganda Food and Nutrition Council (UFNC). A proposed Food and Nutrition Bill had taken over 10 years without being presented to the National Parliament for the process of enactment into law. As such, most of the support for this right came from development partners. Whereas the ministry of health and MAAIF are line ministries in the implementation of food and nutrition policy, the right to food roles of the various duty bearers in Uganda need to be well defined. Capacity development is also needed, particularly related to integrating right to food sector-specific roles into the theoretical development and practical implementation of food and nutrition security programmes at all levels in the country

Nutritional Knowledge, Attitudes, and Practices of Women Living with HIV in Eastern Uganda

HIV and AIDS have posed various medical, nutritional, social and economic problems, female-headed households being the most affected. Poor nutritional knowledge and dietary practices common among the most affected households significantly contribute to the rapid progression of HIV. However, very little data exist concerning these aspects of nutrition among women living with HIV and AIDS in resource-limited settings, such as Uganda. The aim of the study was to investigate the gaps in nutritional knowledge, attitudes, and practices and their relationship with sociodemographic characteristics in an urban population of women living with HIV and AIDS in Uganda. In total, 133 women living with HIV were interviewed using a pretested questionnaire. Most (89.5%) women reported being trained on the importance of nutrition for people living with HIV and AIDS (PLWHA) and believed that it is very important to consume a balanced diet (99.5%). On the contrary, only 21.8% consumed at least three meals per day and 39.8% at least six food-groups. They also reported higher dependency on starchy staples while foods of animal origin and fruits that play vital immunity and protective roles were inadequately consumed. Results of bivariate analysis indicated that consumption of a diversified diet was significantly associated with access to food-aid (p=0.006), possibly because access to food-aid reportedly enhances the ability of the household to access other food items. However, much is still needed to understand the drug-food interaction and dietary diversification and enhance proper dietary practices through sustainable projects that ensure increased access to food. Support groups of the PLWHA are a good vehicle for communication of nutrition information and implementation of nutrition-related projects

Nutritional and health status primary schoolchildren in rural Uganda

Poor nutrition and health can affect children’s education. The nutritional status of school children (9-15 years) was assessed in Kumi district, Eastern Uganda in 2006-2007. Selection of schools was done using modified cluster sampling involving 34 schools (n= 645). Assessments for nutritional status were done anthropometrically (height and weight), biochemically (iron, n=145; iodine, n=87; and vitamin A, n=145) and assessment for health status was done following the formal ether concentration technique for examination for intestinal helminths (n=189) and a quick malaria (n=119) test for malaria parasites. Prevalence rates for stunting, underweight and thinness were 8.7% (95CI 6.7-11.1); 13.0% (95CI 10.6-15.8); and 10.1% (95CI 7.9-12.6), respectively of which males and the older age group of children were more affected. Prevalence rates for iodine deficiency, anaemia, iron deficiency and vitamin A deficiency (VAD) were 3.4% (95CI 0.9-9.1); 24.1% (95CI 17.7-31.6); 82.1% (95CI 75.2-87.7); and 30.3% (95CI 23.3- 38.2), respectively. Anaemia (measured as haemoglobin status), iron deficiency (measured as serum Ferritin) and VAD (measured as serum retinol) were higher among females (26.3%, 95CI 17.5-36.7; 83.8%, 95CI 74.4-90.7; 33.8%, 95CI 24.0-44.6) compared to males (21.5%, 95CI 12.8-32.8; 80%, 95CI 69.0-88.4; 26.2%, 95CI 16.6-37.8). Geohelminth (S.mansoni & N.americanus) and malaria parasitemia were 4.8% and 46.2%, respectively. Prevalence rates for stunting, iodine deficiency and geohelminth infections were low. The high prevalence rates of wasting/thinness, underweight, iron and vitamin A deficiencies show these as significant public health problems among school children in Kumi district. There is a need to focus attention on nutritional and health conditions of school children to improve their conditions. Much can be done to prevent malaria infection by promoting the use of Insecticide Treated Nets and chemoprophylaxis. The biennial dosage with albendazole for deworming, and universal use of iodized salt in Uganda are success stories that should continue; iron deficiency anaemia can be controlled through nutrition education, provision of nutritious school meals coupled with control of malaria and deworming. Since many children attend school, such services if delivered through school systems would assist those school children who most need them

Anthropometric characteristics and nutritional status of older adults in the Lake Victoria Basin of East Africa: Region, sex, and age differences

Background: Malnutrition, either as undernutrition or overnutrition, leads to detrimental alterations in body composition. The objective of this study was to investigate selected anthropometric measurements, and the nutritional status of older men and women living in the Lake Victoria Basin. This was a cross-sectional study.Setting: The setting was selected rural and urban areas of Kisumu, Jinja, and Mwanza, in Kenya, Uganda and Tanzania, respectively.Subjects: The subjects were older adults (227 men and 310 women) aged ≥ 60 years.Outcome measures: The outcome measures were weight, height, arm span, mid-upper-arm circumference (MUAC) and triceps skin-fold thickness (TSF). Body mass index (BMI) and arm muscle area (AMA) were computed using standard equations.Results: The results show that older adults in the three regions were significantly different (p-value < 0.05) in all anthropometric measurements, except MUAC. The women had significantly higher (p-value < 0.05) BMI, TSF, and MUAC, than the men. Negative slopes indicated a decline in all anthropometric measurements with age. Overall underweight (BMI < 18.5 kg/m2) was 26.4%, 58.3% were normal (BMI 18.5-24.9 kg/m2), 10.8% were overweight (BMI 25-29.9 kg/m2), and 4.5% were obese (BMI ≥ 30 kg/m2). Older men (29.5%) were significantly more underweight (p-value < 0.05) than older women (24.2%), with overweight (12.5%) and obesity (6.8%) being significantly higher (p-value < 0.05) in older women.Conclusion: The findings suggest energy depletion and loss of muscle mass, with significant differences in the three regions, and in the sex and age groups. A small proportion was overweight and obese. The decline in anthropometric measurements with age indicates poor nutritional status with aging. Thus, nutrition and health interventions should be specific to regions

Nutritional Knowledge, Attitudes, and Practices of Women Living with HIV in Eastern Uganda

HIV and AIDS have posed various medical, nutritional, social and economic problems, female-headed households being the most affected. Poor nutritional knowledge and dietary practices common among the most affected households significantly contribute to the rapid progression of HIV. However, very little data exist concerning these aspects of nutrition among women living with HIV and AIDS in resource-limited settings, such as Uganda. The aim of the study was to investigate the gaps in nutritional knowledge, attitudes, and practices and their relationship with sociodemographic characteristics in an urban population of women living with HIV and AIDS in Uganda. In total, 133 women living with HIV were interviewed using a pretested questionnaire. Most (89.5%) women reported being trained on the importance of nutrition for people living with HIV and AIDS (PLWHA) and believed that it is very important to consume a balanced diet (99.5%). On the contrary, only 21.8% consumed at least three meals per day and 39.8% at least six food-groups. They also reported higher dependency on starchy staples while foods of animal origin and fruits that play vital immunity and protective roles were inadequately consumed. Results of bivariate analysis indicated that consumption of a diversified diet was significantly associated with access to food-aid (p=0.006), possibly because access to food-aid reportedly enhances the ability of the household to access other food items. However, much is still needed to understand the drug-food interaction and dietary diversification and enhance proper dietary practices through sustainable projects that ensure increased access to food. Support groups of the PLWHA are a good vehicle for communication of nutrition information and implementation of nutrition-related projects