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

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 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

Determinants of infant growth in Eastern Uganda: a community-based cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Child under-nutrition is a leading factor underlying child mortality and morbidity in Sub-Saharan Africa. Several studies from Uganda have reported impaired growth, but there have been few if any community-based infant anthropometric studies from Eastern Uganda. The aim of this study was to describe current infant growth patterns using WHO Child Growth Standards and to determine the extent to which these patterns are associated with infant feeding practices, equity dimensions, morbidity and use of primary health care for the infants.</p> <p>Methods</p> <p>A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003; 723 mother-infant (0–11 months) pairs were analysed. Infant anthropometric status was assessed using z-scores for weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ). Dependent dichotomous variables were constructed using WLZ < -2 (wasting) and LAZ < -2 (stunting) as cut-off values. A conceptual hierarchical framework was used as the basis for controlling for the explanatory factors in multivariate analysis. Household wealth was assessed using principal components analysis.</p> <p>Results</p> <p>The prevalences of wasting and stunting were 4.2% and 16.7%, respectively. Diarrhoea during the previous 14 days was associated with wasting in the crude analysis, but no factors were significantly associated with wasting in the adjusted analysis. The adjusted analysis for stunting showed associations with age and gender. Stunting was more prevalent among boys than girls, 58.7% versus 41.3%. Having brothers and/or sisters was a protective factor against stunting (OR 0.4, 95% CI 0.2–0.8), but replacement or mixed feeding was not (OR 2.7, 95% CI 1.0–7.1). Lowest household wealth was the most prominent factor associated with stunting with a more than three-fold increase in odds ratio (OR 3.5, 95% CI 1.6–7.8). This pattern was also seen when the mean LAZ was investigated across household wealth categories: the adjusted mean difference between the top and the bottom wealth categories was 0.58 z-scores, p < 0.001. Those who had received pre-lacteal feeds had lower adjusted mean WLZ than those who had not: difference 0.20 z-scores, p = 0.023.</p> <p>Conclusion</p> <p>Sub-optimal infant feeding practices after birth, poor household wealth, age, gender and family size were associated with growth among Ugandan infants.</p

The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study

BACKGROUND: Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. METHODS: A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. RESULTS: In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area). CONCLUSIONS: This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities. Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives