Intestinal Helminth Infections and Nutritional Status of Children Attending Primary Schools in Wakiso District, Central Uganda

A cross-sectional study to assess the prevalence of intestinal helminth infections and nutritional status of primary school children was conducted in the Wakiso district in Central Uganda. A total of 432 primary school children aged 6–14 years were randomly selected from 23 schools. Anthropometric measurements of weight, height, MUAC were undertaken and analyzed using AnthroPlus software. Stool samples were examined using a Kato-Katz method. The prevalence of stunting, underweight and moderate acute malnutrition (MAM) was 22.5%, 5.3% and 18.5% respectively. Males had a threefold risk of being underweight (OR 3.2, 95% CI 1.17–9.4, p = 0.011) and 2 fold risk of suffering from MAM (OR 2.1, 95% CI 1.21–3.48, p = 0.004). Children aged 10–14 years had a 2.9 fold risk of stunting (OR 2.9, 95% CI 1.37–6.16, p = 0.002) and 1.9 risk of MAM (OR 1.9, 95% CI 1.07–3.44, p = 0.019). Attending urban slum schools had 1.7 fold risk of stunting (OR 1.7, 95% CI 1.03–2.75, p = 0.027). Rural schools presented a twofold risk of helminth infection (OR 1.95, 95% CI 1.12–3.32, p = 0.012). The prevalence of helminth infections was (10.9%), (3.1%), (1.9%), (0.2%) for hookworm, Trichuria trichiura, Schistosoma mansoni and Ascaris lumbricoides, respectively. The study revealed that 26.6%, 46% and 10.3% of incidences of stunting, underweight and MAM respectively were attributable to helminth infections

Correction: Lwanga, F., et al. Intestinal Helminth Infections and Nutritional Status of Children Attending Primary Schools in Wakiso District, Central Uganda. Int. J. Environ. Res. Public Health 2012, 9, 2910-2921

The author wish to make the following correction to this paper [1]: The author name “Lwanga Francis” should be “Francis Lwanga”

Food Security and Nutritional Status of Children Residing in Sugarcane Growing Communities of East-Central Uganda: A Cross-sectional Study

This article discusses major public health issue in several developing countries including Uganda. Sugarcane farming practiced in several districts of the East-central Uganda is reported to be threatening food and nutrition security.Undernourishment is a major public health issue in several developing countries including Uganda. Sugarcane farming practiced in several districts of the East-central Uganda is reported to be threatening food and nutrition security. We assessed household food and nutrition security in order to inform nutrition policy and program design for communities engaged in cash crop production. We conducted a cross-sectional study in Jinja district east-central Uganda. All households with children aged below five years in Nabitambala parish Busede sub-county were investigated. A total of 646 children from 382 households were studied. Food security data were collected using the Household Food Insecurity Access Scale. Nutritional status of the children was assessed using Height-for-Age, Weight-for-Age and Weight-for-Height to measure stunting, underweight and wasting respectively. Standard deviation (SD) scores (Z-scores) were applied to determine nutritional status. Statistical analysis was done using STATA statistical software package. The prevalence of stunting, underweight and wasting was 33.3%, 27.4% and 18% respectively. Of the 382 households studied 12% were food secure while 14.7%, 23.6% and 49.7% had mild, moderate and severe food insecurity respectively. Of the 95 households with wasted underweight and stunted children, the majority (85.3%, 88.3% and 91%), were food insecure respectively. The percentage of households with children who were malnourished significantly increased with increase in the number of children in the households. There is high prevalence of malnutrition and household food insecurity in the sugarcane growing communities of east-central Uganda. Short and long term measures are required to mitigate food insecurity and malnutrition in these settings especially in households with many children

Nutritional Status of HIV-infected Adolescents Enrolled into an HIV-care Program in Urban and Rural Uganda: A Cross-sectional Study

This article was published in World Journal of Nutrition and Health, 2015, Vol. 3, No. 2, 35-40. Available online at http://pubs.sciepub.com/jnh/3/2/2Malnutrition is a major threat to the health of HIV infected individuals and is associated with increased risks of morbidity and mortality. We assessed the nutritional status of HIV-infected adolescents enrolled into HIV care program in Uganda. We carried out across-sectional study. Data were collected on 205 adolescents aged 10-19 years attending The AIDS Support Organization (TASO) HIV care services in Uganda. All adolescents attending an adolescent clinic day in the respective TASO centers were enrolled into the study. Nutritional status was assessed using BMI-for-Age (BAZ) and Height-for-age (HAZ) as measures of thinness and stunting respectively. Standard deviation (SD) scores (Z scores) were applied to determine the nutritional status. Adolescents whose BAZ and HAZ was ≤-3SD were considered severely undernourished; those ≤-2SD were considered malnourished while those > -2SD were well-nourished. Statistical analysis was done using STATA statistical software package. The prevalence of stunting was 36.2% (72/199) with 11.1% (22/199) of adolescents being severely stunted. The risk factors for stunting included being male (AOR: 4.0; 95% CI: 1.81- 7.02) and residence in rural settings (AOR: 6.0; 95% CI 2.70-12.16). Eighteen percent of the adolescents (36/200) were thin, 8% (16/200) being severely thin. The prevalence of stunting and thinness was high among the HIV infected adolescents. Male adolescents and residing in rural settings are important risk factors of malnutrition among the HIV infected adolescents. There is need for development of comprehensive care and support systems including adequate nutritional care and support for HIV infected adolescents

The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6-23 Months in Sub-Saharan Africa and South Asia

BACKGROUND: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. METHODS: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6-23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. FINDINGS: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. CONCLUSION: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery

Childhood mortality during and after acute illness in Africa and south Asia: a prospective cohort study

Background: Mortality among children with acute illness in low-income and middle-income settings remains unacceptably high and the importance of post-discharge mortality is increasingly recognised. We aimed to explore the epidemiology of deaths among young children with acute illness across sub-Saharan Africa and south Asia to inform the development of interventions and improved guidelines. Methods: In this prospective cohort study, we enrolled children aged 2–23 months with acute illness, stratified by nutritional status defined by anthropometry (ie, no wasting, moderate wasting, or severe wasting or kwashiorkor), who were admitted to one of nine hospitals in six countries across sub-Saharan Africa and south Asia between Nov 20, 2016, and Jan 31, 2019. We assisted sites to comply with national guidelines. Co-primary outcomes were mortality within 30 days of hospital admission and post-discharge mortality within 180 days of hospital discharge. A priori exposure domains, including demographic, clinical, and anthropometric characteristics at hospital admission and discharge, as well as child, caregiver, and household-level characteristics, were examined in regression and survival structural equation models. Findings: Of 3101 children (median age 11 months [IQR 7–16]), 1120 (36·1%) had no wasting, 763 (24·6%) had moderate wasting, and 1218 (39·3%) had severe wasting or kwashiorkor. Of 350 (11·3%) deaths overall, 234 (66·9%) occurred within 30 days of hospital admission and 168 (48·0%) within 180 days of hospital discharge. 90 (53·6%) post-discharge deaths occurred at home. The proportion of children who died following discharge was relatively preserved across nutritional strata. Numerically large high-risk and low-risk groups could be disaggregated for early mortality and post-discharge mortality. Structural equation models identified direct pathways to mortality and multiple socioeconomic, clinical, and nutritional domains acting indirectly through anthropometric status. Interpretation: Among diverse sites in Africa and south Asia, almost half of mortality occurs following hospital discharge. Despite being highly predictable, these deaths are not addressed in current guidelines. A fundamental shift to a child-centred, risk-based approach to inpatient and post-discharge management is needed to further reduce childhood mortality, and clinical trials of these approaches with outcomes of mortality, readmission, and cost are warranted. Funding: The Bill & Melinda Gates Foundation

Characterising paediatric mortality during and after acute illness in Sub-Saharan Africa and South Asia: a secondary analysis of the CHAIN cohort using a machine learning approach

Background: A better understanding of which children are likely to die during acute illness will help clinicians and policy makers target resources at the most vulnerable children. We used machine learning to characterise mortality in the 30-days following admission and the 180-days after discharge from nine hospitals in low and middle-income countries (LMIC). Methods: A cohort of 3101 children aged 2–24 months were recruited at admission to hospital for any acute illness in Bangladesh (Dhaka and Matlab Hospitals), Pakistan (Civil Hospital Karachi), Kenya (Kilifi, Mbagathi, and Migori Hospitals), Uganda (Mulago Hospital), Malawi (Queen Elizabeth Central Hospital), and Burkina Faso (Banfora Hospital) from November 2016 to January 2019. To record mortality, children were observed during their hospitalisation and for 180 days post-discharge. Extreme gradient boosted models of death within 30 days of admission and mortality in the 180 days following discharge were built. Clusters of mortality sharing similar characteristics were identified from the models using Shapley additive values with spectral clustering. Findings: Anthropometric and laboratory parameters were the most influential predictors of both 30-day and post-discharge mortality. No WHO/IMCI syndromes were among the 25 most influential mortality predictors of mortality. For 30-day mortality, two lower-risk clusters (N = 1915, 61%) included children with higher-than-average anthropometry (1% died, 95% CI: 0–2), and children without signs of severe illness (3% died, 95% CI: 2–4%). The two highest risk 30-day mortality clusters (N = 118, 4%) were characterised by high urea and creatinine (70% died, 95% CI: 62–82%); and nutritional oedema with low platelets and reduced consciousness (97% died, 95% CI: 92–100%). For post-discharge mortality risk, two low-risk clusters (N = 1753, 61%) were defined by higher-than-average anthropometry (0% died, 95% CI: 0–1%), and gastroenteritis with lower-than-average anthropometry and without major laboratory abnormalities (0% died, 95% CI: 0–1%). Two highest risk post-discharge clusters (N = 267, 9%) included children leaving against medical advice (30% died, 95% CI: 25–37%), and severely-low anthropometry with signs of illness at discharge (46% died, 95% CI: 34–62%). Interpretation: WHO clinical syndromes are not sufficient at predicting risk. Integrating basic laboratory features such as urea, creatinine, red blood cell, lymphocyte and platelet counts into guidelines may strengthen efforts to identify high-risk children during paediatric hospitalisations. Funding: Bill & Melinda Gates Foundation OPP1131320