Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

BACKGROUND: Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. METHODS: A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. RESULTS: Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively). CONCLUSION: Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda

Azithromycin Mass Treatment for Trachoma Control: Risk Factors for Non-Participation of Children in Two Treatment Rounds

The World Health Organization advocates at least three mass drug administrations (MDAs) with antibiotics when the prevalence of follicular trachoma (TF) is greater than 10% in children under age ten. Full child participation is necessary for maximizing the impact of trachoma control programs. The present paper identifies guardian, household, and program risk factors for households with a child who never participated in two annual rounds of MDAs with azithromycin. In comparison to households with full child participation, guardians with at least one child who never participated had a higher burden of familial responsibility, as represented by reporting ill family members, more children, and were younger in age. In addition, guardians of persistent non-participants seemed less well connected in the community, in terms of reliance on others and not knowing who their assigned community treatment assistants (CTAs) were. These guardians were assigned to CTAs who had a wide geographic dispersion of their assigned households. By developing programs with local groups to find and encourage participation in at-risk households, program managers may have the greatest impact on preventing persistent child non-participation. Increasing the number of distribution days and reducing CTAs' travel time may further prevent non-participation

Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey

Background: Mother-to-child transmission of HIV (MTCT) accounts for over 95% of all paediatric HIV infections worldwide. Several studies have shown that male participation in the antenatal care of their spouses together with couple counselling and testing for HIV, increases use of the interventions for HIV prevention. The prevention programme of MTCT (PMTCT) was launched in Uganda in 2000 and Mbale in 2002. Less than 10% of the pregnant women accepted antenatal HIV testing at Mbale Regional Referral Hospital in 2003; couple counselling and testing for HIV was low. Therefore, we conducted the study to determine the level of male involvement and identify its determinants in the PMTCT programme. Methods: A cross-sectional survey of 388 men aged 18 years or more, whose spouses were attending antenatal care at Mbale Regional Referral Hospital, was conducted in Mbale district, Eastern Uganda. A male involvement index was constructed based on 6 questions. The survey was complemented by eight focus group discussions and five in-depth interviews. Results: The respondents had a median age of 32 years (inter-quartile range, IQR: 28-37). The majority (74%) had a low male involvement index and only 5% of men accompanied their spouses to the antenatal clinic. Men who had attained secondary education were more likely to have a high male involvement index (OR: 1.9, 95% CI: 1.1-3.3) than those who had primary or no formal education. The respondents, whose occupation was driver (OR: 0.3, 95% CI: 0.1-0.7) or those who had fear of disclosure of their HIV sero-status results to their spouses (OR: 0.4, 95% CI: 0.2-0.8), were less likely to have a high male involvement index. Barriers to male involvement in the PMTCT programme were related to both the poor health system, to socio-economic factors and to cultural beliefs. Conclusions: Structural and cultural barriers to men's involvement in the PMTCT programme in Mbale district were complex and interrelated. Community sensitization of men about the benefits of antenatal care and PMTCT and improving client-friendliness in the clinics needs to be prioritised in order to improve low male participation and mitigate the effect of socio-economic and cultural factors

Infant feeding among HIV-positive mothers and the general population mothers: comparison of two cross-sectional surveys in Eastern Uganda

<p>Abstract</p> <p>Background</p> <p>Infant feeding recommendations for HIV-positive mothers differ from recommendations to mothers of unknown HIV-status. The aim of this study was to compare feeding practices, including breastfeeding, between infants and young children of HIV-positive mothers and infants of mothers in the general population of Uganda.</p> <p>Methods</p> <p>This study compares two cross-sectional surveys conducted in the end of 2003 and the beginning of 2005 in Eastern Uganda using analogous questionnaires. The first survey consisted of 727 randomly selected general-population mother-infant pairs with unknown HIV status. The second included 235 HIV-positive mothers affiliated to The Aids Support Organisation, TASO. In this article we compare early feeding practices, breastfeeding duration, feeding patterns with dietary information and socio-economic differences in the two groups of mothers.</p> <p>Results</p> <p>Pre-lacteal feeding was given to 150 (64%) infants of the HIV-positive mothers and 414 (57%) infants of general-population mothers. Exclusive breastfeeding of infants under the age of 6 months was more common in the general population than among the HIV-positive mothers (186 [45%] vs. 9 [24%] respectively according to 24-hour recall). Mixed feeding was the most common practice in both groups of mothers. Solid foods were introduced to more than half of the infants under 6 months old among the HIV-positive mothers and a quarter of the infants in the general population. Among the HIV-positive mothers with infants below 12 months of age, 24 of 90 (27%) had stopped breastfeeding, in contrast to 9 of 727 (1%) in the general population. The HIV-positive mothers were poorer and had less education than the general-population mothers.</p> <p>Conclusion</p> <p>In many respects, HIV-positive mothers fed their infants less favourably than mothers in the general population, with potentially detrimental effects on both the child's nutrition and the risk of HIV transmission. Mixed feeding and pre-lacteal feeding were widespread. Breastfeeding duration was shorter among HIV-positive mothers. Higher educational level and being socio-economically better off were associated with more beneficial infant feeding practices.</p

Evaluation of Business Models for Fecal Sludge Emptying and Transport in Informal Settlements of Kampala, Uganda

Various business models for fecal sludge emptying and transport have been developed to address challenges and their advantages have been documented; however, their evaluation has not been investigated. This study developed an evaluation framework, which was tested in informal settlements in Kampala for sustainable business models of fecal sludge emptying and transport. Through key informant interviews and stakeholder consultations, service delivery challenges from informal settlements in Kampala were identified and included in the framework, which were: high cost of emptying services, spillages, access to facilities, high operational costs and social stigma. The evaluation framework adopted six service criteria: Financial, Institutional, Environmental, Technological, Social and Scalability; these were further defined by fifteen service sub-criteria. The criteria were tested separately on eight business models—for mechanized (cesspool) and semi-mechanized (gulper) technologies. The key output of the evaluation framework (business model scorecard) revealed that two models (scheduled desludging and call center) for cesspool technology and three models (mobile transfer stations, scheduled desludging and call center) for gulper technology have high potential for service improvement in informal settlements. Scheduled desludging and mobile transfer stations can effectively optimize emptying services and subsequently reduce emptying charges, whereas the call center is critical for bridging service delivery

Reducing groundwater contamination from on-site sanitation in peri-urban sub-saharan Africa: Reviewing transition management attributes towards implementation ofwater safety plans

High urbanization in Sub-Saharan Africa (SSA) has resulted in increased peri-urban groundwater contamination by on-site sanitation. The World Health Organization introduced Water Safety Plans (WSP) towards the elimination of contamination risks to water supply systems; however, their application to peri-urban groundwater sources has been limited. Focusing on Uganda, Ghana, and Tanzania, this paper reviews limitations of the existing water regime in addressing peri-urban groundwater contamination through WSPs and normative attributes of Transition Management (TM) towards a sustainable solution. Microbial and nutrient contamination remain prevalent hazards in peri-urban SSA, arising from on-site sanitation within a water regime following Integrated Water Resources Management (IWRM) principles. Limitations to implementation of WSPs for peri-urban groundwater protection include policy diversity, with low focus on groundwater; institutional incoherence; highly techno-centric management tools; and limited regard for socio-cultural and urban-poor aspects. In contrast, TM postulates a prescriptive approach promoted by community-led frontrunners, with flexible and multi-domain actors, experimenting through socio-technical tools towards a shared vision. Thus, a unified risk-based management framework, harnessing attributes of TM and IWRM, is proposed towards improved WSP implementation. The framework could assist peri-urban communities and policymakers in formulating sustainable strategies to reduce groundwater contamination, thereby contributing to improved access to safe water

Valorisation of human excreta for recovery of energy and high-value products : a mini-review

The current approach to managing waste is one of the major reasons for ecosystem imbalances. In many parts of the world, human excreta is indiscriminately dumped in the environment, leading to the entry of high concentrations of nutrients and pathogens. In urban sanitary systems, nutrients are often not recovered, but large amounts of natural resources (e.g. water) are used for treating wastes at the expense of the environment. These practices are unsuitable and pose risks to human health and the environment, as such current efforts are geared towards providing on-site sanitation and opportunities for nutrient and resource recovery. This mini-review summarises the efforts to valorise human waste and process routes for the recovery of value-added products. These involve a review of ecological sanitation, systems that safely collect and treat human waste in situ and advanced waste-to-energy systems to convert recovered materials to fuels, heat and/or electricity. Focus is given to low-cost technological solutions that offer ecological benefits and opportunities to recover useful products. The barriers and opportunities to the adoption of on-site sanitation and appropriate technologies are discussed, considering current limitations and potential benefits. There are opportunities to recover useful products from human wastes; however, further research is needed to ascertain the value and impact of recovered products