Joyce K. Kikafunda

Risk Factors for Early Childhood Malnutrition in Uganda

Objective. To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children <30 months of age in a central Ugandan community, whose main dietary staples are banana (matoki) and maize. Methods. The study was a cross-sectional survey using stratified multistage random sampling to select households with a child <30 months of age in rural and semi-urban environments. A questionnaire was administered to mothers of 261 infants and toddlers in their home setting. Their health status was assessed by clinical examination and anthropometric measurements (mid-upper arm circumference [MUAC], weight, and supine length). Results. A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23.8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight, different factors were found to be associated with risk of stunting and low MUAC, despite these three parameters being significantly correlated. For stunting the risk factors were: age of the child, poor health, prolonged breastfeeding (from >18 months to <24 months), low socioeconomic status of the family, poor education of the mother of infants <12 months, lack of paraffin as fuel, consumption of food of low energy density (<350 kcal/100 g dry matter), presence of eye pathology, and consumption of small meals. Risk factors for low MUAC were poor health, lack of meat and cows milk consumption, low intake of energy from fat, and less well educated and older mothers. Food taboos had no influence on any of the anthropometric measurements. Although 93.1% of the children had been immunized against tuberculosis, polio, diphtheria, and measles and showed better general health than children who were not immunized, there was a high prevalence of infection in the week preceding the survey interview, including diarrhea (23.0%), malaria (32.3%), or cough/influenza (72.8%). Conclusions. This first account of dietary and environmental risk factors involved in the etiology of early childhood malnutrition in Uganda indicates differences in risk factors for marasmus and underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey suggests poor immune function as a result of inadequate nutrition.

Food security status in households of people living with HIV/AIDS (PLWHA) in a Ugandan urban setting

Because HIV/AIDS negatively impacts on the food security status of households, it is crucial to identify how households respond to these impacts, in order to identify positive food security entry points and design strategies that can effectively alleviate food insecurity among the households of people living with HIV/AIDS (PLWHA). A cross-sectional study was thus undertaken to establish how HIV affected households in an urban Ugandan setting in terms of response to food shortages and the interrelations between the practice of agriculture by PLWHA households within and around town, food security, access to food aid and dietary diversity among these households. Data for this cross-sectional study were collected using quantitative methods from 144 randomly recruited households of PLWHA (aged 15-49 years) residing in Jinja town in Eastern Uganda. The study showed that the HIV/AIDS pandemic has increased the inability of affected households in the study area to put enough food on the table, possibly because of the continued decreased productivity in these households and the high expenditure on medical costs. Various coping mechanisms identified in the households of PLWHA may contribute to poor adherence to antiretroviral regimes and poor quality of life for all household members. However, the practice of agriculture by PLWHA households was one of the positive coping mechanisms to alleviate food insecurity.

Breakfast, midday meals and academic achievement in rural primary schools in Uganda: implications for education and school health policy.

Background Underachievement in schools is a global problem and is especially prevalent in developing countries. Indicators of educational performance show that Uganda has done remarkably well on education access-related targets since the introduction of universal primary education in 1997. However, educational outcomes remain disappointing. The absence of school feeding schemes, one of the leading causes of scholastic underachievement, has not been given attention by the Ugandan authorities. Instead, as a national policy, parents are expected to provide meals even though many, especially in the rural areas, cannot afford to provide even the minimal daily bowl of maize porridge. Objective To assess and demonstrate the effect of breakfast and midday meal consumption on academic achievement of schoolchildren. Design, Materials and Methods We assessed household characteristics, feeding patterns and academic achievement of 645 schoolchildren (aged 9–15 years) in Kumi district, eastern Uganda, in 2006–2007, using a modified cluster sampling design which involved only grade 1 schools (34 in total) and pupils of grade four. Household questionnaires and school records were used to collect information on socio-demographic factors, feeding patterns and school attendance. Academic achievement was assessed using unstandardized techniques, specifically designed for this study. Results Underachievement (the proportion below a score of 120.0 points) was high (68.4%); in addition, significantly higher achievement and better feeding patterns were observed among children from the less poor households (p<0.05). Achievement was significantly associated with consumption of breakfast and a midday meal, particularly for boys (p<0.05), and a greater likelihood of scoring well was observed for better nourished children (all OR values>1.0). Conclusion We observed that underachievement was relatively high; inadequate patterns of meal consumption, particularly for the most poor, significantly higher scores among children from ‘less poor’ households and a significant association between academic achievement and breakfast and midday meal consumption.

Anaemia and associated factors among under-fives and their mothers in Bushenyi district, Western Uganda

OBJECTIVE To determine the prevalence of anaemia and associated factors among under-fives and their mothers in a rural area of Western Uganda. DESIGN A cross-sectional investigation using both qualitative and quantitative methods of data collection. Stratified multistage sampling methods were used to select the study sample. A haemoglobinometer was used to assess Hb levels in the blood. SETTING A rural district in Western Uganda. SUBJECTS Children aged 6-59 months and their mothers aged 15-49 years. RESULTS The overall prevalence of Fe-deficiency anaemia among children and their mothers was 26.2 % and 17.9 %, respectively. There was a significant correlation (r = 0.5, P = 0.008) between the Hb levels of the mothers and their children. Place of birth, age of the child, factors related to complementary foods, and formal education and nutrition knowledge of the mother were major factors that were significantly associated (r = 0.05, P = 0.05) with low Hb levels among the children. The most important factors that were associated with low Hb levels of the mothers were their formal education, nutrition knowledge and health status. CONCLUSIONS Fe-deficiency anaemia was found to be a major problem in this cohort of children and their mothers. Dietary factors and sociodemographic factors were the major factors associated with high levels of anaemia among the children and their mothers. It is therefore recommended that rural mothers should be sensitized on best practices for prevention of anaemia among both women and children.

Chemical and nutritional changes associated with the development of the hard-to-cook defect in common beans

Four common bean (Phaseolus vulgaris L.) varieties, Kawanda (K)131, K132, NABE4 and NABE11, were evaluated for the relationship between development of the hard-to-cook (HTC) defect and changes in nutritional quality during 6-month storage under ambient conditions. All varieties developed the HTC defect, but the extent was found to vary with variety. Cooking time increased by 113% in K131, 95.3% in K132, 56.4% in NABE4 and 42.93% in NABE11 after 6 months. The development of the HTC defect was found to be associated with a reduction in phytic acid content (r2=−0.802), in vitro protein digestibility (r2=−0.872) and in vitro starch digestibility (r2=−0.729). The susceptibility to the HTC defect during storage could be attributed to a phytic acid interaction with proteins and carbohydrates, and is also associated with small seed size. Breeding for large seed size could therefore help reduce the development of the HTC defect.

Optimising viscosity and energy density of maize porridges for child weaning in developing countries

The energy density of traditional starch-based weaning foods used in many developing countries is a major constraint in ensuring adequate energy and nutrient intake for infants and young children. Viscosity and energy density of weaning foods are inextricably linked but studies investigating the two and their interrelationships are scarce. In this study, the factors influencing the viscosity and energy density of weaning maize porridges were investigated in a 28 fractional factorial experiment. The factors investigated included: flour particle size (coarse or fine), concentration (6 or 8%), cooking time (5 or 10 min), temperature at time of measurement (30 or 40°C), shear speed (256 or 512 rpm), shear time (20 or 60 min) and addition of energy-dense foods; groundnut paste replacing 25% of the maize flour (w/w) and/or pasteurised cows milk replacing 10% of the water (v/v). The viscosity of the maize porridges was significantly increased by increased concentration and cooking time (P ≤ 0.0001) and use of f...

Food and Nutritional Security of Children of Urban Farmers in Kampala, Uganda

Background Urban agriculture is an important livelihood strategy to increase access to and availability of food in urban settings. Objective We examined the impact of sociodemographic and farming variables on the household food security and nutritional security of an index child aged 2 to 5 years. Our hypothesis was that dietary quality (percentage of energy from animal-source foods [%ASF] and dietary diversity) would have an impact on infection (as measured by C-reactive protein [CRP]), which in turn would have an impact on biochemical indices (hemoglobin and retinol) and anthropometric indices (weight-for-age z-score [WAZ] and body mass index z-score [ZBMI]). We examined the relationships among urban agricultural activities, household food security, and child nutritional security. Methods We conducted a cross-sectional survey of 296 households within each randomly selected study zone in Kampala, Uganda. Correlations were calculated and bivariate and exploratory path analysis was conducted to explore relationships. Results Household food security score was significantly positively correlated with the number of tropical livestock units (r = 0.142, p = .017), dietary diversity (r = 0.230, p < .001), %ASF (r = 0.185, p = .002), and WAZ (r = 0.149, p = .017). Exploratory path analysis demonstrated a significant positive relationship between household food security and %ASF, which in turn was positively associated with retinol. Consumption of animal-source food was significantly negatively associated with C-reactive protein level, which in turn was significantly negatively associated with hemoglobin level, and hemoglobin was significantly positively associated with WAZ. Conclusions Our findings are supportive of efforts to enhance access to land for urban farming and engagement in activities aimed at improving the quality of dietary intake of urban residents, in particular by increasing consumption of animal-source foods.

Nutritional and Sensory Properties of High Energy/Nutrient Dense Composite Flour Porridges from Germinated Maize and Roasted Beans for Child-Weaning in Developing Countries: A Case for Uganda

The study aimed at increasing the energy and nutrient density of traditional weaning porridges from germinated maize and decorticated bean flours. Proximate analysis showed that the porridge from the composite flour had a higher protein and energy density than typical weaning porridges made from maize alone. For a breastfed infant, the blend could meet 75% of the remaining required energy, compared to 52% provided by the porridge from maize alone. Untrained sensory evaluation panelists scored the porridge from the blend as acceptable. This blend therefore has great potential as a weaning food in resource-poor and technologically under-developed countries.

Effect of refining and supplementation on the viscosity and energy density of weaning maize porridges

The study was undertaken to establish the extent to which use of refined maize flour in weaning porridges affects the viscosity and the energy density of the resulting porridges. Maize porridges from both refined and whole flours were made using modified traditional methods and the viscosity of the porridges was measured using a rotational viscometer. Other factors that might influence the viscosity outcome of the porridges such as flour concentration, supplementation with energy-rich foods, cooking time, temperature at the time of measurement simulating feeding temperature and shear speed were included at three levels per factor (low, medium and high) in a Central Composite Design. Overall, refined flour porridges had significantly (P ≤ 0.0001) higher viscosity than whole flour porridges. Increasing concentration and cooking time significantiy (P ≤ 0.0001, P = 0.0003, respectively) increased the viscosity of the maize porridges while addition of groundnut, addition of cows milk and increased shear speed...

Food variety consumption and household food insecurity coping strategies after the 2010 landslide disaster - the case of Uganda.

Objective To evaluate the nutritional situation of the victims of the 2010 landslide disaster in Uganda, food varieties consumed and coping strategies were assessed. Design Cross-sectional. Food variety scores (FVS) were obtained as the total of food items eaten over the last week while an index was based on severity weighting of household food insecurity coping strategies. We included 545 affected and 533 control households. Setting Victims in the affected Bududa district in Eastern Uganda and those victims resettled in the Kiryandongo district, Western Uganda. Results Adjusted for covariates, in Bududa significantly higher mean FVS were observed among: affected than controls; farmers than others; and relief food recipients. Control households scored higher means (se) on severity of coping: 28·6 (1·3) v. 19·2 (1·2; P<0·01). In Kiryandongo, significantly higher FVS were observed among: control households; household heads educated above primary school; those with assets that complement food source; and recipients of relief food. Severity of coping was significantly higher among affected households and non-recipients of relief food. Affected households had a higher likelihood to skip a day without eating a household meal in Bududa (OR=2·31; 95 % CI 1·62, 3·29; P<0·01) and Kiryandongo (OR=1·77; 95 % CI 1·23, 2·57; P<0·01). Conclusions Whereas FVS and severity of coping showed opposite trends in the two districts, resettlement into Kiryandongo led to severe coping experiences. Administrative measures that provide a combination of relief food, social protection and resettlement integration may offset undesirable coping strategies affecting diet.