Factors Associated with Malnutrition among Children in Internally Displaced Person's Camps; Northern Uganda

Introduction Since mid 1990s; Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in the northern and eastern districts. A major cause of morbidity and mortality amongst children in displaced settings is protein energy malnutrition. Objective To estimate the prevalence of and describe the risk factors for protein energy malnutrition among under five years old children living in internally displaced persons camps in Omoro county Gulu district. Methods This was a cross sectional study undertaken among internally displaced people's in Omoro county; Gulu district during 13 - 23rd September 2006. Anthropometric measurements of 672 children aged 3 59 months were undertaken and all their caretakers interviewed. The anthropometric measurements were analyzed using z- scores of height-for-age (H/A) and weight-for-height (W/H) indices. Qualitative data were collected through 6 focus group discussions; key informant interviews and observation. Data were captured using Epi Data version 3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0 computer packages respectively. Results The prevalence of global stunting was found to be 52.4and of global acute malnutrition 6.0. Male children are at risk of being stunted Adjusted OR 1.57 95CI 1.15-2.13; p value=0.004. Children in the age group 3 24 months were at risk of acute malnutrition Adjusted OR 2.78 95CI 1.26-6.15; p value=0.012 while de-worming was protective Adjusted OR 0.44 95CI 0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs include food rations distributed by WFP; cultivation and purchase. Conclusion and Recommendations There is high prevalence of protein energy malnutrition (stunting) among children in the internally displaced people's camps in Gulu district. Male children are at an increased risk of stunting while children aged between 3 24 months are at an increased risk of suffering from acute malnutrition. Stakeholders including local government and relief organizations should intensify efforts to improve the nutritional status of IDPs especially children in the camp settings. The quantity of and access to household food supplies; health education on infant and child feeding and integrated management of childhood illnesses (IMCI) activities in the camps should be strengthened

Risk Factors for Prenatal Mortality in Arua Regional Refferal Hospital, West Nile, Uganda

Background In low-income countries; the majority of neonatal deaths occur during the perinatal period. The fourth millennium development goal of reducing child mortality cannot therefore be met without substantial reduction in perinatal deaths. Objective To investigate the risk factors for perinatal mortality in Arua regional referral hospital; West Nile region. Methods We conducted a facility based unmatched case-control study at Arua Regional Referral hospital during January- March 2006. A total of 60 new cases of perinatal deaths and 120 controls were selected over a 3 months period. A case was defined as any baby born after 28 weeks of gestation either as a still birth or born alive but died within 7 days post delivery. A control was any baby born after 28 weeks of gestation and survived the first seven days of life. Control mothers were followed at home after one week to check if any perinatal death occurred. Logistic regression analysis was used to determine the risk factors for perinatal mortality. Results: The mean age of case mothers was similar to that of controls 24.1 years; range 15-38 years versus 24.9 years range 16-40 years (p-value = 0.52). Babies who died during the perinatal period were more likely not to have been resuscitated (OR= 24.85; 95CI 8.77-74.17). Mothers whose babies died were more likely to have travelled more than 5 kilometres to Arua hospital (OR= 3.89 CI 1.96-7.74); having had transport problem (OR= 3.35; CI 1.00-12.00); first sought help from other health facilities or TBA (OR= 8.03; CI 3.38-19.46); have been referred due to obstetric complications (OR= 11.45; CI 4.75-27.59); and had obstetric interventions i.e. C/S or vacuum extraction (OR= 3.79; CI 1.64-8.83). After controlling for confounding; significant risk factors for perinatal deaths included living more than 5 kilometres from the hospital (Adjusted OR= 0.91; CI 0.83-0.95); transport problem (Adjusted OR= 4.37; CI 1.14-39.75); baby not being resuscitated (Adjusted OR=4.87; CI 4.371-7.11) and baby being born with low Apgar score (Adjusted OR= 6.76; CI 2.75-187.38). Conclusion and Recommendations: Our study has identified several risk factors for perinatal deaths related to poor accessibility to and low quality of health care services in the setting. The study underscores the importance of improved accessibility to and quality of basic and comprehensive emergency obstetrical care. The findings suggest the need to improve the capacity of local health system at first; second and tertiary levels; accessibility to and quality health care services in the settings

Morbidity and Mortality amongst Southern Sudanese in Koboko Refugee Camps; Arua district; Uganda

To determine the causes of morbidity; mortality and assess the nutritional status of children under five years; on Koboko refugee camps; Arua District; Uganda. Design: Review and analysis of refugee treatment records between 1992 and 1994 from maracha and Koboko hospitals and cross sectional nutritional survey of children under five years in camps. Setting: between June 1992 and March 1994; an estimated 70;000 Sudanese refugees were encamped in five transit camps in Koboko county; Arua District. Koboko field hospital was immediately established and Marach hospital designated the referral for refugees. Participants: Hospitalised refugees between 1992 and 1994 in Koboko and Maracha hospitals and children under five years in the camps formed the study popualtions. Interventions: Health facilities and therapeutic nutrition centres were established in the camps. Fortnightly general food distribution and therapeutic feeding programmes were insituted. Severe medical and surgical conditions were referred to marach hospital. Main Outcome measures: Outcome variables considered were morbidity; mortality; case fatality rates; weight/height; weight/age and height/age. Results: Out of 1476 refugees hospitalised in Koboko and Maracha hospitals; 267 died giving a case fatality rate of 18. The leading causes of morbidity were diarrhoea diseases (26.9); ARI (13.6); malaria (10.2); trauma (7.6) and malnutrition (5.0). The main causes of mortality were similar; that is; diarrhoeal diseases (35.9); ARI (23.9);anemia (7.2) and HIV/AIDS (6.8). Conditions associated with high overall case fatality rates were ARI 931.3); HIV/AIDS (30.0) and cardiac failure (29.3) respectively. Nearly half of the children (48.6); H/A - 2SD were stunted; over a third (36.7); W/A - 2SD were underweight and (8.5); W/H - 2SD wasted. Conclusion: Communicable diseases are the predominant causes of morbidity and mortality during the emergency phase of encampment. Timely and effective management of communicable diseases including malnutrition and trauma are crucial to avoid high mortality amongst refugees; coupled with the provision of essential requirements and services such as water; sanitation; food; shelter and immunisation

Maternal mortality estimated using the Sisterhood method in Gulu district; Uganda

A coomunity-based retrospective maternal mortality study using the Sisterhood method was conducted in Gulu district between February and March 1996. The objectives were to estimate the magnitude of and identify factors associated with maternal mortality in the district. A total of 5522 adult respondents; randomly selected from 27 parishes; of the five counties in the district were interviewed. Between 1960-1996 324 maternal deaths occurred in the sisterhood sample. The maternal mortality rate (MMR) was estimated to be 662 per 100;000 deliveries [95confidence interval (CI) 421-839 per 100 deliveries]. The leading causes of maternal death were : haemorrhage 45.1; obstructed labour 26.2; puer sepsis 9.6; anaemia 2.2; AIDS 2.2; and gunshot wounds (GSW) 1.0. Factors associated with maternal mortality included: age - 31.8of the mothers who died were below 20 years; education - 57.1had no formal education; 65of the mothers had delivered at home; 50.6had been attended to by untrained traditional birth attendants (TBA); while 37.8were attended to by relatives. The MMR was found to be 1.3 times higher than the estimated national MMR of 500 per 100;000 deliveries. Most maternal deaths (80.9) were due to preventable causes; being related to low socioeconomic status and low-level education of women in the district. The intractable civil war in the district was a major underlying and contributory factor to the maternal mortality in the area. A multifaceted approach to reduce maternal mortality in the district should target improving the socioeconomic conditions in the district with special emphasis on encouraging and supporting female education. Intensive education on maternal healthcare in antenatal clinics be conducted targeting husbands/spouses and relatives who care for the prenatal/pregnant and postnatal mothers. There is need for more trained TBAs per village who should be given effective support supervision. Ambulance transport services; motor and bicycle be made available at the district and community levels. At a national level the security situation should be improved in the district