Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study.

BACKGROUND: Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda. METHODS: A comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1. RESULTS: A total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers' age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd - 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher. CONCLUSIONS: The comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health.

Extent of integration of nutrition assessment counselling and support interventions in the health system and respective drivers: A case of Tororo district, Uganda.

BACKGROUND: Uganda embraced Nutrition Assessment Counselling and Support (NACS) since 2009 as a health system strengthening approach to improve health and nutrition outcomes. However, scant evidence exists on NACS integration and drivers. This study therefore assessed the extent of NACS integration in the health system and identified key drivers and barriers. METHODS: A mixed method design was employed. In a facilitated panel discussions at each of the 17 health facilities, 4-5 health staff participated, responding to a semi-structured questionnaire. Integration was assessed on a 5-point scoring scale of 1 for not done nor integrated, 2-4 for partial and 5 for fully integration. Data was captured, analysed in microsoft excel and presented using as bar and spider charts. Integration drivers were identified deductively from key informant and in-depth interviews using Atlas.ti 9 and thematic analysis. RESULTS: The NACS integration across the health facility level was partial at a score of 2.9 indicating a weak integration into the health system. Integration across the health system building blocks was partial at; service delivery (3.8), health work force (3.7), health information (3.3), community support system (3.0), governance and leadership (3.0) signifying that NACS activities are provided by Ministry of Health but sub-optimal due to weak capacities. Health financing (2.2) and Health supplies (1.5) were the least integrated due to partner dependence. Under service delivery, deworming (5) was fully integrated and provided by Ministry of Health. The key drivers for integration were; good leadership, financing, competent staff, quality improvement approaches, nutrition talks, community dialogues, nutrition logistics and supplies. CONCLUSION: The NACS integration in the health system was generally low and lacked adequate support. Governance, financing and community follow-up under service delivery require more government investment for enhanced integration.

Effect of a communication intervention on alcohol use during pregnancy in post conflict Northern Uganda: a quasi experimental study.

BACKGROUND: Alcohol use during pregnancy is a preventable risk factor for Fetal Alcohol Spectrum disorders. Psycho-social and educational interventions have been reported to enable women reduce alcohol intake levels during pregnancy and help improve some health outcomes of unhealthy alcohol use. We set out to assess the effect of a communication intervention on alcohol use during pregnancy in post conflict northern Uganda. METHODS: The study employed a quasi - experimental design to assess the effect of a community health worker led communication strategy on pregnant women's knowledge, attitudes and various patterns of alcohol use using Difference in Difference(DiD). 420 respondents were recruited at baseline as at endline. RESULTS: The communication messages were significantly associated with reduced odds of binge drinking (P = 0.018; OR = 0.09; CI = 0.012-0.66). Also those who received the intervention were less likely to drink frequently (P = 0.80; OR = 0.75; 95%CI = 0.074-7.5) or be harmful alcohol users(P = 0.948). The intervention also positively influenced having fair (ß =0.49;P = 0.217;RRR =1.63)or adequate knowledge(ß = 0.89;P = 0.25;RRR = 2.44) and having positive(ß = 0.37;RRR =1.44;P = 0.46) or fair attitude(ß = 0.19;RRR = 1.21; P = 0.693) although not to a significant level. CONCLUSIONS: The communication intervention affected some patterns of alcohol use among pregnant women and not others. Our results contribute to existing evidence that communication interventions are a promising approach in reduction of alcohol exposed pregnancies. Interventions aimed at promoting alcohol abstinence during pregnancy should be implemented alongside other strategies that address factors that influence pregnant women to drink to achieve maximum results.

Factors Associated With Utilization of Ecological Sanitation Technology in Burera District, Rwanda: A Mixed Methods Research.

Background: The utilization of "on-site excreta decomposition technology" known as "Ecological sanitation (Ecosan)" has a rational use of human excreta. It is a resource-oriented sanitation mostly feasible in areas with rocky soil and prone to agriculture. This technology was implemented in Rwanda for more than a decade. However, little is known about Ecosan utilization in the process of scale-up in the community. Aim: The study was carried out to determine enablers and barriers associated with the utilization of Ecosan in Burera district, Rwanda. Methods: A mixed method study was surveyed in 374 households with Ecosan. A systematic random sampling was used to select respondents and a sample was drawn from the 3 administrative sectors of Burera district. We interviewed 20 key informants that included community leaders and sanitation actors. Bivariate, ordered logistic regression with thematic content analysis were used. Results: Ecosan users were unable to practice both urine diversion and the use of Ecosan by-products. Only 39.4% of households were better users. As by the survey results, primary and secondary educational status (AOR 2.60, 95% CI 1.11-6.08) and (AOR 3.49, 95% CI 1.02-11.9), frequency of fecal pit emptying (AOR 3.38, 95% CI (2.18-17.91), ash use (AOR 1.65, 95% CI (0.93-4.64) and concrete slab latrine (AOR 7.31, 95% CI (2.94-17.95) were found to be associated with better use of Ecosan. Qualitative findings suggested unaffordable cost, a touch of excreta taboos, and poor maintenance practices as key barriers to utilization. Conclusion: Overall utilization of Ecosan was poor and the majority of households was not able to use Ecosan for both dry separation of urine from feces and reuse in the gardens. Upgrading existing knowledge about Ecosan with greater emphasis on the use of by-products and adopting good maintenance practices through regular training can promote better utilization of Ecosan.

Alcohol use during pregnancy in post-conflict northern Uganda: pregnant women's experiences and provider perceptions.

BACKGROUND: Alcohol use during pregnancy has been associated with several birth defects and developmental disabilities generally known as Fetal Alcohol Spectrum Disorders (FASD). Contextual in-depth understanding on why women drink while pregnant is scarce. For this reason, we explored pregnant women's experiences, knowledge, attitudes as well as provider perceptions regarding prenatal alcohol consumption to inform interventions meant to address alcohol-exposed pregnancies in post-conflict settings. METHODS: In the months of May and June 2019, 30 in-depth interviews were conducted with pregnant mothers who reported maternal alcohol use during pregnancy. In addition 30 Key informant interviews were carried out with health workers providing Antenatal Care services (ANC) in health facilities in Gulu, Kitgum and Pader districts in Northern Uganda. Data was recorded, transcribed and subjected to thematic content analysis. RESULTS: Women reported diverse views regarding maternal alcohol use during pregnancy. Whereas some felt it was favourable, others had misgivings about it. There was marked variability in knowledge on dangers of drinking during pregnancy. In this study, women reported that they found themselves in alluring situations that predisposed them to drinking alcohol. These included brewing alcohol as a source of livelihood, pregnancy-induced craving for alcohol, and participation in cultural festivities that are characterised by eating and drinking alcohol. Nonetheless, women who consume alcohol during pregnancy were not held in high esteem in the Acholi communities. Various prevention interventions reportedly existed in communities to address alcohol use during pregnancy including ANC health education, public debates, radio talk shows, community health worker group and individual counselling, and local council by laws. CONCLUSIONS AND RECOMMENDATIONS: Pregnant mothers in post-conflict northern Uganda regard alcohol as a remedy to some of the social, economic and health challenges they face. Hence they continue drinking even during pregnancy because of the existing socio-cultural norms that promote it. The findings of this study demonstrate a need for sensitising communities in which pregnant women live so they can provide a supportive environment for mothers to abstain from alcohol consumption during pregnancy. Health care providers should ensure pregnant women consistently receive accurate and honest messages on the dangers of drinking during pregnancy so they can make informed decisions.

Various forms of alcohol use and their predictors among pregnant women in post conflict northern Uganda: a cross sectional study.

BACKGROUND: Alcohol use during pregnancy has been associated with several births and developmental disorders. This study set out to determine the various forms of alcohol consumption among pregnant women and their predictors in post conflict Northern Uganda. METHODS: In the months of May to June 2019, we conducted a cross sectional study among 420 pregnant women seeking antenatal care services at both Government and private health facilities in Gulu, Kitgum and Pader districts in Northern Uganda. We asked them about consumption of various alcoholic beverages. A three stage stratified cluster sampling approach was used and study participants randomly selected from health facilities of interest. We used descriptive statistics to estimate the prevalence of various forms of alcohol use. The chi- square test and logistic regression were used to assess associations of alcohol use among respondents and their socio - demographic and other characteristics. RESULTS: Overall 99 women (23.6%) reported current alcohol use (any amount). Up to 11% (N = 11) of all drinkers were identified by the AUDIT to be women with problem drinking behavior, 8% (N = 8) of women reported hazardous drinking and only four (4%) were women with active alcohol dependent behavior. Predictors of maternal alcohol use included pre-pregnancy alcohol consumption, knowledge, attitude, education level, parity and residence. CONCLUSIONS: This study indicates that alcohol use (any mount) during pregnancy is high while alcohol dependence, problematic and hazardous drinking is low. Knowledge and attitude were important predictors of alcohol use. While alleviating alcohol use, development partners and relevant government departments should consider communication and other interventions that increase knowledge and risk perception on maternal drinking. Other risk factors that predict maternal drinking such as prior alcohol use, residence and parity should be mitigated or eliminated.

Socioeconomic and Demographic Factors Influencing Feeding Practices, Morbidity Status, and Dietary Intakes of Children Aged 7-24 Months in Rural Uganda.

The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7-24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.