ABSTRACT
BACKGROUND: Undernutrition is the most dominant form of malnutrition among children in developing countries. Studies conducted in Tanzania have reported high levels of undernutrition among children below five years of age. However, there is limited information on differences in stunting prevalence across agroecological zones. This study aimed to determine the prevalence of undernutrition and its determinants in the lowland and highland areas in Kilosa District, Tanzania. METHODS: A cross-sectional study was conducted in a sample of 200 randomly selected households from the lowland and 141 from the highland areas of Kilosa District in Morogoro Region, Tanzania. Sociodemographic, feeding practices, hygiene, and sanitation data were collected using a structured questionnaire. Weight and height of children were measured using a standard procedure, and age was calculated from the birth date obtained from the child growth card. Anthropometric data were analyzed by using Emergency Nutrition Assessment (ENA) software. The logistic regression model was used to explore the determinants of undernutrition. RESULTS: Prevalence of stunting, underweight, and wasting was 41.0%, 11.5%, and 2.5% in lowland and 64.5%, 22.0%, and 1.4% in highland areas, respectively. The prevalence of stunting and underweight was higher in the highland compared to the lowland areas (p < 0.001). Significant determinants of underweight were areas of residence (AOR 4.21, 95% CI: 1.62-10.9), age of the children (AOR 5.85, 95% CI: 1.81-18.97), and child birth weight (AOR, 4.98 95% CI: 1.65-15.05), while determinants of stunting were the area of residence (AOR, 2.77 95% CI: 1.43-5.36), maternal age (AOR, 0.33 95% CI: 0.14-0.79), sex of a child (AOR, 1.89 95% CI: 1.03-3.50), and child birth weight (AOR, 3.29 95% CI: 1.21-8.97). CONCLUSION: The prevalence of undernutrition, especially stunting and underweight, was high in the study areas. Determinants of stunting differed between highlands and lowland areas, highlighting the needs of having properly integrated interventions based on the geographical location.
ABSTRACT
BACKGROUND: Although malnutrition particularly stunting is recognized as multi-causal, there has been limited integrated nutrition interventions to reduce its burden in children under-fives and those existing are not well evaluated. This study tested the effectiveness of provision of health and nutrition education and promotion of home gardening in child stunting. METHODS: The study used a quasi-experimental evaluation design. Two rounds of household surveys were done to assess changes in behaviors (uptake of Antenatal Care services and child feeding practices) and stunting among children under-5 years. The sample size was calculated to detect a 10% percent absolute baseline-to-end-line change in stunting. A two-stage stratified sampling process was used to sample 896 and 1736 households at each round of data collection in the intervention and control districts respectively. Mothers delivered in the past 24 months preceding the survey and all children under-5 years residing in selected households were eligible. The difference in difference (DID) analysis was used to estimate effect of the interventions. All ethical clearances were obtained from relevant authorities prior to data collection. RESULTS: A total of 3467 and 4145 children under 5 years were recruited at baseline and endline respectively. The proportional of stunted children decreases from 35.9 to 34.2% in intervention and from 29.3 to 26.8% in the control sites. Overall, no statistically significant stunting reduction was observed between intervention and control sites. However, a significant effect was observed in intermediate outcomes; Uptake of iron folic acid (DID: 5.2%, (95% CI: 1.7-8.7), p = 0.003), health facility delivery (DID: 6.5%, (95% CI: 1.8-11.2), p = 0.006), pre-lacteal feeding (DID: - 5.9%, (95%CI: - 9.2, - 2.5), p = 0.001), breast feeding within 1 h after birth (DID: 7.8%, (95%CI: 2.2-13.4), p = 0.006) and exclusive breast feeding in children under 6 months (DID:20.3%, (95% CI: 10.5-30.1), p = 0.001). CONCLUSION: The 3 years program did not result in significant evidence of stunting reduction, but the observed effect on health and nutrition behavioural indicators are at the causal pathways to improved child nutritional outcomes in the long run. Implementation of these integrated packages over a longer duration is needed to witness significant reduction in the prevalence of stunting.
ABSTRACT
INTRODUCTION: Pregnant women are at a high risk of anaemia, with iron-folate deficiency being the most common cause of anaemia among pregnant women. Despite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area. This study is aimed at investigating adherence to IFAS and associated factors among pregnant women in Kasulu district, north-western Tanzania. METHODS: A health facility cross-sectional survey with a mixed-method approach was conducted in Kasulu district from March to April 2019. A structured questionnaire was given to 320 women with children aged 0-6 months to assess factors associated with adherence to IFAS among pregnant women. Data were entered into SPSS version 22.0 for analysis. Binary logistic regression was further employed to determine the factors associated with adherence to IFAS. Focus group discussions were done with 19 pregnant women and 15 mothers of children aged 0-6 months to obtain more clarifications on the factors associated with adherence to IFAS. Furthermore, in-depth interviews were done with six health care providers to explore their perceptions of IFAS. RESULTS: Out of the 320 respondents of the survey, 20.3% (n = 65) adhered to IFAS. Factors associated with adherence to IFAS among pregnant women included time to start ANC (AOR = 3.72, 95% CI: 1.42, 9.79), knowledge of anaemia (AOR = 3.84, 95% CI: 1.335, 10.66), counseling on the importance of the iron-folic acid (AOR = 3.86, 95% CI: 1.42, 10.50), IFAS given during clinical visit (AOR = 15.72, 95% CI: 5.34, 46.31), number of meals consumed (AOR = 3.44, 95% CI: 1.28, 9.21), number of children (AOR = 3.462, 95% CI: 1.035, 11.58), and distance to health facility (AOR = 0.34, 95% CI: 0.131, 0.886). Qualitative findings revealed that delayed first ANC visit, lack of remainder for pregnant women to take IFAS, low awareness about the negative effects of anaemia, low of knowledge of IFAS and management of side effects, negative beliefs about the use of IFAS, and follow-up mechanism were major reasons for poor adherence. CONCLUSION: Adherence to iron-folic acid supplementation during pregnancy was low. Strengthening systems for creating reminding mechanism, raising community awareness through educational programs to pregnant women and health providers could improve adherence to IFAS.
