Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda.

The safety of homemade weaning foods in low- and middle-income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6-23 months of age in Amuru and Nwoya districts, Northern Uganda, between March 2019 and June 2019. A cross-sectional study was conducted involving 180 caregivers. Data were collected using semi-structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logistic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision-making on household income (p = .006) and households with older children (p = .041). A significant positive correlation was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.

Prevalence of aflatoxin along processing points of locally made complementary food formulae in northern Uganda: Safety and children's exposure across seasons.

Aflatoxin contamination along the processing points of locally made complementary food composite needs to be ascertained and minimized to reduce exposure to weaning children. The study established the concentrations of total aflatoxin (TAF) and aflatoxin B1 (AFB1) along the processing points of locally made malted millet sesame soybean composite (MMSSC) across season one (wet) and season two (dry) and determined children's exposure to them. A total of 363 samples were collected in 2019. TAF and AFB1 concentrations were determined quantitatively using an enzyme-linked immunosorbent assay (ELISA). Consequently, exposure of individual children was assessed as Estimated Daily Intake (EDI), (ng kg-1 bw day-1). All the samples along the processing points had detectable concentrations of TAF and AFB1 ranging from 0.578 µg kg-1 to 1.187 µg kg-1 and 0.221 µg kg-1 to 0.649 µg kg-1 respectively. Contamination was highest in raw materials; soybean (Glycine max) > sesame (Sesamum indicum), followed by stored composite, freshly prepared composite, and least in millet (Eleusine coracana). Contamination varied significantly across seasons with the wet season having higher contamination than the dry season at P = 0.05. All samples (100%) were within the European Commission (EC) acceptable maximum tolerable level for TAF and AFB1 (4 µg kg-1 and 2 µg kg-1) respectively for processed foods for general consumption. But were below the EU acceptable maximum tolerable level for TAF and AFB1 (0.4 µg kg-1 and 0.1 µg kg-1) respectively for processed baby foods cereals. However, all were within the United States- Food and Drug Authority (US-FDA) and East African Community (EAC) set maximum acceptable limit of 20 µg kg-1 for TAFs, 10 µg kg-1 and 5 µg kg-1 for TAF and AFB1 respectively. Conversely, exposure to these toxins was much higher than the Provisional Maximum Tolerable Dietary Intake (PMTDI) of 0.4 ng kg-1 bw day-1 to 1.0 ng kg-1 bw day-1. A significant difference in exposure to both toxins was observed with the weight. The age of 5 months was the most exposed. A concerted effort is needed to reduce children's exposure to MMSSC to TAF and AFB1, taking sesame and soybean as priority ingredients and proper storage based on season to control contamination.

Agroecology influences Salmonella food contamination with high exposure risk among children in Karamoja sub-region: A high diarrhoea prevalent locality in Uganda.

Uganda is among low-income countries where Salmonella induced diarrhoea still contributes significantly to children under five years (CUF) mortality. Karamoja, a sub-region characterised by three agroecologies (pastoral: PE; agro-pastoral: APE; agricultural: AE), is a geographical location that has consistently experienced a high prevalence of diarrhoea among CUF over the last decade nationally. This study examined whether agroecology influences Salmonella food contamination and exposure risk to CUF. A total of 240 food samples (PE: 78; APE: 73; AE: 89) were examined for Salmonella load using Xylose Lysine Deoxycholate Agar and confirmed using polymerase chain reaction targeting invA gene. Analysis of variance for nested design was used to compare Salmonella counts among food types within and across agroecologies and means were separated using Tukey Honestly Significant Difference test at 5% (p < 0.05). Proportion of foods with Salmonella load exceeding World Health Organisation (WHO) set-limit was expressed in percentage. Exposure risk of CUF was computed by multiplying quantity of food intake by Salmonella load and compared to minimum infectious dose (MID) of the pathogen (3 log CFU) whereas chi-square was used to compare proportions of CUF with exposure above or below MID among agroecologies. Salmonella load ranged from 0.00 ± 0.00 to 8.23 ± 1.12 log CFU but varied by food type and agroecology. Salmonella aggregated load in foods from PE was significantly higher than from APE or AE (p < 0.05). The proportion of Salmonella contaminated foods from PE, APE, and AE was 33-90%, 40-67%, and 17-88%, respectively. Salmonella exposure risks to CUF were similar (p > 0.05) at 96%, 92%, and 91% in PE, APE, and AE, respectively. Sorghum-based foods and leafy vegetables were the predominant high-risk foods. This study has revealed that Salmonella contamination of foods with high exposure risk among CUF in Karamoja sub-region varies with agroecology. Efforts to address food contamination in the sub-region should take into account agroecology.

Disparity in prevalence and predictors of undernutrition in children under five among agricultural, pastoral, and agro-pastoral ecological zones of Karamoja sub-region, Uganda: a cross sectional study.

BACKGROUND: Undernutrition accounts for nearly half of under-five child mortality in developing countries where household nutrition is largely dependent on agriculture. Despite the strong influence of agroecology on agriculture in those countries, limited information exists on whether undernutrition in children under five varies with agro-ecological location. METHODS: Using Karamoja sub-region of Uganda, one of the most food insecure parts of Eastern Africa as a case area, and applying a multi-stage sampling procedure, and a structured questionnaire, this study examined in a comparative manner, the prevalence and predictors of undernutrition in children under five among the agricultural, pastoral, and agro-pastoral ecological zones. Chi-square test and Kruskal-Wallis test were used to establish the disparity in prevalence of undernutrition and household contextual characteristics, respectively. Binary logistic regression was used to determine the predictors of undernutrition in children under five among the three agro-ecological zones. The level of statistical significance was set at p ≤ 0.05. RESULTS: The prevalence of underweight, stunting, and wasting ranged from 36 to 58% but varied with agroecology in terms of the peak age ranging from 6 to 37 months. Child characteristics, feeding practices, household economic factors, sanitation factors, and caregiver characteristics that predict undernutrition among children under five were identified (p ≤ 0.05). Caregiver handwashing after using latrine (p = 0.005) and diarrhoea in a fortnight (p < 0.001) increased the likelihood of stunting in pastoral agroecology only whereas cereal storage in both sacks and granary in agro-pastoral zone was associated with reduced likelihood of both underweight (p < 0.001 and p = 0.014) and stunting (p = 0.011 and p = 0.018), respectively. A male child was more likely to be underweight and stunted in pastoral (p = 0.002 and p = 0.011) and agro-pastoral (p = 0.017 and p = 0.002) agroecology, respectively. Household expenses reduced the likelihood of both underweight and wasting in pastoral (p = 0.013 and p = 0.005) and agricultural (p = 0.011 and p = 0.021) agroecology, respectively. Flour storage duration increased the stunting likelihood in pastoral (p = 0.032) and agro-pastoral (p = 0.006) agroecologies. CONCLUSION: This study has revealed that, in a food insecure developing country setting such as Karamoja sub-region of Uganda, undernutrition among children under five varies with agroecology. Thus, nutritional interventions in such locations should be agroecology specific.

Traditional vegetable preservation technologies practiced in Acholi subregion of Uganda improves mineral bioavailability but impacts negatively on the contribution of vegetables to household needs for micronutrients.

The impact of traditional African preservation methods on the contribution of vegetables to household micronutrient needs (Recommended Dietary Allowance: RDA) has largely remained unquantified. Using Acholi subregion of Uganda as a case area, this study examined using the predominant vegetables consumed in fresh and preserved forms (cowpeas-Vigna unguicullata, okra/lady fingers-Abelmoschus esculentus, Malakwang-Hibscus cannabinus, and eggplants-Solanum melongena), the effect of major traditional vegetable preservation methods (sun drying, boiling and sun drying, and salting and sun drying) on the contents of micronutrients (vitamin A, iron, zinc, calcium, magnesium, and phosphorus), the levels of antinutritional factors (total polyphenols, oxalate, tannins, and phytate), bioavailability of iron and zinc, and the contribution of vegetables to the cumulative annual household RDA for micronutrients. Laboratory analysis showed that all the preservation methods, except the sun drying method reduced the contents of micronutrients by 20%-82% (p ≤ .05). The contents of antinutritional factors reduced by 1%-80% while in vitro bioavailability of iron and zinc increased by 21%-296% (p ≤ .05). Nutritional computation revealed that except for calcium, the preservation methods combined, reduced the contribution of the vegetables to cumulative annual RDA for other micronutrients by 28%-60%. These results demonstrate that improvements in bioavailability of essential nutrients (iron and zinc) by traditional preservation methods investigated are associated with significant loss of micronutrients which culminates in significant reduction in the contribution of cultivated vegetables to household RDA for micronutrients. Traditional African preservation methods should be optimized for nutrient retention.

In vitro bioavailability-based assessment of the contribution of wild fruits and vegetables to household dietary iron requirements among rural households in a developing country setting: The case of Acholi Subregion of Uganda.

Wild fruits and vegetables (WFV) are believed to contain substantial quantities of micronutrients and are commonly consumed in rural areas of developing countries endowed with natural vegetation. Previous studies that provided evidence on the contribution of WFV to household micronutrient intake in a developing country setting did not consider the effect of antinutritional factors. Therefore, applying the in vitro bioavailability assessment technique and using the Acholi subregion of Uganda a case area, this study examined the contribution of commonly consumed WFV to the pooled annual household dietary requirement for iron. Laboratory analysis showed that the concentration of antinutrients varied with plant species but the pool was dominated by phytate (10.5-150 mg/100 g) and phenolic substances (38.6-41.7 mg GAE/g). In vitro iron bioavailability varied with plant species was quantitatively higher from vegetables than fruits by 27% although total concentration of the micronutrient was higher in fruits than vegetables by 142%. Nutritional computation, taking into account, household composition, and physiological status revealed that consumption of WFV resulted in a median contribution of 1.8% (a minimum of 0.02 and a maximum of 34.7%) to the pooled annual household dietary iron requirements on the basis of bioavailable iron fraction. These results demonstrate that WFV contributes meagerly to household iron needs but may serve other dietary and non-nutrient health purposes.

The mix of good nutritional attitude and poor nutritional knowledge is associated with adequate intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of Northern Uganda.

Nutritional knowledge and attitude of a population greatly affect intake of essential micronutrients. Much of the understanding on the impact of nutritional knowledge and attitude on nutrient intake has been derived from studies conducted among affluent societies using commercial food products. However, information on the link between status of nutritional knowledge and attitude on intake of essential nutrients from wild fruits and vegetables among rural communities is largely lacking. This study examined the status of nutritional knowledge and attitude associated with intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of northern Uganda. A cross-sectional study design making use of individual household questionnaire and proximate dietary recall of a calendar year consumption period involving 248 randomly selected rural households was applied. Results showed that households had good nutritional attitude but poor nutritional knowledge. Status of knowledge was dependent on nutrition training (p = 0.028; coefficient, ß = 0.710) and age of the respondent (p = 0.044; ß = -0.023), whereas status of attitude was predicted by age of the respondent (p = 0.014; ß = 0.048). Consumption of wild fruits and vegetables contributed adequately to the dietary vitamin A and iron requirements of the households. The results have demonstrated that intake of vitamin A and iron from wild fruits and vegetables among rural households is associated with good nutritional attitude but poor nutritional knowledge. A concerted effort is necessary to improve household nutritional knowledge for better utilization of wild fruits and vegetables.