A Systems Approach in the Prevention of Undernutrition among Children under Five in Tanzania: Perspectives from Key Stakeholders.

Undernutrition among under-fives is one of the major public health challenges in Tanzania. However, there are limited studies assessing the contribution of cultural-related strategies in the prevention of child undernutrition in Tanzania. This study aimed at exploring participants' experiential views regarding developing culturally sensitive strategies for the elimination of child undernutrition for under-fives in Rukwa, Iringa, Ruvuma, Songwe and Njombe regions located in the Southern Highlands in Tanzania. This study applied focus group discussions (FGDs) with forty practitioners to explore culturally-sensitive strategies for effectively preventing child undernutrition in Tanzania. The study participants were purposively selected, and thematic analysis was used to identify themes within the data. This study revealed that district- and lower-level administrative systems should prioritize nutrition interventions in their plans, allocating adequate resources to implement culturally sensitive nutrition interventions, while national-level organs need to strengthen institutional capacity and ensure the availability of funds, skilled human resources and a legal framework for the effective implementation and sustainability of nutrition interventions at the district- and lower-levels. This study highlights that for the successful implementation of culturally sensitive strategies towards the elimination of child undernutrition, there is a need to use a systems approach that allows for collaborative governance whereby different sectors act together to address the persistent malnutrition epidemic.

A Qualitative Exploration on Perceived Socio-Cultural Factors Contributing to Undernutrition Among Under-Fives in the Southern Highlands of Tanzania.

Objective: Under nutrition especially among under-fives is a major public health challenge in Tanzania. However, the contribution of cultural practices to child under nutrition is often overlooked. This study aimed to explore the perceived socio-cultural factors contributing to the persisting under nutrition among under-fives in Tanzania. Methods: The study applied focus group discussion (FDGs) with forty practitioners to examine the sociocultural factors contributing to under nutrition during early childhood. The study participants were purposively selected and thematic analysis was used to identify themes within the data. Results: This study revealed that, under nutrition for under-fives is caused by a number of socio-cultural factors including existence of gender inequality related to dietary practices and qualities, women's excessive workload, patriarchy social-norm, excessive alcohol use and cultural taboos prohibiting women and girls from eating certain types of nutrient dense foods. Conclusion: The study highlights the multiplicity of factors including socio-cultural perspectives contributing to under nutrition among under-fives, and calls for a concerted efforts in developing and implementing issue-specific and culturally sensitive strategies towards elimination of child under nutrition.

Prevalence and Factors Associated with Stunting among Public Primary School Pupils in Kasulu District, Western Tanzania.

BACKGROUND: Underfeeding of a child in the first 2 years of life results in irreversible growth damage. Globally, stunting has declined from 39.7% in 1990 to 26.7% in 2010 while in Africa has remained at 40% since 1990. However, stunting is little known in primary pupils.This study estimated the prevalence of stunting and contributing factors among public primary school pupils in Kasulu District. METHOD: Cross-sectional study was conducted among public primary pupils. Systematic random sampling was used to select study participants and then stratified to 5-7 and 8-12 years. Socio-economic factors, dietary practices, water, sanitation, and hygiene behaviours; school performance/attendance data were collected using a pretested questionnaire. Measurements were standardised to the World Health Organization HAZ-Scores for both girls and boys. Descriptive statistics, bivariate, and multivariable logistic regression were used to generate results. RESULTS: A total of 400 pupils (100%RR) were recruited into the study, mean age of 7.51 (STD= 1.54) years and a half (50.3%) were boys. The prevalence of stunting was 127 (31.8%) (95% CI: 27.2%-36.6%), with no sex difference (63 (31.7%) - girls vs. 64 (31.8%) - boys; p = 0.969). Household wealth influenced stunting; lowest quintile (AOR= 28; 95% CI: 3.64 - 214.6; p<0.001) 2nd quintile (AOR = 17; 95%CI: 2.20 - 138.5; p<0.01), the 3rd quintile (AOR = 8.0; 95%CI: 0.99 - 64.67; p = 0.051) and 4th quintile (AOR = 4.2; 95%CI: 0.49 - 36.75; p = 0.191) when compared to 5th (highest) wealthquintile. Food insecurity (AOR = 10.6; 95%CI: 4.60 - 24.60; p< 0.001), less protein in meal were the risk for stunting (AOR = 14.6; 95%CI: 4.07 - 52.42; p<0.001). Inappropriate hand wash after toilets both at school, (AOR=3.5; 95%CI:1.62-7.58; p=0.001), and home (AOR = 13.0; 95%CI: 2.73 - 61.76; p = 0.001) were the risk for stunting. Stunted pupils had irregular school attendance (AOR = 9.4;95%CI: 4.42 - 19.93; p<0.001) and poor performance (AOR = 23.6; 95%CI: 10.24 -54.19; p<0.001). Food insecurity influenced poor performance (AOR = 3.9; 95%CI:1.67-8.92; p<0.01) and irregular school attendance (AOR=5.4, p=0.000). CONCLUSION: Stunting among public primary school pupils is very high despite the prevention effort. Low wealth, food insecurity, poor hand hygiene, and lack of protein in a meal significantly influence stunting. Also, it affects the pupils' academic performance and attendance, availability of food in both quantity and quality, community nutrition.