Academic literature on the topic 'UNICEF Uganda'

Malnutrition is one of the common problems that afflict the poor in low- and middle-income countries like Uganda. The rate of decline of malnutrition in the country has been very slow for the last 15 years. This problem is of utmost concern in this era of Sustainable Development Goals (SDGs) in which achieving the goals is imperative. The aim of our study was to review literature on the prevalence and socio-economic impacts of malnutrition among children under 5 in Uganda and provide recommendations to address identified gaps. This review assesses available evidences, including journal articles, country reports, the World Health Organization (WHO) reports, the United Nations International Children’s Emergency Funds (UNICEF) reports, and other reports on issues pertaining to malnutrition among children in Uganda. Malnutrition, poverty, and chronic diseases are interconnected in such a way that each of the factors influences the presence and permanence of the other, resulting in a synergistic impact. The prevalence of acute and severe malnutrition among children under 5 is above the World Health Assembly target to reduce and maintain the prevalence under 5% by 2025. There are also limited studies on etiology of anemia as regards its prevalence in Uganda. The study presents a better understanding of the social and economic impact of child malnutrition on the families and the country’s development. The study also strongly suggests that, for Uganda to achieve sustainable development goal 2, financial investments by the government are necessary to address nutrition in the early stages of an individual’s life.

Introduction:World health organization (WHO) and United Nations international childrens fund (UNICEF) recommend all mothers should initiate breastfeeding immediately with the first hours of delivery, thereafter mothers are encouraged to breastfeed their children for at least six months of life before introducing any form of complementary feeding. it is on this global call to promote meeting up with the target set by UNICEF in 2025, a study was conducted in Uganda to assess the determinant of exclusive breastfeeding among breastfeeding mothers attending Masaka regional referral hospital. Methodology:The study was a descriptive cross-sectional study conducted on 220 consenting breastfeeding mothers. The data from the survey was statistically analyzed using SPSS vs 26 and information was presented in frequency tables, bar, and pie charts. Results:This study showed that the majority of the 220 participants were between the age of 26-30years, 81 (36.8%) with 194 (88.2%) were married and 94 (42.7%) had secondary education. It also showed that 56 (25.5%) did ANC visits more than four times with the majority 151 (68.6%) delivered by spontaneous vaginal delivery. 172 (78.2%) delivered at health facility and stayed at the facility for about 1-2 days. 100% of all babies were healthy and did not report any congenital malformations and 213 (96.8%) have never been admitted for malnutrition. The prevalence of EBF was 65.9%. Variables such as Age of the child, the weight of the child, mothers employment, educational status, and religion were statistically significant at P < 0.005. Conclusions:This study showed that the rate of exclusive breastfeeding among mothers attending Masaka regional referral hospital was generally above the expected target by WHA 2025.Hence strategies of improving health education about the benefits of exclusive breastfeeding to the mother and child should be in place.It is recommended that rigorous interventions can build on this study to achieve the WHO recommendation of all infants should be breastfed exclusively 100%.

Margaret Isabirye Kyenkya (photo) grew up in Uganda with five bothers and six sisters. Her Bachelor of Arts was in Social Work and Social Administration (Makerere University, Uganda), and was followed by a Masters in Sociology, (Nairobi University), and a Certificate in Mother and Child Health (International Child Health Institute, London). Her PhD focused on Hospital Administration inspired by the WHO/UNICEF Baby Friendly Hospital Initiative. She has worked as a researcher, the founder of Non-Governmental Organizations, a Senior United Nations Officer (New York Headquarters and several regions), a Manager in the United States Agency for International Development-funded National Health and Nutrition Projects, and a governmental Health and Nutrition Adviser. A certified trainer in a number of health and nutrition areas, a breastfeeding counselor, and a retired La Leche League Leader, Dr. Kyenkya has significantly influenced the course of lactation support and promotion globally. She stated, “My most precious and valued occupation is that of a mother [of five] and grandmother [of eight].” Dr. Kyenkya currently lives in Atlanta, Georgia, in the United States. (This interview was conducted in-person and transcribed verbatim. It has been edited for ease of readability. MK refers to Margaret Kyenkya; KM refers to Kathleen Marinelli.)

ObjectiveTo characterise developmental milestones among young children living in rural communities in Uganda.DesignCross-sectional study.SettingIganga-Mayuge Health and Demographic Surveillance Site in rural eastern Uganda.ParticipantsA total of 720 caregivers of children aged 3–4 years old from a health and demographic surveillance site in rural eastern Uganda were recruited into this study. Caregivers reported on their child’s developmental skills and behaviours using the 10-item Early Childhood Development Index (ECDI) developed by UNICEF. Childhood development was characterised based on the ECDI’s four domains: literacy-numeracy, learning/cognition, physical and socioemotional development. As an exploratory analysis, we implemented a hierarchical agglomerative cluster analysis to identify homogenous subgroups of children based on the features assessed. The cluster analysis was performed to identify potential subgroups of children who may be at risk of developmental problems.ResultsBetween November 2017 and June 2018, 720 caregivers of children aged 3–4 years completed the ECDI. The proportions of children at risk of delay in each domain were as follows: literacy-numeracy: 75% (n=538); socioemotional development: 22% (n=157); physical: 3% (n=22); and cognitive: 4% (n=32). The cluster analysis revealed a three-cluster solution that included 93% of children assigned to a low-risk group, 4% assigned to a moderate-risk group and 3% assigned to a high-risk group characterised by low scores in almost all domains.ConclusionThe findings suggest that a high proportion of children in rural eastern Uganda demonstrate poor literacy-numeracy skills. These results underscore the need to improve population-based screening and intervention efforts to improve early childhood developmental outcomes, particularly in literacy and socioemotional domains, in low-income and middle-income countries such as Uganda.

Abstract Inadequate hygiene coupled with the conjunctive use of the shallow subsurface as both a source of water and repository of faecal matter pose substantial risks to human health in low-income countries undergoing rapid urbanisation. To evaluate water, sanitation and hygiene (WASH) conditions in a small, rapidly growing town in central Uganda (Lukaya) served primarily by on-site water supply and sanitation facilities, water-point mapping, focus group discussions, sanitary-risk inspections and 386 household surveys were conducted. Household surveys indicate high awareness (82%) of domestic hygiene (e.g. handwashing, boiling water) but limited evidence of practice. WHO Sanitary Risk Surveys and Rapid Participatory Sanitation System Risk Assessments reveal further that community hygiene around water points and sanitation facilities including their maintenance is commonly inadequate. Spot sampling of groundwater quality shows widespread faecal contamination indicated by enumerated thermo-tolerant coliforms (TTCs) (Escherichia coli) ranging from 0 to 104 cfc/100 mL and nitrate concentrations that occasionally exceed 250 mg/L. As defined by the WHO/UNICEF Joint Monitoring programme, there are no safely managed water sources in Lukaya; ∼55% of improved water sources comprising primarily shallow hand-dug wells show gross faecal contamination by E. coli; and 51% of on-site sanitation facilities are unimproved. Despite the critical importance of on-site water supply and sanitation facilities in low-income countries to the realisation of UN Sustainable Goal 6 (access to safe water and sanitation for all by 2030), the analysis highlights the fragility and vulnerability of these systems where current monitoring and maintenance of communal facilities are commonly inadequate.

Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30yearsremained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%,respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples,there is need to improve the population’s awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards)that were developed by United Nations Children’s Fund (UNICEF), are currently the standard package used in Uganda’s health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards.A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a three-foodgroup guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status.At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores,which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p =0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-for-age (p = 0.03) Z-scores.These findings,therefore,indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards.Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth.

The slow decrease in child stunting rates in East Africa warrants further research to identify the influence of contributing factors such as water, sanitation, and hygiene (WASH). This study investigated the association between child length and WASH conditions using the recently revised WHO and UNICEF (United Nations Children’s Fund) Joint Monitoring Programme (JMP) indicators. Data from households with infants and young children aged 6–23 months from the Demographic and Health Surveys in Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Associations for each country between WASH conditions and length-for-age z-scores (LAZ) were analyzed using linear regression. Stunting rates were high (>20%) reaching 45% in Burundi. At the time of the most recent Demographic and Health Survey (DHS), more than half of the households in most countries did not have basic or safely managed WASH indicators. Models predicted significantly higher LAZ for children living in households with safely managed drinking water compared to those living in households drinking from surface water in Kenya (β = 0.13, p < 0.01) and Tanzania (β = 0.08, p < 0.05) after adjustment with child, maternal, and household covariates. Children living in households with improved sanitation facilities not shared with other households were also taller than children living in households practicing open defecation in Ethiopia (β = 0.07, p < 0.01) and Tanzania (β = 0.08, p < 0.01) in the adjusted models. All countries need improved WASH conditions to reduce pathogen and helminth contamination. Targeting adherence to the highest JMP indicators would support efforts to reduce child stunting in East Africa.

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan

In Africa, the natural history of SCD is often assumed to be same to the African Diaspora in the US, Jamaica, Europe or Latin America. Yet the environment can be different, including different pathogen exposure, such as malaria. To help better understand this, over 2000 references were identified using the names of all current or past names of African continent countries and the truncated word sickl$, followed by secondary nested and cross reference searches. Six cases series describing causes of death were identified, representing 182 children (Ndugwa, 1973, Athale, 1994, Koko, 1998, Diagne, 2000, Rahimy, 2003, Van-Dunem, 2007). Gender was reported in 172, 73 were female (42%). Age was reported in 118, 52 were < 5 years (44%). Four studies described some impediment to care or arrival for care in extremis in1/4 to over ½ of patients that died. In Uganda, 9/12 (75%) patient died at home. In Gabon 6/23 (26%) patients died within 4 hours of reaching the hospital and 11/23 (48%) within 24 hours. In Benin 2/10 (20%) died of splenic sequestration diagnosed at home; 38/64 (53%) of patients in Mozambique that died, lived outside of the capital. Causes of death were identified in 146 individuals. These included: fever/sepsis: n=59 (40%), including meningitis: n=15 (10%) and pyelonephritis: n=2 (1%); acute anemia: n=43 (29%), including spleen sequestration: n=28 (19%) and aplastic anemia: n=8 (5%); pain: n=22 (15%); acute chest syndrome/pneumonia: n=18 (12%); CNS: n=8 (5%), including stroke: n=4 (3%), seizure/ coma: n=5 (3%); liver disease: n=5 (3%) including hepatitis: n=3 (2%); Other: n=19 (13%) including wasting/ malnutrition: n=7 (5%), heart failure/cardiomyopathy: n=4 (3%), diarrhea and vomiting: n=3 (2%), transfusion reaction: n=2 (1%). Infectious pathogens were identified in 26, including malaria: n=10 (38%), S. pneumoniae: n=3 (12%), Salmonella: n=2 (8%), H. influenza, Klebsiella and Citrobacter: n=1 (4%) each; viral agents were reported in n=8 (31%) including HBV: n=5 (19%), HIV: n=3 (12%). Reported general population hemoglobinopathy surveys after birth revealed the following Relative Risk (RR) of observing individuals with hemoglobin SS compared to Hardy Weinberg expected frequencies (some age cohorts overlap; Tanzania '56, Benin '09, Burkina Faso '70, Central African Republic'75, Gabon'65/'80, Gambia'56, Ghana '56/‘57/'00/'10, Kenya '04/'10, Malawi '72/'00/'04, Mozambique '86, Nigeria '56/'70/'79/'81/'84/'05, Senegal '69, Sierra Leone '56). Age 0-1 years, total n=2112 observed n=22 (1.0%), expected n=16.5 (0.8%), RR=1.3 (95% CI=0.7,2.5), p=0.441. Age 0-6 years, total n=4078; observed n=39 (1.0%); expected n=40.6 (1.0%); RR=1.0 (95% CI=0.6,1.5), p=0.925. Age 5-19 years, total n=1880; observed n= 5 (0.3%); expected n= 24.8 (1.3%); RR=0.2 (95% CI=0.1,0.5); p<0.001. Adults, total n=12814; observed n= 20 (0.2%); expected n= 118.9 (0.9%); RR=0.2 (95% CI=0.1,0.3), p<0.001. Pregnant, total n=5815; observed n= 19 (0.3%); expected n= 78.5 (1.3%), RR=0.2 (95% CI=0.1,0.4), p<0.001. Cohorts of children with SCD are indicated in the table. In summary, access to care, as well as acute anemias are a frequent cause of mortality. Along with viral pathogens and transfusion related deaths this indicates the importance of a safe blood supply. By adulthood, the observed frequency of individuals with SCD is only 1/5 of expected. However, reported clinic cohorts suggest similar if not better survival than in the general population, possibly due to lost to follow up, but also malaria/bacterial infection prevention and nutritional support. Careful prospective studies are needed.TableCohorts of children in Africa with Sickle Cell AnemiaCountryAge median years, (range)Death/TotalnFollow up yearsPatient-yearsDeaths/100 patient-yearsU5M/100 child-yrs♦Uganda, 735 -9, (0-20)12/6282--2.7Senegal, ‘008 (0-22)11/323710331.12.2Senegal, 03330/55612--2.2Benin,032.910/2361.5-6.59831.02.4Kenya,096 (0-13)2/1241.21181.72.7♦: Under five year old mortality 2009 (source: Unicef), divided by 5Prophylactic interventions: Uganda: chloroquine; Senegal: chloroquine (wet season), nets, penicillin prophylaxis <5 yrs, folic acid, parasite treatment & iron supplement as needed; Benin: chloroquine, nets, penicillin prophylaxis, antibiotics for fever, folic acid, nutritional support; Kenya; Proguanil, folic acid, nutritional support, parasite treatment & iron supplement as needed. Disclosures: No relevant conflicts of interest to declare.