A comparative study of nutritional status, complementary foods and feeding practices for children 6 - 23 months old in landslides prone Bududa District

Abstract

Background: Bududa district located in Eastern Uganda experiences frequent landslides and floods resulting into food insecurity which predisposes children 6-23months to undernutrition. This study aimed at assessing the nutritional status of children, feeding practices and quality of complementary foods fed to children in Bukalasi sub-county (affected by landslides) and Bubiita (control) in 2019/2020 Methodology: A comparative cross-sectional survey was conducted. Through 5-stage sampling technique 191 households with children, aged 6-23 months were selected. Using a structured questionnaire, parents/care-givers identified four commonly used complementary foods (CFs). Child nutritional status was categorized according to World Health Organization (WHO) standards. Four focus group discussions (FGD) with mothers, explored commonly used complementary foods, methods of preparation and optimization of foods for analysis. A chi-square tested the association between child nutritional status and categorical variables of gender, age, Minimum Acceptable Diet (MAD) and the socio-economic factors of the household. A means comparison was done by ANOVA for Minimum Dietary Diversity (MDD) with the socio-economic factors and age of children with the amount of nutrients taken. Statistical significance was set at p<0.05. Pearson‘s Bivariate correlation was done to establish the relationship between different variables (child’s age group, feeding frequency, dietary diversity and nutrients intake). Qualitative data was transcribed, coded and categorised into themes and facts so as to establish a sequence of patterns and associations related to the phenomenon being investigated. Results: Child undernutrition in the study area was higher than at national level with a very high prevalence of stunting (40.5%), very high prevalence of underweight (20.7%) and medium prevalence of wasting (8.1%). More children in Bukalasi were significantly underweight than Bubiita (p<0.05). Main source of food was associated with underweight in both the affected and control Sub-counties (p<0.05). Unlike children 6-8months, majority of children aged 9-23months met their food diversity score (p<0.05). Source of income and main source of food were associated with children not meeting their Minimum Acceptable Diet (MAD) (p=0.008 and p=0.003 respectively). The study area had unsafe water with risk levels of e-colis among other microorganisms which were too numerous to count (TNTC), Maize flours from both sub-counties were heavily contaminated with Aflatoxins with levels above the national and EU regulatory limits (10ppb) and (5 ppb) respectively. Conclusion and recommendation: Childhood undernutrition was observed among children from both sub-counties. Notably, the prevalence of stunting, wasting and underweight was higher among children in the disaster affected Bukalasi sub-county and more prevalent in males. Complementary foods provided to the children were deficient of micronutrients especially iron and contaminated with aflatoxins especially in groundnuts and aflatoxins. The water that was used for preparing complementary food for the children was also contaminated with E. coli. Therefore, the government and other stakeholders should design specific interventions to not only combat malnutrition among children but also guide and support caregivers in the selection of safe food items and their formulation for complementary dishes.