Modelling the impact of stunting on childhood survival in Buhweju district and the cost of its prevention

Abstract

Stunting affects close to 2.4 million children in Uganda and it is among the major contributors to the annual loss in productivity equivalent to $899 million. This study sought to identify the risk factors for the persistently high stunting rates in Buhweju district, model impact of stunting reduction on child survival and the cost of interventions required to prevent it.

The study used a cross sectional design that combined several data collection approaches namely; standardized monitoring and assessment of relief and transition (SMART), focus group discussions (FGD), interviews with key informants, and a cross-sectional survey of infant and young child feeding (IYCF) and HIV to answer the research questions related to prevalence and risk factors of stunting. Data entry, cleaning and analysis were carried out using SPSS version 21. A regression analysis was conducted to examine the associations between potential risk factors and stunting. The Lives Saved Tool (LiST) was used to model the impact of stunting on child survival. The cost of interventions required to prevent stunting was estimated using the OneHealth Tool (OHT).

The overall prevalence of stunting was 51%, and boys were significantly (P < 0.05) more likely to be stunted compared to girls, OR = 4.5 (1.0 – 19.9). The persistent high prevalence of stunting in the district was largely attributed to low coverage of child survival interventions, sex of child, morbidity, suboptimal IYCF practices, low consumption of animal-source foods, food insecurity, poverty, and lack of knowledge about optimal IYCF practices and stunting. The high impact LiST model aimed at reducing stunting to zero estimated that 1,297 children under 5 years would be saved and 24,850 cases of stunting averted if the above risk factors were addressed and stunting reduced to zero. The cost of programs for the reduction of stunting under the high coverage scenario was estimated at US$ 21.2 M for the period 2018-2030.

The study revealed that the prevalence of stunting among children 6-59 months in Buhweju district is critical based on WHO classification. Buhweju district does not have adequate resources to address the malnutrition challenge. Any major scale up of programs to prevent stunting in Buhweju district such as universal health coverage, investment in well-designed rural agricultural programmes, and increased cultivation and consumption biofortified staple foods, would necessitate additional resources in excess of US$ 250,000 per year. There is thus need for external sourcing of funding to support the domestic public financing. The findings of this study are important for governmental and nongovernmental agencies that are involved in management of malnutrition in Buhweju district in particular and Uganda in general.