Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda

Effect of video-assisted educational intervention on improving knowledge, attitude and practice among mothers of children below five years on malnutrition: A systematic review

OBJECTIVES

This review aimed to assess the effect of video-assisted educational interventions in enhancing knowledge, attitudes, and practices (KAP) among mothers of malnourished children aged <5 years.

STUDY DESIGN

This was a systematic review.

METHODS

A systematic search was conducted across PubMed, Scopus, and EMBASE databases from inception until November 2022. The selection criteria adhered to the PICOS framework, targeting randomized controlled trials (RCTs) involving mothers who received video-assisted educational interventions alongside comparison groups to evaluate malnutrition-associated KAP outcomes. Risk of bias was assessed using the Cochrane risk of bias assessment tool. Two independent reviewers performed study selection, data extraction, and quality assessment, resolving any disagreements through discussion or consultation with a third reviewer.

RESULTS

Among 11,434 screened articles, seven RCTs met the inclusion criteria, focusing on mothers of children aged <5 years. Statistically significant improvements were observed in maternal knowledge (n = 2), attitude (n = 1), and practice (n = 6) with respect to the feeding practices following video-assisted educational interventions. However, the effect of the educational intervention on children's z-scores remained inconclusive.

CONCLUSIONS

Video-assisted educational interventions were effective in KAP concerning feeding practices among mothers of children aged <5 years. However, their impact on children's z-scores remain inconclusive, emphasising the need for further research to explore factors influencing these outcomes. Further research is needed to determine the long-term effect on children's nutritional status.

Understanding the medical challenges for the diagnosis and treatment of bilateral pitting oedema in children: a qualitative study

Severely malnourished patients can present with bilateral pitting oedema, which is a common sign of Kwashiorkor. However, bilateral pitting oedema can also be an expression of other pathologies. In Mali and DRC, the number of children presenting with bilateral pitting oedema at MSF (Médecins Sans Frontiers/Doctors Without Borders) hospitals are up to 30% (Mali) and 49% (DRC) higher than in other countries, however, the reasons underlying this trend are unknown. Through this qualitative study, we aimed to explore the perspectives and lived experiences of health professionals on the diagnosis and management of children with bilateral pitting oedema. Using a participatory approach, we conducted 21 in-depth interviews, and 2 focus groups with health professionals at MSF health facilities who had worked in the settings of Koutiala (Mali) and Rutshuru (DRC) for at least 6 months. The understanding of the bilateral pitting oedema phenomenon is complex. Health workers described clinical obstacles to reducing mortality, including: i) difficulties making the diagnosis due to a lack of specialized staff and insufficient resources, ii) challenges treating complications that may arise due to the complexity of the diseases associated with bilateral pitting oedema, and iii) lack of scientific evidence in the literature explaining the physiopathology of bilateral pitting oedema. Study participants shared several key recommendations for reducing mortality among children presenting with bilateral pitting oedema, including prevention of bilateral pitting oedema at the community level, standardization of the diagnostic process, strengthening of medical training, and better collaboration both within the medical teams and between teams and the children's families.

Exploring Multiple Barriers to Proper Child Feeding Practices in Rural Districts of Ethiopia

Infants' and young children's health and development rely on optimal feeding techniques. Malnutrition is the leading cause of preventable illness and death in infants and early childhood. This impact is mostly significant in low- and middle-income countries, where childhood illness and mortality rates have risen considerably. To explore the barriers to child feeding practices in the rural Gamo zone, south Ethiopia, from primary caregivers and different key individuals' perspectives. A phenomenological qualitative study approach with a purposive sampling technique was carried out to explore the barriers and facilitators of child feeding practices in the study area from August 14 to September 10, 2023. Data was collected from fathers, health extension workers, the health development army, religious leaders, and community elders who reside in rural communities of the Gamo zone. Three focus group discussions, including 8-10 participants per group with females and three with males until data saturation. A total of 51 discussants and 12 key informants participated in the study. The following barriers were identified from the study. Limited income and employment opportunities, lack of property ownership, limited maternal and husband education, and lack of knowledge about proper child feeding practices are among the factors leading to inadequate nutrition for children. Large family sizes, marriage-related factors like polygamy, early marriage, limited freedom of partner choice, and gender inequalities can affect necessary support for appropriate child feeding practices and negatively impact children's nutrition. Moreover, cultural norms, religious beliefs, lack of awareness regarding the husband's income, and lack of support from family members or communities were identified as barriers that influence child feeding practices. The study unveiled three key themes that impede the adoption of appropriate child feeding practices: economic status, demographic conditions, and sociocultural aspects that affect the feeding practices of children. Effective interventions to improve child feeding practices must consider and address these identified barriers.

Social realities in remote villages: Infant and young child feeding in Kirewa, Uganda

Understanding infant and young child feeding (IYCF) practices in Africa requires an examination of the social context. Social relationships influence people through mechanisms such as social support, social influence, social engagement, access to resources and negative social interactions. This study explores how these mechanisms manifest in IYCF in remote villages in Uganda. In 2018, we conducted two focus group discussions each with mothers, fathers and grandparents, ande interviews with two clan leaders, six village health teamers (VHT) and four healthcare workers (HCW). We deductively searched the data for any indications of elements that could influence child feeding and health using the psychosocial mechanisms of social support, social influence, social engagement, access to resources and negative social interactions as the broader themes. The manifestation of social support involved practical help from mothers-in-law (MIL), financial contributions from fathers, and informational, instrumental, emotional and appraisal support from VHTs. Social influence by MILs mainly concerned the transmission of food-related beliefs and pressure to have many children. The social engagement of young mothers was restricted. Access to resources was stratified and affected by poverty, patriarchy, and knowledge of HCWs and VHTs. Negative social interactions included physical abuse, alcoholism, and fear-based relationships. We found the different psychosocial mechanisms to construct a useful framework for describing the social reality surrounding IYCF. Changing attitudes towards family planning, involving fathers in IYCF, and strengthening the position of VHTs as family advisers can potentially improve IYCF in rural Uganda.

The Climate Crisis and Breastfeeding: Opportunities for Resilience

The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning.

Assessment of pre-referral treatment for malaria, diarrhea, and pneumonia by rural community health workers in Southwestern Uganda: a cross-sectional study

BACKGROUND

Pre-referral treatment aims to stabilize the child's condition before transferring them to a higher level of healthcare. This study explored pre-referral treatment for diarrhea, malaria and pneumonia in children U5. The study aims to assess pre-referral treatment practices among community health workers (CHWs) for children aged 2 to 59 months diagnosed with malaria, diarrhea, and pneumonia.

METHODS

Conducted in 2023, this study employed a quantitative retrospective analysis of secondary data gathered from March 2014 to December 2018. Among the subjects, 171 patients received pre-referral treatment, serving as the foundation for categorical data analysis, presenting proportions and 95% confidence intervals across different categories.

RESULTS

In this cohort, 90 (53%) of the 177 children U5 were male, and age distribution showed 39 (23%), 70 (41%), and 62 (36%) in the 2-11 months, 12-35 months, and 36-60 months categories, respectively. Rapid Diagnostic Test (RDT) malaria results indicated a negative outcome in 83(60%) and positive in 55 (40%) of cases. Symptomatically, 45 (26%) had diarrhea, 52 (30%) exhibited fast breathing, and 109 (63%) presented with fever. Furthermore, 59 (35%) displayed danger signs, while 104 (61%) sought medical attention within 24 h.

CONCLUSION

The study analyzed a sample of 171 children under 5 years old to assess various characteristics and variables related to pre-referral treatment. The findings reveal notable proportions in gender distribution, age categories, RDT results, presence of diarrhea, fast breathing, fever, danger signs, and timely medical visits. The results highlight the need to strengthen pre-referral treatment interventions and enhance iCCM programs.

A scoping review of qualitative studies on sexual and reproductive health and rights in Uganda: Exploring factors at multiple levels

BACKGROUND

Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion.

OBJECTIVES

Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review.

ELIGIBILITY CRITERIA

Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda.

SOURCES OF EVIDENCE

Eight databases searched using qualitative/mixed methods search filters and no language limits.

CHARTING METHODS

Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool.

RESULTS

One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice.

CONCLUSIONS

Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes.

Identifying Predictors for Minimum Dietary Diversity and Minimum Meal Frequency in Children Aged 6-23 Months in Uganda

Adequate complementary foods contribute to good health and growth in young children. However, many countries are still off-track in achieving critical complementary feeding indicators, such as minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD). In this study, we used the 2016 Ugandan Demographic Health Survey (UDHS) data to assess child feeding practices in young children aged 6-23 months. We assess and describe complementary feeding indicators (MMF, MDD and MAD) for Uganda, considering geographic variation. We construct multivariable logistic regression models-stratified by age-to evaluate four theorized predictors of MMF and MDD: health status, vaccination status, household wealth and female empowerment. Our findings show an improvement of complementary feeding practice indicators in Uganda compared to the past, although the MAD threshold was reached by only 22% of children. Children who did not achieve 1 or more complementary feeding indicators are primarily based in the northern regions of Uganda. Cereals and roots were the foods most consumed daily by young children (80%), while eggs were rarely eaten. Consistent with our hypotheses, we found that health status, vaccination status and wealth were significantly positively associated with MDD and MMF, while female empowerment was not. Improving nutrition in infant and young children is a priority. Urgent nutritional policies and acceptable interventions are needed to guarantee nutritious and age-appropriate complementary foods to each Ugandan child in the first years of life.