AN INDEPTH SECONDARY ANALYSIS OF THE UGANDA DHS (1988/89) DATA.

DETERMINANTS OF MALNUTRITION IN UNDER-FIVES IN UGANDA

Jessica Jitta

Michael Migadde

John Mudusu

MINISTRY OF HEALTH CHILD HEALTH AND DEVELOPMENT CENTRE MAKERERE UNIVERSITY

Using the Uganda Demographic and Health Survey (UDHS) 1988/89 data on children under-five years, a secondary analysis of the magnitude, nature and determinants of malnutrition was made. In investigating the determinants of malnutrition, linkages between socio-demographic, parental, household, environmental, health status and health facility utilization factors were studied. In addition, breastfeeding practices and their relationships with a child's nutrition status were investigated.

Generally, malnutrition was high, cutting across geographic, socio-economic and environmental sectors, with nearly half of the under-fives undernourished. Stunting (low height-for-age) was by far the most prevalent malnutrition problem in Uganda. Over half of the children between one and five years of age were moderately or severely stunted. The most critical period in this stunting process was 4-18 months of age. Rapid increases in stunting levels occur early between the age periods of 3-5 to 6-11 and continue in the 12-17 months period.

The highest stunting was found in rural areas, particularly those of South-western, Western and Eastern regions. The risk of malnutrition was relatively higher for male children, those of parents with little or no formal education, among lower socio-economic groups, and in households of more than four under-fives. Increased maternal educational level was more associated with lower stunting in urban than rural areas where household wealth made more of a difference. Other significant risk factors included being of fifth or higher birth order, born of a teenage mother, having poor health status, poor accessibility and utilization of health facilities and environmental factors like drawing water from unprotected sources.

Underweight also rose rapidly during the early months of life to a level half that of stunting and reached a peak at an earlier age (12-14 months). Significant risk factors for underweight included teenager deliveries, low socio-economic status, little or no formal education for the mother, having suffered from diarrhoea and poor accessibility or utilization of health facilities.

Initiation of breastfeeding was universal and seven out of ten children were exclusively breastfed throughout the first four months of life. Regardless of socio-economic background, most mothers were committed to exclusive breastfeeding. Introduction of supplementary foods was timely for most children with only one out of three supplemented after nine months. However, even children supplemented in time, the level of stunting was considerably high. Results also indicated that by the first year, over four in five children were still breastfed; and by the second birthday, about two in five were still breastfed.

The UDHS has provided invaluable data on nutrition status and breastfeeding practices. The results presented here should serve as a basis for future research on malnutrition in Uganda. They point to the need for indepth studies into the process and causes of rapidly early stunting which could not be analyzed using the available data set. The analysis also indicated the need for further research into areas of household food security, child care and feeding practices, workload of mothers, the most vulnerable and disadvantaged population -fostered and street children- and an assessment of the effectiveness of current nutrition programs.

Although a causal analysis could not be made, several strategies were advocated to address the problem of malnutrition. These included: creating awareness at all levels of the alarming level of malnutrition, urgent need to finalise and implement the national Food and Nutrition Policy and Strategy, growth monitoring and promotion, training of appropriate manpower and a multi-sectoral approach to the problem. The need for appropriate nutrition messages -in indigenous languages- was identified, alleviation of poverty and increased accessibility to health facilities -especially for rural mothers was also recommended. Success of these interventions depends on Government's political will and financial commitment.

KEYWORDS[ nutrition, demography]