RISK-FACTORS FOR EARLY-CHILDHOOD MALNUTRITION IN UGANDA

Objective. To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children <:30 months of age in a central Ugandan community, whose main dietary stapl es are banana (matoki) and maize. Methods. The study was a cross-secti onal survey using stratified multistage random sampling to select hous eholds with a child <30 months of age in rural and semi-urban environm ents. A questionnaire was administered to mothers of 261 infants and t oddlers in their home setting. Their health status was assessed by cli nical,examination and anthropometric measurements (mid-upper arm circu mference [MUAC], weight, and supine length). Results. A large minority (21.5%) of the children surveyed were found in poor health after clin ical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23 .8%), underweight (24.1%), or had low MUAC (21.6%). Although rural liv ing, poor health, the use of unprotected water supplies, lack of charc oal as fuel, lack of milk consumption, and lack of personal hygiene we re shown as risk factors for marasmus and underweight, different facto rs were found to be associated with risk of stunting and low MUAC, des pite these three parameters being significantly correlated.. For stunt ing the risk factors were: age of the child, poor health, prolonged br eastfeeding (from >18 months to <24 months), low socioeconomic status of the family, poor education of the mother of infants <12 months, lac k of paraffin as fuel, consumption of food of low energy density (<350 kcal/100 g dry matter), presence of eye pathology, and consumption of small meals. Risk factors for low MUAC were poor health, lack of meat and cow's milk consumption, low intake of energy from fat, and less w ell educated and older mothers. Food taboos had no influence on any of the anthropometric measurements. Although 93.1% of the children had b een immunized against tuberculosis, polio, diphtheria, and measles and showed better general health than children who were not immunized, th ere was a high prevalence of infection in the week preceding the surve y interview, including diarrhea (23.0%), malaria (32.3%), or cough/inf luenza (72.8%). Conclusions. This first account of dietary and environ mental risk factors involved in the etiology of early childhood malnut rition in Uganda indicates differences in risk factors for marasmus an d underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey sugg ests poor immune function as a result of inadequate nutrition. URL: p: //www.pediatrics.org/cgi/content/full/102/4/e45.