2 nd WPHN Congress, UWC 30 th Aug 2 nd Sept, 2016

Transcription

1 Food-based daily Grand Nutrition supplement and nutrition education reduce malnutrition in the 1000 days critical window of opportunity in rural Uganda 2 nd WPHN Congress, UWC 30 th Aug 2 nd Sept, 2016 Florence B. Tushemerirwe, MPHN Assistant Lecturer, Makerere University School of Public Health (MakSPH)

2 Outline Introduction and Objective Methods Results Conclusion Recommendations Way forward Acknowledgements 2

3 Introduction Maternal and child malnutrition persistent global problem, consequences hinder development Malnutrition a deficiency or an excess of food and nutrients intake Globally there is a double burden of disease Our project focus stunting, wasting, underweight Black, Victora et al. 2013, Jennifer Bryce 2008; Saul S Morris

4 The double burden of malnutrition trends among Women years, The Nutrition Transition in the picture 4

5 Malnutrition is a public health challenge Nutrition Challenge/ Regional levels Anaemia (% with HB<12g/dl) Anthropometric indicators (%) Women* years <5yrs Stunting Underweight Global Africa Eastern Africa Uganda Eastern Uganda^ *values for non-pregnant women; ^where available Wasting (moderate/ severe 5

6 Nutritional Status Trends: National Vs Eastern Uganda, UBOS 1995; UBOS 2000; UBOS 2006, UBOS and ICF

7 Target Community Problem Poor infant and young child feeding practices Did not conform to guidelines; 55% received pre-lacteals, 30% received solids + semi-solids 2-3 times daily 0.9% mothers use at least one recommendation Women of reproductive age 12% were thin (BMI <18.5Kg/m 2 ), 28% were anaemic No nutrition interventions and nutrition education Lack of nutrition education is a problem at all levels UBOS and ICF (2012) 7

8 Objective With a seed grant from Grand Challenges Canada Develop and test the feasibility of an integrated model to prevent malnutrition Model consisted of: Daily Food Supplement made from local foods Eaten as a porridge in addition to a daily diet Nutrition education Critical window of opportunity period 8

9 2 phases Methodology Product development Community trials and nutrition education Luuka District Map Bukooma Prospective quasiexperimental design Study population Pregnant mothers, 356 mother-baby pairs, children below 24 months, mentor mothers Bulongo buffer S/C Bukanga Eighteen months 9

10 Ethical Considerations Study approvals were obtained from MakSPH Higher Degrees, Research and Ethics Committee (IRB) National Council of Science and Technology Written Consent from participants Voluntary participation Assent for infants and children below 24 months Permission - sought from district local authorities 10

11 Methods Two phases Proof of concept Phase 1 - Product Development Phase 2 - Nutrition Education Community trial 11

12 Methods Intervention Phase 1 Product Development Grand Nutrition Brand Partnership - MakSPH, Mak School of Food Technology, Nutrition and Bio-engineering and the target Community 6 prototypes, using local technology and local foods Conducted sensory evaluation on a six point hedonic scale Semitrained panelist Community panelists 12

13 Methods Intervention Phase 2 Nutrition Education Integrated into the Ministry of Health PHC package Daily food product added to the target community diet Cooking seminars Strategic Behaviour Change Communication Trainings Local Authority, Village Health Team Members and Mentor mothers Follow up and data collection 13

14 Methods Community trial and nutrition education Intervention arm Daily Food Supplement (Nice cup of porridge daily) Practical Nutrition Education Control arm Only Practical Nutrition Education, given by Community Volunteers and mentor mothers 14

15 Proportion of mothers Proportion of mothers Results - Grand Nutrition Suppl. Product is culturally acceptable First Follow up month Second Follow up month Smell Texture Colour Taste Like very much Like much Neither like nor dislike Dislike much Smell Texture Colour Taste Like very much Like much Neither like nor dislike Dislike much Great point attribute increases in the second follow up month! 15

16 Proportion of children Results - Stunting Severely Stunted (HAZ<-3) Intervention Severely Stunted (HAZ<-3) Control 0 Baseline Month 2 Month Comparing baseline and Month 3 values Households receiving the Grand Nutrition Food Supplement combined with Nutrition Education were less likely to have a stunted child (Pearson chi2 = 6.51, P-value = 0.039) 16

17 Proportion of children Results - Wasting Wasting (-3=WHZ<-2) Intervention Wasting (-3=WHZ<-2) Control Baseline Month 2 Month Comparing baseline and Month 3 values Households receiving the food supplement and nutrition education were less likely to have a wasted child (Pearson chi2 = P- value =

18 Proportion of children Results Reduction in Global Acute Malnutrition Baseline Month 2 Month 3 GAM(<12.5cm) Intervention GAM(<12.5cm) Control Between baseline and month 3, Global Acute Malnutrition reduced by half! 18

19 Proportion of mothers Results improved exclusive breastfeeding practice Intervention Control Total Baseline Month Month Comparing within and between groups, there were significant improvements in exclusive breastfeeding knowledge and practice (p-value = 0.000) Overall, improvement from 47% to 88% at end of project 19

20 Intervention Early Adoption A mixture of cereal, legumes, vegetables Resultant nutritious flour Local Milling Machine 20

21 Conclusion Grand Nutrition Supplementary Food product and context specific nutrition education reduced malnutrition Using Community volunteers enhanced intervention acceptability Familiar with the local context 21

22 Recommendation Validation of findings In a larger sample Would prove the potential in local foods to prevent malnutrition in the 1000 days critical window of opportunity Scale up of findings to improve more lives 22

23 Study Limitations Fathers were scantly involved in study activities They control household decision making Some babies outgrew the study period but were maintained Study did not predict the effect of the Grand Nutrition supplement on children s later life programming Results are based on proportions, not point average increases in variables 23

24 Way forward Reaching out to more mothers and children with the same intervention We invite partners to join us Continue shelf life studies of the Grand Nutrition Product Market the product accessible to many people 24

25 Acknowledgements Grand Challenges Canada International Development Research Centre (IDRC) Canada Makerere University School of Public Health Makerere University Scholl of Food Technology, Nutrition and Bio-engineering Luuka District Community Project Team 25

26 Thank you for listening Contacts Florence B. Tushemerirwe Makerere University School of Public Health P. O. Box 7072, Kampala, Uganda Tel. No (0) Skype: ftusht01 Twitter: ftusht01 26