Using participatory epidemiology to investigate women's knowledge on the seasonality and causes of acute malnutrition in Karamoja, Uganda

The Karamoja region of northeast Uganda had been characterized by high levels of acute malnutrition (AM) for decades, despite substantial aid investment in nutrition programmes. Participatory epidemiology (PE) was used to understand the seasonality of child AM from the perspective of women agro-pastoralists and understand their knowledge and prioritization of the causes of child AM. Women provided highly plausible descriptions and analysis of monthly variations in the occurrence of AM, livelihood factors related to the temporal variation in AM occurrence, the root causes of AM and relationships between these causes. Overall, AM was strongly attributed to declining livestock ownership and access to cow milk and normalized gender discrimination. Monthly calendars revealed important monthly patterns in AM, births and women's workload that had not been previously reported. There was significant agreement (p < 0.01) between independent women's groups (n = 16) for the monthly calendars and causal diagrams, indicating strong reproducibility of the methods. Triangulation indicated good validity of the monthly calendar method. The PE approach demonstrated that agro-pastoralist women with limited formal education could describe and analyse the seasonality of AM and related factors and identify and prioritize the causes of AM. Indigenous knowledge should be valued and respected, and nutrition programmes should shift the emphasis towards far more participatory and community-based approaches. The timing of conventional nutrition surveys in agro-pastoral settings should be based on an understanding of the seasonality of livelihoods.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s13570-023-00269-5.

Early childhood growth in Daasanach pastoralists of Northern Kenya: Distinct patterns of faltering in linear growth and weight gain

OBJECTIVES

Investigations of early childhood growth among small-scale populations are essential for understanding human life history variation and enhancing the ability to serve such communities through global public health initiatives. This study characterizes early childhood growth trajectories and identifies differences in growth patterns relative to international references among Daasanach semi-nomadic pastoralist children living in a hot, arid region of northern Kenya.

METHODS

A large sample of height and weight measures were collected from children (N = 1756; total observations = 4508; age = 0-5 years) between 2018 and 2020. Daasanach growth was compared to international reference standards and Daasanach-specific centile growth curves and pseudo-velocity models were generated using generalized additive models for location scale and size.

RESULTS

Compared to World Health Organization (WHO) reference, relatively few Daasanach children were stunted (14.3%), while a large proportion were underweight (38.5%) and wasted (53.6%). Additionally, Daasanach children had a distinctive pattern of growth, marked by an increase in linear growth velocity after 24 months of age and relatively high linear growth velocity throughout the rest of early childhood.

CONCLUSIONS

These results identify a unique pattern of early childhood growth faltering among children in a small-scale population and may reflect a thermoregulatory adaptation to their hot, arid environment. As linear growth and weight gain remain important indicators of health, the results of this study provide insight into growth velocity variations. This study has important implications for global public health efforts to identify and address sources of early growth faltering and undernutrition in small-scale populations.

CHILD GROWTH: CONCEPT ANALYSIS

ABSTRACT The aim of this study was to analyze the concept of child growth by identifying the attributes and consequences that make up the phenomenon. The concept analysis was supported by 41 studies and based on the evolutionary analysis model and integrative literature review. Five databases, Scopus, CINAHL, LILACS, PubMed, and the Cochrane Library were searched to select articles. The search found that growth has presented different connotations, including social and physiological aspects, which are part of the physical domain of child development. Attributes, antecedents, and consequences identified provide an overview of the phenomenon analyzed, because these point out several aspects previously related to other studies on child growth. The theoretical understanding about child growth can offer nurses in-depth knowledge about factors involved in this process, facilitating intervention-based decision-making.

Why no adult stunting penalty or height premium? Estimates from native Amazonians in Bolivia

Among adults of industrial nations, growth stunting (<-2 SD height Z score) is associated with worse indicators of adult well-being (e.g., income). Does adult stunting also inflict private costs in traditional societies? Adult stunting penalties or height premiums might only emerge when traditional societies modernize. Here we estimate the association between adult stunting and indicators of adult well-being using data from a panel study in progress among the Tsimane', a foraging-farming society of native Amazonians in Bolivia. Subjects included 248 women and 255 men >or=age 22 measured annually during 5 consecutive years (2002-2006). Nine outcomes (wealth, monetary income, illness, access to credit, mirth, schooling, math skills, plant knowledge, forest clearance) were regressed separately against a stunting dummy variable and a wide range of control variables. We found no significant association between any of the indicators of own well-being and adult stunting. Additional analysis showed that stunting bore an association only with poorer mid-arm muscle area. Height premiums and stunting penalties, though evident and marked in modern societies, might not be common in all traditional societies.

Longitudinal weight gain of immunized infants and toddlers in Moroto District, Uganda (Karamoja subregion)

This study examines longitudinal weight gain of a sample of 123 immunized children from Moroto District, northeast Uganda. The weight data were combined from two sources: (1) anthropometric examinations carried out between 1998 and 2004 by a research team from the University of Kansas, and (2) weights recorded on children's immunization records by local health care practitioners. Our findings conform generally to the pattern described in previous studies in this as well as other pastoralist populations in sub-Sahara. Relative to international standards, the weight-for-age status of Karimojong children was best during the first 3 months of infancy. Noticeable declines in weight velocity occurred in the fourth month and after the sixth month. Weight gain was static after the second year, when upward of 40% of children were clinically underweight. Factors influencing weight gain in this sample include immunization status and maternal height, weight, and parity, but these effects explain relatively little of the variance in weight gain. We conclude that immunization is not sufficient to buffer Karimojong children from multiple stressors during teething and weaning. Of these, the practice of canine follicle extraction (CFE) is of most interest, although its effects in this study are ambiguous. The data also are suggestive of variability in the pattern of weight gain between closely spaced birth cohorts. This finding may be of particular importance for the interpretation of growth patterns described for other pastoralist populations in sub-Saharan Africa.