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Kakwangire P, Atukunda P, Ngari M, Westerberg AC, Iversen PO, Muhoozi G. Long-term effects on depressive symptoms among Ugandan mothers - Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting. J Affect Disord 2024; 351:598-606. [PMID: 38307132 DOI: 10.1016/j.jad.2024.01.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda. METHODS The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESD). RESULTS For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference - 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference - 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESD. We did not find any baseline characteristics associated with maternal depression. LIMITATIONS The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms. CONCLUSION Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.
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Affiliation(s)
- Paul Kakwangire
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
| | - Prudence Atukunda
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya and Department of Public Health, School of Health & Human Sciences, Pwani University, Kilifi, Kenya
| | - Ane C Westerberg
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital - Rikshospitalet, Oslo, Norway; School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway; Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Grace Muhoozi
- Department of Family Life and Consumer Studies (Home Economics), Kyambogo University, Kampala, Uganda.
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Kakwangire P, Muhoozi G, Ngari M, Matovu N, Westerberg AC, Iversen PO, Atukunda P. 8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting. Pediatrics 2024; 153:e2023063352. [PMID: 38505933 DOI: 10.1542/peds.2023-063352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years. METHODS The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n = 263; control, n = 248), whereas in the current study, 361 (71%; intervention, n = 185; control, n = 176) pairs were available for analyses. RESULTS The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12-16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits. CONCLUSIONS The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.
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Affiliation(s)
- Paul Kakwangire
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
| | - Grace Muhoozi
- Department of Nutritional Sciences and Dietetics, Kyambogo University, Kampala, Uganda
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya and Department of Public Health, School of Health & Human Sciences, Pwani University, Kilifi, Kenya
| | - Nicholas Matovu
- Centre for Public Health, Institute of Clinical Sciences Block B, Queen's University, Belfast, UK
| | - Ane Cecilie Westerberg
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Prudence Atukunda
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Scarpa G, Berrang-Ford L, Twesigomwe S, Kakwangire P, Galazoula M, Zavaleta-Cortijo C, Patterson K, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Cade JE. Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda. PLOS Glob Public Health 2022; 2:e0000144. [PMID: 36962281 PMCID: PMC10021580 DOI: 10.1371/journal.pgph.0000144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022]
Abstract
Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, Leeds, United Kingdom
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, Leeds, United Kingdom
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Maria Galazoula
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Carol Zavaleta-Cortijo
- Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Didacus B Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
- Ministry of Health, Kampala, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, Rotterdam, Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | | | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
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Scarpa G, Berrang-Ford L, Twesigomwe S, Kakwangire P, Peters R, Zavaleta-Cortijo C, Patterson K, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Harris-Fry H, Cade JE. A Community-Based Approach to Integrating Socio, Cultural and Environmental Contexts in the Development of a Food Database for Indigenous and Rural Populations: The Case of the Batwa and Bakiga in South-Western Uganda. Nutrients 2021; 13:nu13103503. [PMID: 34684504 PMCID: PMC8537349 DOI: 10.3390/nu13103503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Comprehensive food lists and databases are a critical input for programs aiming to alleviate undernutrition. However, standard methods for developing them may produce databases that are irrelevant for marginalised groups where nutritional needs are highest. Our study provides a method for identifying critical contextual information required to build relevant food lists for Indigenous populations. For our study, we used mixed-methods study design with a community-based approach. Between July and October 2019, we interviewed 74 participants among Batwa and Bakiga communities in south-western Uganda. We conducted focus groups discussions (FGDs), individual dietary surveys and markets and shops assessment. Locally validated information on foods consumed among Indigenous populations can provide results that differ from foods listed in the national food composition tables; in fact, the construction of food lists is influenced by multiple factors such as food culture and meaning of food, environmental changes, dietary transition, and social context. Without using a community-based approach to understanding socio-environmental contexts, we would have missed 33 commonly consumed recipes and foods, and we would not have known the variety of ingredients’ quantity in each recipe, and traditional foraged foods. The food culture, food systems and nutrition of Indigenous and vulnerable communities are unique, and need to be considered when developing food lists.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, Leeds LS2 9JT, UK;
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK;
- Correspondence: ; +44-74-15966075
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, Leeds LS2 9JT, UK;
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Remco Peters
- School for Policy Studies, University of Bristol, Bristol BS8 1TH, UK;
| | - Carol Zavaleta-Cortijo
- Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, San Martín de Porres 15102, Peru;
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Didacus B. Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
- Ministry of Health, Lourdel Road, Nakasero P.O. Box 7272, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, 3072 Rotterdam, The Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK;
| | - Janet E. Cade
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK;
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Scarpa G, Berrang-Ford L, Bawajeeh AO, Twesigomwe S, Kakwangire P, Peters R, Beer S, Williams G, Zavaleta-Cortijo C, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Rippin H, Cade JE. Developing an online food composition database for an Indigenous population in south-western Uganda. Public Health Nutr 2021; 24:2455-2464. [PMID: 33843552 PMCID: PMC8145457 DOI: 10.1017/s1368980021001397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop an online food composition database of locally consumed foods among an Indigenous population in south-western Uganda. DESIGN Using a community-based approach and collaboration with local nutritionists, we collected a list of foods for inclusion in the database through focus group discussions, an individual dietary survey and markets and shops assessment. The food database was then created using seven steps: identification of foods for inclusion in the database; initial data cleaning and removal of duplicate items; linkage of foods to existing generic food composition tables; mapping and calculation of the nutrient content of recipes and foods; allocating portion sizes and accompanying foods; quality checks with local and international nutritionists; and translation into relevant local languages. SETTING Kanungu District, south-western Uganda. PARTICIPANTS Seventy-four participants, 36 Indigenous Batwa and 38 Bakiga, were randomly selected and interviewed to inform the development of a food list prior the construction of the food database. RESULTS We developed an online food database for south-western Uganda including 148 commonly consumed foods complete with values for 120 micronutrients and macronutrients. This was for use with the online dietary assessment tool myfood24. Of the locally reported foods included, 56 % (n 82 items) of the items were already available in the myfood24 database, while 25 % (n 37 items) were found in existing Ugandan and Tanzanian food databases, 18 % (n 27 items) came from generated recipes and 1 % (n 2 items) from food packaging labels. CONCLUSION Locally relevant food databases are sparse for African Indigenous communities. Here, we created a tool that can be used for assessing food intake and for tracking undernutrition among the communities living in Kanungu District. This will help to develop locally relevant food and nutrition policies.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, LS2 9JT, UK
- School of Food Science and Nutrition, University of Leeds, UK
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, LS2 9JT, UK
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Areej O Bawajeeh
- School of Food Science and Nutrition, University of Leeds, UK
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Remco Peters
- Leeds Institute of Health Sciences, University of Leeds, UK
| | | | | | | | - Didacus B Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
- Ministry of Health, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, Rotterdam, Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Holly Rippin
- WHO European Office for Prevention and Control of Non-communicable Diseases (NCD Office), Moscow, Russian Federation
| | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, UK
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