Background: Uganda embraced the Nutrition Assessment Counselling and Support (NACS) approach since 2009 as a health system strengthening approach to deliver quality nutrition services for better health and nutrition outcomes of the population. Whilst government and partners provided support for NACS, the extent of its integration in Uganda is unknown. Using Tororo district as a case study, we assessed the extent of NACS assimilation into the health system functions and the respective drivers to inform NACS scale up. Methods: This study used a mixed method design to assess the extent of NACS integration in the health system and the respective drivers. We conducted facilitated panel discussions in 17 health facilities with 4-8 health staff per facility guided by a semi-structured questionnaire. Through consensus, final scores were allotted to each of the health system functions on a five point scoring scale ranging from 1 if not done nor integrated to 5 if NACS was fully integrated. Data were captured and mean scores analysed in excel. Findings were presented in bar and spider charts. Drivers for integration were deductively extracted from the key informant interviews, in-depth interviews and focus group discussions using Atlas.ti 9 and thematic analysis to complement the quantitative data. Results: NACS integration in the health system functions was partial with a mean score of 2.9. The best integrated function was service delivery (3.8) followed by health work force (3.7), health information (3.3), community support system (3.0) and governance and leadership (3.0). Health financing (2.2) and health supplies functions (1.5) were least integrated. Hospitals (3.0) had better integration than HCIV (2.4) and HCIII (2.6). The key drivers for integration were; good leadership, increased funding, competent staff, quality improvement approaches, availability of nutrition logistics and supplies, health and nutrition education talks, and community dialogues. Conclusion: NACS integration in the health system functions was sub-optimal suggestive of a weak nutrition integrated system. Good leadership, capacity building in all health system functions, increased funding, recruitment of nutritionists, nutrition supplies and logistics are important for a fully integrated nutrition service delivery.

Background: Maternal nutrition is closely linked to the survival and development of children during the first 1000 days of life. Maternal wasting, a measure of malnutrition, is measured using the mid-upper arm circumference. However, in 2019, the rate and distribution of wasting among pregnant and lactating women was not known. We described annual trends and distribution of wasting among pregnant and lactating women (PLW), Uganda, 2015-2018, to inform programming on targeted nutritional interventions.Methods: We analyzed nutrition surveillance data from the District Health Information System for all PLW from 2015 to 2018. We used the World Health Organization standard thresholds to determine wasting among PLW by year and region, drawing choropleth maps to demonstrate the geographic distribution of wasting among PLW. We used logistic regression to assess wasting trends. Results: During 2015-2018, 268,636 PLW were wasted (prevalence=5.5%). Of the 15 regions of Uganda, Karamoja (prevalence=21%) and Lango (prevalence=17%) registered the highest prevalence while Toro (prevalence=2.7%) and Kigezi (prevalence=2.0%) registered the lowest prevalence. The national annual prevalence of wasting among PLW declined by 31% from 2015-2018 (OR=0.69, p<0.001). Regions in the north had increasing trends of wasting over the period [Lango (OR=1.6, p<0.001) and Acholi (OR=1.2, p<0.001)], as did regions in the east [(Bugisu (OR=3.4, p<0.001), Bukedi (OR=1.4, p<0.001), and Busoga (OR=1.3, p<0.001)]. The other 11 regions showed declines.Conclusion: The trend of wasting among PLW nationally declined during the study period. Lango and Acholi regions, both of which were experiencing a state of emergency during this period, had both high and rising rates of wasting, as did the Karamoja region, which experienced the highest wasting rates. We recommended that the Ministry of Health increases its focus on nutrition monitoring for PLW and conduct an analysis to clearly identify the factors underlying malnutrition specific for PLW in these regions.