Gender and age disparities in adult undernutrition in northern Uganda: high‐risk groups not targeted by food aid programmes

Abstract

Abstractobjective To determine the prevalence of adult malnutrition and associated risk factors in a postconflict area of northern Uganda.methods A cross-sectional community survey was performed from September 2011 to June 2013. All registered residents in Gulu Health and Demographic Surveillance System aged 15 years and older were considered eligible. Trained field assistants collected anthropometric measurements (weight and height) and administered questionnaires with information on sociodemographic characteristics, food security, smoking and alcohol. Nutritional status was classified by body mass index.results In total, 2062 men and 2924 women participated and were included in the analyses. The prevalence of underweight was 22.3% for men and 16.0% for women, whereas the prevalence of overweight was 1.5% for men and 7.6% for women. In men, underweight was associated with younger (15-19 years) and older age (>55 years) (P < 0.001), being divorced/separated [odds ratio (OR) = 1.91 (95% confidence interval (CI): 1.21-2.99] and smoking (OR = 2.13, 95% CI: 1.67-2.73). For women, underweight was associated with older age (P < 0.001) and hungry-gap rainy season (May-July) (OR = 1.33, 95% CI: 1.04-1.69). Widowed or divorced/separated women were not more likely to be underweight. No association was found between education, alcohol consumption or food security score and underweight.conclusions Our findings are not in line with the conventional target groups in nutritional programmes and highlight the importance of continuous health and nutritional assessments of all population groups that reflect local social determinants and family structures.

Post-conflict household structures and underweight: a multilevel analysis of a community-based study in northern Uganda

“…We are not aware of other studies comparing adult underweight and household headship. However, in a previous study examining individual-level risk factors for adult underweight, divorced men, but not divorced or widowed women, had a higher odds for being underweight ( 12 ) . This gender discrepancy may be explained by the social changes in northern Uganda described by Dolan as collapsing masculinities and the proliferation of small men ( 28 ) , which may apply particularly to men living in female-headed households.…”

“…The estimated HIV prevalence in 2011 for mid-northern Uganda was 10·1 % among women and 6·3 % among men ( 40 ) . HIV is highly stigmatized in northern Uganda, thus it was not possible to obtain reliable information without compromising the community-based study design ( 12 ) . Educational attainment of mothers and household heads has been found to mitigate malnutrition issues in various settings ( 41 ) .…”

“…The current cross-sectional study was conducted in 2011–2013 at the Gulu Health and Demographic Surveillance Site (HDSS) in northern Uganda ( 12 ) . The Gulu HDSS covers a rural area of 250 km 2 named Awach sub-county of Gulu District, 30 km from Gulu Municipality.…”

“…A historical event calendar with both national and local events and landmarks was used to estimate age. Season was included as a binary variable, where 1 represented individuals who were measured during the ‘hungry season’ (May–July) ( 12 ) .…”

“…In the post-conflict period, the global acute malnutrition rates among children aged 6–59 months were higher ( 10 ) than reported during the insurgency ( 11 ) . Additionally, the prevalence of adult underweight was higher in the post-conflict area compared with national rural estimates in 2011 ( 12 ) . Previous nutrition studies in post-conflict settings have focused primarily on children <5 years of age and individual-level risk factors ( 13 – 18 ) .…”