Knowledge of integrated management of childhood illnesses community and family practices (C-IMCI) and association with child undernutrition in Northern Uganda: a cross-sectional study

Abstract

BackgroundChildhood undernutrition is a major challenge in Uganda with a prevalence of wasting and stunting at 5% and 33%, respectively. Community and family practices of the Integrated Management of Childhood Illnesses (C-IMCI) was introduced in sub-Saharan Africa early after the year 2000. C-IMCI was postulated to address major childhood morbidity and mortality challenges with nutrition as one of the outcomes. The association between knowledge patterns of C-IMCI and undernutrition has not been fully established especially in sub-Saharan Africa. This study was done to address the prevalence of stunting and wasting and the association with the knowledge and practices of C-IMCI among caretakers in Gulu district, Northern Uganda.MethodsThis was a community-based cross-sectional study among 442 caretaker-child pairs. A standardized questionnaire was employed to assess the knowledge and practices of the C-IMCI among caretakers including four practices: breastfeeding, immunization, micronutrient supplementation and complementary feeding. Weight and height of children (6–60 months) were recorded. Wasting and stunting were defined as weight-for-height and height-for-age z-score, respectively, with a cut-off < -2 according to the World Health Organization growth standards. Logistic regression analysis reporting Odds Ratios (OR) with 95% confidence intervals (CI) was used to explore associations using SAS statistical software.ResultsThe percentage of caretakers who had adequate knowledge on C-IMCI (basic knowledge within each pillar) was 13%. The prevalence of wasting and stunting were 8% and 21%, respectively. Caretakers’ lack of knowledge of C-IMCI was associated with both wasting (OR 24.5, 95% CI 4.2-143.3) and stunting (OR 4.0, 95% CI 1.3-12.4). Rural residence was also associated with both wasting (OR = 3.1, 95% CI 1.5-6.5) and stunting (OR = 1.7, 95% CI 1.0-2.7). Children younger than 25 months were more likely to be wasted (OR = 3.3, 95% CI 1.7-10.0).ConclusionWe found a low level of overall knowledge of the C-IMCI of 13.3% (n = 59). There is also a high prevalence of childhood undernutrition in Northern Uganda. Caretakers’ limited knowledge of the C-IMCI and rural residence was associated with both wasting and stunting. Interventions to increase the knowledge of the C-IMCI practices among caretakers need reinforcement.

Healthcare providers and caregivers’ perspectives on factors responsible for persistent malnutrition of under 5 children in Buhweju district, South Western Uganda; a phenomenological qualitative study

“…A study in a nutrition education program and community comparison group in Uganda noted that, maternal personal - factors shaped their ability to leverage resources to provide care to their children especially child nutrition, hygiene, access to health care and general household sanitation [ 30 ]. In another study in Northern Uganda by Mukunya and colleagues, reported an association of the prevalence of under nutrition, wasting and stunting with rural residence and limited caregiver knowledge of best practices in terms of Integrated Management of Childhood Illnesses (C-IMCI) [ 31 ].…”

IMCI and ETAT integration at a primary healthcare facility in Malawi: a human factors approach

“…The community aspect of this was not examined in this study but it should be examined more closely in the future. A similar study based in Uganda found that a lack of understanding of the purposes of IMCI among parents and guardians of paediatric patients was associated with malnutrition in the children [37]. Patient education was not displayed by the MAs during their patient interactions.…”

Progress in nutrition related Millennium Development Goals in Uganda before adoption of post-2015 development agenda: Review of goals 1, 2 and 4

“…As a result, on several occasions it has been a reference model in establishing similar UPE systems in other developing countries since it has been faring quite well in Uganda. To a considerable degree, the UPE in Uganda has increased the basic level of maternal education which in turn influences nutritional health and then improves the childhood survivorship [20]. On this matter, literature [19][20] finds a relationship between education (literacy) and food and nutrition.…”

“…To a considerable degree, the UPE in Uganda has increased the basic level of maternal education which in turn influences nutritional health and then improves the childhood survivorship [20]. On this matter, literature [19][20] finds a relationship between education (literacy) and food and nutrition. However, the progressive net enrollment observed between 2000 and 2014 UPE in Uganda was characterized by several constraints which could have curtailed the country's quest of attaining the 100% universal school enrollment target before December 2015.…”