Modelling the impact of stunting on child survival in a rural Ugandan setting

John Bukusuba,Abel Atukwase,Archileo N Kaaya

doi:10.1186/s40795-018-0220-4

Abstract

BackgroundUganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting. This study was conducted to model the impact of stunting on child mortality in the southwest region of Uganda where the prevalence of stunting and child mortality are of great public health concern.MethodsThe study was conducted in Buhweju district in the southwest region of Uganda. The study was cross-sectional involving use of a structured household questionnaire, focus group discussions and interviews with key informants in order to gather relevant information on infant and young child feeding (IYCF) and coverage of antenatal care (ANC) and vaccination programs. The survey of stunting, vaccination and ANC services covered 221 children aged 6–59 months while the assessment of IYCF practices covered 83 children aged 0–23. The Lives Saved Tool (LiST) was used to estimate the impact of stunting on child mortality and cases of stunting averted.ResultsThe study findings indicated that only 33% of the mothers had knowledge of optimal IYCF and 39% of the sampled children were exclusively breastfed. The majority of the mothers (57%) breastfed their children for less than 2 years and only 31% of the mothers practiced appropriate introduction of complementary foods at 6 months. Only 17% of the 0–23-month-olds received a good standard of IYCF. Only 37% of the mothers reportedly attended ANC 4 times or more during pregnancy and among children aged 6–59 months, only 28% were fully vaccinated. The high impact LiST model estimated that 1297 children under 5 years would be saved and 24,850 cases of stunting averted in the study district.ConclusionsThe study concludes that IYCF practices and coverage of expanded programme on immunization (EPI) and ANC in the study population are sub-optimal thus the high prevalence of stunting and child mortality in the region. LiST demonstrated that prevention of stunting would reduce child mortality in rural Uganda. Therefore, increased investment in cost-effective child survival interventions targeting rural areas of Uganda would have a significant impact on stunting and child mortality.

Highlights

Uganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting
Infant and Child Feeding Index (ICFI) The study findings indicated that only 33% of the mothers correctly understood the meaning of optimal infant and young child feeding (IYCF)
Children born to mothers who understood the meaning of optimal IYCF were significantly more likely to receive a good standard of IYCF (p < 0.05)

Summary

Introduction

Uganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting. Bukusuba et al BMC Nutrition (2018) 4:13 by 2020 [7] This could be attributed to uneven subnational progress on child mortality and stunting. The persistent high U5MR may partly be attributed to the low coverage of preventive evidence-based interventions known to be cost-effective in reducing child mortality, for example the expanded programme on immunization (EPI), optimal infant and young child feeding (IYCF) practices and antenatal care [1, 3, 4, 8, 9]. Studies have shown that up to 19% of child deaths can be prevented through optimal IYCF practices [10, 11]. Optimal IYCF practices can have the single largest impact on child mortality of all preventive interventions [12,13,14]

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Discussion

Conclusion