Aflatoxins are toxic metabolites of Aspergillus moulds and are widespread in the food supply, particularly in low‐ and middle‐income countries. Both in utero and infant exposure to aflatoxin B 1 (AFB 1 ) have been linked to poor child growth and development. The objective of this prospective cohort study was to investigate the association between maternal aflatoxin exposure during pregnancy and adverse birth outcomes, primarily lower birth weight, in a sample of 220 mother–infant pairs in Mukono district, Uganda. Maternal aflatoxin exposure was assessed by measuring the serum concentration of AFB 1 ‐lysine (AFB‐Lys) adduct at 17.8 ± 3.5 (mean ± SD )‐week gestation using high‐performance liquid chromatography. Anthropometry and birth outcome characteristics were obtained within 48 hr of delivery. Associations between maternal aflatoxin exposure and birth outcomes were assessed using multivariable linear regression models adjusted for confounding factors. Median maternal AFB‐Lys level was 5.83 pg/mg albumin (range: 0.71–95.60 pg/mg albumin, interquartile range: 3.53–9.62 pg/mg albumin). In adjusted linear regression models, elevations in maternal AFB‐Lys levels were significantly associated with lower weight (adj‐β: 0.07; 95% CI: −0.13, −0.003; p = 0.040), lower weight‐for‐age z ‐score (adj‐β: −0.16; 95% CI: −0.30, −0.01; p = 0.037), smaller head circumference (adj‐β: −0.26; 95% CI: −0.49, −0.02; p = 0.035), and lower head circumference‐for‐age z ‐score (adj‐β: −0.23; 95% CI: −0.43, −0.03; p = 0.023) in infants at birth. Overall, our data suggest an association between maternal aflatoxin exposure during pregnancy and adverse birth outcomes, particularly lower birth weight and smaller head circumference, but further research is warranted.

Background Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda. Methods Data were derived from a prospective birth cohort study conducted from 2014–2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses. Results Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds. Conclusions In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.

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Background: In 2010, Uganda began developing its first multisectoral nutrition plan, the Uganda Nutrition Action Plan (UNAP), to reduce malnutrition. While the UNAP signals high-level commitment to addressing nutrition, knowledge gaps remain about how to successfully implement such a plan. Objective: We tracked the UNAP's influence on the process of priority setting and funding for nutrition from 2013 to 2015. Methods: This study used a longitudinal mixed methods design to track qualitative and budgetary changes related to UNAP processes nationally as well as in 2 study districts. Qualitative changes were assessed through interviews, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews. Results: Important enabling factors named by stakeholders included identity, human resources, sustainable structures, coordination, advocacy, and adaptation of the UNAP to local needs. Evidence suggests that the UNAP facilitated improvements in the last 3 factors. We found no systematic increases in planned nutrition activities, nor did we find increases in allocations or expenditures for nutrition between fiscal years 2013-2014 and 2014-2015. Expenditure data were not always available for all funding mechanisms. In the 2 study districts, there was little flexibility within financing structures to allow for additional nutrition activities. Conclusions: Results suggest the UNAP has played an important role in strengthening the enabling environment for nutrition action. The next UNAP will need to translate these improvements into a greater number of nutrition activities and higher levels of funding at the national and subnational levels.

Uganda has one of the highest levels of childhood stunting in sub-Saharan Africa. It is well documented that the nutritional status of young children is one of the most sensitive indicators of sudden changes in health status and food availability, acting as a proxy indicator of socio-economic development. Kabarole District, the focus of the present study, is one of the most fertile areas in Uganda, with high per capita output of most foods. However, earlier studies in Kabarole District found that over 40% of children below five years of age were stunted. The objective of this study was, therefore, to asses the prevalence of malnutrition and the factors influencing the nutritional status of children below five years of age, in a peri-urban environment in Kabarole District, western Uganda. The study design was a cross sectional descriptive survey, using both qualitative and quantitative methods of data collection. A questionnaire was administered to 93 caretakers of children 6-59 months in randomly selected households, which explored the various factors that could be affecting the nutritional status of the children. Key information was also sought from a focus group discussion of a few selected mothers. Results revealed that stunting was highly prevalent with 41.6% of the children stunted. Under-weight and wasting were established at 15.7% and 3.4%, respectively. Education level of mother/caretaker (p=0.02), age of child (p=0.03), receipt of information on child feeding (p=0.009), illness (p=0.004) and time of introduction of other foods (p=0031) were significantly related to child stunting. On the other hand, household size, number of meals per day and awareness about the causes of malnutrition, were non significantly associated with child stunting. These findings indicate that malnutrition, especially stunting, in this cohort of children in peri-urban areas of Kabalore District, is a big problem. Poor education levels of the mothers/caretakers and poor child feeding practices are some of the factors identified as major contributors to this problem. It is therefore recommended that appropriate nutrition interventions, particularly equipping mothers/caretakers with knowledge and skills in child feeding, child health, sanitation and other best practices for proper childcare, be put in place to address the problem of childhood malnutrition in Kabarole District and other areas in Uganda, and indeed in Sub-Saharan Africa, with similar settings.