IntroductionMalnutrition contributes to half of all deaths among children under-five years in developing countries such as Uganda. Optimal complementary feeding is one of the crucial interventions that could prevent these deaths. This study measured adherence to complementary feeding guidelines and its associated factors among caregivers of children aged 6-23 months in Lamwo district, rural Uganda.MethodsA household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.ResultsA household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.nearly all (97.7%, 341/349) children had ever been breastfed. Complementary feeding was initiated at six months for 47.0% (164/349) of the children. The number of complementary meals ranged from 1-4 meals per day with a mean of 3 meals per day (SD = 0.8). About half (55.8%, 195/349) of the children were given less than the recommended amount of food. Overall only 40.1% (140/349) of all study respondents were adherent to complementary feeding guidelines. The odds of adherence to complementary feeding were higher among caregivers with children aged 6-8 months (AOR = 4.68, 95% CI: 1.91-11.48), children whose fathers had attained 8 or more years of formal education (AOR = 2.27, 95% CI: 1.22-4.19), caregivers with two children under five years (AOR = 5.46, 95% CI: 1.46-20.36), those living in the poorest households (AOR = 3.00, 95% CI: 1.37-6.57) and those who showed willingness to recommend initiation of complementary feeding at six months to another mother (AOR = 1.34 95% CI: 1.06-1.70).ConclusionAdherence to complementary feeding guidelines was very low in this rural African setting indicating an urgent need for interventions such as health education to improve adherence with consequent reduction in rates of under nutrition. These interventions should target caregivers with older children, fathers with less than 8 years of formal education and those living in the wealthiest households.
Currently, there is a high demand for amaranth due to its ability to withstand harsh climatic conditions, making it an ideal crop in the changing climate. There is also increased awareness and education on its nutritional and overall health benefits, and the availability of improved recipes. However, the presence of hazards can hinder the commercialisation of amaranth, which is in most cases traded informally. Food safety issues along the amaranth value chain should, therefore, be addressed to cope with both production and safety demands. The objective of this study, therefore, was to develop a Hazard Analysis and Critical Control Point (HACCP) plan for hazards in the amaranth value chain in Uganda. The seven principles outlined by Codex Alimentarius were followed to develop the HACCP plan. A tree diagram was further used to identify each potential hazard at each processing stage and Critical Control Points (CCPs) along the chain. For the CCPs identified, reliable control mechanisms and corrective actions were established to fulfil the requirements set by the critical limits to guarantee the safety of the products. Verification and records systems were proposed to determine the effectiveness and traceability of the HACCP plan. For each of the identified CCPs, samples were collected purposively and analysed for chemical and microbial contaminants. From the analysis, fifteen processing stages, starting from the land section to cooking and serving, were identified. Out of these, eight stages were defined as CCPs. These were site selection, land and seedbed preparation, irrigation, market display/humidity control, washing before preparation, chopping, cooking, and holding time and serving. At CCP 1, soils were contaminated with lead and cadmium, mercury and aflatoxins but at considerably low levels. At CCP 2, organic fertilisers were only contaminated with E. coli. At CCP3, E. coli was present in irrigation water. Heavy metals were also present in the irrigation water but were below the critical limits. At CCP4, E. coli was absent in water and display surfaces. E. coli was, however, present on raw amaranth. S. aureus was detected on vendors' hands. At CCP5, water was not contaminated with E. coli. At CCP6, only personnel hands were infected with S. aureus and Enterobacteriaceae. No contamination was detected in CCP7 and CCP8. Strict control of E. coli in manure and water and S. aureus and Enterobacteriaceae on personnel hands is required to ensure the amaranth value chain attains good food safety output.
Common beans (Phaseolus vulgaris L) may be contaminated with heavy metals and aflatoxins. Cooked beans may also be contaminated with micro-organisms due to poor hygiene and sanitation practices. Hazard Analysis and Critical Control Point (HACCP), which is a globally recognised food safety program, was proposed as a suitable program to minimise/eliminate the risk of contamination. Therefore, the objective of this study was to develop a HACCP plan for dry common beans in Uganda and an accompanying food safety toolkit. The seven principles of HACCP as outlined by Codex Alimentarius were followed to develop a HACCP plan for the dry common beans value chain in Uganda. A decision tree diagram was further used to identify each potential hazard at each processing stage and Critical Control Points (CCPs) along the chain. The identification of the CCPs was further supported by an evaluation of the actual risk and severity of the hazard. For the CCP identified, reliable control mechanism and corrective actions were established to fulfill the requirements set by the critical limits to guarantee the safety of the products. Verification and records systems were proposed to determine the effectiveness and traceability of the HACCP plan. For identified CCPs, a co-creation methodology was used to develop the food safety toolkit. This was carried out in four sessions that included a background of the chain actors' ambitions to determine the suitability of the toolkit, assessment of CCPs, expert advice on the CCP and an exercise to develop concepts for each CCP. From the analysis, fourteen processing stages starting from land selection to cooking and serving were identified. Out of these, four stages were CCPs. These were land selection and preparation, storage, post-harvest drying, and cooking and serving. Hazards at the CCPs included heavy metals, mycotoxins, and micro-organisms such as S. aureus, E. coli, and Salmonella spp. A combination of good hygiene and sanitation practices and good agricultural practices were recommended as control measures against the hazards. To further equip the value chain actors with mitigation strategies, a food safety toolkit whose usefulness is to give the actors a systematic means to control identified CCPs was developed. In this regard, the toolkit and HACCP plan will complement each other. From the study results, implementation of the toolkit, followed by an assessment of its uptake and impact on livelihoods and food safety risks is recommended.
BackgroundFollowing a finding of alcohol use among children aged 5–8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6–13 years old and related household, community, school, health system and clinical factors.MethodsThe project includes four larger work packages (WPs). WP1 comprises management, WP2 and 3 include the scientific components and WP4 includes integration of results, dissemination, policy and implementation advice. This protocol presents the planned research work in WP 2 and 3. WP2 comprises the adaptation and validation of the alcohol use screening tool Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) to the age group and setting. WP3 comprises four substudies (SS). SS1 is a cross-sectional community household survey with an estimated sample size of 3500 children aged 6–13 years and their caregivers. We apply cluster sampling and systematic sampling within the clusters. Data collection includes a structured questionnaire for caregiver and child, measuring social and demographic factors, mental health status, alcohol and substance use, nutrition history and anthropometry. Urine samples from children will be collected to measure ethyl glucuronide (EtG), a biological marker of alcohol intake. Further, facilitators, barriers and response mechanisms in the health system (SS2) and the school system (SS3) is explored with surveys and qualitative assessments. SS4 includes qualitative interviews with children. Analysis will apply descriptive statistics for the primary outcome of establishing the magnitude of alcohol drinking and substance use, and associated factors will be assessed using appropriate regression models. The substudies will be analysed independently, as well as inform each other through mixed methods strategies at the stages of design, analysis, and dissemination.Ethics and disseminationData protection and ethical approvals have been obtained in Uganda and Norway, and referral procedures developed. Dissemination comprises peer-reviewed, open access research papers, policy recommendations and intersectoral dialogues.Trial registration numberClinicaltrials.gov 29.10.2020 (#NCT04743024).
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