Nutritional status among adults in a post-conflict area, northern Uganda

Description

Abstract

Background: Two decades of armed conflict in northern Uganda forced 2 million people to move into internally displaced peoples’ camps, where they were reliant on food rations from United Nations World Food Programme (WFP). Distributions of food aid may have long-term health implications, but are rarely studied. Population and health data is highly needed in the current post-conflict vacuum of northern Uganda, as well as for humanitarian food aid in future emergencies.

Aim: To determine the prevalence and risk factors for malnutrition among adults in northern Uganda, including past exposures to displacement and food rations from World Food Programme (WFP) during conflict and exposures present in the post-conflict area.

Methods: A cross-sectional study was performed from September 2011 to March 2013. All residents in Gulu Health and Demographic Surveillance System (HDSS) aged ≥15 years were eligible. Trained assistants measured weight and height, and administered questionnaires with information on socio-demographic characteristics, food security, smoking, alcohol intake, WFP food rations and displacement. Nutritional status was classified by body mass index and stature.

Results: 1,874 men and 2,649 women participated in the study (participation rate 55.3% for men and 77.8% for women). For men and women respectively, the prevalence of malnutrition was: underweight 23.8% and 17.7%, overweight 1.4% and 7.0%, and short stature 8.3% and 1.8%. In men, underweight was associated with younger and older age (P<0.001), being divorced/separated (OR 2.13 95% CI 1.33; 3.42), single (OR 1.61 95% CI 1.01; 2.65) and daily smoking (OR 2.04 95% CI 1.58; 2.65). For women, underweight was associated with older age (P<0,001) and rainy season (OR 1.24 95% CI 1.01; 1.53). No association was found between alcohol, education or socio-economic status and underweight. Displaced more than once was associated with decreased odds for underweight compared to having been displaced once (P=0.026 for men and P=0.05 for women). Men who had experienced lack of food at the early critical growth period (-9 – 24 months) during conflict had higher odds of being short statured (OR 25.92 95% CI 12.43; 54.04) than women (OR 6.07 95% CI 1.66; 22.17), compared to men and women who attained final height before the conflict began, though not statistically significant (P=0.057). Women who had been exposed to lack of food at the adolescent growth period (12-19 years) had almost threefold odds of being short statured compared to women who had attained final height before the conflict, though not significant (OR 2.83 95% CI 0.97; 8.22).

Conclusions: Malnutrition was common as underweight with gender and age disparities - young men and elderly were most likely to be underweight. The association between past exposures to displacement, WFP rations and underweight are surprising and further information is needed to clarify the underlying mechanisms. Preliminary analyses suggested that men were more vulnerable to lack of food at the early critical growth during the conflict than women, and only women were vulnerable to lack of food at the adolescent growth period. The findings were not in line with the present focus in humanitarian assistance programmes on children and women. To prevent unintended consequences, mitigate disparities, and improve health, nutritional assessments should be monitored in all population groups regardless of gender and age, both in displacement camps and especially during post-conflict periods.