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Item Optimized heat-moisture treatment decreases the starch digestibility of polished maize flour from predominant varieties consumed in Uganda(Applied Food Research, 2025-05-25) Fassinou, Finagnon Toyi Kevin; Olum, Solomon; Okidi, Lawrence; Ongeng, DuncanIn Uganda, maize flour is the major carbohydrate food source for over 90 % of households. It is largely consumed in polished form characterized by high digestibility, rapidly releasing glucose into the bloodstream, making it unsuitable for metabolic health. This calls for the reduction of maize flour digestibility through increasing its slowly-digestible (SDS) and resistant-starch (RS) contents, typical function of Heat-moisture Treatment (HMT). However, HMT efficacy depends on the botanical starch source and HMT conditions necessitating its optimization. This study investigated optimal HMT conditions to produce polished maize flour with lower starch digestibility by increasing SDS and RS contents for four maize varieties (UH5354, DK777, Longe 10H, and DT Max). Response surface methodology (Box-Bakhen design) was used to set the experimental design with moisture (20–30 %), temperature (80–100 °C), and heating-time (4–8 h) conditions, and corresponding SDS and RS contents, analysed using mega-enzyme procedure. Composite SDS and RS (SDS+RS) were used in the optimisation. Quadratic function was the most appropriate model that fitted the data as exhibited by non significant lack of fit (p > 0.05) and explained at least 80 % of the variance for each variety considered. Optimum moisture (%), temperature ( °C) and heating-time (hours) were 23.17, 80.00, and 4.12 for UH5354, 20.83, 95.43, and 5.42 for DK777, 34.51, 90.46, and 3.01 for Longe 10H and 19.24, 97.02, and 5.88 for DT Max varieties. Relative to the control, these optimal HMT conditions improved the contents of SDS+RS by 8–14 % suggesting their promotion to reduce the high digestibility of polished maize flour among households.Item Prevalence and antibiotic resistance characteristics of non-typhoidal Salmonella enterica serotypes isolated from food and water consumed by children under five years in Karamoja sub-region of Uganda(BMC, 2025-09-02) Mpagi, Ronald; Okidi, Lawrence; Ongeng, DuncanKaramoja, a sub-region in North Eastern Uganda, has consistently experienced a high prevalence of diarrhoea and undernutrition among children under five (CUF) for over a decade. Microbiologically unsafe food is believed to be a key factor for the high prevalence of diarrhoea-associated undernutrition CUF in the sub-region, but specific causative agents have largely remained undelineated. This study investigated the prevalence, serotypes, antibiotic resistance (AMR) characteristics, and association between AMR phenotypes and AMR genes (ARGs) among non-typhoidal Salmonella (NTS) enterica serotypes isolated from water and food in the sub-region. Isolates (45) confirmed by invA PCR amplification were PCR-serotyped targeting various serotype-conserved genes and tested for phenotypic AMR against nine antibiotics and for the presence of ARGs using PCR. Overall prevalence of NTS was at 50%, with S. Typhimurium (53%) being the most dominant, followed by S. Infantis (16%), S. Enteritidis (9%), and S. Dublin (4%). Phenotypic resistance was highest for azithromycin (91.1%) followed by ciprofloxacin (31.1%), cefixime (20%), cefotaxime (20%), ceftazidime (15.6%), ceftriaxone (6.7%), cotrimoxazole (6.7%), chloramphenicol (6.7%) and amoxicillin-clavulanic acid (2.2%). The most prevalent ARGs were mefA (95.3%), gyrA (94.9%), parC (92.3%), blaPSE (81.3%), sul1 (66.6%), and sul2 (66.6%) encoding for macrolides, quinolones, beta-lactams, and sulphonamides, respectively. Phenotypic resistance to beta-lactams, chloramphenicol, cotrimoxazole, and ciprofloxacin was strongly correlated with the presence of blaPSE, floR, sul1, and parC, respectively (p < 0.05). This study has revealed that foods and water in Karamoja sub-region are contaminated with antibiotic-resistant NTS enterica serotypes and therefore need remediation.Item Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021(Elsevier, 2024-10) Okidi, Lawrence; GBD 2021 Stroke Risk Factor CollaboratorsBackground Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]). Interpretation Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden.Item Agroecology influences Salmonella food contamination with high exposure risk among children in Karamoja sub-region: A high diarrhoea prevalent locality in Uganda(Heliyon, 2022-11-11) Okidi, Lawrence; Ongeng, Duncan; Muliro, Patrick Simiyu; Matofari, Joseph WafulaUganda is among low-income countries where Salmonella induced diarrhoea still contributes significantly to children under five years (CUF) mortality. Karamoja, a sub-region characterised by three agroecologies (pastoral: PE; agro-pastoral: APE; agricultural: AE), is a geographical location that has consistently experienced a high prevalence of diarrhoea among CUF over the last decade nationally. This study examined whether agroecology influences Salmonella food contamination and exposure risk to CUF. A total of 240 food samples (PE: 78; APE: 73; AE: 89) were examined for Salmonella load using Xylose Lysine Deoxycholate Agar and confirmed using polymerase chain reaction targeting invA gene. Analysis of variance for nested design was used to compare Salmonella counts among food types within and across agroecologies and means were separated using Tukey Honestly Significant Difference test at 5% (p < 0.05). Proportion of foods with Salmonella load exceeding World Health Organisation (WHO) set-limit was expressed in percentage. Exposure risk of CUF was computed by multiplying quantity of food intake by Salmonella load and compared to minimum infectious dose (MID) of the pathogen (3 log CFU) whereas chi-square was used to compare proportions of CUF with exposure above or below MID among agroecologies. Salmonella load ranged from 0.00 ± 0.00 to 8.23 ± 1.12 log CFU but varied by food type and agroecology. Salmonella aggregated load in foods from PE was significantly higher than from APE or AE (p < 0.05). The proportion of Salmonella contaminated foods from PE, APE, and AE was 33–90%, 40–67%, and 17–88%, respectively. Salmonella exposure risks to CUF were similar (p > 0.05) at 96%, 92%, and 91% in PE, APE, and AE, respectively. Sorghum-based foods and leafy vegetables were the predominant high-risk foods. This study has revealed that Salmonella contamination of foods with high exposure risk among CUF in Karamoja sub-region varies with agroecology. Efforts to address food contamination in the sub-region should take into account agroecology.Item Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021(The Lancet Journal, 2024-03-11) Okidi, Lawrence; GBD 2021 Demographics CollaboratorsBackground Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.Item The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis(Lancet Global Health, 2023-12-19) Okidi, Lawrence; Antimicrobial Resistance CollaboratorsBackground: A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. Methods: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen–drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Findings: In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000–1 316 000) associated with bacterial AMR and 250 000 deaths (192 000–325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000–151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000–82 000], or22%), intraabdominal infections (26 000 deaths [17 000–39 000], or 10%), and tuberculosis (18 000 deaths [3850–39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000–1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant Kpneumoniae and meticillinresistant S aureus were shown to be the leading pathogen–drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. Interpretation : This study reveals a high level of AMR burden for several bacterial pathogens and pathogen–drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen–drug combinations.Item Disparity in prevalence and predictors of undernutrition in children under five among agricultural, pastoral, and agro-pastoral ecological zones of Karamoja sub-region, Uganda: a cross sectional study(BMC Pediatrics, 2022-05-30) Okidi, Lawrence; Ongeng, Duncan; Muliro, Patrick Simiyu; Matofari, Joseph WafulaBackground Undernutrition accounts for nearly half of under-five child mortality in developing countries where household nutrition is largely dependent on agriculture. Despite the strong influence of agroecology on agriculture in those countries, limited information exists on whether undernutrition in children under five varies with agro-ecological location. Methods Using Karamoja sub-region of Uganda, one of the most food insecure parts of Eastern Africa as a case area, and applying a multi-stage sampling procedure, and a structured questionnaire, this study examined in a comparative manner, the prevalence and predictors of undernutrition in children under five among the agricultural, pastoral, and agro-pastoral ecological zones. Chi-square test and Kruskal-Wallis test were used to establish the disparity in prevalence of undernutrition and household contextual characteristics, respectively. Binary logistic regression was used to determine the predictors of undernutrition in children under five among the three agro-ecological zones. The level of statistical significance was set at p ≤ 0.05. Results The prevalence of underweight, stunting, and wasting ranged from 36 to 58% but varied with agroecology in terms of the peak age ranging from 6 to 37 months. Child characteristics, feeding practices, household economic factors, sanitation factors, and caregiver characteristics that predict undernutrition among children under five were identified (p ≤ 0.05). Caregiver handwashing after using latrine (p = 0.005) and diarrhoea in a fortnight (p < 0.001) increased the likelihood of stunting in pastoral agroecology only whereas cereal storage in both sacks and granary in agro-pastoral zone was associated with reduced likelihood of both underweight (p < 0.001 and p = 0.014) and stunting (p = 0.011 and p = 0.018), respectively. A male child was more likely to be underweight and stunted in pastoral (p = 0.002 and p = 0.011) and agro-pastoral (p = 0.017 and p = 0.002) agroecology, respectively. Household expenses reduced the likelihood of both underweight and wasting in pastoral (p = 0.013 and p = 0.005) and agricultural (p = 0.011 and p = 0.021) agroecology, respectively. Flour storage duration increased the stunting likelihood in pastoral (p = 0.032) and agro-pastoral (p = 0.006) agroecologies. Conclusion This study has revealed that, in a food insecure developing country setting such as Karamoja sub-region of Uganda, undernutrition among children under five varies with agroecology. Thus, nutritional interventions in such locations should be agroecology specific.Item The mix of good nutritional attitude and poor nutritional knowledge is associated with adequate intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of Northern Uganda(Food Science & Nutrition, 2018-10-25) Okidi, Lawrence; Odongo, Walter; Ongeng, DuncanNutritional knowledge and attitude of a population greatly affect intake of essential micronutrients. Much of the understanding on the impact of nutritional knowledge and attitude on nutrient intake has been derived from studies conducted among affluent societies using commercial food products. However, information on the link between status of nutritional knowledge and attitude on intake of essential nutrients from wild fruits and vegetables among rural communities is largely lacking. This study examined the status of nutritional knowledge and attitude associated with intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of northern Uganda. A cross- sectional study design making use of individual household questionnaire and proximate dietary recall of a calendar year consumption period involving 248 randomly selected rural households was applied. Results showed that households had good nutritional attitude but poor nutritional knowledge. Status of knowledge was dependent on nutrition training (p = 0.028; coefficient, β = 0.710) and age of the respondent (p = 0.044; β = −0.023), whereas status of attitude was predicted by age of the respondent (p = 0.014; β = 0.048). Consumption of wild fruits and vegetables contributed adequately to the dietary vitamin A and iron requirements of the households. The results have demonstrated that intake of vitamin A and iron from wild fruits and vegetables among rural households is associated with good nutritional attitude but poor nutritional knowledge. A concerted effort is necessary to improve household nutritional knowledge for better utilization of wild fruits and vegetables.Item The effect of rosemary, ginger, or garlic on microbial shelf life and sensory acceptability of nutritionally enriched cassava-based pancake (Kabalagala)(Applied Food Research, 2023-12-22) Assocle, Mahoussi Simone; Okidi, Lawrence; Duncan, OngengIron and vitamin A contents of Cassava-based pancake (Kabalagala), a delicacy among children in northern Uganda have recently been improved through the addition of biofortified iron-rich beans and orange-fleshed sweet potato. The nutritionally improved product (NIK) was designed as a strategy to address iron and vitamin A deficiencies which are endemic challenges among children in Uganda. However, the NIK had a lower microbial shelf life (24 h) than the original product (72 h). The objective of this study was to investigate the potential of the spices; rosemary, ginger, and garlic to improve the microbial shelf life of the NIK. Each of the spices was used individually to prepare NIK at a rate of 0.5, 0.75, and 1 %. The resultant products were evaluated for counts of total microbial load, Enterobacteriaceae, lactic acid bacteria, yeasts and molds as well as consumer sensory acceptability during storage at ambient temperature. Results of One-way Analysis of Variance (ANOVA) showed that all the spices exhibited potency against the microbial groups investigated only when included in the NIK at 0.75 % or 1 % (p < 0.05). The microbial shelf life of the NIK based on total microbial count increased from 24 to 72 h depending on the spice type and concentration. The spice, 1 % ginger resulted in Enterobacteriaceae and yeast and molds counts within acceptable microbial threshold for the entire storage time (72 h) with a maximum load of 3.41 and 2.82 log10 CFU/g, respectively. The NIK containing ginger or garlic at 0.75 or 1 %, was more accepted and the extent of acceptability increased with storage time (p < 0.05). Based on the overall acceptability, the consumer acceptability varied from 1 % garlic >0.75 % garlic >1 % ginger >0.75 % ginger >0.5 % ginger in decreasing order. Spearman's correlation analysis revealed a strong association between the sensory parameters examined (appearance, aroma, texture, taste) and the overall acceptability of the products (p < 0.05). The magnitude of association between appearance, aroma, texture, taste and overall acceptability varied between 0.396–0.703, 0.504–0.679, 0.452–0.589, and 0.498–0.698, respectively. This study has demonstrated that ginger or garlic when applied at 0.75–1 % improves microbial shelf life of NIK concomitant with better consumer sensory acceptability. Therefore, ginger or garlic can be applied at 0.75–1 % to produce microbiologically and sensorially acceptable NIK for use to improve intake of vitamin A and iron among children in Uganda.Item Disparity in prevalence and predictors of undernutrition in children under five among agricultural, pastoral, and agro-pastoral ecological zones of Karamoja sub-region, Uganda: a cross sectional study(BMC Pediatrics, 2022-05-30) Okidi, Lawrence; Ongeng, Duncan; Muliro, Patrick Simiyu; Matofari, Joseph WafulaBackground: Undernutrition accounts for nearly half of under-five child mortality in developing countries where household nutrition is largely dependent on agriculture. Despite the strong influence of agroecology on agriculture in those countries, limited information exists on whether undernutrition in children under five varies with agro ecological location. Methods: Using Karamoja sub-region of Uganda, one of the most food insecure parts of Eastern Africa as a case area, and applying a multi-stage sampling procedure, and a structured questionnaire, this study examined in a comparative manner, the prevalence and predictors of undernutrition in children under five among the agricultural, pastoral, and agro-pastoral ecological zones. Chi-square test and Kruskal-Wallis test were used to establish the disparity in prevalence of undernutrition and household contextual characteristics, respectively. Binary logistic regression was used to determine the predictors of undernutrition in children under five among the three agro-ecological zones. The level of statistical significance was set at p ≤ 0.05. Results: The prevalence of underweight, stunting, and wasting ranged from 36 to 58% but varied with agroecology in terms of the peak age ranging from 6 to 37 months. Child characteristics, feeding practices, household economic factors, sanitation factors, and caregiver characteristics that predict undernutrition among children under five were identified (p ≤ 0.05). Caregiver handwashing after using latrine (p = 0.005) and diarrhoea in a fortnight (p < 0.001) increased the likelihood of stunting in pastoral agroecology only whereas cereal storage in both sacks and granary in agro-pastoral zone was associated with reduced likelihood of both underweight (p < 0.001 and p = 0.014) and stunting (p = 0.011 and p = 0.018), respectively. A male child was more likely to be underweight and stunted in pastoral (p = 0.002 and p = 0.011) and agro-pastoral (p = 0.017 and p = 0.002) agroecology, respectively. Household expenses reduced the likelihood of both underweight and wasting in pastoral (p = 0.013 and p = 0.005) and agricultural (p = 0.011 and p = 0.021) agroecology, respectively. Flour storage duration increased the stunting likelihood in pastoral (p = 0.032) and agro-pastoral (p = 0.006) agroecologies Conclusion: This study has revealed that, in a food insecure developing country setting such as Karamoja sub-region of Uganda, undernutrition among children under five varies with agroecology. Thus, nutritional interventions in such locations should be agroecology specific.Item The need for an educational paradigm shift in sub-Saharan Africa(HAMK Unlimited Professional, 2023-12-21) Ojok, Karlo; Kimatu, Josphert N.; Mutambo, James; Okidi, Lawrence; Ruhiu, Samuel; Määttänen, Satu; Laitinen, EijaTeachers have traditionally been regarded as transmitters and learners as receivers of knowledge. This paradigm is now shaken up with calls to reform the pedagogical practices from teacherdominated to learner-centered methods, to improve the quality of education, and subsequently employment opportunities of graduates. This article discusses the current status quo of teaching and learning in African higher education institutions, and the knowledge required to facilitate an educational paradigm shift towards student-centered methods. In an effort to jumpstart this paradigm shift, the article proposes a research study on teaching perceptions, to determine the factors that contribute to implementing student-centered approaches.Item Prevalence of aflatoxin along processing points of locally made complementary food formulae in northern Uganda: Safety and children’s exposure across seasons(Heliyon, 2023-07-22) Achiro, Eunice; Okidi, Lawrence; Echodu, Richard; Alarakol, Simon Peter; Anena, Juliet; Ongeng, DuncanAflatoxin contamination along the processing points of locally made complementary food composite needs to be ascertained and minimized to reduce exposure to weaning children. The study established the concentrations of total aflatoxin (TAF) and aflatoxin B1 (AFB1) along the processing points of locally made malted millet sesame soybean composite (MMSSC) across season one (wet) and season two (dry) and determined children's exposure to them. A total of 363 samples were collected in 2019. TAF and AFB1 concentrations were determined quantitatively using an enzyme-linked immunosorbent assay (ELISA). Consequently, exposure of individual children was assessed as Estimated Daily Intake (EDI), (ng kg−1 bw day−1). All the samples along the processing points had detectable concentrations of TAF and AFB1 ranging from 0.578 μg kg−1 to 1.187 μg kg−1 and 0.221 μg kg−1 to 0.649 μg kg−1 respectively. Contamination was highest in raw materials; soybean (Glycine max) > sesame (Sesamum indicum), followed by stored composite, freshly prepared composite, and least in millet (Eleusine coracana). Contamination varied significantly across seasons with the wet season having higher contamination than the dry season at P = 0.05. All samples (100%) were within the European Commission (EC) acceptable maximum tolerable level for TAF and AFB1 (4 μg kg−1 and 2 μg kg−1) respectively for processed foods for general consumption. But were below the EU acceptable maximum tolerable level for TAF and AFB1 (0.4 μg kg−1 and 0.1 μg kg−1) respectively for processed baby foods cereals. However, all were within the United States- Food and Drug Authority (US-FDA) and East African Community (EAC) set maximum acceptable limit of 20 μg kg−1 for TAFs, 10 μg kg−1 and 5 μg kg−1 for TAF and AFB1 respectively. Conversely, exposure to these toxins was much higher than the Provisional Maximum Tolerable Dietary Intake (PMTDI) of 0.4 ng kg−1 bw day−1 to 1.0 ng kg−1 bw day−1. A significant difference in exposure to both toxins was observed with the weight. The age of 5 months was the most exposed. A concerted effort is needed to reduce children's exposure to MMSSC to TAF and AFB1, taking sesame and soybean as priority ingredients and proper storage based on season to control contamination.Item Stakeholders’ Perceptions of Agronomic Iodine Biofortification: A SWOT-AHP Analysis in Northern Uganda(Nutrients, 2018-03-24) Olum, Solomon; Gellynck, Xavier; Okello, Collins; Webale, Dominic; Odongo, Walter; Ongeng, Duncan; Steur, Hans DeAgronomic biofortification (i.e., the application of fertilizer to elevate micronutrient concentrations in staple crops) is a recent strategy recommended for controlling Iodine Deficiency Disorders (IDDs). However, its success inevitably depends on stakeholders’ appreciation and acceptance of it. By taking Northern Uganda as a case, this study aimed to capture and compare the perceptions of seven key stakeholder groups with respect to agronomic iodine biofortification. Therefore, we employed a SWOT (Strength, Weaknesses, Opportunities & Threats) analysis in combination with an Analytical Hierarchy Process (AHP). Findings show that stakeholders (n = 56) are generally positive about agronomic iodine biofortification in Uganda, as its strengths and opportunities outweighed weaknesses and threats. Cultural acceptance and effectiveness are considered the most important strengths while the high IDD prevalence rate and the availability of iodine deficient soils are key opportunities for further developing agronomic iodine biofortification. Environmental concerns about synthetic fertilizers as well as the time needed to supply iodine were considered crucial weaknesses. The limited use of fertilizer in Uganda was the main threat. While this study provides insight into important issues and priorities for iodine biofortification technology in Uganda, including differences in stakeholder views, the application of the SWOT-AHP method will guide future researchers and health planners conducting stakeholder analysis in similar domains.Item Traditional vegetable preservation technologies practiced in Acholi subregion of Uganda improves mineral bioavailability but impacts negatively on the contribution of vegetables to household needs for micronutrients(Food Science and Nutrition, 2020-05-20) Bighaghire, Raymond; Okidi, Lawrence; Muggaga, Christopher; Ongeng, DuncanThe impact of traditional African preservation methods on the contribution of veg etables to household micronutrient needs (Recommended Dietary Allowance: RDA) has largely remained unquantified. Using Acholi subregion of Uganda as a case area, this study examined using the predominant vegetables consumed in fresh and pre served forms (cowpeas—Vigna unguicullata, okra/lady fingers—Abelmoschus esculen tus, Malakwang—Hibscus cannabinus, and eggplants—Solanum melongena), the effect of major traditional vegetable preservation methods (sun drying, boiling and sun dry ing, and salting and sun drying) on the contents of micronutrients (vitamin A, iron, zinc, calcium, magnesium, and phosphorus), the levels of antinutritional factors (total polyphenols, oxalate, tannins, and phytate), bioavailability of iron and zinc, and the contribution of vegetables to the cumulative annual household RDA for micronutri ents. Laboratory analysis showed that all the preservation methods, except the sun drying method reduced the contents of micronutrients by 20%–82% (p ≤ .05). The contents of antinutritional factors reduced by 1%–80% while in vitro bioavailability of iron and zinc increased by 21%–296% (p ≤ .05). Nutritional computation revealed that except for calcium, the preservation methods combined, reduced the contribution of the vegetables to cumulative annual RDA for other micronutrients by 28%–60%. These results demonstrate that improvements in bioavailability of essential nutrients (iron and zinc) by traditional preservation methods investigated are associated with significant loss of micronutrients which culminates in significant reduction in the con tribution of cultivated vegetables to household RDA for micronutrients. Traditional African preservation methods should be optimized for nutrient retention.Item Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda(2023-05-31) Achiro, Eunice; Okidi, Lawrence; Nassanga, Prossy; Echodu, Richard; Alarakol, Simon Peter; Nassanga, Prossy; Ongeng, DuncanThe safety of homemade weaning foods in low- and middle- income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6– 23 months of age in Amuru and Nwoya districts, Northern Uganda, be tween March 2019 and June 2019. A cross- sectional study was conducted involving 180 caregivers. Data were collected using semi- structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logis tic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision- making on household income (p = .006) and households with older children (p = .041). A significant positive correla tion was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.Item Disparity in prevalence and predictors of undernutrition in children under five among agricultural, pastoral, and agro-pastoral ecological zones of Karamoja sub-region, Uganda: a cross sectional study(BMC Pediatrics, 2022-05-30) Okidi, Lawrence; Ongeng, Duncan; Muliro, Patrick Simiyu; Matofari, Joseph WafulaBackground Undernutrition accounts for nearly half of under-five child mortality in developing countries where household nutrition is largely dependent on agriculture. Despite the strong influence of agroecology on agriculture in those countries, limited information exists on whether undernutrition in children under five varies with agro-ecological location. Methods Using Karamoja sub-region of Uganda, one of the most food insecure parts of Eastern Africa as a case area, and applying a multi-stage sampling procedure, and a structured questionnaire, this study examined in a comparative manner, the prevalence and predictors of undernutrition in children under five among the agricultural, pastoral, and agro-pastoral ecological zones. Chi-square test and Kruskal-Wallis test were used to establish the disparity in prevalence of undernutrition and household contextual characteristics, respectively. Binary logistic regression was used to determine the predictors of undernutrition in children under five among the three agro-ecological zones. The level of statistical significance was set at p ≤ 0.05. Results The prevalence of underweight, stunting, and wasting ranged from 36 to 58% but varied with agroecology in terms of the peak age ranging from 6 to 37 months. Child characteristics, feeding practices, household economic factors, sanitation factors, and caregiver characteristics that predict undernutrition among children under five were identified (p ≤ 0.05). Caregiver handwashing after using latrine (p = 0.005) and diarrhoea in a fortnight (p < 0.001) increased the likelihood of stunting in pastoral agroecology only whereas cereal storage in both sacks and granary in agro-pastoral zone was associated with reduced likelihood of both underweight (p < 0.001 and p = 0.014) and stunting (p = 0.011 and p = 0.018), respectively. A male child was more likely to be underweight and stunted in pastoral (p = 0.002 and p = 0.011) and agro-pastoral (p = 0.017 and p = 0.002) agroecology, respectively. Household expenses reduced the likelihood of both underweight and wasting in pastoral (p = 0.013 and p = 0.005) and agricultural (p = 0.011 and p = 0.021) agroecology, respectively. Flour storage duration increased the stunting likelihood in pastoral (p = 0.032) and agro-pastoral (p = 0.006) agroecologies. Conclusion This study has revealed that, in a food insecure developing country setting such as Karamoja sub-region of Uganda, undernutrition among children under five varies with agroecology. Thus, nutritional interventions in such locations should be agroecology specific.Item Development of micronutrient dense composite flour for routine enrichment of complementary foods for children 6–24 months old in Acholi sub‑region of Uganda(Discover Food, 2023-12-11) Ugada, Aliet Mmbone; Okidi, Lawrence; Ongeng, DuncanBackground The use of local foods has been widely recognized as a sustainable strategy to address micronutrient deficiencies among resource-constrained households in rural areas in developing countries. Acholi sub-region of Uganda has recently recorded a high prevalence of micronutrient deficiencies due to inadequate iron, zinc, and calcium contents in complementary foods. Thus the sub-region was used as a case study to examine the potential of amaranth grain silverfish-iron rich beans micronutrient dense composite flour in improving nutritional quality of complementary foods. Design Microsoft Excel was used to derive ingredient combinations based on the micronutrient requirements. Laboratory analyses were used to determine (1) nutritional quality; (2) functional properties and; (3) storage stability of the micronutrient-dense composite flour. Data was analysed using a one-sample t-test and analysis of variance by Statistical Package for Social Sciences (SPSS) version 25. Results The micronutrient-dense composite flour contained 19 mg/100 g, 13 mg/100 g, and 354 mg/100 g of iron, zinc, and calcium, respectively. The cost (0.037–0.058 USD) of the micronutrient-dense composite flour required to meet the RDA for iron and zinc among children 6–24 months old was found lower than the cost (4.81 USD) of a sachet of standard micronutrient powder equivalent to RDA. The product exhibited low bulk density (0.68 g/l), high water solubility index (25.56–29.16%), and short reconstitution time (40.00–45.00 s), and remained safe during the entire 70 days of storage. Theoretically, daily enrichment of complementary foods for children 6–11 and 12–24 months old with 58 and 37 g of the composite, respectively would contribute 100% of the recommended dietary allowance for iron and zinc and 50% for calcium. Conclusion The developed micronutrient-dense composite flour has the potential to improve the micronutrient quality of complementary foods. A concerted effort is required to promote its use as a strategy to address micronutrient deficiencies among children 6–24 months in resource-constrained settings.Item Agroecology influences Salmonella food contamination with high exposure risk among children in Karamoja sub-region: A high diarrhoea prevalent locality in Uganda(Heliyon, 2022-11-11) Lawrence Okidia; Duncan Ongeng,; Patrick Simiyu Muliroa; Joseph Wafula MatofariaUganda is among low-income countries where Salmonella induced diarrhoea still contributes significantly to children under five years (CUF) mortality. Karamoja, a sub-region characterised by three agroecologies (pastoral: PE; agro-pastoral: APE; agricultural: AE), is a geographical location that has consistently experienced a high prevalence of diarrhoea among CUF over the last decade nationally. This study examined whether agroecology influences Salmonella food contamination and exposure risk to CUF. A total of 240 food samples (PE: 78; APE: 73; AE: 89) were examined for Salmonella load using Xylose Lysine Deoxycholate Agar and confirmed using polymerase chain reaction targeting invA gene. Analysis of variance for nested design was used to compare Salmonella counts among food types within and across agroecologies and means were separated using Tukey Honestly Significant Difference test at 5% (p < 0.05). Proportion of foods with Salmonella load exceeding World Health Organisation (WHO) set-limit was expressed in percentage. Exposure risk of CUF was computed by multiplying quantity of food intake by Salmonella load and compared to minimum infectious dose (MID) of the pathogen (3 log CFU) whereas chi-square was used to compare proportions of CUF with exposure above or below MID among agroecologies. Salmonella load ranged from 0.00 0.00 to 8.23 1.12 log CFU but varied by food type and agroecology. Salmonella aggregated load in foods from PE was significantly higher than from APE or AE (p <0.05). The proportion of Salmonella contaminated foods from PE, APE, and AE was 33–90%, 40–67%, and 17–88%, respectively. Salmonella exposure risks to CUF were similar (p > 0.05) at 96%, 92%, and 91% in PE, APE,and AE, respectively. Sorghum-based foods and leafy vegetables were the predominant high-risk foods. This study has revealed that Salmonella contamination of foods with high exposure risk among CUF in Karamoja sub-region varies with agroecology. Efforts to address food contamination in the sub-region should take into account agroecology.Item Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda(Food Science and Nutrition, 2023-05-31) Eunice Achiro; Lawrence Okidi; Prossy Nassanga; Richard Echodu; Duncan OngengThe safety of homemade weaning foods in low- and middle- income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6– 23 months of age in Amuru and Nwoya districts, Northern Uganda, be tween March 2019 and June 2019. A cross- sectional study was conducted involving 180 caregivers. Data were collected using semi- structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logis tic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision- making on household income (p = .006) and households with older children (p = .041). A significant positive correla tion was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.Item Agroecology influences Salmonella food contamination with high exposure risk among children in Karamoja sub-region: A high diarrhoea prevalent locality in Uganda(Heliyon, 2022-11-11) Lawrence Okidi; Duncan Ongeng; Patrick Simiyu Muliro; Joseph Wafula MatofariUganda is among low-income countries where Salmonella induced diarrhoea still contributes significantly to children under five years (CUF) mortality. Karamoja, a sub-region characterised by three agroecologies (pastoral: PE; agro-pastoral: APE; agricultural: AE), is a geographical location that has consistently experienced a high prevalence of diarrhoea among CUF over the last decade nationally. This study examined whether agroecology influences Salmonella food contamination and exposure risk to CUF. A total of 240 food samples (PE: 78; APE: 73; AE: 89) were examined for Salmonella load using Xylose Lysine Deoxycholate Agar and confirmed using poly merase chain reaction targeting invA gene. Analysis of variance for nested design was used to compare Salmonella counts among food types within and across agroecologies and means were separated using Tukey Honestly Significant Difference test at 5% (p < 0.05). Proportion of foods with Salmonella load exceeding World Health Organisation (WHO) set-limit was expressed in percentage. Exposure risk of CUF was computed by multiplying quantity of food intake by Salmonella load and compared to minimum infectious dose (MID) of the pathogen (3 log CFU) whereas chi-square was used to compare proportions of CUF with exposure above or below MID among agroecologies. Salmonella load ranged from 0.00 0.00 to 8.23 1.12 log CFU but varied by food type and agroecology. Salmonella aggregated load in foods from PE was significantly higher than from APE or AE (p < 0.05). The proportion of Salmonella contaminated foods from PE, APE, and AE was 33–90%, 40–67%, and 17–88%, respectively. Salmonella exposure risks to CUF were similar (p > 0.05) at 96%, 92%, and 91% in PE, APE, and AE, respectively. Sorghum-based foods and leafy vegetables were the predominant high-risk foods. This study has revealed that Salmonella contamination of foods with high exposure risk among CUF in Karamoja sub-region varies with agroecology. Efforts to address food contamination in the sub-region should take into account agroecology.