Theses and Dissertations

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Predictors of Default Rate in the Outpatient Therapeutic Management of Acute Malnutrition Among Children 6-59 Months in Lamwo and Omoro Districts-Northern Uganda
(Gulu University, 2024) Amony Paska
Severe acute malnutrition (SAM) continues to be a significant threat to the wellbeing of children, contributing to at least 10% of the reported mortality of children under the age of five in northern Uganda. This could be exacerbated by limited information about Outpatient Therapeutic Care (OTC) default rates, poor perception of OTC programs, and other factors that perpetuate default rates. A cross-sectional quantitative study was conducted among 244 Caregivers and hence children under five years in Omoro and Lamwo districts of Northern Uganda to examine factors leading to default rate in OTC management of acute malnutrition. Data was collected using a validated semi-structured questionnaire and analyzed using SPSS version 25. The OTC default rate was found to be 34%, and it is consistent across districts. Caregivers had a positive perception (MS =3.70) towards the effectiveness dimension of the OTC services, and a negative perception (MS=2.3) towards the accessibility and convenience dimension of OTC services. OTC default rates were influenced by marital status, the perceptions of caregivers towards accessibility and convenience of OTC services, distance to the OTC facility, and child’s age, presence of other health conditions (Malaria, HIV etc ) and the waiting time to see the health personnel. This indicates that OTC default rates in northern Uganda are high, and is driven by unfavorable sociodemographic, institutional, physiological, and environmental factors. These factors must therefore be considered in the design of targeted interventions such as educational programs, establishment of support systems which include reminder services, follow-up calls, and recruitment of community-based health workers to ensure all children receive comprehensive care in the management of SAM.
Attitude and Willingness to Consume Locally Made Soymilk by Refugees and Host Community Members in Northern Uganda
(Gulu University, 2024) Okello Emmanuel
The well-being of refugees and host community members is threatened by reliance on diminishing food aid, limited financial capacity and market access, insufficient land for farming, and overpopulation, among other challenges. This situation is exacerbated by food rations that primarily consist of starchy staples with limited or no animal protein, increasing the risk of nutritional deficiencies. The consumption of locally produced plant-based milk substitutes such as soymilk could provide a cost-effective solution to address these risks.However, the acceptance and consumption of such foods depend on consumer attitude and preferences. This study investigated the willingness to consume and the factors influencing attitude towards the consumption of locally made soymilk among refugee and host communitymembers. A cross-sectional mixed-methods study was conducted with 365 participants in Palabek Refugee Settlement, Lamwo District. Data were collected using a semi-structured questionnaire and focus group discussions guide, and analysed using SPSS version 25 and thematic inductive analysis, respectively. The findings reveal that most respondents (75%) had not consumed soymilk prior to the study, with a higher proportion of the host community (29%) reporting prior consumption compared to the refugee group (22%). The majority of respondents (99%) exhibited a positive attitude towards locally made soymilk, with no significantdifferences between the two study groups. Participants expressed a high likelihood of consuming different soymilk flavors (Mean Score = 3.96), with lemongrass flavor being the most preferred, followed by vanilla and plain flavors. Significant differences were noted, as refugees expressed a higher likelihood of consuming these flavors compared to the host community. The willingness to consume soymilk improved significantly after participants were trained on soymilk preparation methods, with mean scores increasing from 4.12 to 4.88 among refugees and from 4.08 to 4.28 among host community members. Household size, education level, monthly income, cost of soymilk and its raw materials, sensory attributes, accessibility of soymilk, health and nutritional benefits were key factors influencing attitude towards soymilk consumption. Organizations, including Non-Governmental Organizations (NGOs) and government agencies, should leverage these factors and the high acceptance of locally made soymilk to design inclusive, culturally sensitive, and nutritionally adequate programs. These programs should address the nutritional needs of both host and refugee communities, fostering resilience and long-term health improvements.
consumer perceptions and demand factors driving consumption of pumpkin products in gulu city
(Gulu University, 2024-01-09) Rubangakene Derrick Otim
Despite nutritional values of pumpkin products, they are not widely consumed by the local population. To enhance consumption of pumpkin products, understanding the influence of consumer perceptions combined with demand factors on consumption of pumpkin product I paramount. The study was set out to examine the relationship between socio-economic factors and sources of pumpkin products, assess the influence of consumer perceptions on consumption of pumpkin products and determine the factors affecting consumer demand decisions for pumpkin products Using a cross-sectional survey 427 households in Gulu City, this study examined the influence of consumer perceptions and demand factors on consumption of pumpkin products. Data analysis involved descriptive statistics and two different models. Negative Binomial Regression Model (NBR) was used to assess the influence of consumer perceptions on consumption and Heckman Two-stage regression model was used to determine factors driving consumer decisions to demand for pumpkin products. Findings show that consumption of pumpkin products is influenced by consumer perceptions on health benefits on heart health, consumer taste and preference for aroma, hard skin, nutty taste, fibreness, perceived health benefits on eye vision, quantity consumed, income, reliance on self-production, boiled preparation, product price, household size, and sensitization on healthy foods. Consumer decision to purchase pumpkin products is driven by perceived health benefits for immunity, eyesight, heart health, and weight loss, marital status, income spent on products, proximity to supermarkets, number of men in the household and sensitization on healthy foods. Consumer decision on quantity demanded for pumpkin products depends on product prices, income price of substitutes, number of men in the household, and sensitization on healthy foods. The study recommends that sensitization programs should structure messages to emphasize the role of pumpkins in enhancing human health.
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
(Gulu University, 2023-11-30) Mpagi , Ronald
Food safety is a key factor that influences nutrition outcomes through its impact on the utilization dimension of food security. Karamoja sub-region is an area that has consistently experienced a high prevalence of diarrhoea-associated undernutrition among children under five years over the last decade. Salmonella is an important enteric pathogen that occur in foods and water in Karamoja sub-region. However, limited information exists on the serotypes and antimicrobial resistance characteristics of non-typhoidal variants of the pathogen in the area. The overall objective of this study was to determine the prevalence and antibiotic resistance characteristics of non-typhoidal Salmonella enterica serotypes that contaminate foods and water consumed by children under five years in Karamoja sub-region. Specifically, the study determined: (i) the prevalence and serotypes; (ii) phenotypic antibiotic resistance characteristics; (iii) genotypic antibiotic resistance characteristics; and (iv) the association between the genotypic and phenotypic antibiotic resistance characteristics of the organisms in question. Two hundred samples of food and water collected from Karamoja sub-region were analysed for Salmonella enterica using culture and PCR targeting invA gene. The confirmed Salmonella isolates were serotyped using multiplex PCR targeting genes conserved in each serotype. The confirmed isolates were further subjected to the disc diffusion test and PCR targeting the corresponding resistance genes to determine the phenotypic and genotypic resistance characteristics, respectively. Results showed the prevalence of non-typhoidal Salmonella enterica to be 45%. Four serotypes were identified with S. typhimurium (53%) being the most dominant followed by S. infantis (16%), S. enteritidis (9%) and S. dublin (4%). Phenotypically, all the confirmed isolates were resistant to at least one antibiotic recommended for treatment of salmonellosis whereas 37.9% were multidrug resistant. Resistance frequency was highest for azithromycin (91.1%) followed by ciprofloxacin (31.1%), cefixime (20%), xi cefotaxime (20%), ceftazidime (15.6%), ceftriaxone (6.7%), cotrimoxazole (6.7%), chloramphenicol (6.7%) and amoxicillin clavulanic acid (2.2%) in decreasing order of magnitude. The most prevalent resistance genes were mefA (95.3%), gyrA (94.9%), parC (92.3%), blaPSE (81.3%), sul1 (66.6%) and Sul2 (66.6%). Phenotypic resistance to chloramphenicol, beta lactams, cotrimoxazole and ciprofloxacin was strongly correlated with the presence of floR (odds ratio (OR)=12.5, 95% confidence interval (CI)0.936-1.000, P=0.031), blaPSE (OR=24.7, 95% CI 0.000-0.064, P=0.001) sul1 (OR=11.9, 95% CI 0.000 0.065, P=0.000)), parC (OR=13.3, 95% CI 0.000-0.064, P=0.015) respectively. This study has revealed that food and water consumed by children under five years in Karamoja sub-region are contaminated with antibiotic resistant non-typhoidal Salmonella enterica serotypes and are therefore not safe for consumption. Therefore, there is need for concerted effort by concerned authorities to address microbial food safety challenges in Karamoja sub-region as well as develop and priotize prevention measures such as vaccinations and use of antimicrobial peptides as alternatives in managing bacterial infections such as salmonellosis
Dietary iron intake and prevalence of iron deficiency anemia among women of childbearing age in Adjumani refugee settlement
(Gulu University, 2024-09-01) Ikomolot Caroline
Anemia is a big threat to global population of women of childbearing age (WCBA). Factors such as malnutrition, infections, and poor sanitation are identified as the main contributors to high prevalence of anemia in this age category. However, information about the contribution of iron deficiency anemia (IDA) to general anemia prevalence remains unknown especially in a refugee settlement where iron intake is compromised by many factors. This study investigated: (i) dietary iron intake; (ii) contribution of iron deficiency to anemia prevalence and (iii) socio-economic and dietary factors influencing serum iron status of 462 WCBA in Adjumani refugee settlement using cross-sectional survey. IDA was determined by analyzing serum ferritin using Human Ferritin ELISA kit (Bio-techne company, United Kingdom), following standard procedure and manual from the manufacturer. According to the results, the dietary iron intake of the study sample was not significantly different (p≤0.05) from recommended daily intake (RDI) of iron except for the intake of the study samples from Pagirinya refugee settlement which was lower than RDI (p≤0.05) and mainly from plant sources. Engagement in income generating activities (IGAs) especially farming and fishing resulted in a significant increase in iron intake (p≤0.05). The prevalence of anemia in the sample was 34.42% with mean hemoglobin concentration of 10.25g/dL but the prevalence varied among the different settlements studied. Iron deficiency anemia (IDA) accounted for 37% of anemia among those who were found to be anemic after the initial screening. Overall, there was a significant impact of IGAs, education, and monthly income on serum iron status of women (p < 0.05). This study has demonstrated that the intake of iron among refugee women was primarily from starchy plant-based food sources but was generally not significantly different from recommended intake except for inter-settlement variations. Despite meeting the recommended iron intake, iron deficiency is still persistent, and the level of anemia is high among refugee women of childbearing ages, suggesting poor quality of dietary iron sources. Therefore, consumption of a mix of animal-based and iron rich-plant food sources among women of childbearing age in Adjumani refugee settlement should be encouraged. The promotion of nutrition interventions could also consider diversifying the economic activities of women in the refugee context to improve the impact.
Influence of Agricultural Commercialization on Micronutrient Nutrition among rural households in Omoro and Otuke Districts of Northern Uganda
(Gulu University, 2023-12-30) Kisebe Lillian
Micro-nutrient deficiencies are a serious nutritional challenge among households in Otuke and Omoro districts of northern Uganda, majority of whom depend on farming for food and income. Agricultural commercialization (AC) is a strategy being promoted to address rural poverty and food and nutrition insecurity in localities such as Omoro and Otuke districts. However limited information exists on how AC influences rural household micronutrient nutrition in such localities. Making use of 400 randomly selected households, this study examined the influence of AC on micronutrient nutrition in Omoro and Otuke districts. Specifically, the study assessed the factors that influence AC and the influence of agricultural commercialization on production and consumption of vitamin A, iron and folate. Using household commercialization index as a measure of agricultural commercialization, results showed that the level of AC in the study area was 61% with Omoro having 63% while Otuke had 54%. Tobit regression analysis showed that gender of the household head (p<0.023), primary food source (p<0.01), credit availability (p<0.01), membership in farmer groups (p<0.05), and methods of land tillage (p<0.001) significantly influenced AC. Two-stage least square regression showed that AC affected the production of iron (p<0.01), folate (p<0.01), and folate consumption (p<0.01). This study has demonstrated that AC has the potential to enhance production and consumption of micro-nutrients of public health concern. Based on these findings, development of strategies and policies that promote AC to address rural household micronutrient intake should take into account the agricultural commercialization factors identified and how commercialization influences production and consumption of micronutrients.
Effect of maize and oyster mushroom blending ratio on nutritional, microbial, and physico-chemical quality of maize-mushroom composite
(Gulu University, 2022-11-23) Kilama, Godfrey
complementary foods made from common starchy cereals like maize have been associated with high level of micronutrient deficiencies in children 6-24 months. Combining locally nutrient-dense underutilized foods like oyster mushrooms with starch-rich maize could enhance the nutritional quality of complementary foods. This study investigated how blending oyster mushrooms to maize flour would improve its nutritional, microbial, physico-chemical, and sensory quality. Refined maize flour was combined at 0% (control), 10%, 20%, 30%, and 40% (w/w) with flour derived from thoroughly cleaned blanched, and sun-dried oyster mushrooms. The nutritional, microbiological, physical-chemical, and sensory qualities of the composites were assessed using standard procedures. With all ratios of mushroom, the nutritional quality of the composites was significantly improved. For example, adding 10%, 20%, 30%, or 40% oyster mushrooms to maize flour increased the protein content from 6.67% to 8.74%, 6.67% to 11.04%, 6.67% to 14.23%, and 6.67% to 17.87%, respectively. Ash and fiber content percentage increment ranged from 0.31 to 2.48% and 0.22 to 3.04%, respectively. The composite's mineral composition had percentages increment ranging from 2.7 to 8.88% for iron, 1.9 to 6% for zinc, 26.03 to 55.33% for calcium, and 15.24 to 51.11% for magnesium. The physico-chemical quality of the composites was better, but the microbiological quality was negatively affected. Despite bioavailability limitations, theoretical nutritional calculations showed that consuming 250g/day of a blend that contains 10% mushroom contributes roughly 75% of the iron and 187% of the zinc requirement of children 6-24 months. The sensory evaluations of the composite-made porridges revealed poor ratings for the color, flavor, aftertaste, and aroma, but had no impact on the acceptability of the porridges made from blends containing 10% mushroom. The viscosity and water absorption of the composites, in particular, favorably impacted caregivers’ acceptability, whereas the capability to absorb oil decreased caregivers’ acceptability. For children 6-24 months who rely on maize porridge as a complementary food, this study suggests combining oyster mushroom with maize flour to increase the nutritional content of the flour mixture.
DEVELOPMENT OF NUTRIENT ENRICHED CASSAVA – ORANGE FLESHED SWEET POTATO-BASED SNACK FOR SCHOOL FEEDING OF CHILDREN AGED 6-15 YEARS
(Gulu University, 2024-12) ULANGO, TOM
Introduction Undernutrition in rural regions is a global concern that is exacerbated by non-sustainable practices such as pupils feeding programs and school gardens. Nutrient-dense, reasonably priced meals can be given to rural populations as a solution. The goal of the current study is to develop a nutrient enriched snack made of cassava-OFSP blend that may be fed to school-age children (6-15 years) in the Zombo district. The snacks were formulated from a blend of cassava, Orange Fleshed Sweet Potato (OFSP), maize, amaranth seed and NARO Bean2 flours and contained both macro (protein, crude fiber, crude fats, ash, energy) and micro (iron, zinc and vitamin A) nutrients Method During the study, both a cross-sectional and a randomized design (CRD) were employed in the investigation. 130 pupils participated in the study and assessed the snack's preferences for colour, flavor, taste and mouth feel. Reducing the proportion of cassava and OFSP less than 25% and 0% respectively in the formulation, significantly (p<0.05) improved the color of the snacks. According to the study, lowering these flour proportions could not have a significant (p>0.05) impact on how good the snack tastes. Additionally, the taste and texture of the snacks SP3 and SP6 improved dramatically (p<0.05) when the amount of cassava flour in the control snack SP2 (100% Cassava flour) was decreased. The study noted that adding other flours instead of cassava boosted the amount of protein in the new product SP5 (40% Orange Fleshed Sweet Potato, 15% Cassava, 20% Maize, 7% Amaranth and 18% Iron Rich Bean Flours) the control SP2 from 20.67% to 26.48% (p<0.05). Similarly, addition of more flours to substitute cassava flour in snack SP2 significantly (p>0.05) increased the crude fiber content from 0.8 in snack SP2 to 6.43% in snack SP3. The study therefore indicates that nutrient dense snacks can be developed using local plant materials that are available in the communities to meet the recommendable dietary requirement of iron 10mg/day for children 6-8 years, 8mg for boys and girls children 9-13 years, 11mg/day and 15mg per day for adolescent boys and girls and girls 14-18 years respectively among school children 6-15 years in Zombo district, West Nile Sub-region. Results: The study developed 9 snack samples SP1 (100:0:0:0:0), control SP2 (0:100:0:0:0), P3 (80:5:0:7:8), SP4 (60:10:10:7:13), SP5(40:15:20:7:18), SP6 (20:20:30:7:23) SP7(0:25:40:7:28), SP8 (0:30:50:7:33) and SP9 (0:0:55:7:38) with various proportions (Orange Fleshed Sweet Potato: cassava: maize: amaranth seed: iron rich bean 2) flours respectively. Sensory analysis indicates that xiii variation in flour proportions resulted in the development of snacks that were significantly different (p<0.05) by 0.84 score for colour compared to the control SP2. Flavour of the snacks improved by 0.61 score in in snack SP3 while, mouth feel had a score difference of 0.83 for snack P6. Generally, flour formulation caused a significant (p<0.05) change in snacks SP7, SP8 and SP9; for colour, SP3, SP4, SP5, SP6 and flavour SP8; SP3 and SP6 respectively but did not (p>0.05) significantly improve taste and preferences of all the snacks despite SP3 score of 3.02 being the highest and lowest (2.79) in snack SP2 (control) using hedonic scale 5 liked most and 1 disliked most. Proximate and micronutrient analysis indicates that SP6, SP9 and SP3 had the highest iron (44.01mg/100g), Zinc (7.17mg/100g) and vitamin A (1441.33µg/100g) respectively however, SP3 had the highest (12.37%) moisture content making the snack prone to spoilage due to growth of microbes. Servings of snack (20g, 70g & 67g) of SP9, would meet 100% RDA of iron, zinc vitamin A for children 9-13 years, similarly, SP9 servings of 27.3g and 37.3g, 80g (girl) and 103g (boys), would meet 100% RDA of iron, zinc and vitamin A for children 6-15 years depending on the nutritional requirements for th various sexes and age of the children. The requirements of RDA of iron (10mg/day), zinc 5mg/day and vitamin A (400µg/RAE) per day for boy and girl children 6-8years respectively, while for by and girl children 9-15years, SP9 and SP6 servings of (20g,70g,67g) and (18.2g,86.5g,57g) would provide the RDA of 5mg/day, 8mg/day 600µgRAE/day for iron, zinc and vitamin A respectively whereas, children 14-15 years would be served 103g and 85.6g of the snacks SP9 and SP6 to meet the RDA of vitamin A (900 µgRAE and 700 µgRAE) for boys and girls respectively and 153.4g serving and 190.3 g serving of SP9 and SP6 would provide 11mg/day for zinc. Conclusion: The study indicates that locally available, nutritious and underexploited plant materials can be used to develop composite flour mixes using cassava, OFSP, maize, amaranth seed and NAROBean2 can be used to create edible and nutrient dense snacks that would meet the RDA for iron, zinc and vitamin recommended for education sector in Uganda to embrace cassava-OFSP-based snacks developed from the locally available foods in the current study with further studies on the effects of soaking, malting, roasting on the nutrient bioavailability. Recommendation Future studies should evaluate water soluble nutrients like iron, zinc and vitamin A bioavailability during the soaking, roasting, and malting processes used during the development of the cassava-OFSP snack formulations. Therefore, schools can develop snacks to enhance nutrient intake among the school children to improve their health and increase their concentration in class
NON-CARBONATED BEVERAGES (HEALTH DRINKS) IN SOUTH WESTERN UGANDA: ANTIOXIDANT POTENTIAL, CONSUMER PERCEPTIONS AND THE ROLE OF NUTRITIONAL AND HEALTH CLAIMS
(Gulu University, 2023) ATUKUNDA, CLAIRE
Non-carbonated beverages comprise of fruit, vegetable, and herbal-based drinks, which are largely known as ‘health drinks’ in Uganda and are widely consumed in Southwestern Uganda. Despite the increased popularity of health drinks on the Ugandan market, particularly in Southwestern Uganda, little is known about: (ⅰ) their antioxidant potential; (ⅱ) consumer perceptions of the healthiness and safety of beverages; and (ⅲ) the influence of nutritional health claims (that are widely used on health drinks) on consumption. Thus, the objective of the study was to examine the antioxidant potential and factors associated with the consumption of health drinks in Southwestern Uganda. A cross-sectional study was conducted among 278 adults in Mbarara City and Sheema district using structured questionnaires. Laboratory analysis of vitamin C, total phenolic content, and total antioxidant activity of selected health drinks was conducted using 2,6-dichlorophenoindophenol (DCPIP), Folin-Ciocalteu, and 2,2- diphenyl- 1 picrylhydrazyl (DPPH) assays respectively. Results showed variations in the vitamin C content (14.19-25.12mg/100ml), total phenolic content (0.37-146.01mg/100ml), and total antioxidant activity (35.48-2491.8 µg/ml) of the different health drinks depending on the type of ingredients used. Theoretical calculations showed that consumption of 320 ml of health drinks would be sufficient to meet the vitamin C intake recommendations and about 40% polyphenol intake recommendations for a healthy life. Majority of the consumers had positive perceptions of beverage healthiness (77.4%) and safety (66.2%). Product health benefits, safety, and information influenced perceived healthiness while perceived safety was influenced by regulatory logos, organoleptic cues, age, gender, household income, and perceived healthiness (p≤0.05). Nutritional health claims influenced about half the respondents to consume health drinks (49.3%). Particularly, nutritional health claims in media advertisements had a significantly higher positive influence on intention to consume than claims on food labels (p=0.019). Besides the claims, perceived xii healthiness and safety also positively influenced consumption intentions. The results of this study demonstrated that (ⅰ) health drinks consumed in Southwestern Uganda are alternative sources of antioxidants for which consumption can lead to substantial contributions to the recommended vitamin C and polyphenol intake; (ⅱ) perceptions of beverage healthiness and safety are important factors that can be exploited to boost consumption of health drinks; and (ⅲ) nutritional health claims can enhance consumption of non-carbonated (health) drinks and are more effective when presented through media advertisements than when presented on food labels.
Biofortification of Finger Millet Grown in Biochar Amended Soils Using Zinc AND Iron
(Gulu University, 2023) Manijawire Alinafe
Recurrent dearth of micronutrients from soils and crops aggravated by the impacts of climate change has augmented an increase of hidden hunger with over 2 billion people affected across the globe. This problem is more rampant in developing countries with devastating economic setbacks, which deprive them from diet diversification. This calls for more interventions in enriching the cereal crops which are naturally low in micronutrients despite being the source of staple food for millions of people in African countries. One of the key approaches towards the drive to reducing malnutrition is biofortification. A two-season pot experiment was carried out at Gulu University’s Faculty of Agriculture and Environment experimental site. The aim of the experiment was to explore the effects of soil and foliar application of mineral based fertilizers (iron and zinc) in biochar amended soils on yield and grain quality of finger milletgrown in allisols and ferralsols. The experiment had eight treatments with four replicates which were arranged in RCBD in both soil types. The results from the experiment revealed that biofortification in biochar amended soils improved yield and quality of finger millet in both soil types. Maximum yield of 50 – 53 g/pot were recorded in both soils with biochar treatments, sprayed with both iron and zinc compared to the yield of 23.8 g/pot -25.5 g/pot in control. Similarly, an increase in protein content from 4.67 % to 11 % was also mirrored in treatments receiving foliar application of both iron and zinc in biochar amended soils. Zinc and iron content were higher in grains (41.5 - 44.6 mg/100g and 11.3 - 13.3 mg/100g, respectively) from treatments which had biochar and were foliarly applied with iron and zinc. Soil organic carbon and moisture content significantly (P < 0.05) influenced Zn and Fe uptake from soil. Overall, both soil and foliar application methods of mineral fertilizers in biochar amended soils are ideal in enhancing nutrient availability for crop growth and yield coupled with improved grain quality.

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