Nutrition Study

Nutritional status of former internally displaced persons in a post-conflict setting: The Case of Awach Demographic Surveillance System (DSS) Site in Northern Uganda

Aim

The nutrition study aims to understand the effect of conflict-related internal displacement, food aid and food insecurity on nutritional status, and to investigate risk factors of malnutrition, including obesity in the post-conflict area of Awach sub-county, Gulu district, Uganda.

Background

Northern Uganda experienced prolonged period of food insecurity during the conflict with resultant high rates of malnutrition. Food aid from World Food Programme (WFP) in Gulu district was considered one of the largest and longest food aid intervention in the world, phased out between November 2008 and January 2010. Both the chronic and acute malnutrition rates were high, reflecting the long-standing food shortage and irregular food supply. Displaced persons had limited access to farmland since they were generally not able to go back to the villages due to insecurity and travel distance. Underlying risk factors for malnutrition that exist during conflict periods tend to persist into the post-conflict period. How the burden of malnutrition and associated risk factors will change during the post-conflict period in northern Uganda remains unknown.

The situation in northern Uganda has not been adequately researched and data is scanty. The initial population displacement into the semi-urban IDP camps mostly located at trading centers (“forced urbanization”) is now being reversed with the resettlement process, a phenomenon of “reverse urbanization”. It is unknown how the magnitude of malnutrition will change in the post-conflict period. However, knowing the pattern and risk factors for both undernutrition and overweight in post-conflict context is important in securing a healthy and productive future generation.

Ojectives

• To determine and classify the nutritional status of children, adolescents and adults in the post-conflict population of Awach DSS.
• To determine the association between IDP camp exposure and nutritional status of former internally displaced persons in Awach DSS.
• To assess nutritional exposures and nutritional status of pregnant women; and determine the association between maternal nutritional status and birth weight of their infants as pregnancy outcome.
• To monitor changes in nutritional status and determine risk factors for malnutrition, including obestity among the population of Awach Sub-county.

Preliminary Results

Preliminary results from March 2012 showed that the Global Acute Malnutrition (GAM) was 8.2% and Severe Acute Malnutrition (SAM) 3.7% among children aged 6-59 months old – indicating a large increase in undernutrition since general distribution of food aid has stopped in Gulu District. Among adults aged 18 years and above 16.7% was classified as underweight (BMI18.5), 77,8% as normal weight ((BMI 18.5-25) and 4.7% as overweight (BMI>25). Results are based on 382 children and 785 adults collected from mid January to mid March 2012.

Expected outcomes:

• To setup a system enabling monitoring of nutritional status longitudinally. The nutrition study initiated in 2011 will serve as a baseline study with the ability to generate unique research data for decades – particularly to investigate research questions and hypothesis in relation to post-conflict characteristics, mobile populations, nutritional status and other health outcomes as diabetes and cardiovascular diseases.

• To establish a birth cohort with children of mothers who have experienced different exposures of food rations from WFP, including type of food, time of gestation and duration of exposure. Providing opportunities for future research in relation to maternal nutrition, early priming, and adverse health outcomes later in life.

The study will providing useful data the District Health Office and other stakeholders to target effective interventions in the process of resettlement in the post-conflict settings. Additionally, it will provide data for WFP to adjust and improve food aid in future emergency settings - both in terms of content and distribution of food.

The study is expected to finish in October 2012 with publications on nutritional status of all age groups in a post-conflict vacuum.

Principal Investigator:

Kaducu Felix Ocaka, MBcHB, MPH, PhD Student, Gulu University, Uganda

Research Assistant:

Stine Schramm, MSc PH Student / Pre-graduate Research Student, University of Southern Denmark, Denmark

Supervisors:

1.     Prof. Morten Sodemann, PhD, University of Southern Denmark, Denmark

2.     Assoc. Prof. Annmarie Touborg Lassen, PhD, University of Southern Denmark, Denmark

3.     Prof. Emilio Ovuga, PhD, Gulu University, Uganda

Co-Supervisors:

1.     Dr. Wamani Henry, PhD, Makerere University School of Public Health, Uganda

2.     Dr. Marianne Skytte Jakobsen, PhD, University of Southern Denmark, Denmark