We carried out the study using a cross-sectional design and employed both qualitative and quantitative research methods. Using cross- sectional study we estimated the prevalence of malnutrition among NDS in Akwang sub-county in Kitgum district. Drawing from a sample of 124 participants and measuring the characteristics of the sampled members. We examined the situation as it were and identified the characteristics of the observed phenomenon. The participants for this study included children aged 15-18 years living with Nodding disease syndrome, attending NDS clinic at Akwang HCIII at the time of data collection, residing in Akwang for at least 12 months and whose parent/caretaker formally consented to participate in the study. We chose this design to understand the experiences and short-term outcomes in a population that is reachable for easy follow-up.
The choice of application of mixed methods, i.e., both qualitative and quantitative methods was motivated by the desire to achieve triangulation of methods which involved comparison of information obtained from different methods such as anthropometric data, interviews, and Focused group discussions on the same study phenomenon with different participants. The qualitative data was mainly generated from key informant interviews from medical and local government personnel in Akwang HCIII and Kitgum DLG. Also, ten caregivers of children with NDS participated in FGDs. This research design was therefore formulated in such a way that it is complementary and mutually reinforcing; that is, design and implementation was carried out to validate responses from one method by triangulating it with others. The use of both qualitative and quantitative methods has equally been advanced by [2], arguing that quantitative methods alone are not sufficient enough to answer adequately all questions related to the evaluation and assessment of increasingly complex healthcare [2]. All methods were performed in accordance with the relevant guidelines and regulations. Prior to the fieldwork, ethical clearance and approval was sought from Uganda Christian University Research and Ethics Committee- . Informed consent was obtained from all subjects and/or their legal guardian. - The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
Presentation of study findings
Table 1: Social demographics of Nodding Disease syndrome children (15-18 years)
Variables
|
Statistics
|
Gender
|
Male
|
58(47%)
|
Female
|
65(53%)
|
Mean (Median)
|
Age
|
18(17-18)
|
Height
|
144.82 (139.55-150.08)
|
Weight
|
46.51 (44.32-48.71)
|
Data source: Primary data, 2019
Table 1 shows that majority of NDS children 65 (53 %) were females. The average age was 17.85 years, mean height was 144.82 cm and the mean weight was 46.51 kg. The mean age and weight were higher for females (17.94 years, 47Kg) compared to the males (17.64 years, 45.09kgs,), the mean height was higher for males (158.75 cm than females (147.78cm).
Socio-Demographic Characteristics of caretakers of NDS children
Of the 124 screened individuals, 123(99.2%) were enrolled in the study. One participant said they didn't want to continue with the study due to personal reasons. The participant was excluded from the analysis. (Table 2)
Table 2: Distribution of caretakers of NDS children by their Socio-Demographic Characteristics
Variable factors
|
Frequency (%)
|
Gender
Male
Female
|
25(20%)
98(80%)
|
Marital status
Married
Single
|
3(2.4%)
120(97.6%)
|
Religion
Christian
Moslems
|
98(98.4%)
2(1.6%)
|
Level of Education
Non formal
Primary
Secondary
Tertiary/ University
|
34(27.6%)
84(68.3%)
1(0.8%)
4(3.2%)
|
Data source: Primary data, 2019
Overall, 124 participants were initially enrolled in this study. Of the 123 participants, 98(80%) were female, Majority belonged to the Christian Faith 98(98.4%) and most care takers didn’t go beyond primary school 84(68.3) in the level of education. Majority of the caretakers 120 (98%), were single.
Prevalence of wasting, stunting and underweight among the NDS Children
Table 3: Prevalence of wasting, stunting and underweight among the NDS Children
Variables
|
Incidence proportion
(%)
|
Acceptable level
|
Wasting
|
|
|
100 % (95 %CI 95-100)
|
<5%
|
Stunting
|
|
|
90 % (95 % CI 81-95)
|
<5%
|
Underweight
|
|
|
78%% 95 %CI 68-86)
|
<5%
|
Data source: primary data, 2019
Of the 123 participants, the overall prevalence rate of wasting was 100 % (95 %CI 95-100), stunting at 90 % (95 % CI 81-95) and Underweight at 78%% 95 %CI 68-86) of nodding disease children.
Table 4 shows the factors that influenced stunting, wasting and underweight respectively among NDS children 15-18 years in Akwang sub county in Kitgum district. Animals and food (p <0.05) and seizure at food (p-value < 0.05) during feeding caused stunting among NDS children in Kitgum which was statistically significant. Religion (p-value<0.008), Food run out (p-value < 0.05), Time to complete Meal (p-value<0.0) were factors that caused wasting among NDS children which was statistically significant. Weaning age (p-value <0.05 Animals and food (p-value<0.0128) were factors that caused underweight among NDS children and they were statistically significant. (Table 3)
Table 4: Factors influencing nutritional status among NDS children
Nutritional status N=123
|
|
P-Value
|
Stunting
|
|
|
|
Lack of food
|
|
0.0212 *
|
|
Time to complete meal
|
-
|
0.9274
|
|
Other foods
|
|
0.1681
|
|
Seizures
|
|
0.0448 *
|
Wasting
|
|
|
|
Religion
|
-
|
0.008*
|
|
Meals per day
|
|
0.924027
|
|
Food shortage
|
|
0.016259 *
|
|
Time to complete meal
|
|
0.446252
|
|
Seizures at food
|
|
0.0005*
|
|
|
|
|
Underweight
|
|
|
|
Early weaning
|
|
0.0386 *
|
|
Lack of food
|
|
0.0128 *
|
|
Rearing animals
|
|
0.4542
|
|
Other foods
|
|
0.3201
|
**Significant at 5% level Data source: Primary data, 2019
Table 5. Multivariate analysis of factors influencing nutritional status, Copying strategies among Nodding children in Akwang sub county in Kitgum District.
Factor
|
P value
|
Actual QR figure
|
95% C.I. for EXP(B)
|
|
Lower
|
Upper
|
Individual Factors
|
Religion
|
|
|
|
|
Christian
|
0.677
|
5.245
|
0.915
|
9.714
|
Muslim
|
0.66
|
1.266
|
0.523
|
2.225
|
Education level
|
|
|
|
|
Formal Education
|
0.003*
|
0.000
|
2.00
|
2.00
|
Primary
|
0.001*
|
0.414
|
1.50
|
1.50
|
Secondary
|
0.007*
|
2.282
|
2.00
|
3.00
|
University/College
|
|
|
|
|
Spousal support
|
|
|
|
|
Early Weaning
|
0.0012*
|
0.433
|
2.001
|
5.926
|
Rearing animals
|
0.921*
|
0.707
|
-6.985
|
10.985
|
Nutritional factors
|
Stunting
|
|
|
|
|
Time to complete meal
|
0.6
|
0.32
|
4.00
|
4.00
|
Meal per day
|
0.001*
|
0.00
|
2.00
|
2.00
|
Institutional factors
|
Wasting
|
|
|
|
|
Seizures
|
0.0010*
|
0.000
|
1.00
|
1.00
|
Meals per day
|
0.0010*
|
0.000
|
2.00
|
3.00
|
Food shortage
|
0.0012*
|
0.121
|
1.00
|
2.00
|
**Significant at 5% level Data source: Primary data, 2019
Table 5 shows the standard ratio for likelihood of different factors to influence malnutrition in children living with Nodding Syndrome. The likelihood of religion influencing malnutrition is not there at all and thus not statistically significant. Non formal education is likely to influence nutrition in nodding disease children (OR=0.000; 95% CI 2.00-2.00; p < 0.003), Spousal support through weaning of these children is also likely to influence their Nutrition Status nutrition (OR=0.433, 95%Cl0.00-5.926, p<0.001). Underweight through Meals per day (OR=0.000, 95%Cl 2.00-2.00, p<0.001) wasting through seizures (OR=0.000, 95%Cl1.00-1.00, p<0.001) and Underweight through food shortages (OR=0.0012, 95%Cl0.00-5.926, p<0.001. are also among the factors that can influence nutrition in Nodding disease children respectively.
Thus, the static shows that are severe Malnutrition, 100%, Manifesting among NDS Children in Akwang sub county
Table 6: The nutritional coping strategies of families with children with NDS in Akwang Sub County, in Kitgum District
Variables N=123
|
Nutritional Coping Strategies
|
|
Yes
|
No
|
Rear animals
|
92(74.8%)
|
31(25.2%)
|
Information on nutrition
|
64(52%)
|
59(48%)
|
Own land
|
119(96.7%)
|
4(3.3%)
|
|
|
|
Data source: Primary data, 2019
|
|
|
Table 6: nutritional coping strategies of families with children with NDS in Akwang Sub County
Table shows that most families are rearing animals (74.8%) compared to the 25.2% who don’t, 96.7% of the families own land which they use to plant all kinds of crops for feeding and rearing cows on, which is used as food to eat, most families try to get as much information on nutrition (52%) as possible has been among the important strategies of most families to cope up with food and nutrition of NDS children in Kitgum.
Qualitative outputs
This section presents summary findings from the Key informant interviews during the assessments of the study. These findings are summarized into themes. They included caretakers’ knowledge on factors influencing stunting, wasting and underweight among NDS children. We used an interview guide to investigate and get in depth information concerning how caretakers understand nodding disease and the different factors that influence stunting, wasting and underweight among NDS children, which would in the end enable us assess the nutritional status and associated factors among children (15- 18 years) with nodding syndrome attending Akwang HCIII. (See Table 7)
Table 7: Understanding the knowledge and factors influencing stunting, wasting and underweight among NDS children.
Theme
|
Sub-theme
|
Category
|
Responses
|
Factors influencing malnutrition status in nodding disease children
|
Care takers’ knowledge
|
Common knowledge and perception
|
-Big problem
-abandonment by male spouses
- nodding their heads and barely eat their food
|
Wasting
|
Characteristic of Nutritional status
|
“Failure to eat, mental confusion, the child becomes inactive/dormant especially in the morning, Unconsciousness, Head nodding.” (Respondent)
|
Stunting
|
Characteristic of nutritional status
|
“Poor families may have like one meal a day unlike well to do families this affects the feeding processing terms of frequencies” (Respondent)
|
Underweight
|
Characteristic of nutritional status
|
“nodding and collapsing, the feeding process is interrupted hence no nutrient entry to the body”(Respondent)
|