This was a cross sectional study carried out on preschool children attending the outpatient departments of Kampala International University Teaching Hospital, Bushenyi Health center IV, Kyabugimbi Health center IV and Kyamuhunga Health Center IV. A pre tested questionnaire, was used to collect data from the caretakers of the children who fit the inclusion criteria. The children’s weight and height were then taken and with the help of the caretaker a stool sample was collected from the child.
Bushenyi district is located in the western region, about 323 km from the capital city Kampala, Uganda. The district is made up of 11 sub-counties, 76 Parishes and a total of 585 villages with an estimated total population of 235,617 people as per the National population and housing census of 2014. Agriculture is the commonest economic activity providing employment for 86.7% of the population. The four health units selected for the study serve the rural and semi urban populations of the greater Bushenyi district.
The study participants were 206 preschool children aged 1–5 years old who attended the selected health centers in Bushenyi District from the 20th March to 30th of July 2019.
Sampling Technique And Sample Size Calculation
The sample size was determined using the single population formula. It was calculated by using a previous prevalence of 17.4% (Zemene et al., 2018) with a margin of error of 0.05 and a confidence level of 95%. In line with it, 220 children was the minimum sample size. The children attending the health units on the 20th March to 30th of July 2019 were consecutively recruited into the study. However, only 206 children fitted the inclusion criteria.
Respondents were caretakers of children aged between 1 and 5 years of age and had brought them to the health unit. Children excluded from the study were those whose caretaker refused to give ethical consent, were too sick or were unable to give stool samples and those who had been dewormed 2–3 months prior to the date of the study.
Socio-clinical Data Collection
An interview based structured questionnaire was used to collect socio-clinical data. The questionnaire was initially developed in English and translated to Runyankole, the local language, and then retranslated back to English for analysis to ensure the consistency. A pre-test was administered on caretakers of 10 preschool aged children attending the pediatric clinic of Kampala International University, Teaching Hospital and relevant amendments were made. Written informed consent was obtained from each caregiver before the interview was conducted.
Assessment For Stunting
The height and weight of each child that fulfilled the inclusion criteria, were taken, recorded and interpreted using WHO Z-scores (WHO, 2009). For children aged above two years, the child stood on a pre-calibrated weighing scale with his/her back against the weighing scale board, his/her heels, buttocks, shoulders and head touching a flat upright head piece. The child was instructed to place their feet, knees and ankles together. The head piece was brought down onto the upper most point on the head and the height was read to the nearest 0.1 cm at the examiner’s eye level. For those children below 2 years length was taken using an infantometer. The child would lie on it and a length read and recorded to the nearest 0.1 cm (Kikafunda & Agaba, 2014). The weight was of the children was read to the nearest 0.1 g.
Stool Sample Collection And Processing
The caregiver was provided with a stool container with a tight cover labeled with the child’s study number. He/she was provided with gloves for his/ her safety while collecting a sample of the child’s stool (using the applicator provided in a specimen container, estimate 20 g). The child and caregiver used a side room near the laboratory to collect the stool sample, after which soap and clean water was provided to their wash hands.
In the laboratory, a gram of the stool sample was emulsified in 8mls of 10% formol water in a screw cap bottle and shaken well to mix. The emulsion was then sieved and the suspension transferred into a glass tube where added 3mls of diethyl ether were added. These were then mixed and centrifuged at 750 revolutions for a minute. Using a stick any fecal debris layer was made loose and decanted to remain with the sediment at the bottom. The sediment was transferred onto a microscopic slide and a cover slip applied. It was then mounted to a light microscope using the 10x objective and 40x objective to examine for soil transmitted helminthes’ eggs (Garcia et al., 2018).When found, the eggs were confirmed using an atlas and further by a laboratory technologist.
Data from pre-coded and completed questionnaires was entered into Microsoft excel, cleaned and analyzed using Statistical Analysis Software (STATA 12.0). The prevalence of children with stunting was calculated and presented as percentages. Information on socio-demographic and clinical factors was descriptively presented as frequencies (percentages). A logistic regression with adjusted Prevalence Ratio was performed to test the association between the socio-demographic and clinical factors and stunting at both bivariate and multivariate levels of analysis. A 95% Confidence Interval was used to assess the strength of association. A P value of P ≤ 0.05 was accepted as statistically significant.
Ethical approval was obtained from the Institutional Research Ethics Committees (IREC-Mbarara University Science and Technology (approval number 20/10–16). At all respective health units, a verbal approval by the health unit’s leaders was obtained on presentation of an IREC approval document. A written informed consent was obtained from each caregiver/child before the interview was conducted. The questionnaires were administered after attending to the primary reasons in order not to interfere with the patients care. The principal investigator participated in the children’s general medical care at out-patient department at the time of data collection. The interviews were carried out in a side room to ensure confidentiality. Names were not written on the questionnaires and only research numbers were used. No individual-based data was reported. After the interview the researcher replied to any concerns the caregiver had. The completed questionnaires were kept under lock and key and only accessed by the principal investigator. Those children found with soil transmitted helminthiasis were treated and those that were stunted a nutritional education was given to their caregivers.