NUTRITIONAL STATUS OF SCHOOLING CHILDREN IN TANZANIA AND UGANDA: RESEARCH AND ACTION

Malnutrition affects millions of children worldwide. With its different faces – undernutrition and overnutrition – it is the result of several determinants, such as the lack/surplus of adequate food, life-style, mother’s low education, socio-economic situation. For this reason, any research on this issue should be tackled with a wide approach. The primary goal of this thesis was to monitor the nutritional status of Ugandan and Tanzanian children attending some primary schools and analyze related factors. We dealt with the lack or misreporting of birth data, a widespread phenomenon in sub-Saharan Africa, which affects the possibility to correctly evaluate nutritional status. We have promoted, with Bhalobasa NGO, awareness campaigns and projects, in Africa and in Italy, on the importance of nutrition for a proper child growth. What follows are the results of each specific action. Insufficient or imprecise birth data: using data retrieved from international surveys (DHS and MICS) we noticed a selection bias favouring children with a valid and complete date of birth that can lead to underestimate undernutrition prevalence up to 28%. Moreover, information bias and errors, that more likely affect unregistered children, contribute to expanding the underestimation of undernutrition even further, a variation that decreases with child age. In the schools investigated, the age data quality presented differences. Indeed, while in Tanzanian we found a good knowledge of age (95% of children have age data, with a mean age error of 0.4 month), information on age was available only for 79.8% of Ugandan children, with a mean age error of 7.5 months. Hence, also our samples have been affected by an unintentional selection bias since we have been forced to exclude a percentage of the children measured for the lack of their birth data. This situation has compelled us to consider the effect of age bias on malnutrition prevalences thus observing that stunting is overestimated, overweight is underestimated, wasting and underweight are not affected by age imprecision. Assessment: We have assessed the nutritional status of 1254 children, 423 in Tanzania and 831 in Uganda, in five schools with different social, cultural and environmental characteristics. Bumbire island (Tanzania) children show high levels of undernutrition (stunting = 31%; underweight = 13%), which are, however, lower than those reported in the national statistics (TDHS, 2011), while overnutrition is rare. In Ugandan schools, levels of undernutrition are high (stunting = 13%; underweight = 6%), but they are lower than the national data on under five children (UDHS, 2011). In both countries we have detected differences in malnutrition prevalence within age classes, with older children presenting more undernutrition (especially stunting) and less overnutrition. The 1-year longitudinal analysis showed a quite stable level of most of the nutritional indicators in Tanzania, a reduction of wasting and underweight prevalence in Uganda, and a worsening of stunting in both countries. Awareness actions: in Africa, we organized meetings with teachers, nurses and caregivers on the importance of nutrition for a proper growth of a child; we have trained teachers and nurses in monitoring children growth. The response has been enthusiastic, and all the people involved have shown interest and actively participated to the workshops and discussions. In Italy, we have organized meetings with students, a specific project with the inhabitants of a small town (Lunamatrona, CA), and also trained Bhalobasa volunteers so to make themselves able to train teachers and nurses, with whom they collaborate in different countries, on issues related to children malnutrition. We believe that these actions, which have all produced good results, should be continued in the future, until each school will be able to promote and carry out their own project.