The Child Nutrition and Development Study (CHNUDEV)
In this study we will examine the effect of employing lay-health workers to educate mothers of small children about adequate nutrition on child health. The setting is in rural areas of South-Western Uganda.
Photo: Per Ole Iversen
Improving growth of small children through diet diversification, better dietary intakes and improved hygiene
The main aim of the study is to investigate how a nutrition/stimulation education based on local needs and context can reduce stunting levels and improve development among children in the districts of Kabale and Kisoro, in South-Western Uganda.
We randomly allocated mothers of 6-8 months old children to intervention and control groups. In the intervention group, we provided nutrition education (delivered by nutritionists-Bachelor graduates). It includes the ten guiding principles of complementary feeding of a breastfed infants and cookery demonstrations as well as advice on oral hygiene. We encouraged every mother to establish a backyard garden and to keep small domestic animals which can provide the family with cheap animal sources of food. Hygiene in food preparation and service were an important part of the nutrition education.
We have taken outcome measures, at baseline when the children were aged 6 - 8 months, then when they were 20-24 and when they were 36 months. We could not detect any differences between the two study groups in any of the anthropometric measures of growth except that children in the intervention group had less growth faltering at 36 months.
In this study we also investigated the effects of the intervention on development outcomes (cognitive, language, motor). We assessed development using of Bayley Scales of Infant and toddler Development 3rd ed. and the Ages and Stages Questionnaire at baseline and when the children were aged 20-24 and 36 months. In addition we used the Mullen Scales of Early Learning scale at 36 months. A consistent finding was that all development outcomes were better among children belonging to the intervention group compared with the controls; at all time points and when assessed with the three research tools. The intervention also led to fewer mothers self-reporting depressive symptoms.
Publications from this and other studies in Africa can be found at the Centre for Global Health: Nutrition.
- Professor Per Ole Iversen, Department of Nutrition, University of Oslo, Norway, Principal Investigator
- Associate Professor Ane Westerberg, Norwegian School of Health Sciences, Kristiania University College, Oslo, Norway
- PhD and nutritionist Grace Muhoozi, Department of Human Nutrition & Home Economics, Kyambogo University, Kampala, Uganda
- PhD and psychologist Prudence Atukunda, University of Oslo, Norway
- Professor Archileo Kaaya, Department of Food Technology and Human Nutrition, Makerere University, Kampala, Uganda
Associate Professor Ingvild Johnsen Brusevold, Institute of Clinical Dentistry, University of Oslo, Norway
Professor Jens-Petter Berg, Department of Medical Biochemistry, Oslo University Hospital, Norway
- Professor Alexandre Vieira, University of Pittsburgh, Pennsylvania, USA
PhD Moses Ngari, The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
Muhoozi, G.K.M., Atukunda, P., Mwadime, R., Iversen, P.O. & Westerberg, A.C. Nutritional and developmental status among 6 to 8 months old children in South-Western Uganda – a cross sectional study. Food Nutr Res 60: 30270, 2016.
Muhoozi, G.K.M., Atukunda, P., Diep, L.M., Mwadime, R., Kaaya, A.N., Skaare, A.B., Willumsen, T., Westerberg, A.C. & Iversen, P.O. Nutrition, hygiene and stimulation education to improve growth, cognitive, language and motor development among infants in Uganda: a cluster-randomized trial. Matern Child Nutr 14:e12527, 2018.
Muhoozi, G.K.M., Atukunda, P., Skaare, A.B., Willumsen, T., Diep, L.M., Westerberg, A.C. & Iversen, P.O. Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow-up of a cluster-randomized controlled trial. Trop Med Int Health 23: 391-303, 2018.
Atukunda, P., Muhoozi, G.K.M, van den Broek, T.J., Kort, R., Diep, L.M., Kaaya, A.N., Iversen, P.O. & Westerberg, A.C. Child development, growth and microbiota: follow-up of a randomized education trial in Uganda. J Glob Health 9(1):010431, 2019.
Atukunda P, Muhoozi GKM, Westerberg AC, Iversen PO. Nutrition, hygiene and stimulation education for impoverished mothers in rural Uganda: Effect on maternal depression symptoms and their associations to child development outcomes. Nutrients. 11;11(7), 2019.
Wacoo, A.P., Atukunda, P., Muhoozi, G., Braster, M., Wagner, M., van den Broek, T., Sybesma, W., Westerberg, A., Iversen, P.O. & Kort, R. Aflatoxins: Occurrence, exposure, and binding to lactobacillus species from the gut microbiota of rural Ugandan children. Microorganisms 8: 347, 2020.
Iversen, P.O., Atukunda, P., Kort, R., Ueland, P.M., Westerberg, A.C. & Muhoozi, G.K.M. No associations between microbiota signalling substances and cognitive, language and motor development among three-year-old rural Ugandan children. Acta Paediatr. Apr 29. doi: 10.1111/apa.15330, 2020.
Atukunda, P., Muhoozi, G.K., Diep, L.M., Berg, J.P., Westerberg, A.C. & Iversen, P.O. The association of urine markers of iodine intake with development and growth among children in rural Uganda: a secondary analysis of a randomised education trial. Public Health Nutr Jul 13:1-10. doi: 10.1017/S1368980020001603, 2020.
Kakwangire, P., Moss, C., Matovu, N., Atukunda, P., Westerberg, A.C., Iversen, P.O. & Muhoozi, G. The association between dietary diversity and development among children under 24 months in rural Uganda: Analysis of a cluster-randomized maternal education trial. Publ Health Nutr (in press).
Iversen, P.O., Ngari, M., Westerberg, A.C., Muhoozi, G. & Atukunda, P. Child stunting concurrent with wasting or overweight: A 6-year follow-up of a randomized maternal education trial in Uganda. Nutrition (in press).
Kort, R., Schlösser, J., Vazquez, A.R., Atukunda, P., Muhoozi, G., Wacoo, A.P., Sybesma, W., Westerberg, A.C., Iversen, P.O. & Schoen, E. Model selection reveals the butyrate-producing gut bacterium Coprococcus eutactus as predictor for language development in three-year-old rural Ugandan children. Front Microbiol (in press).
- The association between dietary diversity and early childhood development among children under 24 months in South-Western Uganda: An exploratory secondary analysis of a cluster randomised maternal education trial; by Paul Kakwangire, London School of Hygiene and Tropical Medicine, 2018.
- Nutrition-related education intervention to improve cognitive development among impoverished small children in rural Uganda: A cost-effectiveness analysis; by Montasir Ahmed, University of Oslo, 2020.
- Cultivation of the anaerobic gut bacterium Coprococcus eutactus and its potential role in the gut-brain axis; by Job Schlösser, University of Amsterdam, 2020.
- Maternal education to improve growth, development and oral health among small children in rural Uganda; by Grace Muhoozi, University of Oslo, 2018.
- Improved child development outcomes in rural Uganda: long-term follow-up of a randomized maternal education trial; by Prudence Atukunda, University of Oslo, 2020.
- Detection and reduction of aflatoxin in the food chain; by Paul Alex Wacoo, University of Amsterdam, 2020.
Participation at conferences, meetings etc.:
- Global Health Conference, Norwegian Global Health Networks with Impact, Bergen, Norway, 2016
- Nordic Nutrition Conference, Gothenburg, Sweden, 2016
- 4th International Conference on Nutrition and Growth, Amsterdam, The Netherlands, 2017
- First East African Research in Progress Meeting, Moshi, Tanzania, 2017
- 7th MUHAS conference, Dar-es-Salaam, Tanzania, 2019
- Best annual poster-prize, Department of Nutrition, University of Oslo, 2019
The University of Oslo
The Throne Holst Foundation
RELIGHT (Center for Global Health, University of Oslo)