Our Work in Africa: Uganda


Uganda
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The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins and nutrition outcomes, the role of livestock promotion in enhancing diet quality, and the links between sanitation (open defecation practices) and nutrition outcomes. Combining resources from Uganda, US institutions, and global partners the research and capacity building activities of the Nutrition Innovation Lab focus on operationally and policy-relevant work that supports both national government and USAID priorities.

Nutrition Innovation Lab – Africa’s vision of success is a set of robust empirical findings that can be quickly translated into policy and practice. We aim for our work to support enhanced outcomes globally not just locally, as new findings are adopted nationally and regionally. Furthermore, we hope our research platform can synergistically help other research entities with related goals.

Capacity Building

  • A total of 21 students will have received Masters or Doctorate degrees with partial or full funding from the Nutrition Innovation Lab-Africa.
  • 20 Ugandan students have attended the rigorous Boston to Bangalore Nutrition Collaborative (BBNC) training course in Bangalore India over the past four years with financial support from the lab.
  • Many government officials have attended workshops and District Dissemination Meetings gaining capacity for designing and implementing nutrition programming.  Our engagement with government officials have included both Local District Governments and Line Minisitries, ie. Ministry of Agriculture, Ministry of Health.
  • Forty professionals attended training on issues in public health nutrition, grant writing and research proposal development.  This is emblematic of our support for career enhancing activites for Ugandan professionals, policy makers, and academics.
  • The Nutrition Innovation Lab is working in collaboration with Makerere University to design and implement a modulated short course in Public Health Nutrition Practices and Programming aimed at filling in curricular gaps in the current set of educational offerings across Uganda. Through short courses students will be equipped to tackle nutritional issues in a multi-faceted and systematic way. These courses are being offered online with a customized version of Tufts University’s online learning system (TUSK), which is an open source platform for learning an content management.

The Nutrition Innovation Lab has undertaken the following research activities in Uganda

Relationships have been forged with partners such as Makerere University, Gulu University, SPRING (Strengthening Partners, results, and Innovations in Nutrition Globally), NASA, Heifer International (HI), UIC, IITA, UGA, International Food Policy Research Institute (IFPRI), and FHI360.  One set of Nutrition Innovation Lab’s core research revolves around the USAID Uganda Community Connector Project (UCCP), an integrated agriculture and nutrition intervention package implemented by FHI360. This includes the following activities:

  • A comprehensive, repeated panel survey assessing agriculture, nutrition, and health pathways and providing evaluation data to UCCP.  The survey was conducted at the end of 2012, and repeated at the end of 2014.
  • A prospective birth cohort study to dis-entangle the nutrition or health gains of key target groups (e.g. pregnant women and infants). The birth cohort study is a ‘platform’ which can be used to assess top-rank hypotheses, like linking Water, Sanitation, and Hygiene (WASH) and mycotoxins (aflatoxin/ mold) to nutrition, while answering key questions on how and why integrated interventions may succeed. The cohort study began enrolling women in 2014.
  • Process research to examine the implementation of multisectoral actions for good nutrition.  This has included key informant interviews with central policy makers, and district administrations.

Additional activities in Uganda include

  • The Nutrition Innovation Lab has supported a birth cohort study in Gulu which has examined food insecurity, depression, and other psycho-social factors which affect maternal and infant nutrition.  This project has been run by Barnabus Natamba of Gulu University.  Exposure to aflatoxin molds during pregnancy and early infancy is being assessed with the support of USAID/ East Africa.
  • An analysis conducted by Kabunga Nassul, Ph.D., examined the relationship of household food insecurity, and anemia in women with fruit and vegetable production.  This analysis found that fruit and vegetable production was linked to consumption and significantly less anemia in women of childbearing age.  This is an example of concrete biologically plausible agriculture to nutrition pathway.
  • The Nutrition Innovation Lab with UIC pilot validated an innovative water quality assessment test, the Aquagenx compartment bag test (ACBT).  Use of the ACBT in the prospective birth cohort study will allow the Lab and UCCP to assess WASH (Water, Sanitation, & Hygiene) relating to under-nutrition and health.
  •   A secondary analysis utilizing a NASA dataset examined agricultural land use, biomass fuel and health. It examined the role of cooking fuels from agricultural land and forests in causing respiratory illness, which are linked to poor nutrition.
  • Modeling the links of agriculture productivity to nutrition through the interaction of seasonality and climate variability with agricultural output and nutrition and how geography (agro-ecology, altitude, remoteness from markets) affects household outcomes is underway.
  • The Nutrition Innovation Lab advocates for the need to examine the role of aflatoxin exposure in maternal and infant nutrition, has lead to an Associate Award to fund further analyses in the Ugandan studies.
  • The Nutrition Innovation Lab Africa in collaboration with the Nutrition Innovation Lab Asia facilitated a study of aflatoxin exposure and nutrition in Timor Leste partnering with the University of Jakarta (Indonesia), UNICEF in Timor Leste and the University of Georgia aflatoxin research laboratories (linked to the Peanut and Mycotoxin Innovation Lab).
  • A series of dissemination seminars have been held at the national and district level over several years.

Microbial Decontamination of Fresh Produce (Strawberry) Using Washing Solutions

Authors: Naresh Shahi; Byungjin Min; Eunice A. Bonsi
This Tuskegee University study was carried out to determine the effect of natural antimicrobial washing solutions against microbial growths on fresh produce specifically strawberries. Selected washing solutions used for strawberry washing, and treatments were sterile water (control), white vinegar (VI), crude lemon juice extract (LE), VI+Origanum oil (VIO), LE+Origanum oil (LEO), and VI+LE+Origanum oil (VILEO).
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Nutrition Collaborative Research Support Program – Africa Annual Report for Year 2

Authors: Nutrition Innovation Lab
The mission of the Nutrition Collaborative Research Support Program-Africa (N/CRSP-Africa) is to discover how policy and program interventions can most effectively achieve large-scale improvements in maternal and child nutrition, particularly when leveraging food-based activities. N/CRSP-Africa emphasizes operationally relevant research that can support national governments across Africa in their attempts to improve nutrition, health, and agricultural productivity. The Management Entity (Tufts University) collaborates with a network of US University partners, including the Schools of Public Health at Harvard University and Johns Hopkins University, the College of...
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Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Chapter 7: Childhood Threats to Adult Cognition in Sub- Saharan Africa: Malaria, Anemia, Stunting, Enteric Enteropathy, and the Microbiome of Malnutrition

Authors: Jeffrey Griffiths; Joyce Kikafunda
Many common childhood conditions are associated with cognitive deficits. While some causes of impaired cognition, such as lead exposure, are well understood, other common conditions in countries such as Uganda – malnutrition, anemia and malaria – are not sufficiently recognized. In this chapter we discuss stunting and its root causes of undernutrition, a lack of sanitation and its relationship to environmental enteropathy and the intestinal microbiome. We also review information about iron-deficiency anemia and malaria, and their neurological and cognitive consequences. We believe that cognitive declines later in life,...
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Factors Associated with Dietary Diversity Among Women of Reproductive Age (15-49 yrs) in Agago District

Authors: Ray Oroma
Despite the internationally accepted recommendation that eating a diversity of foods leads to a healthy diet, and is associated with positive health outcomes such as reduced mortality, little information exists on what factors influence dietary diversity among women of reproductive age in Agago district.  The objective of this study is to determine dietary diversity among women of reproductive age (15-49 years) in Agago district.
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Factors Associated with Complementary Feeding Practices Among Children age 6-23 months in Pader District

Authors: Caroline Nambafu
Infant and young child feeding has been known to compromise the health of children among which complementary  feeding plays a major part. Even communities that have performed adequately in breast feeding have had  their  efforts undermined by complementary feeding hence causing malnutrition among their children.  This study was conducted with the aim of finding out factors that are associated with complementary feeding among the children in Pader district.
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Determinants of Nutritional Outcomes Among Children below Five Years of Age in Uganda

Authors: Happy Providence
 This thesis presents findings of a study that sought to understand determinants of nutritional outcomes of children below five years of age in Uganda. Understanding these determinants was vital because in the Ugandan situation, most of the determinants are not ade8uately understood.  Even for those that are known, the magnitude of their impact and or the relative strengths of their impact on nutritional outcomes across regions is not well known.
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Can Smallholder Fruit and Vegetable Production Systems Improve Household Food Security and Nutritional Status of Women?

Authors: Nassul Kabunga; Shibani Ghosh; Jeffrey Griffiths
This paper aims to empirically infer potential causal linkages between fruit and vegetable (F&V) production, individual F&V intake, household food security, and anemia levels for individual women caregivers of childbearing age. Using a unique and rich dataset recently collected from rural smallholder Ugandan households, we show that the use of a qualitative tool to measure household food insecurity is robust and applicable in other contexts. We also show, using robust econometric methods, that women living in F&V-producer households have a significantly higher intake of F&Vs...
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Assessing the Linkage between Agriculture, Food Security, Nutrition and Health among Women and Children in Rural Ugandan Households

Authors: Nutrition Innovation Lab
Uganda Baseline Report, Oct 2013 There is significant movement globally and in Uganda on addressing issues of nutrition and health in vulnerable populations including women and children. This is especially important since approximately 0.5 million women die each year of pregnancy related complications linked undernutrition, while more than 5 million pre-­‐school children die of preventable causes due to the combined effects of disease and under nutrition.  There is some progress being made globally, with 63 countries as of 2010 on track to achieve the First...
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Improved Dairy Cows in Uganda: Pathways to Poverty Alleviation and Improved Child Nutrition

Authors: Nassul Kabunga
There is limited empirical evidence on the linkages between agrotechnologies, poverty reduction and the pathways to better nutrition outcomes. The introduction and dissemination of improved dairy cow breeds in Uganda is arguably the most significant step taken to develop a modern and commercial dairy industry in the country over the last two decades. This study uses a nationally representative sample of Ugandan households to rigorously examine the impact of adoption of improved dairy cow breeds on enterprise-, household-, and individual child-level nutrition outcomes. We find...
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Cover Image:Biomass Fuels, Forest Loss and Upper-Respiratory Health in Uganda

Biomass Fuels, Forest Loss and Upper-Respiratory Health in Uganda

Authors: Pamela Jagger; Gerald Shively; Selena Elmer
Rural households in developing countries rely heavily on biomass fuels to provide energy for cooking. Biomass supplies have traditionally been sourced from proximate forests and woodlands, but rapid population growth and high rates of deforestation and forest degradation are changing the quantity, type and source of fuels available to rural households. We use panel data from Uganda to measure the influence of forest loss on household fuel portfolios. We also assess how patterns of biomass fuel consumption are related to the incidence of acute respiratory...
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Cover Image:Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Authors: Barnabas K. Natamba; Angela Arbach; Hillary Kilama; Jane Achah; Jeffrey Griffiths; Sera Young
Food security occurs “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework. FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infected with HIV, women and children. Women’s responsibilities in managing family...
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Cover Image-Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Cover-Brown et al 2014

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change

Authors: Molly E. Brown; Kathryn Grace; Gerald Shively; Kiersten B. Johnson; Mark Carroll
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices....
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Cover Image Baseling Report Uganda 2013

Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households

Authors: Joyce Kikafunda Et Al.
There is significant movement globally and in Uganda on addressing issues of nutrition and health in vulnerable populations including women and children. This is especially important since approximately 0.5 million women die each year of pregnancy related complications linked under nutrition, while more than 5 million pre-school children die of preventable causes due to the combined effects of disease and under nutrition. There is some progress being made globally, with 63 countries as of 2010 on track to achieve the First Millennium Development Goal (MDG)...
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Cover Image: Land use change, fuel use and respiratory health in Uganda

Land use change, fuel use and respiratory health in Uganda

Authors: Pamela Jagger; Gerald Shively
This paper examines how biomass supply and consumption are affected by land use change in Uganda. We find that between 2007 and 2012 there was a 22% reduction in fuelwood sourced from proximate forests, and an 18% increase in fuelwood sourced from fallows and other areas with lower biomass availability and quality. We estimate a series of panel regression models and find that deforestation has a negative effect on total fuel consumed. We also find that access to forests, whether through ownership or proximity, plays...
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Cover Image: Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young
In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th....
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Florence M. Turyashemererwa, PhD

In-Country Representative
Mobile: +256774516122 Email: Florence.Kinyata@tufts.edu

Bernard Bashaasha, PhD

Role: Principal Investigator, 
School of Agricultural Sciences, Makerere University
College of Agricultural and Environmental Sciences
Phone: +256414-542277 Mobile: +256772627249 Email: bashaasha@agric.mak.ac.ug

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