Dietary Patterns, Nutritional Status, Prevalence and Risk Factors for Anemia among School Children in Naama Community, Uganda

Background: The disease burden of malnutrition, anemia, malaria and helminth infections among school-aged children is rarely studied in low- and middle-income countries (LMICs) although these children are still at a high risk for these diseases compared with other more studied populations, such as pregnant women and children under 5 years old. Even in countries where the prevalence and trend of anemia and malnutrition are relatively well documented, few studies relate this to dietary factors, which are considered major contributors to anemia and malnutrition in most age groups. Aims: The aims of the study are (1) To determine the prevalence of anemia, malaria, helminth infections and malnutrition in a sample of 95 children, ages 6 to 14, attending primary schools in Naama Community, Uganda, and to observe and quantify school children's dietary patterns and daily nutrient intakes. (2) To find out the association between dietary factors and the risk of anemia and malnutrition. Methods: Measures included school-based, cross-sectional surveys, dietary assessments, anthropometric measurements and biological tests among school children. Photo-assisted 24-hour recall was used to collect daily nutrient intakes, combined with a Food Frequency Questionnaire (FFQ) to capture the dietary patterns. Anthropometrical and biochemical data was collected using standardized protocols. Socioeconomic data was obtained from parent surveys. Results: Ninety-five children in total were enrolled in all or some components of the study. The prevalence of anemia was low (3.2%), and all were mildly anemic. However, the prevalence of malaria and hookworm infections was relatively high, representing 12.9% and 24.4% of the studied population, respectively. In the studied children, 2.8% were underweight, 15.6% stunted and 1.3% thin, using criteria based on the WHO Growth reference. According to the WHO recommendations for nutrient intake, 80% of participants consumed inadequate energy from their daily diet, especially boys. Dietary fat intake was insufficient in 78% of the children. About 25% of the children had a low protein intake and 93% had low intakes of vitamin A. Calcium intake was low in school children's diet- 97.6% of children lacked of calcium. Inadequate vitamin C intake was less common, appearing in one out of three participants (29.1%). Matooke and posho, the most common local staple food, were the major sources for children's energy. Avocado, beans and matooke contributed to the highest fat, protein and vitamin A intake, respectively. Every participant reported consuming cereal/cereal products, roots/tubers/plantain, pulses/nuts, oil/oil-rich foods and fruits during the previous month, while almost one-fifth never consumed milk/dairy products. Vegetables were consumed by most of the respondents. Few (1.6%) of the respondents reported no animal source food in their diet. In general, children ate 3.81(SD: 0.99) out of all five meals in the area. Dinner was consumed by most of the participants (93.7%) while afternoon tea was the least consumed meal and was skipped by half of the childrenNo significant association between dietary factors and anemia were found, mainly due to the small sample size and low prevalence of disease. None of the dietary factors of primary interest were found to be associated with children's Hb concentration, but secondary analysis found the frequency of eating oranges was a protective factor for higher Hb concentration (P=0.015). The association between diet and stunting was not significant, except children who had low dietary fat intakes had a lower risk of being stunted compared with those had adequate fat consumption (OR=0.27, P=0.046). Conclusions: Malaria and helminth infections, but not anemia, in this cohort of school children is relatively high. Stunting was the most prevalent type of malnutrition. Most of the nutrients studied were not adequate in children's diets. The dietary pattern in this sample of children was primarily high in carbohydrates from staple foods and a minimal intake of fat and protein from animal sources. Children generally ate four meals per day. Dietary factors do not explain anemia and stunting in this population.