Browsing by Author "Kakwangire, Paul"

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    8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting
    (Pediatrics, 2024-04) Kakwangire, Paul; Muhoozi, K. M. Grace; Ngari, Moses; Matovu, Nicholas; Westerberg, Cecilie Ane; Iversen, Ole Per; Atukunda, Prudence
    OBJECTIVES: Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years. METHODS: The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n 5 263; control, n 5 248), whereas in the current study, 361 (71%; intervention, n 5 185; control, n 5 176) pairs were available for analyses. RESULTS: The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12–16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits. CONCLUSIONS: The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.
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    Associations between socio demographic exposures, growth and development during infancy with development at the age of eight years among children:
    (Journal of Global Health, 2024) Kakwangire, Paul; Ngari, Moses; Muhoozi, K. M. Grace; Westerberg, Cecilie Ane; Atukunda, Prudence; Iversen, O. Per
    Background: Links between early life exposures and child development later in life are not sufficiently explored in low- and middle-income countries. We studied associations between sociodemographic variables, growth and development at six to eight months with developmental outcomes at eight years. Methods: We used data from a maternal education trial which included 511 mother-infant pairs at children’s age of six to eight months (baseline). In this follow-up study, data from 361 mother-child pairs were available. Questionnaires were used to collect sociodemographic variables. Growth (anthropometry) was measured by study personnel and converted to z-scores according to the World Health Organization (WHO) growth reference. Child development (cognitive, motor and language) at baseline was assessed using Bayley Scales of Infant and Todler Development, third edition (BSID-III). Development at eight years was measured using two neuropsychological tools: Kaufman Assessment Battery for Children Second Edition (KABC-II) and Test of Variables of Attention (TOVA). Results Higher weight-for-age z-scores (adjusted odds ratio (aOR) =0.74; 95% confidence interval (CI) =0.53, 0.98; P=0.04), better maternal education (aOR=0.86; 95% CI=0.78, 0.96; P=0.03). and better household head education (aOR=0.86; 95% CI=0.78, 0.96; P=0.03) at six to eight months of age were associated with lower odds of scoring below average on KABC-II categorical scores at eight years of age. Motor composite scores and maternal parity at six to eight months of age were positively associated with auditory and visual TOVA scores (all P-values <0.05) at eight years. Cognitive composite scores at six to eight months of age were positively associated with visual TOVA scores (P<0.05). In contrast, weight-for-length z-scores and household head age were negatively associated with both auditory and visual TOVA scores (P<0.05). Being a female child was associated with lower auditory and visual TOVA scores (P<0.05). Conclusions: At six to eight months of age, growth and development, gender, maternal education and parity, and household head age and education were associated with child development at eight years. Interventions emphasising improved growth and development in infancy, as well as parental educational attainment, may improve long-term developmental outcomes.
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    The association between dietary diversity and development among children under 24 months in rural Uganda:
    (Public Health Nutrition, 2021-03) Kakwangire, Paul; Moss, Cami; Matovu, Nicholas; Atukunda, Prudence; Westerberg, C. Ane; Iversen, O Per; Muhoozi, K. M. Grace
    Objective: To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children. Design: A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6–8 months with child development domains (communication, fine motor, gross motor, personal–social and problem solving) at 20–24 months of age. Setting: Rural areas in Kabale and Kisoro districts of south-western Uganda. Participants: Children under 24 months. Results: After multivariable analysis, DDS at 6–8 months were positively associated with normal fine motor skills development at 20–24 months (AOR = 1•18; 95 % CI 1•01, 1•37; P = 0•02). No significant association was found between DDS and other development domains. Children who were not ill at 6–8 months had higher odds of developing normal communication (AOR = 1•73; 95 % CI 1•08, 2•77) and gross motor (AOR = 1•91; 95 % CI 1•09, 3•36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0•58; 95 % CI 0•33, 0•98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0•05). Conclusions: We found an association between child DDS at 6–8 months and improvement in fine motor skills development at 20–24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20–24 months. Keywords: Children, Cluster randomised, Development, Dietary diversity, Maternal education, Rural, Uganda