Browsing by Author "Ngari, Moses"

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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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    Child stunting concurrent with wasting or being overweight:
    (Elsevier Inc., 2021-04) Iversen, O. Per; Ngari, Moses; Westerberg, C. Ane; Muhoozi, Grace; Atukunda, Prudence
    Objectives: There is paucity of longitudinal data on combined anthropometric deficiencies in children. Herein, we present data on child stunting concurrent with wasting or being overweight among children in a 6-y follow-up study of a maternal education trial in rural Uganda. Methods: We previously performed a randomized controlled trial where half of 511 mothers of 6- to 8-mo children were given a 6-mo education concerning nutrition, hygiene, and child stimulation. Anthropometry and prevalence of stunting with wasting or being overweight were determined. We applied multilevel mixed-effect logistic regression models and x2 statistic to assess the effects of the intervention and trend in prevalence over time, respectively. Results: Complete data sets were obtained from 307 of 511 children (60%). The prevalence of stunting and wasting or being overweight was <7% both, and did not change significantly over time. Notably, the prevalence of concurrent stunting and being overweight was significantly reduced in the intervention group compared with the controls among children age 36 mo and 60 to 72 mo, with corresponding odds ratios at 0.24 (95% confidence interval, 0.060.90) and 0.10 (95% confidence interval, 0.010.82), respectively. Conclusions: The prevalence of stunting concurrent with wasting or being overweight remained low during the observation period. The intervention may have reduced concurrent stunting and being overweight over time. Keywords: Anthropometry, Children, Maternal education, Overweight, Randomized trial, Stunting, Uganda, Wasting
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    Long-Term Effects of a Randomized Maternal Education Trial in Rural Uganda:
    (The American Journal of Tropical Medicine and Hygiene, 2022) Engh, S. Marit; Muhoozi, K. M. Grace; Ngari, Moses; Skaare, B. Anne; Westerberg, C. Ane; Iversen, O. Per; Brusevold, J. Ingvild; Atukunda, Prudence
    The aim was to examine oral health among 5–6-year-old children whose mothers participated in a 6 months’ cluster-randomized education trial in rural Uganda starting when their children were 6–8 months old. The education focused on nutrition, oral hygiene, and child stimulation. In the current follow-up study, 357/511 (70%) children from the original trial were available for data collection (200 in the intervention and 157 in the control group). Molar caries was assessed on intraoral photographs. Children and/or caregivers answered a WHO health questionnaire for collection of oral data. Dental practices were compared between the intervention and control group using multilevel mixed effect logistic regression accounting for clustering. The children in the intervention group had less caries compared with the control group: 41% versus 60% (odds ratio [OR] 0.46; 95% confidence intervals [CI] 0.24–0.86, P 5 0.02). The use of toothbrush to clean teeth was more frequent in the intervention than in the control group: 66% versus 38% (OR 3.39; 95% CI 1.54–7.45, P 5 0.003), as was high teeth-cleaning frequency: 74% versus 62% (OR 1.72; 95% CI 1.09–2.69, P 5 0.02). Self-reported problems such as toothache (10% versus 19%), difficulty biting (12% versus 24%) and chewing food (8.5% versus 18%) were significantly less frequent among children in the intervention compared with the control group. No significant differences were found in dietary habits. Our data shows that an educational intervention adjusted to a low-resource setting, provided in infancy, resulted in improved oral hygiene and reduced development of dental caries among children aged 5–6 years.
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    Longitudinal assessments of child growth:
    (Elsevier Inc., 2021-08) Atukunda, Prudence; Ngari, Moses; Chen, Xi; Westerberg, C. Ane; Iversen, O. Per; Muhoozi, K. M. Grace
    Background & aims: Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60e72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6e8 months old with data collection at 20e24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation. Methods: We measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care). Results: Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60e72 months, except that children in the intervention group had lower (P ¼ 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60e72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60 e72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings. Conclusion: In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition. Keywords: Body composition, Growth impairment, Growth velocity, Maternal education, Sub-Saharan Africa, Stunting
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    Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study
    (British Medical Journal Publishing Group, 2024-03) Shawon, Riffat Ara; Denno, Donna; Tickell, Kirkby D; Atuhairwe, Michael; Bandsma, Robert; Mupere, Ezekiel; Voskuijl, Wieger; Mbale, Emmie; Ahmed, Tahmeed; Chisti, Md Jobayer; Saleem, Ali Faisal; Ngari, Moses; Diallo, Abdoulaye Hama; Berkley, James; Walson, Judd; Means, Arianna Rubin
    Objectives This study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.Design and setting We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries.Participants A total of 2796 children aged 2–23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study.Primary outcome measures We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations.Results Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted. Conclusions Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.