Browsing by Author "Schramm, Stine"

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    Gender and age disparities in adult undernutrition in northern Uganda: high-risk groups not targeted by food aid programmes
    (Tropical Medicine & International Health, 2016) Schramm, Stine; Ocaka Kaducu, Felix; Smedemark, Siri Aas; Ovuga, Emilio; Sodemann, Morten
    To determine the prevalence of adult malnutrition and associated risk factors in a postconflict area of northern Uganda. methods A cross-sectional community survey was performed from September 2011 to June 2013. All registered residents in Gulu Health and Demographic Surveillance System aged 15 years and older were considered eligible. Trained field assistants collected anthropometric measurements (weight and height) and administered questionnaires with information on sociodemographic characteristics, food security, smoking and alcohol. Nutritional status was classified by body mass index. results In total, 2062 men and 2924 women participated and were included in the analyses. The prevalence of underweight was 22.3% for men and 16.0% for women, whereas the prevalence of overweight was 1.5% for men and 7.6% for women. In men, underweight was associated with younger (15–19 years) and older age (>55 years) (P < 0.001), being divorced/separated [odds ratio (OR) = 1.91 (95% confidence interval (CI): 1.21–2.99] and smoking (OR = 2.13, 95% CI: 1.67– 2.73). For women, underweight was associated with older age (P < 0.001) and hungry-gap rainy season (May–July) (OR = 1.33, 95% CI: 1.04–1.69). Widowed or divorced/separated women were not more likely to be underweight. No association was found between education, alcohol consumption or food security score and underweight. conclusions Our findings are not in line with the conventional target groups in nutritional programmes and highlight the importance of continuous health and nutritional assessments of all population groups that reflect local social determinants and family structures.
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    Perceived barriers to utilization of antenatal care services in northern Uganda: A qualitative study
    (Sexual & Reproductive Healthcare, 2020) Uldbjerg, Cecilie Skaarup; Schramm, Stine; Kaducu, Felix; Ovuga, Emilio; Sodemann, Morten
    Antenatal care (ANC) utilization remains a challenge in efforts to reduce maternal mortality and improve maternal health in Uganda. This study aimed to identify perceived barriers to utilization of ANC services in a rural post-conflict area in northern Uganda. Methods: A qualitative study using in-depth interviews and focus group discussions of seventeen participants (pregnant women, health workers and a traditional birth attendant). The study was informed through a phenomenological approach to capture perceived barriers to utilization of ANC. The study was carried out in post-conflict Awach sub-county, Gulu District, northern Uganda. Data was analyzed using inductive conventional content analysis. Results: The main perceived barriers to ANC utilization were identified as: poor quality of care including poor attitude of health workers; socio-cultural practices not being successfully aligned to ANC; and lack of support from the husband including difficulties in encouraging him to attend ANC. Additionally, institutional structures and procedures at the health centers in terms of compulsory HIV testing and material requirements and transportation were perceived to prevent some pregnant women from attending ANC. Conclusions: Identifying local barriers to ANC utilization are important and should be considered when planning ANC programs. We propose that future efforts should focus on how to ensure a good patient-provider relationship and perceived quality of care, and further how to improve inter-spousal communication and sensitization of husbands for increased involvement in ANC. We recommend more research on how socio-cultural context can meaningfully be aligned to ANC to improve maternal health and reduce maternal mortality.
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    Post-conflict household structures and underweight: a multilevel analysis of a community-based study in northern Uganda
    (Public health nutrition, 2018) Schramm, Stine; Nielsen, Jannie; Kaducu, Felix O.; Okumu, Ceaser L.; Ovuga, Emilio; Sodemann, Morten
    To examine associations between household-level characteristics and underweight in a post-conflict population. Design: Nutritional status of residents in the Gulu Health and Demographic Surveillance Site was obtained during a community-based cross-sectional study, ~ 6 years after the civil war. Household-level factors included headship, polygamy, household size, child-to-adult ratio, child crowding, living with a stunted or overweight person, deprived area, distance to health centre and socio-economic status. Multilevel logistic regression models examined associations of household and community factors with underweight, calculating OR, corresponding 95% CI and intraclass correlation coefficients. Effect modification by gender and age was examined by interaction terms and stratified analyses. Setting: Rural post-conflict area in northern Uganda. Subjects: In total, 2799 households and 11 312 individuals were included, representing all age groups. Results: Living in a female-headed v. male-headed household was associated (OR; 95% CI) with higher odds for underweight among adult men (2·18; 1·11, 4·27) and girls <5 years (1·51; 0·97, 2·34), but lower odds among adolescent women aged 13–19 years (0·46; 0·22, 0·97). Higher odds was seen for residents living in deprived areas (1·37; 0·97, 1·94), with increasing distance to health services (P-trend <0·05) and among adult men living alone v. living in an average-sized household of seven members (3·23; 1·22, 8·59). Residents living in polygamous households had lower odds for underweight (0·79; 0·65, 0·97). Conclusions: The gender- and age-specific associations between household-level factors and underweight are likely to reflect local social capital structures. Adapting to these is crucial before implementing health and nutrition interventions.