Received: 20 November 2023 | Revised: 25 July 2024 | Accepted: 21 August 2024 DOI: 10.1111/mcn.13724 OR I G I NA L A R T I C L E Consumption frequency of ultra‐processed foods and beverages among 6‐ to 36‐month‐olds in Kampala, Uganda Catherine L. Mwesigwa1,2 | Sudeshni Naidoo2 1School of Dentistry, College of Health Sciences, Makerere University, Kampala, Uganda 2Department of Community Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa Correspondence Catherine L. Mwesigwa, School of Dentistry, College of Health Sciences, Makerere University, Kampala, Uganda. Email: mcathy5k@gmail.com Funding information Fogarty International Center of the National Institutes of Health, U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), and President's Emergency Plan for AIDS Relief (PEPFAR), Grant/Award Number: 1R25TW011213 Abstract The nutrition transition in sub‐Saharan Africa has led to increased consumption of ultra‐processed foods in infancy, especially sweet foods. This has heightened the risk for nutrition‐related non‐communicable diseases, including dental caries and over- weight/obesity, and promotes poor food choices later in life. The present study used a cross‐sectional design to investigate the consumption frequency of ultra‐ processed foods and beverages among urban 6‐ to 36‐month‐olds attending four selected health facilities in Kampala using a standardised questionnaire and 24‐h diet recall record. The primary outcome was the consumption of at least one ultra‐ processed food or beverage (UPFB) the previous day, and frequency of UPFB consumption of the week before was the secondary outcome. Four hundred and ten caregiver–child pairs were randomly recruited, 94% of caregivers being mothers with a mean age of 30.7 (±5.3) years. Fifty‐nine per cent of mothers and 73% of fathers had attained a college education. The median age of children was 18 months and 51% were female. Most children (57%) consumed at least one UPFB the pre- vious day. In the week before, 69% had consumed UPFB frequently (4–7 days) which was significantly positively associated with maternal education (odds ratio [OR] = 2.85, 95% confidence interval [CI]: 1.02–7.96, p = 0.045) and child's age ([OR = 2.87, 95% CI: 1.62–5.08, p < 0.001], [OR = 3.68, 95% CI: 1.88–7.20, p < 0.001]). In conclusion, the dietary habits of the surveyed Ugandan population were unhealthy, characterised by the frequent consumption of UPFB with added sugar. There is an urgent need to re‐enforce existing Ugandan food regulation guidelines and policies and to build strong nutritional education programmes to enhance health‐promoting environments in early childhood. K E YWORD S added sugar, commercial complementary foods, complementary feeding, nutrition transition, snacks, sugar‐sweetened beverages, Uganda, ultra‐processed foods, unhealthy diet Matern Child Nutr. 2025;21:e13724. wileyonlinelibrary.com/journal/mcn | 1 of 16 https://doi.org/10.1111/mcn.13724 This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd. http://orcid.org/0000-0002-3493-7008 mailto:mcathy5k@gmail.com https://wileyonlinelibrary.com/journal/mcn http://creativecommons.org/licenses/by-nc/4.0/ http://crossmark.crossref.org/dialog/?doi=10.1111%2Fmcn.13724&domain=pdf&date_stamp=2024-09-06 1 | INTRODUCTION There is a worldwide increase in the use of highly processed foods (ultra‐processed), especially in low‐ and middle‐income countries (LMIC) (Fanzo et al., 2019). Commercial food products are a signifi- cant contributor to the total dietary energy among infants and young children (IYC) in high‐income countries and are often sweetened (Theurich et al., 2020). In sub‐Saharan Africa (SSA), consumption is primarily driven by a general nutritional transition in the region where people of all age groups are gradually changing from consuming traditional diets rich in fibre and micronutrients as they switch to the ultra‐processed ‘westernised diets’, high in sugar, fat and salt and low in fibre and nutrients (Tschirley et al., 2015). The transition is also currently taking place in Uganda especially in urban dwellings (Auma et al., 2019). In early childhood, this includes processed foods during early childhood is characterised by commercially available comple- mentary foods (CACFs), formula (Baker et al., 2016), commercially produced snacks, beverages and a concomitant reduced consumption of home‐prepared complementary foods (Pries et al., 2017). Inad- vertently, this transition is influenced by commercial determinants of health—actions of the private sector intended for their profiteering that are affecting public health negatively (de Lacy‐Vawdon & Livingstone, 2020; Kearns & Watt, 2019). A high consumption of sugar‐containing ultra‐processed foods during early childhood is associated with an increase in the likelihood of nutrition‐related non‐communicable diseases (NR‐NCDs), for ex- ample, dental caries, as well as early childhood caries (ECC) among children (American Academy of Pediatrics, 2020; Gupta et al., 2013) and overweight or obesity (OWO) (Danquah et al., 2020; Popkin, 2002). OWO in early childhood is a strong predictor of adult obesity, morbidity (other NCDs) and mortality (Zhang et al., 2013). Additionally, early childhood is an important period for getting accustomed to various tastes and textures that determine food choices later in life. The intake of sugar or sweeteners in infancy and early childhood influences the acquisition of taste patterns which establish sweet preferences in later life (Mennella, 2014). However, studies have also shown that there is no nutritional requirement for free sugars (Sheiham & James, 2014); instead, free sugars provide significant energy without specific nutrients (WHO and FAO, 2003). Due to such concerns, theWHO provided evidence‐based guidelines for free sugar consumption to be limited to 10% of the total energy intake and preferably a further reduction to less than 5% for dental health (WHO, 2015). In most SSA, there is a double burden of malnutrition, namely the highly prevalent undernutrition and micronutrient deficiencies among IYC and a gradual increase in over‐nutrition as evidenced by an increase in OWO among children in SSA (Steyn & McHiza, 2014). This increase in obesity has been reported over the last decades in richer African countries like South Africa (Popkin & Ng, 2022) but with fewer national figures from Uganda. About 5% of children under 5 years were OWO compared to 28% who were undernourished (Sserwanja et al., 2021). Nevertheless, going by the adult reports of greater proportions of over‐nutrition among urban than rural females (Yaya & Ghose, 2019), this can be used to infer that, similarly, this could be happening among younger children. Therefore, it is possible for urban, affluent populations to have a bigger burden of this con- dition (Ngaruiya et al., 2017). Given these changing trends in diet, especially among urban populations, if no public health interventions are taken, Uganda might soon be faced with similar challenges of increasing over‐nutrition among children and an established double burden of malnutrition. Primarily, most of the efforts in Uganda, including research, nutritional interventions and policies, have focussed on under‐ nutrition. This has consequently left a gap in addressing a public health challenge of other nutrition‐related NCDs like dental decay and over‐nutrition that is steadily increasing and insidiously affecting the population in early childhood. The present study, therefore, investigated consumption frequency of ultra‐processed foods and beverages (UPFBs) among urban/peri‐urban aged 6–36 months. 2 | METHODS A cross‐sectional descriptive survey was carried out from October to December 2021 in Kampala, the capital city of Uganda. Kampala district is fully urbanised. The neighbouring district urbanisation rates are 40%–50% (Uganda Bureau of Statistics [UBOS], 2016). Most of the working population travels from neighbouring peri‐urban areas to the capital city for work and to access services, including seeking health care. Kampala metropolitan has a heterogeneous population comprising several ethnic groups, but English is the official language of communication, while the majority of the indigenous population speaks Luganda. Kampala city population is about 1.7 million and 6.7 million when the neighbouring population is included (Kampala City Council Authority (KCCA) and UBOS, 2019). There are approximately 906 facilities that provide maternal and child services, 6 of which are paediatric specialist centres. The study target population was the caregivers and children aged 6–36 months, attending selected health facilities. The target age group was 6–36 months, aligning with WHO recommendations to start complementary feeding at 6 months Key messages • The frequent consumption of ultra‐processed food or beverage (UPFB) in a Ugandan urban population during the complementary feeding period is an indication of an established nutrition transition. • The frequent consumption of UPFB is characterised by a high sugar content and sweetened diet and therefore the potentially has health detriments in young children. • There is an urgent need to promote traditional diets and minimally processed foods for complementary feeding and introduce policies that discourage consumption of UPFB in early childhood. 2 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense (WHO, 2005). This range also follows the ‘Codex Guidelines on for- mulated complementary foods for older infants and young children’, which considers young children as up to 3 years old (FAO and WHO, 1981). 2.1 | Definition of ultra‐processed food and beverages UPFBs were defined as industrial formulations and prepackaged typically with several ingredients such as sugar, oils, fats, salt, anti‐ oxidants, flavourings and colourants. They are usually ready to eat or drink or require brief heating before consumption (Monteiro et al., 2017). This definition excluded the locally minimally processed cereals (without additives and require boiling during preparation), commonly used for porridge. Since the study was targeting the complementary period, the UPFB definition excluded formula because it is a breast milk substitute intended to supplement breastfeeding rather than complement it. UPFBs were further cate- gorised as CACFs defined as processed packaged products with a label or image indicating that the product is intended for young children less than 3 years old (Sweet et al., 2016). The other category was industrially manufactured foods intended for the general popu- lation which included snacks, sugar‐sweetened beverages (SSB) and any other ultra‐processed foods commonly fed to IYC in Uganda. Snacks included sweets, ice cream, biscuits, breakfast cereals, grain snacks and sweetened baked products or confectionary like bread, cakes, cookies, doughnuts and buns. The SSB included prepackaged fruit drinks, soft drinks, sweetened/flavoured yoghurt or milk, artifi- cially sweetened beverages and sweetened purees. 2.2 | Sample size and sampling Using the formula for calculating survey proportions, the following were used Z = 1.96 (95% confidence), expected proportion, p = 0.23 (from prevalence of snack consumption of 23.1% reported in Dar‐es‐ Salaam (Vitta et al., 2016), precision, d = 0.06. A factor of 2 was used as a multiplier to adjust for the design effect due to multi‐stage cluster sampling. Additionally, 10% was added to cater for non- response, giving a final sample size of 416. A multi‐stage cluster sampling technique was used to select the primary sampling unit. Random sampling of 3/5 divisions in Kampala and thereafter pur- posive selection of one health facility based on the type, size and utilisation rates of child health services. The different types (private, public or private‐not‐for‐profit) serve different categories of popu- lations based on socioeconomic class. The bigger private facilities serve higher income groups (Uganda Bureau of Statistics [UBOS] ICF, TDP, 2018; UBOS, The DHS Program (ICF), 2018). Additionally, a private paediatric clinic from a neighbouring district was selected to represent the more urbanised Kampala metropolitan population. The average monthly utilisation rates were used to allocate clusters using probability proportional to size for each child age category (6–11.9, 12–17.9, 18–23.9) from each of the selected four facilities. The 24–36 months’ age group had an additional 20% to cater for its broader age range. The number (n) of caregiver–child pairs was selected using systematic random sampling which was the primary sampling unit. The sampling interval at this stage was determined by dividing the monthly average utilisation rate by the required number of caregiver–child pairs. Caregivers younger than 18 years, those with limited communication in English or Luganda and very ill children were excluded. 2.2.1 | Data collection The recruitment procedures and the research tools were translated into Luganda, piloted and tested at a nearby government health facility not selected for the main study. A researcher‐administered standardised structured questionnaire was used in an electronic data collection form (Open Data Kit Collect). Additionally, a paper‐ based data collection form for the qualitative 24‐h diet recall without portion sizes was used. A pictorial food chart determined through piloting of common foods was used to aid recall. The questionnaire was adopted from previous studies (Olatona et al., 2017; Pries et al., 2019) with additional questions on the source of nutritional information and contextual socioeconomic measures (UBOS, ICF, TDP, 2018; UBOS, The DHS Program (ICF), 2018). All quantitative variables child age, maternal age and sibling number were collected in a raw, unaltered format. The marital status, parental education and occupation and regularity of income variables were listed and the respondent selected one. The respondents were interviewed on all days of the week to avoid bias with the 24‐h recall due to the day‐of‐the‐week effect at the group level (Tarasuk & Beaton, 1992). The 24‐h recall data were a list of itemised foods, snacks and drinks, including breastfeeding throughout the morning of the previous day and the night till the morning of the interview. For nontraditional meals, research assis- tants obtained further descriptions including asking about the details of brands and flavourings of specific items, preparation, for example, instant cereal, packaged juice, flavoured packaged milk or yoghurt. UPFBs were later established using the study definition after the principal researcher reviewed the product packaging images for label information to confirm the content and level of processing based on the study definition. Data on food frequency the previous week were through a list of items and the frequency with five choices: everyday, at least 4 days, 1–3 days, less than once a week and never. This list included processed food items. 2.2.2 | Data management and analysis Study data were checked daily for accuracy and completeness. All data were merged in Stata. Continuous variables were summarised at univariate analysis using means and standard deviations or medians and interquartile ranges. Categorical variables were described using MWESIGWA and NAIDOO | 3 of 16 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense frequencies and proportions. One of the variables, socioeconomic status, was derived with tertiles (three equal groups: first/lowest, middle and the highest) using principal component analysis of six household characteristics (UBOS, ICF, TDP, 2018; UBOS, The DHS Program (ICF), 2018). Maternal age was categorised into young mothers (≤25 years), adult mothers (26–30 and 31–35) and advanced mothers (≥36 years) based on expert knowledge. The primary out- come variable—consumption of at least one commercial baby food item on the preceding day—was measured as a binary outcome (Yes or No). Children who were sick on the day in question were elimi- nated to from this analysis. The secondary outcome was the con- sumption frequency of ultra‐processed baby foods the week before the interview, an ordinal outcome categorised as frequently (4–7 days a week), moderately (1–3 days a week) or never, and ordinal logistic regression was used for both bivariate and multi- variate analyses to assess the associated factors. The analysis included checking for collinearity and outliers, and the chunk test was used to check for interaction. Stratified analysis was used to control for confounding; if a variable had a percentage difference of 10 or more between the crude and adjusted odds ratios, it was considered to confound the relationship. Overall, 95% confidence intervals were used to determine their statistical significance. 3 | RESULTS A total of 410 children aged 6–36 months were randomly re- cruited for the study. Just over half (51.2%) were female and 42.7% were aged between 13 and 23 months with a median age of 18 months. Table 1 summarises their socio‐demographic characteristics. 3.1 | The proportion of children aged 6–36 months that consumed ultra‐processed foods the previous day (UPFB) in Kampala Only 403 children's results were included in the analysis of UPFB consumption as seven were very sick the day after recruitment. Overall, 56.6% (n = 228/403) of caregivers reported using at least one UPFB and 54.1% (n = 153/286) among 6‐ to 23‐month‐olds. Almost a quarter (24.8%) of children fed on two or more items. Table 2 sum- marises the use of UPFB by parental and child characteristics. Among these were commercially available complementary food (CACF) like infant/baby cereals consumed by 26.1% and 26.6% overall and by 6‐ to 23‐month‐olds, respectively, with ease of preparation being the commonest reason (77.9%) for their use. Over a third (35.2%) of children and 35.7% of 6‐ to 23‐month‐ olds had consumed at least one SSB like soda, juice drinks and sweetened dairy products. The most commonly consumed SSB was sweetened yoghurt (29%, n = 118). Reasons given by caregivers for TABLE 1 Socio‐demographic characteristics of parents and their children aged 6–36 months and other maternal characteristics (n = 410). Variable n % Child characteristics Child's sex Female 210 51.2 Male 200 48.8 Child's age (n = 410) (months) 6–12 (infants) 116 28.3 13–23 175 42.7 24–36 119 29.0 Sibling number (n = 410) No sibling 135 32.9 1 sibling 144 35.2 2 or more siblings 131 31.9 Parental characteristics Maternal education level (n = 394) None/primary level 45 11.4 O levels completed 54 13.7 A levels/Technical/Vocational 62 15.7 College/University 233 59.1 Paternal occupation (n = 361) Unemployed 20 5.5 Business 97 26.9 Skilled, sales, services 38 10.5 Professional 206 57.1 Paternal education level (n = 358) O levels or less completed 61 17.0 A levels/Technical/Vocational 35 9.8 College/University 262 73.2 Parental income (n = 285) Irregular 37 13.0 Regular 248 87.0 Socioeconomic status (n = 395) 1st (lowest) 133 33.7 2nd (middle) 147 37.2 3rd (highest) 115 29.1 Maternal health care and nutritional education‐related characteristics Mother ever attended antenatal care (ANC) (n = 385) No 49 12.7 Yes 336 87.3 4 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense using yoghurt included the child's preference (72.9%), perceived healthiness (58.9%) and suitability for children with poor appe- tite (28%). Thirty‐two per cent and 24.8% of all children and 6‐ to 23‐month‐olds consumed snacks, respectively. Confectionery like bread, buns and doughnuts was consumed by 23.3% of all children. Other snacks included biscuits, breakfast cereals, chocolate, sweets and potato crisps. More than half of the children (53%) had been fed formula food since birth; however, notably, the current consumption of formula was by only 4.9% (n = 20). 3.2 | Consumption frequency of UPFBs among 6‐ to 36‐month‐old children in Kampala Among the 410 children, 83.9% consumed at least one ultra‐ processed food and beverage (UPFB) at least once a week. Further breakdown showed that 79.3%, 63.9% and 71.2% consumed CACF, snacks and SSB at least once, respectively. Among the 291 children aged 6–23 months, the corresponding percentages were 82.8%, 36.8% and 49.8%, respectively. Table 3 summarises the weekly consumption frequency of UPFBs with respect to sociodemographic and health‐related characteristics. When considering consumption frequency, 69.0% of care- givers reported that children consumed at least one UPFB fre- quently (4–7 days a week). Confectionery was the most fre- quently consumed snack, followed by breakfast cereal (Figure 1a). SSB consumption was also notable, with nearly two‐thirds of children consuming at least one SSB once or more within the week (Figure 1b). On the other hand, nearly two‐thirds (65.2%, n = 260/399) consumed at least one SSB once or more within the week, and almost half of these (45%, n = 117/260) consumed them daily. Although the least consumed SSB was soft drinks (13.3%, n = 53/398), a more significant proportion (64.2%, n = 34/53) consumed it daily (Figure 1b). The frequent consumption of UPFB was highest among children whose fathers had higher education or were professionals, as well as those who had ever been formula‐fed. 3.3 | Association between family/child characteristics and weekly frequency of consumption of UPFBs among 6‐ to 36‐month‐old children in Kampala Bivariate analysis was conducted to identify variables with a p ≤ 0.2, which were then included in the multivariable model. Variables such as mothers' age, mothers' and fathers' education levels, socio- economic status, child's age and sibling number were considered. Table 4 summarises the independent associations of these factors. Using multivariate analysis, it was found that 13‐ to 23‐month‐ olds and 24‐ to 36‐month‐olds had significantly higher odds of more frequent UPFB consumption (2.87 and 3.68 times, respectively) compared to 6‐ to 12‐month‐olds ([OR = 2.87, 95% CI: 1.62–5.08, p < 0.001] and [OR = 3.68, 95% CI: 1.88–7.20, p < 0.001]). Children whose mothers had a college education also had higher odds of more frequent UPFB consumption. The relationship between maternal education level, sibling number and UPFB consumption was con- founded by socioeconomic score, while paternal education level confounded the association between maternal education level and UPFB consumption. 4 | DISCUSSION In the present study, 57% of children had consumed UPFB the previous day. Among children aged 6–23 months, 27% consumed CACF, 36% consumed SSB and 25% consumed snacks. These findings concurred with one from Nepal where 25% of 6‐ to 23‐month‐olds consumed CACF (Pries et al., 2016) but much higher than in other LMIC studies (3%–5%) (Pries et al., 2016; Vitta et al., 2016). The difference in findings with another East African population, Zanzibar, at 3% (Vitta et al., 2016) might be due to social and cultural differences in feeding practices (Batalha et al., 2017), with some populations, like urban Ugandans, probably being more adaptable to CACF. CACF, when appropriately formulated, improves nutritional sta- tus by providing essential micronutrients like iron, calcium, zinc and vitamins during the complementary period (PAHO and WHO, 2003; Phu et al., 2012; Pries et al., 2016). However, high consumption of nutritionally unsuitable CACF with high sugar content is concerning (Hutchinson et al., 2021; Maalouf et al., 2017; Marais, 2016). CACF can sometimes be nutrient poor, especially cereals for porridge (Dimaria et al., 2018). Most commonly used CACF in low‐income countries are cereal based (Aryeetey & Tay, 2015; Pries et al., 2017) and used ubiquitously (Theurich et al., 2022). If lacking in essential micro‐nutrients, they will hamper a child's diet from meeting the nutrient requirements. Thus, the high consumption of CACF among urban Ugandans highlights the need for guidelines and regulation of their nutritional composition. The present study found that 36% consumed SSB, consistent with studies from Cambodia (Pries et al., 2016) and Indonesia (Green et al., 2019). Sweetened yoghurts were the most consumed SSB at TABLE 1 (Continued) Variable n % Mother ever attended a nutritional class during ANC (n = 336) No 215 64.0 Yes 121 36.0 Note: SES was derived from a principal component analysis of home ownership, floor type, drinking water source, fuel type, toilet type and land ownership with initial categorisation similar to those used to describe household characteristics by Uganda National Bureau of Statistics (UNBS) in demographic health surveys (Uganda Bureau of Statistics [UBOS], ICF, TDP, 2018; UBOS, The DHS Program (ICF), 2018). MWESIGWA and NAIDOO | 5 of 16 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense TABLE 2 Proportion of ultra‐processed food and beverage consumption within 24 h among 6‐ to 36‐month‐olds from selected health facilities in Kampala (n = 403a). Variable overall No (n/%) 77 (19.1) Yes (n/%) 326 (80.9) 95% CI: 76.7–84.4 Chi‐square p value Marital status (n = 392) Unmarried 20 (48.8) 21 (51.2) 36.0–66.2 0.482 Married 151 (43.0) 200 (57.0) 51.7–62.1 Maternal age (n = 387), years ≤25 32 (50.0) 32 (50.0) 37.9–62.1 0.069b 26–30 67 (50.4) 66 (49.6) 41.2–58.1 31–35 44 (36.7) 76 (63.3) 54.3–71.5 ≥36 26 (37.1) 44 (62.9) 50.9–73.4 Maternal education level (n = 387) None/primary level 86 (37.4) 144 (62.6) 56.1–68.6 0.021b O levels completed 29 (56.9) 22 (43.1) 30.2–57.1 A levels/Technical/Vocational 30 (49.2) 31 (50.8) 38.3–63.2 College/University 24 (53.3) 21 (46.7) 32.6–61.3 Paternal education level (n = 352) O levels or less completed 35 (58.3) 25 (41.7) 29.8–54.5 0.006b © A levels/Technical/Vocational 16 (45.7) 19 (54.3) 37.6–70.0 College/University 93 (36.2) 16 (63.8) 57.7–69.5 Paternal occupation (n = 354) Unemployed 11 (55.0) 9 (45.0) 24.8–66.9 0.027b Business 48 (50.0) 48 (50.0) 40.0–60.0 Skilled, sales, services 17 (44.7) 21 (55.3) 39.2–70.3 Professional 68 (34.0) 132 (66.0) 59.1–72.3 Parent's income (n = 281) 0.461 Irregular 18 (48.7) 19 (51.3) 35.4–67.0 Regular 103 (42.2) 141 (57.8) 51.5–63.9 Socioeconomic status (n = 395) First (lowest) 67 (51.5) 63 (48.5) 39.9–57.0 0.056b Second (middle) 56 (38.9) 88 (61.1) 52.8–68.8 Third (highest) 44 (38.6) 70 (61.4) 52.1–69.9 Child's sex (n = 403) Female 91 (44.2) 115 (55.8) 48.9–62.5 0.756 Male 84 (42.6) 113 (57.4) 50.3–64.1 Child's age (n = 403) (months) 6–12 (infants) 66 (54.9) 48 (42.1) 33.3–51.4 0.001b 13–23 67 (39.0) 105 (61.1) 53.5–68.1 24–36 42 (35.9) 75 (64.1) 55.0–72.3 Sibling number (n = 403) No sibling 60 (44.4) 75 (55.6) 47.0–63.8 0.792 6 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense 32%. Only 6% consumed other beverages, which is surprisingly low compared to other low‐income countries (Pries et al., 2017). Mini- mally processed yoghurt (made from milk and culture) is healthy in the diet (Marco et al., 2017; Salis et al., 2021), but sweetened yo- ghurts are considered ultra‐processed when additives like sugar, flavour and colour are added (Fangupo et al., 2021; Monteiro et al., 2016). Caregivers in the study considered sweetened yoghurt a ‘healthy’ alternative, especially for picky eaters, but this perception poses challenges as children develop a preference for sweet flavours. High sugar content in SSB poses risks of consuming energy‐dense beverages with minimal nutritional benefits and development of dental caries early in life. Caregivers often purchase commercial food products based on children's preferences (Pries et al., 2016). Most snacks consumed in the present study were sweet, emphasising the importance of taste development for nutrition and health. Therefore, interventions should promote health‐promoting tastes, including early exposure to bitter vegetables and bland flavours, limited exposure to sweet tastes at home (Mennella, 2014) and intentional introduction of traditional foods and varied vegetable tastes, even if initially unpleasant. 4.1 | Frequency of the consumption of UPFBs in the previous week On the question of consumption in the previous week, the present study found that over 84% had consumed an UPFB at least once and 69% had consumed them frequently. Snacks were consumed by 64% and SSB by 71% at least once the week before the interview. These findings differed from an Indonesian population that consumed snacks more than SSB, 90% versus 56% (Green et al., 2019). Nevertheless, higher consumption of SSB than sweet snacks remains consistent even within the 24‐h consumption in this Ugandan study population. The only similarity between the Ugandan and Indonesian popu- lations is that the majority consumed sweetened dairy. However, the frequency of consumption of more than 3 days a week was far higher in the present study, with four‐tenths compared to a fifth in Indo- nesia (Green et al., 2019). Additionally, the Ugandan study shows a much higher frequent soft drink consumption of 13%, indicating that this is also of public health concern in the Ugandan urban population. The data from the present study suggest that the frequent consumption of breakfast cereals is a unique finding in Uganda. Moreover, breakfast cereals were consumed by all age groups. This food item was not reported in studies from other LICs. Apart from a Brazilian study in Montes Claros, where 86% of the 415 children aged 6–24 months consumed breakfast cereals within the last 24 h (Lopes et al., 2020), hardly any other studies reported breakfast cereal intake in this age group. In the Ugandan population, breakfast cereal rep- resents foods meant for the general population, which are used because they are ready to eat and, thus, very convenient. However, the concerns surrounding the use of breakfast cereals are partly due to the high sugar content in some of the cereals and their low energy density when they contain high‐fibre content, which is too complex to be digested. These cereals will satiate the young child because of their bulkiness but provide very little energy or TABLE 2 (Continued) Variable overall No (n/%) 77 (19.1) Yes (n/%) 326 (80.9) 95% CI: 76.7–84.4 Chi‐square p value 1 sibling 63 (44.7) 78 (55.3) 47.0–63.4 2 or more siblings 52 (35.9) 75 (59.1) 50.2–67.3 Ever used formula (n = 400) No 89 (48.1) 96 (51.9) 44.7–59.0 0.069b Yes 84 (39.1) 131 (60.9) 54.2–67.2 Baby breastfed last night (n = 403) No 79 (39.3) 122 (60.7) 53.7–67.2 0.096b Yes 96 (47.5) 106 (52.5) 45.5–59.3 Attended antenatal care (n = 379) No 25 (51.0) 24 (49.0) 35.2–62.9 0.257 Yes 140 (42.4) 190 (57.6) 52.1–62.8 Mother's past nutritional class attendance (n = 330) No 86 (40.6) 126 (59.4) 52.6–65.9 0.360 Yes 54 (45.8) 64 (54.2) 45.1–63.1 aSeven children were excluded from analysis because they were sick or changed their regular feeding. bp ≤ 0.2©Fischer's exact test. MWESIGWA and NAIDOO | 7 of 16 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense TABLE 3 Frequency of weekly consumption of ultra‐processed foods and beverages among 6‐ to 36‐month‐old children that attended selected health facilities in Kampala (n = 410). Variable Never, n (%) Moderate, n (%) Frequently, n (%) Overall 66 (16.1) 61 (14.9) 283 (69.0) Marital status (n = 399) Unmarried 12.2 (11.9–31.6) 14.6 (6.6–29.2) 73.2 (57.7–84.6) Married 16.6 (13.2–21.0) 15.1 (11.7–19.2) 68.1 (63.1–72.8) Maternal age (n = 394), years ≤25 20.0 (11.9–31.6) 15.4 (8.4–26.4) 64.6 (52.2–75.3) 26–30 17.8 (12.2–25.2) 20.7 (14.7–28.5) 61.5 (52.9–69.3) 31–35 15.4 (10.0–23.0) 13.0 (8.1–20.2) 71.5 (62.9–78.8) ≥36 7.0 (2.9–15.9) 7.0 (2.9–15.9) 80.3 (69.3–88.0) Maternal education level (n = 394) None/primary level 33.3 (21.0–48.4) 24.4 (13.9–39.2) 14.2 (28.6–57.1) O levels completed 22.2 (12.9–35.4) 18.5 (10.2–31.3) 59.2 (45.6–71.6) A levels/Technical/Vocational 17.7 (10.0–29.4) 12.9 (6.5–23.9) 69.3 (56.7–79.6) College/University 11.6 (8.1–16.4) 12.9 (9.1–17.8) 75.5 (69.6–80.6) Paternal education level (n = 358) O levels or less completed 27.9 (17.9–40) 21.3 (12.7–33.5) 50.8 (38.3–63.2) A levels/Technical/Vocational 14.3 (5.9–30.4) 25.7 (13.8–42.8) 60.0 (42.9–74.9) College/University 12.9 (9.4–17.6) 12.9 (9.4–17.6) 74.1 (68.4–79.0) Paternal occupation (n = 361) Unemployed 20.0 (7.5–43.6) 35.0 (17.3–58.1) 45.0 (24.8–66.9) Business 16.5 (10.3–25.3) 18.5 (11.9–27.6) 64.9 (54.9–73.8) Skilled, sales, services 21.0 (10.8–37.1) 26.3 (14.6–42.7) 52.6 (36.7–67.9) Professional 14.1 (9.9–19.5) 11.6 (7.9–16.8) 74.3 (67.8–79.8) Parent income regularity (n = 285) Irregular 13.5 (5.6–28.9) 10.8 (4.0–25.8) 75.7 (59.1–86.9) Regular 14.9 (10.9–19.9) 14.9 (10.9–19.9) 70.2 (64.1–75.5) Socioeconomic status (n = 395) First (lowest) 24.8 (18.2–32.9) 21.1 (14.9–28.9) 54.1 (45.5–62.3) Second(middle) 12.2 (7.8–18.6) 13.6 (8.9–20.2) 74.1 (66.4–80.6) Third (highest) 12.2 (7.3–19.6) 6.9 (3.4–13.3) 80.9 (72.6–87.1) Child's sex (n = 410) Female 14.3 (10.1–19.7) 13.3 (9.3–18.7) 72.4 (65.9–78.0) Male 18.0 (13.2–23.9) 16.5 (11.9–22.3) 65.5 (58.6–71.8) Child's age (n = 410), months 6–12 (infants) 31.9 (24.0–40.9) 17.2 (11.4–25.3) 50.9 (41.87–59.9) 13–23 10.9 (7.0–16.4) 14.3 (9.8–20.3) 74.8 (67.9–80.8) 24–36 8.4 (4.5–15.0) 13.4 (8.4–20.9) 78.1 (69.8–84.7) Sibling number (n = 410) No sibling 19.2 (13.4–26.8) 14.1 (9.1–21.1) 66.7 (58.2–74.1) 8 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense nutrients for the IYC. It was observed that all age groups consumed breakfast cereals, and this is an even more significant concern among infants because their energy needs are greater than at any other time of development (Dewey & Brown, 2003). Furthermore, wholegrain cereals contain phytate, which binds to iron and zinc, inhibiting their absorption (Van Der Merwe et al., 2007). Unless they are fortified with zinc and iron, unsweetened or with low fibre, when mixed with fresh milk, this meal will not meet the nutritional needs of IYC. Although ready‐to‐eat breakfast cereals meant for older children and adults may have health benefits for these age groups (Fayet‐Moore et al., 2017; Panagiotakos et al., 2008), these are generally discouraged from use in IYC (Van Der Merwe et al., 2007). Additionally, even the one‐tenth that frequently consumed soft drinks and the other tenth who consumed fruit drinks, although few, are also a subpopulation of concern. This finding also calls for other population‐wide interventions that promote optimal IYC feeding prac- tices and discourage the intake of unhealthy drinks (WHO, 2017, 2019). Such interventions in other countries, including those within Africa, have included strict label guidelines that include age recommendations and front‐of‐pack labelling that which indicates the sugar content of an item in a format that is easily understood (Erzse et al., 2019). Other recom- mendations have been to restrict the promotion and marketing of such products in places that young children frequent (WHO, 2017). These findings also reveal that frequency measures from the week before the interview might be a more practical measure for infant and young child diets because these show habits rather than the occasional infrequent consumption of items represented in the 24‐h diet recall. This is especially useful for studies that are not conducted in the community, like the present study, where partici- pants were recruited from facilities. When the frequency is mea- sured, it better reflects at‐risk groups for which targeted interven- tions can be specifically designed. The 24‐h diet recall was modified with a 3‐day diet recall in European studies, and this, too, captured the dietary patterns better rather than the 24‐h recall that represents a single day's meals. 4.2 | Factors associated with frequency of consumption of UPFBs among children aged 6–36 months The results of the present study show that maternal education (OR = 2.85, 95% CI: 1.02–7.96, p = 0.045) and the child's age (13–23 months [OR = 2.87, 95% CI: 1.62–5.08, p < 0.001) and 24–36 months (OR = 3.68, 95% CI: 1.88–7.20, p < 0.001)] were significantly associ- ated with UPFB consumption. Frequency of consumption in the week prior was an ordinal outcome with three tertiles: 1—never, 2—moderate (1–3 days) and 3—very frequent (4–7 days), considered to provide additional infor- mation and determine if there were parental or child characteristics that were associated with consumption of ultra‐processed foods. However, this outcome has not yet been used in published studies. As such, comparison with other studies is a challenge. Other studies, mostly from different Brazilian populations, quantified consumption using several methods including count data on the number of products consumed in 24 h (Lopes et al., 2020), energy contribution using three 24‐h recalls (Soares et al., 2022) or the frequency‐related TABLE 3 (Continued) Variable Never, n (%) Moderate, n (%) Frequently, n (%) 1 sibling 6.9 (3.7–12.5) 15.9 (10.8–22.9) 77.1 (69.5–83.2) 2 or more siblings 22.9 (16.5–30.9) 14.5 (9.4–21.8) 62.5 (53.9–70.5) Ever used formula (n = 407) No 20.5 (15.3–26.9) 16.3 (11.7–22.3) 63.2 (56.0–69.7) Yes 11.5 (7.9–16.5) 13.4 (9.4–18.6) 75.1 (68.9–80.4) Baby breastfed last night (n = 410) No 6.9 (4.1–11.4) 16.3 (11.8–22.1) 76.7 (70.4–82.1) Yes 25.0 (19.6–31.4) 13.5 (9.4–18.8) 61.5 (54.7–67.9) Attended antenatal care (n = 385) No 16.3 (8.3–29.6) 10.2 (4.3–22.5) 73.5 (59.3–84.0) Yes 16.7 (13.0–21.0) 16.1 (12.5–20.4) 67.2 (62.0–72.1) Mother's past nutritional class attendance (n = 336) No 15.3 (11.1–20.8) 16.7 (12.3–22.4) 67.9 (61.3–73.8) Yes 19.0 (12.9–27.0) 14.9 (9.5–22.4) 66.1 (57.2–74.0) Note: Descriptive statistics: frequency (n) and proportions (%) and confidence intervals of proportions. MWESIGWA and NAIDOO | 9 of 16 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense quantitative methods (Batalha et al., 2017) or actual amounts of foods consumed were measured (Sparrenberger et al., 2015). Consistent with the literature, the present study found that older children were more likely to consume UPFB frequently (Batalha et al., 2017; Soares et al., 2021). The frequency of consumption of all UPFB increased with age except for breakfast cereals and infant cereals. Some reasons that were gleaned from a qualitative study were that with increasing age, there is a more relaxed approach to feeding, hence, the introduction and frequent use of snacks. Snacks and beverages meant for adult consumption become more permis- sible with increasing age (Reynolds, 2022). It is also probable that as children grow older and become more verbally expressive and pro- active in having their needs met, they can communicate their pref- erences. Given that most caregivers reported that they feed their children foods and beverages because ‘they like them’, it is expected that even as the children grow older, they reinforce this behaviour from their caregivers. As expected, these items are sweet or with other pleasant tastes and thus preferred by young children. Ideally, IYC should become accustomed to healthy traditional family foods and their array of flavours and textures during the complementary period to promote healthier diets in future (Mennella, 2014). Moreover, the traditional cooking methods and different techniques of food preparation conferred improved nutritional composition, promoted digestion and absorption and provided additional health benefits (Salis et al., 2021). Therefore, it is of great concern that there is an increase in exposure to unhealthy UPFB instead. This sets IYC on a trajectory of poor food choices as they grow older and later in life. In contrast to earlier findings, the maternal education level was significantly positively associated with frequent UPFB consumption. Other studies that have some form of quantification reported that fewer maternal years of schooling were associated with higher or more frequent consumption of UPFB (Batalha et al., 2017; Giesta et al., 2019; Pereira et al., 2022). Generally, low socioeconomic characteristics in high‐ and middle‐income countries are correlated with poor feeding practices, including high consumption of UPF. However, this trend of increasing maternal education as an associated factor cannot be dismissed as a coincidental finding. It re‐ iterates the postulation derived in the present study that favourable socioeconomic characteristics in the urban Ugandan setting influence unhealthy dietary habits of IYC related to ultra‐processed foods. This is further demonstrated by the positive association with other socio- economic indicators in the present study at bivariate analysis: maternal age, paternal education, paternal occupation and socioeconomic score. In high‐ and middle‐income countries, increased schooling and other socioeconomic characteristics are believed to present greater opportunities for caregivers to access information on healthy eating practices in such countries (Giesta et al., 2019), as well as higher socioeconomic characteristics like education can be correlated with higher family income. Income increases access and affordability to healthier but more expensive foods like fruits, vegetables and meat (Relvas et al., 2019). On the contrary, in the present study, the most frequently consumed UPFBs—sweetened yoghurt, infant cereals (instant), breakfast cereals and confectionery—are more expensive items that might not be affordable for lower socioeconomic populations. Therefore, as highlighted by several authors concerning the nutrition transition in LICs, their economic growth has greatly influ- enced the transition, especially income per capita. This has led to increased affordability of a variety of processed and ultra‐processed foods, which has inevitably led to increased consumption of foods that contain high amounts of fat and sugar, and edible oils as opposed to the local staple foods (Popkin et al., 2012; Vorster et al., 2011). This is further demonstrated by African (Adamo et al., 2011) and Ugandan (Nakaggwa, 2019; Nawangi, 2013) data from older age groups where children and adolescents in private schools—a proxy for higher socioeconomic status—are likely to be overweight and obesity (OWO) compared to those from public schools. 4.3 | Use of formula While initially favouring formula, most individuals in low‐income countries like Uganda ultimately opt for cheaper alternatives such F IGURE 1 Frequency of snack and sugar‐sweetened beverages (SSB) in the week before the interview. (a) Frequency of snacks consumption in the week before the interview. (b) Frequency of SSB consumption in the week before the interview. 10 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense TABLE 4 Factors associated with weekly consumption frequency of ultra‐processed foods and beverages among 6‐ to 36‐month‐old children attending selected health facilities in Kampala (n = 410). Variable overall Unadjusted OR 95% CI p Value Adjusted OR 95% CI p Value Marital status (n = 399) Unmarried Ref Ref Married 0.77 0.38–1.57 0.473 Maternal age (n = 394), years ≤25 Ref Ref Ref 26–30 0.93 0.51–1.70 0.821 31–35 1.38 0.73–2.59 0.315 ≥36 2.18 1.01–4.69 0.047* Maternal education level (n = 394) No education/primary level completed Ref Ref Ref Ref Ref Ref O levels completed 1.90 0.88–3.99 0.09* 2.37 0.90–6.23 0.079 A levels/Technical/Vocational 2.84 1.33–6.07 0.007* 2.50 0.85–7.37 0.096 College/University completed 4.02 2.16–7.44 <0.001* 2.85 1.02–7.96 0.045** Paternal occupation (n = 361) Unemployed Ref Ref Ref Business 1.85 0.76–4.50 0.173* Skilled, sales, services 1.19 0.14–3.19 0.731 Professional 2.77 1.18–6.46 0.018* Parent income regularity (n = 285) Irregular Ref Ref Ref Regular 0.77 0.35–1.77 0.527 Paternal education level (n = 358) O levels or less completed Ref Ref Ref Ref Ref Ref A levels/Technical/Vocational 1.61 0.72–3.58 0.246 1.21 0.49–3.03 0.669 College/University 2.74 1.58–4.75 <0.001* 1.23 0.54–2.82 0.624 Socioeconomic status (n = 395) First (lowest) Ref Ref Ref Ref Ref Ref Second (middle) 2.38 1.45–3.88 0.001* 1.25 0.62–2.51 0.525 Third (highest 3.34 1.89–5.90 <0.001* 1.80 0.80–4.03 0.155 Child's sex (n = 410) Female Ref Ref Ref Male 0.73 0.48–1.10 0.137* Child's age (n = 410), months 6–12 (infants) Ref Ref Ref Ref Ref Ref 13–23 3.13 1.92–5.09 <0.001** 1.62–5.08 <0.001** 1.62‐5.08 24–36 3.78 2.16–6.60 <0.001** 1.88–7.20 <0.001** 1.88‐7.20 Sibling number (n = 410) No sibling Ref Ref Ref Ref Ref Ref 1 sibling 1.82 1.08–3.06 0.024* 1.81 0.94–3.47 0.074 2 or more siblings 0.82 0.50–1.34 0.441 0.83 0.45–1.51 0.549 (Continues) MWESIGWA and NAIDOO | 11 of 16 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense as fresh milk or yogurt probably due to the high cost of formula (Sewannonda et al., 2022). Surveys consistently show low formula usage in Uganda, with only 12% of infants in Wakiso consuming it compared to 40% consuming cow's milk before 6 months (Sse- mukasa & Kearney, 2014). National data indicate just 1% reliance on formula (UBOS, ICF, TDP, 2018; UBOS, The DHS Program (ICF), 2018). Given the widespread preference for non‐formula dairy substi- tutes, IYC policy must promote safe and adequate dairy product use during complementary feeding. This requires collaboration with multi‐sectoral policy frameworks to ensure optimal nutrition prac- tices. Efforts should encourage consumption of minimally processed, nutritionally suitable dairy products while discouraging unhealthy alternatives. 4.4 | Commercial determinants of health In the overall considerations of the nutrition transition, the role of ‘commercial determinants of health’ (CDoH) cannot be ignored. Big corporations, many of these transnational, have fuelled the transition by their active role in adversely influencing health due to their profit motives (de Lacy‐Vawdon & Livingstone, 2020). Among the strate- gies, the sugar industry has employed include preventing the sugar policy by counteracting any efforts by public health advocates to describe public health problems and thereby promoting unhealthy diets—the overconsumption of UPFBs. Such actions go as far as providing contradicting statistics, downplaying the severity of health conditions, and when solutions are proposed, they claim they are too costly and impractical (Kearns & Watt, 2019). Thus, as far as the drivers of NCDs like caries and OWO (sometimes known as industrial epidemics) are concerned, the manufacturers are the ‘vectors’, and the unhealthy commodities that is UPFBs act as the ‘agents’ while the individuals are the ‘hosts’ (Jahiel & Babor, 2007). To address these CDoH, international guidelines specific for baby foods have indicated that any foods with added sugar should not be marketed or promoted by labelling them as appropriate for younger age groups (WHO, 2019). 4.5 | Study limitations This facility‐based study was chosen over a community‐based approach due to challenges accessing participants during the COVID‐19 lockdown and afterward. However, facility‐based studies may bias towards those seeking regular health services, and purpo- sive selection may not ensure a representative sample. To address this, efforts were made to include various urban populations across different service contexts and geographic locations, enhancing the external validity of the findings for Uganda's urban infant and young child population. 5 | CONCLUSION The present study reveals a high consumption of UPFBs during the complementary period which could potentially increase the risk of malnutrition, such as overweight/obesity or micronutrient deficien- cies, displacing more nutritious foods, as demonstrated in a study from another LMIC setting (Pries et al., 2019). UPFBs contribute significantly to energy intake among IYC, often containing added sugar. Sugar poses risks for ECC, a chronic condition, and also sets up TABLE 4 (Continued) Variable overall Unadjusted OR 95% CI p Value Adjusted OR 95% CI p Value Ever used formula No Ref Ref Ref Ref Ref Ref Yes 1.80 1.18–2.74 0.006* 1.58 0.9–2.7 0.098 Baby breastfed last night No Ref Ref Ref Yes 0.43 0.28–0.66 <0.001* Attended antenatal care (n = 379) No Ref Ref Ref Yes 0.78 0.40–1.52 0.462 Mother's attendance of nutritional class (n = 336) No Ref Ref Ref Yes 0.89 0.56–1.41 0.620 Note: Ref is the baseline comparative group whose unadjusted or adjusted OR is ‘1’. *p ≤ 0.2. **p ≤. 0.05. 12 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense these children on a life course for poor food choices because of the adaptation to sweet and palatable foods. The popular use of sweet- ened dairy products as a milk substitute highlights the issue of ‘hid- den sugars’ and the low awareness of nutritious foods for children's needs and possibly the potential health effects of consuming unhealthy products. These findings provide baseline evidence on consumption of UPFBs for researchers, health workers, policymakers and stake- holders concerned about urban infant and young child (IYC) nutrition in Uganda. The findings highlight the need for LMICs to acknowledge the nutrition transition paradigm and develop guidelines and policies to address current health promotion needs and challenges in com- plementary feeding. However, there is need for further research in such urban pop- ulations on the health effects of overconsumption of these UPFBs as well as interventions that could promote better food choices for optimum IYC nutrition. Future research should also consider using quantitative food frequency questionnaires as part of the dietary assessments in this subpopulation. Finally, there is great urgency to address the role of commercial determinants of health in Uganda. Policies that discourage the overconsumption of UPFBs in the youngest population are urgently required and could include the use of warning labels (Ares et al., 2023) and clear messages on their inappropriateness for the younger children (WHO, 2019) so as to increase consumer awareness and fiscal policies to reduce purchases (Ahaibwe et al., 2021). AUTHOR CONTRIBUTIONS Catherine L. Mwesigwa conceived and refined the research idea, drafted the initial proposal and was involved in the whole research process, drafting the manuscript and all revisions. Sudeshni Naidoo guided the entire research process from the conception of the research idea, contributed to the drafting of the manuscript and critically analysed it for publication. Both authors gave the final approval of the version to be published. ACKNOWLEDGEMENTS Special thanks go to research team who were involved in the field data collection, Ms Madina Nadduli and Ms Prisca Kusasira and to Ms Grace Nabaggala who helped greatly in analysing the data. Two funding sources are acknowledged for this work. It was partly funded by a research fund of Prof. Naidoo under the University of the Western Cape. It was also supported by the Fogarty International Center of the National Institutes of Health, U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and President's Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. ORCID Catherine L. Mwesigwa http://orcid.org/0000-0002-3493-7008 REFERENCES Adamo, K. B., Sheel, A. W., Onywera, V., Waudo, J., Boit, M., & Tremblay, M. S. (2011). Child obesity and fitness levels among Kenyan and Canadian children from urban and rural environments: A KIDS‐CAN Research Alliance Study. 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Consumption frequency of ultra‐processed foods and beverages among 6‐ to 36‐month‐olds in Kampala, Uganda. Maternal & Child Nutrition, 21, e13724. https://doi.org/10.1111/mcn.13724 16 of 16 | MWESIGWA and NAIDOO 17408709, 2025, 1, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/m cn.13724 by M akerere U niversity, W iley O nline L ibrary on [09/01/2025]. See the T erm s and C onditions (https://onlinelibrary.w iley.com /term s-and-conditions) on W iley O nline L ibrary for rules of use; O A articles are governed by the applicable C reative C om m ons L icense https://apps.who.int/iris/bitstream/handle/10665/346583/WHO-EURO-2019-3590-43349-60813-eng.pdf?sequence=1%26isAllowed=y https://apps.who.int/iris/bitstream/handle/10665/346583/WHO-EURO-2019-3590-43349-60813-eng.pdf?sequence=1%26isAllowed=y https://www.who.int/publications/i/item/924120916X https://www.who.int/publications/i/item/924120916X https://doi.org/10.1371/journal.pone.0064542 https://doi.org/10.1371/journal.pone.0064542 https://doi.org/10.1111/mcn.13724 Consumption frequency of ultra-processed foods and beverages among 6- to 36-month-olds in Kampala, Uganda 1 INTRODUCTION 2 METHODS 2.1 Definition of ultra-processed food and beverages 2.2 Sample size and sampling 2.2.1 Data collection 2.2.2 Data management and analysis 3 RESULTS 3.1 The proportion of children aged 6-36 months that consumed ultra-processed foods the previous day (UPFB) in Kampala 3.2 Consumption frequency of UPFBs among 6- to 36-month-old children in Kampala 3.3 Association between family/child characteristics and weekly frequency of consumption of UPFBs among 6- to 36-month-old children in Kampala 4 DISCUSSION 4.1 Frequency of the consumption of UPFBs in the previous week 4.2 Factors associated with frequency of consumption of UPFBs among children aged 6-36 months 4.3 Use of formula 4.4 Commercial determinants of health 4.5 Study limitations 5 CONCLUSION AUTHOR CONTRIBUTIONS ACKNOWLEDGEMENTS CONFLICT OF INTEREST STATEMENT DATA AVAILABILITY STATEMENT ORCID REFERENCES SUPPORTING INFORMATION