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NILA Birth Cohort project holds 1st research dissemination workshops in Nebbi, Zombo and Kamwenge districts.

Participants pose for a group photo after the meeting.

Some local govt leaders propose coercive methods to enforce sanitation, hygiene and other health practices. Key study findings include:

  • Poor toilet coverage, sanitation and hygiene practices. Majority of the households use un improved pit latrines, bushes or share community pits
  • Lack of access to running water; over 80 % of the households drink contaminated water. Very few boil drinking water
  • Poor Dietary Diversity Score. Majority mainly consume root tubers and legumes
  • Severe cases of anaemia prevalent in pregnant women aged 20-29. This age group hardly seek Antenatal Care Services
  • Farmers lack adequate access to nutritional and agricultural information. Radio is the major source of information.
  • Majority live in grass or leaf thatched houses, have no access to grid electricity and use wood as the common cooking fuel.

What NILA is about.

In October 2014 Makerere University in collaboration with Tufts University and the Harvard School of Public Health embarked on the USAID- “Feed the Future” funded project titled, “Effectiveness of integrated agriculture, health livelihood nutrition interventions to improve maternal and child health nutrition in rural Uganda”. This is a three year study running from 2014 to 2017.

The aim of the study is to understand the effect of integrated interventions on the health and nutritional status of mothers and children under two years of age. The integrated interventions under assessment are nutrition-specific abbreviated as WASH that is Water, Sanitation and Hygiene. Other interventions being evaluated are in agriculture and gender.

The study team from Makerere University include Prof. Bernard Bashaasha who is the Principal Investigator (PI) Prof. Joyce Kikafunda as the Co- PI, Dr Florence Turyashemererwa the Country Project Coordinator and Ms.Annet Kawuma as the Research Specialist. The study team from Tufts University include Dr.Nassul Kabunga a Post doc fellow, Prof. Jeffry Griffiths, Director, Dr. Shibani Ghosh, Assoc. Director and Edgar Agaba a researcher Tufts University. The team from Harvard School of Public Health include Dr. Christopher Duggan Co-PI, Dr. Wafaie Fawzii Co- Investigator and Dr.Nilupa Gunaratna Co- investigator.

The study is the first of its kind in Uganda being conducted in 12 districts in North and South Western Uganda in 16 sub counties.In South Western Uganda, the study is being conducted in Kabale, Kanungu, Kamwenge, Kabarole, and Rukungiri. In Northern Uganda the study is being done in Nebbi, Zombo, Pader, Lamwo, Lira, Kole and Apac.

The study area involves the Community Connecter (CC) intervening districts .The study also selected other districts without CC interventions for comparison purposes. A Community Connector is a USAID “Feed the Future” funded project that has been operating for five years in some districts in Uganda promoting messages and activities on water, sanitation, hygiene, agriculture and gender. NILA comes in through research to assess whether theses interventions are effective.

The study is called Nutrition Innovation Laboratory Africa (NILA) – a Birth Cohort study because it utilises a cohort of mothers and young children followed from pregnancy through the first two years of life. The project is also being undertaken in a number of African countries including Uganda, Malawi and Egypt.

In Uganda, the target of the study is to enrol 5152 pregnant women and children country wide. 322 pregnant mothers in each of the 16 subcounties will be enrolled and followed up over a three –year period. Pregant women aged 15- 49 years in their second and third trimester, living in the study area until study period will be over and those who consented to participate in the study.

A total of 9 visits will be made during the study period of three years starting with pregnant women at three months, followed after every three months to delivery until the baby is two years old.

Information collected at the household level include demographic and social economic information, agriculture, foods security, gender roles and dynamics. Researchers also collected information from the caregivers and children aged 0 – 23 months on diet, health, nutritional status and blood samples. The study also looked at social participation, access to information and program exposure.

16 supervisors and 37 enumerators were enrolled across the districts. Over 20 support staff including fellow bottomists and Laboratory technicians were also enrolled and trained to draw blood for testing nutrition bio-markers like haemoglobin and other diseases like malaria, HIV /AIDS among other tests.

As of October 2015 a total of five visits had been made and the data for the 1st visit completed.

Presentation of the research findings

The research team organised research dissemination workshops on 13th, 14th and 22nd October 2015 in Nebbi, Zombo and Kamwenge districts respectively. The meetings were held at the Local Government District headquarters and attended by district leadership, village health teams, Civil Society organisation and participants in the study.

The purpose of the dissemination meetings was to update local leaders on research findings to help them in their planning and to get their input into the study.

Presentation of research findings from Parombo sub county Nebbi district

In Nebbi district, the research dissemination meeting was officially opened by the Deputy Chief Administrative Officer Jessica Onyeratho on 13th October, 2015. It was attended by Nebbi district Local council members, heads of departments, sub county chiefs, Village Health Teams and participants in the study.

Jessica Onyeratho, Deputy Chief Administrative Officer opening the meeting.

Onyeratho welcomed the participants and thanked the research for the initiative to involve local government officials in discussing the research findings. She pledged to work closely with the relevant departments to take action on issues highlighted in the study.

Major findings on water sanitation and hygiene from Parombo Sub County revealed that only 2% of the households in Parombo subcounty have access to running water. Majority of the households collect water from boreholes, springs and wells.


Nebbi district woman MP also attended the meeting.

Findings from this study also revealed that 87% of the households drink contaminated water with faecal bacteria resulting from poor storage and hygiene.

About 3% of the households use improved pit latrine, 82% have un improved pit latrines while about 10 % use community owned latrines.

Joyce Irachan, Field Supervisor Nebbi, presenting results.

Results from Parombo subcounty further indicated that over 90% of the households live in grass or leaf thatched houses made of wood and mud walls.

The household food consumption patterns as measured by the Household Dietary Diversity Score indicated that households mainly consumed root tubers and legumes. The study reported low consumption of animal proteins and vitamins.

The study also revealed that about 63% of the households are food secure in terms of food access while 22% are severely food insecure according to the assessment done basing on Household Food Insecurity Access Prevalence (HFIAP).


Annet Kawuma, MAK Research Specialist speaking to the participants.

On average, a household in Parombo Sub County has sufficient food for about 8 months in a year thus an average household as measured by Months of Adequate Household Food Provisioning (MAHFP) is moderately insecure in terms of household food access.

Basing on Mid Upper Arm Circumference (MUAC) only 3% of the pregnant mothers are considered to be at the risk for poor birth outcomes. Most women are well nourished.

Severe cases of anaemia were minimal only in age groups 15-19 and 30-39. Anaemia was highly prevalent in age group 20-29. Results from the study indicated that these pregnant women aged between 20-29 hardly sought Antenatal care services. This age group also had a lower uptake of iron.

The study also indicated that farmers in Parombo sub county lack adequate access to agricultural and nutritional information. Radio was found to be the most used source of information.


Asection of the participants.

The dissemination meeting was closed by the Vice Chairman Nebbi District UbedgiuIdo. He described Parombo Sub County as one located at the extreme and whose findings will be used to improve livelihoods in the entire district.



Ubedgiu Ido, Vice Chairman Nebbi district giving his closing remarks.

The chairperson pledged to work on gaps unveiled by the study and implored participants and district leaders to be ready to roll the activities in Parombo sub county to other sub counties in the district for better livelihoods and development.

“We want to work on the issue of water contamination. We are going to send a team of experts to do more on the ground. Mothers are suffering from anaemia due to inadequate drugs. Let us join hands and work as a team. We want to improve livelihoods, we want to transform everybody”, The Chairman emphasised.

Updates on NILA project activities in Atyak sub county , Zombo district

On 14th October, 2015, the research team organised a research dissemination workshop to update Local Government leadership on the progress of the project activities.

The day’s agenda included opening remarks by the Chief Administrative Officer (CAO) Zombo district, presentations from the field supervisors and enumerators, open discussions and closing remarks by the District Chairperson.

Representing the CAO, the Assistant CAO, Akako John Bosco gave highlights of the days activity. He told participants that the team was not going to disseminate research findings but to give an update on how the study was progressing in Atyak sub count, Zombo district.


Akako John Bosco, Assist. Chief Administrative officer Zombo opening the workshop.

“The major thing is nutrition visa a vis pregnant women and our children. They are looking at pregnant women and children whether we are we giving them the right food. So they have chosen Atyak as a study area. We are going to understand whether pregnant women and children are okay. You should by now start thinking. It is a big challenge. Findings will help us to improve grow crops, feed children and mothers to become healthy”. The CAO said.


Alanyo Jacqueline, Vice Chairperson LC5 Zombo district speaking during the meeting.

The team was unable to give the finer details of the study because the data manager handling the dissemination report was not well. They instead gave updates on how the project was progressing.

Makerere University research specialist Annet Kawuma thanked the district leadership for accepting and supporting the research team in the district.

“Between July and October 2014 the research team came on the ground to conduct the district inception meeting on the upcoming study and got very useful updates. The study was introduced at sub county ensure that the community understood the nature of the study” She went on to say:

“We are working in collaboration with TUFTS University, Harvard School of Public Health coordinated by Makerere University. We have a great team on ground, Our children are here, we are targeting bottom-up strategy. Terence Nene is the supervisor NILA Atyak, there is one in Nebbi and Zombo. Denis Ombe Japyem is the enumerator doing house to house data collection”


Annet Kawuma, MAK Research Specialist speaking in Zombo.

The research specialist told participants that the study was being conducted in 12 districts in 16 selected sub counties. The study has 16 supervisors and 37 enumerators across North and South western Uganda. Over 20 support staff including laboratory technicians were also recruited and trained to draw blood for testing nutrition biomarkers and diseases like malaria.

The supervisor Zombo district Binega Terence Nene told participants that the study lost out some mothers during delivery. He however explained that when the mother dies, and the child survives the team follows up on the child health and nutrition status with the caretaker until it is two years old.

Speaking during the meeting the Zombo District Vice Chairperson Alanyo Jacqueline appreciated the study organisers and funders saying, the study will help people of Zombo improve on their health and nutrition.


A section of participants who turned up at Zombo district headquarters.

“As a voice of the voiceless, we are ready to support and sensitize our people what we have learnt from you and they should implement it. In Zombo, our major food crop is cassava which we ferment and therefore loose value resulting to malnutrition....We shall tell our people the benefits of good feeding”, She said

The meeting was closed by the Resident District Commissioner (RDC) represented by the Deputy District Security Officer Michael Onen. Onen described the meeting and presentations as assign of responsibility and accountability in implementation of programs.

Micheal Onen, Zombo District Security Officer, giving closing remarks.

The DISO said as the President’s office, they monitor programs and activities carried out by government and development partners. He appreciated the role of researchers as supplementary partners and pledged governments support to ensure the project success.

“The role of developing partners is supplementary. We appreciate your major role and pledge total support and commitment to make sure that your project activities are successful”. He said.

Presentation of results from Bwizi Sub county in Kamwenge district

On 22nd October 2015the research team organised a research dissemination workshop to update Local Government leadership on research findings from the baseline study conducted in Bwizi Sub County, Kamwenge district.


Kamwenge district health officer, the RDC and the CAO in attendance.

The research dissemination meeting was opened by the Chief Administrative Officer Kamwenge district Twinomujuni Expedito at the district headquarters.

The CAO underscored the importance of nutrition in the child growth, development and intellectual capacity and implored residents to own up the challenges identified by the study and seek solutions to improve the health of the mothers and children.


Twinomujuni Expedito, Kamwenge Chief Administrative Officer opening the meeting.

“As Kamwenge district, we need to improve on nutrition for our mothers and children. The biggest package is with our guests who are researchers from Makerere University and their presentations will inform our discussion. I declare the meeting open”.

The research findings from Bwizi sub county Kamwenge district were presented by the Project Country Coordinator from Makerere University Dr. Florence Turyashemererwa.

The study revealed high prevalence of anaemia in women aged between 20-29 years. Severe cases of anaemia were also reported in age groups 20-29 and 30-39. Another key finding was on the low turnup of these mothers for Antenatal care services.


Dr. Florence Turyashemererwa, NILA Country Project Co ordinator presenting study findings in Kamwenge.

On the household characterises, the study findings indicated that most households are monogamous, headed by men with shelters made of mud and grass. None of the household had access to grid electricity and use wood as the common cooking fuel.

Basing on the household food Dietary Diversity Score, the study revealed that households mainly consumed roots and tubers, legumes and cereals. There was low consumption of vitamins, animal proteins and oil seeds.

On average a household in Bwizi Sub County has sufficient food for about 8 months in a given year. Thus, an average household is moderately food secure in terms of household food access.

On water, sanitation and hygiene, research findings showed that 95 % of the households drink contaminated water. Only 3% of these households have access to running water. The common source of water is the unprotected well or spring.


One of the participants reacts to the presentations in Kamwenge.

The study also revealed poor storage of water and food, poor disposal of rubbish and the need to promote hand washing practices after toilet use.

On social participation, access to information and program exposure, the study found out that radio, community connectors, extension agents and government staff were the most used sources of information.

The meeting was closed by the Resident District Commissioner (RDC) Kamwenge district Birabarema Elijah who commended USAID for funding the research and the research team for communicating health, nutritional and social issues affecting mothers and children in Kamwenge district.

The RDC reported that almost 98% of the district soils favour all types of crops. He expressed dismay over lack of food and called upon all stakeholders to sensitise the residents on the need for adequate food and balanced diet.



Some of the participants.

“Feeding is the first essential component for any human being to grow. Once a kid is delivered, within minutes it looks for the breast. Our soils favour all types of crops. So we should ask ourselves why we don’t have enough food. The challenge is on us leaders to coarse our people and tell them that we need enough food to be healthy”, Mr. Birabarema said.

The RDC decried the poor sanitation and hygiene practices including low toilet coverage, poor bathing and handwashing habits and drinking of un boiled water.

“Sanitation is another important component for a healthy living. But you find a whole family with no toilet just using neighbouring bush! And we are leaders and honourables leading people without toilets! The RDC said adding that:



Biryabarema Elijah, Resident District Commissioner Kamwenge giving the closing remarks.

“There is where we shall apply military. Why cant we have 100% toilet coverage in Kamwenge? We should enforce as leaders for everybody to have a toilet because government will continue spending on drugs. In the developed world people die of accidents and old age. Diseases like cholera dysentery, diarrhoea are for Africans. Why have only 56% of the households boiling drinking water and the rest drink raw water like birds when is some areas people boil water for cows?” The seemingly angry RDC questioned.

He called upon district leaders, health workers and extension officers not to sit in offices and hospitals waiting for patients but also go to the communities to sensitise households and guide them on health, nutrition and related issues raised in the study.

“Let us join hands, a sick society is detrimental and it is a major cause of poverty. Let us work together to sensitise and advise the population on issues raised”

He thanked researchers for choosing Kamwenge district as a study area and implored them to extend the study to other sub counties. Kamwenge has a total of 15 sub counties, on of them is Bwizi where the research was conducted.



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