Determinants of child nutrition and mortality in north-west Uganda

Bull World Health Organ. 1992;70(5):637-43.


An anthropometric survey of children aged 0-59 months in north-west Uganda in February-March 1987 indicated a high prevalence of stunting but little wasting. Use of unprotected water supplies in the dry season, prolonged breast-feeding, and age negatively affected nutrition; in contrast, parental education level improved nutrition. Mortality during the 12 months following the survey was higher among those who had low weight-for-age and weight-for-height, but children who had low height-for-age did not have higher mortality. Weight-for-age was the most sensitive predictor of mortality at specificities > 88%, while at lower specificity levels weight-for-height was the most sensitive. Children whose fathers' work was associated with the distillation of alcohol had a higher risk of mortality than other children. The lowest mortality was among children whose fathers were businessmen or who grew tobacco.

PIP: The most frequently suggested causes of malnutrition are as follows: poverty, low parental education, lack of sanitation, low food intake, malabsorption, diarrhea and other infections, poor feeding practices, family size, short birth intervals, maternal time availability, child rearing practices, and seasonality. The purpose of this study of 1178 children 0-59 months of age from 30 villages in Arua District, Uganda, was to assess the nutritional status of this population and to identify sensitive predictors of mortality and major causes of malnutrition. Anthropometric and socioeconomic and health-related data were obtained between February and March, 1987, on the randomly selected population. Follow-up after a year provided mortality data on the sampled population. The results showed that nutritional status before the first 5 months of life was satisfactory; deterioration followed. Wasting or low weight-for-height existed predominantly among those aged 6-24 months. Stunting was high after 5 months. The proportion of underweight children was greater in the 2nd year of life; improvement occurred thereafter. Mortality rates were around 10% during the first year and declined thereafter to .5% in the 4th year. Mortality was higher among those with low weight-for-age or weight-for-height. The relative risk for mortality was 3 at less than -3 standard deviation (SD) weight-for-age. For less than -2 weight-for-height the relative risk was 4.6. Mortality was higher for children 12 months of age. Weight-for-age was the most sensitive indicator of mortality for the percentage of survivors correctly identified over 88%; for lower specificity weight-for-height was a more sensitive indicator. Paternal occupation was the only household indicator related to child mortality; i.e., high mortality was related to a father's occupation as alcohol distributor, and low mortality, to his occupation as tobacco grower or businessman. In the stepwise multiple regression, a father's education was positively correlated with weight-for-age, and a mother's education, with height-for-age. Negative influences were age, breast feeding, use of unprotected water supplies in the dry season, skin infections, and diarrhea within 2 weeks before the survey. Paternal education was positively associated, and skin infections negatively association, with weight-for-height. Unrelated factors are identified; justification of significant factors is discussed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Anthropometry*
  • Body Height
  • Body Weight
  • Child Nutritional Physiological Phenomena*
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Mortality*
  • Nutrition Surveys*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Socioeconomic Factors
  • Uganda