Nutrition and health of orphan and non-orphan children in Iganga District, Uganda
Barrientos, Patricia Ivette
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Malnutrition is associated with: 1) frequent illness episodes; 2) higher mortality; 3) delayed motor development; 4) lower cognitive function and school performance; 5) impaired work capacity as adults; 6) impaired reproductive performance; and 7) less healthy offspring (Schroeder 2001). Malnutrition is implicated in more than half of all child deaths (UNICEF 1998). In the developing world, the United Nations Children's Fund estimates that over 16% of children under five years of age are severely malnourished (UNICEF 2004). Interrelated to malnutrition are poverty and infection. Although the problems confronted by poor populations may be similar, families housing orphan children may be at a greater disadvantage. A biosocial model was employed to determine which biological and social factors affected the nutritional status and health of children in Iganga District, Uganda. A second goal was to determine if there were differences in the nutritional status of orphan and non-orphan children. By identifying the contributing factors, community programs can be developed to assist families at risk. Using qualitative and quantitative methodology, social, anthropometric, and dietary data were collected. Children 2-15 years old participated in a short medical history, a 24-hour food recall, and anthropometric measurements. Their caregivers were interviewed and 20 of the total 152 households completed a Child Behavior Questionnaire for Parents. Interviews and measurements were conducted in the participants' homes between September 2006 and January 2007. Recruitment of families with orphans was conducted with the assistance of local organizations. Other families were recruited systemically based on the location of their home. Fifteen-year-old boys and girls differed significantly in all five anthropometric indices: height-for-weight z-score (HAZ): P = 0.036, weight-for-age z-scores (WAZ): P = 0.035, body mass index z-scores (BMIZ): P = 0.049, mid-upper arm circumference z-scores (MUACZ): P < 0.001, and sum of skinfolds (SSZ): P = 0.027. Boys were more likely to be moderate or severely stunted than girls. Among orphan groups, children who had lost both parents (double orphans) had lower BMIZ and MUACZ than children those who had lost a father (paternal orphans). Children who lived with less educated primary female caregivers had higher BMIZ and were less likely to be underweight. Participants living with less educated heads-of-households had higher WHZ. The children's relation to the caregivers, household income, and orphan status were not associated with the nutritional classifications of stunting, underweight, and thinness. Children who lived in homes with ventilated improved latrines had higher WAZ than children living in homes that had basic latrines. Overall, more than 30% of the children were classified as either moderately or severely stunted. More than 23% of the children were moderately or severely underweight. Malaria was the most commonly reported children's illness, accounting for more than 40% of illness episodes. Ninety percent of illnesses were treated with medicine purchased in clinic dispensaries or convenience stores. The lack of differences in the nutritional status between orphan and non-orphan can be attributed to the local cohesiveness of family. Traditionally, the raising of children is a collective task performed by the extended family. This was the case with the orphans in this study. The children moved between homes on the advice of clan elders. By de-emphasizing biological offspring from other extended family children, orphans may have the same opportunities as their non-orphan counterparts. Although further research is suggested, programs can be developed to assist the whole community rather than simply targeting households fostering orphan children.