Our Work in Africa: Uganda


Uganda
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The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins and nutrition outcomes, the role of livestock promotion in enhancing diet quality, and the links between sanitation (open defecation practices) and nutrition outcomes. Combining resources from Uganda, US institutions, and global partners the research and capacity building activities of the Nutrition Innovation Lab focus on operationally and policy-relevant work that supports both national government and USAID priorities.

Nutrition Innovation Lab’s vision of success is a set of robust empirical findings that can be quickly translated into policy and practice. We aim for our work to support enhanced outcomes globally not just locally, as new findings are adopted nationally and regionally. Furthermore, we hope our research platform can synergistically help other research entities with related goals.

Capacity Building

  • A total of 21 students will have received Masters or Doctorate degrees with partial or full funding from the Nutrition Innovation Lab.
  • 20 Ugandan students have attended the rigorous Boston to Bangalore Nutrition Collaborative (BBNC) training course in Bangalore India over the past four years with financial support from the lab.
  • Many government officials have attended workshops and District Dissemination Meetings gaining capacity for designing and implementing nutrition programming.  Our engagement with government officials have included both Local District Governments and Line Minisitries, ie. Ministry of Agriculture, Ministry of Health.
  • Forty professionals attended training on issues in public health nutrition, grant writing and research proposal development.  This is emblematic of our support for career enhancing activities for Ugandan professionals, policy makers, and academics.
  • The Nutrition Innovation Lab is working in collaboration with Makerere University to design and implement a modulated short course in Public Health Nutrition Practices and Programming aimed at filling in curricular gaps in the current set of educational offerings across Uganda. Through short courses students will be equipped to tackle nutritional issues in a multi-faceted and systematic way. These courses are being offered online with a customized version of Tufts University’s online learning system (TUSK), which is an open source platform for learning an content management.

The Nutrition Innovation Lab has undertaken the following research activities in Uganda

Relationships have been forged with partners such as Makerere University, Gulu University, SPRING (Strengthening Partners, results, and Innovations in Nutrition Globally), NASA, Heifer International (HI), UIC, IITA, UGA, International Food Policy Research Institute (IFPRI), and FHI360.  One set of Nutrition Innovation Lab’s core research revolves around the USAID Uganda Community Connector Project (UCCP), an integrated agriculture and nutrition intervention package implemented by FHI360. This includes the following activities:

  • A comprehensive, repeated panel survey assessing agriculture, nutrition, and health pathways and providing evaluation data to UCCP.  The survey was conducted at the end of 2012, and repeated at the end of 2014.
  • A prospective birth cohort study to dis-entangle the nutrition or health gains of key target groups (e.g. pregnant women and infants). The birth cohort study is a ‘platform’ which can be used to assess top-rank hypotheses, like linking Water, Sanitation, and Hygiene (WASH) and mycotoxins (aflatoxin/ mold) to nutrition, while answering key questions on how and why integrated interventions may succeed. The cohort study began enrolling women in 2014.
  • Process research to examine the implementation of multisectoral actions for good nutrition.  This has included key informant interviews with central policy makers, and district administrations.

Additional activities in Uganda include

  • The Nutrition Innovation Lab has supported a birth cohort study in Gulu which has examined food insecurity, depression, and other psycho-social factors which affect maternal and infant nutrition.  This project has been run by Barnabus Natamba of Gulu University.  Exposure to aflatoxin molds during pregnancy and early infancy is being assessed with the support of USAID/ East Africa.
  • An analysis conducted by Kabunga Nassul, Ph.D., examined the relationship of household food insecurity, and anemia in women with fruit and vegetable production.  This analysis found that fruit and vegetable production was linked to consumption and significantly less anemia in women of childbearing age.  This is an example of concrete biologically plausible agriculture to nutrition pathway.
  • The Nutrition Innovation Lab with UIC pilot validated an innovative water quality assessment test, the Aquagenx compartment bag test (ACBT).  Use of the ACBT in the prospective birth cohort study will allow the Lab and UCCP to assess WASH (Water, Sanitation, & Hygiene) relating to under-nutrition and health.
  •   A secondary analysis utilizing a NASA dataset examined agricultural land use, biomass fuel and health. It examined the role of cooking fuels from agricultural land and forests in causing respiratory illness, which are linked to poor nutrition.
  • Modeling the links of agriculture productivity to nutrition through the interaction of seasonality and climate variability with agricultural output and nutrition and how geography (agro-ecology, altitude, remoteness from markets) affects household outcomes is underway.
  • The Nutrition Innovation Lab advocates for the need to examine the role of aflatoxin exposure in maternal and infant nutrition, has lead to an Associate Award to fund further analyses in the Ugandan studies.
  • The Nutrition Innovation Lab in collaboration with the Nutrition Innovation Lab Asia facilitated a study of aflatoxin exposure and nutrition in Timor Leste partnering with the University of Jakarta (Indonesia), UNICEF in Timor Leste and the University of Georgia aflatoxin research laboratories (linked to the Peanut and Mycotoxin Innovation Lab).
  • A series of dissemination seminars have been held at the national and district level over several years.

Charting the cost of nutritionally-adequate diets in Uganda, 2000-2011

Authors: George Omiat; Gerald Shively March 2017
Although malnutrition rates have been on the decline in Uganda over the past two decades, they remain high. Challenges to achieving nutritional improvements result, in part, from high staple foods prices, which raise the cost of the food basket and increase the risk of food and nutrition insecurity, especially for poor households who are net buyers of staple foods. Nearly two-thirds of Ugandan households are net buyers of staples, a pattern that highlights the potential importance of food prices as a key driver of food...
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Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Authors: Elizabeth Widen; Claire Biribawa; Daniel Acidri; Winifred Achoko; Harriet Achola; Jeffrey Griffiths; Sera Young January 2017
A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, mid upper arm circumference, triceps skin fold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time.
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Optimizing the Multisectoral Nutrition Policy Cycle: A Systems Perspective

Authors: Sascha Lamstein; Amanda Pomeroy-Stevens; Patrick Webb; Eileen Kennedy December 2016
Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutrition policy cycle, including how governance and financing support that process. It also...
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Prioritizing and Funding the Uganda Nutrition Action Plan

Authors: Amanda Pomeroy-Stevens; Hannah Foehringer Merchant; Abel Muzoora; Ezekiel Mupere; Lidan Du December 2016
In 2010, Uganda began developing its first multisectoral nutrition plan, the Uganda Nutrition Action Plan (UNAP), to reduce malnutrition. While the UNAP signals high-level commitment to addressing nutrition, knowledge gaps remain about how to successfully implement such a plan. We tracked the UNAP’s influence on the process of priority setting and funding for nutrition from 2013 to 2015
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Assessing Progress in Implementing Uganda’s Nutrition Action Plan: District-Level Insights

Authors: Edgar Agaba; Shibani Ghosh; Jeffrey K. Griffiths December 2016
The 2011 Uganda Nutrition Action Plan (UNAP) established 2016 maternal and child nutrition targets. However, there is a lack of routine district-level data collection to assess UNAP implementation.  The Nutrition Innovation Lab collected serial household-level survey data (n = 3600) in 6 districts, including 2 UNAP implementation districts, in 2012 and 2014. Questionnaires focused on food security, nutrition, and health, among others, and included specific indicators relevant to UNAP’s targets.
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Nutrition Innovation Lab Annual Report- Year 6

Authors: Nutrition Innovation Lab November 2016
The following are the annual reports of the Feed the Future Innovation Lab for Nutrition for the fiscal year 2016 starting October 2015 through September 2016 (“Y6”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins...
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Infrastructure mitigates the sensitivity of child growth to local agriculture and rainfall in Nepal and Uganda

Authors: Gerald Shively November 2016
Incorporating agriculture into nutrition policy requires an understanding of how agricultural performance, rainfall, and the economic and physical environments in which children reside relate to linear growth and weight gain. This paper combines anthropometric data from children below the age of 5 y in Nepal and Uganda with rainfall data and other information to measure these connections. Anthropometric outcomes are positively correlated with rainfall prior to birth, during the first year, and during agricultural growing seasons preceding child measurement. High rainfall is found to be...
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The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Authors: Barnabas Natamba; Jane Achan; Rebecca Stoltzfus; Sera Young August 2016
Abstract Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied...
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Cross-sectional but not Longitudinal Measures of Food Insecurity are Associated with the Rate of Weight Gain during Pregnancy in Northern Uganda

Authors: Barnabas Natamba; Francoise Vermeylen; Elizabeth Widen; Shibani Ghosh; Patsy Brannon; Sera Young April 2016
Food insecurity (FI) during pregnancy may lead to adverse health outcomes for affected women. However, little is known on whether such effects are due to short-term within person changes (longitudinal effects) in FI or long-term between person differences (cross-sectional effects) in this exposure. Therefore, the aim of this study was to assess whether differences in cross-sectional measures of FI between women (defined as the mean prenatal IFIAS score) and/or longitudinal changes in FI within women
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Progression of antepartum depression differs by level of perceived social support and food insecurity

Authors: Barnabas Natamba; Francoise Vermeylen; Rebecca Joyce Stoltzfus; Jeffrey Griffiths April 2016
Antepartum depression (AD) is a risk factor for adverse pregnancy outcomes and may be worsened by food insecurity (FI) and lack of social support (SS). We studied the progression of AD from mid gestation to term and examined whether such progression differed by measures of SS and longitudinal measures of FI
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Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV-Infected Pregnant Women and Reduced Linear Growth of HIV-Exposed Infants

Authors: Barnabas Natamba; Jeffrey Griffiths April 2016
Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda.
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HIV-Infected Pregnant and Lactating Women have Higher Serum Aflatoxin levels than HIV–Uninfected Women and Aflatoxin Levels are Higher during Early Postpartum than during Pregnancy among HIV-Infected Women

Authors: Barnabas Natamba; Shibani Ghosh; Jeffrey Griffiths April 2016
Aflatoxins are carcinogenic and may affect linear growth. Prior cross-sectional data from Ghana have shown that aflatoxin levels are ~ 20% higher among HIV-infected than HIV-uninfected post-partum women. It is not known if HIV-infected pregnant women have elevated serum aflatoxin levels during pregnancy, or if aflatoxin levels change during the perinatal period. We therefore studied these relationships among a cohort of 246 women recruited in Gulu, Uganda, and followed through pregnancy and early infant life. All HIV-positive women received HIV antiretroviral therapy for free from...
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HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

Authors: Barnabas Natamba; Jeffrey Griffiths; Patsy Brannon; Saurabh Mehta April 2016
Adequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub-Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth.
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High levels of food insecurity were observed among HIV, TB, and HIV/TB co-infected outpatients in northern Uganda

Authors: Mia Monique Blakstad; Barnabas Natamba April 2016
Food insecurity among individuals living with HIV is well-recognized globally. Since comorbidity with TB is common, particularly in sub-Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.
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District Presentations: Effectiveness of Integrated Agriculture, Health Livelihood and Nutrition Interventions to Improve Maternal and Child Nutrition and Health in Rural Uganda: A Birth Cohort Study.

Authors: Bernard Bashaasha; Florence Kinyata April 2016
These presentations were made in various Ugandan Districts, covering data gathered during the Uganda Birth Cohort Study specific to each of those districts. The presentations were delivered in April of 2016 by Drs. Bernard Bashaasha and Florence Kinyata. Click on the district name to see its specific presentation. Agweng Aduku Agoro Apac Atanga Atyakc Ayer Buganagri Buyanja Bwizi Kebisoni Nyamweru Parombo Kibiito Rugyeyo Ruhija
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Effect of Nutrition-Sensitive Agricultural Extension Program on Nutrition Knowledge and Dietary Practices of Farming Households in Mukono District, Central Uganda

Authors: Elizabeth Asiimwe April 2016
This poster presentation discusses the outcomes of an extension program implemented in the Mukono District of Central Uganda. It was investigating the knowledge levels of nutrition among men and women, as well as factors that influenced diet diversity among farming households.
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Got Baby Food? Understanding the Market for Packaged Complementary Foods in Developing Countries

Authors: William Masters February 2016
This presentation was delivered by Dr. William Masters on Feb. 3, 2016 as a Friedman School Seminar, Tufts University.
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Nutrition Innovation Lab Annual Reports- Year 5

Authors: Nutrition Innovation Lab December 2015
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2015 starting October 2014 through September 2015 (“Y5”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the...
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Community Connector: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This presentation was made to the Ugandan Community Connector and is an update on the Birth Cohort Study in Uganda on Oct. 20, 2015.
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Africa Day: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This poster presentation was featured at the Africa Day for Food and Nutrition Security in Kampala Uganda on Oct. 28-30, 2015.
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Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries

Authors: David Pelletier; Barnabas Natamba; Dia Sanou; Jackson Tumwine August 2015
Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda.
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Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Authors: Shalean Collins; Barnabas Natamba; Angela Arbach; Elizabeth Widen; Pooja Desai; Hijab Khan; Jeffrey Griffiths; Sera Young July 2015
Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal-infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low-income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.
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Understanding Pathways of Better Nutrition: Poster Presentation

Authors: Edgar Agaba June 2015
This poster is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab.  The poster was presented at the LCIRAH Research Conference, June 03-04, 2015.  
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Social support modifies the bidirectional linkages between food insercutiy and prenatal depresseive symptoms while domestic violence alters the unidirectional impact of food insecurity on prenatal depressive symptoms

Authors: Barnabas Natamba June 2015
This presentation by Barnabas Natamba examines and draws links between food security/ nutrition and social support/ mental health/ HIV status.
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Strengthening Policy Actions and Governance for Nutrition

Authors: Patrick Webb; Amanda Pomeroy May 2015
This is the joint Nutrition Lab/SPRING presentation to USAID on common research activities in Nepal and Uganda regarding policy and governance for nutrition.  It was presented May 5th, 2015 in Washington DC.
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Agricultural policy for improved nutrition in Africa and Asia: evidence to guide the US Government’s investments in food security

Authors: William Masters; Katherine Dennison; Jeff Hill; Elizabeth Jordan-Bell; Ahmed Kablan; Melanie Thurber; Lorraine Weatherspoon; James Oehmke May 2015
The roundtable process was designed to complement numerous past and ongoing efforts to assemble and disseminate rigorous evidence on how agricultural change can best help to improve international nutrition, beginning with the first Lancet Maternal and Child Nutrition series in 2008 and its follow-up in 2013 and other systematic reviews (Webb and Kennedy 2014), as well as assessments from private groups such as the Copenhagen Consensus (2014) and the Global Panel on Agriculture and Food Systems for Nutrition (2014), international organizations such as the World...
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Understanding Pathways of Better Nutrition

Authors: Edgar Agaba April 2015
This presentation is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab. It was originally presented it to  Faculty and students on Wednesday, April 29th 2015: Sackler Room 316, 4:00 – 7:30 p.m as part of the ALE Presentations.
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Maternal Food Insecurity is Associated with Loss of Fat, but not Lean Mass during Lactation among Ugandans of Mixed-HIV Status

Authors: E. Widen; B. Natamba; S. Ghosh; J. Griffiths April 2015
HIV-infected women lose more weight during lactation than HIV-uninfected women. Whether this loss is fat-mass (FM) or fat-free mass (FFM) is unknown, but important, as lean mass loss accelerates HIV progression.
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Maternal HIV Infection, but not Food Insecurity, Predicts the Pattern of Weight Gain in Pregnant Women Attending Antenatal Services in Northern Uganda

Authors: Barnabas Natamba; Elizabeth Widen; Patsy Brannon; Sautabh Mehta April 2015
In Sub-Saharan Africa, the differential impact of maternal HIV infection and/or food insecurity on the pattern of weight gain among pregnant women is unknown. To fill this gap, data on 402 pregnant women (33% HIV+ & participating in antiretroviral treatment) enrolled in a perinatal cohort study at Gulu Regional Referral Hospital in northern Uganda were analyzed.
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Social Support Modifies Bidirectional Linkages Between Food Insecurity and Prenatal Depressive Symptoms while Domestic Violence Alters the Unidirectional Impact of Food Insecurity on Prenatal Depressive Symptoms

Authors: Barnabas Natamba; Shibani Ghosh; Sera Young April 2015
To inform perinatal nutrition and mental health interventions, we used a cohort study to: 1) examine the directionality of relationships between maternal food insecurity (MFI) and prenatal depressive symptoms (PDS); and 2) see if social support (SS) or domestic violence (DV) modify this relationship. We enrolled 403 Ugandan pregnant women (33% HIV+ on antiretrovirals)) in mid-gestation and assessed them monthly through delivery for MFI (IFIAS) and the PDS (CES-D) using validated scales.
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Maternal HIV infection, but not food insercutity access score, predicts the rate of weight change in pregnant women attending antenatal services in northern Uganda

Authors: Barnabas Natamba April 2015
This poster examines seasonal food security/ insecurity, MUAC measurements, and HIV status in Uganda.
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Microbial Decontamination of Fresh Produce (Strawberry) Using Washing Solutions

Authors: Naresh Shahi; Byungjin Min; Eunice A. Bonsi March 2015
This Tuskegee University study was carried out to determine the effect of natural antimicrobial washing solutions against microbial growths on fresh produce specifically strawberries. Selected washing solutions used for strawberry washing, and treatments were sterile water (control), white vinegar (VI), crude lemon juice extract (LE), VI+Origanum oil (VIO), LE+Origanum oil (LEO), and VI+LE+Origanum oil (VILEO).
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Connecting the dots between human malaria, livestock, and under-nutrition: An unexpected pathway

Authors: Jeffrey Griffiths; Nassul Kabunga March 2015
Presentation given by Drs. Jeff Griffiths and Nassul Kabunga for USAID in Washington DC, March 15, 2015
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Malaria predicts maternal and child anemia in Uganda and is modulated by altitude and prior IRS

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths for USAID in Kampala, Uganda, Feb. 10, 2015
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Why Food is Not Enough-Boston University

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths at Boston University, February 27, 2015
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Why Food is Not Enough-BBNC

Authors: Jeffrey Griffiths January 2015
Presentation given by Dr. Jeff Griffiths at the Boston to Bangalore Nutrition Collaboration event, January 2015
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Chapter 7: Childhood Threats to Adult Cognition in Sub- Saharan Africa: Malaria, Anemia, Stunting, Enteric Enteropathy, and the Microbiome of Malnutrition

Authors: Jeffrey Griffiths; Joyce Kikafunda December 2014
Many common childhood conditions are associated with cognitive deficits. While some causes of impaired cognition, such as lead exposure, are well understood, other common conditions in countries such as Uganda – malnutrition, anemia and malaria – are not sufficiently recognized. In this chapter we discuss stunting and its root causes of undernutrition, a lack of sanitation and its relationship to environmental enteropathy and the intestinal microbiome. We also review information about iron-deficiency anemia and malaria, and their neurological and cognitive consequences. We believe that cognitive declines later in life,...
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Cover Image: Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young November 2014
In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th....
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“Eat your Fruits and Vegetables and Don’t Get Malaria”: Linkages between Agriculture, Nutrition, and Health in Uganda

Authors: Jeffrey Griffiths November 2014
Presentation given by Dr. Jeff Griffiths for the Center for Global Public Health Event at Tufts University, Nov. 20, 2014
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“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

Authors: SL Young; F Luwedde; B. Okia; P Natureeba; L. Johnson; C. Michel; M. Robine; E. Charlebois; D. Havlir November 2014
We evaluated the acceptability and use of macronutrient supplementation among HIV-infected pregnant Ugandan women receiving antiretroviral therapy in a clinical study (NCT 00993031). We first conducted formative research among 56 pregnant and lactating women to select a supplement regimen. Acceptability and use of the supplementation regimen (35 sachets of lipid-based nutrient supplements (LNS) and 4 or 6 kg of instant soy porridge for the household provided monthly) were evaluated among 87 pregnant women. Organoleptic assessments of LNS were favorable. Participants reported consuming LNS a mean...
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Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

Authors: Sera Young; Flavia Luwedde; Paul Natureeba; Jane Achan ; Veronica Ades; Beth Osterbauer; Edwin Charlebois; Moses Kamya; Diane Havlir; Deborah Cohan November 2014
Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial...
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Cover-Brown et al 2014

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change

Authors: Molly E. Brown; Kathryn Grace; Gerald Shively; Kiersten B. Johnson; Mark Carroll September 2014
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices....
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Cover Image:Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Authors: Barnabas K. Natamba; Angela Arbach; Hillary Kilama; Jane Achah; Jeffrey Griffiths; Sera Young August 2014
Food security occurs “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework. FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infected with HIV, women and children. Women’s responsibilities in managing family...
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Determinants of Nutritional Outcomes Among Children below Five Years of Age in Uganda

Authors: Happy Providence June 2014
 This thesis presents findings of a study that sought to understand determinants of nutritional outcomes of children below five years of age in Uganda. Understanding these determinants was vital because in the Ugandan situation, most of the determinants are not ade8uately understood.  Even for those that are known, the magnitude of their impact and or the relative strengths of their impact on nutritional outcomes across regions is not well known.
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Factors Associated with Complementary Feeding Practices Among Children age 6-23 months in Pader District

Authors: Caroline Nambafu June 2014
Infant and young child feeding has been known to compromise the health of children among which complementary  feeding plays a major part. Even communities that have performed adequately in breast feeding have had  their  efforts undermined by complementary feeding hence causing malnutrition among their children.  This study was conducted with the aim of finding out factors that are associated with complementary feeding among the children in Pader district.
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Factors Associated with Dietary Diversity Among Women of Reproductive Age (15-49 yrs) in Agago District

Authors: Ray Oroma June 2014
Despite the internationally accepted recommendation that eating a diversity of foods leads to a healthy diet, and is associated with positive health outcomes such as reduced mortality, little information exists on what factors influence dietary diversity among women of reproductive age in Agago district.  The objective of this study is to determine dietary diversity among women of reproductive age (15-49 years) in Agago district.
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Cover Image-Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna May 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Cover Image: Land use change, fuel use and respiratory health in Uganda

Land use change, fuel use and respiratory health in Uganda

Authors: Pamela Jagger; Gerald Shively April 2014
This paper examines how biomass supply and consumption are affected by land use change in Uganda. We find that between 2007 and 2012 there was a 22% reduction in fuelwood sourced from proximate forests, and an 18% increase in fuelwood sourced from fallows and other areas with lower biomass availability and quality. We estimate a series of panel regression models and find that deforestation has a negative effect on total fuel consumed. We also find that access to forests, whether through ownership or proximity, plays...
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Can Smallholder Fruit and Vegetable Production Systems Improve Household Food Security and Nutritional Status of Women?

Authors: Nassul Kabunga; Shibani Ghosh; Jeffrey Griffiths April 2014
This paper aims to empirically infer potential causal linkages between fruit and vegetable (F&V) production, individual F&V intake, household food security, and anemia levels for individual women caregivers of childbearing age. Using a unique and rich data set recently collected from rural smallholder Ugandan households, we show that the use of a qualitative tool to measure household food insecurity is robust and applicable in other contexts. We also show, using robust econometric methods, that women living in F&V-producer households have a significantly higher intake of...
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Maternal food insecurity, anemia, and social support are independently associated with prenatal depression among HIV-positive and -negative women attending antenatal services in northern Uganda

Authors: Barnabas Natamba; Thomas Oyok; Sophie Mou; Shibani Ghosh; Rebecca Stoltzfus; Jeffrey Griffiths; Sera Young April 2014
Limited data exist on prenatal depression in in high HIV burden resource-poor settings. Population: 403 pregnant clinic attendees at Gulu Hospital, Uganda. HIV (+) women were oversampled in a ratio of 1 HIV (+): 2 HIV
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Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna February 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Improved Dairy Cows in Uganda: Pathways to Poverty Alleviation and Improved Child Nutrition

Authors: Nassul Kabunga February 2014
There is limited empirical evidence on the linkages between agrotechnologies, poverty reduction and the pathways to better nutrition outcomes. The introduction and dissemination of improved dairy cow breeds in Uganda is arguably the most significant step taken to develop a modern and commercial dairy industry in the country over the last two decades. This study uses a nationally representative sample of Ugandan households to rigorously examine the impact of adoption of improved dairy cow breeds on enterprise-, household-, and individual child-level nutrition outcomes. We find...
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Nutrition Innovation Lab Annual Reports- Year 3

Authors: Nutrition Innovation Lab October 2013
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2013 starting October 2012 through September 2013 (“Y3”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Uganda Baseline Report: Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households.

Authors: Nutrition Innovation Lab October 2013
This report provides baseline and nationally representative data regarding nutritional and health issues in Uganda, particularly in terms of maternal and child health. Areas of assessment include livestock, malaria, aflatoxin exposure, water access, sanitation, and dietary information
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Cover Image Baseling Report Uganda 2013

Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households

Authors: Joyce Kikafunda Et Al. March 2013
There is significant movement globally and in Uganda on addressing issues of nutrition and health in vulnerable populations including women and children. This is especially important since approximately 0.5 million women die each year of pregnancy related complications linked under nutrition, while more than 5 million pre-school children die of preventable causes due to the combined effects of disease and under nutrition. There is some progress being made globally, with 63 countries as of 2010 on track to achieve the First Millennium Development Goal (MDG)...
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Nutrition Innovation Lab Annual Reports- Year 2

Authors: Nutrition Innovation Lab October 2012
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2012 starting October 2011 through September 2012 (“Y2”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Charting the cost of nutritionally-adequate diets in Uganda, 2000-2011

Authors: George Omiat; Gerald Shively March 2017
Although malnutrition rates have been on the decline in Uganda over the past two decades, they remain high. Challenges to achieving nutritional improvements result, in part, from high staple foods prices, which raise the cost of the food basket and increase the risk of food and nutrition insecurity, especially for poor households who are net buyers of staple foods. Nearly two-thirds of Ugandan households are net buyers of staples, a pattern that highlights the potential importance of food prices as a key driver of food...
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Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Authors: Elizabeth Widen; Claire Biribawa; Daniel Acidri; Winifred Achoko; Harriet Achola; Jeffrey Griffiths; Sera Young January 2017
A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, mid upper arm circumference, triceps skin fold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time.
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Optimizing the Multisectoral Nutrition Policy Cycle: A Systems Perspective

Authors: Sascha Lamstein; Amanda Pomeroy-Stevens; Patrick Webb; Eileen Kennedy December 2016
Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutrition policy cycle, including how governance and financing support that process. It also...
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Prioritizing and Funding the Uganda Nutrition Action Plan

Authors: Amanda Pomeroy-Stevens; Hannah Foehringer Merchant; Abel Muzoora; Ezekiel Mupere; Lidan Du December 2016
In 2010, Uganda began developing its first multisectoral nutrition plan, the Uganda Nutrition Action Plan (UNAP), to reduce malnutrition. While the UNAP signals high-level commitment to addressing nutrition, knowledge gaps remain about how to successfully implement such a plan. We tracked the UNAP’s influence on the process of priority setting and funding for nutrition from 2013 to 2015
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Assessing Progress in Implementing Uganda’s Nutrition Action Plan: District-Level Insights

Authors: Edgar Agaba; Shibani Ghosh; Jeffrey K. Griffiths December 2016
The 2011 Uganda Nutrition Action Plan (UNAP) established 2016 maternal and child nutrition targets. However, there is a lack of routine district-level data collection to assess UNAP implementation.  The Nutrition Innovation Lab collected serial household-level survey data (n = 3600) in 6 districts, including 2 UNAP implementation districts, in 2012 and 2014. Questionnaires focused on food security, nutrition, and health, among others, and included specific indicators relevant to UNAP’s targets.
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Nutrition Innovation Lab Annual Report- Year 6

Authors: Nutrition Innovation Lab November 2016
The following are the annual reports of the Feed the Future Innovation Lab for Nutrition for the fiscal year 2016 starting October 2015 through September 2016 (“Y6”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins...
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Infrastructure mitigates the sensitivity of child growth to local agriculture and rainfall in Nepal and Uganda

Authors: Gerald Shively November 2016
Incorporating agriculture into nutrition policy requires an understanding of how agricultural performance, rainfall, and the economic and physical environments in which children reside relate to linear growth and weight gain. This paper combines anthropometric data from children below the age of 5 y in Nepal and Uganda with rainfall data and other information to measure these connections. Anthropometric outcomes are positively correlated with rainfall prior to birth, during the first year, and during agricultural growing seasons preceding child measurement. High rainfall is found to be...
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The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Authors: Barnabas Natamba; Jane Achan; Rebecca Stoltzfus; Sera Young August 2016
Abstract Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied...
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Cross-sectional but not Longitudinal Measures of Food Insecurity are Associated with the Rate of Weight Gain during Pregnancy in Northern Uganda

Authors: Barnabas Natamba; Francoise Vermeylen; Elizabeth Widen; Shibani Ghosh; Patsy Brannon; Sera Young April 2016
Food insecurity (FI) during pregnancy may lead to adverse health outcomes for affected women. However, little is known on whether such effects are due to short-term within person changes (longitudinal effects) in FI or long-term between person differences (cross-sectional effects) in this exposure. Therefore, the aim of this study was to assess whether differences in cross-sectional measures of FI between women (defined as the mean prenatal IFIAS score) and/or longitudinal changes in FI within women
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Progression of antepartum depression differs by level of perceived social support and food insecurity

Authors: Barnabas Natamba; Francoise Vermeylen; Rebecca Joyce Stoltzfus; Jeffrey Griffiths April 2016
Antepartum depression (AD) is a risk factor for adverse pregnancy outcomes and may be worsened by food insecurity (FI) and lack of social support (SS). We studied the progression of AD from mid gestation to term and examined whether such progression differed by measures of SS and longitudinal measures of FI
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Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV-Infected Pregnant Women and Reduced Linear Growth of HIV-Exposed Infants

Authors: Barnabas Natamba; Jeffrey Griffiths April 2016
Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda.
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HIV-Infected Pregnant and Lactating Women have Higher Serum Aflatoxin levels than HIV–Uninfected Women and Aflatoxin Levels are Higher during Early Postpartum than during Pregnancy among HIV-Infected Women

Authors: Barnabas Natamba; Shibani Ghosh; Jeffrey Griffiths April 2016
Aflatoxins are carcinogenic and may affect linear growth. Prior cross-sectional data from Ghana have shown that aflatoxin levels are ~ 20% higher among HIV-infected than HIV-uninfected post-partum women. It is not known if HIV-infected pregnant women have elevated serum aflatoxin levels during pregnancy, or if aflatoxin levels change during the perinatal period. We therefore studied these relationships among a cohort of 246 women recruited in Gulu, Uganda, and followed through pregnancy and early infant life. All HIV-positive women received HIV antiretroviral therapy for free from...
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HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

Authors: Barnabas Natamba; Jeffrey Griffiths; Patsy Brannon; Saurabh Mehta April 2016
Adequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub-Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth.
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High levels of food insecurity were observed among HIV, TB, and HIV/TB co-infected outpatients in northern Uganda

Authors: Mia Monique Blakstad; Barnabas Natamba April 2016
Food insecurity among individuals living with HIV is well-recognized globally. Since comorbidity with TB is common, particularly in sub-Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.
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District Presentations: Effectiveness of Integrated Agriculture, Health Livelihood and Nutrition Interventions to Improve Maternal and Child Nutrition and Health in Rural Uganda: A Birth Cohort Study.

Authors: Bernard Bashaasha; Florence Kinyata April 2016
These presentations were made in various Ugandan Districts, covering data gathered during the Uganda Birth Cohort Study specific to each of those districts. The presentations were delivered in April of 2016 by Drs. Bernard Bashaasha and Florence Kinyata. Click on the district name to see its specific presentation. Agweng Aduku Agoro Apac Atanga Atyakc Ayer Buganagri Buyanja Bwizi Kebisoni Nyamweru Parombo Kibiito Rugyeyo Ruhija
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Effect of Nutrition-Sensitive Agricultural Extension Program on Nutrition Knowledge and Dietary Practices of Farming Households in Mukono District, Central Uganda

Authors: Elizabeth Asiimwe April 2016
This poster presentation discusses the outcomes of an extension program implemented in the Mukono District of Central Uganda. It was investigating the knowledge levels of nutrition among men and women, as well as factors that influenced diet diversity among farming households.
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Got Baby Food? Understanding the Market for Packaged Complementary Foods in Developing Countries

Authors: William Masters February 2016
This presentation was delivered by Dr. William Masters on Feb. 3, 2016 as a Friedman School Seminar, Tufts University.
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Nutrition Innovation Lab Annual Reports- Year 5

Authors: Nutrition Innovation Lab December 2015
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2015 starting October 2014 through September 2015 (“Y5”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the...
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Community Connector: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This presentation was made to the Ugandan Community Connector and is an update on the Birth Cohort Study in Uganda on Oct. 20, 2015.
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Africa Day: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This poster presentation was featured at the Africa Day for Food and Nutrition Security in Kampala Uganda on Oct. 28-30, 2015.
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Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries

Authors: David Pelletier; Barnabas Natamba; Dia Sanou; Jackson Tumwine August 2015
Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda.
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Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Authors: Shalean Collins; Barnabas Natamba; Angela Arbach; Elizabeth Widen; Pooja Desai; Hijab Khan; Jeffrey Griffiths; Sera Young July 2015
Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal-infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low-income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.
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Understanding Pathways of Better Nutrition: Poster Presentation

Authors: Edgar Agaba June 2015
This poster is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab.  The poster was presented at the LCIRAH Research Conference, June 03-04, 2015.  
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Social support modifies the bidirectional linkages between food insercutiy and prenatal depresseive symptoms while domestic violence alters the unidirectional impact of food insecurity on prenatal depressive symptoms

Authors: Barnabas Natamba June 2015
This presentation by Barnabas Natamba examines and draws links between food security/ nutrition and social support/ mental health/ HIV status.
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Strengthening Policy Actions and Governance for Nutrition

Authors: Patrick Webb; Amanda Pomeroy May 2015
This is the joint Nutrition Lab/SPRING presentation to USAID on common research activities in Nepal and Uganda regarding policy and governance for nutrition.  It was presented May 5th, 2015 in Washington DC.
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Agricultural policy for improved nutrition in Africa and Asia: evidence to guide the US Government’s investments in food security

Authors: William Masters; Katherine Dennison; Jeff Hill; Elizabeth Jordan-Bell; Ahmed Kablan; Melanie Thurber; Lorraine Weatherspoon; James Oehmke May 2015
The roundtable process was designed to complement numerous past and ongoing efforts to assemble and disseminate rigorous evidence on how agricultural change can best help to improve international nutrition, beginning with the first Lancet Maternal and Child Nutrition series in 2008 and its follow-up in 2013 and other systematic reviews (Webb and Kennedy 2014), as well as assessments from private groups such as the Copenhagen Consensus (2014) and the Global Panel on Agriculture and Food Systems for Nutrition (2014), international organizations such as the World...
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Understanding Pathways of Better Nutrition

Authors: Edgar Agaba April 2015
This presentation is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab. It was originally presented it to  Faculty and students on Wednesday, April 29th 2015: Sackler Room 316, 4:00 – 7:30 p.m as part of the ALE Presentations.
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Maternal Food Insecurity is Associated with Loss of Fat, but not Lean Mass during Lactation among Ugandans of Mixed-HIV Status

Authors: E. Widen; B. Natamba; S. Ghosh; J. Griffiths April 2015
HIV-infected women lose more weight during lactation than HIV-uninfected women. Whether this loss is fat-mass (FM) or fat-free mass (FFM) is unknown, but important, as lean mass loss accelerates HIV progression.
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Maternal HIV Infection, but not Food Insecurity, Predicts the Pattern of Weight Gain in Pregnant Women Attending Antenatal Services in Northern Uganda

Authors: Barnabas Natamba; Elizabeth Widen; Patsy Brannon; Sautabh Mehta April 2015
In Sub-Saharan Africa, the differential impact of maternal HIV infection and/or food insecurity on the pattern of weight gain among pregnant women is unknown. To fill this gap, data on 402 pregnant women (33% HIV+ & participating in antiretroviral treatment) enrolled in a perinatal cohort study at Gulu Regional Referral Hospital in northern Uganda were analyzed.
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Social Support Modifies Bidirectional Linkages Between Food Insecurity and Prenatal Depressive Symptoms while Domestic Violence Alters the Unidirectional Impact of Food Insecurity on Prenatal Depressive Symptoms

Authors: Barnabas Natamba; Shibani Ghosh; Sera Young April 2015
To inform perinatal nutrition and mental health interventions, we used a cohort study to: 1) examine the directionality of relationships between maternal food insecurity (MFI) and prenatal depressive symptoms (PDS); and 2) see if social support (SS) or domestic violence (DV) modify this relationship. We enrolled 403 Ugandan pregnant women (33% HIV+ on antiretrovirals)) in mid-gestation and assessed them monthly through delivery for MFI (IFIAS) and the PDS (CES-D) using validated scales.
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Maternal HIV infection, but not food insercutity access score, predicts the rate of weight change in pregnant women attending antenatal services in northern Uganda

Authors: Barnabas Natamba April 2015
This poster examines seasonal food security/ insecurity, MUAC measurements, and HIV status in Uganda.
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Microbial Decontamination of Fresh Produce (Strawberry) Using Washing Solutions

Authors: Naresh Shahi; Byungjin Min; Eunice A. Bonsi March 2015
This Tuskegee University study was carried out to determine the effect of natural antimicrobial washing solutions against microbial growths on fresh produce specifically strawberries. Selected washing solutions used for strawberry washing, and treatments were sterile water (control), white vinegar (VI), crude lemon juice extract (LE), VI+Origanum oil (VIO), LE+Origanum oil (LEO), and VI+LE+Origanum oil (VILEO).
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Connecting the dots between human malaria, livestock, and under-nutrition: An unexpected pathway

Authors: Jeffrey Griffiths; Nassul Kabunga March 2015
Presentation given by Drs. Jeff Griffiths and Nassul Kabunga for USAID in Washington DC, March 15, 2015
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Malaria predicts maternal and child anemia in Uganda and is modulated by altitude and prior IRS

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths for USAID in Kampala, Uganda, Feb. 10, 2015
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Why Food is Not Enough-Boston University

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths at Boston University, February 27, 2015
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Why Food is Not Enough-BBNC

Authors: Jeffrey Griffiths January 2015
Presentation given by Dr. Jeff Griffiths at the Boston to Bangalore Nutrition Collaboration event, January 2015
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Chapter 7: Childhood Threats to Adult Cognition in Sub- Saharan Africa: Malaria, Anemia, Stunting, Enteric Enteropathy, and the Microbiome of Malnutrition

Authors: Jeffrey Griffiths; Joyce Kikafunda December 2014
Many common childhood conditions are associated with cognitive deficits. While some causes of impaired cognition, such as lead exposure, are well understood, other common conditions in countries such as Uganda – malnutrition, anemia and malaria – are not sufficiently recognized. In this chapter we discuss stunting and its root causes of undernutrition, a lack of sanitation and its relationship to environmental enteropathy and the intestinal microbiome. We also review information about iron-deficiency anemia and malaria, and their neurological and cognitive consequences. We believe that cognitive declines later in life,...
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Cover Image: Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young November 2014
In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th....
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“Eat your Fruits and Vegetables and Don’t Get Malaria”: Linkages between Agriculture, Nutrition, and Health in Uganda

Authors: Jeffrey Griffiths November 2014
Presentation given by Dr. Jeff Griffiths for the Center for Global Public Health Event at Tufts University, Nov. 20, 2014
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“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

Authors: SL Young; F Luwedde; B. Okia; P Natureeba; L. Johnson; C. Michel; M. Robine; E. Charlebois; D. Havlir November 2014
We evaluated the acceptability and use of macronutrient supplementation among HIV-infected pregnant Ugandan women receiving antiretroviral therapy in a clinical study (NCT 00993031). We first conducted formative research among 56 pregnant and lactating women to select a supplement regimen. Acceptability and use of the supplementation regimen (35 sachets of lipid-based nutrient supplements (LNS) and 4 or 6 kg of instant soy porridge for the household provided monthly) were evaluated among 87 pregnant women. Organoleptic assessments of LNS were favorable. Participants reported consuming LNS a mean...
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Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

Authors: Sera Young; Flavia Luwedde; Paul Natureeba; Jane Achan ; Veronica Ades; Beth Osterbauer; Edwin Charlebois; Moses Kamya; Diane Havlir; Deborah Cohan November 2014
Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial...
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Cover-Brown et al 2014

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change

Authors: Molly E. Brown; Kathryn Grace; Gerald Shively; Kiersten B. Johnson; Mark Carroll September 2014
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices....
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Cover Image:Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Authors: Barnabas K. Natamba; Angela Arbach; Hillary Kilama; Jane Achah; Jeffrey Griffiths; Sera Young August 2014
Food security occurs “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework. FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infected with HIV, women and children. Women’s responsibilities in managing family...
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Determinants of Nutritional Outcomes Among Children below Five Years of Age in Uganda

Authors: Happy Providence June 2014
 This thesis presents findings of a study that sought to understand determinants of nutritional outcomes of children below five years of age in Uganda. Understanding these determinants was vital because in the Ugandan situation, most of the determinants are not ade8uately understood.  Even for those that are known, the magnitude of their impact and or the relative strengths of their impact on nutritional outcomes across regions is not well known.
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Factors Associated with Complementary Feeding Practices Among Children age 6-23 months in Pader District

Authors: Caroline Nambafu June 2014
Infant and young child feeding has been known to compromise the health of children among which complementary  feeding plays a major part. Even communities that have performed adequately in breast feeding have had  their  efforts undermined by complementary feeding hence causing malnutrition among their children.  This study was conducted with the aim of finding out factors that are associated with complementary feeding among the children in Pader district.
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Factors Associated with Dietary Diversity Among Women of Reproductive Age (15-49 yrs) in Agago District

Authors: Ray Oroma June 2014
Despite the internationally accepted recommendation that eating a diversity of foods leads to a healthy diet, and is associated with positive health outcomes such as reduced mortality, little information exists on what factors influence dietary diversity among women of reproductive age in Agago district.  The objective of this study is to determine dietary diversity among women of reproductive age (15-49 years) in Agago district.
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Cover Image-Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna May 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Cover Image: Land use change, fuel use and respiratory health in Uganda

Land use change, fuel use and respiratory health in Uganda

Authors: Pamela Jagger; Gerald Shively April 2014
This paper examines how biomass supply and consumption are affected by land use change in Uganda. We find that between 2007 and 2012 there was a 22% reduction in fuelwood sourced from proximate forests, and an 18% increase in fuelwood sourced from fallows and other areas with lower biomass availability and quality. We estimate a series of panel regression models and find that deforestation has a negative effect on total fuel consumed. We also find that access to forests, whether through ownership or proximity, plays...
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Can Smallholder Fruit and Vegetable Production Systems Improve Household Food Security and Nutritional Status of Women?

Authors: Nassul Kabunga; Shibani Ghosh; Jeffrey Griffiths April 2014
This paper aims to empirically infer potential causal linkages between fruit and vegetable (F&V) production, individual F&V intake, household food security, and anemia levels for individual women caregivers of childbearing age. Using a unique and rich data set recently collected from rural smallholder Ugandan households, we show that the use of a qualitative tool to measure household food insecurity is robust and applicable in other contexts. We also show, using robust econometric methods, that women living in F&V-producer households have a significantly higher intake of...
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Maternal food insecurity, anemia, and social support are independently associated with prenatal depression among HIV-positive and -negative women attending antenatal services in northern Uganda

Authors: Barnabas Natamba; Thomas Oyok; Sophie Mou; Shibani Ghosh; Rebecca Stoltzfus; Jeffrey Griffiths; Sera Young April 2014
Limited data exist on prenatal depression in in high HIV burden resource-poor settings. Population: 403 pregnant clinic attendees at Gulu Hospital, Uganda. HIV (+) women were oversampled in a ratio of 1 HIV (+): 2 HIV
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Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna February 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
0 comments

Improved Dairy Cows in Uganda: Pathways to Poverty Alleviation and Improved Child Nutrition

Authors: Nassul Kabunga February 2014
There is limited empirical evidence on the linkages between agrotechnologies, poverty reduction and the pathways to better nutrition outcomes. The introduction and dissemination of improved dairy cow breeds in Uganda is arguably the most significant step taken to develop a modern and commercial dairy industry in the country over the last two decades. This study uses a nationally representative sample of Ugandan households to rigorously examine the impact of adoption of improved dairy cow breeds on enterprise-, household-, and individual child-level nutrition outcomes. We find...
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Nutrition Innovation Lab Annual Reports- Year 3

Authors: Nutrition Innovation Lab October 2013
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2013 starting October 2012 through September 2013 (“Y3”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Uganda Baseline Report: Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households.

Authors: Nutrition Innovation Lab October 2013
This report provides baseline and nationally representative data regarding nutritional and health issues in Uganda, particularly in terms of maternal and child health. Areas of assessment include livestock, malaria, aflatoxin exposure, water access, sanitation, and dietary information
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Cover Image Baseling Report Uganda 2013

Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households

Authors: Joyce Kikafunda Et Al. March 2013
There is significant movement globally and in Uganda on addressing issues of nutrition and health in vulnerable populations including women and children. This is especially important since approximately 0.5 million women die each year of pregnancy related complications linked under nutrition, while more than 5 million pre-school children die of preventable causes due to the combined effects of disease and under nutrition. There is some progress being made globally, with 63 countries as of 2010 on track to achieve the First Millennium Development Goal (MDG)...
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Nutrition Innovation Lab Annual Reports- Year 2

Authors: Nutrition Innovation Lab October 2012
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2012 starting October 2011 through September 2012 (“Y2”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Charting the cost of nutritionally-adequate diets in Uganda, 2000-2011

Authors: George Omiat; Gerald Shively March 2017
Although malnutrition rates have been on the decline in Uganda over the past two decades, they remain high. Challenges to achieving nutritional improvements result, in part, from high staple foods prices, which raise the cost of the food basket and increase the risk of food and nutrition insecurity, especially for poor households who are net buyers of staple foods. Nearly two-thirds of Ugandan households are net buyers of staples, a pattern that highlights the potential importance of food prices as a key driver of food...
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Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Authors: Elizabeth Widen; Claire Biribawa; Daniel Acidri; Winifred Achoko; Harriet Achola; Jeffrey Griffiths; Sera Young January 2017
A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, mid upper arm circumference, triceps skin fold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time.
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Optimizing the Multisectoral Nutrition Policy Cycle: A Systems Perspective

Authors: Sascha Lamstein; Amanda Pomeroy-Stevens; Patrick Webb; Eileen Kennedy December 2016
Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutrition policy cycle, including how governance and financing support that process. It also...
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Prioritizing and Funding the Uganda Nutrition Action Plan

Authors: Amanda Pomeroy-Stevens; Hannah Foehringer Merchant; Abel Muzoora; Ezekiel Mupere; Lidan Du December 2016
In 2010, Uganda began developing its first multisectoral nutrition plan, the Uganda Nutrition Action Plan (UNAP), to reduce malnutrition. While the UNAP signals high-level commitment to addressing nutrition, knowledge gaps remain about how to successfully implement such a plan. We tracked the UNAP’s influence on the process of priority setting and funding for nutrition from 2013 to 2015
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Assessing Progress in Implementing Uganda’s Nutrition Action Plan: District-Level Insights

Authors: Edgar Agaba; Shibani Ghosh; Jeffrey K. Griffiths December 2016
The 2011 Uganda Nutrition Action Plan (UNAP) established 2016 maternal and child nutrition targets. However, there is a lack of routine district-level data collection to assess UNAP implementation.  The Nutrition Innovation Lab collected serial household-level survey data (n = 3600) in 6 districts, including 2 UNAP implementation districts, in 2012 and 2014. Questionnaires focused on food security, nutrition, and health, among others, and included specific indicators relevant to UNAP’s targets.
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Nutrition Innovation Lab Annual Report- Year 6

Authors: Nutrition Innovation Lab November 2016
The following are the annual reports of the Feed the Future Innovation Lab for Nutrition for the fiscal year 2016 starting October 2015 through September 2016 (“Y6”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins...
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Infrastructure mitigates the sensitivity of child growth to local agriculture and rainfall in Nepal and Uganda

Authors: Gerald Shively November 2016
Incorporating agriculture into nutrition policy requires an understanding of how agricultural performance, rainfall, and the economic and physical environments in which children reside relate to linear growth and weight gain. This paper combines anthropometric data from children below the age of 5 y in Nepal and Uganda with rainfall data and other information to measure these connections. Anthropometric outcomes are positively correlated with rainfall prior to birth, during the first year, and during agricultural growing seasons preceding child measurement. High rainfall is found to be...
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The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Authors: Barnabas Natamba; Jane Achan; Rebecca Stoltzfus; Sera Young August 2016
Abstract Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied...
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Cross-sectional but not Longitudinal Measures of Food Insecurity are Associated with the Rate of Weight Gain during Pregnancy in Northern Uganda

Authors: Barnabas Natamba; Francoise Vermeylen; Elizabeth Widen; Shibani Ghosh; Patsy Brannon; Sera Young April 2016
Food insecurity (FI) during pregnancy may lead to adverse health outcomes for affected women. However, little is known on whether such effects are due to short-term within person changes (longitudinal effects) in FI or long-term between person differences (cross-sectional effects) in this exposure. Therefore, the aim of this study was to assess whether differences in cross-sectional measures of FI between women (defined as the mean prenatal IFIAS score) and/or longitudinal changes in FI within women
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Progression of antepartum depression differs by level of perceived social support and food insecurity

Authors: Barnabas Natamba; Francoise Vermeylen; Rebecca Joyce Stoltzfus; Jeffrey Griffiths April 2016
Antepartum depression (AD) is a risk factor for adverse pregnancy outcomes and may be worsened by food insecurity (FI) and lack of social support (SS). We studied the progression of AD from mid gestation to term and examined whether such progression differed by measures of SS and longitudinal measures of FI
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Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV-Infected Pregnant Women and Reduced Linear Growth of HIV-Exposed Infants

Authors: Barnabas Natamba; Jeffrey Griffiths April 2016
Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda.
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HIV-Infected Pregnant and Lactating Women have Higher Serum Aflatoxin levels than HIV–Uninfected Women and Aflatoxin Levels are Higher during Early Postpartum than during Pregnancy among HIV-Infected Women

Authors: Barnabas Natamba; Shibani Ghosh; Jeffrey Griffiths April 2016
Aflatoxins are carcinogenic and may affect linear growth. Prior cross-sectional data from Ghana have shown that aflatoxin levels are ~ 20% higher among HIV-infected than HIV-uninfected post-partum women. It is not known if HIV-infected pregnant women have elevated serum aflatoxin levels during pregnancy, or if aflatoxin levels change during the perinatal period. We therefore studied these relationships among a cohort of 246 women recruited in Gulu, Uganda, and followed through pregnancy and early infant life. All HIV-positive women received HIV antiretroviral therapy for free from...
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HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

Authors: Barnabas Natamba; Jeffrey Griffiths; Patsy Brannon; Saurabh Mehta April 2016
Adequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub-Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth.
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High levels of food insecurity were observed among HIV, TB, and HIV/TB co-infected outpatients in northern Uganda

Authors: Mia Monique Blakstad; Barnabas Natamba April 2016
Food insecurity among individuals living with HIV is well-recognized globally. Since comorbidity with TB is common, particularly in sub-Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.
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District Presentations: Effectiveness of Integrated Agriculture, Health Livelihood and Nutrition Interventions to Improve Maternal and Child Nutrition and Health in Rural Uganda: A Birth Cohort Study.

Authors: Bernard Bashaasha; Florence Kinyata April 2016
These presentations were made in various Ugandan Districts, covering data gathered during the Uganda Birth Cohort Study specific to each of those districts. The presentations were delivered in April of 2016 by Drs. Bernard Bashaasha and Florence Kinyata. Click on the district name to see its specific presentation. Agweng Aduku Agoro Apac Atanga Atyakc Ayer Buganagri Buyanja Bwizi Kebisoni Nyamweru Parombo Kibiito Rugyeyo Ruhija
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Effect of Nutrition-Sensitive Agricultural Extension Program on Nutrition Knowledge and Dietary Practices of Farming Households in Mukono District, Central Uganda

Authors: Elizabeth Asiimwe April 2016
This poster presentation discusses the outcomes of an extension program implemented in the Mukono District of Central Uganda. It was investigating the knowledge levels of nutrition among men and women, as well as factors that influenced diet diversity among farming households.
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Got Baby Food? Understanding the Market for Packaged Complementary Foods in Developing Countries

Authors: William Masters February 2016
This presentation was delivered by Dr. William Masters on Feb. 3, 2016 as a Friedman School Seminar, Tufts University.
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Nutrition Innovation Lab Annual Reports- Year 5

Authors: Nutrition Innovation Lab December 2015
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2015 starting October 2014 through September 2015 (“Y5”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the...
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Community Connector: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This presentation was made to the Ugandan Community Connector and is an update on the Birth Cohort Study in Uganda on Oct. 20, 2015.
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Africa Day: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This poster presentation was featured at the Africa Day for Food and Nutrition Security in Kampala Uganda on Oct. 28-30, 2015.
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Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries

Authors: David Pelletier; Barnabas Natamba; Dia Sanou; Jackson Tumwine August 2015
Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda.
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Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Authors: Shalean Collins; Barnabas Natamba; Angela Arbach; Elizabeth Widen; Pooja Desai; Hijab Khan; Jeffrey Griffiths; Sera Young July 2015
Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal-infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low-income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.
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Understanding Pathways of Better Nutrition: Poster Presentation

Authors: Edgar Agaba June 2015
This poster is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab.  The poster was presented at the LCIRAH Research Conference, June 03-04, 2015.  
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Social support modifies the bidirectional linkages between food insercutiy and prenatal depresseive symptoms while domestic violence alters the unidirectional impact of food insecurity on prenatal depressive symptoms

Authors: Barnabas Natamba June 2015
This presentation by Barnabas Natamba examines and draws links between food security/ nutrition and social support/ mental health/ HIV status.
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Strengthening Policy Actions and Governance for Nutrition

Authors: Patrick Webb; Amanda Pomeroy May 2015
This is the joint Nutrition Lab/SPRING presentation to USAID on common research activities in Nepal and Uganda regarding policy and governance for nutrition.  It was presented May 5th, 2015 in Washington DC.
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Agricultural policy for improved nutrition in Africa and Asia: evidence to guide the US Government’s investments in food security

Authors: William Masters; Katherine Dennison; Jeff Hill; Elizabeth Jordan-Bell; Ahmed Kablan; Melanie Thurber; Lorraine Weatherspoon; James Oehmke May 2015
The roundtable process was designed to complement numerous past and ongoing efforts to assemble and disseminate rigorous evidence on how agricultural change can best help to improve international nutrition, beginning with the first Lancet Maternal and Child Nutrition series in 2008 and its follow-up in 2013 and other systematic reviews (Webb and Kennedy 2014), as well as assessments from private groups such as the Copenhagen Consensus (2014) and the Global Panel on Agriculture and Food Systems for Nutrition (2014), international organizations such as the World...
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Understanding Pathways of Better Nutrition

Authors: Edgar Agaba April 2015
This presentation is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab. It was originally presented it to  Faculty and students on Wednesday, April 29th 2015: Sackler Room 316, 4:00 – 7:30 p.m as part of the ALE Presentations.
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Maternal Food Insecurity is Associated with Loss of Fat, but not Lean Mass during Lactation among Ugandans of Mixed-HIV Status

Authors: E. Widen; B. Natamba; S. Ghosh; J. Griffiths April 2015
HIV-infected women lose more weight during lactation than HIV-uninfected women. Whether this loss is fat-mass (FM) or fat-free mass (FFM) is unknown, but important, as lean mass loss accelerates HIV progression.
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Maternal HIV Infection, but not Food Insecurity, Predicts the Pattern of Weight Gain in Pregnant Women Attending Antenatal Services in Northern Uganda

Authors: Barnabas Natamba; Elizabeth Widen; Patsy Brannon; Sautabh Mehta April 2015
In Sub-Saharan Africa, the differential impact of maternal HIV infection and/or food insecurity on the pattern of weight gain among pregnant women is unknown. To fill this gap, data on 402 pregnant women (33% HIV+ & participating in antiretroviral treatment) enrolled in a perinatal cohort study at Gulu Regional Referral Hospital in northern Uganda were analyzed.
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Social Support Modifies Bidirectional Linkages Between Food Insecurity and Prenatal Depressive Symptoms while Domestic Violence Alters the Unidirectional Impact of Food Insecurity on Prenatal Depressive Symptoms

Authors: Barnabas Natamba; Shibani Ghosh; Sera Young April 2015
To inform perinatal nutrition and mental health interventions, we used a cohort study to: 1) examine the directionality of relationships between maternal food insecurity (MFI) and prenatal depressive symptoms (PDS); and 2) see if social support (SS) or domestic violence (DV) modify this relationship. We enrolled 403 Ugandan pregnant women (33% HIV+ on antiretrovirals)) in mid-gestation and assessed them monthly through delivery for MFI (IFIAS) and the PDS (CES-D) using validated scales.
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Maternal HIV infection, but not food insercutity access score, predicts the rate of weight change in pregnant women attending antenatal services in northern Uganda

Authors: Barnabas Natamba April 2015
This poster examines seasonal food security/ insecurity, MUAC measurements, and HIV status in Uganda.
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Microbial Decontamination of Fresh Produce (Strawberry) Using Washing Solutions

Authors: Naresh Shahi; Byungjin Min; Eunice A. Bonsi March 2015
This Tuskegee University study was carried out to determine the effect of natural antimicrobial washing solutions against microbial growths on fresh produce specifically strawberries. Selected washing solutions used for strawberry washing, and treatments were sterile water (control), white vinegar (VI), crude lemon juice extract (LE), VI+Origanum oil (VIO), LE+Origanum oil (LEO), and VI+LE+Origanum oil (VILEO).
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Connecting the dots between human malaria, livestock, and under-nutrition: An unexpected pathway

Authors: Jeffrey Griffiths; Nassul Kabunga March 2015
Presentation given by Drs. Jeff Griffiths and Nassul Kabunga for USAID in Washington DC, March 15, 2015
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Malaria predicts maternal and child anemia in Uganda and is modulated by altitude and prior IRS

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths for USAID in Kampala, Uganda, Feb. 10, 2015
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Why Food is Not Enough-Boston University

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths at Boston University, February 27, 2015
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Why Food is Not Enough-BBNC

Authors: Jeffrey Griffiths January 2015
Presentation given by Dr. Jeff Griffiths at the Boston to Bangalore Nutrition Collaboration event, January 2015
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Chapter 7: Childhood Threats to Adult Cognition in Sub- Saharan Africa: Malaria, Anemia, Stunting, Enteric Enteropathy, and the Microbiome of Malnutrition

Authors: Jeffrey Griffiths; Joyce Kikafunda December 2014
Many common childhood conditions are associated with cognitive deficits. While some causes of impaired cognition, such as lead exposure, are well understood, other common conditions in countries such as Uganda – malnutrition, anemia and malaria – are not sufficiently recognized. In this chapter we discuss stunting and its root causes of undernutrition, a lack of sanitation and its relationship to environmental enteropathy and the intestinal microbiome. We also review information about iron-deficiency anemia and malaria, and their neurological and cognitive consequences. We believe that cognitive declines later in life,...
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Cover Image: Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young November 2014
In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th....
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“Eat your Fruits and Vegetables and Don’t Get Malaria”: Linkages between Agriculture, Nutrition, and Health in Uganda

Authors: Jeffrey Griffiths November 2014
Presentation given by Dr. Jeff Griffiths for the Center for Global Public Health Event at Tufts University, Nov. 20, 2014
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“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

Authors: SL Young; F Luwedde; B. Okia; P Natureeba; L. Johnson; C. Michel; M. Robine; E. Charlebois; D. Havlir November 2014
We evaluated the acceptability and use of macronutrient supplementation among HIV-infected pregnant Ugandan women receiving antiretroviral therapy in a clinical study (NCT 00993031). We first conducted formative research among 56 pregnant and lactating women to select a supplement regimen. Acceptability and use of the supplementation regimen (35 sachets of lipid-based nutrient supplements (LNS) and 4 or 6 kg of instant soy porridge for the household provided monthly) were evaluated among 87 pregnant women. Organoleptic assessments of LNS were favorable. Participants reported consuming LNS a mean...
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Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

Authors: Sera Young; Flavia Luwedde; Paul Natureeba; Jane Achan ; Veronica Ades; Beth Osterbauer; Edwin Charlebois; Moses Kamya; Diane Havlir; Deborah Cohan November 2014
Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial...
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Cover-Brown et al 2014

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change

Authors: Molly E. Brown; Kathryn Grace; Gerald Shively; Kiersten B. Johnson; Mark Carroll September 2014
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices....
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Cover Image:Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Authors: Barnabas K. Natamba; Angela Arbach; Hillary Kilama; Jane Achah; Jeffrey Griffiths; Sera Young August 2014
Food security occurs “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework. FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infected with HIV, women and children. Women’s responsibilities in managing family...
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Determinants of Nutritional Outcomes Among Children below Five Years of Age in Uganda

Authors: Happy Providence June 2014
 This thesis presents findings of a study that sought to understand determinants of nutritional outcomes of children below five years of age in Uganda. Understanding these determinants was vital because in the Ugandan situation, most of the determinants are not ade8uately understood.  Even for those that are known, the magnitude of their impact and or the relative strengths of their impact on nutritional outcomes across regions is not well known.
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Factors Associated with Complementary Feeding Practices Among Children age 6-23 months in Pader District

Authors: Caroline Nambafu June 2014
Infant and young child feeding has been known to compromise the health of children among which complementary  feeding plays a major part. Even communities that have performed adequately in breast feeding have had  their  efforts undermined by complementary feeding hence causing malnutrition among their children.  This study was conducted with the aim of finding out factors that are associated with complementary feeding among the children in Pader district.
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Factors Associated with Dietary Diversity Among Women of Reproductive Age (15-49 yrs) in Agago District

Authors: Ray Oroma June 2014
Despite the internationally accepted recommendation that eating a diversity of foods leads to a healthy diet, and is associated with positive health outcomes such as reduced mortality, little information exists on what factors influence dietary diversity among women of reproductive age in Agago district.  The objective of this study is to determine dietary diversity among women of reproductive age (15-49 years) in Agago district.
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Cover Image-Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna May 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Cover Image: Land use change, fuel use and respiratory health in Uganda

Land use change, fuel use and respiratory health in Uganda

Authors: Pamela Jagger; Gerald Shively April 2014
This paper examines how biomass supply and consumption are affected by land use change in Uganda. We find that between 2007 and 2012 there was a 22% reduction in fuelwood sourced from proximate forests, and an 18% increase in fuelwood sourced from fallows and other areas with lower biomass availability and quality. We estimate a series of panel regression models and find that deforestation has a negative effect on total fuel consumed. We also find that access to forests, whether through ownership or proximity, plays...
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Can Smallholder Fruit and Vegetable Production Systems Improve Household Food Security and Nutritional Status of Women?

Authors: Nassul Kabunga; Shibani Ghosh; Jeffrey Griffiths April 2014
This paper aims to empirically infer potential causal linkages between fruit and vegetable (F&V) production, individual F&V intake, household food security, and anemia levels for individual women caregivers of childbearing age. Using a unique and rich data set recently collected from rural smallholder Ugandan households, we show that the use of a qualitative tool to measure household food insecurity is robust and applicable in other contexts. We also show, using robust econometric methods, that women living in F&V-producer households have a significantly higher intake of...
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Maternal food insecurity, anemia, and social support are independently associated with prenatal depression among HIV-positive and -negative women attending antenatal services in northern Uganda

Authors: Barnabas Natamba; Thomas Oyok; Sophie Mou; Shibani Ghosh; Rebecca Stoltzfus; Jeffrey Griffiths; Sera Young April 2014
Limited data exist on prenatal depression in in high HIV burden resource-poor settings. Population: 403 pregnant clinic attendees at Gulu Hospital, Uganda. HIV (+) women were oversampled in a ratio of 1 HIV (+): 2 HIV
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Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna February 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies have shown that it can be difficult to recover from faltering in linear growth during gestation and the...
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Improved Dairy Cows in Uganda: Pathways to Poverty Alleviation and Improved Child Nutrition

Authors: Nassul Kabunga February 2014
There is limited empirical evidence on the linkages between agrotechnologies, poverty reduction and the pathways to better nutrition outcomes. The introduction and dissemination of improved dairy cow breeds in Uganda is arguably the most significant step taken to develop a modern and commercial dairy industry in the country over the last two decades. This study uses a nationally representative sample of Ugandan households to rigorously examine the impact of adoption of improved dairy cow breeds on enterprise-, household-, and individual child-level nutrition outcomes. We find...
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Nutrition Innovation Lab Annual Reports- Year 3

Authors: Nutrition Innovation Lab October 2013
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2013 starting October 2012 through September 2013 (“Y3”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Uganda Baseline Report: Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households.

Authors: Nutrition Innovation Lab October 2013
This report provides baseline and nationally representative data regarding nutritional and health issues in Uganda, particularly in terms of maternal and child health. Areas of assessment include livestock, malaria, aflatoxin exposure, water access, sanitation, and dietary information
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Cover Image Baseling Report Uganda 2013

Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households

Authors: Joyce Kikafunda Et Al. March 2013
There is significant movement globally and in Uganda on addressing issues of nutrition and health in vulnerable populations including women and children. This is especially important since approximately 0.5 million women die each year of pregnancy related complications linked under nutrition, while more than 5 million pre-school children die of preventable causes due to the combined effects of disease and under nutrition. There is some progress being made globally, with 63 countries as of 2010 on track to achieve the First Millennium Development Goal (MDG)...
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Nutrition Innovation Lab Annual Reports- Year 2

Authors: Nutrition Innovation Lab October 2012
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2012 starting October 2011 through September 2012 (“Y2”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring...
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Bernard Bashaasha, PhD

Role: Principal Investigator, 
School of Agricultural Sciences, Makerere University
College of Agricultural and Environmental Sciences

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