Uganda, as at the end of October 2017 was hosting more than 1.3 million refugees across 12 districts in the country. The refugees live alongside their Ugandan host’s communities in the settlements.
The main objective of the survey was to assess the general nutrition and food security, infant and young child feeding, health and anaemia status of refugees and formulate some recommendations for appropriate nutritional and public health interventions to address and sustain the achievements the programme has registered so far. In the settlements, cross-sectional surveys were conducted in each designated settlement employing systematic random sampling.
In West Nile settlements, prevelances of acute malnutrition and anaemia were apparent with some variations. The highest global acute malnutrition (WHZ < -2 SD) prevelance was 12.3% (9.6-15.7% C.I) in Palabek. Other settlements in West Nile region found with higher GAM prevalence were Adjumani with 11.8% (9.3-14.8% C.I), Bidibidi 11.8% (9.0-15.3% C.I), Palorinya 11.1% (7.7-15.6% C.I) and Arua 10.3% (7.8-13.5% C.I). Based on the World Health Organization (WHO) classification on public health significance for children under 5 years of age, GAM prevalence between 10-14% is classified as “SERIOUS” level nutrition situation. However, the higher confidence intervels of GAM prevelance in Palabek, Bidibidi, and Palorinya settlements falls above the 15% of “EMERGENCY THRESHOLDS”. In South West settlements, GAM prevalences were within the acceptable level of <5% as per WHO classification. In South West the GAM prevelances were; Kyaka II (4.0%), Oruchinga (4.1%), Nakivale (3.8%), and Kyangwali (3.2%). Severe Acute Malnutrition (SAM) based on (WHZ < -3 SD was below 1% based on WHO growth standards across the settlements. The highest prevalence of malnutrition based on MUAC was found in Kampala Urban (13.4%), this was followed by Kiryandongo (9.8%), Palorinya (9.8%), Kyaka II (9.3%) and Oruchinga (9.3%). In the refugee settlements MUAC is one of the measure used to to admit acute malnourished children in the feeding programme. MUAC is also a predictor of mortality among malnourished children.
The findings from the survey highlighted “HIGH” prevelance of anaemia above the 40% public health significance (WHO classification) as a significant public health problem in the settlements. The highest prevalence of anaemia for children 6-59 months old was in Bidibidi (56.6%), Lobule (53.0%),
Palorinya (48.8%), Arua (46.0 %), Kyaka II (44.1%), Adjumani (42.3 %), Palabek (45.9 %),
Rwamwanja (43.0%), Kiryandongo (41.4%), and Kyangwali (41.8%). While in the rest of settlements and Kampala Urban ranged from 24.7% - 37.1% classified as “MEDIUM” public health significance (WHO classification). Comparing the results with the nutrition survey in 2016 there is significant reduction in the prevelamce of anaemia in all the refugee settleements during 2017, specifically in Bidibidi reduced from 72.4% to 56.6%, in Lobule reduced from 72.2% to 53.0%, in Rhino camp reduced from 65.0% to 46.0%, in Kiryandongo reduced from 59.3% to 41.4%, and in Kyaka II,
Rwamwanja reduced from 51.1% and 51.7% to 44.1% and 43.0% respectively. Despite of reduction the prevelance of anaemia among children aged 6-59 months remained above the 40% of public health signifance (WHO classification). The prevalence of anaemia among non-pregnant women aged 15-49 years reported the highest in Palabek settlement 47.3% “HIGH” above the 40% of public health significance. While in the rest of settelents ranged between 24.5% - 34.4% classified as “MEDIUM” level public health significance (WHO classification).
The prevelance of stunting or chronic malnutrition among children aged 6-59 months reported the highest 32.6% in Kyangwali settlement which is classified “SERIOUS” level as per WHO classification. In Nakivale, Oruchinga, Kyaka II, Rwamwanja, and Palebek settlements ranged between 20 – 29% classified as “POOR” as per WHO classification. While in Bidibidi, Palorinya, Rhino, Lobul,
Adjumani, and Kiryandongo settlements reported <20% “ACCEPTABLE” level as per WHO classification.
Timely initiation of breastfeeding for children aged 0-23 months was highest in Rwamwanja (90%) and lowest in Palabek (69.1%). Rhino camp (87.5%) had the highest proportions of mothers reported practicing exclusive breastfeeding, this was followed by; Palabek (84.6%) and Adjumani (83.3%).
Continuation of breasfeeding at age of 1-year ranges between 73.0% in Kampala Urban – 100% in Kiryandongo settlement. While the introuduction of solid, semi-solid or soft foods at age of 6-8 months ranged between 37.5% in Palorinya – 69.2% in Kampala Urban. The rate of bottle feeding ranged between 3.8% in Adjumani – 34.3% in Oruchinga settlements.
Briefly, findings suggest that settlements in West Nile had the highest rate of acute malnutrition, while anaemia cuts across settlements posing higher nutritional vulnerability to livelihood and food security opportunities. Rates of malnutrition among Kampala refugees tended to be slightly higher when compared to most settlements.