Analysis of surveillance data from 2015 to 2018 showed a decreasing trend nationally in wasting among pregnant and lactating women. Several regions in the north had increasing trends of wasting, while those in the western and southern parts of Uganda had declined. Two adjoining regions in the north, Karamoja and Lango, had critical levels of malnutrition and a third had serious malnutrition.
Causes of malnutrition are known to be multi-factorial in nature. As a result, strategies such as the Uganda Multi-sectoral Food Security and Nutrition Project (UMFSNP), implemented in 2015 in 15 districts of Uganda , have been enacted to address several of these causes jointly. The target population for UMFSNP includes pregnant and lactating women, children under 2 years, and parent groups participating in nutrition-promoting activities. The overall decline in the prevalence of wasting during the study period is likely linked to this approach, at least in part. Regions in which this plan was implemented, including Ankole, Busoga, Kigezi, Tooro, and West Nile, showed declining trends in wasting in this analysis. The possible success of the UMFSNP suggests a need to scale up the implementation of the multisectoral program to additional districts.
Despite the overall decline in the prevalence of wasting countrywide, disaggregated data showed that some regions, especially those in the north, still have high levels of wasting among PLW. Specifically, the northern regions of Karamoja, Lango, and Acholi were found to have the highest prevalence of wasting in this evaluation. These regions have long had prolonged droughts, insecurity, livestock diseases, and flooding which have crippled crop and livestock production ; in addition, they consistently experience high levels of poverty and often score poorly across multiple health indicators [13, 26, 27]. Karamoja region is mainly occupied by nomadic pastoralists, who typically do not settle in a single place to cultivate crops. This further deepens the food insecurity and also hinders access to preventive measures and treatment of major illnesses that cause or result from malnutrition . The introduction of modern and innovative farming methods for the northern regions, such as use of drought-resistant seeds and mechanization of farming, could help reduce the food insecurity in these regions and mitigate malnutrition .
Despite having the highest prevalence of wasting in our evaluation, the Karamoja region did register a decline, possibly due to the ongoing food aid it has received for over 40 years [29, 30]. While fixed clinics exist in the region, the establishment of supplemental mobile clinics to provide health and nutrition services within Karamoja and surrounding regions might help provide the essential nutrition interventions. This approach has improved health services among other nomadic populations in Kenya and other parts of Africa [31, 32]. Intensification of supplementary and therapeutic feeding programs for pregnant and lactating women is also recommended . Nutrition programs targeting households rather than individuals might improve outcomes, as food in this region is shared within households even when delivered to a single targeted individual, such as a pregnant or lactating mother .
Bugisu region, located in eastern Uganda, showed an increase in wasting during the evaluation period, reaching the ‘serious’ severity level in 2018. This region is subject to recurrent natural disasters, such as mudslides, and floods, that cause crop loss; the most recent of these events occurred during December 2019 [34,35,36]. These types of natural disasters are known to be associated with subsequent malnutrition [37,38,39]. Implementation of assistance in form of food and/or cash transfers could help in preventing malnutrition in such emergencies and should be evaluated as a possible policy option. Such interventions have helped improve the nutrition outcomes in similar contexts. Studies in multiple countries have shown that cash transfers alone or in combination with other interventions prevented malnutrition and improved outcomes [40,41,42].
It is likely that some PLW were counted more than once due to repeat visits to facilities; this may have led to an overestimation of the burden of wasting in our evaluation. Alternatively, the low HMIS reporting rates, especially in 2018, may have led to an underestimation of wasting.