SUPPORTED BY THE USAID-FANTA PROJECT, THE UGANDA ACTION FOR NUTRITION (UGAN) SOCIETY, MAKERERE

UNIVERSITY, KYAMBOGO UNIVERSITY AND VICTORIA UNIVERSITY

TAKING NUTRITION TO THE COMMUNITY: THE

MAKERERE, KYAMBOGO & VICTORIA UNIVERSITY

NUTRITION STUDENTS’CAMP

OCTOBER 2015

ii

ACKNOWLEDGEMENTS

The success of this joint nutrition students’ camp was dependent on support and partnerships.

The Uganda Action for Nutrition (UGAN) Society provided technical support to the nutrition

student bodies of Makerere, Kyambogo & Victoria Universities. Without the enthusiasm and

dedication of the following nutrition students: Rita Kayeny (Makerere University), Hawa

Kimbugwe (Kyambogo University), Kyampeire Daphne (Victoria University).

Our sincere appreciation is extended to the USAID-funded Food and Nutrition Technical

Assistance (FANTA) Project for the financial and additional technical support, Kampala Capital

City Authority (KCCA) and the participating universities for all the assistance rendered in

making this event a success.

AUTHORSHIP

This report was written by Peterson Kato Kikomeko and Tracy Lukiya Birungi of the Uganda

Action for Nutrition (UGAN) Society.

The authors grant full permission for use of this report provided appropriate citation is done.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTS ............................................................................................................ ii

AUTHORSHIP ............................................................................................................................... ii

LIST OF ACRONYMS ................................................................................................................. iv

LIST OF FIGURES ....................................................................................................................... iv

LIST OF TABLES ......................................................................................................................... iv

1. Introduction ................................................................................................................................. 1

2. Profile of Human Nutrition and Dietetics Student Bodies.......................................................... 2

2.1 Student Nutrition Association at Makerere University ............................................................. 2

2.1.1 Activities of MUHUNSA ...................................................................................................... 2

2.2 Student Nutrition Association at Kyambogo University .......................................................... 4

2.3 Student Nutrition Association Victoria University ................................................................... 4

3. Activities Undertaken in the Third Annual Students Nutrition Camp 2015 ............................... 5

4. Nutrition Assessment Results ..................................................................................................... 5

4.1 Sex and Age of Assessed Individuals ....................................................................................... 7

4.2 Occupation of Assessed Individuals ......................................................................................... 7

4.3 Assessment of Body Mass Index and Hypertension ................................................................. 8

4.4 Deductions from the results ...................................................................................................... 9

ANNEX 1: Activities in pictures .................................................................................................. 10

iv

LIST OF ACRONYMS

BMI Body Mass Index

CAES College of Agricultural and Environmental Science

DBP Diastolic Blood Pressure

FANTA Food and Nutrition Technical Assistance

HTN Hypertension

KCCA Kampala City Council Authority

KYUNDISA Kyambogo University Human Nutrition and Dietetic Association

MUHUNSA Makerere University Human Nutrition Students Association

MUMONUC Makerere University Mobile Nutrition Clinic

NCDs Non-communicable Diseases

SBP Systolic Blood Pressure

SPSS Statistical Package for Social Scientists

UGAN Uganda Action for Nutrition

UMA Uganda Manufacturers Association

WHO World Health Organisation

LIST OF FIGURES

Figure 1: Age of Assessed Individuals ...................................................................................................... 7

Figure 2: Occupation of Assessed Individuals (N=190) ............................................................................ 8

LIST OF TABLES

Table 1: The International Classification of adult underweight, overweight and obesity according

to BMI ........................................................................................................................................................ 6

Table 2: Classification for Hypertension ................................................................................................... 6

Table 3: Cross tabulation of BMI and Hypertension ................................................................................. 9

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1. Introduction

Nutrition is key for national socio-economic growth and development of any country. In

Uganda’s context, under-nutrition affects a large percentage of the population with 33% of all

children under five years stunted1, the situation being different from region to region. Given the

scourge of under-nutrition, there is need for human capacity with professional skills to meet the

evolving demands of nutrition. The two biggest public universities in Uganda (Makerere and

Kyambogo) and some private universities (Victoria, Islamic and Mukono University) are training

nutrition graduates to fill the need of professional nutrition and dietetic graduates.

As part of student training, it is vital that students are equipped with knowledge and skills to

respond to community nutrition demands and that those students are linked with service

providers. For the past years, the Uganda Action for Nutrition (UGAN)2 Society in partnership

with the USAID-funded Food and Nutrition Technical Assistance Project (FANTA)3 have

supported nutrition student bodies of Makerere and Kyambogo to hold annual nutrition

awareness campaigns at the Uganda Railway grounds (in Kampala) and also participated in other

national nutrition exhibitions (at Nambole National Stadium in 2014). Through such campaigns,

students are supported to engage with community and service providers and in so doing they

gain capacity as well as foster community understanding of the benefits of nutrition. Experience

from the past events showed that the communities reached wished for more engagement and

awareness campaigns.

In 2015, the UGAN sought support from the FANTA project, Kyambogo University, Makerere

University and Victoria University to support nutrition students of the respective universities to

organise community awareness nutrition activities. The joint nutrition students’ camp was

organised and held from the 15th

to 17th

October, 2015 at the Uganda Railway Grounds,

Kampala. A total of 20 students participated in the different nutrition camp activities per day.

This camp was organised to coincide with the World Food Day celebrations of 2015.

Supporting student community engagement falls within the UGAN’s broad aim of engaging

1 Uganda Demographic and Health Survey 2011

2 www.ugansociety.org

3 http://www.fhi360.org/projects/food-and-nutrition-technical-assistance-iii-project-fanta-uganda

2

young nutrition professionals in the nutrition arena and also linking students to the large

community of nutrition practice. This is broadly embedded in the UGAN’s strategic development

plan of 2014-2019.

2. Profile of Human Nutrition and Dietetics Student Bodies

2.1 Student Nutrition Association at Makerere University

At Makerere University, human nutrition students established and registered a nutrition body

under the name “Makerere University Human Nutrition Students Association” (MUHUNSA) in

2012. This is an association made up of students (with support and guidance from lecturers and

alumni) belonging to the Nutrition fraternity at Makerere University. The association was

officially registered on 10th

November 2012 with registration No. 0040 and was officially

launched on 5th

April, 2013 at the School of Food science, Nutrition and Bio- engineering.

The occasion was graced by the Head of Nutrition Department Ministry of Health Uganda and

the Chairperson of the Uganda Dietetic Association.

The main objective of MUHUNSA is to enlighten students on the reality of nutrition and

empower them to be agents of change for national development.

2.1.1 Activities of MUHUNSA

MUHUNSA actively participated in numerous activities since it officially came to action. These

activities are highlighted below:

The College of Agricultural and Environmental Science (CAES) Exhibitions at Makerere

University freedom square: MUHUNSA participated in three of these exhibitions:

On 15th- 18th

March 2013

The second from 2nd

to 5th

April, 2014

The third from 9th

to 11th

April 2015.

The association also continued to participate in the Annual CAES exhibitions.

The 21st source of the Nile exhibition in Jinja district from 8

th to 14

th July 2013

The Uganda Manufacturers Association Trade Show at UMA Show Grounds in Lugogo

Kampala from 2nd

to 10th

October 2013

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The parliamentary Healthy week at the Parliament of Uganda, CHOGM grounds.

The National Council for Higher Education Exhibition in March 2014.

The association believed that empowering communities through nutrition education and fostering

the use of the locally available foods could make a paramount contribution in reducing

malnutrition in Uganda. The main activities carried out in this regard and at the different

occasions were:

Anthropometric measurements to assess nutrition status

Teaching individuals about the critical role diet plays in every one's health

Food illustrations were displayed to show the different locally available foods and

explain the relevance of each, while stressing on the need of deity diversity.

In September 2013, the association started a Makerere University Mobile Nutrition Clinic

(MUMONUC) as a three year project with an aim to:

Assess communities and individuals for nutrition needs

Screen community members for nutrition related non-communicable diseases(NCD’s)

Offer nutrition education so as to address the high rates of malnutrition (both over and

under nutrition) in Uganda.

The actual implementation of the MOMUNUC project was delivered through nutrition camps to

be held annually at the Uganda Railway grounds alongside Jinja Road. MUHUNSA worked in

conjunction with the School of Food Science, Nutrition and Bioengineering, Makerere

University and some organizations; FANTA, UGAN and DIET CLINIC in Bukoto and the

project outputs were delivered along various broad areas as outlined below;

1) Nutrition assessment to screen for the malnourished clients (over and under nutrition)

and hence create nutrition awareness in order to determine the suitable intervention.

This was done through:

Anthropometry i.e. weight and height measurement to determine the BMI and waist

circumference.

Measurement of random blood sugars to screen for diabetes (high blood glucose)

Blood pressure check-up to screen for hypertension (high blood pressure)

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Food demonstrations using a tangible food pyramid with locally available foods

2) Explanations of dietary guidelines and recommendations.

Each client was given a leaflet showing the general dietary guidelines and

recommendations developed by MUHUNSA.

Nutrition education and counselling basing on the individual’s nutrition status and

body requirements as indicated by the results on the nutrition assessment form.

Answering nutrition related questions put across by the participants/ clients.

Since 2013, the association was able to successfully carryout two Nutrition Camps the

first was in September 2013 and the second on 14th

-16th

September 2014. A summary of

the results of the previous activities were documented and shared in different fora.

2.2 Student Nutrition Association at Kyambogo University

Students of Human Nutrition and Dietetic at Kyambogo University formed and registered an

association in 2009 under the name Kyambogo University Human Nutrition and Dietetic

Association (KYUNDISA). KYUNDISA has recently been involved in the following activities:

KYUNDISA attended and participated in the MUMONAC 2014

KYUNDISA also held its first nutrition week at Kyambogo university which took place

from 20th

-25th

October 2014

KYUNDISA also had a nutrition outreach to Nabisunsa Girl’s school for two days in

November, 2014.

Generally, the services offered by the students during these activities include:

Nutrition advice

BMI measurement

Blood pressure measurement

Blood glucose measurement

2.3 Student Nutrition Association Victoria University

Victoria University had its first intake of Human nutrition and dietetic students in 2014. The

students had not by the time of this event established an association. However, the UGAN

recognizes the need of engaging with these students for as long as they are willing to participate

in joint student activities.

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3. Activities Undertaken in the Third Annual Students Nutrition Camp 2015

The joint student’s event was held under the theme “The role of nutrition in improving health”.

The activities undertaken in the third annual nutrition student’s camp included:

Nutrition assessment

Food demonstrations using dietary guidelines and recommendations

Nutrition counselling and dietary planning

Exhibition of nutrition interventions or action

4. Nutrition Assessment Results

Nutrition assessment results were recorded and later on tabulated. Data recorded included that

for assessed individual age, sex, occupation, weight, height, blood glucose, systolic and diastolic

blood pressure. Recorded data was analysed using the Statistical Package for Social Scientists

(SPSS) computer software package.

From the data, nutrition indices for the body mass index (BMI) were computed and the

classifications of hypertension were also done. Categories for BMI were done according to the

WHO international classification as shown in Table 1. Body Mass Index (BMI) is a simple index

of weight-for-height that is commonly used to classify underweight, overweight and obesity in

adults. It is defined as the weight in kilograms divided by the square of the height in metres

(kg/m2).

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Table 1: The International Classification of adult underweight, overweight and obesity

according to BMI

Classification BMI(kg/m2)

Principal cut-off

points Additional cut-off points

Underweight <18.50 <18.50

Severe thinness <16.00 <16.00

Moderate thinness 16.00 - 16.99 16.00 - 16.99

Mild thinness 17.00 - 18.49 17.00 - 18.49

Normal range 18.50 - 24.99 18.50 - 22.99

23.00 - 24.99

Overweight ≥25.00 ≥25.00

Pre-obese 25.00 - 29.99 25.00 - 27.49

27.50 - 29.99

Obese ≥30.00 ≥30.00

Obese class I 30.00 - 34.99 30.00 - 32.49

32.50 - 34.99

Obese class II 35.00 - 39.99 35.00 - 37.49

37.50 - 39.99

Obese class III ≥40.00 ≥40.00

Source: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html Accessed 06-January 2016

Based on blood pressure readings, individuals were also classified as either being normal for

hypertension or hypertensive using cut-offs as shown in Table 2.

Table 2: Classification for Hypertension

Category Blood Pressure, mm Hg

Normal SBP 90-119 and DBP 60-79

Prehypertension SBP 120-139 or DBP 80-89

Stage 1 HTN SBP 140-159 or DBP 90-99

Stage 2 HTN SBP ≥160 or DBP ≥100

DBP = diastolic blood pressure; SBP = systolic blood pressure

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Results presented here are for age, sex, occupation, BMI and hypertension. They exclude those

for blood glucose as only a small percentage of individuals were accessed for blood glucose

given the shortage of glucose strips.

4.1 Sex and Age of Assessed Individuals

A total of 190 individuals were assessed during the nutrition camp. Of these, 68% were males

and 32% females. The mean age was 35.6 years with a higher percentage of aged 30 years (about

7%). In general, the most clients assessed (about 70.9%) were in the age range of 19-40 years

(see Figure 1).

Figure 1: Age of Assessed Individuals

4.2 Occupation of Assessed Individuals

Individuals assessed in the camp were engaged in various occupations. The most however

(34.7%) were engaged in business related activities followed by 11.1% who reportedly worked

as drivers. Other occupations as summarized in Figure 2 were in smaller proportions.

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Figure 2: Occupation of Assessed Individuals (N=190)

4.3 Assessment of Body Mass Index and Hypertension

The most individuals (42.9%) assessed were of normal BMI followed by those who were

overweight (30.9%). Hypertension-wise, majority of the individuals (45.1%) were or non-

hypertensive while 41.1% were found pre-hypertensive according to the classification criteria

used (see Table 3).

A cross tabulation of the clients body mass index with hypertension as summarized in Table 3

showed that the majority of assessed individuals (20.6%) were normal for both BMI and

hypertension. These were followed by 16.6% who were pre-hypertensive with normal BMI,

14.9% overweight and normal for hypertension, 13.7% overweight and pre-hypertensive.

Amongst individuals with hypertension, the greatest percentage (5.7%) had normal BMI and

4.6% were obese. The assessment did not explore in detail about the likely causes of

hypertension and overweight and obesity.

34.7

7.9

0.5

5.8

3.2 1.6

11.1

7.9 6.8

3.2 4.2

1.6

5.3 6.3

0

5

10

15

20

25

30

35

40

Per

cen

tag

e

Occupation

OCCUPATION OF ASSESSED INDIVIDUALS

Business

Student

Security

Unemployed

Sales

Lawyer

Driver

Mechanic

Teacher

Police

Catering

Housewife

Boda boda

Accountant

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Table 3: Cross tabulation of BMI and Hypertension

BMI category Hypertension Percentage

Normal Pre-hypertension Stage 1 Stage 2

Underweight 5.7 0.6 0 0 6.3

Normal 20.6 16.6 5.7 0 42.9

Overweight 14.9 13.7 1.7 0.6 30.9

Obese 4.0 10.3 4.6 1.1 20.0

Percentage 45.1 41.1 12 1.7 100

4.4 Deductions from the results

It is worth noting that that this was a nutrition camp set out in an urban community setting almost

in the centre of Kampala city and that individuals participated at will. All individuals assessed

were above the age of 18 years and thus considered adults according to the constitution of the

Republic of Uganda. Occupation wise, we also note that most individuals were engaged in

business related activities. Also, more males turned up for assessment than females but

conclusive explanation could not be given for this occurrence. Some explanation can however be

due to the fact that besides the venue for this event exist a lorry park yard mainly dominated by

males. This could partly account for the observation of a big percentage of drivers being

assessed.

Health-wise, close to half the assessed individuals (41.1%) were pre-hypertensive, 13.7% were

hypertensive and 50.9% of the individuals had their BMI above the recommended cut-offs for

normal BMI by the World Health Organization (WHO). Given the spontaneity of the individuals

who turned up for assessment, the results depict a poor health status amongst the city dwellers. A

robust study needs to be undertaken to assess the actual health status of Kampala city dwellers so

as to inform health policy decisions.

The student nutrition camp shows that such student engagements are vital in supporting city

health authorities to assess health and nutrition related issues and are also vital in exposing

students to the broader field of community nutrition practice. Once strengthened can bolster

university community partnerships.

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ANNEX 1: Activities in pictures

MUHUNSA members preparing

for counselling sessions

Banner used during the nutrition

camp

Client after having height and

weight measured

BMI Reference Table Charts used

during the nutrition camp

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Student measuring waist

circumference of a client

Student measuring MUAC of a

client

Students taking a client through the

Food Pyramid

Nutrition counselling sessions

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Rita Kayeny – Project Coordinator,

MUHUNSA

Hawa Kimbugwe – President,

KYUNDISA

Victoria University Nutrition

Students