HN/HND graduates
The demographics, training, and occupation characteristics of HN/HND graduates who responded to the survey are summarised in Table 1. Responses were received from 132 of the 450 invited participants; giving a general response rate of 29.3%. This response rate was higher than that usually obtained for online/email-based surveys [41]. Of the respondents, the majority were females (64.4%) and most (56.8%) were in the age category of 25-29 years.
Table 1: Demographic, Training and Occupation Characteristics of HN/HND Graduates
Characteristic
|
N
|
Category
|
n(%)
|
Gender
|
132
|
Female
|
85 (64.4)
|
Male
|
47 (35.6)
|
Age categories
|
132
|
20-24
|
12 (9.1)
|
25-29
|
75 (56.8)
|
30-34
|
31 (23.5)
|
35-39
|
11 (8.3)
|
40 and above
|
3 (2.3)
|
Institution attended
|
132
|
Kyambogo University
|
112 (84.8)
|
Makerere University
|
20 (15.2)
|
Year of study completion
|
132
|
2013-2016
|
81 (61.4)
|
2009-2012
|
36 (27.3)
|
2005-2008
|
15 (11.4)
|
Post-graduate training
|
132
|
None
|
73 (55.3)
|
Master’s Degree
|
31 (23.5)
|
Post-Graduate Diploma/Certificate
|
26 (19.7)
|
Doctorate
|
2 (1.5)
|
Category of the place of the first internship
|
127
|
Regional referral hospital
|
54 (42.5)
|
National referral hospital
|
26 (20.5)
|
District hospital
|
16 (12.6)
|
Non-Government non-profit hospital
|
11 (8.7)
|
Other Government hospital
|
4 (3.1)
|
Private for-profit hospital
|
4 (3.1)
|
Health Center IV*
|
3 (2.4)
|
Health Center III**
|
3 (2.4)
|
Non-Government organization
|
3 (2.4)
|
Research-based institution
|
2 (1.6)
|
Donor project
|
1 (0.8)
|
Region where the first internship was undertaken
|
127
|
Central
|
70 (55.1)
|
Western
|
24 (18.9)
|
Eastern
|
18 (14.2)
|
Northern
|
15 (11.8)
|
Category of the second place of internship
|
106
|
Non-Government organization
|
32 (30.2)
|
Regional referral hospital
|
17 (16.0)
|
District hospital
|
11 (10.4)
|
Donor project
|
10 (9.4)
|
Non-Government non-profit hospital
|
7 (6.6)
|
Health Center IV*
|
6 (5.7)
|
Government Ministry Department/Agency
|
6 (5.7)
|
Private for-profit hospital
|
6 (5.7)
|
National referral hospital
|
5 (4.7)
|
Research-based institution
|
5 (4.7)
|
Other Government hospital
|
1 (0.9)
|
Region where the second internship was undertaken
|
105
|
Central
|
63 (60.0)
|
Western
|
21 (20.0)
|
Northern
|
12 (11.4)
|
Eastern
|
9 (8.6)
|
Category of current place of employment
|
115
|
NGO
|
70 (60.9)
|
Health Facility
|
14 (12.2)
|
District Local Government
|
8 (7.0)
|
Academia
|
7 (6.1)
|
Donor Agency/United Nations
|
6 (5.2)
|
Government MDAs
|
6 (5.2)
|
Industry
|
4 (3.5)
|
Region of current employment
|
115
|
Northern
|
40 (34.8)
|
Central
|
39 (33.9)
|
Western
|
18 (15.7)
|
Outside Uganda
|
11 (9.6)
|
Eastern
|
7 (6.1)
|
HN/HND: Human Nutrition/Human Nutrition and Dietetics; MDAs: Ministries, Departments, and Agencies
* Health Centre IV: A level IV primary care facility in Uganda is one immediately below a district hospital; targets 100,000 people; acts as a referral facility for lower primary care facilities under its jurisdiction; has provisions for in-patient and laboratory services, and an operating theatre. It is usually staffed by qualified clinical officers, nurses, nurse aides, and doctors [42]. ** Health Centre III: In Uganda, a Health Centre III is a mid-level primary care facility; has provisions for basic laboratory services, maternity care, and inpatient care (often for onward referral); and is usually staffed by nurse aides, qualified nurses, and clinical officers [42].
In regards to training, the majority of respondents (84.8%) obtained their HN/HND Bachelor's degree from Kyambogo University and most (61.4%) completed their studies in the years 2013-2016. Close to half of the respondents (44.7%) had undertaken further training at different levels; post-graduate diploma/certificate (19.7%), master's degree (23.5%), and Ph.D. (1.5%).
In regards to places of internship, regional referral hospitals and the national referral hospital were the main places attended during the first internship at 42.5% and 20.5% respectively. On the contrary, non-government organizations and regional referral hospitals were mainly attended for the second internships at 30.2% and 16% respectively. As per the regions of Uganda where internships were undertaken, most respondents undertook their first internship in the central region (55.1%) followed by the western region (18.9%). The same trend was observed for the second internship with 60% and 20% of respondents respectively.
As for current employment; the majority of the respondents (60.9%) were employed by non-governmental organizations and the minority by healthcare-related facilities (12.2%). The northern and central regions of Uganda had the most graduates employed at 34.8% and 33.9% respectively. A small percentage of graduates (9.1%) reportedly worked outside Uganda.
Academic staff and work/internship supervisors
A total of 14 academic staff and 11 work/internship supervisors were interviewed in this study as shown in Table 2. The majority (64.3%) were females, 57.1% worked in Kyambogo University, 57.1% held doctorate level of training, and 42.9% had more than ten years of lecturing experience. On the other hand, 63.6% of the interviewed work/internship supervisors were males, 63.6% worked in regional referral hospitals, and 54.5% were in the position of a senior nutritionist.
Table 2: Demographic Characteristics of Interviewed Academic Staff and Work/Internship Supervisors
Participant Category
|
N
|
Characteristic
|
Category
|
n(%)
|
Academic staff
|
14
|
Gender
|
Female
|
9 (64.3)
|
Male
|
5 (35.7)
|
University
|
Kyambogo
|
8 (57.1)
|
Makerere
|
6 (42.9)
|
Level of Training
|
Doctorate
|
8 (57.1)
|
Masters
|
6 (42.9)
|
Years of Lecturing Experience
|
≥10 years
|
6 (42.9)
|
6-10 years
|
4 (28.6)
|
≤ 5 years
|
4 (28.6)
|
Work/internship supervisors
|
11
|
Gender
|
Male
|
7 (63.6)
|
Female
|
4 (36.4)
|
Category of Employer
|
Regional referral hospital
|
7 (63.6)
|
Non-government organisation
|
4 (36.4)
|
Work Position
|
Senior Nutritionist
|
6 (54.5)
|
Program Manager
|
2 (18.2)
|
Nutritionist
|
2 (18.2)
|
Director
|
1 (9.1)
|
HN/HND: Human Nutrition/Human Nutrition and Dietetics
Stakeholders’ perceptions of the nutrition and dietetics challenges faced by communities
As summarised in Table 3, the top five challenges mentioned by the HN/HND graduates included malnutrition in its different forms (60.5%); poor nutrition knowledge (43%); food insecurity (37.7%); non-communicable/chronic diseases (25.4%); and undesirable cultural and religious beliefs and practices (14.9%). Other challenges mentioned by the graduates included low dietary diversity (10.5% respondents); misleading information on nutrition (9.6%); inadequate maternal, infant, young child, and adolescent nutrition feeding practices (7.9%); and inadequate water, sanitation, and hygiene practices (7%).
Based on the illustrative quotes by the academic staff and the work/internship supervisors as further summarised in Table 3, the nutrition-specific challenges were related to the high prevalence of malnutrition in its different forms; low dietary diversity as “very few families can afford to eat the recommended minimum dietary diversity…”; and inadequate maternal, infant, young child, and adolescent feeding due to the observation that “… most children are weaned early and left under the care of their grandparents…” Some of the nutrition-sensitive challenges were observed to be related to food insecurity due to “limitations in food access and availability…”; poor nutrition knowledge given that “some community members lack knowledge on which foods to eat, how to prepare food, and on the frequency of feeding…”; undesirable cultural and religious beliefs and practices; and misleading nutrition information due to “limited access to information on nutrition & dietetics…”
Table 3: Stakeholders’ Perceptions on the Nutrition and Dietetics Related Challenges Faced by Communities
Graduates Perceptions (N=114)
|
Academic Staff and Work/internship Supervisors Perceptions
|
Nutrition and dietetics related challenges
|
Respondents
n(%)*
|
Illustrative quotes
|
Malnutrition in its different forms
|
69(60.5)
|
“There is a high prevalence of acute and chronic malnutrition in addition to other diseases…”
“Some clients present with obesity, diabetes, asthma, cancer, and constipation. We see people of three categories; those that come for prevention, those who seek curative services, and those seeking treatment for infectious conditions”.
“Disability due to micronutrient deficiencies, severe underweight, high stunting, wasting, anaemia, …”
|
Poor nutrition knowledge
|
49(43.0)
|
“Some community members lack knowledge on which foods to eat, how to prepare food, and on the frequency of feeding…”
“Lack of extensive knowledge on cause-effect relation of disease and malnutrition…”
|
Food insecurity
|
43(37.7)
|
“90% of all the problems are because of food [insecurity]…”
“Limitations in food access and availability…”
“…household food insecurity…”
|
Non-communicable/chronic diseases
|
29(25.4)
|
“Non-communicable disease rates…”
|
Undesirable cultural and religious beliefs and practices
|
17(14.9)
|
“Cultural beliefs and food taboos…”
|
Low dietary diversity
|
12(10.5)
|
“Very few families can afford to eat the recommended minimum dietary diversity…”
“Most people only have two meals a day and children are fed the same number of times as adults…”
|
Misleading information on nutrition
|
11(9.6)
|
“Limited access to information on nutrition & dietetics…”
|
Inadequate maternal, infant, young child, and adolescent nutrition feeding practices
|
9(7.9)
|
“… most children are weaned early and left under the care of their grandparents…”
“…poor maternal and child health care…”
|
Inadequate water, sanitation, and hygiene practices
|
8(7.0)
|
“Poor hygiene and sanitation…”
|
Insecurity and economic related challenges
|
7(6.1)
|
“…sociocultural economic challenges…”
“…border insecurity and cattle rustling by the Turkana…”
|
Limited access to and utilization of land for production
|
6(5.3)
|
|
Climatic changes
|
5(4.4)
|
“…drought [and] occasional floods…”
|
Poor post-harvest handling and food quality control practices
|
2(1.8)
|
|
*Multiple response analysis with percentage computed based on number of respondents rather than the total number of responses; HN/HND: Human Nutrition/Human Nutrition and Dietetics
Stakeholders’ perceptions of the nutrition and dietetics services requested for and provided to communities
Graduates' responses were grouped under seven major domains as summarised in Table 4. Under the category of services requested by communities, responses were received from 109 graduates with the main services falling in the domains of nutrition awareness, education, and counselling (55%); integrated management of acute malnutrition (46.8%); food security and livelihoods support (33.9%); management of non-communicable diseases (26.6%); nutrition screening (22.9%); maternal, infant, young child, and adolescent nutrition (17.4%); and water, sanitation and hygiene (10.1%).
For the nutrition and dietetic services provided by employers, the majority of respondents (56%) mentioned nutrition awareness, education, and counselling services as being the main provided services; followed by integrated management of acute malnutrition (54%); food security and livelihood support (47%); nutrition screening (28%); management of non-communicable and communicable diseases (22.0%); maternal, infant, young child and adolescent nutrition (19%); and water, sanitation and hygiene (14%).
When asked about their views on the would-be priority nutrition and dietetics services to provide, most graduates (64.3%) mentioned services under the domain of nutrition awareness, education, and counselling; followed by food security and livelihood support (41.8%); integrated management of acute malnutrition (31.6%); maternal, infant, young child, and adolescent nutrition (14.3%); management of non-communicable and communicable diseases (12.2%); and water, sanitation and hygiene (8.2%). Some illustrative quotes to justify the responses are summarised along with the responses in Table 4.
The responses by the academic staff and the work/internship supervisors in regards to the nutrition and dietetic services provided in communities were coded under similar themes as those used for the HN/HND graduate as also summarised in Table 4. Based on the illustrative quotes, under the theme of management of non-communicable and communicable diseases; respondents noted the provision of interventions that largely address the management of nutrition-related problems by ‘fairly’ large hospitals and referral hospitals. Relatedly, services in regards to the treatment of severe acute malnutrition, therapeutic feeding, and supplementation with Ready-to-use-therapeutic feeds for those that meet the required criteria were perceived to be provided under the theme of integrated management of acute malnutrition.
Under the theme of food security and livelihood support; mention was made for the provision of nutrition livelihood programs, food relief, and cash for work interventions. Some of the services perceived to be provided under the theme of maternal, infant, young child, and adolescent nutrition included child health and nutrition services in clinics, antenatal nutrition education, food demonstrations in infant and young child feeding, and health education. Under the theme of nutrition screening, mention was made of nutrition assessment and routine community nutrition screening for children. Some of the services mentioned under the theme of nutrition awareness, education, and counselling included guidance and counselling and community nutrition education. Other mentioned services included water, sanitation, and hygiene; and product development and food processing under the themes of water, sanitation, and hygiene, and business and industry respectively.
Table 4: Stakeholders’ Perceptions of the Demanded and Provided Nutrition and Dietetic Services
Nutrition and dietetic services domains
|
HN/HND Graduates
|
Academic staff and Work/internship Supervisors
|
Requested by communities (N=109)
|
Provided by employers (N=100)
|
Considered a priority to provide (N=98)
|
Respondents
n(%)*
|
Respondents
n(%)*
|
Respondents
n(%)*
|
Illustrative quotes on the nutrition and dietetic services provided in communities
|
Nutrition Awareness, Education & Counselling
|
60(55)
|
56(56)
|
63(64.3)
|
“Guidance and counselling…”
“Nutrition guidance and counselling…”
“Mainly nutrition education is provided…”
“Nutrition education in the community…”
|
Integrated management of acute malnutrition
|
51(46.8)
|
54(54)
|
31(31.6)
|
“It is mainly the treatment of severe acute malnutrition through hospitals…”
“Supplementation with ready-to-use-therapeutic feeds for those that meet the required criteria …”
“Therapeutic feeding …”
|
Food Security and livelihood support
|
37(33.9)
|
47(47)
|
41(41.8)
|
“Nutrition livelihood programs…”
“Food relief…”
“Cash for work intervention …”
|
Management of non-communicable diseases
|
29(26.6)
|
22(22)
|
12(12.2)
|
“Interventions that largely address management of nutrition-related problems…”
“Nutrition in illness in fairly larger hospitals and regional referral hospitals…”
“Diet/meal planning…”
|
Nutrition Screening
|
25(22.9)
|
28(28)
|
7(7.1)
|
“Nutrition assessment …”
“Routine community nutrition screening for children …”
|
Maternal, infant, young child and adolescent nutrition
|
19(17.4)
|
19(19)
|
14(14.3)
|
“Child health nutrition services at clinics and hospitals…”
“Antenatal nutrition education…”
“Food demonstration in infant and young child feeding …”
“Health education on infant and young child feeding practices …”
|
Water, sanitation, and hygiene
|
11(10.1)
|
14(14)
|
8(8.2)
|
“Water sanitation and hygiene services”
|
Business and industry
|
_
|
_
|
_
|
“Product development, food processing …”
|
* Multiple response analysis with percentage computed based on number of respondents rather than the total number of responses; HN/HND: Human Nutrition/Human Nutrition and Dietetics
Stakeholders’ perceptions of the nature of work and job roles performed by practicing HN/HND graduates
As per the graduates’ responses, the nature of work done by the practicing graduates was categorised under seven major domains (see Table 5) of organizational leadership and management (69.6%); management of nutrition-related disease conditions at health facility and or community level (59.1%); nutrition and health promotion (57.4%); research and documentation (53%); advocacy, communication and awareness (23%); academia (7.1%); and that of the business/industry (3.6%).
Table 5: Categories of Work and Related Roles Performed by HN/HND Professionals Practicing in Uganda
Categories of Work
|
Identified Work/Job Roles
|
Category of Work Domain
|
N
|
Graduates whose work relates to domain
n(%)
|
Work roles
|
N
|
Graduates performing mentioned role
n(%)*
|
Organizational Leadership and Management
|
115
|
80(69.6)
|
Leadership
|
80
|
60(75)
|
Project planning, management, & implementation
|
43(53.8)
|
Project monitoring and evaluation
|
79
|
24(30.4)
|
Budgeting and accountability
|
80
|
18(22.5)
|
Human resources management
|
15(18.8)
|
Organizational representation and networking
|
13(16.3)
|
Proposal/report writing
|
79
|
5(6.3)
|
Resource mobilization
|
80
|
3(3.8)
|
Technical support/guidance
|
79
|
3(3.8)
|
Management of Nutrition Conditions at Health Facility and or Community level
|
115
|
68(59.1)
|
Nutrition screening or assessment
|
67
|
51(76.1)
|
Inpatient therapeutic care
|
39(58.2)
|
Outpatient therapeutic care
|
39(58.2)
|
Supplementary feeding
|
35(52.2)
|
Nutrition education and counselling
|
66
|
26(39.4)
|
Nutrition supplies management/procurement
|
67
|
14(20.9)
|
Monitoring, supervision, and QI
|
13(19.4)
|
Community nutrition work
|
11(16.4)
|
Management of other nutrition-related disease conditions
|
66
|
5(7.6)
|
Emergency nutrition
|
66
|
4(6.1)
|
MIYCAN
|
67
|
4(6.0)
|
Nutrition and health promotion
|
115
|
66(57.4)
|
Nutrition and health education
|
66
|
41(62.1)
|
Capacity building
|
65
|
34(52.3)
|
Technical support
|
12(18.5)
|
Growth monitoring and promotion
|
66
|
2(3)
|
Research and documentation
|
115
|
61(53)
|
Dissemination
|
61
|
61(100)
|
Report writing
|
45(73.8)
|
Undertaking research
|
28(45.9)
|
Data entry and analysis
|
5(8.2)
|
Proposal writing
|
4(6.6)
|
Advocacy, Communication, and Awareness
|
113
|
26(23)
|
Community/stakeholder engagements
|
26
|
20(76.9)
|
Stakeholder orientation
|
2(7.7)
|
Networking
|
2(7.7)
|
Resource mobilization
|
1(3.8)
|
Coordinating advocacy events
|
1(3.8)
|
Academia
|
112
|
8(7.1)
|
Lecturing and student supervision
|
8
|
87.5
|
Research
|
8
|
12.5
|
Business/Industry
|
112
|
4(3.6)
|
Product development
|
4
|
1(25)
|
Product marketing
|
4
|
1(25)
|
Technical Assistance
|
4
|
1(25)
|
Product certification
|
4
|
1(25)
|
* Multiple response analysis with percentage computed based on number of respondents rather than the total number of responses; HN/HND: Human Nutrition/Human Nutrition and Dietetics; MIYCAN: Maternal, infant, young child, and adolescent nutrition; QI: quality improvement
For the respondents whose work entailed aspects of organizational leadership and management; the main mentioned roles included leadership (75%); project planning, management and implementation (53.8%); project monitoring and evaluation (30.4%); budgeting and accountability (22.5%); and human resources management (18.8%).
For the respondents with job roles categorized under the domain of management of nutrition conditions at the health facility and community level, the main mentioned work roles included nutrition screening or assessment (76.1% of respondents); offering of inpatient and outpatient therapeutic care each at 58.2%; supplementary feeding (52.2%); nutrition education and counselling (39.4%), nutrition supplies management (20.9%); monitoring, supervision and quality improvement (19.4%); and community nutrition work (16.4%).
The main work roles performed by graduates engaged in nutrition and health promotion included nutrition and health promotion (62.1%); capacity building (52.3%); offering technical support (18.5%); and growth monitoring and promotion (3%).
For undergraduates engaged in research and documentation, all (100%) reportedly participated in dissemination; followed by 73.8% that undertook report writing, 45.9% that participating in carrying out nutrition surveys, 8.2% that did data entry and analysis, and 6.6% that contributed to proposal writing.
For the undergraduates whose job roles were categorized as falling in the domain of advocacy, communications, and awareness, the majority (76.9%) mentioned carrying out community/stakeholder engagements. This was followed by undertaking stakeholder orientations and networking each at 7.7% and coordinating advocacy events (3.8%).
Besides the feedback from the HN/HND graduates, this study also explored the views of academic staff and those of the work/internship supervisors on the types of employment in which the HN/HND graduates were engaged as well as the work/job roles they performed. From the responses, it was evident that employed graduates mainly worked as nutritionists in different positions; across different sectors; and in both government and non-government agencies. As per the following respondents’ narratives, the ministry of health, non-governmental organizations, academic institutions, private health facilities, United Nations agencies, hotels, district local governments, and special care homes included some of the mentioned employers.
“They are employed in the public service as nutritionists at the national level, in the ministry of health, in regional referral hospitals, and at local government level …. [They] also work as nutrition specialists with various NGO’s and United Nations bodies.”
“Nutritionists in humanitarian relief based organizations; nutrition program managers in NGOs; nutritionists and dieticians in the national referral hospital, district hospitals, and private hospitals; nutrition and diet consultants; lecturers; and researchers.”
The graduates were regarded to be performing multiple cross-cutting roles in the different types of employment. For instance, one of the respondents noted the HN/HND job roles to involve “Conducting nutrition education for various groups; individual nutrition counselling sessions for various nutrition-related conditions; dietary assessment; conducting of food demonstration sessions in infant and young child feeding; and nutrition project planning and implementation.”
The performed roles were however observed by one of the respondents to vary according to the job position, “Roles vary depending on the rank. Supervisory work is done as one grows in rank; other roles assigned depending on rank include nutrition assessment; … undertaking nutrition interventions for clients; giving food supplements, and client follow up.”
Stakeholders’ perceptions of the knowledge and skills required of HN/HND graduates in Uganda
From the multiple responses by the HN/HND graduates, twenty knowledge and skills themes were identified. Based on these themes; an evaluation of the respondents' perceptions in regards to knowledge and skills expected of HN/HND graduates; knowledge and skills gaps amongst individual graduates; knowledge and skills inadequately attained while at university; and the knowledge and skills recommended as a training minimum for HN/HND was done as summarised in Table 6.
In regards to the knowledge and skills expected of HN/HND graduates, responses were received from 132 respondents. The top six mentioned themes were integrated management of acute malnutrition (75.8%); communication, education, and counselling (62.1%); medical/clinical nutrition therapy (56.8%); research, proposal, and report writing (52.3%); nutrition screening and assessment (47.7%); and leadership and management (47%).
For the knowledge and skills gaps amongst individual graduates; responses were received from 120 graduates. The top six mentioned gaps included medical/clinical nutrition therapy (61.7%); project planning, management, monitoring and evaluation (38.3%); integrated management of acute malnutrition (31.7%); communication, education, and counselling (18.3%); leadership and management (11.7%); and research, data analysis, proposal and report writing (10%).
Concerning the knowledge and skills not adequately attained during undergraduate training, feedback was received from 100 respondents. The top six knowledge and skills themes were medical/clinical nutrition therapy (61%); research, data analysis, proposal and report writing (23%); leadership and management (19%); project planning, management, monitoring and evaluation (17.6%); integrated management of acute malnutrition; and communication, education, and counselling (13% each); and nutrition advocacy (10%).
As relates to the knowledge and skills recommended for minimum training, 97 respondents provided feedback. The top recommended knowledge and skills themes were in the categories of medical/clinical nutrition therapy (44.3%); integrated management of acute malnutrition (41.2%); communication, education, and counselling (27.8%); nutrition screening and assessment (25.8%); leadership and management (19.6%), and nutrition advocacy (13.4%).
Table 6: HN/HND Graduates Perceptions of the Knowledge and Skills Required for Health Systems Performance
Knowledge & Skills Themes
|
Expected of HN/HND Graduates (N=132)
|
Gaps Amongst Individual Graduates (N=120)
|
Inadequately Attained while at University (N=100)
|
Recommended as Training Minimum (N=97)
|
|
Respondents n(%)*
|
Respondents n(%)*
|
Respondents n(%)*
|
Respondents n(%)*
|
Integrated management of acute malnutrition
|
100(75.8)
|
38(31.7)
|
13(13)
|
40(41.2)
|
Communication, education, and counselling
|
82(62.1)
|
22(18.3)
|
13(13)
|
27(27.8)
|
Medical/clinical nutrition therapy
|
75(56.8)
|
74(61.7)
|
61(61)
|
43(44.3)
|
Research, data analysis, proposal, and report writing
|
69(52.3)
|
12(10.0)
|
23(23)
|
19(19.6)
|
Leadership and management
|
62(47)
|
14(11.7)
|
19(19)
|
19(19.6)
|
Nutrition screening and assessment
|
63(47.7)
|
13(10.8)
|
8(8)
|
25(25.8)
|
Project planning, management, monitoring, and evaluation
|
49(37.1)
|
46(38.3)
|
17(17)
|
6(6.2)
|
Nutrition Advocacy
|
46(34.8)
|
12(10)
|
10(10)
|
13(13.4)
|
Maternal, infant, young child, and adolescent nutrition
|
43(32.6)
|
7(5.8)
|
1(1)
|
9(9.3)
|
Nutrition computing
|
32(24.2)
|
8(6.7)
|
11(11)
|
11(11.3)
|
Agribusiness
|
11(8.3)
|
2(1.7)
|
-
|
3(3.1)
|
Public health
|
9(6.8)
|
1(0.8)
|
1(1)
|
3(3.1)
|
Quality improvement
|
9(6.8)
|
-
|
4(4)
|
-
|
Product development and food safety management
|
9(6.8)
|
6(5.0)
|
4(4)
|
-
|
Records and data management
|
6(4.5)
|
-
|
-
|
-
|
Emergency nutrition
|
2(1.5)
|
1(0.8)
|
1(1)
|
-
|
Water, sanitation, and hygiene
|
2(1.5)
|
-
|
-
|
2(2.1)
|
Professional ethics
|
1(0.8)
|
4(3.3)
|
-
|
-
|
Internal medicine
|
-
|
1(0.8)
|
-
|
-
|
Human anatomy
|
-
|
-
|
7(7)
|
-
|
* Multiple response analysis with percentage computed based on number of respondents rather than the total number of responses; HN/HND: Human Nutrition/Human Nutrition and Dietetics
Similar to the responses by HN/HND respondents, the perceptions of academic staff and work/internship supervisors were multifaceted. Illustrative quotes of the academic staff and work/internship supervisors' responses when coded to the same knowledge and skills domains as was for the HN/HND respondents are summarised in Table 7. Under agribusiness, the need for knowledge and skills in crop management and backyard farming was mentioned. Under medical/clinical nutrition therapy, it was expressed that Nutrition and Dietetics professionals needed knowledge and skills on how to assess, categorize and apply diet therapy to correct and manage disease abnormalities and dietary recommendations for specific age groups. Relatedly, HN/HND graduates were noted to have knowledge and skills gaps in clinical care and support for clients; management of clients in the absence of medical officers; management of non-communicable diseases; making of proper diagnosis; and dietetic management.
Under the domain of nutrition computing, it was expressed that undergraduates needed to have the knowledge and skills necessary for the use of technology, basic computing, and data analysis. Knowledge and skills gaps were noted to exist in the form of inadequate mastery of statistics and limited exposure to the use of modern technology.
Under the broad domain of maternal, infant, young child, and adolescent nutrition, stakeholders expressed a need for knowledge and skills in infant and young child feeding, as well as knowledge and skills in specific areas of maternal, infant, young child, and adolescent nutrition. However, some respondents noted the existence of knowledge and skills gaps in infant and young child feeding.
In the domain of leadership and management, knowledge and skills were noted to be required in team working skills, interpersonal and organizational skills; critical thinking; and the management of human and material resources. Respondents noted the existence of knowledge and skills gaps in leadership and governance, conflict management and negotiation, and mobilization and fundraising.
Some of the knowledge and skills noted as being required in the domain of communication, education, and counselling included nutrition education and counselling, facilitation skills, communication more so as relates to behavioural change, and nutrition education and advocacy. Noted knowledge and skills gaps existed in communication skills and interpersonal skills, confidence talking to the public, education session planning and implementation, inability to effectively communicate with clients, development of IEC materials, and presentation skills.
Under the domain of nutrition screening and assessment, knowledge and skills were said to be expected of undergraduates in nutrition anthropometry, biochemical, clinical, and dietary assessment. The undergraduates were however said to have inadequate skills in nutrition assessment.
In the domain of project planning and management, knowledge and skills were said to be expected of undergraduates in planning, budgeting, policy formulation, and nutrition governance; understanding of multisectoral nutrition programming, and project implementation. Notable knowledge and skills gaps existed in monitoring and evaluation, project planning, budgeting, and writing bidding proposals for organizations.
The expected knowledge and skills under the domain of research, data analysis, proposal, and report writing related to undertaking field and laboratory-based research; statistical data analysis and interpretation; report writing; and analytical skills. However, knowledge and skills gaps were said to exist in different areas including proposal writing, general research knowledge, and report writing and data collection.
In the domain of anatomy, physiology, pharmacology, pathology, and biochemistry, respondent expressed a need for knowledge and skills in anatomy, drug prescription with minimal reliance on medical doctors, understanding of the relationship between foods and the blood system, pharmacy and pathology, and biochemistry and food microbiology. Some noted knowledge and skills gaps were in the ability to link nutrition and body system functions, and limitations in anatomy and physiology.
In the broad domain of product development and food safety management, knowledge and skills were expected of undergraduates in quality control analysis, food safety in nutrition, and food standards and laws.
Under the domain of professional ethics, respondents indicated the need for undergraduates to exhibit knowledge and skills in ethics and professionalism. However, knowledge and skills gaps were noted in work ethics and client management, and general ethics and professionalism.
An extra domain of laws, policies, and regulations was created based on the trainer's and supervisors' responses. Under this domain, Nutrition and Dietetics professionals were expected to exhibit an understanding of key policies and guidelines on nutrition at the global and national levels. However, it was echoed that HN/HND professionals exhibited knowledge and skills gaps in nutrition policy and legislation.
Table 7: Academic staff and Work/internship Supervisors Perceptions on the Knowledge and Skills Required of HN/HND Graduates
Knowledge and Skills Domain
|
Illustrative quotes
|
Required of Nutrition and Dietetics Professionals in Uganda
|
Knowledge and Skills Gaps
|
Agribusiness
|
“Crop management, backyard farming …”
|
|
Medical/clinical nutrition therapy
|
“How to apply diet therapy to correct or manage abnormalities …”
“Dietetic management of some disease conditions …”
“Prevention of overweight and obesity …”
“Special preparation food skills for various age groups and health conditions …”
“Assessment, categorization, and management of patients using therapeutic feeds …”
“Dietary recommendations for specific age groups …”
|
“Clinical care and support for clients …”
“Most lack the ability to manage a client in the absence of a medical officer …”
“Nutrition management of non-communicable diseases …”
“Inability to make a proper diagnosis of a disease … and manage it dietetically …”
|
Nutrition computing
|
“Use of technology …”
“Basic computing …”
“Data analysis …”
|
“Inadequate exposure to the use of modern technology…”
“Statistics was not well mastered …”
|
Maternal, infant, young child, and adolescent nutrition
|
“Integrated management of acute malnutrition; infant and young child feeding… nutrition assessment, counselling, and support …”
“Infant and young child feeding …”
|
“Infant and young child feeding …”
|
Leadership & Management
|
“Team working skills, good interpersonal, … organizational skills”
“Critical thinking …”
“Ability to execute … duties with minimum or no supervision”
|
“Lack of leadership and governance skills …”
“Conflict management, negotiation skills, strategies to boost and sustain the performance of the organization and its employees …”
|
Communication, education, and counselling
|
“Nutrition education and counselling …”
“Facilitation skills since they are working with people …”
“Communication skills … but also need skills that are more specific to behavioural change”
“Nutrition education and advocacy …”
|
“Communication skills, interpersonal skills …”
“Confidence talking to the public …”
“Education session planning and implementation”
“Inability to effectively communicate with clients …”
“Development of IEC materials …”
“Presentation skills …”
|
Nutrition screening and assessment
|
“Nutrition assessment …”
“Nutrition assessment i.e. anthropometry, biochemical, clinical, and dietary assessment for all people …”
|
“Nutrition assessment …”
|
Project planning, management, monitoring, and evaluation
|
“Planning, budgeting, policy formulation and dissemination, nutrition governance …”
“Understanding of multi-sectoral nutrition programming …”
“Project implementation …”
|
“Monitoring and evaluation …”
“Project planning …”
“Budgeting …”
“Writing bidding proposals for organizations …”
|
Research, Proposal, & Report writing
|
“Research both field-based and laboratory-based …”
“Data analysis and report writing …”
“Analytical skills to be able to carry out research and analyse different problems…”
“Data collection, statistical analysis, and interpretation …”
|
‘Proposal writing …”
“General research knowledge …”
“Report writing and data collection …”
|
Product development and food safety management
|
‘Quality control analysis …”
“Food safety in nutrition …”
“Food standards and laws …”
|
|
Professional Ethics
|
“Ethics and professionalism …”
|
“Work ethics, Client management …”
“Ethics and professionalism …”
|
Anatomy, Physiology, Pharmacology, Pathology, Biochemistry
|
“Anatomy …”
“Drug prescription with minimal reliance on medical doctors …”
“Understanding of the relationship between foods and the blood system …”
“Pharmacy and pathology …”
“Biochemistry and food microbiology …”
|
“Linking nutrition and body system functions …”
“Anatomy and physiology …”
|
Laws, policies and regulations
|
“Knowledge and skills of key policies and guidelines that guide nutrition …”
|
“Nutrition policy and legislation …”
|
HN/HND: Human Nutrition/Human Nutrition and Dietetics
Observations from the stakeholder validation workshop
A one-day results validation workshop was undertaken on the 3rd of October 2019 at the Grand Global Hotel located in Makerere Kikoni, Kampala Uganda. The workshop aimed to engage stakeholders in reviewing and commenting on the appropriateness of the study results. The workshop followed a predefined formal agenda that was communicated to the participants before the workshop. Key on the agenda was the oral presentation of the study background, methodology, and results by the principal researcher; plenary reactions, discussions, and suggestions in regards to the presented content; and three group exercises each followed by a plenary presentation and discussions. To document workshop proceedings, three experienced note-takers were engaged in taking notes; audio recording of the plenary presentations and discussions was done, and photographs were taken at different intervals. The validation workshop was attended by 31 participants (one from the food/business industry, five working with private hospitals, twelve working with universities, two working with district local governments, six working with NGOs, one working with a research-based institution, two working with regional referral hospitals, one working as a private consultant, and one working with the ministry of health).
In general, the participants judged the study to be vital and timely towards informing on-going processes in the development of a national HN/HND training and practice standard that was considered inexistent at the time of the study; “Uganda has no National standard stipulating the training and practice requirements for nutrition and dietetics …. We hope this research can be used to inform such process”. One of the participants sought clarification on how the study links and informs curriculum reforms; “At what point do the study findings link with the curriculum; is it the issue of competencies not being in the curriculum or is it due to how the teaching is done? How do we link these?”
Participants further recognised the multisectoral nature of implementing nutrition interventions at the global and national level and called for the need to take caution when identifying the knowledge and skills required of HN/HND graduates to perform in a multisectoral setting:
“Issues like water, sanitation, and hygiene; food security; and livelihood support as reported in the findings are very key as they introduce an element of multi-sectorality… caution needs to be undertaken in regards to the nutrition and dietetics training needs under the multisectoral approach. We must be cautious about the knowledge and skills required under the multisectoral setting.”
Relatedly, the need to appreciate the roles of other professions in the multisectoral approach; linking with them, and understanding their views in regards to the knowledge and skills they expect of HN/HND professionals was emphasised:
“We should appreciate that other professions providing services that are supportive of nutrition and dietetics services do exist. We need to know how to link with them to implement multisectoral nutrition and dietetics services.”
“We need to know how other professionals perceive of our profession, and the knowledge and competencies they expect of us…. Coming from a clinical and research setting, I sense others don’t know what to expect of nutritionists. Can we collect additional data on this? Getting the perceptions of other professionals that work with nutritionists and dietitians on what they expect of nutritionists and dietitians can enable us to make better curriculum reforms in nutrition and dietetics training.”
In discussing the knowledge and skills required for the practice of HN/HND in Uganda, observations were made that some knowledge and skills areas had been lowly ranked:
“Why was the response rate on professional ethics low? Is it because adherence to ethics is low in professional nutrition and dietetics practice or is it because nutrition and dietetics professionals do not value ethics? The curriculum needs to fully equip trainees with professional ethics because there is still a challenge on which ethics guide nutrition and dietetics practice in Uganda.”
“Patient clerking was missed out in the results yet it is an important competency that has to be mastered by nutritionists and dietitians…”
Some participants also argued that graduates exhibited minimal competency in some of the areas considered core for the practice of HN/HND in Uganda
“Nutrition in emergencies is not well taught in Uganda to Bachelor’s students of nutrition yet many undergraduates work in emergency contexts and or with humanitarian agencies whose work entails aspects of emergency nutrition…”
“The current transmission of knowledge is insufficient… fresh undergraduates severely lack practical clinical skills…”
“The undergraduates we have can generate statistics but not use the information yet professionals should be able to interact with the information, generate evidence to guide programming … statistics are basic at the undergraduate level but undergraduates need more than is stipulated for this level…. [Graduates] don’t appreciate the use of statistics to guide programming, this is reflected when they start working.”
“Knowledge and skills need to be tailored to the environment in which the undergraduates operate. What challenges are undergraduates facing in the environments they are operating? We should consider the policy and planning environment because these affect professional work.”
The need to introduce and or strengthen training in family planning, procurement, leadership, and nutrition policy formulation was recommended:
“It may be important to consider including family planning, strengthening training in procurement and logistics of nutrition materials and supplies, and adding nutrition leadership and management as these are lacking in the HN/HND Bachelors training curriculum.”
“Many of the challenges presented are in the services sector but not in policy yet [many] challenges exist in the implementation of nutrition-related policies. Nutrition and dietetics related challenges presented have limited focus on policies being implemented yet the government, in terms of systems capacity, under the Ministries of Health and Agriculture focuses on implementing what is stipulated in the policies. I suggest for the need to undertake further reflection on nutrition-related policies in the country and the capacity of concerned ministries to implement nutrition as stipulated in the existing policies and sectoral strategies…”
“There is a need to improve utilization of HMIS [Health Information Management Systems] data collected from the community by nutritionists.”
The need to undertake assessments to determine the capacity readiness of institutions of higher learning to train HN/HND in Uganda was also emphasised; “Have you considered looking at the capacity of the different institutions training nutrition undergraduates in Uganda in terms of research, equipment, and human resources…?”