The aim of this study was to assess dietary practices and nutritional status of elderly persons in the post-conflict context of Northern Uganda. The study found the prevalence of malnutrition at 53.9%, with more than half (61.7%) of respondents reporting a moderate decrease in food intake in past months. The biggest proportion of the elderly mainly ate sorghum, millet, and maize products, beans, and pigeon peas. Increasing age, having primary education compared to having no education, staying within < 5km from the health facility, and a dietary diversity score ≥ 60 were significantly associated with having malnutrition.
This study found majority of the participants to be malnourished. The prevalence similar to that reported from other settings elsewhere that reported prevalence of up to 54%[9, 17]. However, the current study reports a slightly higher prevalence than the 33.3% reported by a study from Uganda[5]. Additionally, some other studies elsewhere have also reported a much lower prevalence of malnutrition[18, 19]. The discrepancy may be due to the differences in tools used to measure malnutrition. The current study used the short form of MNA tool while the previous studies used BMI and the longer version of the MNA tool. Nonetheless, the comparatively high prevalence of malnutrition in the current study could be a reflection on the food insecurity in this region and a need for nutritional and food relief programs among the elderly persons.
In the current study, participants mainly consumed starchy cereals, legumes and tubers. Animal products and fruits were least consumed as previously reported from other household surveys in northern [10] and central [4] Uganda. This could be explained by the fact that most people are farmers[10] and agriculture was the commonly practiced occupation even in our study. But also, it suffices to mention that the most consumed foods – sorghum, millet, Boo and Otigo are the staple foods of Northern Uganda[20]. Hence, ease of access could be one of the reasons for the routine consumption of staples by the elderly persons. But also, majority of the participants barely had income. Perhaps they couldn’t afford to purchase the other recommended nutritious foods which they don’t grow. Nevertheless, the consumption of carbohydrate-rich meals with a plant-based protein and minimal or no micro-nutrient foods is a common trend in Uganda[21].
The study found that malnutrition was likely to be more prevalent among older respondents compared to the younger elderly persons. This may be explained by the decreasing taste for food and preferences over time among elderly persons, which eventually affects the intake of nutrients hence infringing on their nutritional health. Our finding concurs with findings elsewhere[3, 17, 18]. Contrary to previous studies[4, 9, 17, 19], having some education background did not protect the elderly against malnutrition. Education empowers people with knowledge including appropriate dietary practices which may enable them make proper nutrition-related choices[10] hence minimizing the chances of being undernourished. However, the discrepancy in the current findings may be attributable to the effects of the war on the cognitive functioning like memory of these survivors[22, 23]. The diminished memory leaves minimal or no difference in nutrition comprehension between participants that ever had an education and those who didn’t. This highlights a need for elderly health promotion programs in post-conflict settings. But also, although the study was powered enough to answer the study objectives, the small sample size could have hindered detection of some probable associations. We recommend future studies to consider bigger samples.
Furthermore, the current study found that people who were residing within 5km radius from a health facility were more likely to be malnourished contrary to what was reported in Rwanda[24] where improved healthcare accessibility reduced the likelihood of malnutrition. However, the finding is also not biologically plausible as one would expect ease of access to healthcare services to improve health outcomes. The discrepancy could be because “distance from the facility” in the current study was measured through self-report with no objective validation of the participants’ reports. This may have introduced information bias and some responses may have been influenced by social desirability bias. On the hand, the finding may reflect under-utilization of healthcare services and poor health seeking behaviors in this population. Elderly programs may consider community and home-based care approaches and qualitative studies may also help expound on this behavior.
In this study we found that people who had a higher DDS (≥ 60) were less likely to be malnourished. The findings are similar to those from Ethiopia[18]. Eating a balanced diet is recommended to prove nourishment[25] and so it is not uncommon that people who eat healthy stay healthy even the older adults[26].
The study findings are not to be considered without any reservations. Although the study extensively explored the dietary habits and frequency of food in-take, we did not study meal timing which is key in proper nutrition[27]. We recommend further studies to consider the timing aspect and how it may influence nutrition in this population. Likewise, a qualitative study to explore other factors like psychosocial, cultural and environmental factors may be considered for further research to further explain malnutrition elderly persons. Needless to mention, this was a cross-sectional study hence we could not establish causal associations. Lastly, our study was limited to the rural setting. Although this may hinder generalization of the study findings to urban settings, in it lies the uniqueness of our study concept as the conflicts in northern Uganda coupled with the limited opportunities in rural areas left rural settings more vulnerable to the aftermaths of the wars[28] compared to the urban areas making them more of interest to study.