Catley Andy, Arasio Raphael Lotira, Hopkins Charles
Feinstein International Center, Friedman School of Nutrition Science and Policy, Tufts University, PO Box 6934, Kampala, Uganda.
Pastoralism. 2023;13(1):7. doi: 10.1186/s13570-023-00269-5. Epub 2023 Mar 2.
The Karamoja region of northeast Uganda had been characterized by high levels of acute malnutrition (AM) for decades, despite substantial aid investment in nutrition programmes. Participatory epidemiology (PE) was used to understand the seasonality of child AM from the perspective of women agro-pastoralists and understand their knowledge and prioritization of the causes of child AM. Women provided highly plausible descriptions and analysis of monthly variations in the occurrence of AM, livelihood factors related to the temporal variation in AM occurrence, the root causes of AM and relationships between these causes. Overall, AM was strongly attributed to declining livestock ownership and access to cow milk and normalized gender discrimination. Monthly calendars revealed important monthly patterns in AM, births and women's workload that had not been previously reported. There was significant agreement ( < 0.01) between independent women's groups ( = 16) for the monthly calendars and causal diagrams, indicating strong reproducibility of the methods. Triangulation indicated good validity of the monthly calendar method. The PE approach demonstrated that agro-pastoralist women with limited formal education could describe and analyse the seasonality of AM and related factors and identify and prioritize the causes of AM. Indigenous knowledge should be valued and respected, and nutrition programmes should shift the emphasis towards far more participatory and community-based approaches. The timing of conventional nutrition surveys in agro-pastoral settings should be based on an understanding of the seasonality of livelihoods.
The online version contains supplementary material available at 10.1186/s13570-023-00269-5.
尽管在营养项目上投入了大量援助，但乌干达东北部的卡拉莫贾地区几十年来一直存在着严重的急性营养不良（AM）问题。参与式流行病学（PE）被用于从农牧民妇女的角度了解儿童急性营养不良的季节性，并了解她们对儿童急性营养不良原因的认识和优先排序。妇女们对急性营养不良的月度变化、与急性营养不良发生时间变化相关的生计因素、急性营养不良的根本原因以及这些原因之间的关系提供了非常合理的描述和分析。总体而言，急性营养不良主要归因于牲畜拥有量下降、无法获得牛奶以及常态化的性别歧视。月度日历揭示了急性营养不良、出生和妇女工作量方面重要的月度模式，这些模式此前未被报道。独立妇女团体（n = 16）在月度日历和因果图方面存在显著一致性（P < 0.01），表明这些方法具有很强的可重复性。三角验证表明月度日历方法具有良好的效度。参与式流行病学方法表明，受正规教育有限的农牧民妇女能够描述和分析急性营养不良的季节性及相关因素，并确定急性营养不良的原因并进行优先排序。应重视和尊重本土知识，营养项目应将重点转向更具参与性和基于社区的方法。在农牧区进行传统营养调查的时间应基于对生计季节性的了解。
在线版本包含可在10.1186/s13570 - 023 - 00269 - 5获取的补充材料。
