title: Knowledge of integrated management of childhood illnesses community and family practices (C-IMCI) and association with child undernutrition in Northern Uganda: a cross-sectional study.
abstract: BACKGROUND
  Childhood undernutrition is a major challenge in Uganda with a prevalence of wasting and stunting at 5% and 33%, respectively. Community and family practices of the Integrated Management of Childhood Illnesses (C-IMCI) was introduced in sub-Saharan Africa early after the year 2000. C-IMCI was postulated to address major childhood morbidity and mortality challenges with nutrition as one of the outcomes. The association between knowledge patterns of C-IMCI and undernutrition has not been fully established especially in sub-Saharan Africa. This study was done to address the prevalence of stunting and wasting and the association with the knowledge and practices of C-IMCI among caretakers in Gulu district, Northern Uganda.
  
  
  METHODS
  This was a community-based cross-sectional study among 442 caretaker-child pairs. A standardized questionnaire was employed to assess the knowledge and practices of the C-IMCI among caretakers including four practices: breastfeeding, immunization, micronutrient supplementation and complementary feeding. Weight and height of children (6-60 months) were recorded. Wasting and stunting were defined as weight-for-height and height-for-age z-score, respectively, with a cut-off < -2 according to the World Health Organization growth standards. Logistic regression analysis reporting Odds Ratios (OR) with 95% confidence intervals (CI) was used to explore associations using SAS statistical software.
  
  
  RESULTS
  The percentage of caretakers who had adequate knowledge on C-IMCI (basic knowledge within each pillar) was 13%. The prevalence of wasting and stunting were 8% and 21%, respectively. Caretakers' lack of knowledge of C-IMCI was associated with both wasting (OR 24.5, 95% CI 4.2-143.3) and stunting (OR 4.0, 95% CI 1.3-12.4). Rural residence was also associated with both wasting (OR = 3.1, 95% CI 1.5-6.5) and stunting (OR = 1.7, 95% CI 1.0-2.7). Children younger than 25 months were more likely to be wasted (OR = 3.3, 95% CI 1.7-10.0).
  
  
  CONCLUSIONS
  We found a low level of overall knowledge of the C-IMCI of 13.3% (n = 59). There is also a high prevalence of childhood undernutrition in Northern Uganda. Caretakers' limited knowledge of the C-IMCI and rural residence was associated with both wasting and stunting. Interventions to increase the knowledge of the C-IMCI practices among caretakers need reinforcement.
authors.affiliation: Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda. zebdaevid@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Mukunya
authors.forename: Samuel
authors.initials: S
authors.lastname: Kizito
authors.forename: Tonny
authors.initials: T
authors.lastname: Orach
authors.forename: Regina
authors.initials: R
authors.lastname: Ndagire
authors.forename: Emily
authors.initials: E
authors.lastname: Tumwakire
authors.forename: Godfrey Zari
authors.initials: GZ
authors.lastname: Rukundo
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Mupere
authors.forename: Sarah
authors.initials: S
authors.lastname: Kiguli
mesh_terms: D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019468:Disease Management; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics; D012424:Rural Population; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology