Determinants of Nutritional Status among Geriatric Populations in Kween District, Eastern Uganda

  

    
Variables 
    
Frequency 
    
Malnourished
    
X2
    
P-value
  
  

    
Yes
    
No
  
  

    
In the past month, how often has    your food supply run out before you were able to get more food from either    your garden or the market?
    
 
    
 
    
 
    
 
    
 
  
  

    
 Never 
    
25(10.0%)
    
3(12.0%)
    
22(88.0%)
    
 
    

  
  

    
Sometimes 
    
202(80.8%)
    
12(5.9%)
    
190(94.1%)
    
3.203
    
 0.202 
  
  

    
Often 
    
23(9.2%)
    
2(4.3%)
    
21(95.7%)
    
 
    
 
  
  

    
In the past month, how often have    you had to borrow money for food in order to ensure that your household eats    enough? 
    
 
    
 
    
 
    
 
    
 
  
  

    
Never 
    
35(14.0%)
    
5(14.3%)
    
30(85.7%)
    
 
    
 
  
  

    
Sometimes 
    
187(74.8%)
    
10(5.3%)
    
177(94.7%)
    
5.648 
    
0.059 
  
  

    
Often
    
28(11.2%)
    
0(0.0%)
    
28(100.0%)
    
 
    
 
  
  

    
In the past month, how often have    you had to limit the amount that you yourself ate in order to make sure that    the other members of the household eat enough food?  
    
 
    
 
    
 
    
 
    
 
  
  

    
Never 
    
23(9.2%)
    
3(13.0%)
    
20(87.0%)
    
 
    
 
  
  

    
Sometimes 
    
202(80.8%)
    
12(5.0%)
    
190(95.0%)
    
 12.77
    
0.004 
  
  

    
 Often
    
25(10.0%)
    
1(4.0%)
    
24(96.0%)
    
 
    
 
  
  

    
In the past month, how often have    you or your children been forced to skip meals because the food is not    enough?
    
 
    
 
    
 
    
 
    
 
  
  

    
Never 
    
37(14.8%)
    
3(8.1%)
    
34(91.9%)
    
 
    
 
  
  

    
Sometimes 
    
191(91.2%)
    
12(6.3%)
    
179(93.7%)
    
 21.58
    
 0
  
  

    
Often
    
22(8.8%)
    
0(0.0%)
    
22(100.0%)
    
 
    
 
  
  

    
In the past month, have you    worried that you yourself is not getting an adequate diet?
    
 
    
 
    
 
    
 
    
 
  
  

    
Yes   
    
 
    
 
    
 
    
 
    
 
  
  

    
 No   
    
207(%82.8)
    
14(6.8%)
    
193(93.2%)
    
 0.059
    
 0.807
  
  

    
 
    
43(17.2%)
    
1(2.3%)
    
42(97.7%)
    

    

  
  

    
In the past month, have you    worried that the children or other members of the household are not getting    an adequate diet?
    
 
    
 
    
 
    
 

    
 
  
  

    
Yes  
    
214(85.6%)
    
8(3.7%)
    
206(96.3%)
    
 
    
 
  
  

    
No
    
36(14.4%)
    
4(11.1%)
    
32(88.9%)
    
 1.068
    
 0.301
  
  

    
In the past month, have you had to    reduce your household size to reduce food costs? 
    
 
    
 
    
 
    
 
    
 
  
  

    
Yes  
    
177(70.8%)
    
11(6.2%)
    
166(93.8%)
    
 
    
 
  
  

    
No
    
73(29.2%)
    
4(5.5%)
    
69(94.5%)
    
 2.49
    
0.076
  
  

    
In the past month, have you had to    sell some of your non-productive household assets to buy food? 
    
 
    
 
    
 
    
 
    
 
  
  

    
Yes  
    
191(76.4%)
    
12(6.3%)
    
179(93.7%)
    
 
    
 
  
  

    
No 
    
59(23.6%)
    
3(5.1%)
    
56(94.9%)
    
0.531 
    
 0.025
  
  

    
In the past month, how often have    you or your children been forced to go for a whole day without eating because    the food is not enough? 
    
 
    
 
    
 
    
 
    
 
  
  

    
Never 
    
 
    
 
    
 
    
 
    
 
  
  

    
Sometimes 
    
38(15.2%)
    
5(13.2%)
    
33(86.8%)
    
 4.659
    
 0.097
  
  

    
Often
    
197(78.8%)
    
9(4.6%)
    
188(95.4%)
    
 
    
 
  
  

    
 
    
15(6.0%)
    
1(6.7%)
    
14(93.3%)
    

    

  
  

    
In the past month, how often has    the food for your household been insufficient? 
    
 
    
 
    
 
    
 
    
 
  
  

    
Never  
    
24(9.6%)
    
2(8.3%)
    
22(91.7%)
    
 
    
 
  
  

    
Sometimes  
    
205(82.0%)
    
15(7.3%)
    
190(92.7%)
    
30.747
    
 0.000
  
  

    
Often
    
21(8.4%)
    
0(0.0%)
    
21(100.0%)
    

    

  

Table 4: Assessment of food security index associated with nutrition status of the elderly.

Discussion

There are few published studies on geriatric nutrition. In this study, majority of the respondents were between 61-70 years, which suggests a probable longer-life that may give hopes to many. We too found a statistical association in the risk of geriatric malnutrition with increase in age. This agrees with previous findings [4,20,27,28], and is ascribed to systemic deteriorations and body changes [19,28,29]. Also, being in a monogamous marriage had a nutritional significance, similar to previous findings [3,27-30]. This is explained by the fact that marriage is a socio-cultural phenomenon that is associated with improved support and motivation to cook, eat and find solutions together [31,32]. As majority of the participants reportedly did not attain, or had low education, it could be one of the promoters of malnutrition. This vividly concurs with previous findings [8,20,21], in which it was urged that one can tell the utilization of education and health services from education and health status. As most participants were uneducated, it confirms the likelihood of poor economic status as earlier indicated that educational status possibly could reflect the outcome of household economic welfare, and determines the nutritional and health status of individuals [13,22]. We also found that majority of the households had more than 6 children which could be due to early marriages and child bearing to late reproductive age; a feature that agrees with earlier reports which indicated that every increase in family size causes decrease per capita food and nutritional availability, and reduces the nutritional and health quality thus risk to malnutrition [2,12]. There were 44.8% who could have two full meals in a day and this could be because most people reported that they go to the garden and find it hard coming midway to cook food or could be a way of economizing the available food or also due to food insufficiency as a number of them reported running short of food at one point in time which therefore has a nutritional significance [4,11,32]. Relatedly, 74.5% had at least one serving of dairy products a day and 66.0% consumed two or more servings of fruits or vegetables daily which could be because of easy accessibility. Interestingly, nearly all participants (96.4%) were able to feed without any problem which had a nutritional significance, and it contravenes a previous report [7], in which it was reported that despite the question of inadequacy, swallowing problems due to old age may also pause challenges in feeding and increases the risk of geriatric malnutrition. Further, 55.6% of the participants acknowledged not knowing whether they were healthy or not which had an association with one’s nutritional status given the fact that most didn’t bother taking weights, a feature attributed to lack of awareness [13].

On the food security context, most respondents (N=187, 74.8%) reported to have sometimes run out of food supply in the past six months before they could get more from either their gardens or the market. A big number of respondents (N=191, 91.2%) agreed to sometimes having limited amount to eat in order to make sure that the other members of the household got what to eat. This is ascribed to poverty, and the fact that most respondents were unemployed; a fact in agreement with earlier report that “food insecurity” exists every time the accessibility of nutritiously adequate, safe foods or the capacity of acquiring individually and socially satisfactory foods in suitable ways is restricted or uncertain [3]. The study also found out that 207 respondents (82.8%) or their children sometimes skipped meals because the food was not enough, 214 respondents (85.6%) worried that they were not getting an adequate diet.

Conclusion

Based on our results, age, weight, number of children, frequency of meals, availability of a sufficient supply of food, decline in weight, BMI, psychological and neurological problems, full meals a person takes, prescription drugs a person takes, mode of feeding and whether they had a radio, oxen cart, bicycle, cow/s, sheep and chicken had nutritional significance. Of importance also was whether the respondents had clean drinking water, a latrine, and source of light, how often they limited the food they ate, skipped meals or had insufficient food in the previous six months. The study further confirms that level of formal education attained is an important determinant of employment, utilization of health and educational services. To this, we make the following propositions; 1) there is need to supplement with fruits and vegetables; 2) the government together with stakeholders ought to launch collective approach of sensitizing and educating the masses about the importance of elderly care; 3) the social assistance grants for empowerment which is covering only 15 districts in Uganda ought to be extended to Kween and the amount increased from the current 25,000 Uganda Shs per month to ensure adequate financial support of these senior citizens; 4) the feeding program ought to target the elderly more since they are the ones with poor nutritional status; 5) Food Based Approaches (FBAs), which include food production, dietary diversification and food fortification, are sustainable strategies for improving the micronutrient status of the elderly population.

Ethics Approval and Consent to Participate

We received ethical approval from Clarke International University (Formerly, International Health Sciences University) Research Ethics Committee (REC). All respondents provided written informed consent after receiving detailed description of the study. Eligible participants were consented in privacy and no incentives were given. Anonymity of the respondents was ensured at all stages of data analysis.

Acknowledgement

The authors express our utmost gratitude to our respondents who voluntarily responded to our questionnaire. We are grateful to research assistants for the field support.

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