Strengthening Nutrition Surveillance in Uganda: What have we learned?

Abstract

Background: The World Health Assembly resolution of 2012 recommended a comprehensive implementation plan for maternal and child nutrition outlining six global targets on stunting, wasting, underweight, low birth weight, anaemia and exclusive breastfeeding to be achieved by 2025. Currently, many national nutrition surveillance systems are weak and need to be strengthened to be able to track these targets. This study aimed to understand whether the Accelerating Nutrition Improvements (ANI) project supported by the WHO in Uganda ANI improved the reporting of nutrition indicators in the District Health Information System-2 (DHIS2). 

Methods: The project focused on six pilot districts in Eastern and Western Uganda. A series of processes including an analysis of the strengths and weaknesses of the DHIS2 and the Health Management Information System (HMIS) was undertaken. A nutrition report format with recommended indicators was developed and customized into DHIS2. Capacity building was supported for health workers on the HMIS/DHIS2 and data quality. 

Results: Over a one year implementation period a >100% increase in reporting through the DHIS2 was noted for a number of indicators including the number of children assessed for nutrition status; folic acid uptake by pregnant women and infants breastfed within the first hour of birth. Other indicators that showed improvements included children assessed for length/height (82%); mothers who received maternal (51%) and infant feeding counselling (48%). A number of challenges including human resources, poor data quality and a lack of the required materials and tools existed. 

Conclusions: The strengthening of nutrition surveillance has shown that reporting on nutrition indicators is possible and can be improved. However, data quality, human resource capacity and timely availability of the required tools need to be addressed.