Burden of infants at risk of poor growth and development among children under six months of age in selected health facilities within Kampala

Abstract

Background: Globally, infants under six months face a high burden of morbidity and mortality driven by complications of poor growth and development, yet previous research and nutrition programs have focused predominantly on children aged 6-59 months. However, infants under six months are not a homogenous group they include those with poor birth outcomes, known risk factors, poor growth patterns, or poor anthropometry each requiring different management. The World Health Organization's 2023 revised guidelines introduced the categorization of infants under six months "at risk of poor growth and development" to enable early detection and intervention. However, data on the prevalence and factors associated with this at-risk population in Uganda remain limited. Objectives: To determine the prevalence of “infants at risk of poor growth and development (PGD)” and associated factors among infants under six months of age attending outpatient clinics in selected health facilities within Kampala, Uganda. Methods: A cross-sectional study was conducted among 832 infants aged 6 weeks to under 6 months attending outpatient clinics at Kawempe National Referral Hospital, Kisenyi HC IV, and Kisugu HC III in Kampala. Consecutive sampling was used. A semi-structured questionnaire collected data on infant, maternal, and household factors. Infants at risk were defined using WHO 2023 criteria (poor birth outcomes, known risk factors or poor anthropometry). Data were analyzed using STATA 17.0 with modified Poisson regression to estimate adjusted prevalence ratios (aPR). Results: The prevalence of infants at risk of poor growth and development was 46.2% (95%CI 42.8-49.6%). Factors significantly associated with increased risk were: non-maternal caregiving (aPR 1.77, 95%CI 1.25-2.52, p-value 0.001), maternal illness during pregnancy (aPR 1.43, 95%CI 1.17-1.76, p-value 0.001), and household history of loss of a child under five years (aPR 1.52, 95%CI 1.09-2.13, p-value 0.014). Protective factors included adequate antenatal care visits (4-7 visits: aPR 0.73, 95%CI 0.60-0.89, p-value 0.002; ≥8visits: aPR 0.71, 95%CI 0.51-0.99, p-value 0.042) and mosquito net use (aPR 0.70, 95%CI 0.55-0.88, p-value 0.002). Conclusion: The high prevalence (nearly 1 in 2 infants) suggests that risk begins very early in life and may be under-ascertained by current surveillance systems focusing on older children. The findings highlight the need for broader screening criteria and targeted interventions addressing maternal health and caregiving environments to ensure infants reach their developmental potential.