Post-conflict household structures and underweight: a multilevel analysis of a community-based study in northern Uganda.

Objective: To examine associations between household-level characteristics and underweight in a post-conflict population. Design: Nutritional status of residents in the Gulu Health and Demographic Surveillance Site was obtained during a community-based cross-sectional study, similar to 6 years after the civil war. Household-level factors included headship, polygamy, household size, child-to-adult ratio, child crowding, living with a stunted or overweight person, deprived area, distance to health centre and socio-economic status. Multilevel logistic regression models examined associations of household and community factors with underweight, calculating OR, corresponding 95% CI and intraclass correlation coefficients. Effect modification by gender and age was examined by interaction terms and stratified analyses. Setting: Rural post-conflict area in northern Uganda. Subjects: In total, 2799 households and 11 312 individuals were included, representing all age groups. Results: Living in a female-headed v. male-headed household was associated (OR; 95 % CI) with higher odds for underweight among adult men (2.18; 141, 4.27) and girls <5 years (1.51; 0.97, 134), but lower odds among adolescent women aged 13-19 years (0-46; 0.22, 0.97). Higher odds was seen for residents living in deprived areas (1.37; 0.97, 1.94), with increasing distance to health services (P-trend <0.05) and among adult men living alone v. living in an average-sized household of seven members (3.23; 1.22, 8-59). Residents living in polygamous households had lower odds for underweight (0.79; 0.65, 0.97). Conclusions: The gender- and age-specific associations between household-level factors and underweight are likely to reflect local social capital structures. Adapting to these is crucial before implementing health and nutrition interventions.