Ease-of-Use, Acceptability, and Perceptions of a Photographic Figure Rating Scale for Child Wasting Assessment by Low-Literate Mothers in Buyende District, Uganda

Abstract

Child malnutrition remains a significant health concern in Uganda, particularly in rural areas such as Buyende District. This study explored the attitudes, perceptions, and acceptability of low-literate mothers towards using a photographic figure rating scale to assess wasting in children under 5 years old. A mixed-methods approach was used, including focus group discussions and key informant interviews with mothers of infants 9 - 12 months old in six subcounties of Buyende district. Qualitative data were analyzed using content analysis. Most mothers were dissatisfied with their children’s body sizes, with 67.6% perceiving their children to be underweight, having moderate acute malnutrition, or having severe acute malnutrition. Over 74% desired their children to be overweight or obese. Key factors influencing infant feeding included limited paternal support, household poverty, and mothers’ heavy workloads. Mothers generally found the photographic figure rating scale to be acceptable and easy to use. Low-literate mothers in this rural Ugandan setting demonstrated the ability to use a photographic figure rating scale to assess their children’s nutritional status. However, cultural preferences for larger infant body sizes and socio-economic constraints present challenges in addressing child malnutrition. Culturally sensitive interventions that engage fathers and address underlying poverty are needed alongside innovative assessment tools.