The study revealed that overall, stakeholders appraised community nutrition, behavioural nutrition and ecological nutrition as the three most highly ranked research options towards improving nutritional status while molecular nutrition research option was the lowest. The reasons community nutrition was ranked highest was possibly because it is considered to provide quick solutions to community based nutrition problems and for being relatively low cost and easy to conduct. This implies that in general, stakeholders perceive community nutrition interventions as the most appropriate research option towards addressing the problem of malnutrition in the country. A recent study by Lachat et al., 2014 also revealed that nutrition stakeholders in sub-Saharan Africa identified community nutrition interventions amongst the top priorities for nutrition research to improve nutrition status [18].
The findings of our study are in agreement with the policy recommendations by the government of Uganda in the Nutrition Action Plan 2011–2016, which outline operational research as a priority investment area. The target research areas identified in the policy document includes improved community and household level food processing for value addition, improved post-harvest handling and storage of food crops, community based school feeding pilot programs and investigation and demonstration of labour-saving technologies for women with young children. Furthermore, emphasis is put on the scale up of cost-effective community-based initiatives for prevention and control of malnutrition through community-based management of acute malnutrition [19].
Behavioural nutrition was the second most highly ranked research option. This may be because the technical experts to implement behavioural nutrition research are available in the country. A study by Holdsworth et al., 2014 reported that stakeholders in sub-Saharan Africa believe that the technical expertise to conduct behavioural nutrition is widely available in Africa [20]. This implies that given the required resources, implementation of behavioural nutrition research is feasible in the setting.
Ecological nutrition was the third most highly ranked research option. Ecological research option is considered to be in line with the countries’ development priorities in agriculture and environment and thus has good political will towards its implementation. This intervention can also be implemented using readily available scientific technologies for instance planting drought resistant crops. Under pessimistic scenarios, ecological nutrition was ranked low, in the fifth position. One possible reason for the low ranking may be because of its inability to provide quick solutions to urgent problems of the day. Another possible reason is that it requires experts across disciplines for it to be implemented effectively. In terms of addressing malnutrition, some researchers contend that it’s beneficial in linking agriculture and ecology with human nutrition and health [21], and that ecological nutrition has a significant role to play in directing agricultural interventions for improved nutrition [22].
Nutritional epidemiology was ranked low in the fourth position. This is not surprising because the national health system, which is supposed to capture epidemiological data on nutrition, faces several challenges. For instance there are weaknesses in the health management information systems and the infrastructure to capture data at both the district and sub-district levels is poor. This therefore limits proper use of nutritional epidemiology research. However, nutrition epidemiology ranking improved to second position under pessimistic conditions. This is attributed to the fact that it has less political interference compared to other research options like community nutrition research. Although it’s recognised for providing evidence for community nutrition interventions, some African nutrition stakeholders doubt its importance in addressing malnutrition in its own right [20]. However, nutritional epidemiology can provide nutritional surveillance information which is useful in nutrition planning and programming.
The study revealed that therapeutic/clinical nutrition enjoys good political will, public trust and support. However, it was surprisingly ranked low in the second last position. The poor ranking may be attributed to the fact that therapeutic/clinical nutrition studies are usually facility based and the infrastructure to conduct this type of research is inadequate hence limiting its contribution to address nutrition problems in the Ugandan setting.
Molecular nutrition research was the lowest ranked option under both optimistic and pessimistic scenarios in the settings. Molecular nutrition was perceived to have several shortcomings including limited laboratory equipment and technical personnel, the ethical dilemmas associated with its conduct, its high cost of implementation as well as the long period it takes to realise its impact. However, in the developed setting, it can make major contribution to the development of important nutrition interventions [23].
Study limitations
The study findings should be interpreted with caution. The participants are not representative of all the nutrition stakeholders in Uganda. The study was part of a large multi-country study undertaken in Benin, South Africa, Tanzania and Uganda. Comparatively, a small number of stakeholders contributed their views towards research options to improve nutrition status in the respective countries. However, being a largely qualitative study, the findings provide useful insights that could contribute to addressing the challenges of malnutrition in Uganda.
The participants were selected from amongst those at the highest levels in their organisations. However, their views did not represent the official positions of their organisations. The selection of the participants was done in order to obtain individuals with considerable knowledge and expertise on nutrition research activities and policy issues in their respective organizations. We might have, omitted individuals at lower levels within their organisations with valuable views about nutrition research interventions.
We used purposive sampling to identify stakeholders within their stakeholder groups and thereafter, the selected stakeholders referred the team members to other stakeholders within in their respective stakeholder groups. This may have led to selection of respondents with similar interests in the topic being addressed, while omitting other respondents presumed to have different interests.
We limited the selection of participants to few individuals due to the fact that we had a small sample size to work with. This limited the variety of potential participants. As a result other key stakeholders for instance plant breeders/biotechnologists/plant pathologists in the agricultural sector were not included. However, we think that the respondents we interviewed gave valuable insights given their extensive experience and expertise in their fields.