The purpose of this study was to provide a national overview on internal migration of children and to relate these migration patterns to the nutritional status of children. This study specifically investigated the internal migration that took place during the life span of the National Food Consumption Survey study population and relates that to their dietary intake and anthropometric status.

The purpose of this study was to provide a national overview on internal migration of children and to relate these migration patterns to the nutritional status of children. This study specifically investigated the internal migration that took place during the life span of the National Food Consumption Survey study population and relates that to their dietary intake and anthropometric status.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Objective: To examine the factors that may influence the vitamin A and anthropometric status of 24-59-month-old children from an impoverished community with a very high prevalence of stunting, but virtually no vitamin A deficiency. Design: Cross sectional, descriptive study with analytical components. Setting: Calvinia West, Northern Cape Province, South Africa Subjects: Biological mothers (n=150) and their children aged 24-59 months (n=150) living in Calvinia West from 6 months of age or younger. Methods: A general interviewer-administered questionnaire comprising of socio-demographic information, a 24-hour recall and an adjusted food frequency questionnaire, focussing on liver intake, were used in the data collection process. Anthropometric measurements (weight and height) were also performed. Results: Results showed that liver consumption alone contributed to more than 100% of the Estimated Average Requirement (EAR) for vitamin A of the pre-school children in this community. Liver was eaten by 84.7% (n=127) of the children and 68% (n=102) of them ate liver at least once per month. The average portion size of the children who consumed liver was 66g at a time. The national food fortification programme contributed to a further 80 μg Retinol Equivalents (RE) and the national supplementation programme 122μg RE of vitamin A per day. There was a significant (p=0.028) inverse association between the amount of liver intake and household income. Liver intake was also significantly (p=0.016) higher in the children whose mothers were unskilled as opposed to those with skilled mothers. According to the World Health Organization (WHO) growth standards 36.9% (n=55) of the children were stunted (low height for age), 25.5% (n=38) were underweight for age and 12.1% (n=18) were wasted (low weight for height). The mean birth weight of the children (n=141) was 2826g (SD=592). Of these children, 27.7% (n=39) had a low birth weight (<2500g). There was a significant positive correlation (r=0.250; p=0.003) between the birth weight of the child and the child's current height for age. The height of the mother, as well as several indicators of socio-economic status, also correlated significantly with the height for age of the child. Conclusion: In this impoverished community the anthropometric status of the children was poor, but vitamin A deficiency was largely addressed through the regular intake of liver. Poor anthropometric status is therefore not always an indicator of micronutrient deficiencies and blanket supplementation approaches are not necessarily the solution in a country with diverse cultures and eating habits. Apart from the immediate risks and consequences of underweight, stunting and wasting in a community, stunting may also lead to overweight and obesity in the long term. This may result in diseases of lifestyle in later life, adding a further burden to an already weakened community. Appropriate evidence-based interventions aimed at the first thousand days of life should be a priority in this community. / AFRIKAANSE OPSOMMING: Doel: Om die faktore wat kan bydrae tot die vitamien A en die antropometriese status van kinders 24-59-maande in 'n arm gemeenskap met 'n baie hoë voorkoms van dwerggroei, maar byna geen vitamien A gebrek, te ondersoek. Ontwerp: Beskrywende, deursnit studie met analitiese komponente Omgewing: Calvinia Wes, Nood Kaap provinsie, Suid-Afrika Deelnemers: Biologiese moeders (n=150) en hul kinders in die ouderdomsgroep, 24-59-maande (n=150) woonagtig in Calvinia Wes sedert 6 maande van ouderdom of jonger. Metodes: 'n Vraelys bestaande uit sosio-demografiese inligting, 'n 24-uur herroep en 'n aangepaste voedsel frekwensie vraelys gefokus op die inname van lewer, was gebruik om data in te samel en voltooi deur die onderhoudvoerder. Antropometriese metings (gewig en lengte) was ook geneem. Resultate: Resultate het getoon dat lewer inname bygedra het tot meer as 100% van die geskatte gemiddelde behoefte van vitamien A vir die voorskoolse kind in hierdie gemeenskap. Lewer was deur 84.7% (n=127) van die kinders ingeneem en 68% (n=102) het dit ten minste een keer per maand geëet. Die gemiddelde porsie grootte van die kinders wat lewer ingeneem het, was 66g op 'n keer. Die nasionale voedsel fortifisering program het 'n verdere 80 μg Retinol Ekwivalente (RE) en die nasionale supplementasie program 122μg RE vitamin A per dag bygedra. Daar was 'n betekenisvolle (p=0.028) omgekeerde korrelasie tussen die die hoeveelheid lewer wat deur die kinders ingeneem is en die huishoudelike inkomste. Lewer inname was ook betekenisvol (p=0.016) meer in kinders wie se moeders ongeskool was teenoor die met geskoolde moeders. Volgens die Wêreld Gesondheid Organisasie se groeistandaarde het 36.9% (n=55) van die kinders dwerggroei getoon (te kort vir hul ouderdom), 25.5% (n=38) was ondergewig vir hul ouderdom en 12.1% (n=18) uitgeteer (ondergewig vir hul lengte). Die gemiddelde geboortegewig van die kinders (n=141) was 2826g (SA=592). Van hierdie kinders het 27.7% (n=39) 'n lae geboortegewig (<2500g) gehad. Daar was 'n betekenisvolle positiewe korrelasie (r=0.250; p=0.003) tussen die geboortegewig van die kind en die huidige lengte vir ouderdom. Die lengte van die moeder, sowel as ander sosio-ekonomiese status aanwysers het ook betekenisvol gekorreleer met die lengte vir ouderdom van die kind. Samevatting: In hierdie arm gemeenskap was die antropometriese status van die kinders swak, maar vitamien A gebrek was grootliks aangespreek deur die gereelde inname van lewer. 'n Swak antropometriese status is dus nie altyd 'n aanduiding van mikronutriënt tekorte nie en 'n oorkoepelende aanslag van supplementasie is nie noodwendig 'n oplossing in 'n land met diverse kultuur en eetgewoontes nie. Behalwe vir die onmiddelike gevare van ondergewig, dwerggroei en uittering in 'n gemeenskap, het kinders met dwerggroei 'n groter risiko om oorgewig en vetsugtig te word in die langtermyn. Dit kan lewensstyl siektes veroorsaak in latere lewe en 'n verdere las op 'n reeds verswakte gemeenskap plaas. Toepaslike intervensies, gemik op die eerste duisend dae van lewe, behoort 'n prioriteit te wees in hierdie gemeenskap.

Submitted in fulfillment of the requirements for the degree of Masters of Applied Science in Food and Nutrition, Durban University of Technology, Durban, South Africa, 2017. / Introduction: The nutrition transition is a global phenomenon affected by developing economic prosperity. ‘Nutrition transition’ may be defined as changes in dietary patterns and nutrient intakes occurring in individuals, families, groups of people or whole populations when the food environment and other circumstances change. Post-1994 democratic elections in South Africa, economic laws called for the de-racialization of the economy. As a result of the annulment of the apartheid laws in the 1990s entrepreneurial opportunities became available for black people. Based on the 2011 Census, the middle class constituted 8.3 million (17%) out of the 51 million population in South Africa. Blacks made up 51%, whites 34%, coloureds 9% and Indians 6%. This is a vast difference from two decades prior to this when blacks made up only 3.3% of the population, with coloureds making up 9.1% and Indians 18.5%. In a number of Sub-Saharan African studies obesity has been shown to have a significant link to socio-economic status determined by access to water and electricity, smaller numbers of members residing in one household and increased amounts of money spent on food among other factors, which all promote a tendency to leading a more Westernised lifestyle. The main objective of the study was to determine the anthropometric status and analyse the food consumption of a community of emerging middle income status in Umlazi Township (Ward 84) outside Durban in the province of KwaZulu-Natal. Methods: This study had a sample size of n=250 adult men (n=56) and women (n=194) who were heads of households or primary caregivers above the age of 19 years old with households receiving a total household income of more than R100 000.00 per annum/ more than R8000.00 per month. The study was quantitative and descriptive in nature with different tools used to measure the sample population. These included waist circumference and height and weight measurement to determine BMI and WHtR. A socio-demographic questionnaire was completed where the multi-dimensional poverty index (MPI) was established; a food frequency questionnaire (FFQ) and three 24-hour food recall were also administered to all participants; one weekend day recall and two weekday recalls. Data were analysed on SPSS and nutrient analysis done through Food Finder Version 3 Software and compared to the World Health Organisation standards recommendations for optimal health. Results: The mean age of the group was 52 years old. Slightly more than half (51.6%; n=129) of the population was unemployed. Retired participants made up 27.2% (n=68) of the population. The majority (80%) of the households indicated that between one to three members contributed to the total household income. The MPI of the Ward 84 community amounted to 9.09. The prevalence of obesity was 37.59% (n=21) among men and 76.80% (n=149) for women. Women had a higher prevalence of risk factors linked to non-communicable diseases than men. Mineral and fat soluble vitamin intake was deficient; however protein and carbohydrates were consumed in excess with means of 187.70% and 111.43% respectively. Top 20 foods consumed lists indicated that little fruit or vegetables were consumed. The average food variety score was medium indicating the consumption of between >30 but <60 different foods across the total population. A positive relationship of statistical significance was found between food variety score and income (p=0.007). Conclusion: The Ward 84 community consisted of an ageing population with households mostly supported by another member’s income from within or outside the household. The adults had sufficient education to have secured promotions in the employment arena and could afford a lifestyle similar to that of those who had always been more privileged. Although the Umlazi residents benefited from good housing and infrastructure and appeared to have averted poverty, the prevalence of overnutrition malnutrition was high and linked with an excessive intake of macronutrients. Majority (70%) of the community of Ward 84 is ‘food secure’ as indicated by the number of participants’ households indicating never having a shortage of money to buy food. This correlates negatively with the high prevalence of overweight and obesity (BMI) (p=-0.029). According to literature a persistent issue in black communities is the acceptance of an overweight body image being perceived as ‘healthy’ and an indicator of affluence. This community appears to be in the 4th stage/ pattern of the nutrition transition. It appears that a ‘westernised diet’ and lifestyle is more accessible and is embraced by this urban community as described in various literature and seen in the top 20 foods lists compiled from the 24 hour recalls. There is some oversight regarding the nutrient quality of a varied diet and achieving energy balance with macronutrient intake linked to informed nutritional choices. Suggested interventions could include the dissemination of information regarding nutrition and practical suggestions to achieve energy balance. In addition, future research could investigate the prospects of introducing participation in urban agriculture, investigate the issue of physical activity, and foster an environment for more physical activity and increase availability and access to micronutrient dense foods and investigate the development of a body mass index specifically for the black African population. / M

Thesis (Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objectives: To describe the mothers/ primary caregivers’ (PCGs) and children’ anthropometric status; their household food security and poverty in relation to type of housing; and compare households receiving and not receiving a Child Support Grant (CSG) in relation to mothers/ PCGs’ anthropometric status, their dietary diversity, age, employment, educational level, monthly household income, size, food security and children’s anthropometric status. Design: Cross sectional, descriptive study. Subjects: Mothers/ PCGs (443) and their children from 211 households in Avian Park and 242 Zweletemba in Worcester, Western Cape Province. Methods: Data collected by interviewer administered questionnaires included socio-demographic data, Lived Poverty Index, Household Food Insecurity Access Scale (HFIAS) and dietary diversity score (DDS). Anthropometric measurements included weight, height and waist circumference (WC) of mothers/ PCGS and weight, height and mid-upper-arm circumference of children. Households living in formal (brick houses, town houses, flats) and informal (squatter shacks, huts) houses, and households receiving CSGs and those without CSG, were compared using X2-test for categorical data and the independent t-test for continuous data. Results: Prevalence of stunting, underweight and wasting in children was 20.7%, 5.6% and 1.2% respectively. Overweight and obesity occurred in 27% and 37% of mothers/PCGs respectively and together with a mean WC (89.5 cm; SD 16.7) indicated an increased risk for non-communicable diseases. Food security existed in 63.1% households. Formal households were more food secure than informal households (68% versus 50%; p=0.0004) and fewer mothers/ PCGs of formal households had a DDS < 4 (52.2% versus 64.7%; p = 0.0157). The healthier socio-economic situation in formal households compared to informal households was shown by the higher monthly income (R3 479 versus R2 316; p = 0.0009) and Household Asset Index (2.24 versus –5.31; p <0.0001). Age, marital status, education level and employment status of mothers/primary caregivers in CSG households and non-CSG households were similar. Household size was larger (p<0.0001) in CSG (median = 5 persons) versus non-CSG households (median = 4 persons); CSG households had more people per room (2.7 [SD 1.5] versus 2.3 [SD 1.2]; p=0.0037). CSG households had lower monthly income than non-CSG households (R2 723 [SD R3 297] versus R4 520 [SD R6 464]; p=0.0033). Mean HFIAS scores showed more food insecurity in CSG households than non-CSG (3.55 versus 2.37; p= 0.0178), but dietary diversity was similar. Stunting in children was higher in CSG (34.9%) versus non-CSG (22.7%) households. CSG mothers/PCGs had larger (p = 0.021) waist circumferences (90.0 cm; SD = 16.8) than non-CSG mother/PCGs (88.5 cm; SD = 16.5) Conclusion: Childhood malnutrition and maternal overweight /obesity co-existed. Dietary diversity of all mothers/ PCGs was low. The assessment of type of housing and social security showed children in informal housing households had a poorer socio-economic situation and children in CSG households also experienced more monthly income poverty and household food insecurity. The level of stunting was higher in CSG households. Improving low dietary diversity should be a priority in interventions addressing food insecurity, taking into consideration this may be more difficult to achieve in informal households and CSG households. / AFRIKAANSE OPSOMMING: Doel: Om die antropometriese status van moeders/ primêre versorgers en hul kinders; hul huishoudelike voedselsekerheid en armoede met betrekking tot tipe behuising waarin hul woon, te beskryf; asook om huishoudings wat ‘n kindersorgtoelaag ontvang te vergelyk met die daarsonder in terme van die antropometriese status van moeders/ primêre versorgers, hul dieetdiversiteit, ouderdom, indiensneming/ werkstatus, opvoedkundige vlak, huishoudelike maandelikse inkomste en grootte, voedselsekerheid en die antropometriese status van hul kinders. Ontwerp: ‘n Beskrywende, deursnit studie. Deelnemers: Moeders/ primêre versorgers (447) en hul kinders van 211 huishoudings in Avian Park en 242 in Zweletemba. Metodes: Data-insameling is gedoen met onderhoudvoerder geadministreerde vraelyste insluitend sosio-demografiese inligting, die belewing-van-armoede-indeks, huishoudelike voedselonsekerheid-en-toegangskaal en dieetdiversiteitstelling. Antropometriese metings van moeders/ primêre versorgers het behels gewig, lengte en middelyfomtrek en gewig lengte en bo-armomtrek van kinders. Huishoudings woonagtig in formele (baksteenhuise, meenthuise, woonstelle) en informele huise (plakkershutte), en huishoudings wat die kindersorgtoelaag ontvang en nie, is vergelyk met behulp van die X2-toets vir kategoriese data en ‘n onafhanklike t-toets vir aaneenlopende data. Resultate: Die voorkoms van dwerggroei, ondergewig en uittering in kinders was onderskeidelik 20.7%, 5.6% en 1.2%. Oorgewig en vetsug het onderskeidelik voorgekom by 27% en 37% van moeders/ primêre versorgers en hul gemiddelde middelyfomtrek was 89.5 sentimeter (SA 16.7), wat aanduidend is van ‘n verhoogde risiko vir nie-oordraagbare siektes. Voedselsekerheid het voorgekom in 63.1% van huishoudings. Formele huishoudings het meer voedsekerheid ervaar as informele huishoudings (68% versus 50%; p=0.0004) en minder formele huishouding moeders/ primêre versorgers het ‘n dieetdiversiteitstelling < 4 (52.2% versus 64.7%; p = 0.0157) gehad. Beter sosio-ekonomiese omstandighede van formele huishoudings in vergelyking met informele huishoudings was sigbaar in hul hoër maandelikse inkomste (R3 479 versus R2 316; p = 0.0009) en huishoudelike bates-indeks (2.24 versus –5.31; p <0.0001). Die ouderdom, huwelikstatus, opvoedkundige vlak en werkstatus van moeders/ primêre versorgers in huishoudings wat ‘n kindersorgtoelaag ontvang en die huishoudings daarsonder was soortgelyk. Huishoudingsgrootte was groter (p<0.0001) in kindersorgtoelaag- (mediaan = 5 persone) versus geen-kindersorgtoelaaghuishoudings (mediaan = 4 persone); In kindersorgtoelaaghuishoudings het meer persone ‘n kamer gedeel (2.7 [SA 1.5] versus 2.3 [SA 1.2]; p=0.0037). Die maandelikse inkomste in kindersorgtoelaaghuishoudings was laer as in dié daarsonder (R2 723 [SA R3 297] versus R4 520 [SA R6 464]; p=0.0033). Die huishoudelike voedselonsekerheid-en-toegangskaal-tellings het meer voedselonsekerheid (p = 0.0178) getoon in kindersorgtoelaaghuishoudings as in huishoudings daarsonder (3.55 versus 2.37; p= 0.0178), maar hul dieetdiversiteit was dieselfde. Dwerggroei was meer in kindersorgtoellaagkinders (34.9%) versus geen-kindersorgtoelaagkinders (22.7%). Die gemiddelde middellyfomtrek van kindersorgtoellaagmoeders/ -primêre versorgers was groter (t-toets: p = 0.021) (90.0 cm; SA = 16.8) as die van moeders/ primêre versorgers wat nie ‘n kindersorgtoelaag (88.5 cm; SA = 16.5) ontvang het nie. Samevatting: Wanvoeding in kinders, tesame met oorgewig en obesiteit in moeders/ primêre versorgers is waargeneem Die dieetdiversiteit van die moeders/ primêre versorgers was laag. Die ontleding van die rol van behuising en sosiale sekerheid het getoon dat die sosio-ekonomiese omstandighede van kinders woonagtig in informele behuising, asook die waarvoor moeders/ primêre versorgers ‘n kindersorgtoelaag ontvang het, is blootgestel aan meer inkomste-armoede en voedselonsekerheid in hul huishoudings. Die verbetering van lae dieetdiversiteit moet ‘n prioriteit wees in intervensieprogramme om voedselsekerheid aan te spreek, met inagneming dat die bereiking daarvan moeilker mag wees om in informele en kindersorgtoelaag-huishoudings.

A qualitative, descriptive, exploratory and contextual study was undertaken to explore and describe how clinic nurses practice their role regarding growth development monitoring and anthropometric measurement of children and interpretation of their values. An accessible population of twelve clinic nurses of all categories were purposively recruited to participate in the study. In depth individual interviews were conducted to generate data. Interviews were audio-taped and transcribed by the researcher verbatim. The direct quotes of participants were coded and arranged into meaning units for analysis. Tech’s (1990:142-145) eight steps of analysis to analyse the textual qualitative data as cited by Creswell (2009:186) was used until themes, categories and subcategories were identified and developed. Data analysis was triangulated by using Atlas.ti computer software version 7.0 to organise text, audio data files coding, memos and findings into project files. An independent coder analysed data for validation using content analysis. Data analysis revealed that nurses had challenges in ways of doing practice evidenced by inconsistencies and discrepancies in GDM, APM of children and incorrect interpretation of their values. Non-compliance to protocols from both nurses and parents was a significant finding. Shortage of resources was reported as a major hindrance. Guidelines were formulated to guide clinic nurses. Recommendations were proposed that the matter be taken up by nurse managers, educators and leadership from the Department of Health / Health Studies / D. Litt. et Phil. (Health Studies)