MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Introduction Malnutrition remains the major cause of child mortality and an essential component in child development and future productivity of the child in the world. With the increasing prevalence of undernutrition, micronutrient deficiencies, and over nutrition in South Africa, it calls for interventions which will help reduce malnutrition since child‟s growth is partly dependant on their diet. This study aimed at determining the association between post-weaning dietary patterns at age one and growth at age two among children from the Birth-To-Twenty cohort in Johannesburg, South Africa. Specific objectives: To describe dietary intake patterns (Diet Diversity Score and Food Variety Score) growth at age one and two among boys and girls in BT20, the prevalence of malnutrition (Stunting, wasting and underweight) among boys and girls in BT20, and to determine the association between dietary patterns at age one and growth at age two. Hypothesis There is no association between post-weaning dietary patterns at age one and growth at age two in the Birth-To-Twenty Cohort study. Study design: Prospective longitudinal study. Setting; Birth-To-Twenty Cohort study Johannesburg, South Africa. Inclusion criteria –Must have complete data on dietary questionnaires and growth data at age two. Data Collection data was collected on following variables; dietary patterns, socio-economic status, growth (height and weight), complimentary feeding, birthweight and gestational age. Anthropometric data (height and weight) was collected at age one and two. Food frequencies questionnaires were used for data collection. Data Analysis STATA 10 was used for data cleaning and analysis. Descriptive and inferential analysis was carried out. Multiple regression analysis was used to assess the association between outcome variable (growth at age 2) and dietary patterns at age 1(12months) and growth at age 2 (24months), and dietary patterns at age 1 controlling for confounders. P-values were calculated to test for v statistical significance at 5% significance level. Results: Ninety six percent of the infants were introduced to solid foods when they were less than 6 months. The Food Variety Score (FVS) was 32.4 and 32.6 for boys and girls respectively; Diet Diversity Score (DDS) was 9.7 and 9.8 for boys and girls respectively. A proportion of 20.5% (n=164) infants were underweight at birth, the prevalence of stunting among the boys rose from 8% at year one to 19% at year two, wasting demonstrated a slight increase from 5% to 8%, underweight too showed a sharp increase from 11% to 25%. Among the girls stunting prevalence increased from 6% at year one to 20% at year 2, wasting slightly rose from 3% to 4% and underweight from 6% to 11%. There was 7.7% (n=35) catch up growth and 20.7% (n=94) catch down with regard to stunting. A proportion of 3.3% (n=15) infants had catch up for weight-for-height and 5.5% (n=25) had a catch down growth. 3.7% (n=17) had catch up growth with regard to weight-for- age and 11.2% (n=51) had catch down growth. Birthweight, underweight and stunting at age one, gender and ethnicity were associated with growth at age two. There was no association between dietary patterns at age one and growth at age two. Conclusion: Diet diversity is good within Soweto and consequently food diversity is not associated with infant growth, however other factors such as macronutrient intake and morbidity maybe important in the Soweto context. Inappropriate feeding practices such as feeding the infant with high sugar diet, high fat and refined foods should be addressed so as to curb the increasing catch down growth at age two. Introduction of solid foods at less than 6 months of age should also be addressed; this can be done by emphasising that exclusive breastfeeding in community health programs for the first 6 months.

Submitted in fulfilment of the requirements for the degree of MASTER OF SCIENCE Faculty of Health Sciences, University of the Witwatersrand Johannesburg, 2012 / Research indicates that there is a strong association between household composition and household stability, and child well-being. Black South African family life has historically been affected by the social, political and economic pressures of colonialism, the migrant labour system, and Apartheid policies. It has been shown that Black households have been in a constant state of flux as members move between rural and urban households, as well as, within urban environments. This situation of intense household fluidity and household compositional changes continues to persist. High rates of urbanisation, the fluid job market, and fast social change are all associated with high levels of mobility and household compositional change. Kin networks remain a significant informal safety net for households in order to absorb change. The movement of children between family members, or child fostering is an important mechanism for maintaining networks of support. Children are frequently moved between different households in urban areas so as to maximise their care and education. These changes could potentially influence their overall well-being and, in particular, their academic performance.

Many South African school children are known to travel fairly long distances to school each day, in pursuit of the best possible educational opportunities in a schooling system that is known to vary greatly in quality. This thesis documents the dimensions and determinants of the daily, education-related travel of primary school aged children in Johannesburg-Soweto, South Africa. It uses data on a sample of 1428 children drawn from the Birth to Twenty cohort study to provide the first population-based data on the extent of learner mobility in contemporary urban South Africa. Learner mobility is measured in three different ways: firstly by the straight line distance between a child‘s home and his or her school; secondly by whether the child‘s school falls into the same geographical area as his or her home; and thirdly by whether the child attends his or her nearest, grade-appropriate school. The thesis provides clear evidence for extensive mobility using all three of these approaches to measurement. Over 25% of children were found to be travelling more than 5km each way to school and back on a daily basis. Almost 60% of children attended a school outside of the Census 2001 Sub-Place (roughly equivalent to a suburb) in which they lived, and fewer than 20% of children attended the grade-appropriate school nearest to their home. Counter to expectations, these figures were fairly stable over time, suggesting that educational mobility does not increase substantially as children age or transition to high school. Mobile children attended significantly more well-resourced and well-performing schools than their non-mobile peers, and the quality of schools attended increased with distance travelled. This substantiates the assumption that children and families make use of educational mobility to improve the quality of education that they are able to access. The analyses presented in the thesis suggest that two distinct patterns of mobility, with different determinants, are in use in the Johannesburg-Soweto area. The first relates primarily to travel from townships to historically advantaged schools in suburban Johannesburg, and typically requires substantial economic investment and extensive parental involvement. The second form of mobility operates at a more local level, and relates to children and families making choices between a number of relatively local schools. This form of mobility is less resource intensive. Children engaging in the first form of mobility were more likely to attend a particularly advantaged school, and to have a well-educated mother. By contrast, children engaged in the second form of mobility were more likely to live in a disadvantaged area, and come from households with moderate SES levels. iv The findings of this thesis provide important insights into the nature of school choice in South Africa, which have implications for educational policy, and the understanding of the nature of urban poverty as experienced by South African children. They also contribute to the international school choice literature, by providing novel information about the implications of relatively unregulated school choice for educational inequality and segregation in the South African context.