M. Tech. (Department of Hospitality, Tourism and PR Management)/ -- Vaal University of Technology / Both under and over nutrition are prevalent among children in South Africa. At national level, children suffered from under nutrition. Childhood malnutrition starts early in life, the first two years being the most vulnerable period. Malnutrition is a public health problem in South Africa, especially in young children, requiring a systematic approach to improve nutrition services and promote behavior change. The objective of this cross-sectional study was to determine the nutritional status of the primary school children in Qwa-Qwa in South Africa. The study was carried out in two phases, namely Phase 1 (Planning) and Phase 2 (data collection and analysis of socio-demographics, 24-hour recall, a food frequency questionnaire, dietary diversity and anthropometric measurements). Weight and height were measured for 70 children (100% of the sample) and analysed according to the World Health Organization documents (WHO 2007) to determine nutritional status of the respondents. The data were captured on an Excel spreadsheet by the researcher and analysed for descriptive statistics such as frequencies, standard deviations and confidence intervals on the Statistical Package for Social Sciences (SPSS), version 18.0 program. A convenience sample of 70 primary school children aged 7-13 years, including girls (n=38) and boys (n=32) forming part of 105 purposively selected households were recruited for the study. The results showed that the majority of the households (80.4%) had been living in Qwa-Qwa for more than five years and lived in RDP brick houses (86.7%) with more than four rooms (56.3%). The monthly income of the households was less than R1000.00 in the majority of the households (73.9%) and 42.0% of the households spent < R100 on food per week which is calculated at R14.29 per day and R 2.86 per household member per day. The respondents consumed a mainly carbohydrate rich diet as 10 of the 20 most consumed food items were carbohydrates (mean daily intake) such as stiff maize meal porridge(195g), soft maize meal porridge (174g) , brown and white bread(122g), potato, cooked (66g), samp, cooked (187g), potato fries (85g), breakfast cereal (300g) and rice cooked (140g). Only three vegetables and fruit formed part of the Top 20 food items mostly consumed. It is showed that very small portion sizes of mostly the vegetables and fruit as well as the protein-rich food sources were consumed. The dietary intakes of the nutrients showed deficient intakes of all except, carbohydrate, iron, Vitamin K and B12. However, these nutrients showed an adequate intake, but there were still 38% of all respondents who did not consume 100% of the EAR for the CHO compared to 38%, 73%, 71% and 60% for Fe, vitamin A, vitamin B12 and K respectively. Vitamin C intakes were low which was consistent with only three vegetables and fruit which showed that children consumed small amounts of vegetables and fruit portions. The mean (±SD) Food Variety Score for all the food groups consumed from all the food groups in a period of seven days was 23.96 (±16.08). These results revealed poor dietary diversity. Cereal was the food group with the highest mean food variety score in this study population. The mean ±SD FVS of 23.96 (±16.08) revealed poor dietary diversity in the children despite the relatively high food variety (88 individual foods consumed in seven days). More boys (28.5%) were underweight (<-2SD) compared to fewer girls (17.4%). There is thus acute malnutrition in this group of the children which is consisted with the insufficient food intakes reflected by the 24-hour recall and dietary diversity measurements. Stunting was prevalent in 21.1% and 18.7% of the girls and boys respectively, with 4.3% of all the children being severely stunted (<-3SD). This indicates chronic malnutrition and or the presence of infections over a long period leading to failure of linear growth. None of the boys and girls were overweight or obese, whilst (71.8 %) of boys and (81.5%) of girls were of normal weight. It can be concluded that poverty, household food insecurity and poor dietary intakes and diversity resulted in poor nutritional status of the children in this community. The high prevalence of inadequate nutrient intakes and poor nutritional status (under-nutrition) amongst the children in this study, demonstrates the need for effective sustainable food and nutrition interventions aimed at improving dietary intake and diversity as well as the poor nutritional status. / Vaal University of Technology, SANPAD

The importance of women’s status for child nutrition has recently been recognized. However, pathways through which women’s status can affect their caretaking practices and child nutrition have not been fully determined. The aim of this thesis was to evaluate associations between aspects of women’s status – including exposure to domestic violence and level of autonomy and social support – with their level of stress, feeding practices and child nutritional status in two different cultural settings: Bangladesh and Nicaragua. Data were acquired from population-based studies. For Study I we used data from the Bangladesh 2007 Demographic and Health Survey, and Study II was embedded in the 2009 Health and Demographic Surveillance System conducted in Los Cuatro Santos, rural Nicaragua. Studies III and IV were part of the MINIMat study, conducted in rural Bangladesh. In-person interviews were conducted and validated questionnaires were used in each of the studies. Anthropometric characteristics of the children were recorded based on standardized World Health Organization techniques. In Bangladesh, we found women with lifetime experience of domestic violence to be more likely to report emotional distress during pregnancy, cease exclusive breastfeeding before 6 months and have a stunted child. Further, we found a negative association between experience of domestic violence and duration of excusive breastfeeding to be mitigated with breastfeeding counseling. In Nicaragua, a lower level of maternal autonomy was associated with more appropriate breastfeeding practices such as higher odds of exclusive breastfeeding and longer continuation of breastfeeding. Further, a maternal lower level of social support was associated with better child nutritional status. In conclusion, this investigation showed that different dimensions of women’s status were associated with their feeding practices and child nutritional status and also revealed that the strength and direction of these associations may vary by the child’s age, setting and other contextual factors. These findings suggest that women’s status might have an important public health impact on child health and its role should be considered in programs and policies aiming to improve child health and nutrition.

A população indígena brasileira sofre um acelerado e complexo processo de mudanças nos diversos aspectos de sua vida, inclusive quanto à prática de amamentação, à alimentação e ao reflexo no estado nutricional infantil, decorrentes do contato com não indígenas. Diante disso, buscou-se conhecer a prática da amamentação, da alimentação e o estado nutricional de crianças indígenas com até cinco anos de idade, em uma aldeia localizada na região oeste do estado de São Paulo. Realizou-se um estudo etnográfico, segundo os pressupostos teórico e metodológicos de Cliford Geertz 1, com a associação estatística para a descrição do estado nutricional das 24 crianças que atendiam aos critérios do estudo e 31 mulheres, mães e familiares das crianças do estudo, que auxiliavam nos cuidados alimentares das crianças. Os dados objetivos, sobre o estado nutricional infantil, foram coletados em prontuários, por medidas antropométricas das crianças e entrevistas estruturadas com as mães; os qualitativos foram obtidos por meio de entrevistas em profundidade com as mães, avós e bisavós. A análise das narrativas obtidas resultou em um conjunto de categorias antropológicas agrupadas em dois temas: Aleitamento: tradições e crenças indígenas e As comidas indígenas: reflexo da interculturalidade, dos quais emergiu o tema central: A alimentação infantil, o movimento entre a tradição e a interculturalidade. A alimentação infantil, considerando a prática da amamentação e da oferta de alimentos para as crianças, neste estudo, aparece em um movimento entre a tradição e a interculturalidade, em que inexiste o aleitamento exclusivo, mas há manutenção de aleitamento materno para crianças até aos cinco anos. O leite de vaca in natura é considerado o que sustenta, mas amamentar é um costume mantido pelas mulheres, para nutrir também a dimensão emocional da criança. Os chás são oferecidos, precocemente, para a cura de doenças. Os leites industrializados e os aditivos lácteos são inseridos na comunidade em situações específicas pelos não indígenas. Os alimentos sólidos são introduzidos às crianças com idade entre os quatro e seis meses, sendo escolhidos conforme a sua disponibilidade no cultivo doméstico e possibilidade de aquisição. A principal comida consumida é o caldo de feijão misturado com arroz ou batata cozida amassada. As tradições se misturam aos novos hábitos decorrentes do contato com a cultura não indígena. Isso já é refletido no estado nutricional das crianças com o surgimento de casos de sobrepeso infantil. / Brazilian indigenous people suffers a rapid and complex process of changes in many aspects of your life, even regarding breastfeeding practices, nutrition and the effects on infant nutritional status resulting from contact with non-indigenous people. Therefore, it was aimed to investigate the practice of breastfeeding, feeding and nutritional status of indigenous children younger than five years old in a village located in the western region of the State of São Paulo. Was conducted an ethnographic study according to the theoretical and methodological assumptions of Clifford Geertz, with statistical association to describe the nutritional status of 24 children who met the study criteria and 31 women, mothers and families of the children in the study, who assisted in nutritional care of children. Objective data on child nutritional status were collected from medical records by anthropometric measures and structured interviews with mothers; qualitative data were obtained through in-depth interviews with mothers, grandmothers and great-grandmothers. The analysis of the narratives obtained resulted in a set of anthropological categories grouped into two themes: Breastfeeding: traditions and indigenous beliefs e Indigenous meals: the interculturality reflection, from which emerged the central theme: Infant feeding, movement between tradition and interculturality. Infant feeding, considering breastfeeding and children provision of food, in this study, appears in a movement between tradition and interculturality, in which exclusive breastfeeding does not exist, but there is maintenance of maternal food for children up to five years old. Cows milk in natura is considered what sustains, but breastfeeding is a custom maintained by women to also nurture the emotional dimension of the child. Teas are offered routinely to cure diseases. The Industrialized milk and the milk additives are inserted in specific situations in the community by non-indigenous people. Solid food are introduced to children aged between four and six months, chosen according to their availability in the domestic cultivation and possibility of acquisition. The main food consumed is the bean soup mixed with rice or mashed baked potato. Traditions mingle with new habits resulting from contact with non-indigenous culture. This is already reflected in the nutritional status of children with the emergence of cases of childhood overweight.

INTRODUÇÃO: As prevalências de desnutrição infantil ainda são altas nos países da África Subsaariana; porém, há indícios de que a obesidade em adultos esteja aumentando. Neste cenário, se, por um lado, é importante combater a desnutrição, por outro, é fundamental identificar as tendências do excesso de peso ao longo do tempo, a fim de prevenir grandes elevações de obesidade e doenças crônicas. Com isso, os objetivos desta pesquisa foram: descrever as tendências de obesidade ao longo das últimas décadas em mulheres em idade fértil e em crianças menores de 5 anos, paralelamente àquelas de desnutrição nesse mesmo grupo de crianças em países da África Subsaariana; e identificar os fatores associados à desnutrição em crianças menores de 2 anos em um município de Luanda, Angola. MÉTODOS: Para descrever as tendências da situação nutricional, foram utilizados dados de inquéritos nacionais (Demographic and Health Surveys e Multiple Indicator Cluster Samples) de 13 países do continente africano, que tinham pelo menos quatro inquéritos disponíveis. Foram traçadas tendências para os desfechos: obesidade em mulheres com idade entre 15 e 49 anos, e sobrepeso, baixa estatura (stunting), baixo peso para altura (wasting), baixo peso para idade (underweight) e baixo peso ao nascer em crianças com menos de 5 anos. Para as tendências individuais de cada país, foi realizada regressão linear, enquanto para as tendências considerando o conjunto dos 13 países, empregou-se modelo de regressão multinível. Quanto à identificação dos fatores associados com a desnutrição, foram utilizados dados de um estudo transversal de base populacional realizado em Cacuaco, município da província de Luanda, em 2010. Os desfechos estudados foram baixa estatura (stunting) e baixo peso para idade (underweight). Foram estimadas razões de prevalência (RP) por regressão de Poisson com variância robusta utilizando modelo hierarquizado. RESULTADOS: A prevalência de obesidade cresceu entre mulheres em idade fértil na maior parte dos países estudados, em média 2,8 pontos percentuais por década (P<0,001), acompanhada por importante diminuição de stunting, em média de 5,6 pontos percentuais por década (P<0,001) e diminuição bem menor de wasting, em média de 1,1 ponto percentual por década (P=0,09), sem evidência, até o momento, de aumento de sobrepeso em crianças abaixo de 5 anos (aumento de 1,0 ponto percentual por década, P=0,14). Em Angola, das 749 crianças incluídas no estudo, 232 [32,0% (IC 95%: 28,7-35,5%)] tinham baixa estatura e 109 [15,1% (IC 95%: 12,6-17,9%)] estavam com peso baixo para idade. Na análise multivariável final, foram identificados os seguintes fatores associados com os desfechos pesquisados: ocorrência de diarreia nos últimos 15 dias (RP 1,39 [IC95% 1,06-1,84]) para baixa estatura; e presença de óbito de outros filhos (RP 1,52 [IC95% 1,01-2,28]) para baixo peso para idade. Em modelo composto apenas de fatores distais e intermediários, a presença de cuidador principal (outro que não a mãe) aumentou a prevalência de baixa estatura em 42% (RP 1,42; IC95% 1,10-1,84) e para cada mês mais tarde que a mãe o iniciou pré-natal, a prevalência de baixo peso para idade aumentou em 20% (RP 1,20; IC95% 1,03-1,40). CONCLUSÃO: Foi possível descrever a tendência preocupante de aumento de obesidade em mulheres em idade fértil nos países estudados. Em Angola, poucos fatores individuais foram descritos, sugerindo que a influência de fatores coletivos é importante. Esses dados devem ser úteis para o planejamento de ações visando, por um lado, à prevenção de uma epidemia de obesidade em crianças na África Subsaariana e, por outro, ao enfrentamento atual das altas taxas de desnutrição em crianças em Angola e outros países. / INTRODUCTION: The prevalence of child malnutrition is still high in sub-Saharan Africa; however, there is evidence that obesity in adults is increasing. In this scenario, on the one hand, it is important to tackle malnutrition, while on the other, it is essential to identify trends in excess weight over time, so as to focus attention on the prevention of large increases in obesity and the chronic diseases it causes. Thus, the objectives of this study were to describe trends in sub-Saharan Africa in obesity over the past decades in women of childbearing age and in children under 5 years of age, in parallel with those of malnutrition in the same group of children; as well as to identify factors associated with malnutrition in children under 2 years living in the suburban area of Luanda, Angola. METHODS: To describe the trends in nutritional status, secondary data from national surveys (Demographic and Health Surveys and Multiple Indicator Cluster Samples) of 13 African countries having at least four available surveys, were used. Trends were described for the outcomes obesity in women aged 15 to 49, and overweight, stunting, wasting, underweight and low birthweight in children under 5 years. For individual trends in each country, linear regression was performed. For trends considering the group of 13 countries, we used a multilevel regression model. To identify the factors associated with malnutrition, data from a cross-sectional population-based study held in Cacuaco, a municipality of Luanda, in 2010 were used. The outcomes studied were stunting and underweight. Prevalence ratios (PR) were estimated by Poisson regression with robust variance using a hierarchical model. RESULTS: The prevalence of obesity increased among women of reproductive age in most of the countries studied, on average 2.8 percentage points per decade (P<0.001), accompanied by significant reduction of stunting, on average 5.6 percentage points per decade (P<0.001) and a decrease, though much smaller, of wasting, on average 1.1 percentage points per decade (P=0.09), with no evidence, to date, of an increase in overweight in children under 5 years (increase of 1.0 percentage points per decade, P = 0.14).In Angola, among the 749 children included in the study, 232 [32.0% (95% CI: 28.7 to 35.5%)] were stunted and 109 [15.1% (95% CI: 12.6- 17.9)] were underweight. In the final multivariate analysis model, the following factors have been identified as associated with the studied outcomes: occurrence of diarrhea in the last 15 days (PR 1.39 [95% CI 1.06 to 1.84]) for stunting; and death of other children from the same mother (PR 1.52 [95% CI 1.01-2.28]) for underweight. In a model composed only of distal and intermediate factors, the primary caregiver not being the mother increased the prevalence of stunting by 42% (PR 1.42, 95%CI 1.10- 1.84) and each month that prenatal care was delayed increased the prevalence of underweight by 20% (PR 1.20, 95% CI 1.03-1.40). CONCLUSION: These results enabled the identification of a worrying increasing trend of obesity in women of childbearing age in the studied countries, in a context in which child malnutrition still prevails, especially stunting. In Angola, although it was possible to identify factors associated with malnutrition never before studied in Luanda, few individual factors were identified that increased the prevalence of malnutrition, suggesting that the problem results primarily from factors affecting society as a whole. These data should be useful for planning aimed, on the one hand, to prevent an epidemic of obesity in children in sub-Saharan Africa, and on the other, meeting the challenge of current widespread childhood malnutrition in Angola and other countries.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1572. Adviser: R. Sue Day. Includes bibliographical references.

This study determined attitudes of kindergarten through fifth grade teachers about school nutrition environments, their perceived influence on school nutrition environments, and self-reported classroom behaviors. Specific objectives were to: (a) identify perceived factors that influence the school nutrition environment, according to teachers surveyed; (b) examine relationships between elementary school teacher attitudes about school nutrition environments and perceived influence on the environment; (c) examine relationships between elementary school teachers’ attitudes about school nutrition environments, and self-reported classroom behaviors; (d) examine relationships between perceived influence over the school nutrition environment and self-reported classroom behaviors; and, (e) examine relationships between teachers’ demographic characteristics and attitudes and perceived influence on school nutrition environments, and self-reported classroom behaviors. Research was conducted in a mid-size Florida school district including 501 participants from 23 elementary schools. The Teacher Survey on School Nutrition Environments instrument was developed and validated by the researcher. Teachers identified the Food and Nutrition Services department as having the greatest impact on school nutrition environments, followed by student lunches and snacks sent from home. Responses to open-ended questions identified parents as part of the problem in developing healthy school nutrition environments. The Food and Nutrition Services department and parents were identified as having primary responsibility for encouraging healthy food choices at school, followed by administration, then teachers. Teachers did not perceive opportunities to provide input or to impact the school nutrition environment beyond their classrooms. The greater self-efficacy the teachers possessed, the more they felt they influenced the nutrition environment, and the more likely they were to offer menu suggestions, to sit or eat with students, to discuss food-related topics, and to integrate nutrition into lessons. Similar results were noted for teachers with college coursework in nutrition and those who were more experienced teachers. Classroom teachers should be encouraged to become involved and to recognize their role in developing and maintaining a healthy school nutrition environment. Increased communication should occur between school nutrition programs and teachers. Local wellness policy development and implementation should emphasize teachers’ influence.

Our nation’s youth face health challenges today that are drastically different from the health problems of youth in generations past. The drastic rise in childhood obesity rates prompted the 108th Congress to look for an innovative solution to the problem, mandating that each school district receiving federal funding for Free and Reduced Lunch must create and adopt a local wellness policy. This study examines whether relationships exist between Georgia’s school districts’ wellness policies and specific demographic characteristics of the district. Dependent variables include compliance, phase of implementation, and presence of a school health council. This study conducted univariate analysis using chi square and odds ratio coupled with binary logistic regression. Analysis shows that percent of minority students, as an independent variable, is significantly associated with compliance with the Child Nutrition and WIC Reauthorization Act.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Dissertation (Ph.D.).--University of Texas Graduate School of Biomedical Sciences at San Antonio, 2007. / Vita. Includes bibliographical references.

Thesis (D.P.H.)--University of Michigan.