Philosophiae Doctor - PhD / The significance of malnutrition in public health has increasingly gained recognition in South Africa due to its negative effect on the quality of life, both at the individual and societal levels. The most vulnerable groups to suffer from malnutrition are pregnant and lactating women as well as children below 5 years of age. Given the importance of maternal and child health, this study is set out to assess the prevalence and trend of maternal and child malnutrition in South Africa. In addition to the health cost, there is also economic cost, resulting from malnutrition. Therefore, the association between malnutrition and labour force participation is of academic and policy interest due to the crucial role the labour force plays in stimulating economic growth.

This study highlights the importance of national factors in explaining the wide variations in child malnutrition that exists among population groups in the three Central Asian Republics under study, and as an avenue through which the investigation of the processes by which other factors influencing child malnutrition can be executed. This study has been guided by the proposition that the effects of socio-economic, health and the environmental factors vary by province of residence. The suggested theory underlying this proposition is the structural violence theory, which stems from the evidence of differences in malnutrition levels among provinces of residence within the three countries under study. Against the background of this theory, the study explores and compares the effects, on child malnutrition of sixteen covariates of malnutrition within these countries. The study assessed, first, the nutritional status of children below 3 years using the three anthropometric indices, weight-for-age, height-for-age and weight-for-height. Secondly, it examined the confounding factors that influence nutritional status in the Central Asian Republics. The DHS data for Kazakhstan, Kyrgyzstan and Uzbekistan were used. The data of the countries were combined in order to create a more usable dataset for multivariate analyses. This descriptive analysis was done on all relevant variables in order to get a better understanding of the dynamics involved in the data. A binary logistic regression analysis estimating models using the stepwise forward method (based on Wald statistics) on the pooled dataset was carried out controlling socio-economic, health and environmental characteristics. Separate analysis was carried out to study the odds of being underweight, and stunted among children in the study population. Analyses for the odds of being wasted were not performed because the percentage of wasted children was too low. The main results indicate that province of residence within a country, country of residence, number of people in a household, household wealth, birth weight, age of child, knowledge of ORT, maternal education, number of children under five years, and source of drinking water, are strong predictors of child nutritional status in the three Central Asian Republics. Furthermore, it has revealed that chronic malnutrition (stunting), which is long-term undernutrition, is most prevalent in all three countries but at varied levels. An unexpected finding is that fully vaccinated children were highly likely to be malnourished compared to children who were partially vaccinated. Since stunting appears in early ages in Central Asian children many of the children in this study may be stunted before they receive all the recommended vaccinations. This could also be influenced by the poor nutritional status of the mother who cannot provide nutritious breast milk. Another unexpected finding was that breast-feeding especially in children more than six months old had a strong negative association with stunting and underweight. Women who breastfeed longer may be doing so because they lack the resources and nutritional knowledge to provide their children with adequate nutrition. Another explanation for the observed adverse association of breastfeeding and nutritional status beyond infancy is that of reverse causality, where mothers continue to breastfeed children who appear small for their age. In summary, the results from both the descriptive and binary logistic regression analysis are similar in terms of the explanatory variables and the statistical significance in the models. The study recommends more area-specific (province) policies for the development of nutritional intervention programmes including closer attention to childcare and mother care programmes. / Thesis (PhD (Sociology))--University of Pretoria, 2007. / Sociology / PhD (Sociology) / Unrestricted

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Apesar do declínio dos déficits nutricionais em menores de cinco anos nas últimas décadas, a desnutrição infantil ainda se configura como problema de saúde pública, apresentando altas prevalências em algumas regiões do Brasil e em outros países em desenvolvimento, além de inúmeras repercussões negativas na morbi-mortalidade. A saúde mental materna (SMM) tem sido cada vez mais considerada como um aspecto relevante para a saúde infantil. Apesar disso, pouco enfoque tem sido dado às suas repercussões sobre o estado nutricional infantil. Investigar a associação entre SMM e estado nutricional infantil no sexto mês de vida. Conduziu-se um estudo seccional inserido em uma coorte prospectiva com 235 crianças aos seis meses advindas de unidades básicas de saúde do município do Rio de Janeiro. Para formar os desfechos, médias de peso-para-comprimento e peso-para-idade foram expressas em escores z usando a nova curva de referência da OMS (2006) para menores de cinco anos. Aplicou-se a versão em português do General Health Questionnaire com 12 itens (GHQ-12) e 4 opções de resposta para aferição da SMM. Utilizou-se sistemas de pontuação de forma a gerar duas variáveis discretas: GHQ-bimodal (zero a 12 pontos) e GHQ-Likert (zero a 36 pontos). Tomando como referência a variável GHQ-bimodal, foram empregados os pontos de corte >3 para detecção de transtornos mentais comuns (TMC), >5 para transtornos mentais mais graves e >9 para sintomas depressivos. A análise da associação entre SMM e desfechos nutricionais se baseou em modelos de regressão linear. A amostra revelou escores z médios de 0,23 para peso-para-comprimento e de 0,05 para peso-para-idade. As prevalências de TMC, transtornos mentais mais graves e sintomas depressivos foram de 39,9%, 23,7% e 8,3%, respectivamente. Após ajuste pelo peso ao nascer, maiores pontuações no GHQ-bimodal e GHQ-Likert estiveram associadas a menores médias de peso-para-comprimento. Para este desfecho, os filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores-z mais baixos em relação aos filhos de mulheres sem estes agravos (p = 0,026). Observou-se, também, uma média de 0,67 escores-z mais baixos em filhos de mulheres com sintomas depressivos em relação aos filhos de mulheres não deprimidas (p = 0,010). Apenas sintomas depressivos na mãe estiveram associados significativamente com valores médios mais baixos de escore-z de peso-para-idade (p = 0,041). Não se observou associação significante entre TMC e os desfechos avaliados. A SMM esteve relacionada à inadequação do estado nutricional de crianças aos seis meses. O reconhecimento precoce e tratamento destes agravos durante o puerpério poderiam ser estratégias adjuvantes para melhorar a situação nutricional infantil e, por fim, reduzir a morbi-mortalidade associada aos déficits nutricionais. / Despite the decline of nutritional deficits in children under five years in the last decades, infant malnutrition remains a public health problem, with high prevalence in some regions of Brazil and other developing countries and numerous adverse effects on morbidity and mortality. Maternal mental health (MMH) is being increasingly considered a relevant aspect in the context of child health. Nevertheless, little focus has been given to the MMH impact on nutritional status. To investigate the association between maternal mental health and child nutritional status at six months of life. A cross-sectional study inserted in a prospective cohort was conducted with 235 children at six months of age recruited in primary health care centers in Rio de Janeiro, Brazil. To form the outcomes, means of weight-for-length and weight-for-age were expressed in z scores using the new WHO growth standards (2006) for children under five years of age. The Portuguese version of the General Health Questionnaire with 12 items and four answer options (GHQ-12) was applied to measure MMH. Two scoring systems were used to create discrete variables: GHQ-bimodal score (zero to 12 points) and GHQ-Likert score (zero to 36 points). Using the GHQ-bimodal score a cut-off point of >3 was used for the detection of common mental disorders (CMD), a cut-off of >5 for more severe mental disorders, and a cut-off of >9 for depressive symptoms. Analysis of association between MMH and nutritional outcomes was based on linear regression models. The sample showed average z scores of 0.23 for weight-for-length and 0.05 for weight-for-age. The prevalence of CMD, more severe mental disorders and depression was 39.9%, 23.7% and 8.3%, respectively. After adjusting for birth weight, higher scores of GHQ-bimodal and GHQ-Likert were associated with lower mean z scores of weight-for-length. For this outcome, children of women with more severe mental disorders had, on average, 0.37 z-scores lower when compared to children of women without these disorders (p = 0.026). Also, children of women with depressive symptoms had, on average, 0.67 z-scores lower than those from non-depressive mothers (p = 0.010). Only maternal depressive symptoms showed significantly association with lower weight-for-age (p = 0,041). There was no statistically significant association between TMC and both nutritional outcomes. MMH was related to inadequate nutritional status of children at six months of age. Early recognition and treatment of mental health problems in the postpartum period might be an adjuvant strategy to improve child nutritional status and ultimately reduce the morbidity and mortality associated with nutritional deficits.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Apesar do declínio dos déficits nutricionais em menores de cinco anos nas últimas décadas, a desnutrição infantil ainda se configura como problema de saúde pública, apresentando altas prevalências em algumas regiões do Brasil e em outros países em desenvolvimento, além de inúmeras repercussões negativas na morbi-mortalidade. A saúde mental materna (SMM) tem sido cada vez mais considerada como um aspecto relevante para a saúde infantil. Apesar disso, pouco enfoque tem sido dado às suas repercussões sobre o estado nutricional infantil. Investigar a associação entre SMM e estado nutricional infantil no sexto mês de vida. Conduziu-se um estudo seccional inserido em uma coorte prospectiva com 235 crianças aos seis meses advindas de unidades básicas de saúde do município do Rio de Janeiro. Para formar os desfechos, médias de peso-para-comprimento e peso-para-idade foram expressas em escores z usando a nova curva de referência da OMS (2006) para menores de cinco anos. Aplicou-se a versão em português do General Health Questionnaire com 12 itens (GHQ-12) e 4 opções de resposta para aferição da SMM. Utilizou-se sistemas de pontuação de forma a gerar duas variáveis discretas: GHQ-bimodal (zero a 12 pontos) e GHQ-Likert (zero a 36 pontos). Tomando como referência a variável GHQ-bimodal, foram empregados os pontos de corte >3 para detecção de transtornos mentais comuns (TMC), >5 para transtornos mentais mais graves e >9 para sintomas depressivos. A análise da associação entre SMM e desfechos nutricionais se baseou em modelos de regressão linear. A amostra revelou escores z médios de 0,23 para peso-para-comprimento e de 0,05 para peso-para-idade. As prevalências de TMC, transtornos mentais mais graves e sintomas depressivos foram de 39,9%, 23,7% e 8,3%, respectivamente. Após ajuste pelo peso ao nascer, maiores pontuações no GHQ-bimodal e GHQ-Likert estiveram associadas a menores médias de peso-para-comprimento. Para este desfecho, os filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores-z mais baixos em relação aos filhos de mulheres sem estes agravos (p = 0,026). Observou-se, também, uma média de 0,67 escores-z mais baixos em filhos de mulheres com sintomas depressivos em relação aos filhos de mulheres não deprimidas (p = 0,010). Apenas sintomas depressivos na mãe estiveram associados significativamente com valores médios mais baixos de escore-z de peso-para-idade (p = 0,041). Não se observou associação significante entre TMC e os desfechos avaliados. A SMM esteve relacionada à inadequação do estado nutricional de crianças aos seis meses. O reconhecimento precoce e tratamento destes agravos durante o puerpério poderiam ser estratégias adjuvantes para melhorar a situação nutricional infantil e, por fim, reduzir a morbi-mortalidade associada aos déficits nutricionais. / Despite the decline of nutritional deficits in children under five years in the last decades, infant malnutrition remains a public health problem, with high prevalence in some regions of Brazil and other developing countries and numerous adverse effects on morbidity and mortality. Maternal mental health (MMH) is being increasingly considered a relevant aspect in the context of child health. Nevertheless, little focus has been given to the MMH impact on nutritional status. To investigate the association between maternal mental health and child nutritional status at six months of life. A cross-sectional study inserted in a prospective cohort was conducted with 235 children at six months of age recruited in primary health care centers in Rio de Janeiro, Brazil. To form the outcomes, means of weight-for-length and weight-for-age were expressed in z scores using the new WHO growth standards (2006) for children under five years of age. The Portuguese version of the General Health Questionnaire with 12 items and four answer options (GHQ-12) was applied to measure MMH. Two scoring systems were used to create discrete variables: GHQ-bimodal score (zero to 12 points) and GHQ-Likert score (zero to 36 points). Using the GHQ-bimodal score a cut-off point of >3 was used for the detection of common mental disorders (CMD), a cut-off of >5 for more severe mental disorders, and a cut-off of >9 for depressive symptoms. Analysis of association between MMH and nutritional outcomes was based on linear regression models. The sample showed average z scores of 0.23 for weight-for-length and 0.05 for weight-for-age. The prevalence of CMD, more severe mental disorders and depression was 39.9%, 23.7% and 8.3%, respectively. After adjusting for birth weight, higher scores of GHQ-bimodal and GHQ-Likert were associated with lower mean z scores of weight-for-length. For this outcome, children of women with more severe mental disorders had, on average, 0.37 z-scores lower when compared to children of women without these disorders (p = 0.026). Also, children of women with depressive symptoms had, on average, 0.67 z-scores lower than those from non-depressive mothers (p = 0.010). Only maternal depressive symptoms showed significantly association with lower weight-for-age (p = 0,041). There was no statistically significant association between TMC and both nutritional outcomes. MMH was related to inadequate nutritional status of children at six months of age. Early recognition and treatment of mental health problems in the postpartum period might be an adjuvant strategy to improve child nutritional status and ultimately reduce the morbidity and mortality associated with nutritional deficits.