Children less than five years of age are at a risk of growth failure worldwide. The South African National Food Consumption Survey (NFCS) of 1999 showed that 25.5% of children aged 1 - 3 years were stunted. Poor growth of young children in developing countries (South Africa included) has been associated with multiple micronutrient deficiencies because of the use of starchy plant-based complementary foods with little variety, especially among resource poor households. Dietary diversification through the use of crop and livestock production has been recommended as a strategy to improve the micronutrient intake and food security of households in resource poor settings. This study was a cross sectional secondary analysis of the South African NFCS of 1999 data, designed to investigate the impact of crop and livestock production on nutrient intake, dietary diversity, intake of selected food groups, hunger perceptions and anthropometric status of children aged 1 - 3 years in South Africa. Children from households producing crops only (n=211), crops and livestock (n=110), livestock only (n=93) and non-producers were compared at the national, in rural areas and among households with a total income of less than R12 000.00 per household per year. In rural areas and among households with a total income of less than R12 000.00 per household per year, children in the crops and livestock group had higher nutrient intakes for energy, vitamin 86, calcium and folate than the other groups (p<0.05), while the crops only group had higher nutrient intakes for vitamin A and vitamin C. The majority of children in all the four study groups had less than 67% of the RDAs for vitamin A, vitamin C, folate, calcium, iron and zinc. In addition , children in all the groups had a median dietary diversity score of four out of 13 food groups. In rural areas and among low income households, higher percentages (over 60%) of children in the crops only group consumed vegetables while the non-producers group was the lowest (47.7%). The non-producers group had the highest percentages of children consuming meat and meat products and the crops and livestock and livestock only groups had the lowest percentages. In both rural areas and among households withlow income, the majority of the households in all the study groups were experiencing hunger. In rural areas, one in five households were food secure. Crop and livestock production improved the nutrient intake and the intake of vegetables of children in rural and poor households. However, nutrient intakes were not adequate to meet the recommended nutrient levels. The high levels of food insecurity require support of these households to increase crop and livestock production and, integration of nutrition education to increase the consumption of the produced products. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

The Integrated Nutrition Programme (INP) was implemented in 1995 to target child malnutrition in South Africa. This study assessed the impact of the INP on child malnutrition by province and age group using secondary data. Data from three national nutrition surveys, conducted in 1994, 1999 and 2005, were used to describe trends in child stunting, underweight, wasting, vitamin A deficiency and iron deficiency. The relationship between the prevalence of the human immunodeficiency virus (HIV) in prenatal women and child nutritional status; challenges and constraints to implementing the INP at provincial level; and government responses to nutrition recommendations by lead experts in the 1994 and 1999 surveys were also investigated. Child nutritional status varied across provinces. In some provinces such as the Northern Cape, stunting, underweight and wasting remained consistently high. Stunting decreased in the Eastern Cape, but rates of wasting increased between 1994 and 2005. On the other hand, Gauteng and the Western Cape generally had lower rates of malnutrition compared to the other provinces. This may be due to these provinces being the most economically active in the country thus more opportunities for employment and higher purchasing power of foods rich in micronutrients. By 2005, vitamin A deficiency had doubled in most provinces despite mandatory food fortification being implemented in 2003. KwaZulu-Natal had the highest rates of vitamin A deficiency, while Limpopo had the highest rates of iron deficiency. By 2005, malnutrition had decreased in children aged seven to nine years, but had increased in those aged one to three years. There was a significant positive correlation (p<0.01) between the prevalence of HIV in prenatal women and vitamin A deficiency nationally. The prevalence of HIV in prenatal women was positively correlated (p<0.05) with rates of wasting in children aged one to three years. Limited skills, inadequate monitoring and evaluation, and limited infrastructure were common challenges and constraints to implementing the INP at provincial level. The effect of HIV on human resources and the higher demands of HIV infected patients also posed a challenge to provinces as they implemented the INP. Government responded to most recommendations made by nutrition experts. Supplementation,food fortification, growth monitoring and nutrition promotion programmes were implemented. Based on the data, it would appear that INP activities targeted at school-going children were more effective than those targeting children under-five. Although food fortification was implemented in 2003, the vitamin A content of fortified products might not have met legislative requirements. Additionally, because vitamin A is unstable to heat and light, if vitamin A fortified foods are cooked or stored this may also influence the bioavailability of vitamin A. Maternal HIV status might have attenuated child nutrition outcomes due to the negative effect of HIV on related health conditions such as child caring and feeding practices. Some of the challenges and constraints at provincial level might have negatively affected the implementation of the INP and consequently its impact. Although government responded to most recommendations made by nutrition experts, ongoing monitoring and evaluation of child nutritional status were not adequately done, which might have also negatively affected INP outcomes. In addition, factors in the macro-environment such as food inflation and access to basic sanitation, could have lessened the impact of the INP on child malnutrition. Interventions directed at malnutrition in children under-five need to be prioritised. There needs to be rigorous monitoring of micronutrient content, especially vitamin A, of fortified foods. Future studies need to include assessment of nutritional status in HIV affected and infected children to help identify specific needs and develop appropriate policies. Frequent nutrition surveillance to assess key child malnutrition indicators is required. / Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009.

Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / There is convincing evidence linking school feeding to improved educational outcomes. The Primary School Nutrition Programme (PSNP) was first implemented in 1994 and aimed to improve educational outcomes by alleviating short-term hunger and improving school attendance and punctuality. Responsibility for the programme was transferred from the Department of Health (DoH) to the Department of Education (DoE) in 2004 and the name was changed to the National School Nutrition Programme (NSNP) at this time. Previous evaluations of the PSNP / NSNP had reported problems associated with foodservice management and general management aspects of the programme. The study was a cross-sectional, observational investigation of foodservice management and general management practices in primary schools running the National School Nutrition Programme (NSNP) in Pietermaritzburg, KwaZulu-Natal. Twenty-three schools were visited to investigate practices at each school relating to compliance with DoE menus and prescribed service time of the meal, the food delivery system and utilities available. The food handling and hygiene training and practices and general management practices linked to the NSNP were investigated. Most of the schools (78%) were using the DoE menus but only half (52%) served the meal at or before 10h00, which is an ongoing problem. Receiving and storage procedures were adequate at most schools. Food quality does not appear to be a problem in the Pietermaritzburg schools. The lack of expiry dates on food packages remains a problem area and should be addressed. Most of the schools had a designated kitchen area but these facilities could be upgraded. Most schools cooked on gas and 35% of schools had no running water in the kitchen. Kitchens should, at least, have hot and cold running water and adequate working space. Most schools reported that they run out of gas during the month. The monthly DoE allocation for gas should be reviewed to ensure schools have enough gas for the whole month. The holding time for cooked food should be kept to a minimum to minimise the risk of food poisoning. Some schools had insufficient plates (26%) and cutlery (35%). Standardised portion sizes were served at 70% of schools and food handlers reported that learners usually finish all the food. Food handlers at 70% of the schools had received training in food safety and hygiene but 26% of these had only received training once. Training was found to be significantly associated with hand washing (p=0.002), clean uniforms (p=0.036) iv and sanitising practices (p=0.035). Training should be provided in short, ongoing sessions. General management aspects of the NSNP remain a problem. Policies and procedures should be drawn up and implemented to provide a minimum standard of operations at schools. Monitoring should be conducted on a regular basis. The NSNP is running reasonably well in Pietermaritzburg. Adhering to prescribed meal times and upgrading kitchen facilities could result in improvements. Food handler training could also be conducted more frequently. General management aspects need to be improved.

Childhood obesity is a major health problem facing children in the United States. How parents view their children's weight is an important consideration for health care professionals. The purpose of this study was to explore parental perceptions of their children's weight and health.

Thesis (M. Tech. (Food Service Management, Dept. of Hospitality and Tourism))--Vaal Univrsity of Technology. / Inadequate food intake and unhygienic practices are usually associated with poor nutrition practices. Malnutrition stems from poor quality and quantity of foods, but is also contributed to by factors of inadequate maternal and child health care, lack of education and information and insufficient health services. The first phase of this study was to assess the nutritional status and nutritional knowledge of primary school children within a peri-urban community, through the implementation of a situational analysis. Validated 24-hour (hr) recall, food frequency (FFQ), nutrition knowledge and health questionnaires were used to conduct the situational analysis of this community. Parents (n=52) representative of 400 (13.0 percent) children voluntarily agreed to participate and 45 children completed the baseline survey. Results indicated a community faced with poverty as unemployment (60.9 percent) was high, education levels amongst the parents ranging between primary (33.3 percent) and secondary school (54.9 percent). The dietary patterns of the children revealed a carbohydrate-based diet with very few (n=2) consuming a variety of fruit and vegetables. Some nutrition knowledge amongst the children was evident, with a mean 60.2 percent in correct answers for the true/false questions. The children within the community were at risk of becoming stunted, with small numbers having deficiencies in iron. Therefore, it was decided to implement a nutrition education programme (NEP) in the second phase of the study to address malnutrition amongst primary school children. The objectives of the second phase were 1) to implement a NEP amongst the primary school children to assess the impact on nutrition knowledge and dietary practice, and 2) to determine the retention of knowledge after nine months and whether any correlation occurred between knowledge and dietary practices. The school environment was chosen to ensure attendance and create a suitable learning environment to which the children were already accustomed. Two groups, namely experimental (n=82) and control (n=91), were assigned for this study. The control group received no form of nutrition education during the intervention period. The experimental group received nine 45 minute lessons over a period of nine weeks. The nutrition education tools (NETs) were made up of a text and activity book, supplemented by a card and board game. Pre- and post-nutrition intervention knowledge and 24-hr recall questionnaires were completed to assess differences in nutrition knowledge and dietary practices between the two groups. The intervention made a significant impact on the nutrition knowledge of the experimental group, with a 13 percent improvement between pre and post results. Topics which required more emphasis included the importance of variety in the diet, the functions and sources of certain nutrients, and the classification of certain food groups and the daily serving requirements. In the long-term evaluation, nutrition knowledge was retained and related to topics of the inclusion of milk and fat on a daily basis, the serving size of starch, dairy products and fruit and vegetables, and the classification of low-fat snack items. Retention of knowledge was poor for the source of vitamin C. A few changes were made in the dietary choices of the children after the intervention, with the inclusion of more carbohydrates and one fruit. During the long-term evaluation, the children included more protein sources, but carbohydrates remained dominant within the Top 20 list. The energy distribution in the long term changed towards more energy being supplied from protein (15.6 percent) and fat (34.4 percent), compared with post results of 13.7 and 25.8 percent respectively. The multivariate analysis revealed a significant correlation between the protein intake of the Top 20 list and the question relating to the number of eggs (p=0.00) to be consumed daily, as well as the link between vitamin C (p=0.00) and fruit and vegetable intake. A limitation is that a small number of children (n=27) could not complete the post test, with another 34 children not present to complete the long-term evaluation. The children had very little control of the dietary patterns as their mothers were primarily responsible for food procurement, preparation and feeding. A recommendation is to commence the intervention in the beginning of the year and to consider a co-ordinated approach with parents to encourage dietary changes. / Vaal University of Technology and SANPAD

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Consumer Sciences: Food and Nutrition in the Faculty of Applied Sciences at the Cape Peninsula University of Technology 2013 / Child undernutrition is the outcome of numerous complex and interrelated factors. It is considered a worldwide health concern, also in Botswana. Undernourished infants are especially vulnerable to develop nutritional deficiencies and diseases. Tsabana was developed as a weaning food to improve the diet quality of undernourished infants in Botswana but also as a dietary intervention product for the four-month- to five-year-old age group to improve the nutritional status of Batswana children. The study undertook a theoretical nutritional appraisal of Tsabana and assessed its acceptance and use in rural districts of Botswana. A quantitative approach that incorporated a survey was used as the research design for the study. A pre-tested questionnaire consisting of close-ended questions in the multiple choice format was used to collect the data on the field acceptance and use of Tsabana. The questionnaire was completed by 105 caregivers of infants aged six to 36 months old visiting the selected clinics with the research sites the Ngamiland, North East, Central and Kweneng rural districts. The energy, macro- and micronutrient content adequacy of Tsabana was compared to the Codex Alimentarius Standard for Processed Cereal-based Foods for Infants and Young Children (Codex Standard 074) and the Proposed Nutrient Composition for Fortified Complementary Foods (PNCFCF). Sorghum and soya are the two major ingredients of Tsabana which contribute to its protein and energy provision. The nutrient appraisal revealed that the level of energy provided by Tsabana is more than the specified Codex Alimentarius Standard composition but slightly less than the PNCFCF specified range, whereas the protein level is within the specified ranges as put forward by both the Codex composition and the PNCFCF, respectively. The results further revealed that in comparison to the PNCFCF the content of vitamins A, E, C and pyridoxine, zinc, iodine and iron were less than the specified ranges. The content of vitamins A and D met the compositional guidelines of the Codex Alimentarius Standard. The micronutrient provision of Tsabana in relation to the World Health Organization (WHO) recommended nutrient intakes was mostly adequate except for pyridoxine which was inadequately provided for both seven- to 18-month-old (33% provision) and one- to three-year-old (52% provision) infants at the daily rations of 75 gram (g) and 200 g powder respectively. Some minerals also were provided at inadequate amounts, e.g. iodine at a daily provision of 42% as well as iron at 26% for seven- to 12-month-old and 12- to 18-month-old infants both provided at a daily ration of 75 g Tsabana powder. Zinc was only provided at 19% of the WHO recommended intake for seven- to 12-month-old and 14.8% for 12- to 18-month-old infants. As with the absence of omega-3 and omega-6 fatty acids, the minerals selenium and copper are not provided by Tsabana. The micronutrient fortification compounds used in Tsabana for the mineral and vitamin additions as vitamin A palmitate, cholecalciferol, vitamin E acetate, calcium pantothenate, carbonate and tri-calcium phosphate (ratio 1:18:482), zinc sulphate and potassium iodate are readily bioavailable, but not the vitamin A and vitamin E compounds used. The iron fortificant used is not stipulated on the Tsabana package. The field survey results revealed that Tsabana was well accepted by the infants as perceived by their caregivers as the majority indicated that Tsabana was enjoyed (80%) and that it tasted nice (71.4%). The majority (78.1%) of the caregivers also indicated that the wellbeing of the infants improved on receiving Tsabana. Most (51.4%) of them also knew that Tsabana is more nutritious than other cooked porridges. Tsabana though was not used properly as most of the caregivers fed Tsabana to the infant only once a day (60.9%) instead of two to three times (for infants six- to 18-month-olds) and did not use enough water (3½ cups) (76.2%) to cook one feeding of Tsabana as stipulated on the Tsabana package. The product use factors, which include the number of daily Tsabana feedings provided, the addition of sugar to the cooked Tsabana, the amount of water used to cook one feeding of Tsabana and the cooking period of one feeding were the factors significantly (p < 0.05) linked to the perceived infant acceptance of Tsabana. The number of daily Tsabana feedings was linked to the perceived enjoyment of Tsabana (p < 0.05) and its perceived texture (p < 0.05) and colour (p < 0.05) acceptance. While the addition of sugar to the cooked Tsabana was linked to its perceived enjoyment (p < 0.05), the amount of water used to its perceived taste acceptance (p < 0.05) and the cooking period of one feeding to its perceived colour acceptance (p < 0.05). For instance, more caregivers in relation to the enjoyment of Tsabana and its colour and texture acceptance who perceived it not to be enjoyed and not having a nice colour or texture, indicated not to feed it daily in comparison to caregivers who perceived that Tsabana was enjoyed by the infants and that it had a nice colour and texture. The caregiver perceived infant wellbeing improvement through the provision of Tsabana and the perceived difference between Tsabana and other cooked porridges were the only two clinic-related factors which significantly (p < 0.05) influenced the infant acceptance of Tsabana as perceived by the caregivers. For instance, while the majority (86.2%, 84.8% and 80%, respectively) of the caregivers who perceived the infant taste acceptance of Tsabana as very nice, nice or acceptable indicated that providing Tsabana to the infant improved the infant’s wellbeing, the majority (80%) who perceived it as not tasting nice indicated that providing Tsabana to the infant had not improved the infant’s wellbeing. More than half of the caregivers who perceived the infant texture acceptance of Tsabana as acceptable (59.4%) or nice (56.8%) indicated that Tsabana provides more nutrition to the infant. However, less than half (46.2%) of the caregivers who perceived the texture of Tsabana as not nice indicated that it provides more nutrition to the infant. The caregiver education level was the only demographic factor that significantly (p < 0.05) influenced the acceptance of Tsabana. The majority (90.3%) of the caregivers who attained a secondary education level (form 1 to form 4) and higher, perceived the infant texture acceptance of Tsabana as nice, acceptable or not nice. In contrast, the majority who perceived the texture acceptance as very nice attained either no schooling/standard one to seven (73.9%) and not a secondary level or higher (26.1%). It could be speculated that caregivers who attained a higher education level may be more critical of such attributes such as the texture acceptance of Tsabana. Most (59%) of the caregivers indicated that they did not receive any information regarding Tsabana from the clinic personnel. Caregiver education on Tsabana and infant nutrition will impart sufficient knowledge and skills to prepare, store and adequately feed Tsabana to their infants as well as provide a variety of foods in adequate amounts to contribute to their optimal growth and development. This is a vital undertaking as it was evident from the study that most of the factors that influenced the acceptance of Tsabana were the product use factors. The study additionally found that foods such as meat, poultry and fish, as well as fruit and vegetables, which should be included in the daily dietary provision, were provided to most of the study infants on a weekly basis only.

This study looked at how cholesterol levels of students, ages 11-15, who participated in the NSLP and the SBP would be affected compared with those students who only participated in the NSLP. Fasting blood samples (lOmL) were analyzed from 15 students who ate lunch only (L) and 15 students who ate both breakfast and lunch (BL) from the Driver Middle School food service at least 3 times a week. Blood was analyzed for changes in total cholesterol, HDL, LDL, and Triglycerides from baseline to 4 months. Results showed a significant decrease in total cholesterol and LDL, and a significant increase in triglycerides from baseline to 4 months in both the L group and the BL group. This may be attributable to hormone levels during sexual maturation in prepubescent and pubescent students. / Department of Family and Consumer Sciences

In 2001, the percentage of fourth grade students who were overweight (26%) in Wells County, Indiana was twice the national average (13%). A Robert Wood Johnson Local Initiative Funding Partners grant was submitted and received to provide this community with resources to help combat unhealthy lifestyles. The purpose of this study was to examine differences in body mass index, food choices and nutrition knowledge and attitudes of fourth grade students in Wells County to determine if the prevalence of overweight had been reduced, and provide insight into children's food choices and nutrition knowledge. Of the 1,347 fourth grade students who completed the SPAN questionnaire over the four years, 23 percent were overweight. Over the four years, the prevalence of overweight did not increase to higher levels, providing modest support for the impact of Operation Wellness on students' weight. The students in this rural community ate fewer meals, snacked more frequently, did not eat enough fruits or vegetables, and ate too many high-fat/high-sugar foods compared to recommended standards. Students from the Southern Wells School District were significantly more aware of the relationship between diet, weight, and health than students in the other two school districts. / Department of Family and Consumer Sciences

The dietary outcomes of a school-based heart health promotion program in a low-income, multiethnic, inner-city neighbourhood of Montreal, Canada, were investigated. Eight intervention schools and sixteen control schools participated in the project from 1993 to 1997. Twenty-four hour recall data, as well as data on anthropometric and sociodemographic characteristics, were collected from a subsample of all students in grades 4--6 (aged 9--12 years) at baseline (n = 498), after two years (n = 491), and after four years (n = 347). There were no significant differ in nutrient intakes between 1995 and 1997, so these data were combined for analyses. Compared to students in control schools, students exposed to the program had a significantly increased mean intake of vitamin C per 1000 kcal (4184 kJ) (p = 0.0013). Compared to students in designated intervention schools at baseline, mean make of vitamin C per 1000 kcal was significantly increased (p = 0.002) and mean folate intake was significantly domed (p = 0.0058) in exposed to the program. When the intervention group was restricted to only those students who had received 16 hours or more of program exposure (n = 113), there were no significant differences in any nutrient intakes when compared to control students or students in intervention schools at baseline. This program was unsuccessful in changing nutrient intakes of school-aged children, contributing further evidence that conscious dietary change is difficult to achieve by means of a school-based program with a reasonable number of curriculum hours.

Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009. / Full text also available online. Scroll down for electronic link.