Thesis (M. Tech. (Environmental Health)) -- Central University of technology, Free State, 2013 / Malnutrition and concomitant infections are major contributing factors to child morbidity and mortality in developing countries such as South Africa. Globally, children benefiting from school feeding programmes are generally from communities with low socio-economic statuses. The meals provided through feeding schemes, such as the National School Nutrition Programme (NSNP) in South Africa, are aimed at significantly supplementing the beneficiaries’ daily energy and nutrient requirements. The possible nutrient deficiency of meals provided through such programmes compromises the nutritional well-being of children, promotes malnutrition and renders children more susceptible to infectious diseases. Furthermore, illness, particularly caused by diarrhoeal and infectious diseases, is a major factor contributing to child malnutrition as the human body is unable to efficiently digest foods and absorb nutrients during illness. Therefore, the microbiological safety of the foods served to children via feeding schemes is essential. In an effort to contribute towards the safety and wholesomeness of foodstuffs served through the NSNP, the present study was conducted with a view to assess the nutritional quality and safety of the foodstuffs. The knowledge, attitudes and practises (KAP) of food handlers and NSNP representatives/committee members at the schools were also investigated in order to assess origins of potential food contamination. Data collected via nutritional analyses of meals served to school children were compared to the nutrient-based standards set by the United Kingdom as guidelines for an average school lunch. The carbohydrate, energy, calcium and zinc contents of the school meals were below the standards, the majority of the meals met the protein and iron standards and all meals complied with the standards for lipid and vitamin C contents. During the microbiological analysis study, preparation surfaces yielded higher counts of all detected organisms (total coliforms, Escherichia coli, Staphylococcus aureus and yeasts and moulds) compared to the hands of food handlers. Therefore possible sources of contamination may be foodstuffs, animal pests and environmental elements such as dust. However, significant differences of surface microbial counts could not be established (P > 0.05) and thus cross-contamination may have resulted among surfaces, possibly augmented by shortfalls in cleaning regimes. The majority of the participants of the questionnaire survey reportedly washed their hands and cleaned all surfaces several times during the day with water and detergent. In addition, a disinfectant was used by some of the food preparers during cleaning. Furthermore, participants stated that their aprons were washed daily. These claims were in agreement with the findings of the surface microbial study with regards to the hands, however, they did not match the findings of the preparation surfaces which contained the highest counts of total coliforms, E. coli and S. aureus of the three surfaces analysed, and aprons responsible for the highest yeast and mould counts. Improper storage and food preparation methods, such as the application of high temperatures, excessive exposure to UV light and oxygen, and high moisture conditions, may result in the deterioration of nutrients. Storage conditions which may permit pest infestation may also increase the risk of food-related illnesses and risk could be further elevated by application of improper cleaning and sanitation practices. In order for the NSNP to operate effectively, it is essential that the national and provincial Departments of Basic Education, which are responsible for the overall administration of the NSNP, and schools’ personnel function in an integrated manner through support structures and effective communication. Infrastructural limitations (lack of proper kitchen facilities and ventilation) and shortage of resources while administering the NSNP were the main challenges observed during the present study. Due to these hurdles, adhering to food safety practices and maintaining nutritional quality of foods may be a challenge. Continuous training in personal and general hygiene is also a necessity in preserving food safety. Furthermore, nutritional quality of foodstuffs may be preserved through proper storage practices and application of preparation methods which minimize loss of nutrients.

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

Submitted in fulfillment of the requirements of the Masters of Applied Science in Food and Nutrition, Durban University of Technology, 2015. / AIM: The aim of the study was to identify the need, develop, implement and determine the effect of a Grade R Nutrition Education Programme (NEP) in order to make recommendations to the South African Department of Basic Education (DBE) to include an effective NEP in the pre-primary school education curriculum. OBJECTIVES: The objectives for this study is in two phases, The objective of the baseline study was to assess the need for nutrition education (NE) in Grade R in suburban areas of Durban and identify the most suitable nutrition education tools (NETs) for this age group. For the intervention study the objectives were 1) to develop a nutrition knowledge questionnaire (NKQ) to determine the existing nutrition knowledge of Grade R learners in suburban government and private schools in Durban, 2) to develop a nutrition education programme (NEP) for Grade R based on the South African Food-Based Dietary Guidelines (FBDGs) and the food groups, 3) to implement the NEP in Grade R in a government and private school, 4) to determine the effect of the NEP on the retention of FBDGs (Section one) and food group (Section two) knowledge, and 5) to compare the results between the control group (CG) and the government (EGG) and private (EPG) experimental school groups, and between genders. METHODS: A self-administered nutrition education needs questionnaire was completed by 20 Grade R teachers in Durban suburban schools. Nutrition education material was identified based on the results from the pilot study and a Nutrition education programme developed. The classroom-based intervention study involved 120 Grade R learners in three schools, two experimental schools: government (n=37) and private (n=40), with a control school (n=43), with 35 percent (n= 42) male and 65 percent (n=78) female participants, ranging in age from five to seven years. A validated questionnaire assessed baseline nutrition knowledge of these children. A qualified foundation phase teacher was trained to implement the NEP. The experimental school groups received eight one hour nutrition education (NE) lessons over an eight week period; the control group did not receive any NE. During the lesson firstly theory was covered then the children worked on the related fun activities in the Healthy Eating Activity Book (HEAB) and lastly involved in the nutrition educational games. These included a food group plate puzzles, a NEP board game, a card game and ‘My little story books’. A post-test determined the impact of the intervention. RESULTS: The baseline study confirmed the need for NE in Grade R and identified suitable NETs that were used in the intervention. At pre-test, the nutrition knowledge of Grade R children in the two experimental groups (EG) and one CG was very similar with knowledge of FBDGs greater than knowledge relating to the food groups. Both Grade R EGs showed a significant increase in knowledge for the whole test immediately after the intervention with the CG, achieving similar post-to pre-test results. The intervention had a significant impact on nutrition knowledge of Grade R children in both experimental schools (EGG p=0.004 and EPG p=0.001). The EPG were most knowledgeable regarding FBDGs with no significant difference in knowledge of the EGG. Food group knowledge in all schools was poor at baseline and the NEP resulted in the EGG obtaining the highest post-test results. Post-intervention for the whole test the EGG were marginally (0.80 percent) more knowledgeable than the EPG. The knowledge of boys and girls were very similar in pre-and post-test results. However, the boys were fractionally more knowledgeable than the girls in relation to the whole post-test. In Section two, relating to food group knowledge, girls were slightly more knowledgeable than boys although both genders lacked knowledge in relation to which foods belonged to a particular food group. CONCLUSION: The primary aim of formal NE was met as the statistical significance between the CG and experimental group post-test results was evident in the majority of Section one questions and in all questions in Section two. The NEP resulted in similar increase in knowledge of Grade R learners in the government and private experimental school groups in Durban. In addition, the boys and girls showed a minimal difference in nutrition knowledge.

Thesis (MPhil) Stellenbosch University, 2014 / ENGLISH ABSTRACT: In an increasingly complex world where food security remains a challenge in many areas and especially Africa; it is essential to educate children about food – from production to consumption; and to ensure they eat enough as this is a crucial factor for concentration and learning abilities. How can we teach children about food in a sustainable way? This study focuses on schools in Tigray, Northern Ethiopia, which have a school feeding programme, school garden and nutrition curriculum. The question studied is: To what extent do two primary schools in central- and east Tigray (North Ethiopia) integrate the feeding scheme, school garden and nutrition curriculum? The methodology chosen is a case study and the empirical data was collected through interviews, surveys and observations. Principals of 14 schools were interviewed about the school gardens, curricula and school gardens. Two schools were then selected for a further in-depth research. The school gardens, mostly initiated by the staff, serve the purpose of creating income for the school and teaching students the skills of gardening. The curriculum is standard for Tigray and focuses on different food types and creating a balanced diet. The school food in most schools is provided by the World Food Programme (WFP), but some exceptions exist. This research shows that integration between the three objectives will be beneficial. Obstacles include getting the staff ‘on board’ as a priority and controlling the unification of the three, for example schools feel that they have less ownership over the feeding scheme because it is organised by an external NGO. This study suggests stakeholders view school gardens, nutrition education and school feeding schemes under one umbrella for the ultimate benefit of creating a sustainable model to teach about food. The case study provides an insight to the specific challenges in Tigray, Ethiopia but important conclusions can also be generalised. / AFRIKAANSE OPSOMMING: In ’n toenemend komplekse wêreld waar voedsel sekuriteit in baie gebiede, veral in Afrika ’n uitdaging bly, is dit baie belangrik om kinders oor voedsel op te voed - vanaf produksie tot by die verbruik daarvan, en ook om seker te maak dat hulle genoeg eet, wat baie belangrik is vir konsentrasie en die vermoë om te leer. Hoe kan ons kinders op ’n volhoubare manier leer oor voeding? Hierdie studie fokus op twee skole in Tigray, in Ethiopië wat skoolvoedingskemas, skooltuine en voedingkurrikula het. Die vraag wat gevra is, is: Tot watter mate integreer hierdie twee skole in Tigray die voedingskemas, die skooltuine en die voedingkurrikula? Die gekose metodologie is ’n gevallestudie. Empiriese data is ook deur middel van onderhoude, oorsigte en observasies versamel. Onderhoude oor skooltuine, voedingskemas en die kurrikula is gevoer met die skoolhoofde van 14 skole. Twee skole is toe gekies vir in-diepte navorsing. Die skooltuine bring geld in vir die skool en word ook gebruik om vir die leerling tuinmaakvaardighede aan te leer. Die kurrikulum is standaard vir die hele Tigray en word deur die Wêreld Voedsel Program verskaf. Daar is egter ’n paar uitsonderings. In hierdie navorsing is daar bewys dat die integrasie van die skooltuin, die voedingskema en die kurrikula, goeie gevolge kan hê. Dit is egter belangrik dat die skool personeel moet saamwerk en dat die vereniging van die drie beheer moet word. Skole voel bv. Tans dat hulle nie eienaarskap oor die voedingskema het nie, want dit word deur eksterne NROs beheer. Hierdie navorser stel voor dat die skooltuine, skoolvoedingskema en die voedingkurrikulum onder een sambreel beskou moet word met die doel om ’n volhoudbare model vir die onderrig van voeding te skep. Die gevallestudie verskaf insig in die spesifieke uitdagings in Tigray, Ethiopië, maar belangrike slotsomme kan ook veralgemeen word.

The aim of this study was to investigate whether Sibusiso, a Ready Food Supplement (SRFS), developed by the Gift of the Givers Foundation was able to promote weight gain among underweight children between 1 and 10 years of age. The study also aimed to train CAST community workers on how to assess and identify underweight children and to determine the number of underweight children aged 1-10 years who were currently on the CAST food aid program in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal. This non-randomised intervention study was carried out on a total of 19 out of 20 subjects that initially qualified for inclusion into the study. A monitoring tool was used to collect data on anthropometrical measurements, symptoms experienced, disease conditions identified, level of appetite, meal consumption and energy for each subject for a period of three months. Study subjects were from families living in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal, who were part of a food aid programme run by non-governmental organisation Church Alliance of Social Transformation (CAST). SRFS was compared to Recommended Energy Allowances (REA) and Recommended Daily Allowances (RDA) to determine the amount of energy and macronutrients that SRFS provided to subjects in their different age groups. The predominant health conditions and symptoms experienced by the subjects were assessed. General improvement in appetite, meal consumption and energy levels among subjects were monitored during the supplementation period Out of 19 subjects who were supplemented with SRFS over the three month period, it was established that more children from Chesterville than Cato Manor were part of the CAST food parcel programme. SRFS was not able to meet 100% of the RDA and REA for subjects in their different age groups. However, SRFS was able to promote weight among subjects as 50% of subjects were able to achieve normal weight-for-age growth by the third month of supplementation. Human Immunodeficiency Virus (HIV) infection was the predominant disease condition experienced among subjects. A steady decline in the frequency of infection symptoms experienced among subjects was observed. Appetite, meal consumption and energy levels among subjects increased during the three moth supplementation period. In conclusion, SRFS was successful in promoting weight gain among underweight children and was able to improve the overall wellbeing of subjects by alleviating the burden of disease conditions and infection symptoms while improving appetite, meal consumption and energy levels. SRFS therefore was beneficially utilised in the CAST food aid programme. SRFS had beneficial effects on the health and nutritional status of the study subjects during the observed period of its use in the CAST food aid programme and its continued use is recommended. / Thesis (M.Sc.Diet.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

Urban agriculture is a strategy poor urban, informal settlement residents adopt to reduce poverty and improve food security and child nutrition. It is widely asserted in the literature and development circles that household vegetable gardens can provide a significant percentage of recommended dietary allowances of macro- and micro-nutrients in the diets of pre-school children. These children are vulnerable in terms of food access and nutrition. The first five years of a child’s life are crucial to psychological well-being. This study set out to determine the impact of home gardens on access to food, dietary diversity and nutrient intake of pre-school children in an informal settlement in Eatonside, in the Vaal Region, Johannesburg, South Africa. The home gardening project was undertaken in five phases, namely the planning phase; a baseline survey (including quantitative food intake frequencies, 24-hour recall, individual dietary diversity questionnaires and anthropometric measurements); a training programme on home gardens; planting and tending the gardens and evaluating the impact of home gardens on access to food, dietary diversity and nutrient intake of pre-school children. Children aged two to five years (n=40) were selected to participate in the study. The sample population consisted of 22 boys and 18 girls. The children were categorised into three groups at the start of the project: children of 24-35 months (four boys and one girl), 36-47 months (four boys and five girls) and 48-60 months (14 boys and 12 girls). All but 10 per cent of the children’s consumption of foods in the food groups increased. At the start of the project, low consumption rates were observed for white tubers and roots, vitamin A-rich fruit, other fruit and fish. After the gardening project, the number of children consuming vegetables increased considerably. There was an increase in the intake of food groups over the period of the project. The number of children consuming vitamin A-rich increased the most, with all children (45 per cent improvement) consuming vitamin A-rich vegetables at the end of the project, compared with just over half at the start of the project. The consumption of vegetables increased with 78 per cent of the children consuming beans and 33 per cent beetroot. Most children (95 per cent) consumed cabbage, carrots and spinach post-home gardening. Seventy eight percent of children consumed beans by the end of the project, but only a third of the children had consumed beetroot during the post-project survey period. Intakes of all nutrients considered in the study improved by the end of the project, except for energy and calcium, which dropped marginally, but both remained at around 50 per cent below requirements. Twenty five percent of boys (24-35 months) were underweight and below the 50th percentile at the pre- and post-project stages. The same boys were severely stunted (on average -4.41 standard deviations below the third percentile). Of the boys aged 36-47 months, 25 per cent were stunted pre-project, but by the end of the project, this number had decreased to 50 per cent. Twenty one per cent of the older boys (48-60 months) were within their normal height for age. Twenty five per cent of girls were underweight (36-47 months). A slight change was observed in the 36-47 month group, where the mean changed from -0.14 standard deviations (below 50th percentile) pre-project to -0.5 (below 50th percentile) post-project. All girls aged 24-35 months were below -2 standard deviations pre-project. After the home gardening project, the figure dropped to 50 per cent. For girls aged 36-47 months, 25 per cent were below -3 standard deviations after the project, compared with 20 per cent pre-project. Height-for- age for girls aged 36-47 months dropped by 10 per cent below -2 standard deviation post-home gardening. Girls from 24 to 35 months were severely stunted [-3.02 (below 3rd percentile) pre- and -2.31 (below 5th percentile) post-project]. Stunting was observed in 36-47 months girls who had means of -2.39 (below 3rd percentile) and 1.86 (below 25th percentile) both pre-and post-gardening respectively and were at risk of malnutrition. The older girls were well nourished with means of height-for-age at -0.88 (below 50th percentile) pre-project and -0.92 (below 50th percentile) post-project. Home-gardening improved food access, dietary diversity, energy, protein, carbohydrate, fat, fibre, vitamin A and iron intakes, but did not make a significant impact on the malnutrition of the children in the project or ensure adequate intakes. Home gardens had a positive impact on height-for-age scores; but had no significant impact on mean weight-for-age and height-for-weight z-scores of the pre-school children. Increases in carbohydrate and fat intakes were shown to have the only significant impact on the children’s nutritional status and only with regard to improving height-for-age scores. The results show that the gardens did not have the expected impact on children’s nutrition, but confirm that increases in incomes from gardening are likely to have a greater impact through savings from consuming produce grown and selling produce to buy energy-dense foods for the children. This needs to be considered in nutrition interventions. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Information on the present situation of household food insecurity in South Africa is fragmented. There is no comprehensive study comparing different indicators of household food security. Better information on the household food security situation in South Africa would permit relevant policy formulation and better decision-making on the allocation of limited resources. The availability of a national dataset, the first South African National Food Consumption Survey data (1999) , provided the opportunity to investigate some of the issues raised above, and to contribute to knowledge on the measurement of household food security. The aim of this study was to use the data from the 1999 National Food Consumption Survey (NFCS) to : • Determine and compare the prevalence of household food insecurity using different indicators of household food security ; • Determine the overlap of households identified as food insecure by the different indicators (i.e. how many of the same households are identified as food insecure); and to • Investigate whether there was any correlation between the indicators selected . The indicators of household food security selected were: household income, household hunger experienced, and using the index child: energy and vitamin A intake (from 24 Hour Recall (24HR) and Quantified Food Frequency data), dietary diversity (from 24HR data) and anthropometric indicators stunting and underweight. The cut offs to determine food insecure household were those used in the NFCS and the cut off for dietary diversity was exploratory. The main results of the study were as follows : • The prevalence estimates of household food insecurity ranged from 10% (underweight indicator) to 70% (low income indicator). Rural areas consistently had a higher prevalence of household food insecurity than urban areas . The Free State and Northern Cape provinces had higher levels of household food insecurity, with the Western Cape and Gauteng the lower levels of household food insecurity . • Quantified Food Frequency (QFF) data yielded lower prevalence of household food insecurity estimates than 24 hour recall (24HR) data. Household food insecurity as determined by low vitamin A intakes was higher than that determined by low energy intakes for both the 24HR and QFF data . • There was little overlap with the indicators (9-52%), indicating that the same households were not being identified by the different indicators. Low dietary diversity, low income, 24HR low vitamin A intake and hunger had higher overlaps with the other indicators. Only 12 of 2826 households (0.4%) were classified by all nine indicators as food insecure. • The dataset revealed a number of statistically significant correlations. Overall , low dietary diversity, low income, 24HR low energy intake and hunger had the stronger correlations with the other indicators. Food security is a complex, multi-dimensional concept, and from the findings of this study there was clearly no single best indicator of household food insecurity status. Overall , the five better performing indicators (higher overlaps and correlations) were : low income, 24 hour recall low energy intake, 24 hour recall low vitamin A intake, low dietary diversity and hunger; this merits their use over the other selected indicators in this study. The indicator selected should be appropriate for the purpose it is being used for, e.g. estimating prevalence of food insecurity versus monitoring the long term impact of an intervention. There are other important criteria in the selection of an indicator. Income data on a national scale has the advantage of being available annually in South Africa, and this saves time and money. The 24HR vitamin A intake and 24HR energy intake indicators has as its main draw back the skill and time needed to collect and analyse the information, which increases cost and decreases sustainability. Dietary diversity and hunger have the advantage of being simple to understand, and quicker and easier to administer and analyse. It is suggested that a national food security monitoring system in South Africa uses more than one indicator, namely : 1) household income from already existing national data, 2) the potential for including a hunger questionnaire in the census should be explored, and 3) when further researched and validated, dietary diversity could also be used in national surveys. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Abstract: Introduction: Exclusive breastfeeding for the first six months of an infant's life is recommended worldwide. In 1998 the South African Demographic and Health Survey (SADHS) showed that only 10% of mothers exclusively breastfeed at three months. As the HIV virus is transmissible via breast milk, UNAIDS (2002) recommends that women in developing countries should be given a choice of feeding method after being counselled on the risks and benefits of breast feeding versus formula feeding. As a result, the Prevention of Mother-to-Child Transmission (PMTCT) programme was launched in KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child Transmission of the HIV virus. However, research has shown that infant feeding practices are influenced by numerous factors. Ultimately mothers will feed their infants in a manner they feel comfortable with, even if it is not always the most appropriate choice. Aim: The aim of this study was to determine and compare current infant feeding practices and some of the factors that influenced these practices among Zulu mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT clinics in Central Durban, KwaZulu-Natal. Methodology: A cross-sectional, descriptive survey was conducted amongst 150 mothers sampled from three non-PMTCT clinics and 150 mothers sampled from three PMTCT clinics. Systematic random sampling of mothers attending the two types of clinics was used to ensure an equal number of mothers· with infants aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number of mothers interviewed per clinic was determined proportionate to clinic size. Interviews were conducted in Zulu by trained fieldworkers according to a structured interview schedule consisting of 87 open- and closed-ended questions. Summary of most important findings and conclusion: Overall, one quarter of the mothers attending non-PMTCT and one third of mothers at PMTCT clinics were practising exclusive breastfeeding at the time of the survey. The general trend was that mothers attending PMTCT clinics were more inclined than those attending non-PMTCT clinics to breastfeed their infants exclusively (34% versus 24% respectively) or to formula feed (16,7% versus 12,7% respectively). Furthermore, there was a significant decline in exclusive breastfeeding and predominant breastfeeding with increasing infant age in both clinic groups. The opposite held true for mixed feeding and formula feeding in that infants were more inclined to mixed feeding or formula feeding with increasing infant age. In both clinic groups, exclusive breastfeeding was the method of choice in the 0 - < 6 week age category, while a preference for mixed feeding was shown in the 6 - < 14 week category. This trend persisted in the 14 week - < 6 month age category, especially in the non-PMTCT clinics, while there was a small but pronounced increase in formula feeding amongst PMTCT mothers. Although these findings can be explained as a result of implementing the PMTCT programme, the positive trends observed in non-PMTCT clinics serve as an indicator that the Integrated Nutrition Programme (INP) and Baby Friendly Hospital initiative have also had an impact on the feeding choices mothers make. Despite the limited duration of the PMTCT programme at the time of the study, indicators of the impact of the intervention include that a lower percentage of PMTCT mothers introduced foods and/or liquids in addition to breast milk to their infants before six months of age compared to non-PMTCT mothers. Furthermore, more mothers attending PMTCT clinics were shown how to breastfeed and were more likely to have received information about formula feeding. Despite these indicators of a positive impact of the PMTCT programme, the mean age for introducing liquids and/or solids in addition to breast milk was about six weeks and the incidence of this practice was very high for both groups. The similar incidence of formula feeding observed between the two clinic groups suggests the presence of constraints to safe infant feeding choices among mothers attending PMTCT clinics. As observed, infant feeding practices were still not ideal in either of the two clinic groups. However, the high level of antenatal clinic attendance documented for both groups serves as evidence that, if opportunities for providing mothers with appropriate infant feeding advice are utilized optimally, the antenatal clinic could serve as an ideal medium through which infant feeding education can take place, especially as the clinic-based nursing staff were cited as the most important source of infant feeding information by both groups of mothers in the antenatal and postnatal phases. The documented infant feeding practices should be interpreted against the backdrop of factors such as socio-demographic characteristics of the mothers, availability of resources such as social support from peers and significant others and reigning infant feeding beliefs that could influence infant feeding decisions. Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were determined by means of multivariate logistic regression analysis. Significant values were obtained for both clinic groups in terms of the infant not having received liquids in addition to breast milk. No additional predictors were found amongst mothers attending non-PMTCT clinics, however predictors amongst mothers attending PMTCT clinics included whether the mother had not visited the clinic since the infant's birth, whether she practiced demand feeding and whether she was experiencing stress at the time of the study. The limited number of predictors of exclusive breastfeeding documented in this study, especially among non-PMTCT mothers may be explained by the fact that infant feeding behaviour is multifactorial by nature and the interaction between factors that influence feeding choice is strong. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

Thesis (Msc Food Sc (Food Science))--Stellenbosch University, 2008. / The physical and mental development of underprivileged children, living in developing countries, is detrimentally affected by the exposure to poverty, malnutrition and poor health. The aim of the present study was to determine the possible risk of nutritional deficiencies of children (aged 5 – 6 years) in a low socio-economic community in the Grabouw area of the Western Cape, South Africa. The nutritional status of the children was evaluated by using anthropometric measurements (weight and height). Furthermore, the dietary intake provided by the meals offered at the schools they attended (Agapé 1 and Agapé 2), was assessed using the school menus. The latter were analysed using the FoodFinder3® computer programme (Medical Research Council of SA, Tygerberg, South Africa). Three supplementary food products (biscuit, health bar and soy milk-based drink) were subsequently developed to address possible nutritional deficiencies. The microbial stability of the products was determined, after which sensory acceptability of all three products was determined using a consumer panel consisting of children (n = 51; M:F = 27:24; 5 – 6 years) from the mentioned schools within the low socio-economic community. Anthropometric results were in agreement with those found by the National Food Consumption Survey (NFCS) (1999) and the South African Vitamin A Consultative Group (SAVACG) (1995), with stunting found to be most prevalent (16%). Only 5% of the children were found to be underweight and none were found to be wasted. The developed biscuit and health bar was found to be microbiologically safe when stored for at least 30 d at 25° and 35°C respectively, and the soy milk-based drink for 7 d if stored at refrigeration temperatures (5°C). Concerning the sensory preference, no significant difference was found between the preference for any of the developed products by the males and the females. For the specific products the preference for the biscuit did not differ significantly from the health bar, nor did the health bar differ significantly from the soy milk-based drink, but the biscuit did differ significantly (p = 0.006) from the soy milk-based drink for preference. The biscuit was found to be the most preferred of the three products and the soy milk-based drink the least. The majority of the juvenile consumer panel (95%) found all three developed food products acceptable and could, therefore, be considered possible supplementary foods in a school nutrition programme. The aim of nutritional supplementation is to supplement the existing diet and in doing so ensuring a more ideal nutrient intake closer to what is recommended by the recommended dietary allowance (RDA). It is proposed that nutritional deficiencies should, however, not only be addressed by means of nutritional supplementation, but should also be assisted by the nutrition education of the parent/guardian so as help them to make informed nutritional choices and in doing so providing their children with the nutrients necessary for optimal mental and physical development.