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

M. Tech. (Food Service Management, Dept. of Hospitality and tourism, Faculty of Human Sciences)|, Vaal University of Technology, / INTRODUCTION: Caring for children is a challenge that requires a number of resources including knowledge, a reasonable workload, time and social support of the caregiver. Maternal education is an important asset in providing good care giving practices: child feeding practices and the use of preventative health services depend on knowledge more than on household resources. Poverty has been linked with poor childcare and child malnutrition; South African children especially those who are living in informal settlements, are vulnerable to poverty. Appropriate practices by caregivers have enabled them to raise well~ nourished children in a community where there is poverty. This implies that caregiver's attitudes, beliefs and practices in relation to childcare, and proper utilisation of limited resources can make a major difference in their children's health, growth and development. In order to plan appropriate interventions in the Eatonside informal settlement, an improvement in the knowledge of, attitude toward and practice of childcare and care giv1ing is required. OBJECTIVES: To examine the knowledge, attitudes and practices (KAP) of caregivers regarding childcare and care giving behaviours with children aged 0- 60 months and to assess existing types of care arrangements in the study area. STUDY DESIGN: An exploratory study was conducted among 145 randomly selected caregivers of children aged 0-60 months, living in the informal settlement of Eatonside. Knowledge and practices were determined by focus group discussions (FGD); an attitude scale questionnaire was used to determine attitude; and a hygiene and feeding observation checklist was used to determine the hygiene and feeding practices.

As sociedades mundiais passam por mudanças substanciais que repercutem nas áreas da segurança alimentar e das políticas públicas sociais. Apesar de terem ocorrido significativas conquistas econômicas e sociais nos últimos anos, no Peru ainda existe dificuldade para oferecer segurança alimentar a toda sua população e isto se reflete na alta prevalência de subnutrição infantil concentrada principalmente nos espaços rurais, onde até o primeiro semestre de 2010, 30,9% das crianças são subnutridas. Esta situação representa uma ameaça para a sustentabilidade do desenvolvimento do Peru, devido aos efeitos irreversíveis da subnutrição na capacidade intelectual e física do indivíduo. Sendo a pobreza uma das principais causas da subnutrição, os programas de transferência condicionada de renda têm um grande potencial em favorecer a segurança alimentar dos beneficiados. Neste contexto o presente estudo tem como objetivo mostrar os reflexos na segurança alimentar dos beneficiados do programa de transferência condicionada de renda JUNTOS, na comunidade indígena de Pilpichaca, uma das comunidades mais pobres e com maior prevalência de crianças subnutridas do Peru. Foi realizado um estudo descritivo e quantitativo em uma amostra de 90 famílias. A escolha das famílias beneficiadas foi feita aleatoriamente em uma relação de todas as famílias beneficiadas com crianças menores de cinco anos. O levantamento dos dados foi feito através de questionário fechado apresentado as mães. Pretendia-se conhecer: a forma de acesso aos alimentos, à água e esgoto, acesso aos programas públicos de suplementação e complementação alimentar, uso da transferência de renda, mudança no consumo de alimentos, o estado nutricional nas crianças menores de cinco anos, a relação entre as variáveis: estado nutricional e o tempo de exposição ao programa JUNTOS; e a avaliação do Programa JUNTOS pelas mães beneficiadas. Os resultados mostram que aumentou o consumo de alimentos de alto valor nutritivo e o gasto com alimentos também é favorecido. Os resultados da regressão linear apontam que há uma relação proporcional entre o estado nutricional e o tempo de exposição ao programa JUNTOS, mas esta não é estatisticamente significativa. A transferência de renda representa 51.2% da renda familiar e as mães avaliaram o programa JUNTOS como uma boa política pública. / In Peru, although significant economic and social achievements have occurred in recent years, there is still a difficulty in providing food to entire population. This is reflected in a high prevalence of child malnutrition, mainly concentrated in rural areas, where, in the first half of 2010, even 30.9% of children is malnourished. This situation represents a threat to sustainable development of Peru, the irreversible effects of malnutrition on physical and intellectual capacity of the individual. With poverty being a major cause of malnutrition, the programs of conditional cash transfer have great potential to promote food security of beneficients. In this context, this study aims to show the effects of food security of the beneficients of the program of conditional cash transfer: JUNTOS, in the indigenous community of Pilpichaca, one of the poorest communities and with the highest percentage of malnourished children in Peru a descriptive and quantitative analysis on a sample of 50 families was made. The choice of beneficiary households was made randomly from a list of all beneficiary families with children under 5 years. The survey was made through different closed questionnaires presented to the mothers. The aim was to know: how to access food, water and sanitation, as well as public programs to food complement and supplementation, use of income transfer, change in food consumption, nutritional status among children under five years, the relationship between variables: nutritional status and exposure time to the program JUNTOS and program JUNTOS evaluation by mothers benefited. The results show that increased intake of foods of high nutritive value, spending on food is in plus, but can not show a significant relationship, between nutritional status and exposure time to the program JUNTOS. The transfer of income represents 51.2% of a total family income. The mothers generally rated JUNTOS as a good public policy.

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Wong Pui-ying. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 59-62). / Abstracts in English and Chinese. / Chapter 1 --- Introduction --- p.1 / Chapter 2 --- Literature Review --- p.3 / Chapter 2.1 --- Income and Nutrition --- p.3 / Chapter 2.2 --- Determinants of Child Health --- p.4 / Chapter 2.2.1 --- Income --- p.4 / Chapter 2.2.2 --- Parental Education --- p.6 / Chapter 2.2.3 --- Other Determinants --- p.8 / Chapter 3 --- "Empirical Model, Data and Variables" --- p.11 / Chapter 3.1 --- Empirical Model --- p.11 / Chapter 3.2 --- Data --- p.13 / Chapter 3.3 --- Variables --- p.14 / Chapter 3.3.1 --- Dependent Variables for Child Nutrition --- p.14 / Chapter 3.3.2 --- Dependent Variables for Child Health --- p.15 / Chapter 3.3.3 --- Independent Variables --- p.18 / Chapter 4 --- Empirical Results --- p.20 / Chapter 4.1 --- Determinants of Child Nutrition --- p.20 / Chapter 4.1.1 --- The Income Effect --- p.20 / Chapter 4.1.2 --- Non-linear Effect of Income --- p.21 / Chapter 4.1.3 --- Parental Education --- p.21 / Chapter 4.1.4 --- Permanent Income --- p.22 / Chapter 4.1.5 --- Difference between Rural and Urban Areas --- p.23 / Chapter 4.2 --- Determinants of Child Health --- p.23 / Chapter 4.2.1 --- The Income Effect --- p.23 / Chapter 4.2.2 --- Non-linear Effect of Income --- p.25 / Chapter 4.2.3 --- Parental Education --- p.25 / Chapter 4.2.4 --- Permanent Income --- p.26 / Chapter 4.1.5 --- Difference between Rural and Urban Areas --- p.27 / Chapter 4.2.5 --- Other Variables --- p.28 / Chapter A. --- "Parental Heights, Weights and Health Status" --- p.28 / Chapter B. --- Water and Sanitation --- p.29 / Chapter C. --- Insurance --- p.30 / Chapter D. --- Parental Health-Related Behaviors --- p.31 / Chapter 5 --- Conclusion --- p.33 / Tables --- p.34 / References --- p.59

In the U.S., few children meet federal recommendations for fruit and vegetable consumption, putting them at increased risk for overweight, obesity and several non-communicable diseases. Interventions to increase fruit and vegetable consumption delivered within the school setting are advantageous in that they provide the opportunity to reach many youths in period of life during which key diet-related behaviors are formed that may track into adulthood. The National School Lunch Program (NSLP), a federal food assistance program that serves over 30 million meals daily in over 100,000 schools in the U.S., is one example of an intervention that may increase fruit and vegetable consumption among children. Recent regulatory changes to the program via the 2010 Healthy Hunger-Free Kids Act (HHFKA) require compliance with minimum daily and weekly minimums for fruit and vegetables offered to students at lunch to receive federal reimbursement, which has resulted in increased availability of fruits and vegetables. Although preliminary evaluations of the regulatory changes have documented small increases in consumption, there is interest in identifying other programs and policies to ensure that components are consumed. Yet there is little meta-evidence that critically examines aspects related to the design of school-based intervention studies assessing fruit and vegetable consumption. This dissertation describes a systematic mapping review of the literature and three empirical studies which inform the development of a conceptual evaluation framework for designing studies to measure fruit and vegetable consumption among elementary students in the U.S. within schools participating in the NSLP. A systematic mapping review of the literature technique was used to identify studies conducted among elementary students in grades K-5th within schools in the United States in the period from 2004 to present with the primary outcome fruit and vegetable consumption at the lunch meal. A total of 61 records were included in the review, categorized as either methodological validation studies (n=10) or as studies of factors related to students’ consumption of fruits and vegetables (n=51). Validation studies were conducted with four types of dietary assessment methods within the school lunch setting, all demonstrating moderate accuracy relative to the referent method: weighed plate waste, direct observation, digital photography and self-report instruments. In the studies examining factors related to fruit and vegetable consumption at school lunch, the frequency of methods was as follows: weighed plate waste method (n=21), direct observation (n=14), digital photography methodology (n=12), and self-report (n=4). Most studies utilized cross-sectional (n=15) or quasi-experimental designs (n=24). A socio-ecological framework was used to group 19 environmental factors examined in these studies into 5 clusters of factors: individual, item-specific, meal-specific, cafeteria environment and school-wide/policy. While many factors were explored across studies, relatively few studies accounted for multiple factors in their analyses, leaving room for potential confounding. Three empirical studies were conducted within a larger, cross-sectional evaluation of FoodCorps, a national farm-to-school program that promotes fruit and vegetable consumption in school-aged children. First, this dissertation conducted a validation study to estimate the accuracy of a self-report questionnaire instrument relative to digital photography for measuring fruit and vegetable consumption in elementary students from 23 schools in a five-phase study. High agreement was observed between student reports of fruit and vegetable items on tray and items observed in digital photographs (match rate ranged from 77 to 88% depending on phase), as well as reports of amounts of fruit and vegetable items consumed (ranges from 67 to 83% depending on phase). There were no differences observed in accuracy of reporting between 2nd and 3rd grade students. It can therefore be concluded that a group-administered self-report instrument can be used to measure fruit and vegetable consumption in a school setting among 2nd and 3rd grade students, providing a potentially less costly instrument than existing objective methods. Second, a descriptive study reports intra-class correlation estimates for fruit and vegetable outcomes, quantifying the variation in these outcomes attributable to the school-level that can be used in power calculation for future studies. Using 2,571 before- and after-meal digital photographs collected of students’ lunch trays across 40 days of data collection within 20 schools, the intra-class correlation coefficients (ICC) were estimated via multilevel regression models. The observed ICCs for all fruit and vegetable consumption outcomes ranged from 0.159 (vegetables on tray, continuous) to 0.472 (vegetables on tray, binary). Within each of food item category (fruit, vegetables, or fruit and vegetables combined), the highest ICC was observed for items on tray (binary). A multilevel linear model which included as covariates the percent of students eligible for free/reduced price lunch and the percent of white students was shown to decrease the ICC for each fruit and vegetable outcome variable except fruit on tray (binary). The largest for decrease in ICC was for the outcome fruit and vegetables on tray (in cup equivalents), wherein the model reduced ICC from 0.268 to 0.018, a 93% decrease. The power calculations for cluster randomized controlled trial that can conducted using these ICCs will help to ensure that researchers have adequately powered their studies. Third, select cafeteria environmental factors were examined in a cross-sectional study as they relate to students’ fruit and vegetable consumption at the lunch meal. Using the digital photographs of 2,571 lunch trays from the previous study, the association between fruit and vegetable consumption and several environmental factors was examined. The average consumption of fruit and vegetables was 0.35 cup equivalents (SD=0.31) and 0.24 cup equivalents (SD=0.29), respectively, among students who had them on their tray. When considering students who had a fruit or a vegetable or both on their tray (96% of the sample), the average was 0.45 cup equivalents (SD=0.40). Hierarchical linear models examined environmental variables and fruit and vegetable consumption outcomes: the number of fruit and vegetable items offered (range from 3 to 14 items) was positively associated with vegetable consumption (B=0.021; SE=0.006; P<0.001); noise (rage from 70 DbA to 84 DbA) was negatively associated with fruit consumption (B=-0.012; SE=0.004; P=0.003) and fruit and vegetable consumption (B=-0.017; SE=0.004; P<0.001); recess scheduled before lunch was positively associated with fruit consumption (relative to recess after lunch; B=0.100; SE=0.023; P<0.001) and fruit and vegetable consumption (B=0.096; SE=0.023; P<0.001). Despite cross-sectional evidence of an association, future research is necessary to systematically manipulate these variables to understand their impact. The results from these three studies and the systematic mapping review are used to develop a conceptual evaluation framework that can be used by researchers to improve the quality and design of studies promoting fruit and vegetable consumption among elementary school-aged children in the U.S.

Food selectivity exhibited by children with autism creates a myriad of barriers for families and children, ranging from social to nutritional. The typical approach to food selectivity is pathological. The pathological approach attempts to eliminate food selectivity through the use of techniques such as escape extinction. While successful in decreasing aspects of food challenges, such as food refusals, the pathological approach does not necessarily establish desired responses to foods or mealtimes (e.g., favorable affect, approach, generalized sampling, etc.). The purpose of the current study was to explore an alternative, constructional approach to food challenges presented by two children diagnosed with autism. This approach focuses on the development of favorable responses to food through the use of shaping. Furthermore, the shaping process involved a conceptual and procedural widening of the stimulus and response classes selected. The results of a non-concurrent multiple baseline experiment, suggest this approach was successful in expanding the number of food the children tasted and ate while maintaining favorable or neutral affect and child assent.

The current research was developed from a review of the literature on the influence of parental control on children's eating and weight, and in particular the research examining parental restriction and poor self-regulation of energy. The impetus for the research was the confusion in the literature about the positive and negative aspects of control and the need to explore the influence of parental control at earlier periods of child development in socio economically diverse samples. The aim of the first study was to investigate the factor structure and psychometric properties of the Child Feeding Questionnaire (CFQ) in an Australian sample of preschool children. Consistent with previous research, the factor structure was problematic with respect to the Restriction subscale. The two items that ask about the use of rewards showed poor cohesion with other items on the Restriction subscale, raising concerns about the conceptualisation of restriction as measured by the CFQ. The second study sought to determine whether currently available measures of restriction were appropriate for assessing parent behaviours with toddlers, and to explore the strategies that mothers use to control their toddlers' intake of energy-dense snack foods. A qualitative methodology was employed and interviews were conducted with 22 mothers who had toddlers aged between 18 and 24 months. A key finding was a lack of variability in responses to the CFQ Restriction subscale in contrast to the range of individual differences in parents' reported use of control. A thematic analysis provided the basis for the development of a questionnaire to quantify the key concepts that were identified. Exploratory factor analysis was then used to refine these concepts resulting in a five factor structure that has been named the Toddler Feeding Questionnaire (TFQ). The TFQ incorporates a broad range of measures of parental control over feeding, including how much parents allow access to energy-dense foods (Allow Access), the rules associated with managing intake of these foods (Rules), and flexibility in the way rules are applied (Flexibility). It also includes a measure of parental self-efficacy beliefs (Self-efficacy), which may influence the use of feeding practices, and a measure of toddlers' attraction to energy-dense foods (Child's Attraction), a characteristic of the child that may influence both parent feeding practices and energy intake. The factor structure was examined in a sample of mothers of toddlers, and replicated in a second sample of mothers of preschool children, who responded retrospectively about their feeding practices. Subsequent analyses were conducted to examine the internal consistency, test-retest reliability, convergent, discriminant and concurrent validity of the TFQ factors to provide a preliminary validation of the instrument. To further examine the validity of the TFQ, feeding practices of normal weight, overweight and obese parents were compared. The relationship between the TFQ factors (based on retrospective reports) and BMI z scores in preschool children were also examined. In the preschool sample only, normal weight parents had significantly more rules compared to obese parents and were less flexible compared to overweight parents, and obese parents allowed their children more access to snack foods compared with overweight and normal weight parents. The TFQ factors were not associated with BMI z scores in preschool children. The final study investigated the association between feeding practices, including the TFQ factors and CFQ Restriction, and self-regulation of energy intake in toddlers. The main aim was to determine if the TFQ factor Allow Access would moderate the relationship between CFQ Restriction and ad libitum intake of snack foods, using an age appropriate adaptation of the Free Access Procedure developed by Fisher and Birch (1999a). The findings confirmed a moderating influence of Allow Access. Restriction was a significant predictor of intake only when Allow Access was high. The implications of this finding for the development of parental feeding advice and the conceptualisation of parental control are discussed. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331550 / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2008

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Little is known about the nutritional status of urban refugees. This study assesses the prevalence of malnutrition in a sample of refugee children in Cairo and analyses associations between growth indicators and their determinants. This cross-sectional study surveyed a sample of African refugee children (n=201) under two years of age. In home interviews, height and weight were measured and maternal and household characteristics, handwashing and breastfeeding practices and recent child illness were assessed. In this sample, 13% of refugee children were stunted, 4% were underweight and 8% were wasted. Multivariate analysis revealed that growth was independently and positively associated with having a flush toilet, good handwashing practices, and not recently having fever. Older children were significantly smaller than reference children of the same age, but child age was not associated with malnutrition. Further monitoring and assessment of long-term growth and development of refugee children in Cairo is required. Good child care practices should be promoted in the community.