Thesis (PhD (Food Science))--University of Stellenbosch, 2006. / Long-chain polyunsaturated fatty acids (LCPUFA), especially the n-3 LCPUFA metabolic products eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) play an important role as regulators in many biological processes. To date hake (Merluccius capensis) heads, a rich source of EPA and DHA, have been discarded at sea. The South African Fisheries Policy Development Committee concerned with the environmental impact of this practice has rendered it undesirable. The high prevalence of under-nutrition amongst children in South Africa can be addressed by the supplementation of their diet with this unexploited fish source. The aim of the current study was to develop a microbiologically safe and sensory acceptable sandwich spread using fish flour prepared from fish heads, as a prime ingredient. The intervention trial aimed to compare the effects of an increased dietary intake of n-3 LCPUFA, specifically DHA, on the blood fatty acid levels and absenteeism (as indicator of immune function), as well as the cognitive status, of the subjects. The microbiological content of the sandwich spread was determined after storage for 20 d at 5°C and 15 d at 25°C. Sensory evaluation was performed by consumers (n = 95; M:F = 44:51; 6 – 9 yr) to determine acceptance of the five different flavours individually incorporated into the sandwich spread to mask the fishy note and to provide different flavour options. For the intervention trial subjects (n = 351) were stratified within class group (A - E) and gender and randomly assigned to two treatment categories, an experimental group (EG; n = 174) receiving 25 g sandwich spread.d-1 (191.66 mg DHA. d-1) and a control group (CG; n = 177) receiving an analogous placebo. On school days (104 d), each subject received two sandwiches consisting of two slices of bread (ca. 60 g), spread with 25 g of either the placebo or the experimental spread. Blood samples were drawn at baseline and post intervention. Plasma fatty acid and red blood cell (RBC) membrane status, C-reactive protein levels, as well as vitamin and micronutrient status, were determined. Trained test administrators conducted a battery of cognitive tests. According to South African Government health standards, the sandwich spread remained microbiologically safe after storage. Male and female consumer respondents revealed a significant difference between gender preferences of the five different spread flavours (p <0.05). Significant treatment effects (p <0.05) were observed in n-3 LCPUFA status of the EG, as well as for their absenteeism from school. The two subtests of the Hopkins Verbal Learning test, Recognition and Discrimination Index, showed significant differences between the EG and CG (p <0.05) post intervention in the Grade 2 subjects. The Spelling tests also showed a significant difference between the two groups (p <0.05). In the current study a microbiologically safe and sensory acceptable sandwich spread was developed and tested during an intervention trial, and could possibly in future, provide a healthier option in the School Nutritional Programme. This study proved that supplementation of children (6 - 9 yr) with n-3 LCPUFA, with specific reference to EPA and DHA from a marine source, could have a beneficial effect on their fatty acid status and absenteeism from school. Based on the outcomes of the Hopkins Verbal Learning test and Spelling test, the current study proved that an n-3 fatty acid-rich spread improved the learning ability and memory of children.

Thesis (MTech (Biomedical Technology))--Peninsula Technikon, 2004. / The prevalence of obesity amongst both the adult and paediatric population has assumed almost epidemic proportions in many developed and developing countries. A recent study by the Medical Research Council found that a disturbing 20% of all South African children could be categorized as being obese. Limited data is currently available on the prevalence of obesity in South African children, particularly from the previously disadvantaged population. Given the global epidemic of paediatric obesity, hypertension and type-2-diabetes and the limited available data relating to obese South African children, further studies to enhance the understanding of the risk factors associated with the epidemic are imperative.

Submitted in fulfilment of the requirements for the degree Master of Applied Science in Food and Nutrition, Durban University of Technology, 2015. / Objective: To determine the contribution of packed school lunches to the daily food intake of girls and boys in two Primary Schools in East London. Methods: The study was conducted among 199 girls and boys aged 9-13 years. Three 24-Hour recalls and a Food Frequency Questionnaire were completed during an interview with the participants to gather data on dietary patterns over a period of three consecutive days. Additionally, the contents of one lunch box per participant were recorded and weighed. Anthropometrics and socio-demographics were also completed during the interview. Results: The three 24-Hour Recall nutrient measurements revealed a low energy intake in 91 percent for the girls and 77 percent for the boys who were consuming below the recommended Estimated Energy Requirement for energy. The lunchboxes contributed one-third of the daily nutrient intake of the children. The 24-Hour recall revealed an energy-dense, carbohydrate-based diet. The contribution of total fat (30-32%) to the total energy is higher than the World Health Organization (WHO) recommendation of 15-30 percent. The daily fruit and vegetable intake (215.1g and 216.9g), according to the 24-Hour recall and lunchbox analysis respectively, was insufficient compared to the WHO-recommendation of >400g /day. Although the mean intake of most of the nutrients was sufficient, a large number of the participants did not meet requirements for the age group. The risk of overweight was high (24% for girls and 29.2% for boys) with 1.5 percent falling into the obese category. Conclusion: The results of the study indicated a high-fat and carbohydrate intake and a very low fruit and vegetable intake. The girl participants had better food choices for the lunchboxes but the majority of the participant’s daily intake did not meet the basic requirements of a balanced diet. The risk of overweight in the age category is an increasing problem among low- and high-income countries. Nutritional education should concentrate on healthy food choices in school lunchboxes as a large part of the day is spent at school.

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.

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.

Aim: To determine whether the tuck shop purchasing habits of Grade 4 learners were contributing towards the development of childhood overweight and obesity. Objectives: To assess the nutritional quality of the food and beverages available for learners to purchase; items regularly purchased from the tuck shop as well as factors influencing the learner’s decision to purchase these items; the anthropometric and socio-demographic characteristics of grade 4 learners as well as their nutrition knowledge related to the tuck shop items purchased. Method: A survey administered to 11 tuck shop managers, a questionnaire administered to 311 Grade 4 learners and two single-sex focus groups of 5 learners each were conducted. Results: Fifty six percent of the sample were female (n=173) and 44% were male (n=138). Twenty seven percent of the study sample was overweight (n = 83) and 27% were obese (n = 85). Eighty six percent of learners (n = 266) claimed to buy from their school tuck shop. Twenty two percent of learners purchased from their tuck shop at least three times per week (n =58). Learners who purchased from the tuck shop had a significantly higher BMI than those who did not (p = 0.020). Learners who purchased from the tuck shop spent on average R8,38 per day with a minimum of R1 and a maximum of R40 (standard deviation R5.39). The most popular reasons for visiting the tuck shop included “this is my favourite thing to eat or drink” (66.5%, n = 177) and “I only have enough money to buy this item” (47.0%, n = 125). Savoury pies were the most popular "lunch" item for all learners for both food breaks (45%, n = 5 schools and 27.3%, n = 3 schools) selling the most number of units (43) per day at eight of the eleven schools (72.7%). Iced popsicles were sold at almost every school, ranked as the cheapest beverage and also sold the most number of units (40.7). Healthy beverages sold included canned fruit juice and water, while healthy snacks consisted of dried fruit, fruit salad, bananas, yoghurt and health muffins. The average healthy snack contained almost half the kilojoules of its unhealthy counterpart (465kJ vs 806kJ). Nutritional analyses of the healthy lunch options revealed total fat contents that exceeded the DRI and South African recommended limit. Perceived barriers to stocking healthy items included cost and refrigeration restrictions. The average score for the food groups was only 33% indicating that learners were not familiar with the Food Based Dietary Guidelines (FBDG). Further analyses showed that the total knowledge scores of those learners that reported to buy from the tuck shop frequently, was significantly lower when compared to the total knowledge scores of those learners who bought from the tuck shop less frequently (13.0 ± 3.9 and 11.6 ± 3.1, respectively; p < 0.05). Logistic regression analysis confirmed that the total knowledge of a learner could be used to predict whether he or she is more likely to make purchases from the tuck shop (significance = 0.017). Focus group results revealed that learners are aware of “healthy” and “unhealthy” tuck shop items. Most learners stated that they would continue to purchase items from their tuck shop if all “unhealthy” items were removed. Conclusion: Primary school tuck shops of well resourced schools in Pietermaritzburg are contributing to childhood overweight and obesity through a combination of factors. These include the poor nutritional quality of the items stocked at the tuck shop as well as the poor tuck shop purchasing practices. Much consultation is required amongst dieticians, school principals and privatised tuck shop managers to overcome barriers to stocking healthy items. School management and government have an important role to play in imposing restrictions on the sale of unhealthy items; along with improving the quality of the nutrition education curriculum to ensure that learners are able to translate their knowledge into healthier purchasing practices. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

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.

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.

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.