Thesis (Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objectives: To describe the mothers/ primary caregivers’ (PCGs) and children’ anthropometric status; their household food security and poverty in relation to type of housing; and compare households receiving and not receiving a Child Support Grant (CSG) in relation to mothers/ PCGs’ anthropometric status, their dietary diversity, age, employment, educational level, monthly household income, size, food security and children’s anthropometric status. Design: Cross sectional, descriptive study. Subjects: Mothers/ PCGs (443) and their children from 211 households in Avian Park and 242 Zweletemba in Worcester, Western Cape Province. Methods: Data collected by interviewer administered questionnaires included socio-demographic data, Lived Poverty Index, Household Food Insecurity Access Scale (HFIAS) and dietary diversity score (DDS). Anthropometric measurements included weight, height and waist circumference (WC) of mothers/ PCGS and weight, height and mid-upper-arm circumference of children. Households living in formal (brick houses, town houses, flats) and informal (squatter shacks, huts) houses, and households receiving CSGs and those without CSG, were compared using X2-test for categorical data and the independent t-test for continuous data. Results: Prevalence of stunting, underweight and wasting in children was 20.7%, 5.6% and 1.2% respectively. Overweight and obesity occurred in 27% and 37% of mothers/PCGs respectively and together with a mean WC (89.5 cm; SD 16.7) indicated an increased risk for non-communicable diseases. Food security existed in 63.1% households. Formal households were more food secure than informal households (68% versus 50%; p=0.0004) and fewer mothers/ PCGs of formal households had a DDS < 4 (52.2% versus 64.7%; p = 0.0157). The healthier socio-economic situation in formal households compared to informal households was shown by the higher monthly income (R3 479 versus R2 316; p = 0.0009) and Household Asset Index (2.24 versus –5.31; p <0.0001). Age, marital status, education level and employment status of mothers/primary caregivers in CSG households and non-CSG households were similar. Household size was larger (p<0.0001) in CSG (median = 5 persons) versus non-CSG households (median = 4 persons); CSG households had more people per room (2.7 [SD 1.5] versus 2.3 [SD 1.2]; p=0.0037). CSG households had lower monthly income than non-CSG households (R2 723 [SD R3 297] versus R4 520 [SD R6 464]; p=0.0033). Mean HFIAS scores showed more food insecurity in CSG households than non-CSG (3.55 versus 2.37; p= 0.0178), but dietary diversity was similar. Stunting in children was higher in CSG (34.9%) versus non-CSG (22.7%) households. CSG mothers/PCGs had larger (p = 0.021) waist circumferences (90.0 cm; SD = 16.8) than non-CSG mother/PCGs (88.5 cm; SD = 16.5) Conclusion: Childhood malnutrition and maternal overweight /obesity co-existed. Dietary diversity of all mothers/ PCGs was low. The assessment of type of housing and social security showed children in informal housing households had a poorer socio-economic situation and children in CSG households also experienced more monthly income poverty and household food insecurity. The level of stunting was higher in CSG households. Improving low dietary diversity should be a priority in interventions addressing food insecurity, taking into consideration this may be more difficult to achieve in informal households and CSG households. / AFRIKAANSE OPSOMMING: Doel: Om die antropometriese status van moeders/ primêre versorgers en hul kinders; hul huishoudelike voedselsekerheid en armoede met betrekking tot tipe behuising waarin hul woon, te beskryf; asook om huishoudings wat ‘n kindersorgtoelaag ontvang te vergelyk met die daarsonder in terme van die antropometriese status van moeders/ primêre versorgers, hul dieetdiversiteit, ouderdom, indiensneming/ werkstatus, opvoedkundige vlak, huishoudelike maandelikse inkomste en grootte, voedselsekerheid en die antropometriese status van hul kinders. Ontwerp: ‘n Beskrywende, deursnit studie. Deelnemers: Moeders/ primêre versorgers (447) en hul kinders van 211 huishoudings in Avian Park en 242 in Zweletemba. Metodes: Data-insameling is gedoen met onderhoudvoerder geadministreerde vraelyste insluitend sosio-demografiese inligting, die belewing-van-armoede-indeks, huishoudelike voedselonsekerheid-en-toegangskaal en dieetdiversiteitstelling. Antropometriese metings van moeders/ primêre versorgers het behels gewig, lengte en middelyfomtrek en gewig lengte en bo-armomtrek van kinders. Huishoudings woonagtig in formele (baksteenhuise, meenthuise, woonstelle) en informele huise (plakkershutte), en huishoudings wat die kindersorgtoelaag ontvang en nie, is vergelyk met behulp van die X2-toets vir kategoriese data en ‘n onafhanklike t-toets vir aaneenlopende data. Resultate: Die voorkoms van dwerggroei, ondergewig en uittering in kinders was onderskeidelik 20.7%, 5.6% en 1.2%. Oorgewig en vetsug het onderskeidelik voorgekom by 27% en 37% van moeders/ primêre versorgers en hul gemiddelde middelyfomtrek was 89.5 sentimeter (SA 16.7), wat aanduidend is van ‘n verhoogde risiko vir nie-oordraagbare siektes. Voedselsekerheid het voorgekom in 63.1% van huishoudings. Formele huishoudings het meer voedsekerheid ervaar as informele huishoudings (68% versus 50%; p=0.0004) en minder formele huishouding moeders/ primêre versorgers het ‘n dieetdiversiteitstelling < 4 (52.2% versus 64.7%; p = 0.0157) gehad. Beter sosio-ekonomiese omstandighede van formele huishoudings in vergelyking met informele huishoudings was sigbaar in hul hoër maandelikse inkomste (R3 479 versus R2 316; p = 0.0009) en huishoudelike bates-indeks (2.24 versus –5.31; p <0.0001). Die ouderdom, huwelikstatus, opvoedkundige vlak en werkstatus van moeders/ primêre versorgers in huishoudings wat ‘n kindersorgtoelaag ontvang en die huishoudings daarsonder was soortgelyk. Huishoudingsgrootte was groter (p<0.0001) in kindersorgtoelaag- (mediaan = 5 persone) versus geen-kindersorgtoelaaghuishoudings (mediaan = 4 persone); In kindersorgtoelaaghuishoudings het meer persone ‘n kamer gedeel (2.7 [SA 1.5] versus 2.3 [SA 1.2]; p=0.0037). Die maandelikse inkomste in kindersorgtoelaaghuishoudings was laer as in dié daarsonder (R2 723 [SA R3 297] versus R4 520 [SA R6 464]; p=0.0033). Die huishoudelike voedselonsekerheid-en-toegangskaal-tellings het meer voedselonsekerheid (p = 0.0178) getoon in kindersorgtoelaaghuishoudings as in huishoudings daarsonder (3.55 versus 2.37; p= 0.0178), maar hul dieetdiversiteit was dieselfde. Dwerggroei was meer in kindersorgtoellaagkinders (34.9%) versus geen-kindersorgtoelaagkinders (22.7%). Die gemiddelde middellyfomtrek van kindersorgtoellaagmoeders/ -primêre versorgers was groter (t-toets: p = 0.021) (90.0 cm; SA = 16.8) as die van moeders/ primêre versorgers wat nie ‘n kindersorgtoelaag (88.5 cm; SA = 16.5) ontvang het nie. Samevatting: Wanvoeding in kinders, tesame met oorgewig en obesiteit in moeders/ primêre versorgers is waargeneem Die dieetdiversiteit van die moeders/ primêre versorgers was laag. Die ontleding van die rol van behuising en sosiale sekerheid het getoon dat die sosio-ekonomiese omstandighede van kinders woonagtig in informele behuising, asook die waarvoor moeders/ primêre versorgers ‘n kindersorgtoelaag ontvang het, is blootgestel aan meer inkomste-armoede en voedselonsekerheid in hul huishoudings. Die verbetering van lae dieetdiversiteit moet ‘n prioriteit wees in intervensieprogramme om voedselsekerheid aan te spreek, met inagneming dat die bereiking daarvan moeilker mag wees om in informele en kindersorgtoelaag-huishoudings.

Text in English with abstracts in English, isiXhosa and isiZulu / Mother’s nutrition knowledge, one of the guiding factors in developing children’s healthy eating patterns, has received relatively little research attention. This study determines the influence of demographic factors on mothers’ nutritional knowledge in Mthatha in the Eastern Cape Province of South Africa. Quantitative, exploratory descriptive survey used group administrative questionnaire. Closed and open ended questions solicited data in 350 purposely and conveniently selected respondents. SSPS 26.0 Version analysed the data and Factor Analysis summarized for easy interpretation. Although SA FBDG are based on the current consumption of locally available foods, respondents were largely unaware of this tool. Mothers receive informal education on Dietary Guidelines from health centres, but no one knows the extent to which they understand and apply the information. There is general lack of correlation between nutrition knowledge and its application. Mothers require nutrition education and practical application of FBDG to improve their and children’s nutrition security. / Luncinane kwaye alukho nzulu uphando olukhe lwenziwa ngolwazi lomzalikazi ngendlela yokondla. Olu lwazi yenye yeenqobo zokukhokela isiqhelo sokutya ngokunempilo. Esi sifundo senziwe eMthatha, kwiMpuma Koloni yoMzantsi Afrika kwaye siqwalasela ifuthe leempawu zesimo soluntu kulwazi lomzalikazi ngendlela yokondla. Uphando lwenziwe ngokuqwalasela ulwazi olufunyenwe kubantu abaninzi ngokunika amaqela abantu uludwe lwemibuzo. Imibuzo enempendulo ethe gca (evalekileyo) okanye enempendulo exhomekeke kwizimvo zomntu (evulekileyo) yabuzwa kubantu abangama-350 ababekhethwe ngobuchule. Iinkcukacha zolwazi zahlalutywa ngokusebenzisa ubuchwepheshe beSSPS 26.0 lwaze uhlalutyo olwaziwa ngokuba yiFactor Analysis lwashwankathela ukuze ulwazi olufunyenweyo lutolikeke lula. Nangona isikhokelo sendlela yokutya esaziwa ngokuba yiSouth Africa food-based dietary guidelines (SA FBDG) sisekelwe kukutya okufumanekayo endaweni, abathathi nxaxheba abaninzi kolu phando babengazi nto ngesi sikhokelo. Abazalikazi bafumana imfundo engekho sesikweni ngesikhokelo sendlela yokutya kumaziko empilo, kodwa akukho mntu waziyo ukuba bayiqonda kangakanani, beyilandela kangakanani loo nto bayifundiswayo. Kukho ukungahambelani okuxhaphakileyo eluntwini phakathi kolwazi ngendlela yokutya nokulusebenzisa olo lwazi. Abazalikazi badinga ukufundiswa ngendlela yokutya nokusebenzisa isikhokelo iFBDG ukuze baphucule indlela yokutya bona nabantwana babo ngokukhuselekileyo. / Lusathole ukunakwa okuncane kakhulu kwezocwaningo ulwazi lukamama mayelana nokudla okunomsoco, okungenye yezinto eziqondisayo ekuthuthukiseni izindlela zokudla okunempilo ezinganeni. Lolu cwaningo luzocubungula futhi luhlonze umthelela wezimo zenhlalo ezigabeni zabantu abahlukahlukene olwazini lomama mayelana nokudla okunomsoco eMthatha esifundazweni saseMpumalanga Koloni eNingizimu Afrika. Ucwaningokuhlola (isaveyi) olukhwantithethivu (olugxile emananini kanye nobuningi) oluhlolisisayo futhi oluchazayo, lwasebenzisa iphephamibuzo eligcwaliswa ngababambiqhaza abayiqembu. Imibuzo evalekile kanye nemibuzo evulekile yasetshenziswa ukuthola idatha kubabambiqhaza bocwaningo abangama-350 ababekhethwe ngabomu ukufezekisa izinhloso zocwaningo. I-SSPS 26.0 Version yahlaziya idatha kanti futhi i-Factor Analysis yafingqa idatha ukuze ihumusheke kalula. Nakuba imihlahlandlela yokudla okunomsoco yaseNingizimu Afrika (SA FBDG) isuselwe ekudliweni kokudla okutholakala kuleli lizwe njengamanje, ababambiqhaza babengenalo ulwazi lokuthi kukhona imihlahlandlela enjengalena. Omama bayafundiswa, ngendlela engahlelekile, ezizindeni zezempilo mayelana neMihlahlandlela Yokudla Okunempilo, kodwake akekho owaziyo ukuthi baluqonda kangakanani ulwazi abaluthola lapho, futhi balusebenzisa kangakanani. Kuvamise ukuthi kungabi khona ukuhambisana nokuxhumana phakathi kolwazi oluphathelene nokudla okunomsoco kanye nokusetshenziswa kwalo. Omama bayakudinga ukufundiswa mayelana nokudla okunomsoco futhi kuqinisekiswe ukuthi imihlahlandlela yama-FBDG isetshenziswa ngendlela ephathekayo futhi ebonakalayo ukuze bakwazi ukwenza ngcono ukutholakala kokudla okunomsoco, kubona omama ngokwabo kanye nezingane zabo. / Life and Consumer Sciences / M.C.S.

This study evaluates the school feeding programme at Magog Primary School. It sets out as its objective to find out how the programme operates and its potential impact on school children, including challenges, if any, and recommends solutions to mitigate the challenges. It was motivated by the need to provide information which could be used as a basis to ensure that the nutritional and educational objectives of the National School Nutritional Programme are achieved. A review of literature demonstrated that, within the developmental framework, the point of view of civil society, government and the academia on the school feeding programmes are a valuable strategy to intervene in the nutritional and cognitive development of learners. It also made it evident that there are diverse views as to whether the School Feeding Programme is achieving its intended objectives. The findings of this study suggest that, although the programme has the potential to improve nutrition and health, enrolment, attendance and cognitive development, there are still some challenges and areas that need to be addressed and improved. These challenges arise as a result of lack of effective monitoring and evaluation, geographical location of the schools and other implementation flaws. The consequences are that the objectives of the National School Nutritional Programme are placed at risk. / Development Studies / M.A. (Development Studies)

Dissertation submitted in fulfillment of the requirements for the Degree of Magister Technologiae: Consumer Science Food and Nutrition, Durban University of Technology, 2011. / Nutrition plays a fundamental role in the care and support of people living with the Human Immunodeficiency Virus (HIV) and children in particular are affected by HIV and the Acquired Immunodeficiency Syndrome (AIDS) epidemic in Africa in various ways. The epidemic puts children at risk physically, psychologically and economically. Children are indirectly affected by HIV and AIDS when the epidemic has a negative impact on their communities and the services these communities provide. Undernutrition is a major problem in HIV-positive children in South Africa with severe malnutrition as a common finding in HIV-positive children. HIV contributes to an increased incidence and severity of undernutrition and micronutrient deficiency. Low serum levels of vitamins A, E, B6, B12 and C, betacarotene, selenium, zinc, copper and iron deficiencies are frequently documented during all stages of HIV-infection. Malnutrition in turn further weakens the immune system which increases the susceptibility to infections and the duration and the severity of infections. Thus, the immune response is less effective and less vigorous when an individual is undernourished. Although guidelines exist for the treatment and management of HIV-infected children, it is clear from the literature that exceptional measures are needed to ensure the health and well-being of the children are met. Furthermore, residential care should not only be considered as a last resort for children’s care, but also as an intervention that requires more than merely addressing children’s basic physical needs. Nutrition education has been utilised globally and in South Africa to address nutrition related problems. The main purpose of nutrition education is to provide individuals with adequate and accurate information, skills and motivation to buy, produce and consume the correct foods to stay healthy and lead an active life. Aim The purpose of this study was to develop reliable and valid nutrition education material for the child care workers (CCWs) of Immune Compromised children vi resident in Children’s Homes in the Durban area in order to maintain the child’s immune system and to optimise their quality of life. Methodology The FAO framework used for planning, implementing and evaluating a nutrition education programme was followed to develop the nutrition education material in this study. Phase I included a situational analysis of the children homes involved. The residential care settings that participated in this study included three Children’s Homes in Durban. The total purposive sample included: boys (5–19 years) n = 112, girls (5–19 years) n = 38 and CCWs n = 40. The sample of HIV-positive children included boys (5–19 years) n = 3 and girls (5– 19 years) n = 6. The physical measurements obtained for this study to determine nutritional status were weight and height. The anthropometric measurements were captured and analysed by the researcher using the World Health Organisation’s AnthroPlus version 1.0.2. Statistical software. The following indices were included: height-for-age (stunting), weight-for-age (underweight) and BMI-for-age (overweight and wasting). The WHO growth standards for school-aged children and adolescents were used to compare the anthropometric indicators. Dietary intake measurements were done by analysing the cycle menus by means of the Food Finder® Version 3 computer software program and comparing the results with the Dietary Reference Intakes (DRIs), specifically the EAR and AI where the EAR were not available. The data were analysed to determine the adequacy of energy and nutrient intake. Average portion sizes were established by the plate waste studies method as well as observation of practices, interviews with the central buyer and focus group discussions with the CCWs. Nutrition knowledge of the CCWs was determined by a self-administered questionnaire developed and tested for reliability and validity. The problems identified in Phase I through the implementation of the questionnaires and other methods directed the design of messages in Phase II. Once suitable media was selected, nutrition education material was developed based on existing guidelines pertaining to HIV and AIDS. The material developed was then tested for reliability and validity before it was produced. vii Results The anthropometric measurements indicated that the majority of the HIV-negative boys and girls were of normal height-for-age and weight-for-age. The results also showed that possible risk of overweight and overweight were more prevalent in girls whereas underweight was more prevalent in boys. Furthermore, the results indicated that a third (33.0%) of the HIV-positive children were stunted and 16.7% was severely stunted. Findings of the menu analysis indicated that both girls and boys consumed three times more carbohydrates than the recommended intake. The DRIs for girls and boys were met for energy and protein in all the age groups except boys aged 14-18 years did not meet the DRI for energy. However, the comparison of the actual intake of the macro nutrients with the WHO guidelines indicated that the protein (10.78%) and carbohydrate (58.07%) is within the recommendations of 10- 15% and 55–75% respectively. This comparison also showed that the total fat intake of 31.15% was above the recommended intake of 15-30%. None of the age groups met the DRIs for fibre. The comparison of the intake with the WHO guidelines also indicated that the total dietary fibre intake was only 19.67g/day and not 27–40g/day. The actual fruit and vegetable intake was a mere 68.64g/day instead of 400g/day as recommended. None of the groups met the DRIs for calcium and iodine. The results clearly showed that micro nutrient inadequacies were more prevalent in the dietary intake of age groups 9-13 and 14-18 years in both girls and boys. Inadequate intake of magnesium, vitamin A, vitamin C, riboflavin, niacin, vitamin B6, pantothenate, biotin, vitamin E and vitamin K were evident in the age group 14-18 year. Overall, it is evident from the results on nutrition knowledge that although the respondents’ knowledge was fair on general nutrition guidelines, the results of the nutrition knowledge questionnaire indicated that knowledge on the importance of a variety in the diet is lacking. The CCWs displayed a very poor knowledge of the recommended number of fruit and vegetable portions per day as well as correct serving sizes of vegetable portions. A very poor knowledge also existed regarding the role of healthy eating in maintaining and supporting the immune system and a limited knowledge on correct hygiene practices was noted. The fridge magnets developed included five messages relating to nutrition and four messages relating to food safety and hygiene. viii Conclusion This study established that malnutrition is apparent in the children’s homes and that there were many gaps in the nutrition knowledge of the CCWs. These gaps included the role of good nutrition in the support and maintenance of the immune system and the importance of adequate intake of fruit and vegetables daily. The NEM developed in this study will address these gaps.

This study evaluates the school feeding programme at Magog Primary School. It sets out as its objective to find out how the programme operates and its potential impact on school children, including challenges, if any, and recommends solutions to mitigate the challenges. It was motivated by the need to provide information which could be used as a basis to ensure that the nutritional and educational objectives of the National School Nutritional Programme are achieved. A review of literature demonstrated that, within the developmental framework, the point of view of civil society, government and the academia on the school feeding programmes are a valuable strategy to intervene in the nutritional and cognitive development of learners. It also made it evident that there are diverse views as to whether the School Feeding Programme is achieving its intended objectives. The findings of this study suggest that, although the programme has the potential to improve nutrition and health, enrolment, attendance and cognitive development, there are still some challenges and areas that need to be addressed and improved. These challenges arise as a result of lack of effective monitoring and evaluation, geographical location of the schools and other implementation flaws. The consequences are that the objectives of the National School Nutritional Programme are placed at risk. / Development Studies / M. A. (Development Studies)

The purpose of this study was to explore the extent to which a School Nutrition Programme can catalyse community-based environmental learning and promote food security in the school and the community. This is an interpretive case study of a junior secondary school in the rural Eastern Cape province of South Africa. The school is located in an area characterised by high levels of poverty and under-nutrition. The school’s food garden, a central focus of this study, contributes to the School Nutrition Programme, which falls under the National School Nutrition Programme (NSNP). The aim of the NSNP is to alleviate poverty in public schools. This case study was conducted by means of questionnaires, semi-structured interviews, and document analysis and field observations. The data set was analysed, firstly, to ascertain if the School Nutrition Programme functions as a community of practise (Wenger, 1998). Thereafter, the data set was analysed to identify the knowledge related to food security and environmental sustainability that is learned and shared in the School Nutrition Programme, and also how such learning took place. The study found that the School’s Nutrition Programme was indeed operating as a community of practice and that it created a platform for sharing explicit and tacit knowledge and skills related to food security and environmental sustainability. The case study also revealed the contextual and experience-based nature of knowledge related to food cultivation.

MCur / Department of Advanced Nursing Science / Background: Globally, malnutrition among children is one of the most challenging and critical public health problem, and it remains one of the most common causes of morbidity and mortality among children under the age of 5 years. There is no exception for the Vhembe District. Purpose: The study determined the perceptions of young mothers regarding causes of malnutrition in children under the age of 5 years in the Vhembe District, of the Limpopo Province. Methodology: This study used qualitative, exploratory, descriptive and contextual design to collect data among young mothers regarding causes of malnutrition in children under 5 years. Twelve young mothers were sampled using probability, simple random sampling at selected hospitals population. In-depth individual interviews were used to collect data and analysed using Tesch’s steps. Measures to ensure trustworthiness and ethical consideration were adhered to throughout the study. Results: Three themes emerged from the analysed data, namely: Young mothers’ perceived causes of malnutrition, young mother’s beliefs about malnutrition, and health care seeking actions for a malnourished child. Recommendations: This study recommend a strategies to integrate young mothers into the health promotion regarding their understanding and experiences about malnutrition. Policies on child nutrition should be reviewed regularly in the Vhembe District for prevention and management of malnutrition in children under 5. / NRF