Thesis (Mnutr)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: INTRODUCTION: Malnutrition is a silent emergency. WHO estimates that 55% of all child deaths in developing countries are associated with malnutrition. Inadequate dietary intake and disease are the two immediate causes of malnutrition. The underlying causes are household food insecurity, inadequate maternal and child-care and poor water/ sanitation and inadequate health services. Stunting is a major problem in pre-school children in South Africa. This indicates a long term inadequate dietary intake. Furthermore, the initiation of breastfeeding in South Africa is about 90%, and the duration thereof tends to be less than 3 months after birth. A great majority of children in this country consume a diet deficient in energy and of poor nutrient density to meet their micronutrient requirements. The aim of this study was to identify feeding practices of infants that could contribute to the development of malnutrition. METHOD: This was a cohort study with a prospective experimental design. Forty-four of the original 73 mother-infant pairs that were recruited, were interviewed monthly on feeding practices of the infants. Anthropometric measurements (weight and height of the infants) were measured monthly. RESULTS: Weight-for-age Z-scores dropped significantly with age from around 4 months, when weaning had started. Inadequate dietary intake, more specifically weaning practices and breastfeeding practices, were identified as the immediate cause that could contribute to the development of malnutrition in this community. Except for the positive relationship between the level of education of the father and an increase in HAZ over time, growth was not affected by socio-economic and demographic factors in this community. This is probably because of the fact that there were very small differences in socio-economic and demographic factors. CONCLUSION: Weaning and breastfeeding practices should be addressed in all nutrition education programmes. / AFRIKAANSE OPSOMMING: INLEIDING: Wanvoeding is 'n stil gevaar. Die WGO skat dat daar 'n verband is tussen wanvoeding en ongeveer 55% van alle kindersterftes in ontwikkelende lande. 'n Onvoldoende dieetinname en siekte is die twee onmiddellike oorsake van wanvoeding. Onvoldoende huishoudelike voedselsekuriteit, onvoldoende moeder- en kindsorg en swak sanitasie en watervoorsiening asook onvoldoende gesondheidsorg is die onderliggende oorsake. Dwerggroei is 'n groot probleem in Suid-Afrika onder voorskoolse kinders. Dit dui op 'n langdurige onvoldoende dieetinname. Bydraend hiertoe, is die aanvang van borsvoeding in Suid-Afrika ongeveer 90%, maar die duurte van borsvoeding is minder as 3 maande na geboorte. Die meerderheid van alle kinders in Suid-Afrika se dieet het 'n tekort aan energie en die nutriëntdigtheid van hulle diëte voldoen nie aan hulle daaglikse behoeftes ten opsigte van mikronutriënte nie. Die doel van hierdie studie was om voedingspraktyke te identifiseer wat kan bydra tot die ontwikkeling van wanvoeding. METODE: Dit was 'n kohortstudie met 'n prospektiewe eksperimentele ontwerp. Vier-en-veertig van die oorspronklike aanvanklike moeder-babapare wat gewerf is, is maandeliks ondervra met betrekking tot die voedingspraktyke van die baba en antropometriese metimgs (gewig en lengte van die baba) is maandeliks geneem. RESULTATE: Z waardes van gewig vir ouderdom het beduidend gedaal namate die kinders ouer geword het, veral vanaf 4 maande, toe spening begin het. 'n Onvoldoende dieetinname, meer spesifiek spenings- en borsvoedingspraktyke, is geïdentifiseer as die onmiddellike oorsake wat tot die ontwikkeleing van wanvoeding kan bydra in hierdie gemeenskap. Daar was 'n positiewe verband tussen lengtegroei (Z waardes van lengte vir ouderdom) en die vlak van opvoeding van die vader. Groei is nie deur die ander sosio-ekonomiese en demografiese faktore beïnvloed nie, moontlik as gevolg van die klein verskille in sosio-ekonomiese en demografiese eienskappe van die studie populasie. GEVOLGTREKKING: Spenings- en borsvoedingpraktyke behoort aandag te geniet in alle voedingsvoorligtings-programme.

Thesis (MVoeding)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Objectives and scope of investigation Following the 1996 recommendations of a FAO/WHO expert panel for the development of food-based dietary guidelines (FBDGs) unique and specific to the needs of the populations of different countries, a South African FBDG Working Group was formed and ultimately also a Paediatric FBDG (PFBDG) Working Group with the task of the latter being the development of FBDGs for children younger than 7 years. A set of preliminary PFBDGs, chosen to address the most pressing paediatric public health issues, namely protein-energy malnutrition, micronutrient deficiencies and infectious diseases, were formulated for each age group sub-category (0-6 months, 6-12 months and 1-7 years). The following set of preliminary PFBDGs for the age group 6-12 months were approved by the Working Group to be subjected to consumer testing: • Enjoy time with your baby • From six months start giving your baby small amounts of solid foods • Gradually increase your baby’s meals to five times a day • Keep breast feeding your baby • Offer your baby clean, safe water regularly • Teach your baby to drink from a cup • Take your baby to the clinic every month Assessment of the consumer’s comprehension, interpretation of the proposed guidelines, and ability to apply them, was considered essential before the PFBDGs could be finalised, disseminated to the consumer, and implemented as an educational tool for health professionals and community workers. This study was also the first in which PFBDGs were tested, and was intended to be a pilot study for further testing of PFBDGs for this age category in other parts of the country, adapted for different circumstances. The investigation was conducted among women who were mothers or caregivers to infants 6-12 months of age in the Afrikaans-, English- and Xhosa-speaking communities of the greater Oudtshoorn area, including Bongulethu, Bridgeton and Toekomsrus and its adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar. Methodology The study was designed to be an observational, descriptive and cross-sectional study. Qualitative data was collected from a sample of 64 volunteers who took part in ten focus group discussions each attended by between 3 and 11 participants. Group discussions were recorded on videotape and quantitative and qualitative questionnaires measured pre-discussion knowledge and comprehension of guidelines, perceived hindrances to compliance with guidelines and perceived importance of guidelines as well as socio-demographic data. Results and conclusions With this study, useful and enlightening information was obtained which met the research objectives. Participants discussed the guidelines in depth and information obtained from the questionnaires were found to support what was said during the discussions. Body language or non-verbal communication as observed, and recorded on videotape, also complemented the information gained from the discussions. Summarily it can be said that the guidelines were well-received and perceived as important by the majority of respondents, although some of the guidelines were initially not well-understood without explanation. Furthermore, the fact that the applicability of the guideline on prolonged breast feeding seems to be the most problematic, is a cause for concern. In view of the results obtained in this study, it can be concluded that PFBDGs will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The findings of this study will be submitted to the PFBDG Working group for consideration before finalisation of the guidelines for the age group 6-12 months. / AFRIKAANSE OPSOMMING: Doelwitte en omvang van die studie Na aanleiding van die 1996 aanbevelings van ‘n VLO/WGO paneel van kenners vir die ontwikkeling van voedselgebaseerde dieetriglyne (VGDR) wat uniek en spesifiek gerig is tot die behoeftes van die bevolkings van verskillende lande, is ‘n Suid-Afrikaanse VGDR Werkgroep gevorm en uiteindelik ook ‘n Pediatriese VGDR (PVGDR) Werkgroep met die opdrag van laasgenoemde om VGDRe te ontwikkel vir kinders jonger as 7 jaar. ‘n Stel voorlopige Pediatriese VGDRe, gekies om die mees dringende pediatriese publieke gesondheidsvraagstukke, naamlik proteïn-energie wanvoeding, mikronutriënttekorte en infektiewe siektetoestande aan te spreek, is geformuleer vir elke ouderdomsgroep subkategorie (0-6 maande, 6-12 maande en 1-7 jaar). Die volgende stel voorlopige PVGDRe vir die ouderdomsgroep 6-12 maande is deur die Werkgroep goedgekeur om aan verbruikerstoetsing te onderwerp: • Geniet tyd saam met jou baba • Begin vanaf ses maande om jou baba klein hoeveelhede vaste kos te gee • Vermeerder jou baba se maaltye geleidelik na vyf keer per dag • Hou aan om jou baba te borsvoed • Bied gereeld vir jou baba skoon, veilige drinkwater aan • Leer jou baba om uit ‘n koppie te drink • Neem jou baba elke maand kliniek toe Evaluering van die verbruiker se begrip, interpretasie van die riglyne en die vermoë om die riglyne te implementeer, is as noodsaaklik beskou voordat die PVGDRe gefinaliseer kon word, vrygestel kon word aan die publiek, en aan professionele- en gemeenskapsgesondheidswerkers beskikbaar gestel kon word as ‘n onderrighulpmiddel. Hierdie studie was die eerste waarin PVGDRe getoets is en dit is bedoel as ‘n voorloperstudie vir verdere toetsing van PVGDRe vir hierdie ouderdomskategorie in ander dele van die land en aangepas vir ander omstandighede. Die ondersoek is gedoen onder vroue wat moeders of versorgers van babas van 6-12 maande was in die Afrikaans- Engels- en Xhosasprekende gemeenskappe van die groter Oudtshoorn area wat Bongulethu, Bridgton en Toekomsrus insluit asook die nabygeleë plattelandse gemeenskappe van Dysselsdorp, Calitzdorp, Uniondale, Ladismith en Zoar. Metodiek Die studie is ontwerp om ‘n waarnemende en beskrywende analise van ‘n deursnee van die studiepopulasie moontlik te maak. Kwalitatiewe data is verkry van ‘n proefmonster van 64 vrywilligers wat deelgeneem het aan tien fokusgroep besprekings wat elk deur 3 tot 11 persone bygewoon is. Groepbesprekings is op videoband opgeneem en kwantitatiewe en kwalitatiewe vraelyste het voorbesprekings kennis en begrip van die voorgestelde riglyne, vermeende verhindering tot uitvoering van die riglyne en vermeende belangrikheid van riglyne sowel as sosio-demografiese inligting gemeet. Resultate en gevolgtrekkings Met hierdie studie is bruikbare en verhelderende inligting verkry wat beantwoord het aan die doelwitte van die studie. Deelnemers het die riglyne in diepte bespreek en dit is bevind dat inligting wat van die vraelyste verkry is, ook dit bevestig het wat gedurende die sessies bespreek is. Lyftaal en nie-verbale kommunikasie soos waargeneem en soos op videoband vasgelê, het ook die inligting ondersteun wat van die besprekingsessies verkry is. Opsommend kan gesê word dat die riglyne goed ontvang is en as belangrik beskou is deur die meerderheid van respondente. Sommige van die riglyne was nie vir deelnemers goed verstaanbaar sonder meegaande verduideliking nie. Verder is die feit dat die toepasbaarheid van die riglyn met betrekking tot ‘n verlengde tydperk van borsvoeding voorgekom het as die mees problematiese, ‘n rede tot kommer In die lig van die resultate van hierdie studie, kan daar tot die slotsom gekom word dat PVGDRE ondersteun sal moet word deur omvattende en gepaste onderrigmateriaal om effektief te kan wees wanneer dit aan die publiek bekend bekend gestel word. Die bevindings van hierdie studie sal aan die Pediatriese VGDR Werkgroep voorgelê word vir oorweging voordat riglyne vir die ouderdomsgroep 6-12 maande gefinaliseer word.

Text in English with abstracts in English, Venda and Sepedi / Background: Suitable complementary feeding practices in young children can ensure optimal nutrition status and reduce under 5 mortality rates (Jones et al., 2014). Inadequate dietary diversity (DD) of the complementary diet both in quality and quantity is one of the major problems affecting infants and young children worldwide (Ntila et al., 2017). Adequate and appropriate nutrition during infancy and early childhood is vital for the growth and development of every child to reach full human potential (PAHO, 2003; WHO, 2008a; UNICEF, 2016). Nutritional vulnerability increases when other factors are also involved, such as poor breast and complementary feeding practices combined with high rates of infectious diseases (Solomons & Vossenaar, 2013; Ntila et al., 2017). There are pockets of information available on complementary feeding practices and its social determinants from specific areas in South Africa, regarding infant and young child feeding practices beyond six months of age and requires further investigation (Issaka et al., 2015; Seonandan & McKerrow, 2016). Aim: To explore the association between mothers’ socio-cultural environment and the dietary diversity of their children between the ages of 6 and 24 months, who attend the health care clinic in Olievenhoutbosch Township, Gauteng. Methodology: A quantitative cross-sectional explorative study was implemented. Data collection was conducted at Olievenhoutbosch clinic in Gauteng during February and March 2019. Mothers of children aged between 6 and 24 months were included and interviewed. Consecutive sampling was applied. The data collection instruments were a set of structured questions to obtain socio-demographic, nutritional knowledge, maternal attitude and feeding practices data. The infant and young child minimum dietary diversity (IYCMDD) questionnaire adapted from the WHO questionnaire was used to determine the DD of each child. Ethical clearance was obtained from the Ethics Committee of the College of Agriculture and Environmental Sciences (CAES) at the University of South Africa. Descriptive and inferential statistics was applied using SPSS version 25 (SPSS Inc, Chicago, IL, USA). Results: The sample of mothers (n=103) were educated (75% completed matric and 18% completed post-school education), unemployed (73%) and mostly single (53%) which are all factors playing a role in child nutrition. The majority (58%) of children were between the ages of 6 and 11 months while 42% were between the ages of 12 and 24 months. The milk feeding practices differed significantly between the younger and older groups of children with 35% of the younger children receiving breastmilk (in addition to complementary foods), compared to 21% of the older group. Almost half (44%) of the total group reported that maize meal porridge was the first food introduced to their children. Less than half of the mothers (45%) initiated the first foods at the recommended age of 6 months but started as early as one month of age (13%). All children (100%) consumed foods from the “grains, roots and tubers” food group the previous day. Significantly less children from the younger age group were reported to have consumed dairy (38% vs 77%, p<0.001) (other than breast or formula milk), animal flesh foods (31% vs 59%, p=0.014) and legumes (8% vs 24%, p=0.034), compared to the older age group. Significantly more children from the older group met the minimum dietary diversity (MDD) of four food groups compared to the younger group (67% vs 38%, p=0.019). No association was found between most socio-cultural factors (maternal age, marital status, education and employment status) and DD. However, there was an association between maternal ethnicity and DD (𝑥2=16.62, p=0.002). Also, maternal nutrition knowledge and the child’s DD had a significant, positive linear relationship (p=0.026). Lastly, maternal attitude towards feeling confident in not overfeeding the child were associated with meeting the MDD. Conclusion: The diets of young children residing in Olievenhoutbosch, do not meet the criteria for a minimally acceptable diet with only 50% meeting the MDD. Legumes and animal source foods are not consumed in sufficient quantities for complementary feeding. Maternal ethnicity and nutritional knowledge were associated with the child’s DD. More emphasis should be placed on DD for young children. / Vhubvo: Maitele o teaho a thikhedzo ya kuṋetshedzele kwa zwiḽiwa kha vhana vhaṱuku a nga khwaṱhisedza vhuimo ha gumofulu ha pfush na u fhungudza phimo ya dzimpfu dza vhana vha fhasi ha miṅwaha ya fhasi ha 5 (Jones na vhaṅwe, 2014). U sa lingana ha u fhambana ha kuḽele (DD) ha nndyo thikhedzi kha ndeme na tshivhalo ndi dziṅwe dza thaidzo khulwane dzi kwamaho dzitshetshe na vhana vhaṱuku u mona na shango (Ntila na vhaṅwe, 2017). Mufusho wo linganaho na wo teaho musi vhe dzitshetshe na kha vhuhana thangeli ndi dza ndeme kha nyaluwo na nyaluso ya ṅwana muṅwe na muṅwe uri a vhe na vhukoni hoṱhe (PAHO, 2003; WHO, 2008a; UNICEF, 2016). U vha khomboni ha mufusho zwi a ṋaṋa musi hu na zwiṅwe zwithu zwi dzhenelelaho, sa maitele a sa fushi a u mamisa na u tikedza zwo ṱangana na phimo ya nṱha ya malwadze a phirela (Solomons & Vossenaar, 2013; Ntila na vhaṅwe., 2017). Haya ndi mafhungo u ya nga zwipiḓa are hone kha maitele a u ḽisa ha thikhedzo na zwivhangi zwa matshilisano u bva kha vhuṅwe vhupo ha Afrika Tshipembe, maelana na u ḽisa dzitshetshe na vhana vho no fhirisaho miṅwedzi ya rathi, naho ṱhoho iyi i tshi ṱoḓa u senguluswa hafhu (Issaka na vhaṅwe, 2015; Seonandan & McKerrow, 2016). Ndivho: U itela u lavhelesa u elana ha vhupo ha zwa matshilisano na ikonomi ha mme na DD ya vhana vhavho vha vhukati ha miṅwedzi ya 6 na 24, vhane vha ya kiḽiniki ya ndondola mutakalo ngei kha Tshikolobulasi tsha Olievenhoutbosch, Gauteng. Ngona: Ngudo dza vhubuḓasia dza ndingedzo dzo shumiswa. Data yo kuvhanganywa ngei kha kiḽiniki ya Olievenhoutbosch kha ḽa Gauteng nga Luhuhi na Ṱhafamuhwe 2019. Vhomme a vhana vha miṅwedzi ya vhukati ha 6 na 24 vho dzheniswa vha vhudziswa. Vhukhethatsumbonanguludzwa ha thevhekano ho shumiswa. Sethe ya mbudziso dzo dzudzanywaho yo shumiswa u wana u phambano dza matshilisano, nḓivho ya mufusho, kusedzele kwa vhomme na data ya phatheni dza kuḽele. Mbudzisombekanywa ya phambano ya gumofulu ya kuḽele kwa dzitshetshe na vhana vhaṱuku (IYCMDD) u bva kha WHO yo shumiswa u vhona DD ya ṅwana muṅwe na muṅwe. Ṱhanziela dza vhuḓifari dzo wanala u bva kha Komiti ya zwa Vhuḓifari ya Khoḽidzhi ya zwa Vhulimi na Saintsi dza zwa Mupo (CAES) kha Yunivesithi ya Afrika Tshipembe. Mbalombalo dza ṱhalutshedzo na dza u sumbedzisa dzo shumiswa nga u shumisa vesheni ya SPSS 25. Mvelelo: Tsumbonanguludzwa dza vhomme (n = 103) vho funzwaho (75% vho fhedza maṱiriki na 18% yo bvelaphanḓa ya fhedza pfunzo ya nṱha ha tshikolo, vha sa shumi ndi (73%) nahone vhanzhi ndi vha tshilaho vhe vhoṱhe (53%), zwi re zwivhumbi zwoṱhe zwine zwa dzhenelela kha mufusho wa ṅwana. Vhunzhi (60%) ya vhana vho vha vhe vhukati ha miṅwedzi ya 6 u ya kha ya 11, 40% vhe vhukati ha ya 12 u ya kha 24. Kumamisele kwo fhambana vhukuma vhukati ha zwigwada zwa vhaswa na zwa vhahulwane, hune 35% ya vhana vhaṱuku vha vha vha khou wana mikando ya vhomme avho (nṱhani ha zwiḽiwa zwa u tikedza), hu tshi vhambedzwa na 21% ya tshigwada tsha vhahulwane. U ṱoḓa u swika kha hafu (44%) ya tshigwada tshoṱhe vho amba uri mukapu wa mugayo ndi zwone zwiḽiwa zwo thomaho u ḓivhadzwa vhana vhavho. Vhomme vha re fhasi ha hafu (45%) vho them zwiḽiwa zwa u thoma kha miṅwedzi yo themendelwaho ya 6 fhedzi vhaṅwe vha thoma u ṱavhanya vhe kha ṅwedzi muthihi (13%). Vhana vhoṱhe (100%) vho vha vho no ḽa ḽiwa zwi fanaho na thoro, midzi na khufhi sa zwigwada zwa zwiḽiwa ḓuvha ḽo fhiraho. Vha si gathi vhukuma kha vhana vha tshigwada tsha vhaṱuku vho pfi vho ḽa zwiḽiwa zwa mafhi (38% i tshi vhambedzwa na 77%, p < 0.001) (zwi si mafhi a mikando kana a boḓelo), zwiḽiwa zwa ṋama ya phukha (31% i tshi vhambedzwa na 59%, p = 0.014) ḽingaṋawa (8% vha tshi vhambedzwa na 24%, p = 0.034), vha tshi vhambedzwa na zwigwada zwa vhahulwane. Vhunzhi ha vhana vha bvaho kha tshigwada tsha vhahulwane vho swikelela phambano ya gumoṱuku ya nndyo (MDD) ya zwigwada zwiṋa zwi tshi vhambedzwa na tshigwada tsha vhaṱuku (67% i tshi vhambedzwa na 38%, p = 0.019). Ahuna u elana ho wanalaho vhukati ha zwivhumbi zwa mvelele na matshilisano (vhukale ha vhomme, vhuimo ha mbingano, pfunzo na vhuimo ha mushumo) na DD. Fhedzi, ho vha na u elana vhukati ha murafho wa vhomme na DD (𝑥2 = 16.62, p = 0.002). Zwiṅwe hafhu, nḓivho ya mufusho ya vhomme na DD ya ṅwana zwo vha na vhushaka, ha ndeme hu elanaho huvhuya (p = 0.026). Tsha u fhedzisela, kusedzele kwa vhomme kha u ḓipfa vhe na vhuḓifulufheli na u sa ḽisa ṅwana u fhira tshikalo zwo elana na u swikelela MDD. Khunyeledzo: Nndyo ya vhana vhaṱuku vha dzulaho ngei Olievenhoutbosch a i swikeleli maga a gumoṱuku a ṱanganedzwaho a nndyo; ho swikelelwa fhedzi 50% ye ya swikelela MDD. Ḽingaṋawa na tshiko tsha zwiḽiwa zwa zwipuka a zwi khou ḽiwa lwo linganaho kha thikhedzo ya kuḽele. Murafho wa vhomme na nḓivho ya mufusho zwo elana na DD ya ṅwana. Ho vha na khwaṱhisedzo hafhu kha DD ya vhana vhaṱuku. / Tšweletšo ya taba: ditiro tša maleba tša phepo ya tlaleletšo mo go bana ba bannyane di ka netefatša maemo a godimo a phepo le go fokotša kelo ya mahu mo go bana ba ka fase ga mengwaga ye 5 (Jones et al., 2014). Go fapafapana ga dijo fao go sa lekanago (DD) ga dijo tša tlaleletšo go bobedi boleng le bontši ke ye nngwe ya mathata a magolo ao a amago masea le bana ba bannyane lefase ka bophara (Ntila et al., 2017). Phepo ye e lekanego gape ya maleba nako ya bosea le bonnyane e bohlokwa go kgolo le tlhabollo ya ngwana yo mongwe le yo mongwe go fihlelela bogolo bjo bo feletšego (PAHO, 2003; WHO, 2008a; UNICEF, 2016). Kgolo ya hlaelela ya dijo ge dintlha tše dingwe le tšona di amega, go swana le ditshepedišo tša go fokola le phepo ya tlaleletšo go hlakanywa le malwetši a mantši a go fetela (Solomons & Vossenaar, 2013; Ntila et al., 2017). Go na le dipotla tša tshedimošo tšeo di lego gona go ditiro tša phepo ya tlaleletšo le dikelo tša leago go tšwa mafelong a go ikgetha mo Afrika Borwa, mabapi le masea le bana ba bannyane ka morago ga dikgwedi tše tshela, mme hlogo ye e nyaka dinyakišišo (Issaka et al., 2015; Seonandan & McKerrow, 2016). Nepo: go nyakišiša dikamano gare ga bomme le tikologo ya leago le setšo le DD ya bana ba gare ga dikgwedi tše 6 le tše 24, bao ba tsenetšego kliniki ya tša maphelo ya Olievenhoutbosch Township, Gauteng. Mekgwatshepetšo: thuto ya diphatišišo tša go hlakanela ga dikgao e phethagaditšwe. Kgoboketšo ya tshedimošo e dirilwe kliniking ya Olievenhoutbosch mo Gauteng nakong ya Febereware le Matšhe 2019. Bommago bana ba dikgwedi tša gare ga tše 6 le 24 di akareditšwe le go botšišwa. Sehlopha sa go latelana se šomišitšwe. Sete ya dipotšišo tšeo di hlamilwego di šomišitšwe go hwetša tsebo ya dimokrafi ya leago, dijo, maikemišetšo a bomme le tshedimošo ka ga mekgwa ya go fepa. Masea le mehuta ya go fapana ya dijo tša bana (IYCMDD) letlakalapotšišo go tšwa go WHO le šomišitšwe go ela DD ya ngwana yo mongwe le yo mongwe. Hlakišo ya maitshwaro e hweditšwe go Komiti ya Maitshwaro ya Kholetšhe ya Temo le Disaense tša Tikologo (CAES) mo Yunibesithing ya Afrika Borwa. Dipalopalo tša tlhaloso le taetšo di šomišitšwe ge go diragatšwa mohuta wa SPSS 25. Dipoelo: Sekgao sa bomme (n = 103) ba be go ba rutegile (75% ba phethile mphato wa marematlou le 18% ba tšwetšepele go phetha dithuto tša ka morago ga mphato wa marematlou), ga ba šome (73%) le bontši ga se ba nyalwe (53%), tšeo ka moka e lego dintlha tša go raloka karolo ye kgolo go phepo ya bana. Bontši (60%) bja bana ba magareng ga mengwaga ye 6 le ye 11, le 40% e be e le magareng a dikgwedi tše 12 le tše 24. Ditiro tša go nyantšha di fapana kudu gare ga bana ba bannyane le dihlopha tša bana ba bagolwane, ka 35% tša bana ba bannyane bao ba amogelago maswi a letswele (go tlaleletša dijo tša tlaleletšo), ge go bapetšwa le 21% tša batho ba bagolwane. Go nyaka go ba seripagare (44%) sa palomoka seo se begilego gore bogobe bja mabele ke dijo tša mathomo tšeo di tšweleditšwego go bana ba bona. Ka fase ga seripagare sa bomma (45%) ba thomile dijo tša bona tša mathomo ka mengwaga ye e digetšwego ya dikgwedi tše 6 efela di thomile ka kgwedi ya mathomo (13%). Bana ka moka (100%) ba jele dijo go tšwa go dithoro, medu le sehlopha sa dijo tša digwere mo letšatšing le le fetilego. Palo ye ntši ya bana ba bannyane go tšwa go mengwaga ye mennyane ba begilwe ba jele dijo tša maswi (38% vs 77%, p < 0.001) (ntle le maswi a letswele goba a go rekwa), dijo tša nama ya phoofolo (31% vs 59%, p = 0.014) le dinawa (8% vs 24%, p = 0.034), ge go bapetšwa le batho ba mengwaga ya bagolo. Bontši bja bana go tšwa go sehlopha sa ba bagolo ba kgotsofaditše dinyakwa tša go fapana tša dijo (MDD) ya dihlopha tše nne ge go bapetšwa le dihlopha tše dinnyane (67% vs 38%, p = 0.019). Ga go dikamano tšeo di humanwego gare ga dintlha tše dintši tša leago le setšo (mengwaga ya tswalo, maemo a lenyalo, thuto le maemo a mošomo DD. Le ge go le bjalo, go bile le dikamano gare setšo le DD (𝑥2 = 16.62, p = 0.002). Le, tsebo ya dijo le DD ya bana, tswalano ya maleba ya tatelano (p = 0.026). Sa mafelelo, mmono wa bomme go ikwa ba na le boitshepo ka go se fepe ngwana go feta tekanyo tšeo di amanago le go kopana le MDD. Thumo: Dijo tša bana ba bannyane ba go dula Olievenhoutbosch ga ba kgotsofatše dinyakwa tša dijo tše di amogelegago; fela 50% e kopane le MDD. Dinawa le dijo tša mothopo ya diphoofolo ga di lewe ka bontši bja go lekana go dira dijo tša tlaleletšo. Mohlobo le tsebo ya dijo di be di amane le DD ya ngwana. Kgatelelo ye kgolo e swanetše go bewa go DD go bana ba bannyane. / Department of Life and Consumer Science / M.A. (Consumer Science)

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)

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

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)

Background: The health benefits and economic gains of exclusive breastfeeding for the mothers and the new-born are well-documented in the literature as discussed in the background and the rationale for this study. The effectiveness of the social cognitive based interventions in promoting breastfeeding among women in general is also documented. However, there is lack of evidence regarding social-cognitive strategies that could be used to promote exclusive breastfeeding practices among primiparous mothers in Ethiopia means that current exclusive breastfeeding promotion interventions or strategies may not produce the expected outcomes. This assumption seems to be supported by low rate of early initiation of breastfeeding in country (52.1% instead of at least 75% as recommended by WHO) and shorter period of breastfeeding (one month) among mothers in Addis Ababa (CSA and ICF 2012) despite various strategies and interventions that have been implemented. Aims: The study was conducted with the aim of determining the social-cognitive predictors of exclusive breastfeeding among primiparous mothers during the first six months post-delivery with the view of developing social-cognitive strategies to promote exclusive breastfeeding practices among primiparous mothers in Addis Ababa, Ethiopia. Research design and method: The study was carried out within the quantitative positivist paradigm. The study was divided into two phases. The researcher used quantitative longitudinal, descriptive, exploratory and correlational designs to determine the social cognitive predictors of exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia within the first six months post-delivery. The results of the first phase assisted the researcher to design social-cognitive strategies to promote exclusive breastfeeding among primiparous mothers using a Delphi survey. A Delphi survey design was used to assist the researcher to develop the social-cognitive strategies to promote exclusive breastfeeding among primiparous mothers. It consisted of three rounds of mailed self-completion questionnaires. The Delphi was supported with critical review and synthesis of literature throughout the strategies’ development process. Descriptive summary statistics were used to analyse the prenatal breastfeeding behaviour of 141 primiparous mothers followed from the last antenatal care visits up to six months after delivery. Bivariate correlational and multiple logistic regression analyses were used to identify the social cognitive determinants and predictors of exclusive breastfeeding within the first hour post-delivery and six months thereafter. Findings: Positive breastfeeding outcome expectancy and high breastfeeding self-efficacy were identified as the independent social cognitive predictors of exclusive breastfeeding among primiparous mothers in Ethiopia. These predictors were used to develop social cognitive strategies to promote exclusive breastfeeding, which comprise six main components: (1) scientific evidence for the strategies, (2) the rationale for the strategies, (3) the aim of the strategies, (4) the scope of the strategies, (5) the guiding principles, and (6) the key results areas. These strategies were developed and validated with the inputs from 37 experts on breastfeeding and social cognitive theory. Two key results areas (build individual capacity for exclusive breastfeeding and create an enabling environment) and five strategic objectives were formulated and validated. Conclusions: The successful implementation of the social cognitive strategies to promote exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia as described above will require among others (1) in-service training on social cognitive skills for healthcare providers with focus on how to build self-efficacy and outcome expectancy, (2) the development of self-efficacy and outcome expectance assessments tools relevant to the Ethiopian context, and (3) additional support and resources from the healthcare managers. Recommendations: To the researcher recommend that programs aimed at promoting exclusive breastfeeding practices among primiparous mothers should be based on the combined attributes of positive social cognitive outcome expectance and high breastfeeding self-efficacy. Further research is needed to develop assessment tools for breastfeeding self-efficacy and outcome expectancy before the implementation of the proposed strategies. / Health Studies / D. Litt. et Phil. (Health Studies)

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler’s estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks’ postmenstrual age (PMA) met Ziegler’s estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks’ PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants ≤ 30 weeks GA at birth in three newborn intensive care units NICUs. Results: During the first week of life, the percentages of prescribed and delivered energy (69% [65 kcal/kg/day]) and protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks’ PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (p<0.03). A difference of 1 g/kg/day represents a total deficit of 42 - 54 grams over the course of a month. At 36 weeks’ PMA, 53% of the VLBW infants had extrauterine growth restriction, or EUGR (<10th percentile) on the Fenton growth grid and 34% had EUGR on the Lubchenco growth grid. Conclusions: The delivered nutrient intakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks’ PMA was 6.7% lower than Ziegler’s estimate. One-third to one-half of the infants have EUGR at 36 weeks’ PMA.

Text in English / This study aimed at exploring Barriers to compliance with exclusive breastfeeding and timely introduction of complementary feeding practices in Ofla District, Tigray Region in Ethiopia. A quantitative exploratory descriptive study was conducted to explore and describe the barriers that restrict mothers /caregivers to comply with exclusive breast feeding practice until six months and with introduction of solid, semi-solid and soft foods at six months in Ofla District. Data were collected using structured questionnaire, from a total of 112 samples of which 75 mothers and care givers with children aged 0-5 months and 38 children aged 6-8 months participated. The data were entered into a computer and analysed though the Statistical Package for Social Sciences (SPSS) software. The findings revealed that there are barriers related Doer mothers and Non-Doer mothers perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues for actions, perceived social acceptability and positive and negative attitudes towards exclusive breastfeeding and initiation of complementary feeding. On the other hand, the participant’s perception of both groups with regard to perception of Divine (God’s) Will on two child feeding practices was insignificantly the same. Both groups perceived that children could get sometimes malnourished because of spiritual or supernatural causes. / Health Studies / M.A. (Public Health)