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Sub-Saharan Africa is more affected by the HIV epidemic than any other region of the world. At the same time, malnutrition remains a major public health concern. HIV and malnutrition are interlinked, both epidemiologically and physiologically, contributing to high mortality and poor growth and development of children in sub-Saharan Africa. This thesis aims to explore the impact of HIV on the treatment and care of children with severe acute malnutrition in Malawi. The thesis will investigate mortality and nutritional recovery in HIV-infected and uninfected children with SAM; HIV infection and nutritional status in carers of children with SAM; and caregiver perspectives on quality of care for children with SAM. The study is based on a prospective cohort study of 454 children with SAM and meta-analysis of 17 relevant studies; a cross sectional study of 322 carer-child pairs; and a qualitative study using a grounded theory approach.

This thesis describes and discusses a study conducted in a centralwest Bangladesh village, between March 1981 and January 1982, with a view to testing the hypothesis that intra-household allocation of food discriminates against women and children and that the discrimination puts the vulnerable members of the household at extra risks during periods when food and financial resources of households are scarcest. Intra-household allocation of food was studied by weighing the individual food intakes of household members for three consecutive days, at four different seasons covering periods of normal food availability, relative shortage and abundance of food. Nutritional status was assessed py consecutive measurement of weight (monthly) and height (quarterly). Information was collected on socio-economic status of households, people's perception of food needs (physiological) of individuals, household decision making and strategies in coping with shortage by structured and unstructured interviews and through personal observations. The sample consisted of 320 individuals in 53 households. Analysis of the study revealed lack of marked and consistent socioeconomic differentials in intake and outcome, but that highly significant seasonal differences did exist. The most important finding of the study is that although the intake of women and girls over 5 years was lower than that of men and boys over 5 years, the male-female differential did not generally exceed the differential between the two sexes that might be expected on the basis of body size and activity. Only in the 1-4 year age group was there a significant difference between energy intakes of males and females when corrected for body size. Furthermore, contrary to what has been generally postulated in the literature, (often based on qualitative information), women and children were not discriminated against during periods of food shortage, but were rather generally given preferential treatment in the allocation of available food. It is believed that the study adds to our understanding as to how seasonal fluctuations affect the food intake of 'poor' people in rural Bangladesh and how people cope with predictable cyclical periods of food shortage.

Thesis (D. Tech. (Food Service Management, Dept. of Hospitality and Tourism)--Vaal University of Technology / The main objective of this study was to determine the level of malnutrition in a primary school(children aged six to 13 years old) in an informal settlement and to plan and implement a school-feeding intervention programme. Before and after the intervention blood was drawn from 160 children. Quantitave Food Frequency Questionnaires and 24-hour recall questionnaires were completed in interviews with the parents. Anthropometric measurements included weight-for-age, BMI-for-age and height-for age. The baseline results (QFFQ and 24-hour recall) indicated that zinc (64%), iron (83%) and energy intake levels (59%) were lower than the recommended range for children in this age group when compared to the DRIs (Dietary Reference Intakes). Food most commonly purchased and consumed were maize meal, tea, sugar and oil as indicated by the top 20 foods purchased list With regard to anthropometric indices, 10% were severely underweight (weight-for-age below ≤5th percentile from the reference NCHS median), 15% were severely wasted (BMI-for-age ≤5th percentile) and 15.3% severely stunted (height-for-age ≤5th percentile). A maize meal wholewheat vetkoek was developed that provided 25% of the daily needs of the children for zinc and iron, making use of ingredients from the top 20 list The vetkoek was biochemically tested and optimised to ensure optimal nutritional content The vetkoek was also sensory analysed by a sample of school children (n=30) for acceptability. The vetkoek was administered for seven months, daily except for school holidays and weekends, to 60 randomly selected children forming the experimental group, with 60 other children receiving a fruit as the control group and 40 children receiving the Primary School Nutrition Programme. The post-intervention results indicated that the children in all three groups ignificantly improved in weight and height and their zinc and iron intake also increased significantly. The post-intervention dietary intake results showed that the product contributed significantly to the quality of the diet. The vetkoek group consumed 358% of iron and 176% of zinc when compared to the DRis, with the PSNP group consuming 167% of iron and 99% zinc and the fruit group 200% of iron and 120% of zinc. Although few statistically significant changes occurred biochemically, clinical changes occurred in all three groups. This study proved that any food provision can have a beneficial impact on the growth of a malnourished child. / Vaal University of Technology and National Research Foundation

This study assessed aspects of targeting of the PEM scheme in Gauteng province. This food supplementation scheme targets beneficiaries including children 0-6 years, using largely anthropometric criteria. Routine provincial intervention data was analysed and related to available data cm expenditure, population and indices of socio-economic need. Only 28% were children in the critical 7-36 month age group; and coverage was very low, with no correlation between indices of need and programme implementation by area. An exit interview to a sample of caretakers of 0-6 year old children in four clinics (two Local Authority, two provincial) examined the process of identification of beneficiaries. Low attendance by children over 1 year and 40% errors in growth monitoring, more frequent among sick children, effectively reduced screening coverage among the most at-risk. Health worker misclassification resulted in an 81% exclusion error among those meeting entry criteria, while 4% of the total were wrongly enrolled. Advice and nutrition promotion to caregivers was inadequate. Recommendations include service re-organisation, community-based initiatives and better monitoring.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Magister Artium (Social Work) - MA(SW) / Complex factors contribute to child malnutrition. These include various factors for example stress, trauma, cognitive abilities and education, poverty, environmental and cultural practices. Caregivers’ situations and perceptions regarding these factors are of utmost importance in child malnutrition. Lesotho has a high incidence of malnourished children irrespective of various interventions to address the problem. The research question that the researcher wanted to answer is: What are caregivers’ perceptions on factors contributing to their children’s malnutrition? This was the question as caregivers’ environments and perceptions influence child malnutrition and they are the ones that accompany the children to the hospital where this research was done. The research goal was to get an understanding of caregivers’ perceptions on factors contributing to malnutrition. In order to reach the goal. the objectives were: To explore the factors contributing to malnutrition; to describe the factors contributing to malnutrition and to give recommendations to social workers and the multi-disciplinary team in order to address the factors contributing to malnutrition as preventative measures.