Thesis (M. Sc. (Physiology)) -- University of Limpopo, 2019 / Aim: The purpose of this study was to assess the prevalence and risk factors associated with malnutrition and nutritional status of rural and urban primary school children aged 6–9 years. Literature background: Malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries, affecting 10.9% of people globally, particularly in Southern Asian (15.7%) and sub-Saharan African (23.2%) countries undergoing urbanisation. Urbanisation affects diet, physical activity levels, body fatness, body composition and socio-economic factors. There is currently a shortage of information on the effect of urbanisation on nutritional status, especially in poor areas such as the Limpopo Province of South Africa. It is important to understand the effects that body fatness and associated risk factors have on stunting, wasting, underweight, and overweight/obesity in urban and rural children. Subjects and design: This was a cross-sectional study including rural (n=106) and urban (n=68) primary school children aged 6–9 years. Anthropometric (weight and height) and skinfold measurements were taken and a 24-hour recall dietary assessment was conducted twice to include a week day and a weekend day. A questionnaire was used to gather demographic, health, dietary and physical activity information. Results: The prevalence of stunting, wasting, underweight, and overweight/obese children in this population was 14%, 6%, 20%, and 26% respectively. Furthermore, the prevalence stunting, wasting, and underweight were higher in rural areas compared to urban areas. Meanwhile, the prevalence of overweight/obesity was higher in urban areas as compared to rural areas. Gender, area (urban/rural) (p=0.0001), birthweight, time spent on sedentary activities, monthly household income (p=0.0210), mode of transport to school, and breastfeeding (p=0.0560) were all found to be significantly associated with malnutrition. Weekday dietary intake of Vitamins A and D was significally associated with BF%, whereas weekend consumption of energy, protein, calcium, iron, phosphorus, and zinc were not significantly associated with BF%. The mean energy and calcium intake between the urban and rural vi population only differed significantly over weekends and not during the week, while vitamin D differed significantly between urban and rural populations during the week only. Conclusions: The current study demonstrates that children in rural areas were significantly more wasted than those residing in urban areas, while those residing in urban areas were significantly more overweight/obese compared to rural areas. All indicators used for undernutrition were associated significantly with gender and the prevalence were higher males compared to females, but this significance disappeared for overnutrition. Families with a higher income tended to have children who were overweight or obese compared to families with a lower income. Children spending a lot of time on sedentary activities were more likely to be overweight or obese, and breastfeeding seemed to protect children from becoming overweight or obese, while low birth weight was associated with stunting. The weekaday and week-end diets indicate that school feeding schemes in the rural areas may be effective in increasing total energy intake in children and this should be further investigated. In this population, stunting, wasting, and underweight were not limited to rural areas, and should still be a health concern in urban areas, despite the fact that overweight/obesity is also prevalent in urban areas. Thus, overweight/obesity in this population can be prevented by promoting breastfeeding and physical activity, while at the same time discouraging children from partaking in too many sedentary activities. / National Research Foundation (NRF)

Thesis (M.Sc. (Physiology)) -- University of Limpopo, 2016 / Cardiovascular diseases (CVDs) are major public health problems nowadays in Africa. From prospective studies, it is also known that risk factors for CVDs start early in life and increase morbidity and mortality in sub-Saharan African adults. Mostly the risk factors of CVDs are malnutrition and hypertension. Economic development in South Africa leads to lifestyle changes that contribute to a high prevalence of high blood pressure (BP) and malnutrition. However, little is known about the relationship of anthropometric indicators and BP in children from the developing countries. Therefore the aim of this study was to determine the association between anthropometrics indicators and BP among rural children in Ellisras area of Limpopo province, South Africa. All 1961 children (n=1029 boys, n=932 girls) aged 5-12 years underwent anthropometric and BP measurements using standard procedure. Receiver operating characteristics (ROC) curve was used to assess the ability of anthropometric indicators to discriminate children with high BP. ROC was used to determine the area under curve (AUC), cut-off value, sensitivity and specificity for underweight in children for each age and gender. Linear regression was used to assess the relationship between anthropometric indicators and BP. ROC curve showed that height (AUC = 0.700, 95%Cl 0.581 to 0.818), SH (AUC= 0.690, 95%Cl 0.573 to 0.786) and SH/H (AUC=0.670, 95% 0.533 to 0.807) can significantly (P<0.05) identify Ellisras children with hypertension. AUC for neck circumference (NC) (0.698), mid upper arm circumference (MUAC) (0.677) and body mass index (BMI) (0.636) for boys were statistically significant (P<0.05) for high systolic blood pressure (SBP), while in girls AUC of BMI was not significant (P>0.05) for high diastolic blood pressure (DBP). The regression analysis showed a positive significant (P<0.05) association of SBP with NC (β=0.764, 95%CI 0.475 to 1.052) and MUAC (β=1.286, 95% Cl 0.990 to 1.581) for unadjusted and adjusted age and gender. NC (β=0.628 95% Cl 0.303 to 0.953) and MUAC (β=1.351 95% CI 1.004 to 1.697) showed a significant association with SBP. However, MUAC had a significant association with DBP for both unadjusted and adjusted age and gender. Sitting height (SH) was significantly associated with SBP (β = 0.134, 95% Cl 0.210 to 0.416) and DBP (β = 0.088, 95% Cl 0.086 to 0.259) for unadjusted. After adjusted for age and gender, SH was significantly associated with both SBP (β = 0.161, 95% Cl 0.220 to 0.532) and DBP (β = 0.101, 95% Cl 0.066 to 0.329). There was a positive significant association between BP and anthropometric indicators in this population study, though the association of DBP and NC disappeared after adjustments for age and gender. Furthermore, there is a positive significant association between DBP and SBP with the components of height amongst Ellisras rural children. NC and MUAC are the simplest techniques with good interrater reliability and could be used to screen underweight in children. / Vrije University, Amsterdam, The netherlands University of Limpopo National Research Foundation (NRF)

Introduction<p>Près de 842 millions de personnes dans le monde sont toujours sous- alimentées ou exposées à une insécurité alimentaire chronique. Or une consommation insuffisante en protéines et en calories, ainsi que les carences en micronutriments ont un impact majeur sur la morbidité et la mortalité, en particulier chez les enfants. On estime qu’entre 2000 et 2005 le nombre d’enfants présentant une insuffisance pondérale a augmenté dans la plupart des régions d’Afrique sub saharienne, alors qu’il diminuait dans toutes les autres régions en développement. Il est plus que nécessaire de chercher des solutions efficaces et économiquement adaptées pour la prise en charge de la malnutrition.<p>De nos jours, plusieurs ONG et associations humanitaires proposent la spiruline, comme «une solution efficace et durable aux problèmes de la malnutrition» et encouragent les projets de culture artisanale de spiruline dans le monde et particulièrement les pays en développement comme le Niger. Les effets bénéfiques attribués à la spiruline comme complément alimentaire dans la récupération nutritionnelle sont multiples: elle est considérée comme une cyanobactérie, riche en protéines, en acide gras, en minéraux, en vitamines et contient de la chlorophylle, des fibres et un pigment bleu (la phycocyanine).<p>L'objectif général de notre travail est d’étudier l’impact de la supplémentation en spiruline chez des enfants en malnutrition sévère lors de la récupération nutritionnelle.<p><p>Méthodologie<p>Ce travail a regroupé quatre types d’études:<p>• Une revue secondaire sur les données nutritionnelles issues des enquêtes démographiques et de santé au Niger et certaines enquêtes et rapports ponctuels sur la nutrition afin de déterminer l'évolution de la prévalence de la malnutrition des enfants de moins de 5 ans et d'identifier les facteurs déterminants de cette malnutrition;<p>• Une revue systématique/meta analyse des études sur la supplementation en spiruline en milieu hospitalier pour évaluer dans quelle mesure la spiruline utilisée comment supplément alimentaire a un effet bénéfique sur la réhabilitation nutritionnelle;<p>• Une étude d’observation à visée descriptive et analytique dans deux centres de récupération nutritionnelle intensive (CRENI) en milieu hospitalier au Niger ;<p>• Un essai clinique randomisé en double aveugle dans trois centres de récupération nutritionnelle afin d’étudier l'impact de la supplémentation en spiruline sur la mortalité, la morbidité, les mesures anthropométriques et les mesures biologiques d'enfants en malnutrition sévère hospitalisés dans des CRENI au Niger.<p><p>Résultats<p>La revue des données existantes sur la nutrition au Niger a montré que la prévalence de l’émaciation (Z-score poids/taille <-2)) des enfants a dépassé depuis 1992 le seuil critique de 10% défini par l'OMS, avec stagnation entre 1998 et 2000 et légère augmentation entre 2004 et 2005. La prévalence du retard de croissance staturale (Z-score taille/âge <-2) était en augmentation depuis 1992. Les facteurs identifiés, favorisant la malnutrition des enfants sont multiples: le niveau socio-économique bas des parents, les caractéristiques des enfants (sexe masculin, âge plus élevé), les pratiques alimentaires (non allaitement), les morbidités et les aléas climatiques.<p>Dans les centres de récupération nutritionnelle intensive (CRENI), Le marasme était le type de malnutrition le plus fréquent (68,7%). La mortalité était de 14,5% et le modèle de régression logistique montrait que le risque de décès était plus élevé chez les enfants de moins d’un an [(OR ajusté (IC 95%): 2,8 (1,9 – 5,8)] et chez ceux de périmètre brachial < 11,5 cm [1,5 (1,7 – 4,0)]. Les résultats ont montré que quand l’âge de l’enfant augmentait, le Z-score taille/âge diminuait en moyenne alors que le Z-score poids/taille augmentait. L’augmentation du nombre d’hospitalisations antérieures était associée à une diminution des Z-scores taille/âge et poids/âge. On observait également que le Z-score poids/taille était significativement plus bas chez les garçons et chez les mères avec BMI de < 18,5 kg/m². La prise en charge médicale et diététique dans ces CRENI avait permis un gain de poids moyen de 12,9g/kg/j.<p>En se référant aux normes OMS, les apports énergétiques apportés par les aliments utilisés ne permettaient pas de couvrir les besoins des enfants en récupération. Les types d’aliments utilisés étaient le lait thérapeutique F100 et une farine de mil fabriqué localement « vitamil ». <p>La supplémentation en spiruline chez des sujets malnutris a été étudiée par certains auteurs.<p>La revue de 7 études (3 essais contrôlés randomisés et 4 essais non contrôlés) a permis de constater que la supplémentation en spiruline avait un effet positif sur un certain nombre de paramètres comme le poids, le périmètre brachial, la taille, l’albumine, le pré albumine, les protides et l’hémoglobine. Cependant, il faut noter que ces études n’avaient pas le même protocole et n’étaient pas homogènes, Une méta analyse ne permettait pas alors d’avoir des résultats fiables.<p>L’essai clinique randomisé en double aveugle de supplémentation en spiruline chez des enfants en malnutrition sévère a donné les résultats suivants :<p>La proportion de décès était de 8,5% dans le groupe spiruline et 13,5% dans le groupe placebo, mais la différence n'était pas significative (P = 0,12). Néanmoins la survie étaitµ meilleure dans le groupe spiruline et la durée de la diarrhée était significativement réduite par la supplémentation en spiruline.<p>La durée médiane d'hospitalisation était significativement inférieure dans le groupe spiruline: Med (min - max): 16 (8 - 51) par rapport au groupe placebo: Med (min - max): 23 (7 - 60) (P Log Rank < 0,001). La fonte des oedèmes était significativement plus rapide dans le groupe spiruline: Med (min - max): 5 (3 - 12) versus Med (min - max): 6 (1 - 21) dans le groupe placebo (P Log Rank = 0,05). Les effets de la suppléméntation en spiruline sont plus importants sur le gain pondéral moyen (p<0,001) et le gain en périmètre brachial (p<0,001) que sur le gain statural (NS).<p> L’effet de la spiruline semble être minime sur l’évolution du taux d’albumine (proportion d’enfants dont le taux s’était normalisé :15,7% groupe spiruline versus 11,2% groupe placebo (NS), mais plus efficace sur le taux des enfants ayant présenté des oedèmes à l’admission. L’évolution du taux d’hémoglobine était statistiquement meilleure dans le groupe spiruline (proportion d’enfants dont le taux s’était normalisé :44,9% versus 33,3% groupe placebo, P = 0,010) particulièrement chez les enfants de moins de 24 mois. Les gains d’albumine et d’hémoglobine n’étaient pas corrélés au gain du poids.<p>Cet essai a montré que les densités parasitaires (plasmoduim falciparum) sanguines à l’admission à J3 et à J7, ne différaient pas de façon significative entre le groupe spiruline et le groupe placebo. Les enfants admis avec toux et diarrhée guérissaient plus rapidement dans le groupe spiruline que dans le groupe placebo. Le gain de poids à la sortie d’hospitalisation était meilleur dans le groupe spiruline chez les enfants VIH positif. Le passage du taux de CD4 à une valeur &61619;500/mm³ à J56 était dans 43% des cas attribuable à la supplémentation en spiruline chez les enfants VIH positif (NS). Tous les enfants qui avaient un taux de CRP >20 mg/l à l’admission, avaient diminué leur taux (CRP &61603;& / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district / Health Studies / M.A. (Public Health)

Thesis (PhD)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: A community-based growth monitoring (GM) project was established in a rural village in KwaZulu-Natal. The project is an example of community-based activities that were based on a participatory approach of problem assessment and analysis. The first phase of the study comprised of a situation assessment. The aim was to evaluate the nutritional status and related factors of children aged 5 years and younger. It included a cross-sectional survey (questionnaire and anthropometric measurements), focus group discussions and interviews with key informants. From a nutritional point of view, the situation assessment identified a need for regular GM of infants and small children, increased availability of foods rich in micronutrients, and nutrition education. Relevant findings of the situation assessment were used during a project planning workshop that was attended by community representatives. The community's concern about the health of the preschool children and the lack of health facilities, and the need for regular weighing of their children prompted the establishment of a community-based GM project. The GM project was run by nutrition monitors, through home-based centres (named Isizinda). Monthly activities at the Isizinda included GM, nutrition education, and recording of morbidity and mortality data. Children who were either in need of medical attention or showed growth faltering were referred to the nearest clinic. During the latter half of the study, the GM project was integrated with a household food production project and the Isizinda served as promotion and training centres for agricultural activities. Project activities were continuously monitored by reviewing the attendance register, scrutinising the Isizinda files, observation and staff meetings. Community meetings (at least twice a year) allowed for two-way feedback and addressing questions and concerns. Acceptability of the GM activities was measured in terms of attendance and maternal perceptions. The coverage of the Isizinda project was estimated at approximately 90% and at least 60% of these children were adequately covered. The Isizinda data showed an equal distribution of child contacts over the various age categories and was representative of the community. The attendance data suggest that community-based GM is a viable option to be used for screening and nutrition surveillance, and as platform for nutrition education. Most mothers comprehended the growth curve. Positive behavioural changes have been observed in the community and the Isizinda data showed a steady decline in the prevalence of diarrhoea. The Ndunakazi mothers were appreciative towards the Isizinda project because of a better understanding of the benefits of regular GM. They expressed a sense of empowerment regarding the knowledge that they have gained. The community had a strong desire for the project to continue. The Isizinda project showed that community-based GM can provide the infrastructure for developing capacity for agricultural activities within the community. Data from the household food production project showed that maternal knowledge regarding nutritional issues can be improved through nutrition education given at the GM sessions and that, when GM is integrated with agricultural activities, a significant improvement in child malnutrition can be obtained. The Isizinda project falls within the framework of the Integrated Nutrition Programme, and can bridge the gap in areas which lack health facilities. / AFRIKAANSE OPSOMMING: ’n Gemeenskaps-gebaseerde groeimoniteringsprojek is tot stand gebring in ’n landelike gebied in KwaZulu-Natal. Die projek is 'n voorbeeld van gemeenskapsgebaseerde aktiwiteite wat gebaseer was op 'n deelnemende benadering van probleem bepaling en analise. Die eerste fase van die studie was a situasie analise. Die doel was om die voedingstatus en verwante faktore van kinders 5 jaar en jonger te bepaal. Dit het 'n dwarssnit opname (vraelys en antropometriese metinge), fokus groep besprekings en onderhoude met kern persone ingesluit. Uit 'n voedingsoogpunt het die situasie analise 'n behoefte vir gereelde groeimonitoring van babas en klein kinders, verhoogde beskikbaarheid van voedsels ryk in mikronutriente and voedingsvoorligting aangedui. Toepaslike bevindinge van die situasie analise was gebruik tydens ’n beplannings werkswinkel wat deur verteenwoordigers van die gemeenskap bygewoon is. Die gemeenskap se besorgdheid oor die gesondheid van voorskoolse kinders en die gebrek aan gesondheidsfasilitieite, asook hul behoefte om hul kinders gereeld te laat weeg, het aanleiding gegee tot die totstandkoming van ’n gemeenskaps-gebaseerde groeimoniteringsprojek. Die program is gedryf deur monitors deur tuisgebaseerde sentrums (genoem Isizinda). Maandelikse aktiwiteite by die Isizinda het groeimonitering, voedingvoorligting en die insameling van morbiditeit en mortaliteit inligting ingesluit. Kinders wie mediese sorg benodig het of wie groeivertraging getoon het, is na die naaste kliniek verwys. Die groeimoniteringsprojek is tydens die laaste helfte van die studie met ’n huishoudelike voedselproduksieprojek geintegreer en die Isizinda het as promosie- en opleidingsentrum vir die landbou aktiwitiete gedien. Projek aktiwiteite is deurgaans gemonitor deur die bywoningsregister en Isizinda leêrs deur te gaan, waarnemings en personeel vergaderings. Vergaderings met die gemeenskap (ten minste twee per jaar) het voorsiening gemaak vir wedersydse terugvoering en die aanspreek van vrae en besorgdhede. Die aanvaarbaarheid van die groeimoniterings aktiwiteite is gemeet in terme van bywoning en persepsies. Die Isizinda projek het ongeveer 90% van die kinders gedek, van wie ten minste 60% voldoende gemoniteer is. Die Isizinda data het ’n eweredige verspreiding van besoeke oor die verskillende oudersdomgroepe aangetoon. Die Isizinda data was ook verteenwoordigend van die gemeenskap. Die bywoningssyfers dui aan dat gemeenskapsgebaseerde groeimonitoring 'n lewensvatbare opsie is vir sifting en voeding opnames, en as 'n platform vir voedingvoorligting. Meeste moeders kon die groeikaart interpreteer. Positiewe gedragsveranderinge is in die gemeenskap waargeneem en die Isizinda data het ’n geleidelike afname in die voorkoms van diarree getoon. Die Ndunakazi moeders was waarderend teenoor die Isizinda projek as gevolg van 'n beter begrip ten opsigte van die voordele van gereelde groeimonitering. Hulle het 'n gevoel van bemagteging uitgespreek ten opsigte van hul verbeterde kennis. Hulle was mening dat die projek moes voortgaan. Die Isizinda projek het aangetoon dat gemeenskapsgebaseerde groeimonitoring die infrstruktuur kan skep vir die ontwikkeling vir kapasiteit vir landbou aktiwiteite binne die gemeenskap. Inligting van die huishoudelike voedselproduksieprojek het aangetoon dat die moeders se kennis ten opsigte van voedings verwante aspekte verbeter kan word deur voedingvoorligting wat gegee word tydens die groeimonitering sessie en dat, as groeimonitoring geintegreer is met landbou aktwiteite, 'n verbetering in die voedingstatus van die kind verkry kan word. Die Isizinda projek val binne die raamwerk van die Geintegreerde Voedingsprogram en kan die gaping dek in areas waar geen gesondheidsfasilteite is nie.

The aim of this study was to investigate whether Sibusiso, a Ready Food Supplement (SRFS), developed by the Gift of the Givers Foundation was able to promote weight gain among underweight children between 1 and 10 years of age. The study also aimed to train CAST community workers on how to assess and identify underweight children and to determine the number of underweight children aged 1-10 years who were currently on the CAST food aid program in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal. This non-randomised intervention study was carried out on a total of 19 out of 20 subjects that initially qualified for inclusion into the study. A monitoring tool was used to collect data on anthropometrical measurements, symptoms experienced, disease conditions identified, level of appetite, meal consumption and energy for each subject for a period of three months. Study subjects were from families living in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal, who were part of a food aid programme run by non-governmental organisation Church Alliance of Social Transformation (CAST). SRFS was compared to Recommended Energy Allowances (REA) and Recommended Daily Allowances (RDA) to determine the amount of energy and macronutrients that SRFS provided to subjects in their different age groups. The predominant health conditions and symptoms experienced by the subjects were assessed. General improvement in appetite, meal consumption and energy levels among subjects were monitored during the supplementation period Out of 19 subjects who were supplemented with SRFS over the three month period, it was established that more children from Chesterville than Cato Manor were part of the CAST food parcel programme. SRFS was not able to meet 100% of the RDA and REA for subjects in their different age groups. However, SRFS was able to promote weight among subjects as 50% of subjects were able to achieve normal weight-for-age growth by the third month of supplementation. Human Immunodeficiency Virus (HIV) infection was the predominant disease condition experienced among subjects. A steady decline in the frequency of infection symptoms experienced among subjects was observed. Appetite, meal consumption and energy levels among subjects increased during the three moth supplementation period. In conclusion, SRFS was successful in promoting weight gain among underweight children and was able to improve the overall wellbeing of subjects by alleviating the burden of disease conditions and infection symptoms while improving appetite, meal consumption and energy levels. SRFS therefore was beneficially utilised in the CAST food aid programme. SRFS had beneficial effects on the health and nutritional status of the study subjects during the observed period of its use in the CAST food aid programme and its continued use is recommended. / Thesis (M.Sc.Diet.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

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.

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.

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.

A ready-to-use food (RUF), Sibusiso, has the potential to alleviate protein- energy malnutrition. However, its nutritional composition, physical properties, consumer acceptability, and economic feasibility for use are unknown. This study aimed to determine the nutritional composition and physical properties of a RUF, Sibusiso. As well as to assess the consumer acceptability of Sibusiso to healthy and HIV infected children on antiretroviral (ARV) medication, and the caregiver‟s attitudes towards Sibusiso. The feasibility of using Sibusiso for nutrition rehabilitation was also determined. Methodology: Four samples of Sibusiso and a peanut butter (control) were analysed for their nutritional composition and physical properties. The consumer acceptability of Sibusiso to healthy children and HIV infected children on ARVs (ART group) was determined using a five-point facial hedonic rating scale. Focus group discussions were conducted to assess the attitudes and perceptions of caregivers surrounding Sibusiso. These caregivers had children who were either malnourished or at risk of malnutrition. The financial feasibility of using Sibusiso for nutrition rehabilitation was determined using published data. The results revealed that Sibusiso was a good source of energy (2624 kJ/100 g) and quality protein (15.7 g/100 g). The nutritional composition of Sibusiso met the WHO/WFP/SCN/UNICEF recommendations for RUF. Instrumental colour analysis indicated that both Sibusiso and the peanut butter had a brown colour, although Sibusiso was slightly lighter. Sibusiso had the same spreadability or hardness as the peanut butter, but it was stickier than the peanut butter. Based on the sensory evaluation, Sibusiso was found acceptable to both healthy (n=121) and HIV infected children (n=51). Over 65% of the children in both the healthy and ART group liked the taste, smell and mouthfeel of Sibusiso. The caregivers also found Sibusiso acceptable and were willing to buy it, but at half its current price (60 ZAR/ 500 g). The price of Sibusiso and perception of the caregivers that Sibusiso was a peanut butter were the main factors that affected their willingness to buy the product. Financial feasibility analysis showed that the estimated cost (5.99 ZAR/day) of rehabilitating a child using Sibusiso was higher than the KwaZulu-Natal Department of Health nutrition budget of 0.02 ZAR/day. Sibusiso is a good source of energy and quality protein, and it is fairly acceptable to children with HIV and caregivers. This indicates that Sibusiso has a potential to alleviate protein-energy malnutrition in the targeted groups. Yet, Sibusiso is expensive. There would be a need to somehow reduce the cost of Sibusiso so that it would be financially feasible to use it in nutrition intervention programmes. / Thesis (M.Sc.Hum.Nut.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.