A research report submitted to the school of public health, University of the Witwatersrand, Johannesburg, partial fulfillment of the requirements for the degree of Masters of science in biostatistics. / Background: Globally malnutrition is an underlying cause of death and accounts for over 45% of under-5 mortality mainly resulting from diarrhoea and pneumonia. The post-2015 era has seen, more than 25% of Kenya’s population being food insecure, with considerable geographicandtemporaldisparities. Ourprimaryaimwastounderstandthedeterminants ofmalnutritionrelatedmorbidityandmortalityintheruralKilifiHDSS,withaspecialfocus on children admitted in Kilifi County Hospital (KCH) during 2002-2015. Methodology: Our study participants were all the children between the ages of 6 months to 15 years who were admitted two times or more at the KCH. The outcomes were derived from malnutrition-related admissions based on wasting (WHZ<-2) and oedema and the discharge outcome whether alive or died. There were 3114 children with a total of 7620 admissions for children with more than one admission. In the exploratory data analysis, temporality and seasonality were determined using SARIMA time series models. Morans I index was used to investigate for the presence of spatial autocorrelation. SatScan was used to identify the spatial clusters of malnutrition related admissions and mortality. To understand mortality patterns, geo-additive logistic models were fitted to the KCH data. Mixed effects negative binomial models with separate space and temporal random effects were fit using the Maximum Likelihood and Bayesian Estimation procedures. The Bayesian methods were used to estimate the spatial parameters using Markov Chain Monte Carlo (MCMC) assisted with either Metropolis Hastings or Integrated Nested Laplace Approximations (INLA). iii ABSTRACT Results: Therewere17,740childrenobservedovertheperiodofstudyand4.01%ofthosedied. A total of 23,347 admission events were observed of which 7,128 were malnutrition related. Outofthe17,740childrenadmitted, 3,114hadoneormoreadmissionevent. A seasonal hike in the May to July month was identified for malnutrition admission. Children with morethanoneadmission,(7620admissions)~24%(n=1858)hadamalnutritioneventand 6.24%ofthemdied. SpatialhotspotsclusterswereidentifiedintheNorthandSouthofthe creek and areas near Kilifi Town was identified as cold spots. Children with two or more severe diseases are more likely to have a malnutrition admission event and females are less likely to be admitted with malnutrition. There was a protective effect as the children grewolderandalsoastheirbodyweightsincreased.Themaleshadahigherriskofdeath compared to the females and a year increase in age reduced the risk of death by 15%. Conclusion: Abetterunderstandingofthefactorsthatcontributetomalnutritionattributableadmission and mortality can be used to advocate for and develop earlier and more appropriate responses. Additionally, this can provide an indication of future trends and the potential impact of interventions.Importantly, including spatial and temporal random effects biostatistical modelling can help reduce bias reporting and help understand better the patterns of morbidity and mortality. Campaigns providing food and/or vitamin or other supplements can contribute to reducing morbidity and ultimately deaths in Kenyan childrenandbuildingmorehealthfacilitiestoreducethedistanceoftraveltocareishighly recommendable. / GR2018

Background: The World Health Organisation (WHO) initially recommended F100 formula in the treatment of severe malnutrition. F100 is made with full cream milk powder, sugar, oil and water with added minerals and vitamins. Ready to-use therapeutic food (RUTF) is a highly nutrient dense food enriched with minerals and vitamins, with a similar nutrient profile but greater energy and nutrient density than F100. RUTF has shown to be effective in the treatment of severe and moderate wasting and is associated with an increased recovery rate. In South Africa no studies are available on the recovery rate of children with severe acute malnutrition treated with RUTFs. Aim: To compare the recovery of clinically stable severe acute malnourished children, between the age of 12 and 60 months, treated with either F100 or RUTF as nutrition supplement. Methods: A randomised clinically controlled trial was performed. All children referred to Clairwood hospital with severe acute malnutrition (SAM), defined as a weight for height measurement of <70 percent of the median and/or < -3 SD below the mean WHO reference values or the presence of bilateral oedema were included in this study. Children were stratified according to age and gender and subsequently randomly assigned with randomisation tables to either the RUTF or F100 group. A total of 35 children were included in this study and data from 34 were analysed with 17 in each group. Results: Most children included in this study were between 12 and 18 months with boys in the majority. Both groups had a large percentage of HIV-infected children (70 percent in the RUTF group and 76 percent in the F100 group), with Tuberculosis (TB) co-infection in some of the children. One child died due to HIV related complications. The rate of weight gain was 7.77g/kg/day in the RUTF group and 6.11g/kg/day in the F100 group. There was no statistical significant difference established between groups (p = 0.46). The majority of children recovered within 21 days on the RUTF while the majority of children in the F100 group recovered after 6 weeks. There were no changes in height during the rehabilitation of these children. MUAC changes were observed with 92 percent having a mid-upper arm circumference (MUAC) of > 11.5cm after a 6 week intervention with RUTF and F100. Conclusion: RUTF resulted in better rates of recovery and can be used efficiently in rehabilitating children with SAM in a supervised facility setting. These preliminary results also point towards significant potential savings regarding hospitalisation costs since faster recovery has been demonstrated by children in the RUTF group.

The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

M. Tech. (Hospitality and Tourism, Faculty of Human Sciences), Vaal University of Technology. / The primary objective of this study was to formulate a multi-mix, which could supply at least one-third of the daily requirements of primary school children, aged six to 13 years. The secondary objective was to ensure the adherence to the criteria of multi-mix formulation, which included affordability, convenient, palatability, culturally acceptable and cost effective, whilst providing high nutritional value for the specified target group. The nutritional criteria included the Index Nutrient Quality (INQ) and Energy Density (ED) requirements, for a specific target group. This study was conducted in Eatonside, an informal settlement situated in Gauteng. A situational analysis previously conducted in Eatonside (Napier 2003) showed that the children between the ages of six and 13 years, were 17% underweight (weight-for-age -2SD from the reference NCHS median), 12,7% were wasted (BMI-for-age -2SD) and 18% stunted (height-for-age -2SD). With the nutritional requirements of children and the most consumed food list, the multi-mix formulation began. Foods from the Top 20 list (Napier 2003), were combined with the ingredients most common within the households, and vegetable gardens already established . Estimated nutritional values were calculated using the food composition tables of South Africa. The ingredients were prepared and chemically analysed to determine the experimental nutritional value and to assess if the nutritional objectives were being achieved. The multi-mix was then combined with other commonly consumed ingredients to form recipes and sensory evaluated by professionals and the primary school children to assess the acceptability of the multi-mix and recipes. The multi-mix and recipe products were then sent for shelf life testing to assess its storage time at room temperature. The results from the nutritional analyses showed nutrient values to be above 30 percent of the Estimated Average Requirements (EAR). The INQ of the targeted nutrients was above 1,0 and the ED at 3,7kcal/g, which was within the 3,6-4,5 kcal/g requirements. The sensory evaluation for the multi-mix recipes had proved favourable response to snack items with preference for sweet products. The final evaluation session resulted in scores of 83.9 percent preference to the biscuit with the sweet muffin scoring 94.5 percent liking, whilst the savoury muffin at 73.1 percent. The average scores for all three recipes were above 80 percent. The multi-mix had a shelf life of minimum one-month, the biscuit, seven days and muffins, only 24 hours, at room temperature. The objectives of cultural acceptability had been achieved through the positive response from the use of ingredients within the community. The multi-mix had been cost effective as the final cost of R1.55, was within the R2.90 spent per person per day, for all three meals (Oidewage-Theron eta/. 2005). Further studies need to be conducted in order to implement the multi-mix into an intervention within the community to assess the effect on nutritional status. This study, aimed to reduce the underlying cause of malnutrition, food insecurity, by improving the nutritional status of children aged six to 13 years with the strengthening of food intake, through the combination of various scant ingredients, a multi-mix, providing maximum nutritional value with small quantities. An advantage of the multi-mix is a lower cost when compared with tablet supplementation on the market and versatility in relation to various recipes. / Vaal University of Technology National Research Foundation

The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

Submitted in fulfillment of the requirements for the Degree in Masters in Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Introduction Malnutrition continues to be a major public health problem, especially in children under 5 years of age. Nutritional status is one of the indicators of overall well-being and human resources development of a nation. Aim of the study The aim of the study was to explore and describe experiences of Community Care Givers regarding the assessment of malnutrition in children under 5 years of age in eThekwini District Health Sub-district North area six. Methodology A qualitative, exploratory, descriptive study was used to conduct the study. Semi-structured individual face to face interviews were conducted with 13 participants. The study was guided by Pender’s Model of Health Promotion. Results The findings of the study revealed that participants were dissatisfied with mid upper arm circumference training. They reported lack of support and supervision in their performance such that mid upper arm circumference was non-prioritized. They were dissatisfied with remuneration and they worked under unsafe conditions. Conclusion In order to combat malnutrition in children under 5 years in the community, Community Care Givers need to be vigorously educated on the rationale of malnutrition assessment of children under 5 years in the communities so that they can have insight into what they are doing. Community Care Givers have multiple roles and may need to prioritize their work; this is not easy and requires specific guidance and training from skilled health professionals. / M

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, 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 (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.

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.