Children less than five years of age are at a risk of growth failure worldwide. The South African National Food Consumption Survey (NFCS) of 1999 showed that 25.5% of children aged 1 - 3 years were stunted. Poor growth of young children in developing countries (South Africa included) has been associated with multiple micronutrient deficiencies because of the use of starchy plant-based complementary foods with little variety, especially among resource poor households. Dietary diversification through the use of crop and livestock production has been recommended as a strategy to improve the micronutrient intake and food security of households in resource poor settings. This study was a cross sectional secondary analysis of the South African NFCS of 1999 data, designed to investigate the impact of crop and livestock production on nutrient intake, dietary diversity, intake of selected food groups, hunger perceptions and anthropometric status of children aged 1 - 3 years in South Africa. Children from households producing crops only (n=211), crops and livestock (n=110), livestock only (n=93) and non-producers were compared at the national, in rural areas and among households with a total income of less than R12 000.00 per household per year. In rural areas and among households with a total income of less than R12 000.00 per household per year, children in the crops and livestock group had higher nutrient intakes for energy, vitamin 86, calcium and folate than the other groups (p<0.05), while the crops only group had higher nutrient intakes for vitamin A and vitamin C. The majority of children in all the four study groups had less than 67% of the RDAs for vitamin A, vitamin C, folate, calcium, iron and zinc. In addition , children in all the groups had a median dietary diversity score of four out of 13 food groups. In rural areas and among low income households, higher percentages (over 60%) of children in the crops only group consumed vegetables while the non-producers group was the lowest (47.7%). The non-producers group had the highest percentages of children consuming meat and meat products and the crops and livestock and livestock only groups had the lowest percentages. In both rural areas and among households withlow income, the majority of the households in all the study groups were experiencing hunger. In rural areas, one in five households were food secure. Crop and livestock production improved the nutrient intake and the intake of vegetables of children in rural and poor households. However, nutrient intakes were not adequate to meet the recommended nutrient levels. The high levels of food insecurity require support of these households to increase crop and livestock production and, integration of nutrition education to increase the consumption of the produced products. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

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.

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

MSCPNT / Department of Nutrition / Malnutrition is a problem facing virtually every country in the world. Inappropriate feeding practices such as bottle feeding, early introduction of weaning foods, lack of variety in the diet are a known major cause of the onset of malnutrition in young children. Lack of nutrition knowledge, particularly about feeding practices, is critical as it affects the nutritional status of children. The purpose of this study was to determine the influence of caregivers’ nutrition knowledge and feeding practices on the nutritional status of 2 to 5 years old children in the Makhuduthamaga Municipality, South Africa. A crosssectional study with an analytical component was carried out in the Makhuduthamaga Municipality in the Limpopo Province, South Africa. One hundred and twenty children aged 2 to 5 years and their caregivers were conveniently sampled from four villages. A validated questionnaire was used to gather demographic information, caregivers’ nutritional knowledge and feeding practices. Anthropometric measurements taken were weight, height and mid-upper arm circumference (MUAC) of the children as well as weight and height of the caregivers. Descriptive and inferential statistics were utilized. Chi-square was used to determine the influence of caregiver’s nutrition knowledge and feeding practices on the nutritional status of children. The significance level was set at p< 0.05. Most caregivers (66.7%) were between the ages of 19 and 35 years. More than half (54.2%) of the children were male. Most of the caregivers (70%) had attended school up to secondary level and only 4.2% had obtained a tertiary qualification. Most of the caregivers (85%) were unemployed. Children were mostly (70.2%) cared for by their biological mothers. Some caregivers reported not to have any source of nutrition education (41.7%), while 43.3% reported that health professionals were their source of nutrition education. Both nutrition knowledge and feeding practices were not satisfactory in the current study. Almost all children (94.2%) were breastfed at some stage in their lives. However, 47.5% were given infant formula while they were still less than six months old. It was found that more than half of the caregivers (62.5%) introduced solids foods before 6 months. Maize meal soft porridge was reported as the main solid food first introduced to 66.7% of the children, followed by infant cereals (25%). Stunting was found in 41.7% of children. Prevalence of overweight and obesity was observed amongst both caregivers and children. Overweight and obesity prevalent of caregivers was at 30.8%. No significant correlation was observed between the caregivers’ nutrition knowledge, the feeding practices and the nutritional status of children. However, family income showed positive correlation with the nutritional status of children. Nutrition education strategies intertwined with economic empowerment of mothers should be enforced to capacitate caregivers to voluntarily make proper feeding practices. / NRF

MCur / Department of Advanced Nursing Science / Malnutrition is globally considered the key risk factors of illness and death which affect over 90 million children under the age of five. The study aim was to determine the perception of caregivers regarding factors contributing to malnutrition in children under 5 years in the Vhembe District of the Limpopo province. A qualitative approach, explorative, descriptive and contextual design was used in the study. Nine participants were sampled through simple random sampling. Data was collected through in- depth individual interview and was analysed through Tesch‘s analytical approach. Measures to ensure trustworthiness and ethical consideration were adhered to throughout the study. Three themes emerged from study, namely: caregivers perceived contributory factors to malnutrition, financial difficulties and help that were sought from various available resources. In conclusion, feeding practices to most of the participants was a challenge, they had financial difficulties since they were not working and depended on social and child grants for living, and the study recommends the development of strategies to assist caregivers in preventing malnutrition in children. / NRF

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made. / Health Studies / M.A. (Nursing Science)

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

Thesis (Mnutr)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Problem Definition: In the context of HIV/AIDS malnutrition is almost universal among children, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to be the occurrence of opportunistic infections with micro-organisms such as oral Candida. Objective: The aim of this study was to determine the nutritional status of children with oral complications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritional status. Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who were admitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, South Africa. The nutritional status of the children was assessed over a maximum period of six months by nutrient intake, anthropometric status, and by biochemical parameters and clinical and oral examination on admission and at discharge from hospital. Results: Children with HIVand TB infection presenting with or without oral lesions were similarly malnourished throughout the period of hospitalization. There was no improvement in the nutritional status as indicated by height and weight measurements. Throughout the time of hospitalization, 7% of the children had a combination of stunting, underweight and wasting. Average nutrient intake was not found to be higher than the Recommended Dietary Allowance (RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrate intake provided most of the daily energy (36% and 42%, the difference not being statistically significant). There was a significant increase in the intake of energy (p=O.04) and a decrease in total fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admission was higher than at time of discharge. Selected sub-optimal biochemical values were prevalent among the children studied, with 45% and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at discharge respectively. Both on admission and at discharge, 38% of the children had Haemoglobin levels below normal values. Serum ferritin levels below normal values were present in almost all the children and the trend was similar for the prevalence of low zinc values. Sub-normal plasma retinol was present in 79% of the children at time of admission, while only 21% had deficient values at time of discharge (p=O.03). On admission, 29% of the children had vitamin evalues below the normal range whereas at time of discharge 17% of the children had values below normal (p=O.04). A total of 29% children presented with oral complications on admission. These included oral herpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children were asymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher (p=O.057) among the children who were not diagnosed with oral complications. Conclusions: This study confirmed that malnutrition is not only a common and serious problem associated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolation where Opportunistic Infections are present. The severity of malnutrition depends on various factors including oral complications. Additionally, appropriate management and treatment of tuberculosis did not appear to affect the nutritional status significantly. Recommendations: On the basis of these findings, and because of the increased risk of growth failure and developmental delays, children should be referred for full nutritional evaluation as soon as possible after diagnosis of HIV -infection. In addition, there is a need for intervention programmes to identify the immediate underlying causes of malnutrition and the ways in which such causes interact, in order to ensure that such interventions increase the resistance of HIV infected infants and children to the disease. / AFRIKAANSE OPSOMMING: Probleemdefiniëring: Binne die konteks van MIVNIGS is wanvoeding bykans universeelonder kinders en van die nadelige effekte van proteïen energie wanvoeding is die voorkoms van opportunistiese infeksies (Ol) met mikro-organismes soos orale candida die algemeenste. Doelwit: Die doel van dié studie was om die voedingstatus van kinders met orale komplikasies in verhouding tot MIVNIGS en die effek van orale letsels op voedingstatus, te bepaal. Proefpersone/omgewing: 'n Groep van 24 kinders, met beide tuberkulose en MIVNIGSinfeksie, wat agtereenvolgend in die kindersaal van Brooklyn Bors-Hospitaal in Kaapstad, Suid- Afrika opgeneem is, is bestudeer. Vir 'n periode van ses maande is die kinders se voedingstatus geassesseer deur middel van voedingstofinname, antropometriese status en biochemiese parameters met opname in en ontslag uit die hospitaal. Kliniese en orale ondersoeke was op elke kind uitgevoer met opname sowel as ontslag. Resultate: Kindres met HIV en tuberkulose, met of sonder orale letsels, het soortgelyke wanvoeding tydens hospitalisering ervaar het. Volgens antropometriese metings was daar geen verbetering in die voedingstatus nie. 'n Kombinasie van belemmerde groei, ondergewig en uittering het in 7% van die kinders tydens hospitalisering voorgekom. Nie een van die gemiddeldes van die voedingstowwe was hoër as die Aanbevole daaglikse toelatings (ADT) in enige van die kinders wat bestudeer is nie. Met opname sowel as ontslag, was koolhidraatinname die grootste energieverskaffer met onderskeidelik 36% en 42% (alhoewel die verskil nie statisties beduidend was nie). Daar was 'n beduidende toename in energie-inname (p=O.04) en 'n afname in totale vetinname (p=O.03) met ontslag. Alhoewel nie beduidend nie, was die gemiddelde proteïeninname hoër met ontslag. Die voorkoms van geselekteerde sub-optimale biochemiese waardes met toelating en ontslag wys dat onderskeidelik 45% en 41% van die kinders lae serum albumienwaardes «2.9g/dL) getoon het. Subnormale plasma retinol het in 79% van die kinders met toelating voorgekom, terwyl slegs 21% gebrekkige waardes (p=O.03) met ontslag getoon het. Tydens opname, sowel as met ontslag, was 38% van die kinders se hemoglobienvlakke laer as die normale. Serum ferritienvlakke was amper by al die kinders laer as die normale vlakke te bespeur, met sinkvlakke wat op soortgelyke lae vlakke voorkom. Met toelating was 29% van die kinders se Vitamien C-waardes laer as normaal en met ontslag was sowat 17% se waardes steeds laer as die normaal (p=O.04). Met toelating het 29% van die kinders orale komplikasies getoon. Ingeslote hierby was orale herpes, orale sproei, refluks, bloeiende tandvleise en stomatis/ angulêre cheilose. Slegs twee kinders was asimptomaties met orale Candida van die mondholte gediagnoseer. Die gemiddelde proteïeninname was hoër (p=O.057) onder die kindres wat nie orale komplikasies getoon het nie. Gevolgtrekking: Hierdie studie bevestig dat wanvoeding me net 'n algemene en ernstige probleem is wat met MIV en VIGS geassosieer word nie, maar ook in die teenwoordigheid van opportunistiese infeksies, die voedingsprobleem nie in isolasie gehanteer kan word nie. Die graad van wanvoeding hang af van ander faktore, insluitende orale komplikasies. Voldoende behandeling van TB het ook nie 'n beduidende effek op voedingstatus gehad nie. Aanbevelings: Op hierdie bevindings gebaseer, en as gevolg van die verhoogde risiko VIr belemmerde groei en vertraagde ontwikkeling wat al die liggaamstelsels van MIV -positiewe kinders affekteer, moet kinders so gou as moontlik nadat die MIV-infeksie gediagnoseer is, vir volle voedingsevaluasies verwys word. Daarmee gepaardgaande is daar 'n behoefte aan programme wat die onmiddellike onderliggende oorsake van wanvoeding identifiseer, asook om interaksie van hierdie oorsake met HIV vas te stel, ten einde intervensies wat weerstand van HIVkinders en-babas verbeter, positieftoe te pas.