Introduction: Malnutrition is a health issue directly and indirectly contributing towards high rates of morbidity and mortality globally, particularly in developing countries. South Africa (SA) is faced with a double burden of diseases with a high prevalence of both under and over nutrition. The high prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) in SA worsens undernutrition. HIV/AIDS increases nutrient requirements and inadequate food intake results in malnutrition. Nutrition support through food supplementation is important to combat the high prevalence of malnutrition in sub-Saharan African countries including South Africa. Thus, a groundnut-soya based supplementary paste, Sibusiso, has been produced. However, its nutritional composition and acceptability have not been studied. Objectives: (i) To determine the nutritional composition and physical properties of a ready-to-use supplement, Sibusiso, (ii) To determine the sensory acceptability of Sibusiso among healthy subjects; and sensory acceptability and perceptions of Sibusiso by subjects treated for HIV and HIV/TB. Materials and methods: The nutritional composition, colour and texture of Sibusiso and a commercial peanut butter (control) were analysed following standard procedures. A cross-sectional consumer acceptability test was done using a 5-point facial hedonic scale (healthy control group, n = 68; HIV, n = 88 and HIV-TB co-infection treated, n = 51). A total of six focus group discussion sessions (HIV subjects = 4 sessions and HIV/TB co-infected subjects = 2 sessions) were also conducted. Results and discussions: The protein content of Sibusiso (16 g/100 g) was almost half that of the commercial peanut butter (control), (25 g/100 g). However, Sibusiso contained 1.4 times more ash (4 g/100 g) and almost twice as much carbohydrate (40 g/100 g) compared to the commercial peanut butter (22 g/100 g). The fat (40 g/100 g) and energy (2 624 kJ/ 100 g) content of Sibusiso was not substantially different from that of the commercial peanut butter which was 43 g/100 g and 2 852 kJ/100 g, respectively. The lysine content of Sibusiso (58 mg/g) was about 1.7 times higher than that of the commercial peanut butter. The methionine (11 mg/g) and histidine (35 mg/g) content of Sibusiso was almost twice that of the commercial peanut butter, respectively. The nutrient content of Sibusiso was either similar or slightly more than that of other ready-to-use supplements such as Plumpy’nut®. Sibusiso met the FAO/WHO/UNU recommendations for essential amino acids. The consumption of 50 g of Sibusiso per day may provide approximately 35% of the Estimated Energy Requirements (EER) and 30% of the Recommended Dietary Allowance (RDA) for protein for adults. Sibusiso was brown in colour, similar to the commercial peanut butter. Its textural attributes were found similar to that of the commercial peanut butter but harder and stickier. The acceptability of Sibusiso was significantly associated (p ≤ 0.05) with the health status of consumers. Overall, Sibusiso was liked by 94% of HIV and HIV/TB individuals (mean score: 4) compared to 85% for the healthy group (control). More than 90% of the HIV/TB and HIV treated individuals liked the taste compared to the control group (86%, mean score: 4). The colour and mouthful were rated 'good' by more than 80% of the HIV and HIV/TB group, mean score: 3, with only 68% among the healthy group, mean score: 4.1. Conclusion: Sibusiso is a good source of nutrients and was found to be acceptable to HIV and HIV/TB treated consumers. It may be effective in alleviating disease-related malnutrition among vulnerable individuals such as those infected by HIV and HIV/TB. / Thesis (M.Sc.Hum.Nut.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Submitted in fulfillment of the requirements for the degree Master Technology: Consumer Science Food and Nutrition, Durban University of Technology, Durban, South Africa, 2014. / Food security is a global concern and the insecurity thereof is prevalent in South Africa even though the country is deemed to be secure in terms of food availability. The study was conducted to determine the socio-economic, health and nutrition and food security status of the community living in the Valley of a Thousand Hills in KwaZulu Natal, in addition to analysing their coping strategies. Two hundred and fifty seven respondents were required to participate in this study. Data were collected by interviewing the respondents using pre-designed and pre-tested questionnaires; socio demographic questionnaires, dietary intake questionnaires- namely 24 hour recall and Food Frequency Questionnaire (FFQ) and the coping strategy questionnaires were used. Lastly anthropometric measurements were taken to determine BMI. A prevalence of extreme poverty exists as a magnitude of the high unemployment rate, out of which 75.8% had been unemployed for more than 3 years. The household monthly income was less than R500 per month for 37.3% of the respondents. The mean Food Variety Scores (FVS) (±SD) for all foods consumed from the food groups during seven days was 22.45 (±10.32), indicating a low food variety score. In this study the food group diversity is summarized as the majority of the respondents (91.1%, n=226) being classified with a good dietary diversity score using 6-9 food groups. The mean of the three 24-Hour recall nutrient analysis indicated a deficient intake by both men and women in all of the nutrients (100% of the men and women could not meet the DRI’s for energy and calcium) except for the mean (±SD) carbohydrate intake by men aged 19-50 (214.71 ± 80.22). The main source of food intake was from the carbohydrate food group with an insufficient intake of animal products, dairy products and fruits and vegetables respectively; contributing to the macro and micro nutrient inadequacies. Ninety six percent of this community experienced some level of food insecurity with the worst Coping Strategy Index food insecurity score being 117 out of a possible 175. Four percent of this community was classified as being food secure. Overweight and obesity were the most exceptional anthropometric features by the women respondents with 26.5% (n=66) being overweight and 57% (n=142) obese. The men’s anthropometric features were predominantly normal weight. This study has established poverty and unemployment as being the principal contributors for the food insecurity experienced by the populace and poor dietary intakes. The low food variety diet consumed by the respondents resulted in the DRI’s not achieved for most nutrients. The majority of the respondents only consumed two meals a day, as a coping strategy to reduce/prevent temporary food insecurity. Intervention strategies are needed to improve the food security status and dietary intake of the community members to overcome the crisis of malnutrition. / M

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.

Food insecurity remains a major challenge affecting the rural poor households in South Africa. The consumption of green leafy vegetables is important to address micronutrients deficiency in rural communities and, at the same time, it contributes to fibre intake. This study investigated the people’s attitude towards the cultivation and utilisation of ILVs in rural communities. A cross-section survey study was conducted among 1 000 respondents in randomly selected households in communities. The majority of respondents were not willingly consuming ILVs. This is because most consumers were black and of the low-income group. ILVs that are consumed grow mainly in the wild. The regular consumption of these vegetables as indicated in this study is interesting, as this will help in mitigating micronutrient deficiency. Furthermore, these vegetables could be incorporated in formulated food to improve iron and zinc, especially in infant foods formulation. Based on the findings of this study it would be important to find ways of encouraging cultivation of ILVs for both nutrition and as income generating activities. / Life and Consumer Science / M.CS.

The aim of this study was to determine how nurses manage the nutritional care of children under the age of five years at the primary healthcare level. A quantitative approach with an explorative descriptive design was used. A self-administered questionnaire and was used to collect data. The population was 34 professional nurses working in the child health sections of 16 clinics, all of whom were accessible, but one did not respond. Ten out of the target population were also observed using an observational checklist. Findings show lack of proper implementation of Integrated Management of Childhood Illnesses (IMCI) guidelines and incorrect use of the Road-to-Health booklet. Secondly, the nurses at the child healthcare section had a high workload or had little experience in child care. The need for more emphasis on nutrition during IMCI training and the re-orientation of nurses on the optimal use of the Road-to-Health booklet were identified. / Master of Public Health (MPH) / Health Studies

MSc (Microbiology) / Department of Microbiology

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

A high rate of micronutrient deficiencies persists in Africa with the most vulnerable groups being women and children. The Moringa oleifera tree has been identified to help alleviate malnutrition at household level because of its rich content of vitamin A in its plant form - beta-carotene, iron and vitamin C. The objectives of this study was to identify households that consumed Moringa, to identify households that required diet diversification through the use of a Household Dietary Diversity Score (HDDS) and to determine the acceptability of various dishes prepared from Moringa leaves as a possible contribution to the alleviation of malnutrition in resource poor communities. The dietary diversity score of the traditional Bapedi community is 4.7 and the results of the acceptability test of dishes prepared with Moringa indicated that Moringa could be recommended as an additional food ingredient to add micronutrient to the diet of Bapedi communities. / Agriculture and Environmental Sciences / M.A. (Human Ecology)

A high rate of micronutrient deficiencies persists in Africa with the most vulnerable groups being women and children. The Moringa oleifera tree has been identified to help alleviate malnutrition at household level because of its rich content of vitamin A in its plant form - beta-carotene, iron and vitamin C. The objectives of this study was to identify households that consumed Moringa, to identify households that required diet diversification through the use of a Household Dietary Diversity Score (HDDS) and to determine the acceptability of various dishes prepared from Moringa leaves as a possible contribution to the alleviation of malnutrition in resource poor communities. The dietary diversity score of the traditional Bapedi community is 4.7 and the results of the acceptability test of dishes prepared with Moringa indicated that Moringa could be recommended as an additional food ingredient to add micronutrient to the diet of Bapedi communities. / Agriculture and Environmental Sciences / M.A. (Human Ecology)