Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009. / Full text also available online. Scroll down for electronic link.

Submitted in the fulfillment of the requirements of a Masters of Applied Science in Food and Nutrition, Durban University of Technology, Durban, South Africa, 2017. / Aim: The main aim of this study was to profile the primary school children`s household socio-economic status and evaluate their nutritional status for a healthy and active live in Chesterville, outside Durban in KwaZulu-Natal. The sample comprised of 250 children (147 girls and 103 boys), aged between 4 to 8 years and 9 to 13 years who volunteered to participate in the study and school was randomly selected. Methodology: A quantitative research method was applied using various nutrition security assessment tools complemented by the socio-economic household profile to determine household`s ability to acquire food. Anthropometric status using WHO growth indicators assessed stunting, wasting and underweight status of the children. This was followed by the 24-hr recall and food frequency questionnaire to probe children`s diet diversity. Descriptive statistics was used to analyse data. Result: The anthropometric indices showed that 10.3% of the children were severely stunted (<-3SD height-for-age), 33.5% were stunted (<-2SD), 2.9% were severely wasted (<-3SD BMI-for age), 5.3% were wasted (<-2SD) with 68.5% at possible risk of overweight (>+1SD), 24.3% of the children were overweight is (>+2SD) and 5.6% were obese (>+3SD) according to the WHO z-scores. The results indicate the prevalence of obesity which could be a result of the high consumption of carbohydrate dense food in the group surveyed. The parents/ caregivers and the children need nutrition education on healthy eating habits to improve their lifestyle. The socio-demographic profile of the households indicated that 61% of the parents/ caregivers were unemployed and 39% were employed. Seventy three percent of the households were headed by women, 50% of the parents/ caregivers owned their homes, 63.6% had a tap inside the house and 94% had access to a flush toilet/sewerage system inside the house, 38% had passed grade 8 – the highest level of education, 14.4% of the parents/caregivers earned less than R2000 per month, and 10.4% earned less than R2500 per month. The low-income level, lack of post matric qualification in some of the parents /caregivers and the high unemployment rate of 61% could be a contributory factor to malnutrition in this community. Most of the parents/caregivers resided in the township and 94% lived in brick houses, while 35.6% lived in a shack that was built outside the house as an extension of the house. Most of the parents/caregivers (88%) purchased their food from a supermarket. Thirty-five-point two percent of the parents/ caregivers indicated not having enough money to spend on food, 32.8% indicated that often there is not enough money to spend on food, and 15% indicted that there is always not enough money to spend on food. Seventy-five-point two percent of the parents/ caregivers purchased their food once a month while 12.4% purchased their food once a week. Township South Africans tend to purchase food instead of growing their own food because of the lack of vegetating space. The lack of buying power and food shortages eventually leads to malnutrition. The lack of higher education in this community decreases the chances of permanent employment as a result the low-income bracket and the inability to purchase food in some occasions. The food group diversity score showed that 64% of the respondents consumed food from nine food groups. The carbohydrate group had the highest score (6.08±1.322) followed by the vegetable group (4.76±1.383) and the meat group (4.51±1.269). The mean carbohydrate intake was higher than the Dietary Reference Intake (DRI) for girls and boys (>100% of the DRIs). The intake of fruit was lower than the >400g goal as recommended by the World Health Organisation (WHO). The consumption of fibre was low with both girls and boys consuming <100% of the fibre requirements. Iron was consumed by 54.6% of the girls in the required amount of 100% of the DRIs. The energy intake for both girls and boys was 7025.8±16278 and 7205.4± 1860.834 respectively. The girls’ consumption of protein was 11.9% and boys’ consumption was 11.4% and this is within the recommended 10-15% of the WHO. Conclusion: The results indicate both overnutrition and undernutrition in children that were part of the survey. The top 20 food intake indicated inadequate eating patterns and that diets consisted of energy dense foods, such as carbohydrates and fats which could be responsible for obesity in the children. The high unemployment and low-income rate and inadequate money to spend on food can contribute to the prevalence of stunting and wasting in the children. Nutrition education and nutrition interventions such as focus on healthier foods, healthier methods of preparing food, a balance diet and physical activity are necessary to improve quality of life and improve health. / M

Thesis (Mnutr)--Stellenbosch University,2003. / ENGLISH ABSTRACT: Most of the risk factors for coronary heart disease (CHD) such as hypertension, dyslipidaemia, smoking, non-insulin dependent diabetes mellitus (NIDDM), obesity, physical inactivity and heredity are common in South African populations, with Indians ranking among those with the highest prevalence in the country. Little published literature is available on eating patterns in pre-school children in the Indian population. Therefore, this study a ims to assess the nutritional status of a group of Indian pre-school children in Howick West (a small suburb in the Kwa-Zulu Natal Midlands). Methods: This was a cross-sectional study of 50 Indian pre-school children between the ages of 1-5 years, randomly selected from a total of 632 available Indian households in Howick West. Written, informed consent was obtained from the mother/caregiver of each child that participated in the study. Standardized and validated 24-hour-recall (24-H-R) and quantitative food frequency questionnaires (QFFQ), used in the National Food Consumption Survey (NFCS) of 1999, were adapted and used to assess habitual intake and eating patterns of the 50 Indian pre-school children. Height and weight measurements using standardized methodology were used to assess the anthropometric status of the children. Results: The prevalence of underweight was 14%. Stunting affected only 8% of the children, and 2% were at risk of overweight. The mean energy intakes of the children were above that recommended for age. A high fat intake was observed, with total fat contributing 42% to the daily total energy (TE) intake. The contributions of total carbohydrate and protein to TE intake were 45% and 10%, respectively. Low mean intakes of the following micronutrients were observed (less than 67% of the RDA): Calcium (22% of the children), Vitamin D (90%), Zinc (56%) and Iodine (90%), respectively. Based on the 24-H-R, the intakes of the remaining micronutrients were either above or equivalent to that recommended for age when compared to the 1989 RDAs. Conclusions: Despite a relatively high prevalence of underweight compared to overweight in these preschoolers, dietary analysis has indicated adequate dietary intakes in terms of total energy recommended for the age groups studied. However, total fat intake which represented 42% of TE, was high, with saturated fat (SF) contributing 15% to TE intake. This finding is cause for concern as excessive consumption of dietary fat has been implicated in the aetiology of CVD, obesity and some forms of cancer, and CHD is one of the main causes of morbidity and mortality in South Africa, especially among the Indian segment of the population. / AFRIKAANSE OPSOMMING: Meeste van die risikofaktore vir koronêre hartsiektes (KHS) soos hipertensie, dislipidemie, rook, nie-insulien afhanklike diabetes (NIADM), vetsug, fisiese onaktiwiteit en oorerflikheid, kom algemeen onder Suid-Afrikaanse bevolkingsgroepe voor, met Indiërs onder dié met die hoogste voorkoms in die land. Min gepubliseerde inligting is beskikbaar oor die eetgewoontes van voorskoolse kinders onder die Indiër bevolking. Die doel van hierdie studie was dus 0 m die voedingstatus van 'n groep Indiër voorskoolse kinders in Howick Wes ('n klein voorstad in die Kwa-Zulu Natal Middellande) te bepaal. Metodes: Dit was 'n dwarssnit studie van 50 voorskoolse Indiër kinders tussen die ouderdomme van 1-5 jaar, ewekansig geselekteer uit 632 beskikbare Indiër huishoudings in Howick Wes. Geskrewe en ingeligte toestemming is ontvang van die moeder/versorger van elke kind wat aan die studie deelgeneem het. Gestandaardiseerde en gevalideerde 24-uur herroep (24-H-R) en voedsel frekwensie vraelyste (QFFQ) soos gebruik in die Nasionale Voedsel Inname Studie (NFCS) van 1999, is aangepas en gebruik om gewoontelike inname en eetgewoontes van die 50 Indiër voorskoolse kinders te bepaal. Lengte en gewig is m.b.v. standaad tegnieke bepaal om die antropometriese status van die kinders te evalueer. Resultate: Die voorkoms van ondergewig was 14%. Dwerggroei het slegs 8% van die kinders geaffekteer en 2% het 'n risiko vir oorgewig getoon. Die gemiddelde energie inname van die kinders was hoër as wat aanbeveel word vir hierdie ouderdomsgroep. 'n Hoë vetinname is gevind, met 'n totale vet bydrae van 42% tot die daaglikse totale energie (TE) inname. Die bydrae van koolhidrate en proteïen tot TE was 45% en 10% respektiewelik. Lae gemiddelde innames van die volgende mikrovoedingstowwe is gevind (minder as 67% van die RDA): kalsium (22% van die kinders), vitamien D (90%), sink (56%) en jodium (90%), respektiewelik. Gebasseer op die 24-H-R, was die inname van die oorblywende mikrovoedingstowwe óf hoër óf gelyk aan wat aanbeveel word vir die betrokke ouderdomsgroep wanneer vergelyk word met die 1989 RDA. Gevolgtrekkings: Ten spyte van 'n relatiewe hoë voorkoms van ondergewig in vergelyking met oorgewig in hierdie voorskoolse kinders, was dieetinname voldoende in terme van totale aanbevole energie vir die ouderdomsgroep. Totale vetinname, wat 42% van TE uitgemaak het, was egter hoog en versadigde vette het 15% van TE bedra. Hierdie verskynsel is 'n rede tot kommer aangesien oormatige vetinname reeds geïmpliseer is in die etiologie van KHS, vetsug en sommige vorms van kanker, en KHS is een van die belangrikste oorsake van morbiditeit en mortaliteit in Suid Afrika, veralonder die Indiër bevolking.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Research aim The study aimed to explore the associations between agricultural biodiversity, household food security and dietary diversity in households with children aged 24 to 59 months in two rural areas of Kenya, of which one had higher rainfall and agricultural biodiversity than the other. Methods Study sample and location The study adopted a cross-sectional analytical approach to investigate the associations in resource in poor households in two rural areas; Akithii and Uringu of Kenya. Of the 525 households randomly selected, 261 were from Uringu division and 264 from Akithii division. Two independent cross-sectional surveys were conducted; Phase one in September to October 2011 (during the dry season) while Phase 2 took place in March 2012 (during the rainy season). A questionnaire was developed to gather information on the socio-demographics of the household, breastfeeding and infant feeding practices, immunization and childhood illnesses. Dietary intake was measured during each season by conducting a repeated 24-hour recall (24-hr recall) with the mother/care giver of the household. A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended dietary intake (RDI) value for that nutrient. A mean adequacy ratio (MAR) was calculated for 11 nutrients as the mean of the NARs of these nutrients. Dietary diversity was measured using data from the 24-hour recalls and classifying it into nine food groups. A dietary diversity score (DDS) was calculated based on each different food group which was consumed during the period of recall up to a maximum of nine if the food had been consumed from each of the nine groups. Household food security (HFS) was measured using the Household Food Insecurity Access Scale (HFIAS). The agricultural biodiversity was calculated by counting the number of different crops and animals eaten either from domestic sources or from the wild. Weight and height measurements of children and their mothers/care givers were taken. Weight for age (WAZ), height for age (HAZ) and weight for height z (WHZ) scores were determined for children, while body mass index (BMI) measurements were calculated for the adult women. The relationships between continuous response variables and nominal input variables were analyzed using appropriate analysis of variance (ANOVA) or pooled, paired and independent mean T-tests when only two groups were involved. Results Dietary intake was low with the majority of households not meeting the RDIs for most nutrients. The MAR was 61.3%; 61.8% for Phase 1 and 2 respectively. The DDS was low at 3.3 ±1.2 for both Phases. The majority of households were food insecure with a HFIAS mean of 12.8 ± 6.19 and 10.9 ± 7.49 for Phase 1 and 2 respectively. Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Two food items from the natural habitat originated from plants and one from animals. Exclusive breastfeeding up to the recommended six months was practiced at low rates of 23.4% while 39.3% of mothers in both divisions introduced complementary foods before 6 months of age. Stunted growth among the children was high at a mean of 30.5% (n=291). Boys had higher stunted growth rates in both divisions compared to the girls. A significant positive relationship was established between the number of contributors to household income with height for age z-scores (HAZ) scores of the children (Spearman r=-0.15, p=0.02). The number of household assets also significantly influenced HAZ scores (Spearman r=-0.17, p=0.01), the higher the number of household assets, the lower HAZ scores were. During Phase 1 (dry season) (pooled t-test, p<0.001), levels of food insecurity were higher compared to Phase 2 (wet season) (pooled t-test, p<0.001); showing the influence of season on food security. Phases 1 & 2 showed that Akithii had a significantly higher level of food insecurity (Mann-Whitney U; p<0.01), and a lower DDS (chi-square test, p<0.001) compared to Uringu. Children in Akithii consumed a less diversified diet than those in Uringu. Agricultural biodiversity was positively and significantly related to: HFIAS (Spearman r=-0.10, p=0.02); DDS (ANOVA, p<0.001); all NARs (Spearman, p<0.05) and MAR (Spearman, p<0.001).This implies that households with higher agricultural biodiversity were more likely to be food secure, have higher dietary diversity levels and a diet comprising a higher nutritional value. DDS was significantly correlated to MAR and NARs of all the nutrients studied in this study. Findings showed that DDS was also consistently significantly inversely correlated to Household Food Insecurity Access Prevalence (HFIAP) (R =-0.185, t (N-2)-3.889), p=0.0001). This correlation showed that an increase in dietary diversity inversely affected HFIAS. A significant relationship was found between HFIAP and MAR (ANOVA, p=0.00268); indicating that households with a higher MAR were more likely to be food secure. There was a significant correlation between the BMI of the mother/care giver and the WAZ scores of the children (r=0.1410, p<0.001); indicating that higher HAZ scores were found in mothers with higher mean BMI values. There was a significant difference between households with and without children with stunted growth in DDS (ANOVA; p=0.047) and HFIAS (ANOVA; p=0.009) but not with agricultural biodiversity score (ANOVA; p=0.486). The agricultural biodiversity mean score for households with children presenting with stunted growth were, however, lower at 6.8, compared to 7.0 for those with normal growth however the p value was not significant. This indicates that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not regarding agricultural biodiversity. This further implies that the potential of DDS and HFIAS to be used as proxy measures for stunting be further explored. Conclusion Agricultural biodiversity has a positive impact on household food security, dietary diversity, dietary adequacy and child growth. Food security is closely linked to dietary diversity and dietary adequacy; therefore improving one is likely to improve the other two and impact positively on child growth status. Interventions to improve child health and food security in resource poor rural households should aim at increasing dietary diversity through agricultural biodiversity. / AFRIKAANSE OPSOMMING: Navorsingsdoel Die studie is daarop gemik om die assosiasies tussen die landbou-biodiversiteit, huishoudelike voedselsekerheid en dieetdiversiteit in huishoudings met kinders tussen die ouderdomme van 24 tot 59 maande in twee landelike gebiede van Kenia, waarvan een 'n hoër reënval en landbou-biodiversiteit as die ander gehad het, te verken. Metodes Studie steekproef en plek Die studie het 'n deursnit-analitiese benadering aangeneem om die assosiasies te ondersoek in hulpbron-arm huishoudings in twee landelike gebiede; Akithii en Uringu van Kenia. Van die 525 huishoudings wat ewekansig gekies is, was 261 van Uringu afdeling en 264 van Akithii afdeling. Twee onafhanklike deursnit-opnames is uitgevoer; fase een in September tot Oktober 2011 (tydens die droë seisoen), terwyl Fase 2 in Maart 2012 (gedurende die reënseisoen) plaasgevind het. 'n Vraelys is ontwikkel om inligting oor die sosio-demografie van die huishouding, borsvoeding en babavoeding praktyke, immunisering en kindersiektes in te samel. Dieetinname is gemeet tydens elke seisoen deur die uitvoer van 'n herhaalde 24-uur herroep met die moeder / versorger van die huishouding. 'n Voedingstof toereikendheidsverhouding (VTR) is bereken vir elke voedingstof, uitgedruk as die persentasie van die voedingstof wat voldoen aan die aanbevole dieetinname (ADI) waarde vir daardie voedingstof. 'n Gemiddelde toereikendheidsverhouding (GTR) is bereken vir 11 voedingstowwe uitgedruk as die gemiddelde van die VTR‘s van hierdie voedingstowwe. Dieetdiversiteit is gemeet deur data vanuit die 24-uur herroepe, geklassifiseer in nege voedselgroepe. 'n Dieetdiversiteit telling (DDT) is bereken op grond van elke verskillende voedselgroep wat gedurende die tydperk van herroep ingeneem is tot 'n maksimum van nege, indien die voedsel verbruik is uit elk van die nege groepe. Huishoudelike voedselsekerheid (HVS) is gemeet deur die huishoudelike voedselonsekerheid toegangskaal (HVOTS) te gebruik. Die landbou-biodiversiteit is bereken deur die som te bereken van die aantal verskillende gewasse en diere geëet óf van huishoudelike bronne óf uit die natuur. Gewig en lengte metings is geneem van die kinders en hul moeders / versorgers. Gewig vir ouderdom (GVO), lengte vir ouderdom (LVO) en gewig vir lengte (GVL) Z-tellings is bepaal vir die kinders, terwyl die liggaamsmassa-indeks (LMI) metings bereken is vir die volwasse vroue. Die verhoudings tussen aaneenlopende reaksie veranderlikes en nominale inset veranderlikes is ontleed met behulp van toepaslike analise van variansie (ANOVA) of saamgevoegde, gepaarde en onafhanklike gemiddelde T-toetse, indien slegs twee groepe betrokke was. Resultate Dieetinname was laag en die meerderheid van huishoudings het nie aan die ADIs vir die meeste voedingstowwe voldoen nie. Die GTR is 61,3% en 61,8% vir onderskeidelik fase 1 en 2. Die DDT is laag; 3,3 ±1,2 vir beide fases. Die meerderheid van huishoudings was voedselonseker met 'n gemiddelde HVOST van 12,8 ±6,19 en 10,9 ±7,49 vir onderskeidelik fase 1 en 2. Landbou-biodiversiteit was laag met 'n totaal van 26 items, 23 huishoudelike en 3 vanuit die natuurlike habitat. Twee voedselitems uit die natuurlike habitat was afkomstig van plante en een vanaf diere. Eksklusiewe borsvoeding, tot die aanbevole ses maande, was laag en beoefen deur 23,4%, terwyl 39,3% van die moeders, in beide streke, komplimentêre voedsel voor 6 maande ouderdom bekendgestel het. Vertraagde groei onder die kinders was hoog met 'n gemiddeld van 30,5% (n=291). Seuns het hoër vertraagde groei in beide streke in vergelyking met dogters getoon. ʼn Beduidende positiewe verhouding is gevind tussen die aantal bydraers tot huishoudelike inkomste en lengte vir ouderdom z-tellings (LOZ) van die kinders (Spearman r=-0,15, P=0,02). Die aantal huishoudelike bates het ook LOZ tellings (Spearman r=-0,17, P=0,01) aansienlik beïnvloed; hoe hoër die aantal huishoudelike bates, hoe laer die LOZ tellings. Tydens fase 1 (droë seisoen) (saamgevoegde t-toets, p<0.001), was vlakke van voedselonsekerheid hoër in vergelyking met fase 2 (nat seisoen) (saamgevoegde t-toets, p <0.001), wat die invloed van die seisoenaliteit op voedeselsekerheid uitwys. Fase 1 en 2 het gewys dat Akithii ʼn beduidende hoër vlak van voedselonsekerheid gehad het (Mann-Whitney U; p<0.01) en ʼn laer DDT (chi-square toets, p<0.001) in vergelyking met Uringu. Kinders in Akithii het ʼn dieet laer in diversiteit ingeneem as die in Uringu. Landbou-biodiversiteit is positief en beduidend verwant aan: HVOTS (Spearman r = -0,10, P = 0,02); DDT (ANOVA, p<0.001), alle VTR‘s (Spearman, p <0.05) en GTR (Spearman, p <0.001). Dit impliseer dat huishoudings met 'n hoër landbou-biodiversiteit, meer geneig is om voedselseker te wees, hoër dieetdiversiteit vlakke en ʼn hoër voedingswaarde het. DDT is beduidend gekorreleer aan GTR en VTT‘s van al die voedingstowwe wat bestudeer is in hierdie studie. Bevindinge het getoon dat DDT konsekwent en beduidend omgekeerd gekorreleer is met huishoudelike voedselonsekerheid toegang prevalensie (HVOTP) (R=-0,185, t(N-2)-3,889), p=0,0001). Hierdie korrelasie toon dat 'n toename in dieetdiversiteit HVOTS omgekeerd beïnvloed het. ʼn Betekenisvolle verhouding is gevind tussen HVOTP en GTR (ANOVA, p=0,00268); wat aandui dat huishoudings met 'n hoër GTR meer geneig is om voedselsekerheid te toon. Daar is 'n beduidende korrelasie tussen die LMI van die moeder / versorger en die GOZ tellings van die kinders (r=0,1410, p<0.001), wat aandui dat hoër LOZ tellings gevind is in moeders met hoër gemiddelde LMI waardes. Daar is 'n beduidende verskil tussen huishoudings met en sonder kinders met dwerggroei se DDT (ANOVA; p=0.047) en HVOTS (ANOVA; p=0.009) maar nie die landbou-diversiteit telling nie (ANOVA; p=0.486). Die gemiddelde landbou-diversiteit telling vir huishoudings met en sonder kinders met dwerggroei is egter laer met 6.8 in vergelyking met 7.0 vir die met normale groei. Die p-waarde is egter nie beduidend nie. Dit dui aan dat huishoudings met kinders met dwerggroei en daarsonder beduidend verskillend is ten opsigte van DDT en HVOTS, maar nie met landbou-diversiteit in die studie nie. Dit impliseer verder dat die potensiaal van DDT en HVOTS om gebruik te word as alternatiewe metings vir dwerggroei verder ondersoek moet word. Gevolgtrekking Landbou-biodiversiteit het 'n positiewe impak op huishoudelike voedselsekerheid, dieetdiversiteit, dieettoereikendheid en groei van kinders. Voedselsekerheid is nou gekoppel aan dieetdiversiteit en dieettoereikendheid, daarom sal die verbetering van die een waarskynlik die ander twee positief beïnvloed asook ʼn positiewe impak hê op die groei van kinders. Intervensies vir die verbetering van kindergesondheid en voedselsekerheid in hulpbron-arm landelike huishoudings moet poog om dieetdiversiteit te verhoog deur landbou-biodiversiteit.

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.

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.

MCur / Department of Advanced Nursing Science / Background: Globally, malnutrition among children is one of the most challenging and critical public health problem, and it remains one of the most common causes of morbidity and mortality among children under the age of 5 years. There is no exception for the Vhembe District. Purpose: The study determined the perceptions of young mothers regarding causes of malnutrition in children under the age of 5 years in the Vhembe District, of the Limpopo Province. Methodology: This study used qualitative, exploratory, descriptive and contextual design to collect data among young mothers regarding causes of malnutrition in children under 5 years. Twelve young mothers were sampled using probability, simple random sampling at selected hospitals population. In-depth individual interviews were used to collect data and analysed using Tesch’s steps. Measures to ensure trustworthiness and ethical consideration were adhered to throughout the study. Results: Three themes emerged from the analysed data, namely: Young mothers’ perceived causes of malnutrition, young mother’s beliefs about malnutrition, and health care seeking actions for a malnourished child. Recommendations: This study recommend a strategies to integrate young mothers into the health promotion regarding their understanding and experiences about malnutrition. Policies on child nutrition should be reviewed regularly in the Vhembe District for prevention and management of malnutrition in children under 5. / NRF