Aim. The aim of this study was to document and provide a critical analysis of the South African Food-Based Dietary Guidelines (FBDGs) development process, and to assess the appropriateness of the proposed South African FBDGs. To achieve this aim, specific study objectives included the following : (1) To document and critically analyse the South African FBDGs process in relation to the 10-step development process recommended by the FAO/WHO. (2) To assess the appropriateness of the proposed South African FBDGs in terms of consumer comprehension (perceptions, general understanding and specific interpretations), and application of the guidelines (ability to apply the guidelines when planning a typical day' s meals for their families). (3) To assess the compatibility of the proposed South Africa FBDGs in terms of food categorisation as perceived by consumers, and as depicted in the food guides that are commonly used. Methodology. An extensive literature review on the development of international dietary guidelines, the emergence of FBDGs and the FAO/WHO FBDGs process, together with documentation of the South African FBDGs process, was used to critically analyse the process used for developing the proposed South African FBDGs. Focus group discussions (n=15) and structured individual interviews (n=230) were held in ten magisterial districts within KwaZulu Natal (KZN), randomly selected according to settlement strata (rural, urban informal, urban formal) and ethnicity (Black, Indian, White) to reflect the KZN population. Participants were women with no formal nutrition training, who made the food purchasing and preparation decisions in the household. A total of 103 women participated in the focus group discussions and 230 women in the structured individual interviews. Results. The process followed by the SA FBDG Work Group has ensured that the proposed South African FBDGs are country-specific in that each FBDG is evidence-based and relates to specific nutrition-related public health concerns of South Africans. Except for the "Eat healthier snacks" FBDG, participants understood and interpreted the FBDGs as intended by health professionals, and could construct a day's meals to reflect the FBDGs. Only two other FBDGs were identified as confusing in terms of terminology used, namely, "legumes" and "foods from animals". By rewording these guidelines the FBDGs would be highly compatible in terms of personal food categorisation. Use of food guides was low, mainly due to a lack of knowledge about how to use them. In terms of food categorisation as depicted by the reportedly most commonly used food guides (3- and 5- Food Group Guides), these food guides are incompatible with the proposed FBDGs. Conclusions. Within the South African context, the FAO/WHO FBDGs development process was feasible and practical to implement. However, to ensure sustainability of the South African FBDGs process, it is strongly recommended that the Department of Health appoint a representative scientific committee specifically for the purpose of reviewing and reformulating the South African FBDGs. Results indicate that a single set of FBDGs can be appropriate for all South Africans provided that certain guidelines are reworded as suggested; and that all the guidelines are accompanied by explanatory information citing commonly consumed foods/drinks as well as practical examples of how to apply the guidelines in light of perceived barriers. In terms of the appropriateness of food guides commonly used in South Africa, there is a need to either move away from the concept of food groups and/or to develop a new South African food guide that is compatible with the proposed FBDGs. / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 2002.

The study found that there is marked poverty in Lekoko village, and that food security is lacking. Purchasing power of household commodities and consumables is observed to be non-existent. Agriculture as a form of food security has eluded many because of drought. All those who practised subsistence fanning are unable to do so. Food security is greatly impaired; the people cannot access sufficient aid and nutritious food. This includes the problem of food production, preservation and storage. The projects and programmes initiated by the Government to alleviate poverty do not reach the people. Substantial changes are needed to expedite the distribution of food Production resources. Formal and informal institutions should be involved in bringing about transformation of the structures, which are currently blocking the socio-economic. Premium access to information and social networks as well as to the State should be improved. The onus rests with extension officers to support the people and bring about generation of livelihoods with institutional reform to reduce vulnerability and risks. / M.A. (Peace Studies and International Relations) North-West University, Mafikeng Campus, 2005

This dissertation is a study of the ambit of the right to food as it is contained in the South African Bill of Rights and the steps needed to realise the right. Existing and potential food insecurity, hunger and malnutrition provide the social context for this research. The rationale for conducting the research is primarily two-fold. Firstly, the access to sufficient food is an indispensable right for everyone living in this country. Secondly, the right to food in South Africa has not been subject to extensive academic study to date. Socio-economic rights are fully justiciable rights in this country, equally worthy of protection as civil and political rights. Furthermore, socio-economic rights (like the right to food) are interdependent with civil and political rights: neither category can meaningful exist without realisation of the other. The right to sufficient food is found in section 27(1)(b) of the South African Constitution. Children have the additional right to basic nutrition in terms of section 28(1)(c). The right to sufficient food is subject to the internal limitation of section 27(2) that the state must take reasonable measures, within its available resources, to achieve the progressive realisation of the right. Furthermore, as with all rights in the Bill of Rights, both these rights are subject to the general limitations clause found in section 36. There is international law authority in various human rights instruments for the protection of the right to food and what the right entails. In accordance with section 39 of the Constitution, such international law must be considered when interpreting the right to food. It is argued that a generous and broad interpretation of food rights in the Constitution is called for. Existing legislation, state policies and programmes are analysed in order to gauge whether the state is adequately meeting its right to food obligations. Furthermore, the state’s food programmes must meet the just administrative action requirements of lawfulness, reasonableness and procedural fairness of section 33 of the Constitution and comply with the Promotion of Just Administrative Justice Act. The dissertation analyses the disparate and unco-ordinated food and law policies in existence, albeit that the National Food Security Draft Bill offers the hope of some improvement. Particular inadequacies highlighted in the state’s response to the country’s food challenges are a lack of any feeding schemes in high schools and insufficient food provision in emergency situations. Social assistance grants available in terms of the Social Assistance Act are considered due to their potential to make food available to grant recipients. On the one hand there is shown to be a lack of social assistance for unemployed people who do not qualify for any form of social grant. On the other hand, whilst presently underutilised and not always properly administered, social relief of distress grants are shown to have the potential to improve access to sufficient food for limited periods of time. Other suggested means of improving access to sufficient food are income generation strategies, the introduction of a basic income grant and the creation of food framework legislation. When people are denied their food rights, this research calls for creative judicial remedies as well as effective enforcement of such court orders. However, it is argued that education on what the right to food entails is a precondition for people to seek legal recourse to protect their right to food. Due to a lack of case authority on food itself, guidance is sought from the findings of South Africa’s Constitutional Court in analogous socio-economic rights challenges. Through this analysis this dissertation considers the way forward, either in terms of direct court action or via improved access to other rights which will improve food access.

Submitted in fulfillment of the requirements of the Masters of Applied Science in Food and Nutrition, Durban University of Technology, 2015. / AIM: The aim of the study was to identify the need, develop, implement and determine the effect of a Grade R Nutrition Education Programme (NEP) in order to make recommendations to the South African Department of Basic Education (DBE) to include an effective NEP in the pre-primary school education curriculum. OBJECTIVES: The objectives for this study is in two phases, The objective of the baseline study was to assess the need for nutrition education (NE) in Grade R in suburban areas of Durban and identify the most suitable nutrition education tools (NETs) for this age group. For the intervention study the objectives were 1) to develop a nutrition knowledge questionnaire (NKQ) to determine the existing nutrition knowledge of Grade R learners in suburban government and private schools in Durban, 2) to develop a nutrition education programme (NEP) for Grade R based on the South African Food-Based Dietary Guidelines (FBDGs) and the food groups, 3) to implement the NEP in Grade R in a government and private school, 4) to determine the effect of the NEP on the retention of FBDGs (Section one) and food group (Section two) knowledge, and 5) to compare the results between the control group (CG) and the government (EGG) and private (EPG) experimental school groups, and between genders. METHODS: A self-administered nutrition education needs questionnaire was completed by 20 Grade R teachers in Durban suburban schools. Nutrition education material was identified based on the results from the pilot study and a Nutrition education programme developed. The classroom-based intervention study involved 120 Grade R learners in three schools, two experimental schools: government (n=37) and private (n=40), with a control school (n=43), with 35 percent (n= 42) male and 65 percent (n=78) female participants, ranging in age from five to seven years. A validated questionnaire assessed baseline nutrition knowledge of these children. A qualified foundation phase teacher was trained to implement the NEP. The experimental school groups received eight one hour nutrition education (NE) lessons over an eight week period; the control group did not receive any NE. During the lesson firstly theory was covered then the children worked on the related fun activities in the Healthy Eating Activity Book (HEAB) and lastly involved in the nutrition educational games. These included a food group plate puzzles, a NEP board game, a card game and ‘My little story books’. A post-test determined the impact of the intervention. RESULTS: The baseline study confirmed the need for NE in Grade R and identified suitable NETs that were used in the intervention. At pre-test, the nutrition knowledge of Grade R children in the two experimental groups (EG) and one CG was very similar with knowledge of FBDGs greater than knowledge relating to the food groups. Both Grade R EGs showed a significant increase in knowledge for the whole test immediately after the intervention with the CG, achieving similar post-to pre-test results. The intervention had a significant impact on nutrition knowledge of Grade R children in both experimental schools (EGG p=0.004 and EPG p=0.001). The EPG were most knowledgeable regarding FBDGs with no significant difference in knowledge of the EGG. Food group knowledge in all schools was poor at baseline and the NEP resulted in the EGG obtaining the highest post-test results. Post-intervention for the whole test the EGG were marginally (0.80 percent) more knowledgeable than the EPG. The knowledge of boys and girls were very similar in pre-and post-test results. However, the boys were fractionally more knowledgeable than the girls in relation to the whole post-test. In Section two, relating to food group knowledge, girls were slightly more knowledgeable than boys although both genders lacked knowledge in relation to which foods belonged to a particular food group. CONCLUSION: The primary aim of formal NE was met as the statistical significance between the CG and experimental group post-test results was evident in the majority of Section one questions and in all questions in Section two. The NEP resulted in similar increase in knowledge of Grade R learners in the government and private experimental school groups in Durban. In addition, the boys and girls showed a minimal difference in nutrition knowledge.

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.

This study evaluates the school feeding programme at Magog Primary School. It sets out as its objective to find out how the programme operates and its potential impact on school children, including challenges, if any, and recommends solutions to mitigate the challenges. It was motivated by the need to provide information which could be used as a basis to ensure that the nutritional and educational objectives of the National School Nutritional Programme are achieved. A review of literature demonstrated that, within the developmental framework, the point of view of civil society, government and the academia on the school feeding programmes are a valuable strategy to intervene in the nutritional and cognitive development of learners. It also made it evident that there are diverse views as to whether the School Feeding Programme is achieving its intended objectives. The findings of this study suggest that, although the programme has the potential to improve nutrition and health, enrolment, attendance and cognitive development, there are still some challenges and areas that need to be addressed and improved. These challenges arise as a result of lack of effective monitoring and evaluation, geographical location of the schools and other implementation flaws. The consequences are that the objectives of the National School Nutritional Programme are placed at risk. / Development Studies / M.A. (Development Studies)

This study evaluates the school feeding programme at Magog Primary School. It sets out as its objective to find out how the programme operates and its potential impact on school children, including challenges, if any, and recommends solutions to mitigate the challenges. It was motivated by the need to provide information which could be used as a basis to ensure that the nutritional and educational objectives of the National School Nutritional Programme are achieved. A review of literature demonstrated that, within the developmental framework, the point of view of civil society, government and the academia on the school feeding programmes are a valuable strategy to intervene in the nutritional and cognitive development of learners. It also made it evident that there are diverse views as to whether the School Feeding Programme is achieving its intended objectives. The findings of this study suggest that, although the programme has the potential to improve nutrition and health, enrolment, attendance and cognitive development, there are still some challenges and areas that need to be addressed and improved. These challenges arise as a result of lack of effective monitoring and evaluation, geographical location of the schools and other implementation flaws. The consequences are that the objectives of the National School Nutritional Programme are placed at risk. / Development Studies / M. A. (Development Studies)

MSCPNT / Department of Nutrition / Objectives: The study objectives were to determine demographic and environmental factors that can affect nutritional status of children receiving CSG, to assess the nutritional knowledge of caregivers, to determine the proportion of CSG spent on food and to determine the nutritional quality of food bought from CSG. Design: Cross-sectional descriptive with an analytical component Subjects: PCG of children under the age of 5 receiving CSG in Mogalakwena Municipality. 189 caregiver-child pairs were interviewed, in their households. Methods: Data collected by the interviewer included demographic data, Use of CSG, nutritional knowledge and the HHFI and anthropometric measurements were done by a 3rd year Nutrition student. Results: About 36.5% of participants were in the age 26-35 years, 75.7% were unmarried, 84.1% were unemployed and 72% had no matric. Mean age for children studied was 2.84±1.33, 77.8% of participants stayed in a household of more than 5 people. In terms of types of housing, 56% had formal houses, 55% had access to pit latrines and 52.9% used communal taps to access water, 41.3% used electricity for energy while 23.3% used wood to stretch the availability of electricity. Mean CSG received was R386.22 ±R208.75. Majority of participants (56.1%) indicated that CSG supports the whole family and 64.6% of the families depended solely on CSG for survival, while 27% of families had elderly people receiving pension grant which was supplementing the CSG. The CSG was used for different items, majority of families used 94.2% of the money for food at a mean of R171.55±159.25, followed by toiletry (71.6%) at a mean R61.89±69.24, then clothing (68.9%) at a mean of R70.77±97.14. Stokvel was also mentioned as one of the items contributed for by CSG, 32.3% of participants used more than R50.00 for stokvel. Different food items were purchased using CSG, 80.5 % of the money was used to purchase starchy food, mealie meal being the highest commodity at 43.7%. Offal (35.8%) was the highest protein source purchased followed by poultry at 26.4% and soya soup at 20%. Potatoes (19.6%) were mentioned as the most purchased vegetable, followed by cabbage (14.8%). There was a 53.5% of prevalence of stunting, of this 19.6% of children were severely xiii stunted, 5.3% underweight, and 32.3% of wasting. There were 22.1 % of PCG who were overweight and 12.1% were obese. The PCG BMI was negatively associated with WAZ (r= -0.48, p=0.515). There was a positive association between PCG BMI and HAZ (r=0.103, p=0.158), however when caregivers BMI was correlated to BAZ the association was strongly negatively significant (r=0.206, p=0.004). Most PCG received nutrition education from relatives, 71.1% were never educated on nutrition, 57.9% of children were fed 3X/ day. Conclusion: It is apparent from the study that malnutrition, precisely stunting is still a problem in South Africa, however this does not disregard the impact that CSG has on the lives of the poor. It affords the families to access basic needs in the household such as food, toiletry, electricity and even stokvel. The role of nutritionists/ dieticians is paramount in helping mothers to choose healthier economic food for the children in order to curb the burden of malnutrition. / NRF

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

Foodborne diseases are a major challenge to school feeding programmes because inadequate food safety knowledge and skills of staff can result in unsafe food handling practices and cross-contamination, thus causing foodborne disease outbreaks. The aim of this study was to investigate the food safety and quality assurance measures of the National School Nutrition Programme (NSNP) in Mpumalanga Province, South Africa. The research design was cross-sectional quantitative in nature. A total of 300 NSNP food service managers/coordinators and 440 food handlers were selected to participate in the study. Data collection was by means of a selfadministered structured questionnaire and 192 food contact surface swap samples from 32 primary and secondary public schools.The majority of schools offering NSNP meals were located in informal settlements and most were found to lack basic resources such as electricity and potable tap water in their kitchens. 93% of food handlers did not know about Hazard Analysis Critical Control Point (HACCP). The NSNP food service managers in some schools, especially in schools located in rural settlements, were found to have little knowledge or awareness of HACCP. No school was found to have implemented the HACCP, and only a few staff had received food safety training. Inadequate food safety knowledge was worst in schools located in informal settlements due to a lack of training. Up to 60% of food handlers did not know the correct procedure for washing a cutting board after it had been used. In addition, just over 95% of the food handlers did not know how to sanitise utensils and cutting surfaces after cutting up raw meat. The lack of hygiene was confirmed by the presence of Listeria monocytogenes, Staphylococcus aureus, E.coli 015:H7, Salmonella and Shigella species on food contact surfaces. A total of 22 different bacteria genera were identified. It is essential to monitor NSNP kitchen hygiene practice to ensure the minimal contamination of food products and newly recruited food handlers should be trained on food handling practice and principles to ensure the safety of prepared food for school children. / Health Studies / D. Phil. (Consumer Science)