Magister Public Health - MPH / Background: NAMDEB is a Namibian alluvial diamond mining company, owned in equal shares by the government of republic of Namibia and De Beers. It is mining in the open-cast mines along the southern coast of Namibia, using various methods and equipments such as bowl scrapers, bulldozers, trackdozers and excavators. NAMDEB have got different mining site, where employees are residing in hostels near the mine. One of those mines is the Pocket Beaches mine where this study took place. The study investigated the prevalence and factors associated with obesity amongst employees of Pocket Beaches mine. Obesity rates are increasing at an alarming rate worldwide; 1.2 billion people worldwide are overweight of which 300 million are clinically obese. Of concern is that obesity is a risk factor for many diseases including hypertension, diabetes and other forms of cancers. Although there are several mine workers who on reporting to occupational health services for minor ailment are found to be overweight or obese, we are not certain of the extent of the problem. The health risk associated with obesity could cause a big loss to NAMDEB in terms of care cost, low productivity and absenteeism. Aim: The aim of this study was to investigate the prevalence and determinants of obesity amongst NAMDEB employees working at Pocket Beaches diamond mine Study design: a descriptive, cross-sectional study measured the prevalence of obesity and describes the factors that are associated with obesity and overweight. Study population: NAMDEB employees who were working at Pocket Beaches mine. A simple random sampling technique was used to select participants. 87 employees were selected from 188 total NAMDEB employees working at Pocket Beaches mine. Data collection: Data was collected through interviews. Anthropometric measurements namely weight, height and abdominal circumference were collected using a standard protocol. Analysis: Data was analyzed using Epi Info 2002. Body Mass Index (BMI) was calculated as kg/m2. Overweight was defined as BMI = 25 to 29.9 kg/m2 and obesity as BMI ≥ 30 kg/m2. Waist Circumference ≥80 cm was used to identify central obesity in women and ≥90 cm in men. The frequency of participation in physical activity, barriers to physical activity and food consumption is reported in percent and means. Result: The study found prevalence 42% overweight and 32% obesity among employees of NAMDEB. A significant number of participants 48% never participate in moderate exercise per week. 71% of participants reported lack of motivation to exercise and too tired after work as the major barriers to physical activity. The consumption of fatty foods such as fried chicken and fried meat was common among study subjects. A large number of respondents 79% eat fried chicken regularly while 74% eat fried meat regularly. 79% of participants consumed inadequate fruits and vegetable (1 fruit and vegetable per day). The two most mentioned reasons for low fruits and vegetables consumption were lack of fruits and vegetables in hostel food menu and 14% don’t like fruits. / South Africa

PhD, Faculty of Health Sciences, University of the Witwatersrand / Background: In low- to middle-income countries, rising levels of overweight and obesity are a result of multiple transitions, in particular, a nutrition transition. Consequently, in these countries, metabolic diseases are contributing increasingly to disease burden, despite the persisting burden of undernutrition and infectious diseases. Understanding the patterns and factors associated with persistent undernutrition and emerging obesity in children and adolescents, and concomitant risk for metabolic disease, is therefore of criticial importance. This should contribute to public health policy on interventions to prevent adult disease. Aims: To better understand the double burden of malnutrition in a poor, high HIV prevalent, transitional society in a middle-income country; In so doing, to inform policies and interventions to address the double burden of malnutrition. Methods: A cross-sectional growth survey was conducted in 2007 targeting 4000 children and adolescents 1-20 years of age living in rural South Africa. The survey was nested within the ongoing Agincourt Health and Socio-demographic Surveillance System, which acted as the sampling frame and also provided data for explanatory variables. Anthropometric measurements were performed on all participants using standard procedures. In addition, HIV testing was done on children aged 1 to 5 years and Tanner pubertal assessment was conducted among adolescents 9-20 years. A one-year follow-up of HIV positive children included a matched control group of HIV negative counterparts. Data collection involved both quantitative and qualitative methods. Growth z-scores were used to determine stunting, underweight and wasting and were generated using the 2006 WHO growth standards for children up to five years and the 1977 NCHS/WHO reference for older children. Overweight and obesity were determined using the International Obesity Task Force cut-offs for BMI for children aged up to 17 years and adult cut offs of BMI =25 and =30 kg/m2 for overweight and obesity respectively for adolescents 18 to 20 years. Waist circumference cut-offs of =94cm for males and =80cm for females, and waist-to-height ratio of 0.5 for both sexes, were used to determine central obesity and hence metabolic disease risk in ix adolescents. Descriptive analysis described patterns of nutritional status by age, sex, pubertal stage and HIV status. Linear and logistic regression was done to determine predictors of nutrional outcomes. A p-value of <0.05 was considered statistically significant. Results: Prevalence of undernutrition, particularly stunting, was substantial: 18% among children aged 1-4 years, with a peak of 32% in children at one year of age. Stunting and underweight were also substantial in adolescent boys, with underweight reaching a peak of 19% at 14 years of age. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was prominent among adolescent girls, increasing with age, and reaching a peak of 25% at 18 years. Risk for metabolic disease using waist circumference cut-offs was substantial among adolescents, particularly girls, increasing with sexual maturation, and reaching a peak of 35% at Tanner stage 5. Prevalence of HIV in children aged 1-4 years was 4.4%. HIV positive children had poorer nutritional outcomes than that of HIV negative children in 2007. The impact of paediatric HIV on nutritional status at community level was, however, not significant. Significant predictors of undernutrition in children aged 1-4 years, documented at child, maternal, household and community levels, included child’s HIV status, age and birth weight; maternal age; age of household head; and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease in adolescents aged 10-20 years, documented at individual/child and household levels included child’s age, sex and pubertal development; and household-level food security, socio-economic status, and household head’s highest education level. There was a high acceptance rate for the HIV test (95%). One year following the test, almost all caregivers had accepted and valued knowing their child’s HIV status, indicating that it enhanced their competency in caregiving. Additionally, nutritional status of HIV positive children had improved significantly within a year of follow-up. Conclusions: The study describes co-existing child stunting and adolescent overweight/obesity and risk for metabolic disease in a society undergoing nutrition transition. While likely that this profile reflects changes in nutrition and diet, variation in infectious disease burden, physical activity patterns, and social influences need to be investigated. The findings are critical in the wake of the rising public health importance of metabolic diseases in low- to middle-income countries, despite the unfinished agenda of undernutrition and infectious diseases. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged. In addition, gender-biased nutritional patterns call for gender-sensitive policies and interventions. The study further documents a significant role of paediatric HIV on nutritional status, and the potential for community-based paediatic HIV testing to ameliorate this. Targeted early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.

Quilombolas são descendentes de escravos africanos. Os quilombolas do Ribeira estão estabelecidos em áreas remotas ao longo da Bacia do Rio Ribeira de Iguape (sul do Brasil), cobertas pela vegetação da Mata Atlântica, um dos hotspots de biodiversidade do mundo. Desde os primórdios da ocupação (século XVIII), os quilombolas tem sido historicamente dependentes do cultivo de arroz, milho, mandioca e feijão pelo sistema de corte-e-queima. No entanto, desde a década de 1970, seus estilos de vida vem sendo profundamente alterados por mudanças da economia-política regional como, por exemplo, a construção de estradas e escolas rurais, o estabelecimento de áreas de conservação na região e pela implementação de programas governamentais de transferência de renda. Assim, algumas tendências locais consistem no aumento da renda e na substituição do cultivo de corte-e-queima pela intensificação agrícola e trabalho assalariado. Para compreendermos como as mudanças nas estratégias produtivas podem estar interagindo com os padrões nutricionais locais, coletamos dados de dieta, antropometria e alocação de tempo dos indivíduos de duas comunidades quilombolas peri-urbanas/rurais. As pessoas da primeira comunidade encontram-se mais voltadas para o plantio de cultívares comerciais, trabalho assalariado e artesanato do que aquelas da segunda, que orientam suas atividades produtivas sobretudo para a agricultura de subsistência e para o extrativismo de produtos florestais não madeireiros. Apesar das diferenças nas estratégias produtivas, encontramos os mesmos padrões de dieta e de atividade física em ambas as comunidades: seus núcleos calórico-proteicos parecem ser constituídos por comidas ricas em calorias, processadas ou provenientes de animais domesticados e em ambas as comunidades parece haver uma tendência de redução quanto à demanda energética associada às atividades produtivas a ocorrência simultânea destas tendências caracterizam a ocorrência de um processo demográfico mais amplo chamado Transição Nutricional (TN) (Popkin e Gordon-Larsen, 2004). Em conclusão, nossos dados sugerem que independentemente da estratégia produtiva adotada, ambas as comunidades passam por de TN e que as mulheres vêm sendo mais impactadas pelo processo do que os homens, em razão destes últimos, provavelmente, ainda se manterem envolvidos, em algum nível, com atividades agrícolas. Os programas governamentais de transferência de renda (bolsa-família) podem ser relevantes na definição das similaridades nos padrões de consumo alimentar encontrados. / Quilombolas are African slave descendants. The Ribeira Valley is one of the most important areas of concentration of Quilombos in Southern Brazil. The Ribeira Quilombolas are settled in remote areas along the Ribeira River system covered by Atlantic rain forest vegetation, one of the worlds biodiversity hotspots. Since the first settlements (18th Century), they have been historically dependent on shifting cultivation of rice, maize, manioc and beans. However, since 1970\'s their life style has been profoundely affected by changes in regional political economy, such as the opening of a roadway, the establishment of conservation areas in the region and the setting-up of rural schools. Some of the local trends consist of replacing shifting cultivation and increasing household income mainly through agricultural intensification, wage labour and government cash transfer programs. In order to grasp the way changes in economic strategies have affected the nutritional patterns, we collected data of diet, anthropometry and time allocation of individuals from two Quilombola peri-urban/rural communities. People from the first community have become more oriented to commercial crops, wage labor and handicrafts than people from the other one, still more tied to subsistence agriculture and the gathering of non-timber forestall products. Despite the differences in productive strategies, we found the same diet and physical activity patterns: the energy-protein core consisted of the same energy rich and processed foodstuff or foods from domesticated animals, and Quilombolas seem to have had their energy demands reduced, probably because of the decrease of agricultural activities. However, only men are still significantly involved in agricultural oriented activities. We concluded that regardless of the economic strategy adopted, both communities are undergone Nutrition Transition process (a global trend that consists of increasing the comsumption of energy rich foodstuff and of decreasing of energy expenditure levels (Popkin e Gordon-Larsen, 2004)) and women might be more impacted by the process than men. Additionally, government cash transfer programs seem to affect the diet and physical activities patterns found.

No description available.

Background: The global burden of cardiovascular diseases (CVDs) is escalating as part of the rapid health transition that developing countries are experiencing. This increase is associated with shifts in demographics and economics, two of the major factors that affect diet and activity. The term social drift phenomenon (SDP) is used to describe the observations that: in the early stages of the epidemiological and nutrition transitions, it is usually the more affluent, higher socio–economic groups that are affected; in the later stages, it is the poor, lower socio–economic groups that display the consequences of these transitions. Therefore, in developing countries at the beginning of the transition, affluent people have higher prevalence of obesity and increased CVD risk. In developed countries, at much later stages of the transition, obesity and increased CVD risk is more prevalent in the lower socio–economic groups. In South Africa, the Transition and Health during Urbanisation of South Africans (THUSA) study which was done in 1996/1998 indicated that at that time, most of the risk factors for CVD were observed in the more urbanised (richer) subjects. It is not known if this pattern changed in any way due to the present rapid urbanisation of South African blacks. Therefore, in this study we explored the associations between socio–economic status (SES) (measured by level of urbanisation, education and employment) and CVD risk factors in an African population undergoing transition in the North–West Province of South Africa, that were prevalent in 2005 when the baseline data for in the Prospective Urban and Rural Epidemiology (PURE) study were collected. Objectives: The main objective of this dissertation was to examine the SDP in an African population in a nutrition and health transition, by: (i) Reviewing the literature on associations between socio–economic variables and biological health outcomes focusing on CVD risk factors in developed and developing countries; (ii) Analysing the baseline data from the 2005 PURE study to examine the relationships between components of SES, namely level of iii urbanisation, education and occupation, and nutrition–related CVD risk factors in men and women participating in the PURE study; and (iii) Comparing results on these associations between CVD risk factors and SES from the PURE study with those found in the THUSA study, which was conducted almost 10 years earlier, to examine if social drift in these associations has taken place. Study design: The dissertation is based on a comparison of the CVD risk factors and socio–economic status of the THUSA and PURE studies. Secondary analysis of the baseline cross–sectional epidemiological data from the PURE study was executed. The South African PURE study is part of a 12–year Prospective Urban and Rural Epidemiology study which investigates the health transition in urban and rural subjects in 22 different countries. The main selection criterion was that there should be migration stability within the chosen rural and urban communities. The rural community (A) was identified 450 km west of Potchefstroom on the highway to Botswana. A deep rural community (B), 35 km east from A and only accessible by gravel road, was also included. Both communities are still under tribal law. The urban communities (C and D) were chosen near the University in Potchefstroom. Community C was selected from Ikageng, the established part of the township next to Potchefstroom, and D from the informal settlements surrounding community C. The baseline data for PURE were collected from October to December 2005. A total of 2010 apparently healthy African volunteers (35 years and older), with no reported chronic diseases of lifestyle, tuberculosis (TB) or known human immunodeficiency virus (HIV) were recruited from a sample of 6000 randomly selected households. Methods: A variety of quantitative and qualitative research techniques was used by multidisciplinary teams to collect, measure and interpret data generated from biological samples and validated questionnaires. For this study, the statistical package for social sciences (SPSS) package (version 17.0, SPSS Inc) was used to analyze the data. Means and 95% confidence intervals (CI) of CVD risk and dietary factors were calculated. Participants of both genders were divided into different groups (according to urbanisation, education and employment levels) and compared. Estimated significant differences between rural and urban participants were determined with analysis of variance using the general linear model (GLM), multivariate procedure. Univariate analysis was used to explore further the influence of education on CVD risk factors and dietary intakes. Employment was used as a proxy for income, and pairwise comparisons using GLM, multivariate procedure were done for comparing the three groups (Not answered, employed and not employed). Tests were considered significant at P<0.05. Results: Comparison of urban with rural subjects participating in the PURE study showed that urban men had significantly higher systolic and diastolic blood pressures and lower fibrinogen levels than rural men. In women, systolic and diastolic blood pressure, fasting blood glucose and serum triglycerides were significantly higher in urban subjects whereas fibrinogen levels were significantly lower among urban subjects. After examining the relationship between the level of education and CVD risk factors, we observed that men with higher education levels had significantly higher BMI. In women, serum triglycerides and blood pressure were lower and BMI was significantly higher in the educated subjects. Because it was difficult to distinguish between reported household and individual income levels, we compared CVD risk factors of employed and unemployed subjects. Employed men had significantly higher BMI whereas the unemployed men had significantly higher fasting glucose and fibrinogen levels. Although mean blood pressure of employed men was higher than that of unemployed men, the difference did not reach significance. In women, the only significant difference seen was that employed women had lower high density lipoprotein (HDL) cholesterol, fasting glucose, triglycerides and fibrinogen levels, but they had a significantly higher BMI. Employed women had significantly higher BMI than unemployed women (27.9 [26.3–29.4] versus 26.5 [26.0–27.0] kg/m2). It seems that most of the nutrition related CVD risk factors were still higher in the higher socio–economic group, a situation similar to that reported in the THUSA study. v Conclusion: The results of this study showed little evidence of a major social drift in CVD risk factors from subjects participating in the 1996/1998 THUSA study to those in the 2005 PURE study. Most cardiovascular disease risk factors are still higher in the higher SES groups. However, there were some indications (increased fibrinogen in both men and women living in rural areas; higher triglyceride and fasting glucose levels in unemployed women; no significant differences in blood pressure and total cholesterol across different SES groups which existed in the THUSA study) that a social drift in CVD risk factors in our African population is on the way. This means that promotion of healthy, prudent diets and lifestyles should be targeted to Africans from all socio–economic levels for the prevention of CVD. / Thesis (M.Sc (Dietetics))--North-West University, Potchefstroom Campus, 2011.

Background: The global burden of cardiovascular diseases (CVDs) is escalating as part of the rapid health transition that developing countries are experiencing. This increase is associated with shifts in demographics and economics, two of the major factors that affect diet and activity. The term social drift phenomenon (SDP) is used to describe the observations that: in the early stages of the epidemiological and nutrition transitions, it is usually the more affluent, higher socio–economic groups that are affected; in the later stages, it is the poor, lower socio–economic groups that display the consequences of these transitions. Therefore, in developing countries at the beginning of the transition, affluent people have higher prevalence of obesity and increased CVD risk. In developed countries, at much later stages of the transition, obesity and increased CVD risk is more prevalent in the lower socio–economic groups. In South Africa, the Transition and Health during Urbanisation of South Africans (THUSA) study which was done in 1996/1998 indicated that at that time, most of the risk factors for CVD were observed in the more urbanised (richer) subjects. It is not known if this pattern changed in any way due to the present rapid urbanisation of South African blacks. Therefore, in this study we explored the associations between socio–economic status (SES) (measured by level of urbanisation, education and employment) and CVD risk factors in an African population undergoing transition in the North–West Province of South Africa, that were prevalent in 2005 when the baseline data for in the Prospective Urban and Rural Epidemiology (PURE) study were collected. Objectives: The main objective of this dissertation was to examine the SDP in an African population in a nutrition and health transition, by: (i) Reviewing the literature on associations between socio–economic variables and biological health outcomes focusing on CVD risk factors in developed and developing countries; (ii) Analysing the baseline data from the 2005 PURE study to examine the relationships between components of SES, namely level of iii urbanisation, education and occupation, and nutrition–related CVD risk factors in men and women participating in the PURE study; and (iii) Comparing results on these associations between CVD risk factors and SES from the PURE study with those found in the THUSA study, which was conducted almost 10 years earlier, to examine if social drift in these associations has taken place. Study design: The dissertation is based on a comparison of the CVD risk factors and socio–economic status of the THUSA and PURE studies. Secondary analysis of the baseline cross–sectional epidemiological data from the PURE study was executed. The South African PURE study is part of a 12–year Prospective Urban and Rural Epidemiology study which investigates the health transition in urban and rural subjects in 22 different countries. The main selection criterion was that there should be migration stability within the chosen rural and urban communities. The rural community (A) was identified 450 km west of Potchefstroom on the highway to Botswana. A deep rural community (B), 35 km east from A and only accessible by gravel road, was also included. Both communities are still under tribal law. The urban communities (C and D) were chosen near the University in Potchefstroom. Community C was selected from Ikageng, the established part of the township next to Potchefstroom, and D from the informal settlements surrounding community C. The baseline data for PURE were collected from October to December 2005. A total of 2010 apparently healthy African volunteers (35 years and older), with no reported chronic diseases of lifestyle, tuberculosis (TB) or known human immunodeficiency virus (HIV) were recruited from a sample of 6000 randomly selected households. Methods: A variety of quantitative and qualitative research techniques was used by multidisciplinary teams to collect, measure and interpret data generated from biological samples and validated questionnaires. For this study, the statistical package for social sciences (SPSS) package (version 17.0, SPSS Inc) was used to analyze the data. Means and 95% confidence intervals (CI) of CVD risk and dietary factors were calculated. Participants of both genders were divided into different groups (according to urbanisation, education and employment levels) and compared. Estimated significant differences between rural and urban participants were determined with analysis of variance using the general linear model (GLM), multivariate procedure. Univariate analysis was used to explore further the influence of education on CVD risk factors and dietary intakes. Employment was used as a proxy for income, and pairwise comparisons using GLM, multivariate procedure were done for comparing the three groups (Not answered, employed and not employed). Tests were considered significant at P<0.05. Results: Comparison of urban with rural subjects participating in the PURE study showed that urban men had significantly higher systolic and diastolic blood pressures and lower fibrinogen levels than rural men. In women, systolic and diastolic blood pressure, fasting blood glucose and serum triglycerides were significantly higher in urban subjects whereas fibrinogen levels were significantly lower among urban subjects. After examining the relationship between the level of education and CVD risk factors, we observed that men with higher education levels had significantly higher BMI. In women, serum triglycerides and blood pressure were lower and BMI was significantly higher in the educated subjects. Because it was difficult to distinguish between reported household and individual income levels, we compared CVD risk factors of employed and unemployed subjects. Employed men had significantly higher BMI whereas the unemployed men had significantly higher fasting glucose and fibrinogen levels. Although mean blood pressure of employed men was higher than that of unemployed men, the difference did not reach significance. In women, the only significant difference seen was that employed women had lower high density lipoprotein (HDL) cholesterol, fasting glucose, triglycerides and fibrinogen levels, but they had a significantly higher BMI. Employed women had significantly higher BMI than unemployed women (27.9 [26.3–29.4] versus 26.5 [26.0–27.0] kg/m2). It seems that most of the nutrition related CVD risk factors were still higher in the higher socio–economic group, a situation similar to that reported in the THUSA study. v Conclusion: The results of this study showed little evidence of a major social drift in CVD risk factors from subjects participating in the 1996/1998 THUSA study to those in the 2005 PURE study. Most cardiovascular disease risk factors are still higher in the higher SES groups. However, there were some indications (increased fibrinogen in both men and women living in rural areas; higher triglyceride and fasting glucose levels in unemployed women; no significant differences in blood pressure and total cholesterol across different SES groups which existed in the THUSA study) that a social drift in CVD risk factors in our African population is on the way. This means that promotion of healthy, prudent diets and lifestyles should be targeted to Africans from all socio–economic levels for the prevention of CVD. / Thesis (M.Sc (Dietetics))--North-West University, Potchefstroom Campus, 2011.

Philosophiae Doctor - PhD / Type 2 diabetes mellitus (T2DM) and pre-diabetes contribute increasingly to the global burden of disease. Along with other behavioural risk factors, diet plays a key role in the onset and management of the disease, in turn largely determined by what foods are immediately accessible in local food environments. With this in mind, this thesis aims to answer the research question: What role do local food environments play in promoting or inhibiting access to healthy foods as part of the self - management of T2DM in urban and rural communities in South Africa, and what can be learned from an international perspective? Specific research objectives include, to: 1. Understand the current national-level policy context with regard to the observed rise in NCDs, their proximal determinants (specifically an observed change in diet patterns), and contributing environmental factors; 2. Identify the current food-related environmental factors associated with the onset and/or management of T2DM in an urban and a rural setting (as well as in four additional international settings in order to provide an international perspective); 3. Explore community perspectives of the role the local food environment plays in the self-management of T2DM in an urban and a rural setting; and, consequently 4. Recommend intervention- and/or policy-related actions that can be implemented based on study findings. A review of the literature and relevant policies was conducted towards achieving the first research objective. Quantitative data were systematically collected at an urban and rural site in South Africa through the creation of an ‘environmental profile’ in an attempt to achieve the second objective – comparable urban and rural data was also collected as part of a larger study at two other international sites (Kampala, Uganda and Stockholm, Sweden) to provide an international perspective. Included in the third objective is the collection of qualitative data through a community based participatory research method at the same urban and rural sites in South Africa. Finally, intervention and/or policy-related recommendations are developed based on study findings and in consultation with relevant stakeholders through interviews. / 2018-12-14

Made available in DSpace on 2016-03-28T12:34:08Z (GMT). No. of bitstreams: 2 457.pdf: 1673025 bytes, checksum: 4f882c148f27c393a8f55cfb99d4963a (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Centro de Pesquisas Aggeu Magalhães. Recife, PE, Brasil / A transição nutricional causou transformações no perfil de adoecimento da população, sendo o diabetes mellitus tipo 2 uma das principais patologias. A atenção primária à saúde é fundamental na implantação de políticas públicas para controle do diabetes, de forma a administrar os fatores de risco e a oferecer conhecimentos que favoreçam a adesão aos tratamentos medicamentoso e nutricional. No caso da adesão ao tratamento, ressalta-se a forte influência das redes de convívio social que norteiam a experiência da doença pelo sujeito. Este estudo visa analisar a experiência da doença dos portadores de diabetes mellitus tipo 2, acompanhados em domicílio por agentes comunitários de uma Unidade Básica de Saúde da Família de Araguari, Minas Gerais. Trata-se de pesquisa qualitativa ligada ao Programa de Pós-Graduação em Saúde Pública do Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz. A metodologia utilizada está baseada em uma tentativa de exercício etnográfico, cujos sujeitos foram entrevistados em seus domicílios pela pesquisadora responsável. Os resultados mostram que a experiência da doença inicia-se com a descoberta do diabetes relacionada a sintomas de polidipsia e poliúria, percebidos pelos próprios sujeitos e diagnosticados na unidade de saúde. O primeiro tratamento buscado é a assistência médica do serviço de saúde, sendo as práticas integrativas utilizadas somente pelos diabéticos considerados descompensados. A descompensação surge pelo desequilíbrio social do meio em que o doente vive. Este estudo pode contribuir para a melhor adesão ao tratamento oficial do diabetes, a partir da valoração da cultura dos doentes pelo serviço de saúde oficial, de modo a desconstruir o discurso biomédico na rede municipal de saúde em questão

Quilombolas são descendentes de escravos africanos. Os quilombolas do Ribeira estão estabelecidos em áreas remotas ao longo da Bacia do Rio Ribeira de Iguape (sul do Brasil), cobertas pela vegetação da Mata Atlântica, um dos hotspots de biodiversidade do mundo. Desde os primórdios da ocupação (século XVIII), os quilombolas tem sido historicamente dependentes do cultivo de arroz, milho, mandioca e feijão pelo sistema de corte-e-queima. No entanto, desde a década de 1970, seus estilos de vida vem sendo profundamente alterados por mudanças da economia-política regional como, por exemplo, a construção de estradas e escolas rurais, o estabelecimento de áreas de conservação na região e pela implementação de programas governamentais de transferência de renda. Assim, algumas tendências locais consistem no aumento da renda e na substituição do cultivo de corte-e-queima pela intensificação agrícola e trabalho assalariado. Para compreendermos como as mudanças nas estratégias produtivas podem estar interagindo com os padrões nutricionais locais, coletamos dados de dieta, antropometria e alocação de tempo dos indivíduos de duas comunidades quilombolas peri-urbanas/rurais. As pessoas da primeira comunidade encontram-se mais voltadas para o plantio de cultívares comerciais, trabalho assalariado e artesanato do que aquelas da segunda, que orientam suas atividades produtivas sobretudo para a agricultura de subsistência e para o extrativismo de produtos florestais não madeireiros. Apesar das diferenças nas estratégias produtivas, encontramos os mesmos padrões de dieta e de atividade física em ambas as comunidades: seus núcleos calórico-proteicos parecem ser constituídos por comidas ricas em calorias, processadas ou provenientes de animais domesticados e em ambas as comunidades parece haver uma tendência de redução quanto à demanda energética associada às atividades produtivas a ocorrência simultânea destas tendências caracterizam a ocorrência de um processo demográfico mais amplo chamado Transição Nutricional (TN) (Popkin e Gordon-Larsen, 2004). Em conclusão, nossos dados sugerem que independentemente da estratégia produtiva adotada, ambas as comunidades passam por de TN e que as mulheres vêm sendo mais impactadas pelo processo do que os homens, em razão destes últimos, provavelmente, ainda se manterem envolvidos, em algum nível, com atividades agrícolas. Os programas governamentais de transferência de renda (bolsa-família) podem ser relevantes na definição das similaridades nos padrões de consumo alimentar encontrados. / Quilombolas are African slave descendants. The Ribeira Valley is one of the most important areas of concentration of Quilombos in Southern Brazil. The Ribeira Quilombolas are settled in remote areas along the Ribeira River system covered by Atlantic rain forest vegetation, one of the worlds biodiversity hotspots. Since the first settlements (18th Century), they have been historically dependent on shifting cultivation of rice, maize, manioc and beans. However, since 1970\'s their life style has been profoundely affected by changes in regional political economy, such as the opening of a roadway, the establishment of conservation areas in the region and the setting-up of rural schools. Some of the local trends consist of replacing shifting cultivation and increasing household income mainly through agricultural intensification, wage labour and government cash transfer programs. In order to grasp the way changes in economic strategies have affected the nutritional patterns, we collected data of diet, anthropometry and time allocation of individuals from two Quilombola peri-urban/rural communities. People from the first community have become more oriented to commercial crops, wage labor and handicrafts than people from the other one, still more tied to subsistence agriculture and the gathering of non-timber forestall products. Despite the differences in productive strategies, we found the same diet and physical activity patterns: the energy-protein core consisted of the same energy rich and processed foodstuff or foods from domesticated animals, and Quilombolas seem to have had their energy demands reduced, probably because of the decrease of agricultural activities. However, only men are still significantly involved in agricultural oriented activities. We concluded that regardless of the economic strategy adopted, both communities are undergone Nutrition Transition process (a global trend that consists of increasing the comsumption of energy rich foodstuff and of decreasing of energy expenditure levels (Popkin e Gordon-Larsen, 2004)) and women might be more impacted by the process than men. Additionally, government cash transfer programs seem to affect the diet and physical activities patterns found.

My thesis examines food allocation and nutritional outcomes in a sample of 152 individuals in thirty-two households of sugarcane workers in the municipality of Gameleira, Northeast Brazil. Anthropometric data show that undernutrition and overnutrition coexist in the study population, and often within households – a consequence of the changes in diet and physical activity linked to the nutrition transition. Food allocation was examined using an indicator of the frequency of consumption of high status foods - non-staple foods which are considered more desirable than staples because they add variety and taste to an otherwise monotonous diet. I created an intra-household index of food allocation in order to observe each individual's consumption in relation to the average in his or her household at two seasonal points of the year. The sample was split into two groups, a group of more affluent households in which high status foods were eaten on the harvest and non-harvest dietary recalls, and a group of less affluent households in which no-one ate high status foods on the non-harvest recall. I found gender biases in the allocation of food in favour of men relative to women, and girls relative to boys, in the higher income group, but no gender biases in the group of less affluent households. In relation to age, I found biases in favour of children relative to adults in less affluent households, but not during seasonal shortage in the higher income households. The biases were greater in households with higher incomes, but lower in households in which women controlled some household income relative to households in which men controlled all income. I considered whether discriminatory behaviour underpins these biases, based largely on periods of observation in a sub-sample of six households, and concluded that food distribution operates as a powerful medium for the expression of differential status among men and women, but not among boys and girls, who have equal status in this population.