Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction A paucity of data exists regarding growth patterns and nutrition-related problems in infants (<12 months) on antiretroviral treatment (ART) and the infant feeding knowledge, beliefs, attitude and practices of their caregivers. Aim To describe the growth and nutrition-related problems of infants (<12 months) attending the Antiretroviral (ARV) clinic at Red Cross Children’s Hospital, as well as the knowledge, attitudes, beliefs and practices of their caregivers concerning infant feeding. Methods A cross-sectional, descriptive study was conducted with census sampling. Thirty infants and 31 caregivers were included in the sample. Anthropometric measurements were performed and interviewer-administered questionnaires were utilised to obtain the knowledge, attitude, beliefs and practices of the caregivers. The mean Z-score of each measurement as well as the weight-for-age, length-for-age, weight-forlength and bodymass index-for-age for each infant were determined, analysed, interpreted and described according to the World Health Organisation (WHO) growth standards for children. Results Thirty-nine percent (n=11) of the mothers (n=28) did not receive infant feeding counselling prior to delivery, while only 9 (32%) received the minimum number of at least 4 sessions, as prescribed by the Department of Health. It was not assessed whether the counselling occurred before delivery. The mean age of the infants was 6.9 (SD 3.3) months. Eighty-three percent (n=25) had an opportunistic infection prior to data collection. Twenty-three percent (n=7) were underweight-forage and 40% (n=12) of the infants were stunted. Vomiting and diarrhoea were the most common nutrition-related problems experienced. A statistical significant positive correlation (p=0.003) was found between an infant’s duration on ART and W/A z-score. Only two caregivers were breastfeeding at the time of data collection, but 34% (n=10) of the other caregivers had at some stage breastfed their infant. Formula feeding practices were poor. Sixty-two percent (n=18) were not preparing the feeds correctly and only six (21%) were correctly cleaning and sterilising the bottles. Thirty-nine percent (n=11) of the infants were not receiving an adequate amount of milk per day. Sixty-five percent (n=11) of the infants (>six months) did not receive a diet the previous day which met the minimum WHO dietary diversity indicator and only 18% (n=3) received a minimum acceptable diet. Caregivers had an average knowledge concerning infant feeding. Thirteen percent (n=4) knew the correct definition of exclusive breast- or formula feeding. Sixty-eight percent (n=21) did not know what mixed feeding meant, or the dangers associated with it. Most caregivers (n=25, 81%) knew that oral rehydration solution had to be given when infants developed diarrhoea, but only 48% (n=15) knew how to prepare it and only 6% (n=2) knew how to administer it. Seventy-five percent (n=9) of caregivers did not know what should be done when experiencing breast problems. Sixty-four percent (n=19) of the caregivers believed that if a HIV-positive woman breastfeeds she would definitely transmit HIV to her infant. Conclusion The infant sample showed a variety of erratic growth patterns with a high prevalence of underweight and stunting. Infant feeding knowledge of caregivers was average, but not deemed sufficient to translate into appropriate, safe and optimal infant feeding practices. The breastfeeding prevalence was low. Formula preparation, feeding and hygiene practices were poor and dietary intake of infants was not optimal. The quality and quantity of HIV infant feeding counselling sessions received at antenatal clinic visits were poor and need to be addressed. / AFRIKAANSE OPSOMMING: Inleiding Daar is 'n tekort aan data oor groeipatrone en voedingsverwante probleme by babas (<12 maande) op antiretrovirale behandeling asook die babavoedingkennis, -oortuigings, -houdings en -praktyke van hul versorgers. Doelwit Om ondersoek in te stel na die groei- en voedingsverwante probleme by babas (<12 maande) in die antiretrovirale kliniek by Rooikruis-kinderhospitaal, sowel as die babavoedingkennis, - oortuigings, -houdings en -praktyke van hul versorgers. Metodes 'n Beskrywende dwarssnitstudie is met sensussteekproefneming onderneem. Dertig babas en 31 versorgers is by die steekproef ingesluit. Antropometriese metings was gedoen en onderhoude was met behulp van vraelyste gevoer ten einde inligting oor die versorgers se kennis, houdings, oortuigings en praktyke te bekom. Elke baba se gemiddelde z-telling per meting sowel as die gewig-vir-ouderdom, lengte-vir-ouderdom en liggaamsmassa-indeks-vir-ouderdom was volgens die Wêreldgesondheidsorganisasie (WGO) se groeistandaarde vir kindersbepaal, ontleed, vertolk en beskryf. Resultate Altesaam 39% (n=11) van die moeders (n=28) het nie voor die bevalling voorligting oor babavoeding ontvang nie, terwyl slegs 9 (32%) die Departement van Gesondheid se voorgeskrewe minimum 4 sessies, deurloop het. Dit was nie bepaal of hierdie sessies voor die bevalling ontvang was nie. Die gemiddelde ouderdom van die babas was 6,9 (standaardafwyking 3,3) maande. 'n Totaal van 83% (n=25) het voor data-insameling 'n opportunistiese infeksie gehad, 23% (n=7) was ondergewig-vir-ouderdom, en 40% (n=12) van die babas se lengtegroei was ingekort. Die algemeenste voedingsverwante probleme was braking en diarree. Daar blyk 'n statisties beduidende positiewe korrelasie (p=0.003) te wees tussen die duur van die baba se antiretrovirale behandeling en sy/haar gewig-vir-ouderdom-z-telling. Slegs twee versorgers het hul babas ten tyde van die studie geborsvoed, hoewel 34% (n=10) van die versorgers in 'n stadium geborsvoed het. Voedingspraktyke met die gee van melkformule was swak. Altesaam 62% (n=18) het die melkformule verkeerd aangemaak en slegs ses (21%) het die bottels behoorlik skoongemaak en gesteriliseer. Nege-en-dertig persent (n=11) van die babas het te min melk per dag ontvang. Vyf-en-sestig persent (n=11) van die babas (>6 maande) se melkinname die vorige dag het nie aan die minimum WGO aanbevole dieetdiversiteitsaanwyser voldoen nie, en slegs 18% (n=3) het 'n minimum aanvaarbare dieet gevolg. Versorgers se kennis ten opsigte van babavoeding was gemiddeld, met net 13% (n=4) wat die korrekte omskrywing van eksklusiewe bors- of formulevoeding geken het. 'n Totaal van 68% (n=21) het nie geweet wat gemengde voeding beteken of watter gevare dit inhou nie. Die meeste versorgers (n=25, 81%) het geweet dat orale rehidrasie oplossing toegedien moet word wanneer babas aan diarree ly, maar slegs 48% (n=15) het geweet hoe om dit aan te maak en 'n skrale 6% (n=2) hoe om dit toe te dien. Vyf-en-sewentig persent (n=9) van die versorgers het nie geweet wat om te doen as hulle probleme met hul borste ervaar nie. Altesaam 64% (n=19) van die versorgers het geglo dat 'n MIV-positiewe vrou definitief haar baba MIV sal gee indien sy hom/haar sou borsvoed. Samevatting Die steekproef babas het 'n verskeidenheid onreëlmatige groeipatrone getoon en baie was ondergewig of het ook dwerggroei getoon. Versorgers se kennis van babavoeding was gemiddeld, maar nie voldoende om tot toepaslike, veilige en optimale babavoedingspraktyke aanleiding te gee nie. Die voorkoms van borsvoeding was laag. Melkformulevoorbereiding, - voeding en -higiëne was swak, en babas se voedinginname was nie ideaal nie. Die gehalte van en hoeveelheid voorligting oor MIV-babavoeding met besoeke aan voorgeboorteklinieke was swak en moet aangespreek word.

Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Background: The role of antioxidants and adequate nutrition in the prevention and course of cancer treatment is globally recognised in nullifying the effects of free radicals and increasing the nutritional status of children during treatment. Objective: To investigate whether children with cancer meet their Dietary Reference Values and Safe Intakes for antioxidants, energy and protein. Design: Single centre prospective study. Setting: Children were recruited from the East of England Primary Treatment Centre using convenience sampling over 8 months. Forty-two children and adolescents diagnosed with a Solid tumour, Lymphoma or Leukaemia were eligible for data analysis (n=20 male; n=22 female). Method: Data was collected with an Estimated Food Record (EFR) in the 1st (EFR1) and 3rd month (EFR2) post-diagnosis. In the week following EFR completion, parents and/or children were contacted to complete four non-consecutive days of 24-hr food recalls. Data was categorised into diet alone, diet + food supplement (FS), tube feeding (tube) or diet + multi-vitamin-mineral supplementation (VMS). Malnutrition was determined by weight-for-age z-scores. Nutrient intake was compared to the Recommended Nutrient Intake (RNI), the Estimated Average Requirements (EAR) and the Lower Recommended Nutrient Intake (LRNI). Result: The sample consisted of 33% (n=14) diagnosed with Leukaemia, 24% (n=10) with Lymphoma and 43% (n=18) with Solid tumours. Sixty seven percent (n=28) underwent chemotherapy and 33% (n=14) a combination of therapies. Significant correlations were seen between the assessment tools in the diet alone category for both months for; vitamins A, C, E, selenium and protein and for EFR1 for zinc and energy. In both months greater numbers of children achieved ≥100% of requirements for diet + VMS (EFR 1; p<0.05; EFR2 p<0.05) than for other feeding modes. Vitamin C achieved the highest intakes compared to the RNI at 773% (EFR1) and 829% (EFR2). Intakes above 200% of the RNI were seen for vitamins A, C, E, selenium and zinc. No significant differences were seen between modes of feeding in either month for selenium or zinc. Vitamin A (EFR1≤ 100% diet alone p<0.05) and zinc (EFR1≤ 100% diet alone p=0.02) met the least of the LRNI in the 1st month compared to other antioxidants. No statistical significant difference was observed between the number of children attaining their EAR’s between the 3 modes of feeding in the 1st month and 3rd month. In the 1st month 27% (n=8) of participants consumed vitamin and/or mineral supplements, 18% in the 3rd month (n=4). In the 1st month 5% (n=2) of children were moderately malnourished and 10% (n=4) in 3rd month. Conversely in the 1st month 3% (n=1) were overweight and 3% (n=1) obese; the leukaemia group predominant. Conclusion: The research tools showed good correlation. Children using vitamin and/or mineral supplements mostly achieved their RNI’s compared to other feeding modes. Across feeding modes some children achieved antioxidant intakes above 200% RNI. LRNI’s on diet alone were not achieved for vitamin A and zinc. The study showed Leukaemics as having a higher prevalence of obesity. More research is required to determine the clinical implications of these findings. / AFRIKAANSE OPSOMMING: Agtergrond: Die rol van anti-oksidante en voldoende voeding in die voorkoming en verloop van kanker behandeling word wêreldwyd erken vir vernietiging van die effek van vry radikale en die verbetering van voedingstatus van kinders tydens behandeling. Doelwit: Om ondersoek in te stel of kinders met kanker hul Dieet Verwysingswaardes en Veilige Innames vir anti-oksidante, energie en proteïen bereik. Ontwerp: Enkel sentrum prospektiewe studie. Omgewing: Kinders was gewerf deur middel van gerieflikheidsteekproefneming oor 8 maande vanaf die “East of England Primary Treatment Centre”. Twee-en-veertig kinders en adolessente gediagnoseer met 'n Soliede tumor, Limfoom of Leukemie het in aanmerking gekom vir dataanalise (n=20 manlik, n=22 vroulik). Metode: Data was ingesamel met ‘n Geskatte Voedsel Rekord (GVR) in die eerste (GVR1) en derde maand (GVR2) na diagnose. In die week na voltooiing van die GVR is ouers en/of kinders gekontak om vier onopeenvolgende dae van 24-uur herroepe te voltooi. Data was verdeel in dieet alleen, dieet + voedsel supplement (VS), buisvoeding (buis) of dieet + multi-vitamien-mineraal supplementasie (VMS). Wanvoeding was bepaal deur middel van gewig-vir-ouderdom z-tellings. Nutriënt inname was vergelyk met die Aanbevole Nutriënt Inname (ANI), die Geskatte Gemiddelde Behoeftes (GGB) en die Laer Aanbevole Nutriënt Inname (LANI). Resultate: Die steekproef het bestaan uit 33% (n=14) gediagnoseer met Leukemie, 24% (n=10) Limfoom en 43% (n=18) Soliede tumore. Sewe-en-sestig persent (n=28) het chemoterapie ontvang en 33% (n=14) ‘n kombinasie van terapieë. Betekenisvolle korrelasies was waargeneem tussen die assesseringsinstrumente in die dieet alleen kategorie vir beide maande vir vitamiene A, C, E, selenium en proteïen en vir GVR1 ook vir sink en energie. In beide maande het ‘n groter aantal kinders ≥100% van hul behoeftes bereik vr dieet+VMS (GVR1; p<0.05; GVR2 p<0.05) as vir ander modi van voeding. Vitamien C het die hoogste innames bereik vergeleke met die ANI teen 773% (GVR1) en 829% (GVR2). Innames bo 200% van die ANI was waargeneem vir vitamiene A, C, E, selenium en sink. Geen betekenisvolle verskille was waargeneem tussen modi van voeding in enige maand vir selenium en sink nie. Vitamien A (GVR1≤100% dieet alleen p<0.05) en sink (GVR1≤100% dieet alleen p=0.02) het die minste van die LANI bereik in die eerste maand vergeleke met ander anti-oksidante. Geen statisties beduidende verskil was waargeneem tussen die aantal kinders wat hul GGB’s bereik het tussen die 3 voedingswyses in die eerste en derde maande nie. In die eerste maand het 27% (n=8) van deelnemers vitamien en/of mineraal supplemente ingeneem, en 18% (n=4) in die derde maand. In die eerste maand was 5% (n=2) van kinders matig wangevoed en 10% (n=4) in die derde maand. In die eerste maand was 3% (n=1) van kinders oorgewig en 3% (n=1) vetsugtig, die leukemie groep spesifiek. Gevolgtrekking: Die navorsingsinstrumente het goeie korrelasie getoon. Kinders wat vitamien en/of mineraal supplemente gebruik het het meestal hul ANI’s bereik vergeleke met ander modi van voeding. Oor voeding modi het sommige kinders anti-oksidant innames bo 200% ANI bereik. LANI’s op dieet alleen was nie bereik vir Vitamien A en sink nie. Hierdie studie het aangetoon dat dié met Leukemia ‘n hoër prevalensie van oorgewig/vetsug getoon het. Meer navorsing is nodig om die kliniese implikasies van die bevindinge te bepaal.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Job satisfaction of registered dietitians (RDs) is a very poorly researched subject on a global scale. Apart from a handful of studies conducted in the United States of America (USA) from the 1980’s through to the early 1990’s and only one recently published in 2006, there is no other published information relating to this topic. As a result a crosssectional descriptive study was conducted using a national survey of all 1509 dietitians registered with the Health Professions Council of South Africa (HPCSA). Data was collected using a 2 part self-administered questionnaire, the first part collected demographic data and the second part collected data pertaining to job satisfaction attitude. The job satisfaction questionnaire was based on the Job Satisfaction Survey (JSS), measuring nine themes of: salary, promotion, knowledge and skills, professional colleagues, members of the multi-disciplinary team, communication, the work environment, rewards of the job and nature of work. Based on the registration contact details of RDs, the questionnaires were distributed by either e-mail or post, giving a final response rate of 22,5% (n=340), representing over a fifth of the dietetic workforce registered with the HPCSA. Overall the data indicated that South African RDs were only slightly satisfied (65,7%) with their current employment, with no significant ifference in overall job satisfaction between those working and living overseas (68,4%)(n=23) and those in South Africa (65,7%)(n=317). Despite there being a positive attitude towards the nature of work (tending towards confirmation of career satisfaction), lower levels of satisfaction were primarily found to be due to poor salaries, lack of promotional opportunities and a perception of low professional image. No extreme levels of satisfaction were found. In regard to associations between demographic variables and job satisfaction, a significant positive correlation was found to occur between age (Spearman’s p=0,036), professional experience (Mann-Whitney U p=0,035), area of expertise (Mann-Whitney U p=0,001), hours of work (Kruskal-Wallis p=0,021) and the location of work (rural versus urban based work) (Mann-Whitney U p=0,00001). Therefore it is predicted that over the next five years, there will be poor staff retention of RDs in dietetic posts, where the greatest loss will be in the Department of Health (DOH), where approximately 83% of current DOH staff (n=113) will be searching for alternative employment. Recommendations therefore include that there should be a re-evaluation of RD pay scales, career-pathing with promotional opportunities, boosting the RD professional image and enhancing dietetic undergraduates programs by including the teaching of nondietetic skills such a business skills and entrepreneurship, required to support dietetic practice on a broader scale.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: Nausea and vomiting during pregnancy (NVP) is a common medical condition. Due to possible harmful side-effects that conventional medicine may pose to the fetus, many mothers choose not to use it, and are left helpless against NVP. There is a need for alternative treatment to relieve NVP symptoms. Objectives: This systematic review (SR) investigated current evidence regarding ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy, by identifying adverse events or side-effects. Search strategy: Electronic search of bibliographic databases (1966-February 2011). Selection criteria: Randomized controlled trials (RCTs) of the efficacy of ginger by any route, as treatment for NVP in pregnant women regardless of their age or stage of pregnancy. Data collection and analysis: The principal investigator and independent reviewer individually identified relevant studies, extracted data and assessed trial quality. Data analysis was performed using the RevMan5 software. Differences at the level of p<0.05 were considered to be statistically significant. Results: Eleven RCTs involving 1176 pregnant women were included. The quality of evidence was low, hence the high risk of bias and imprecision of results. Ginger significantly improved the symptoms of nausea when compared to placebo, when comparing the results of this SR to past SRs, and taking into account a meta-analysis performed on two relatively large included studies (mean difference (MD) 1.20, 95% confidence interval (CI) 0.56-1.84, p=0.0002, I2=0%). However, another meta-analysis on two smaller studies indicated no significant improvement in nausea. Ginger did not significantly improve nausea when compared to vitamin B6 (MD 0.34, 95% CI -1.52-2.20, p=0.7, I2=91%). Similarly, ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p=0.06, I2=71%). Subgroup analyses performed seemed to favor the lower daily dosage of <1500mg ginger to possibly be more effective for the relief of nausea. Ginger did not pose a significant risk for spontaneous abortion when compared to placebo (RR 3.14, 95% CI 0.65-15.11, p=0.15; I2=0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p=0.19, I2=40%). Similarly, ginger did not pose a significant risk for the side effects of heartburn or drowsiness when compared to placebo or vitamin B6. When compared to dimenhydrinate, ginger posed a smaller risk for drowsiness (RR 0.08, 95% CI 0.03-0.18) and no increased risk for heartburn. Conclusions: This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and quality of evidence). Ginger did not have a significant impact on vomiting episodes, nor pose a risk for side effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from the symptoms of NVP. Large RCTs are necessary to confirm the possible benefit of ginger as treatment for NVP. / AFRIKAANSE OPSOMMING: Agtergrond: Naarheid en vomering tydens swangerskap (NVS) is ‘n algemene mediese toestand. As gevolg van moontlike skadelike newe-effekte wat konvensionele medikasie kan veroorsaak vir die fetus, vermy baie moeders dit en word hulpeloos gelaat teen NVS. Dus is daar behoefte aan alternatiewe behandeling vir NVS. Doelwitte: Hierdie sistematiese literatuuroorsig (SO) het huidige literatuur ondersoek wat verband hou met gemmer vir behandeling van NVS. Die primêre doelwit was om effektiwiteit van gemmer as behandeling vir NVS te assesseer. Die sekondêre doelwit was om veiligheid van gemmer tydens swangerskap te assesseer, deur ongunstige gebeure en newe-effekte te identifiseer. Soektogstrategie: Elektroniese soektog van bibliografiese databasisse (1966-Februarie 2011). Seleksiekriteria: Verewekansigde gekontrolleerde proewe (RCTs) van gemmer deur enige roete as behandeling van NVS, in swanger vroue ongeag ouderdom of stadium van swangerskap. Dataversameling en –analise: Die hoof navorser en ‘n onafhanklike hersiener het individueel relevante studies geidentifiseer, data ekstraksie onderneem en studie-kwaliteit geassesseer. Data-analise is uitgevoer deur die RevMan5 sagteware te gebruik. Verskille by die vlak van p<0.05 was beskou as statisties betekenisvol. Hoof resultate: Elf RCTs waarby 1176 swanger vroue betrokke was, is ingesluit. Die studie-kwaliteit was swak, dus die hoë risiko vir sydigheid en onakkuraatheid van resultate. Gemmer het beduidend die simptome van naarheid verbeter in vergelyking met plasebo, wanneer die resultate van hierdie SO met vorige SO’s vergelyk word, en die meta-analise in ag geneem word wat op twee relatiewe groot ingeslote studies uitgevoer is (gemiddelde verskil (MD) 1.20, 95% vertrouens interval (VI) 0.56-1.84, p=0.0002,I2=0%). Kontrasterend, het ‘n ander meta-analise van twee kleiner studies geen beduidende verbetering in naarheid aangedui nie. Gemmer het nie beduidend naarheid verbeter wanneer dit met vitamien B6 vergelyk word nie (MD 0.34, 95% VI -1.52-2.20, p=0.7, I2=91%). Soortgelyk, het gemmer nie die aantal vomerings-episodes verminder, in verglyking met plasebo nie, maar daar was wel ‘n neiging na verbetering (MD 0.72, 95% VI -0.03-1.46, p=0.06, I2=71%). Die subgroup-analise blyk ten gunste te wees van die laer daaglikse dosis van <1500mg gemmer om meer effektief te wees vir die behandeling van naarheid. Gemmer het nie ‘n beduidende risiko ingehou vir spontane aborsie, wanneer dit vergelyk word met plasebo (relatiewe risiko (RR) 3.14, 95% VI 0.65-15.11,p=0.15;I2=0%), of vitamien B6 nie (RR 0.49, 95% VI 0.17-1.42,p=0.19;I2=40%). Soortgelyk, het gemmer nie ‘n beduidende risiko ingehou vir newe-effekte van sooibrand of duiseligheid, wanneer dit vergelyk word met plasebo of vitamien B6 nie. Wanneer dit vergelyk word met dimenhidrinaat, het gemmer ‘n kleiner risiko ingehou vir duiseligheid (RR 0.08, 95% VI 0.03-0.18) en geen verhoogde risiko vir sooibrand nie. Gevolgtrekkings: Hierdie SO dui ‘n potensiële voordeel van gemmer aan in vermindering van naarheid tydens swangerskap (inagnemend van die klein hoeveelheid studies, wisselende uitkomste-rapportering en studie-kwaliteit). Gemmer het nie ‘n beduidnede impak gehad op vomerings-episodes nie, en ook nie ‘n risiko ingehou vir newe-efekte of ongunstige gebeure tydens swangerskap nie. Volgens bewyse uit hierdie SO, kan gemmer beskou word as ‘n skadelose en moontlike effektiewe alternatiewe opsie vir vroue wat lei aan NVP. Grootskaalse RCTs is nodig om die moontlike voordeel van gemmer as behandeling vir NVS te bevestig.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: It is estimated that 1.3 billion people worldwide are either overweight or obese, making this a global epidemic. An effective weight-loss method involves the lifestyle changes of increased physical activity and lowered energy intake. These changes are difficult to carry out and to maintain. As a result, there is a soaring demand for weight-loss aids, including dietary supplements, which exploit consumers’ eagerness to find an effortless weight-loss solution. These supplements are easily accessible, require no prescription and are heavily marketed to suggest that weight loss is achievable without exercise and dieting. One such dietary supplement, Bioslim, is tested in this study. The aim of this study was to investigate whether Bioslim results in greater weight loss than a placebo, and whether the marketing of the Bioslim brand has an influence on the placebo response. Overweight adults residing in Cape Town (n = 87) were recruited by advertising in community newspapers and setting up stands at shopping centres. The subjects were randomised into one of four groups: Bioslim in Bioslim packaging (n = 26), Bioslim in unbranded packaging (n = 22), placebo in Bioslim packaging (n = 17) and placebo in unbranded packaging (n = 22). At baseline, the subjects were given one of the four products and anthropometric measurements (weight, height and skinfold thickness) were taken. After four weeks, these measurements were repeated. The subjects also had to complete a questionnaire regarding their experiences. The body mass index (BMI) for the total population was 31.90 kg/m2 (SD = 3.91) at baseline and 31.89 kg/m2 (SD = 3.92) at follow-up. None of the measured anthropometric variables had changed significantly after four weeks. When the total study group sample was analysed, based on the allocated drug treatment groups (active or placebo), neither group showed significant weight loss from baseline to follow-up. Twenty-three subjects from the Bioslim group and 21 from the unbranded group reported exercising during the trial. The total group’s exercise time correlated significantly with fat-mass reduction (r = -0.31, p = 0.004). Furthermore, when data was analysed separately for the active and placebo groups, the active group showed a significant correlation (r = -0.45, p = 0.0012), while the placebo group showed an insignificant correlation (r = -0.05, p = 0.77). The same was not reflected in weight loss (r = -0.007, p = 0.95). It is concluded that Bioslim is an ineffective weight-loss supplement: subjects receiving active pills evidenced no significant beneficial changes in weight, waist circumference or body composition. More than half of the subjects attempted dieting and exercising, but these efforts were insufficient to impact on weight loss. The marketing and packaging of Bioslim did not enhance the placebo effect. One subject from the active group withdrew from the study, complaining of severe headaches and heart palpitations. There was no difference in adverse events reported by the remaining active and placebo group subjects. In conclusion, this study emphasises the need for better regulation of the efficacy and safety of dietary supplements. / AFRIKAANSE OPSOMMING: Daar word geskat dat 1.3 biljoen mense wêreldwyd oorgewig of vetsugtig is, wat dit ‘n globale problem maak. ‘n Effektiewe gewigsverlies metode inkorporeer leefstyl veranderinge soos verhoogde fisiese aktiwiteit en ‘n laer energie inname. Hierdie veranderinge is moeilik om uit te voer en vol te hou. Die gevolg is ‘n stygende aanvraag vir gewigsverliesprodukte en supplemente, wat verbruikers se gretigheid om ‘n maklike gewigsverlies oplossing te kry, uitbuit. Hierdie supplemente is maklik verkrygbaar sonder ‘n voorskrif en word aggressief bemark met bewering dat gewigsverlies moontlik is sonder oefening en dieetaanpassing. Een van die beskikbare produkte, Bioslim, is getoets in die studie. Die doel van die studie was om te ondersoek of die gewigsverlies produk, Bioslim, lei tot ‘n groter gewigsverlies as ‘n plasebo produk en of die bemarking van die Bioslim handelsmerk ‘n invloed op die plasebo-effek het. Oorgewig volwassenes woonagtig in Kaapstad (n = 87) is gewerf deur advertering in gemeenskapskoerante en deur stalletjies by inkopiesentrums. Die proefpersone is ewekansig in vier groepe ingedeel: Bioslim in Bioslim verpakking (n = 26); Bioslim in verpakking sonder ‘n handelsmerk (n = 22); ‘n plasebo produk in Bioslim verpakking (n = 17) en ‘n plasebo produk in verpakking sonder ‘n handelsmerk (n = 17). Met aanvang van die studie is een van die vier produkte aan die proefpersone gegee en antropometriese metings (gewig, lengte en velvoudikte) is gemeet. Metings is na vier weke herhaal. Die proefpersone moes ook ‘n vraelys oor hul ervarings voltooi. Die liggaamsmassa indeks (LMI) van die totale populasie was 31,90 kg/m2 (SD = 3.91) by basislyn en 31.89 kg/m2 (SD = 3.92) met opvolg. Geen van die antropometriese veranderlikes het betekenisvol verander na vier weke nie. Met ontleding van die totale studie polulasie, gebasseer op die toegekende behandeling (aktiewe of plasebo bestanddele), is gevind dat geen groep ‘n betekenisvolle gewigsverlies getoon het van basislyn tot opvolg nie. Drie-en-twintig proefpersone uit die Bioslim groep en 21 uit die geen-handelsmerk-groep het gerapporteer dat hul geoefen het gedurende die studie. Die totale groep se oefenings tydsduur het betekenisvol gekorreleer met ‘n verlaging in vetmassa (r = -0.31, p = 0.004). Met verdere analiese van die data in die aktiewe en plasebo groepe, is gevind dat die aktiewe groep ‘n betekenisvolle korrelasie getoon het (r = -0.45, p = 0.0012), maar die plasebo groep nie (r = -0.05, p = 0.77). Hierdie bevinding is nie gevind in die gewigsverlies nie (r = -0.007, p = 0.95). Die gevolgtrekking word gemaak dat Bioslim ‘n oneffektiewe gewigsverlies supplement is, aangesien proefpersone wat die aktiewe pille geneem het, geen betekenisvolle voordelige veranderinge in hul gewig, middelomtrek of liggaamsamestelling getoon het nie. Alhoewel ‘n betekenisvolle korrelasie gevind is tussen oefeningsduur en verlies aan vetmassa in meer as die helfte van die proefpersone, was die omvang daarvan onvoldoende om ‘n impak op hul gewigsverlies te hê. Die bemarking en Bioslim handelsmerk het nie die placebo-effek versterk nie. Een persoon uit die aktiewe groep het van die studie onttrek as gevolg van erge hoofpyn en hartkloppings. Daar was geen verskil in die nadelige effekte gerapporteer deur die oorblywende proefpersone in die aktiewe en plasebo groepe nie. Ten slotte beklemtoon die studie die behoefte aan beter regulering van die effektiwiteit en veiligheid van dieetsupplemente.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Continuous Professional Development (CPD) is a tool to develop and maintain professional competence and to facilitate lifelong learning. CPD is compulsory for health professionals in South Africa, and has an additional mandatory requirement that five Continuing Education Units (CEU’s) must be obtained annually on human rights, ethics and medical law. A literature search yielded limited information on ethics education specifically for South African dietitians. As a result a cross-sectional descriptive study was conducted on all dietitians registered with the Health Professions Council of South Africa (HPCSA) for the year 2010 – 2011 to determine whether dietitians feel that there is a need or demand for standardised ethics update courses, and if so, the format in which dietitians would prefer these courses. All data was collected via self-administered questionnaires that sought demographic data, data on dietitians’ awareness of ethics aspects, and the format/s preferred for standardised ethics update courses. The questionnaires were distributed electronically or via the postal system. The response rate to the study was 4.5%, which was low. The results indicated that 58.7% of dietitians obtain the minimum requirement of 5 ethics CEU’s per year. Only 21.7% feel that there are sufficient opportunities to gain 5 ethics CEU’s and 40.2% are satisfied with the content of current CPD activities related to ethics. There are very low levels awareness and knowledge of existing guidance documents on conduct and ethics aspects available on the HPCSA’s website, and only 9.8% of respondents have carefully read and studied this information. Dietitians prefer lectures and Internet-based activities for courses on ethics. The study concluded there is a definite demand amongst respondents for standardised ethics update courses and an urgent demand for support with conduct and ethics issues. Recommendations are focused on ways to raise awareness of existing supportive documents available from the HPCSA on conduct and ethics issues as well on the formation of sub-committees dealing with ethics aspects and possible development of standardised update courses on ethics. / AFRIKAANSE OPSOMMING: Voortgesette Professionele Ontwikkeling (VPO) is ’n instrument om professionele bevoegdheid te ontwikkel en te handhaaf, en om lewenslange leer te fasiliteer. VPO is verpligtend vir professionele gesondheidspersoneel in Suid-Afrika, en stel ’n bykomende verpligting om jaarliks vyf VPO-eenhede oor menseregte, etiek en mediese reg te verwerf. ’n Literatuurstudie het beperkte inligting oor etiekonderwys, spesifiek vir Suid-Afrikaanse dieetkundiges, opgelewer. ’n Kruisdeursnee beskrywende studie is uitgevoer op alle dieetkundiges wat by die Raad vir Gesondheidsberoepe van Suid-Afrika (RGBSA) vir die jaar 2010-2011 geregistreer is, om te bepaal of daar by hulle ’n behoefte bestaan of vraag is na nuwe gestandaardiseerde kursusse oor etiese aspekte, en, indien wel, die formaat waarin dieetkundiges hierdie kursusse sal verkies. Alle data is deur middel van selfgeadministreerde vraelyste versamel wat inligting ingewin het oor demografiese data, data oor dieetkundiges se bewustheid van etiese aspekte en die formaat wat vir nuwe gestandaardiseerde kursusse oor etiek verkies word. Die vraelyste is elektronies of via die posstelsel versprei. Die reaksieskoers op die studie was 4.5%, wat laag is. Die resultate dui aan dat 58.7% van die dieetkundiges die minimum vereiste van vyf VPO-eenhede oor etiek per jaar behaal. Slegs 21.7% voel dat daar voldoende geleenthede is om vyf eenhede in etiek te verwerf en 40.2% is tevrede met die inhoud van huidige VPO-aktiwiteite wat met etiek verband hou. Daar is baie lae vlakke van bewustheid en kennis van bestaande rigsnoerdokumente oor optrede en etiese aspekte op die RGBSA se webtuiste beskikbaar, en slegs 9.8% van die respondente het die inligting deeglik gelees en bestudeer. Dieetkundiges verkies lesings en Internet-gebaseerde aktiwiteite vir kursusse oor etiek. Die studie kom tot die gevolgtrekking dat daar ’n definitiewe aanvraag onder respondente is na nuwe gestandaardiseerde kursusse oor etiek en ’n dringende vraag na ondersteuning ten opsigte van etiese kwessies en optrede. Aanbevelings fokus op maniere om ’n bewustheid te kweek van bestaande ondersteuningsdokumente oor etiese kwessies wat by die RGBSA beskikbaar is, asook oor die vorming van subkomitees wat werk met etiese aspekte en die moontlike ontwikkeling van gestandaardiseerde bygewerkte kursusse oor etiek.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2007. / Introduction In order to address poor breastfeeding rates, both nationally and internationally, there is a great need for ongoing breastfeeding training for students of health care professions and health care workers (HCWs). Despite the availability of courses, there is a need for new approaches to ensure greater and more effective coverage in breastfeeding training. The students of today relate well to the use of computers in the learning environment. It was therefore deemed appropriate to explore this training method as a means to enhance the breastfeeding learning experience for students of health care professions and, more specifically, for undergraduate dietetic students. This study was aimed at adapting and validating an Indian computer-based undergraduate breastfeeding training module, intended for use by South African (SA) undergraduate dietetic students, in order to assess whether computer-based learning in breastfeeding training could address the relevancy of the topic, assess how students view the learning experience and determine whether it could contribute to a gain in knowledge of the subject. Methods An Indian computer-based undergraduate breastfeeding training module in PowerPoint format was adapted to suit the SA scenario. It was converted into web-based interactive material using the Virtual Training Studio (VTS) software tool. The adapted module was assessed for face and content validity by 19 peer reviewers and 17 third year Stellenbosch University (SU) dietetic students, by means of a self-administered questionnaire. A focus group discussion was also conducted with the third year students. The impact of the adapted module on knowledge was evaluated by means of a pre- and post-knowledge test on a total of 29 second year SU (n=14) and University of the Western Cape (UWC, n=15) dietetic students. Results All of the peer reviewers and students were of the opinion that their information technology (IT) skills were sufficient to complete the adapted module. The majority of the peer reviewers (94%, n=17) also indicated that they had adequate IT facilities and that it was feasible to administer the module. Peer reviewers and students enjoyed the presentation and delivery mode of the adapted module. Third year students indicated that computer-based learning (CBL) was a “nice way of learning”, but pleaded that it should not be used as the sole source of instruction. The majority of the peer reviewers and students (53%, n=19) rated the mode of learning to be equally effective compared to conventional lectures, 35% rated it as being more effective and 11% as less effective. Eighty six percent of peer reviewers and students felt that the information in the adapted module was sufficient to enable the students to take the necessary preventive- or treatment action. The majority (91%) were of the opinion that the information in the adapted module was appropriate for the specific needs and cultural context in SA. There was a significant increase in the knowledge test scores for second year students at SU and UWC. Conclusion The SA VTS breastfeeding training module can be integrated effectively as part of multi-media methods to increase knowledge and enhance breastfeeding training for undergraduate dietetic students, as well as other students of health care professions and, possibly, HCWs in institutions striving to become Baby Friendly.

Thesis (MNutr(Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objective: The aim of this study was to determine the body composition, dietary intake and supplement use among training olympic and ironman distance triathletes residing in the Western Cape region. Design: Descriptive, analytical, cross-sectional study design Setting: Western Cape Province (South Africa) Subjects: Triathletes residing in the Western Cape region registered with Triathlon South Africa (N = 26) Outcome measures: Percentage body fat, total energy intake, macro– and micronutrient intake, use and reasons for use of nutritional supplements or nutritional ergogenic aids. Results: The mean age of the men and women was 37.9 [Standard Deviation (SD) 6.82] and 37.5 (9.6) years respectively. The corresponding mean amount of training per week for men and women respectively were 15.1 (4.1) and 15.3 (4.7) hours. The percentage body fat as determined by multi-frequency bio-electrical impedance analysis of the men and women were 12.97% (4.3) and 21.4% (6.3) respectively. The mean dietary macronutrient intake as determined by a three day food record for men was for total energy intake 14 534.7kJ (4509.8), carbohydrate intake 5.3g/kg body weight (BW) (1.9), protein intake 2.0g/kg BW (0.5) and fat intake 34.6% (10.31) of total energy requirements. Dietary micronutrients not reaching 67% of dietary reference intakes (DRI) from food alone included iodine (44%) and fluoride (49%). Vitamin C (154%). Micronutrient intake above upper limit (UL) was sodium (213%), manganese (162%) and niacin (228%). The dietary macronutrient intake for women was for total energy intake 9004.1kJ (2368.8), carbohydrate intake 3.5g/kg BW (1.0), protein intake 1.2g/kg BW (0.2) and fat intake 29.8% of total energy intake (6.0). Micronutrients not reaching 67% of the DRI were chloride (61%), iodine (31%) and fluoride (52%). Micronutrient intake above the UL was vitamin C (218%) and manganese (174%). The dietary intake of the men was inadequate in carbohydrate, provided sufficient energy and protein and excessive fat. The dietary intake of the women was inadequate in total energy and carbohydrate, with an adequate protein intake and excessive fat intake. Although the sample size was very small, some associations were found between dietary intake and clinical health status. Seventy three percent of the triathletes use over the counter dietary supplements. The supplements used most often included carbohydrate supplements (81%), multivitamin and mineral supplements (81%) single vitamins (65%), protein supplements (100%), single minerals (58%), antioxidants (54%) and herbal supplements (42%). Most popular reasons for consuming supplements included recovery (62%), increasing energy supply (61%), enhancing immune function (50%), exercise performance enhancement (46%), increasing muscle mass (54%) and to make up for an inadequate diet or nutrient replacement (31%). Conclusion: Percentage body fat of the men and women were at the upper end of the range associated with elite athletes. The athletes have a fairly good intake of macro– and micro-nutrients. Inadequate habitual carbohydrate intake can be attenuated by the vast majority of the triathletes taking additional carbohydrate supplementation. Supplements were used widely among the athletes, whether it is scientifically proven to be beneficial or not.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2007. / INTRODUCTION: The study’s objective was to evaluate the South African Continuing Professional Development (CPD) system for dietitians, by determining their perceptions of the systems’ implementation and participation in CPD activities within the system, that was in place from 1 September 2001 until 1 April 2006. METHODS: The study was designed as an observational descriptive study. Three data gathering techniques were used, incorporating both quantitative and qualitative methods:- i) A national survey of dietitians was conducted using a self-administered questionnaire. The 40 item questionnaire comprised 3 sections, i.e. socio-demographics, the CPD system, and CPD activities. Content and face validity was conducted followed by pilot testing, prior to distribution via post and e-mail, to 1589 dietitians. ii) After the survey, 3 focus group discussions (FGD) were held with 19 Pretoria-based dietitians, to discuss issues that emerged from the questionnaire responses. iii) In-depth interviews were conducted with 6 CPD personnel representing the Health Professions Council of South Africa (HPCSA), CPD Committee and the Association for Dietetics in South Africa (ADSA) providing insights from an administrative and managerial perspective. RESULTS: A response rate of 20% was achieved for the national survey. More respondents found the ADSA and CPD office helpful, friendly, easy to contact and their CPD queries efficiently handled. However respondents and FGD participants stated that the HPCSA was difficult to contact and CPD queries were unresolved. Respondents called for simplified rules and guidelines to improve understanding of the system since they felt that CPD information/correspondence was lengthy and difficult to understand. The majority of respondents (54.5%; n=156) and most FGD participants did not find the CPD administration fee reasonable. Affordability of CPD activities was also a concern with 55.2% (n=164) stating that activities were expensive. A few FGD dietitians and 29.65% (n=88) of respondents did agree that there were both expensive and affordable activities to choose from. Statistically significant differences were found between the amounts of money spent on CPD across the various practice areas, qualifications and between provinces. Dietitians’ current CPD practices were mainly attendance at lectures and seminars, followed by conferences and then journal articles. If given a preference, however, respondents ranked conferences as their top preference followed by lectures. Journal clubs were rated third, ahead of journal reading. Barriers to CPD participation included cost, limited activities close by, obtaining leave from work, family obligations and internet access. Variety and usefulness of topics for presentations and articles were also criticised, as was the technical nature of questions. In the new system, the reduced annual CPD points requirement was appreciated, however 51.7% (n= 161) preferred not to keep their own CPD records. CONCLUSION: The study provided some insights into dietitians’ perceptions of the CPD system. Strengths of the current system were stated as improved knowledge, improved patient care and networking with colleagues. Issues identified for improvement include simpler CPD correspondence and reasonable fees. Additionally, ways should be sought to minimise barriers to participating in CPD. Addressing these issues will contribute to the provision of quality CPD within a system that is acceptable to its participants.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / INTRODUCTION: Since the start of the Prevention of Mother-to-Child Transmission (PMTCT) Programme at Dr George Mukhari Hospital in 2001, there has been no evaluation of the effect of formula feeding on the growth and dietary intakes of enrolled infants. AIM: The aim of this study was to determine the short-term growth, anthropometry and dietary intake of infants from two to ten weeks of age were entered into the PMTCT Programme at the Department of Human Nutrition at Dr George Mukhari Hospital from two to ten weeks of age. METHODS: This was a descriptive, longitudinal (eight weeks duration) study. Anthropometric assessment including length and head circumference was performed at two weeks of age and thereafter at ten weeks of age. Weight measurement was performed at age two weeks (visit 1), six weeks (visit 2) and ten weeks (visit 3). Anthropometric measurements were compared with CDC 20003 growth charts. Feeding practices and dietary intake (24 hour diet recall interview) were assessed at each of the four week interval visits and evaluated according to the DRIs59. At the third visit, a socio-demographic interview and a usual food intake interview were performed. RESULTS: A total of 151 [male (N = 75) and female (N = 76)] infants completed the study. A total of 110 (72%) mothers resided in the Soshanguve area and 138 (91%) of the mothers had attended high school. The majority (75%) of mothers was not generating an income from employment. Generally, mothers had access to safe drinking water and all (99%) but two mothers used pre-boiled water before preparing infant formula. The accuracy and correctness of reconstituting infant formula decreased with each visit as feeds were increasingly made too dilute. A total of 124 (82%) infants were exclusively formula fed. The remainder received water, water with sugar and/or complementary feeds. Mean energy and macronutrient intakes of both males (N = 65, 87%) and females (N = 61, 80%) were below recommendations at age two weeks. Of all the macronutrients, fats were consumed the least by both males (N = 67, 89%) and females (N = 66, 87%) at visit 1. Catch up growth was evident and nutrient intakes improved as the study progressed. The mean weight gain of all infants from visit 1 to 2 was 1.2 (SD 0.3) kg and 0.9 (SD 0.3) kg from visit 2 to 3 (exceeding the CDC 20003 recommendation for both male and female infants). The incidence of underweight, wasting and head circumference-for-age below the third percentile decreased from visit 1 to 3, but the number of stunted infants increased towards visit 3. The majority of infants in this study grew well in their first ten weeks of life. Growth accelerated as infants became older and growth faltering improved by ten weeks of age. CONCLUSION: Overall, the growth of the infants referred to the PMTCT Programme at the Department of Human Nutrition at Dr George Mukhari Hospital would appear to be adequate but mothers’ approach to formula feeding practices needs to be improved in some aspects of feeding their infants.