Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / Background: Cancer patients have been documented to use complementary and alternative medicine (CAM) frequently, a subject that has been extensively researched. There is however a lack in the current literature of controlled studies that investigate the prevalence of CAM use among cancer patients compared to non-cancer controls. Aim: To assess and compare the prevalence of dietary related CAM use among adult cancer patients and non-cancer controls in the Norwich area, England. Methods: Self-administered questionnaires were used to survey cancer patients attending a comprehensive cancer centre in Norwich, and non-cancer controls attending three dental surgeries also in the Norwich area. Questions addressed patient demographics, information relating to cancer diagnosis (cancer cases only) and information on CAM use. CAM users were asked about types and duration of CAM use, reasons for use, information sources used, disclosure to health professionals, reported side effects and benefits and satisfaction with CAM therapies. Results: Questionnaires were distributed to 132 cancer cases and 126 controls, with 98 and 96 assessable replies received from the cases and controls respectively. Overall, 47% of the cancer cases used CAM, in comparison to 53% of the control group, with no significant difference (p=0.673) between the two groups. Large quantities of juice, multivitamins, fish oils and glucosamine were the most popular CAM therapies among the two groups. Usage was significantly associated with the cancer site (p=0.036) and duration of cancer diagnosis (p=0.050). Only 54% of the cancer cases and 44% of the controls informed a health professional about their CAM use. The main reasons for using CAM were to boost the immune system and to improve quality of life. Reported benefits included increased optimism and hope. Conclusions: Although CAM was commonly used by British cancer patients, there was no significant difference in comparison to the non-cancer controls. Therefore, increased awareness and knowledge of CAM use should not be limited only to those working with oncology patients, but be extended to health professionals in all patient groups.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2007. / OBJECTIVE: The objectives of this study were to determine the nutritional practices used in burns units in South Africa and to compare them with the latest available literature in order to make appropriate recommendations for possible implementation. METHODS: Validated questionnaires were sent out to surgeons, dietitians and professional nurses working in burns units that complied with the inclusion criteria. Information on the units was obtained from an advertisement placed via email through ADSA. Non-random sampling was done and all the burns units were included in the study. Descriptive cross-sectional statistics were used to analyze the data. RESULTS: Twelve burns units were identified. Ten of the burns units’ health professionals (surgeons, dietitians and professional nurses) participated in the study. All the health professionals had experience in burned patients’ management judging by the average number of year’s experience. The average number of adult burned patients treated was 188 (58-350) and the mortality per year was 16% [Standard Deviation (SD) 6.4%] About half of the professionals indicated they used a protocol for the implementation of nutrition support. A degree of miscommunication was noted between the health professionals working in the units. Very few units (n=2) were able to perform wound excisions within 72 hours post-burn. All the dietitians used predictive equations when estimating energy requirements and the most popular formula remained the Curreri formula. Various different predictive equations were used. Even though most institutions indicated that micronutrient supplementation was routine practice, no standard regimen existed and supplementation varied significantly between units. The oral route, enteral route or a combination were used to feed patients with different degrees of burns, and the majority (60%) of the health professionals stated that they waited until oral diets were tolerated before enteral nutrition was stopped. The nasogastric enteral route remained the most popular route. Very few units used other feeding routes, and they would rather opt for TPN if nasogastric feeding should fail. The estimated nutritional requirements were met in 90% of patients in whom the feeding tube was successfully placed. From the results it appeared that dietitians were less confident regarding the use of immunonutrition in burned patients, in spite of the available literature. Anabolic agents were not very commonly used in South Africa, probably due to the high cost. Patients were not followed-up regularly by dietitians. CONCLUSION The results of this study indicated that despite the use of correct recommendations in certain instances there remained a definite degree of variation and uncertainty amongst health professionals. There also appeared to be poor communication between health professionals. The burns units in South Africa should use set standards for nutritional managements, obtain and implement strict feeding protocols and improve communication amongst the health professionals.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Background: In Africa, internet access and use is plagued by numerous barriers. Whilst South Africa (SA) boasts a better population penetration than the rest of Africa there is a lack of regulation regarding the internet and e-mail use amongst health professionals and their patients. The aim of this study was to assess the use of the internet amongst dietitians and medical doctors (MDs) in clinical practice in SA and draft a policy on such usage amongst health professionals and their patients. Methods: A cross-sectional analytical web-based survey was conducted amongst registered dietitians and MDs. A cover letter including a hyperlink to the self-administered questionnaire was e-mailed to all dietitians and a proportionate, stratified random sample of MDs with contactable e-mail addresses. The questionnaire consisted of open and closed questions, including demographics, influence of the internet on the quality of care of patients, quality control with web resources and aspects of information technology (IT) which were recommended by health professionals to be incorporated as part of undergraduate health science education Results: A total of 176 health professionals participated in the study (106 dietitians and 70 MDs). The mean age of the dietitians was 32.6± (8.0) and the MDs 50.5± (8.9). The majority of the respondents in this study population were White (82%) females (67%). On average, practitioners had been in practice for 9.1(8.0) years. The majority of dietitians (58%) and MDs (68%) had access to the internet at both their practice or workplace and their home. More dietitians (65%) than MDs (41%) were using e-mail or internet. MDs did not use the internet for research purposes, whilst a fifth of dietitians (21%) reported using the internet as a research tool. A greater percentage of the sample [MDs (69%) and dietitians (82%)] reported that, the internet had improved the quality of care of their patients. The dietitians (60%) and MDs (53%) in this study sample were unclear about how to source information and determine the reliability or accuracy of the information obtained from internet resources. Conclusion: Internet is incorporated into the practice of most dietitians and to a lesser extent by MDs. In this study, the need for training amongst health professionals regarding the use of the internet was highlighted. The study reflects that even though health professionals were unsure of the credibility of the internet information resourced, it did not stop the use of the internet in the practice. This is an area of concern, since it could potentially result in the distribution of misinformation. This warrants regulation on the use of the internet in health practices in SA. A policy on the use of IT in health care practice has been drafted. Further research on the use of IT in the healthcare practice is required before the policy can be finalized. The advantage is that some elementary information is now available. The challenge is to ensure that the time lapse between additional research, policy finalization and policy implementation is kept to a minimum. / OPSOMMING: Agtergrond: In Afrika is internet toegang en gebruik met baie hindernisse belas. Alhoewel Suid-Afrika (SA) met ‘n beter bevolkingspenetrasie as die res van Afrika spog is daar ‘n gebrek aan regulasie in verband met internet en e-pos gebruik tussen gesondheidswerkers en hul pasiënte. Die doel van hierdie studie was om die gebruik van die internet deur dieetkundiges en mediese dokters (MDs) in kliniese praktyk in SA te assesseer en om ‘n konsepbeleid rakende sulke gebruik tussen gesondheidswerkers en hul pasiënte op te stel. Metode: ‘n Dwarssnit analitiese web-gebaseerde opname is met geregisteerde dieetkundiges en MDs onderneem. ‘n Dekkingsbrief met ‘n webskakeling (hyperlink) tot die selfgeadministreerde vraelys is aan alle dieetkundiges en aan ‘n eweredig, gestratifiseerde ewekansige steekproef van MDs met kontakbare e-pos adresse gestuur. Die vraelys het uit oop en toe vrae bestaan, insluitend demografie, invloed van die internet op die kwaliteit van sorg van pasiënte, kwaliteitskontrole met web-hulpmiddels en aspekte van informasie tegnologie (IT) wat deur gesondheidswerkers aanbeveel was om deel te word van voorgraadse gesondheidswetenkaplike onderrig. Resultate: ‘n Totaal van 176 gesondheidswerkers het aan die studie deelgeneem (106 dieetkundiges en 70 MDs). Die gemiddelde ouderdom van die dieetkundiges was 32.6± (8.0) jaar en die MDs 50.5± (8.9) jaar. Die meerderheid respondente in hierdie studie populasie was blank (82%) en vroulik (67%). Oor die algemeen was praktisyne vir 9.1± (8.0) jaar in praktyk. Die meerderheid dieetkundiges (58%) en MDs (68%) het toegang tot die internet by beide hul praktyk of werkplek en hul huis. Meer dieetkundiges (65%) as MDs (41%) het e-pos of internet gebruik. MDs het nie die internet vir navorsingsdoeleindes gebruik nie, terwyl ‘n vyfde van dieetkundiges (21%) raporteer het dat hulle die internet vir navorsingsdoeleindes gebruik het. ‘n Groot persentasie van die populasie [MDs (69%) en dieetkundiges (82%)] het gerapporteer dat die internet tot ‘n verbetering in sorg van hul pasiënte gelei het. Die dieetkundiges (60%) en MDs (53%) in hierdie studie was onseker hoe om informasie te verkry en die betroubaarheid en akuraatheid van die informasie vanaf internetbronne te bevestig. Opsomming: In hierdie studie word internet in die praktyke van die meerderheid dieetkundiges en tot ‘n mindere mate in die van MDs geinkorporeer. Die noodsaaklikheid vir opleiding in die gesondheidsberoepe met betrekking tot die gebruik van die internet is aan die lug gebring. Hierdie studie weerspieël dat alhoewel gesondheidswerkers onbewus was van die geloofwaardigheid van internet informasie, dit nie die gebruik van die internet in hul praktyk gestop het nie. Dit is ‘n area van kommer aangesien dit potensieel na die verspreiding van misinformasie kan lei. Dit motiveer dus reguleering van die gebruik van die internet in gesondheidspraktyke in SA. ‘n Beleid oor die gebruik van IT in gesondheidspraktyke is in konsepvorm opgetrek. Verdere navorsing oor die gebuik van IT in gesondheidspraktyke word benodig om die konsepbeleid te finaliseer. Die voordeel is dat basiese inligting nou beskikbaar is. Die uitdaging is om te verseker dat die tydsduur tussen addisionele navorsing, beleidsfinaliseering en beleidsimplementering tot ‘n minimum gehou word.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / OBJECTIVES: To determine perceived Quality of Life (QOL) of the diabetic patient and to assess whether QOL is associated with diabetes-related markers. DESIGN: This was a descriptive cross sectional study. SETTING: A multiethnic group of type 1 and 2 diabetic patients (n= 68) attending a diabetic clinic in Alberton, South Africa, were evaluated. SUBJECTS OUTCOME MEASURES: QOL was assessed by means of the Audit of Diabetes-Dependant Quality of Life (ADDQoL) questionnaire. Glycaemic control, duration of Diabetes Mellitus (DM), type of DM, diabetic complications, level of education and nutritional status were evaluated. RESULTS: Ninety eight percent of diabetic patients perceived their DM to impact negatively on their QOL (p=0.03). QOL and glycaemic control were significantly (p=0.03) related. QOL and the duration (p=0.80) or type (p=0.77) of DM were not significantly related. QOL ratings were lower in participants who had hypertension and hyperlipidaemia, whereas this trend was not present in those with microvascular complications. There was a trend towards a negative relationship between QOL and weight (p=0.10), BMI (p=0.10) and WC (p=0.41). All 13 individual life domains were significantly related (p < 0.05) to QOL for the group as a whole. Rankings of individual life domains differed between type 1 and type 2 diabetics (p<0.05) as well as between black and white subjects (p<0.05). CONCLUSIONS: These results show that DM impacts on various aspects of QOL and that various population sub-groups perceive their DM to impact differently on their QOL. QOL assessments should therefore form part of DM management and should be culturally sensitive.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of this study was to explore the barriers that doctors experience to referring patients to dietitians. The study sample (n = 700) included a selection of all practicing medical doctors and specialists in the Gauteng province of South Africa. Registration with the Health Professions Council of South Africa (HPCSA) was a prerequisite. METHOD: This was a quantitative study using a validated questionnaire e-mailed to participating doctors in order to determine factors affecting their referral practices. The first part of the questionnaire consisted of demographic and general information about the respondent and the second and third parts consisted of a series of closed-ended questions that related to specific issues of nutrition information and dietitian referral practices respectively. The questionnaire comprised a total of 21 questions. Subjects were sent the questionnaire by e-mail and given four weeks to respond. Three reminder e-mails were sent to encourage participation. Statistical analysis methods included: Kruskal-Wallis, Pearson Chi-square, likelihood ratios, linear-by-linear associations, as well as Goodman and Kruskal tau tests. RESULTS: Of the questionnaires sent out, 134 (19%) out of 700 were finally useable. Doctors who had a nutrition component in their training referred patients to dietitians more often than those who did not and older doctors referred to a dietitian less often (Chi-square tests, p < 0.05). A correlation was observed between the duration of medical practice and frequency of referral (p = 0.03) while gender had no influence on referral practice. A correlation (p < 0.001) was also found between frequency of referral and university of study with symmetric measures. Hyperlipidaemia, diabetes mellitus and obesity were identified as the conditions doctors would most likely refer to a dietitian. For 45% of the doctors insufficient time during consultation was the strongest barrier to providing nutrition councelling to their patients. The barrier identified most commonly was that doctors were unaware of dietitians in the vicinity of their practices (49%). Sixty four percent of doctors believed that better marketing by dietitians would increase their referrals, and 21.4% believed that the title ‘nutritionist’ or ‘nutrition specialist’ would be more suitable for the profession of dietetics. CONCLUSION: The findings of the study indicate that a number of factors contribute to the barriers that doctors experience to referring patients to dietitians. Although the study was limited by a small sample, it nevertheless draws attention to the responsibility of both dietitians and doctors to work together toward providing patients with a more efficient team approach treatment and care system. More qualitative studies are needed to explore the identified barriers further, especially within the South African context, as well as to establish appropriate recommendations to overcome the barriers to referral.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2005. / A diet high in fat results in dietary-related diseases, which have reached epidemic proportions in South Africa. Nutritional labelling has the potential to alter consumers’ knowledge of attitude and behaviour towards their fat intake. The purpose of the study was to investigate the effects of nutritional labelling on the population’s fat-intake through a systematic literature review. Electronic databases, reference lists of relevant studies and the Internet were searched, to identify studies that could help to answer the problem statement. Relevant citations were independently identified by two investigators based on the established inclusion-criteria. After this the full text of the selected citations were obtained and filtered independently by each investigator based on the inclusion- and exclusion criteria. The characteristics of each study was recorded in specially developed data extraction forms by the investigator herself and was checked by a second investigator. The primary objective of the study was to investigate nutritional labelling on food packaging. Two other forms of labelling were included to gain a more concise perception of consumers’ knowledge and practices regarding information on fat. These other forms were point-of-sale labelling (in supermarkets, in restaurants, by vending machines) and experimental labelling (labels spesifically designed to indicate the fat-content of a food item). A total of 59 relevant studies were included based on the inclusion-criteria. Although only a few studies assessed the effect of labelling on diet, there was evidence that the use of labels resulted in lower fat intake. Women older than 35 years with higher education levels, who used nutritional supplements, and who were in the maintenance stage of change to a lower fat diet, and who believed in the importance of nutrition, were between 50% to 80% higher users of information about fat than their counterparts. Fat is the food component which was most looked at on the food label (50% to 80%). Small changes in fat intake occured due to point-of-sale labelling, but labelling programmes which combined labelling with additional information on fat (e.g. pamphlets), increased visibility and nutrition education programmes, were more successful. People generally perceived products lower in fat as less pleasant, but sensory judgement of the products labelled with a low fat content were related to a person’s beliefs and concerns towards fat. Nutritional labelling can be an effective measure, which can be used to reduce the population’s fat intake; however, more research is needed to assess the effect of labelling on fat content of their diet. Regulations and education is needed to enhance the consumer’s trust in and capability in the use of labelling to make better food choices and to alter their diet. The success of labelling is dependant on a well-educated and motivated population, as well as the necessary information in a format which is understandable to the consumer.

Thesis (MNutr (Interdisciplinarty Health Sciences. Human Nutrition))--University of Stellenbosch, 2005. / Objectives: To determine aspects of knowledge, attitudes and practices of Medical Practitioners on obesity and weight management in three urban centres in Kenya. Research methods and procedures: A cross sectional survey of a randomly selected sample of 485 Medical Practitioners (MPs) from three urban centres in Kenya namely Nairobi, Mombasa and Kisumu was carried out. Four hundred and thirty (89% response) questionnaires were fully completed and returned. Data was gathered on the demographics of the study population; knowledge of nutrition and obesity; awareness of obesity as a health problem assessment, management (diet, exercise and pharmacology) and practices regarding obesity as well as if and how the MPs would like their knowledge of obesity improved.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Embargo expiry date: 2010-07-31 plt 2010 / ENGLISH ABSTRACT: The prevalence of chronic diseases of lifestyle such as cardiovascular disease, cancer, type 2 diabetes mellitus and obesity are increasing worldwide due to changes in lifestyle patterns, including changes in the food consumption patterns of consumers. There are numerous players who need to be involved in addressing current lifestyle patterns and in encouraging positive behaviour change. Food companies have a role in evaluating the composition of the products that they offer, as well as in educating consumers with regard to healthy eating practices through both the on-pack information that they supply and in their nutrition strategies and programmes. The main objective of the study was to investigate the nutrition strategies that food companies in South Africa use to communicate with the consumers and to compare it with the knowledge, attitudes and practices of the consumers towards the nutrition information that they receive. The secondary objective was to develop guidelines for food companies in their promotion of the prevention of chronic diseases of lifestyle. Methodology The study population consisted of a sample of 7 food companies operating in South Africa and a sample of 230 South African consumers. Data were collected through test questionnaires aimed at each specific study population. The data were analysed statistically for each study population and the data between the two study populations were compared. Results Most food companies that participated stated that they have a nutrition strategy which outlines their consumer communication policy, but none of these were made available to the researcher. Seventy-one percent of the food companies also indicated that they address chronic diseases of lifestyle in their nutrition strategies, with cardiovascular disease being the main focus. The medium used most frequently by food companies for nutrition education of the consumer is the food label. The majority of food companies agree that they do have a responsibility towards the education of the consumer, but stated that it is not solely their responsibility. Ninety-six percent of consumers read (always or sometimes) the labels of food products when making a purchase. The older the consumer, the more unlikely they are to read the ingredients statement on the label. Consumers are most concerned with cardiovascular disease when purchasing food products. Ninety-five percent of consumers agreed that food companies have a responsibility towards them with regard to nutrition education. The consumers indicated that they prefer food labels and television as the medium for nutrition education, but that they trust doctors and nutritionists the most to relay nutrition messages. Conclusion Consumer education on the prevention of chronic diseases of lifestyle is essential if the behaviour change, necessary to address their rising prevalence, is to become a part of consumers’ lifestyles. Food companies should be actively involved with consumer education pertaining to healthy eating and healthy lifestyle habits. Communication with regard to nutrition education is critical and should be consistent with an integrated approach involving all the role players including the food industry, the Department of Health (DOH) and the Department of Education (DOE). / AFRIKAANSE OPSOMMING: Die prevalensie van kroniese lewensstyl siektes soos hartvatsiektes, kanker, tipe 2 diabetes mellitus en vetsug is wêreldwyd aan die toeneem weens ’n verandering in die lewenstyl van verbruikers wat ’n weer ‘n verandering in eetgewoontes teweeg bring. Daar is verskeie rolspelers betrokke wat ’n bydrae kan lewer om die huidige lewensstyl patrone van verbruikers aan te spreek en om positiewe gedragsveranderinge te bevorder. Voedselmaatskappye speel ‘n tweeledige rol: deur die samestelling van voedselprodukte wat hulle versprei te evalueer, en deur die verbruiker op te voed oor gesonde eetgewoontes. Maatskappye se voedingstrategieë en programme, asook die verpakking van produkte, kan gebruik word om voedingsinligting te verskaf. Die studie se hoof doelwit was om die voedingstrategieё te ondersoek wat deur voedselmaatskappye in Suid Afrika gebruik word en om dit te vergelyk met die kennis, houding en praktyke van die verbruiker teenoor voedingsinligting wat hulle ontvang. Die sekondêre doelwit was om riglyne vir voedselmaatskappye te ontwikkel ter ondersteuning van die maatskappye se inisiatiewe om kroniese lewensstyl siektes te voorkom. Metodologie Die studiepopulasie het bestaan uit ’n steekproef van 7 voedselmaatskappye wat in Suid Afrika werksaam is en ‘n steekproef van 230 Suid Afrikaanse verbruikers. Data is ingesamel deur twee uitgetoetsde vraelyste te gebruik wat spesifiek geteiken was vir elke studie populasie. Die data is statisties geanaliseer vir elke studie populasie en die studie populasies is ook met mekaar vergelyk. Resultate Die meeste voedselmaatskappye wat deelgeneem het aan die studie verklaar dat hulle ‘n voedingstrategie het wat die wyse waarop daar met die verbruiker kommunikeer word uitstippel, nogtans was geeneen van die voedingstrategieë beskikbaar gestel aan die navorser nie. Een en sewentig persent van die voedselmaatskappye het ook aangedui dat kroniese lewensstyl siektes aangespreek word in hul voedingstrategieë en dat daar gefokus word op hartvatsiektes. Voedselmaatskappye gee voorkeur aan die voedseletiket as medium vir voedingvoorligting aan die verbruiker. Die meeste voedselmaatskappye het saamgestem dat hul wel ‘n verantwoordelikheid het teenoor die verbruiker ten opsigte van voedingvoorligting, maar beskou dit nie as uitsluitlik hul verantwoordelikheid nie. Ses en negentig persent van die verbruikers lees voedsel etikette (altyd of soms) wanneer hul aankope doen. Dit blyk dat die ouer verbruiker minder geneig is om die bestanddelelys te lees. Verbruikers is oorwegend bekommerd oor hartvatsiektes wanneer hulle voedselaankope doen. Vyf en negentig persent van die verbruikers stem saam dat voedselmaatskappye ‘n verantwoordelikheid het teenoor verbruikers ten opsigte van voedingvoorligting. Die verbruikers gee voorkeur aan die voedsel etiket en televisie as mediums vir voedingvoorligting, maar hul vertrou meestal op dokters en voedingkundiges om die voedingboodskappe oor te dra. Gevolgtrekking Om gedragsverandering by verbruikers mee te bring met die oog daarop om die toename in kroniese lewensstyl siektes aan te spreek, is dit essensiëel om die verbruiker toe te rus met die nodige kennis oor die voorkoming van kroniese lewenstyl siektes. Voedselmaatskappye behoort aktief betrokke wees by verbruiker opvoeding oor gesonde leef- en eetgewoontes. Kommunikasie ten opsigte van voedingvoorligting moet konsekwent wees en ‘n geїntegreerde benadering moet deur alle rolspelers gevolg word, insluitende voedselmaatskappye, die Departement Gesondheid en die Onderwysdepartement.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Thesis presented in partial fulfillment of the requirements for the degree of Master of Nutrition at Stellenbosch University. / ENGLISH ABSTRACT: The glycemic index (GI) has proven to be a valuable nutritional tool in the management and prevention of diabetes and other chronic diseases of lifestyle 1,3,4,5,6,79,12,14,15. In this quantitative, cross-sectional, observational and descriptive study, the aim was to determine the knowledge and level of comprehension of South African registered dietitians with regard to GI and glycemic load (GL) as well as to determine their ability to use/implement the GI in the treatment of diabetes / insulin resistance. A questionnaire was emailed to 388 registered dietitians for completion. The questionnaire was based on relevant scientific literature and divided into three parts. The first part gathered demographical information about the participants, with special emphasis on where they had acquired their knowledge of GI principles. The second and third parts contained closed-end questions to which the participants were required to answer ‘true’ or ‘false’ or were presented with a multiple choice. Twenty-five questions specifically focused on the GI and the other 12 focused on GL. One hundred and fourteen subjects took part in the study. The results showed that most dietitians (54 %) did not learn GI principles at university and that the year that they qualified did not affect test results. The University attended did not seem to affect test results either, with the exception of Medunsa (Medical University of South Africa), where graduates scored on average significantly lower than the rest of the group). The test scores varied between 43% and 97%. The average test score for the group was 71% with those dieticians in private practice scoring the highest average (76%) compared to those working in other practice areas. Although 84% percent of participants reportedly used GI principles in their daily practice with patients, compared to only 33% who reportedly used GL principles, results showed no significant difference between knowledge or comprehension levels of GI and GL or the ability to implement GI or GL principles. To conclude, South African dietitians seem to have a good general knowledge of GI, but there is still room for improvement in order to ensure that dietitians can become experts in the field. It is recommended that curricula be revised to give this subject more attention during formal university training. / AFRIKAANSE OPSOMMING: Navorsing het bewys dat die Glukemiese Indeks (GI) ‘n waardevolle wetenskaplike hulpmiddel is in die voorkoming en bestuur van diabetes en ander chroniese siektes van lewenstyl 1,3,4,5,6,79,12,14,15 . Die doelwit in hierdie kwantitatiewe, dwars-snit, beskrywende studie was om die kennis- en begripsvlak van Suid-Afrikaanse dieetkundiges te toets rakende die GI en glukemiese lading (GL) asook hul vermoëns om hierdie beginsels toe te pas en te gebruik in die behandeling van diabetes en insulienweerstandigheid. ‘n Vraelys is aan 388 dieetkundiges gepos. Die vraelys was gebasseer op relevante wetenskaplike literatuur en het uit drie afdelings beslaan. Die eerste afdeling was ten doel om demografiese inligting oor deelnemers te bekom met spesifieke belang by die afkoms van hul kennis oor die GI. Die tweede en derde afdelings het bestaan uit vrae waarop ‘waar’ of ‘vals’ gemerk moes word of uit veelvuldige keuse vrae. Vyfen-twintig vrae het gefokus op die GI en twaalf vrae het gefokus op die GL. Eenhonderd-en-veertien persone het deelgeneem aan die studie. Die resultate het getoon dat meerderheid van die deelnemers (54%) nie die beginsels aangaande die GI op universiteit geleer het nie. Die jaar waarop graduasie plaasgevind het, het blykbaar nie ‘n invloed op uitkoms gehad nie, en die universiteit waar graduasie plaasgevind het, het ook nie die uitslag beïnvloed nie, uitsluitend Medunsa (waar gegradueerdes aansienlik swakker gevaar het as die res van die groep). Toets uitslae het gewissel tussen 43% en 97%. Die gemiddelde toetspunt was 71%. Dieetkundiges werkend in privaat praktyk het die hoogste gemiddelde toetspunt van 76% behaal in vergelyking met dieetkundiges wat in ander velde praktiseer. Ten spyte daarvan dat 84% deelnemers aangetoon het dat hulle GI beginsels in hulle werksomstandighede toepas, in vergelyking met slegs 33% wat GL beginsels toepas, was daar geen noemenswaardige verskil in uitkomste rakende deelnemers se kennis of begripsvlak van GI of GL, of hul vermoë om verwante beginsels toe te pas nie. Ter opsomming wil dit voorkom of Suid- Afrikaanse dieetkundiges oor ‘n goeie vlak van algemene kennis betrekkende die GI beskik. Daar is wel steeds ruimte vir verbetering om te verseker dat dieetkundiges as ware kenners op die gebied kan optree. Dit word aanbeveel dat universiteite se kurrikulums aangepas word om sodoende voorsiening te maak vir verbeterde voor-graadse opleiding oor die onderwerp.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction : The health status of women in peri-urban areas has been influence by the South African political transition. Despite some progress, maternal and child mortality rates are still unacceptably high. A mother’s nutritional status is one of the most important determinants of maternal and birth outcomes. The Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not always appropriate to use in a peri-urban setting as many women attend their first antenatal clinic later on in their pregnancy. Two alternative methods, the gestational BMI (GBMI) and the gestational risk score (GRS), have been used elsewhere to screen for at risk pregnancies, but have not been used in a South African peri-urban setting. Furthermore, examining socio-economic variables (SEV) aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional antenatal clinic appointments and priority during labour. Aim: The first aim was to investigate the strength of the GBMI and GRS methods for predicting birth outcomes and maternal morbidities. The second aim was to investigate the relationships between SEV, GBMI and maternal morbidities. Methods: This was a sub-study of the Philani Mentor Mothers Study. A sample of 103 and 205 were selected for investigating the prediction methods and SEV respectively. Maternal anthropometry, gestational weeks and SEV were obtained during interviews before birth. Information obtained was used to calculate GBMI and GRS and to assess the SEV. Birth outcomes were obtained from the infant’s clinic cards and maternal morbidities were obtained from interviews two days after the birth. Results No significant association was found between GBMI and birth outcomes and maternal morbidities. A significant positive association was found between GRS and birth head circumference percentile (r=0.22, p<0.05). The higher the GRS, the higher the risk of an infant spending longer time in the hospital (Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found between GBMI and the following SEV factors; age (r=0.33, p<0.05), height (r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status (U=2.54, p<0.05). No statistically significant relationships were found between gestational hypertension and gestational diabetes mellitus and SEV. Conclusion: From the findings of this sub-study there were some promising results, however it is still unclear as to which method is the most appropriate to predict adverse birth outcomes and maternal morbidity. It is recommended that the GBMI and GRS once-off methods be repeated in a larger population to see if there are more parameters that could be predicted. Women who were older, shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic status tended to have a greater GBMI. This can lead to adverse birth outcomes and increases the risk of women developing maternal morbidities and other chronic diseases later in their life. Optimal nutrition and health promotion strategies targeting women before conception should be implemented. / AFRIKAANSE OPSOMMING: Inleiding: Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n Moeder se voedingstatus is een van die mees belangrike bepalende faktore van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses. Doelstellings: Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite. Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en moeder-morbiditeite te ondersoek. Metodes: Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie, swangerskap weke en SEV was verkry gedurende onderhoude voor geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae na die geboorte. Resultate: Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05). Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05), lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05), huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75, p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen statisties beduidende verhoudings was gevind tussen swangerskap hipertensie, swangerskap diabetes mellitus en SEV nie. Gevolgtrekking Sommige bevindinge van hierdie sub-studie dui op belowende resultate, alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n groter populasie om te sien of daar meer parameters is wat voorspel kan word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en ‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel. Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken voor bevrugting behoort geïmplementeer te word.