Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / There is convincing evidence linking school feeding to improved educational outcomes. The Primary School Nutrition Programme (PSNP) was first implemented in 1994 and aimed to improve educational outcomes by alleviating short-term hunger and improving school attendance and punctuality. Responsibility for the programme was transferred from the Department of Health (DoH) to the Department of Education (DoE) in 2004 and the name was changed to the National School Nutrition Programme (NSNP) at this time. Previous evaluations of the PSNP / NSNP had reported problems associated with foodservice management and general management aspects of the programme. The study was a cross-sectional, observational investigation of foodservice management and general management practices in primary schools running the National School Nutrition Programme (NSNP) in Pietermaritzburg, KwaZulu-Natal. Twenty-three schools were visited to investigate practices at each school relating to compliance with DoE menus and prescribed service time of the meal, the food delivery system and utilities available. The food handling and hygiene training and practices and general management practices linked to the NSNP were investigated. Most of the schools (78%) were using the DoE menus but only half (52%) served the meal at or before 10h00, which is an ongoing problem. Receiving and storage procedures were adequate at most schools. Food quality does not appear to be a problem in the Pietermaritzburg schools. The lack of expiry dates on food packages remains a problem area and should be addressed. Most of the schools had a designated kitchen area but these facilities could be upgraded. Most schools cooked on gas and 35% of schools had no running water in the kitchen. Kitchens should, at least, have hot and cold running water and adequate working space. Most schools reported that they run out of gas during the month. The monthly DoE allocation for gas should be reviewed to ensure schools have enough gas for the whole month. The holding time for cooked food should be kept to a minimum to minimise the risk of food poisoning. Some schools had insufficient plates (26%) and cutlery (35%). Standardised portion sizes were served at 70% of schools and food handlers reported that learners usually finish all the food. Food handlers at 70% of the schools had received training in food safety and hygiene but 26% of these had only received training once. Training was found to be significantly associated with hand washing (p=0.002), clean uniforms (p=0.036) iv and sanitising practices (p=0.035). Training should be provided in short, ongoing sessions. General management aspects of the NSNP remain a problem. Policies and procedures should be drawn up and implemented to provide a minimum standard of operations at schools. Monitoring should be conducted on a regular basis. The NSNP is running reasonably well in Pietermaritzburg. Adhering to prescribed meal times and upgrading kitchen facilities could result in improvements. Food handler training could also be conducted more frequently. General management aspects need to be improved.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objective: Primary: To investigate the effect of pasteurisation on the composition of expressed breast milk from HIV positive mothers and its adequacy in relation to the growth of their VLBW premature infants. Methods: A descriptive, prospective case-controlled pilot study was performed in 3 regional state hospitals in the Western Cape, South Africa. The control and study groups consisted of 12 HIV negative and 11 HIV positive mothers, with their VLBW premature infants, respectively. All mothers (19 - 35 years old) belonged to the Xhosa ethnic group. All infants were born <34 weeks gestation and birth weight <1500g. Eight breast milk samples were collected on days 6, 7, 13, 14, 20, 21, 27 and 28 from all mothers during the first 28 days after birth. Breast milk was expressed by hand or pump from either the right or left breast. Half of each breast milk sample was kept raw. The remaining sample was Pretoria pasteurised, after which both samples were subdivided into 3 or 4 aliquots to determine energy, protein, carbohydrate, fat, folate, calcium, phosphorus, magnesium, sodium, otassium, iron, copper, zinc content and HI viral load (study group only). The mothers’ dietary intake during pregnancy and lactation was obtained by means of a quantitative food frequency questionnaire and repeated 24-hour recall respectively. The infants’ dietary intake was recorded daily. Mothers’ anthropometric measurements taken at study entry and exit were weight, height and mid-upper arm circumference. All infants’ daily weight, as well as length and head circumference at birth and on day 28 postpartum was obtained. Biochemical analysis was performed on the blood samples obtained at study entry and exit from all mothers and infants. For statistical analysis, Statistica® (release no 7, 2006) was used for repeated measures analysis of variance (ANOVA) to determine the effect of HIV, pasteurisation, milk expression and time on the composition of the breast milk. Results: There was no significant difference in the studied macro- and micronutrient composition between raw or pasteurised expressed breast milk from HIV positive and HIV negative mothers with premature infants. A significant decline in breast milk protein (p<0.01), magnesium (p=0.045), potassium (p=0.002), zinc (p<0.01) and copper (p=0.03) content was observed for the whole study population over time, while folic acid content increased significantly (p=0.012) over time. The sodium/potassium ratio of both groups remained strongly indicative of the presence of sub-clinical mastitis. A significant (p=0.03) greater mean volume of milk was obtained with pump [42.5 Standard Deviation (SD) 18.1 ml], compared to hand expression [36.7 (16.7) ml]. Method of expression did not result in a significant difference in breast milk composition for any of the nutrients studied. Eight (35%) infants were born SGA while 21 (91%) infants were SGA on day 28. The infants gained a mean of 16.37 (4.5) g/kg/day (i.e. 91% of the recommended growth rate of >18g/kg/day) from the day on which birth weight was regained. The control and study group infants respectively consumed a mean of 3.27 (1.36) and 3.21 (1.36) g protein/kg/day and 138.1 (33.8) and 142.3 (33.8) kcal total energy/kg/day. This corresponds to a PER of 2.6 (control group) and 2.5 (study group) respectively, which cannot provide for the increased growth needs of the SGA infant in need of catch-up growth. Six infants experienced an incident of Grade 1 NEC which resolved and all completed the study. Two (18%) HIV-exposed infants were found to be HIV positive at 28 days post delivery. Four participating infants died. No adverse event or mortality was related to the study protocol as no intervention was undertaken. Conclusion: HIV positive Xhosa mothers provide as nutritious breast milk to their VLBW premature infants as HIV negative Xhosa mothers. Maternal nutrient intake during pregnancy and lactation did not have a significant effect on the nutritional composition of breast milk, except for folate content.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / Objective: To identify the reasons why high socio-economic class women in the Cape Metropole decide not to breastfeed; to identify the factors that influence the decision-making process when deciding which infant formula to feed the infant aged 0–6 months of age and to evaluate whether the type and volume of infant formula selected by the mother is appropriate for the infant’s needs. Method: The study was conducted as an observational descriptive study and consecutive sampling was used. Data was collected by means of a self-administered questionnaire that was available both in Afrikaans and English. Both open and closed ended questions were included. A Likert scale comprising four possible answers was used to determine attitude. Results: A total of 55 utilizable questionnaires were obtained. The majority of the mothers decided only after the birth of their infant to rather opt for formula feeding. Evident factors that were identified as a barrier to breastfeeding include a lack of knowledge and experience as well as a lack of facilities at public places and at work to breastfeed. Perceived benefits of infant formula included that the father could help with the workload and thus the father does not feel left out if the mother is breastfeeding, the mother knows what volume of infant formula the infant receives and it is more convenient if she is working. The mothers were overall not concerned about possible side effects of breastfeeding e.g. leaking and engorgement and did not feel that their breasts were physically not of optimal physiology e.g. too small or too large to be able to breastfeed. Conclusion: Numerous internal as well as external factors influence high socio-economic class women in the Cape Metropole when they decide whether to breastfeed or formula feed their infants. The identified barriers to breastfeeding will have to be addressed in this population in order to reach the WHO/UNICEF recommendation of exclusive breastfeeding up to the age of 6 months, and thereafter breastfeeding up to 2 years of age with the introduction of appropriate complementary foods.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / PROJECT AIM The aim of this qualitative cross-sectional descriptive study was to test the comprehensibility of the preliminary Food-Based Dietary Guidelines for healthy children aged 1-7 years. Objectives included assessing exposure to Food-Based Dietary Guidelines, assessing comprehension of the proposed Paediatric Food-Based Dietary Guidelines (perceptions, interpretation and understanding of terminology, concepts and descriptions), and assessing whether the guidelines can be used in meal planning. METHOD The proposed study was submitted to the Committee for Human Research, Faculty of Health Sciences, Stellenbosch University, and was subsequently approved. Focus group discussions were used to collect data. The discussions were facilitated by the investigator in either English or Afrikaans, according to a predetermined discussion guideline. Mothers with children aged 1-7 years old voluntarily participated in the study. With permission from the Department of Education, mothers were contacted via randomly chosen pre-primary schools, crèches and playgroups. Focus groups were formed on the basis of language and socio-economic status (SES), using randomly selected suburbs to represent lower, middle and upper SES groups. Sixteen focus groups were conducted: 2 pilot groups, 1 English and 1 Afrikaans lower SES, 3 English and 3 Afrikaans middle SES groups, and 3 English and 3 Afrikaans upper SES groups. RESULTS A total of 76 mothers participated in the study. On the whole, the mothers understood the proposed Paediatric Food-Based Dietary Guidelines as intended by the Paediatric Working Group. The rationale behind the guidelines was not always known, but grasped once explained. No substantial differences were found between English and Afrikaans data. Differences were found between SES groups, with the highly educated upper SES groups having a better understanding of the nutritional information than the other groups. In all groups, mothers suggested that slight changes be made to the wording of the guidelines, and that examples and additional information be given along with each of the guidelines. Overall they agreed that the proposed guidelines might prove to be useful. CONCLUSION The proposed Paediatric Food-Based Dietary Guidelines were well received by the mothers in the focus groups. The target population which would most benefit from these guidelines would be the less educated, lower SES groups, as more highly educated mothers seem to already have greater exposure to nutritional information. This study shows that once the guidelines have been modified, they may be used as a comprehensive guide for nutritional education.

225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices. / Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner. / Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission (PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should receive education that will enable them to make informed decisions about infant feeding options. Rapid, same-day HIV testing and results that are available immediately, enable health care workers to be responsible for providing pre- and post-test counselling (which includes infant feeding options) on the same day. This could place a tremendous workload and time pressure on the health care workers. The aim of this study was to determine how "informed" is the literate mother's decision regarding infant feeding options, who participated in the PMTCT Programme, in the Gert Sibande District, Mpumalanga, South Africa. Method: Data was collected from health care workers and mothers on the PMTCT Programme at 23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the PMTCT site manager at each PMTCT site, by means of once-off, self-administered questionnaires, which had been previously tested and validated. Results: Health care workers' attitude towards the PMTCT Programme was positive, although some (14%) indicated that what was expected of them was not achievable in their working environment. The most prominent change relating to the personal preferences of health care workers regarding infant feeding options for HIV-infected mothers, after attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most (65%) indicated it was possible to stay neutral in a counselling session regardless of personal preference for infant feeding and 60% of those who could not stay neutral, still thought it was in the mother's best interest to be counselled by them. Most (98%) agreed mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff was stationed at PMTCT sites, only 53% used the feeding option cards when counselling mothers and indicated that more educational material was needed. Sixty one percent of the health care workers demonstrated the preparation of the formula to the mothers and allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the health care workers knew the correct answers to knowledge questions relating to breastfeeding and formula-feeding, respectively. Not one health care worker, nor mother, knew all the steps in preparing a formula feed. Most (80%) mothers made decisions based on information provided to them by health care workers and only a small (13%) percentage were influenced by the community to practise a different feeding option than what they had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care workers, influenced the decision made by mothers regarding infant feeding options and seeing that most mothers made their decision, based on information provided by health care workers, it is concluded that mothers can only make an informed decision about infant feeding options if they are advised appropriately by well trained, equipped and informed health care workers. / AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak. Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee, wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike werkslading op die gesondheidswerkers plaas. Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert Sibande distrik, Mpumalanga, Suid-Afrika. Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6 veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide vraelyste, wat van tevore getoets en gevalideer was. Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel 14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie, het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem. Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde voedingsopsie te praktiseer as wat hulle gekies het. Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting ontvang deur goed opgeleide en ingeligte gesondheidswerkers.

Thesis (Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objectives: To describe the mothers/ primary caregivers’ (PCGs) and children’ anthropometric status; their household food security and poverty in relation to type of housing; and compare households receiving and not receiving a Child Support Grant (CSG) in relation to mothers/ PCGs’ anthropometric status, their dietary diversity, age, employment, educational level, monthly household income, size, food security and children’s anthropometric status. Design: Cross sectional, descriptive study. Subjects: Mothers/ PCGs (443) and their children from 211 households in Avian Park and 242 Zweletemba in Worcester, Western Cape Province. Methods: Data collected by interviewer administered questionnaires included socio-demographic data, Lived Poverty Index, Household Food Insecurity Access Scale (HFIAS) and dietary diversity score (DDS). Anthropometric measurements included weight, height and waist circumference (WC) of mothers/ PCGS and weight, height and mid-upper-arm circumference of children. Households living in formal (brick houses, town houses, flats) and informal (squatter shacks, huts) houses, and households receiving CSGs and those without CSG, were compared using X2-test for categorical data and the independent t-test for continuous data. Results: Prevalence of stunting, underweight and wasting in children was 20.7%, 5.6% and 1.2% respectively. Overweight and obesity occurred in 27% and 37% of mothers/PCGs respectively and together with a mean WC (89.5 cm; SD 16.7) indicated an increased risk for non-communicable diseases. Food security existed in 63.1% households. Formal households were more food secure than informal households (68% versus 50%; p=0.0004) and fewer mothers/ PCGs of formal households had a DDS < 4 (52.2% versus 64.7%; p = 0.0157). The healthier socio-economic situation in formal households compared to informal households was shown by the higher monthly income (R3 479 versus R2 316; p = 0.0009) and Household Asset Index (2.24 versus –5.31; p <0.0001). Age, marital status, education level and employment status of mothers/primary caregivers in CSG households and non-CSG households were similar. Household size was larger (p<0.0001) in CSG (median = 5 persons) versus non-CSG households (median = 4 persons); CSG households had more people per room (2.7 [SD 1.5] versus 2.3 [SD 1.2]; p=0.0037). CSG households had lower monthly income than non-CSG households (R2 723 [SD R3 297] versus R4 520 [SD R6 464]; p=0.0033). Mean HFIAS scores showed more food insecurity in CSG households than non-CSG (3.55 versus 2.37; p= 0.0178), but dietary diversity was similar. Stunting in children was higher in CSG (34.9%) versus non-CSG (22.7%) households. CSG mothers/PCGs had larger (p = 0.021) waist circumferences (90.0 cm; SD = 16.8) than non-CSG mother/PCGs (88.5 cm; SD = 16.5) Conclusion: Childhood malnutrition and maternal overweight /obesity co-existed. Dietary diversity of all mothers/ PCGs was low. The assessment of type of housing and social security showed children in informal housing households had a poorer socio-economic situation and children in CSG households also experienced more monthly income poverty and household food insecurity. The level of stunting was higher in CSG households. Improving low dietary diversity should be a priority in interventions addressing food insecurity, taking into consideration this may be more difficult to achieve in informal households and CSG households. / AFRIKAANSE OPSOMMING: Doel: Om die antropometriese status van moeders/ primêre versorgers en hul kinders; hul huishoudelike voedselsekerheid en armoede met betrekking tot tipe behuising waarin hul woon, te beskryf; asook om huishoudings wat ‘n kindersorgtoelaag ontvang te vergelyk met die daarsonder in terme van die antropometriese status van moeders/ primêre versorgers, hul dieetdiversiteit, ouderdom, indiensneming/ werkstatus, opvoedkundige vlak, huishoudelike maandelikse inkomste en grootte, voedselsekerheid en die antropometriese status van hul kinders. Ontwerp: ‘n Beskrywende, deursnit studie. Deelnemers: Moeders/ primêre versorgers (447) en hul kinders van 211 huishoudings in Avian Park en 242 in Zweletemba. Metodes: Data-insameling is gedoen met onderhoudvoerder geadministreerde vraelyste insluitend sosio-demografiese inligting, die belewing-van-armoede-indeks, huishoudelike voedselonsekerheid-en-toegangskaal en dieetdiversiteitstelling. Antropometriese metings van moeders/ primêre versorgers het behels gewig, lengte en middelyfomtrek en gewig lengte en bo-armomtrek van kinders. Huishoudings woonagtig in formele (baksteenhuise, meenthuise, woonstelle) en informele huise (plakkershutte), en huishoudings wat die kindersorgtoelaag ontvang en nie, is vergelyk met behulp van die X2-toets vir kategoriese data en ‘n onafhanklike t-toets vir aaneenlopende data. Resultate: Die voorkoms van dwerggroei, ondergewig en uittering in kinders was onderskeidelik 20.7%, 5.6% en 1.2%. Oorgewig en vetsug het onderskeidelik voorgekom by 27% en 37% van moeders/ primêre versorgers en hul gemiddelde middelyfomtrek was 89.5 sentimeter (SA 16.7), wat aanduidend is van ‘n verhoogde risiko vir nie-oordraagbare siektes. Voedselsekerheid het voorgekom in 63.1% van huishoudings. Formele huishoudings het meer voedsekerheid ervaar as informele huishoudings (68% versus 50%; p=0.0004) en minder formele huishouding moeders/ primêre versorgers het ‘n dieetdiversiteitstelling < 4 (52.2% versus 64.7%; p = 0.0157) gehad. Beter sosio-ekonomiese omstandighede van formele huishoudings in vergelyking met informele huishoudings was sigbaar in hul hoër maandelikse inkomste (R3 479 versus R2 316; p = 0.0009) en huishoudelike bates-indeks (2.24 versus –5.31; p <0.0001). Die ouderdom, huwelikstatus, opvoedkundige vlak en werkstatus van moeders/ primêre versorgers in huishoudings wat ‘n kindersorgtoelaag ontvang en die huishoudings daarsonder was soortgelyk. Huishoudingsgrootte was groter (p<0.0001) in kindersorgtoelaag- (mediaan = 5 persone) versus geen-kindersorgtoelaaghuishoudings (mediaan = 4 persone); In kindersorgtoelaaghuishoudings het meer persone ‘n kamer gedeel (2.7 [SA 1.5] versus 2.3 [SA 1.2]; p=0.0037). Die maandelikse inkomste in kindersorgtoelaaghuishoudings was laer as in dié daarsonder (R2 723 [SA R3 297] versus R4 520 [SA R6 464]; p=0.0033). Die huishoudelike voedselonsekerheid-en-toegangskaal-tellings het meer voedselonsekerheid (p = 0.0178) getoon in kindersorgtoelaaghuishoudings as in huishoudings daarsonder (3.55 versus 2.37; p= 0.0178), maar hul dieetdiversiteit was dieselfde. Dwerggroei was meer in kindersorgtoellaagkinders (34.9%) versus geen-kindersorgtoelaagkinders (22.7%). Die gemiddelde middellyfomtrek van kindersorgtoellaagmoeders/ -primêre versorgers was groter (t-toets: p = 0.021) (90.0 cm; SA = 16.8) as die van moeders/ primêre versorgers wat nie ‘n kindersorgtoelaag (88.5 cm; SA = 16.5) ontvang het nie. Samevatting: Wanvoeding in kinders, tesame met oorgewig en obesiteit in moeders/ primêre versorgers is waargeneem Die dieetdiversiteit van die moeders/ primêre versorgers was laag. Die ontleding van die rol van behuising en sosiale sekerheid het getoon dat die sosio-ekonomiese omstandighede van kinders woonagtig in informele behuising, asook die waarvoor moeders/ primêre versorgers ‘n kindersorgtoelaag ontvang het, is blootgestel aan meer inkomste-armoede en voedselonsekerheid in hul huishoudings. Die verbetering van lae dieetdiversiteit moet ‘n prioriteit wees in intervensieprogramme om voedselsekerheid aan te spreek, met inagneming dat die bereiking daarvan moeilker mag wees om in informele en kindersorgtoelaag-huishoudings.

Thesis (Mnutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction Adequate fruit and vegetable consumption can provide many health and nutrition benefits, and can contribute to nutritional adequacy and quality of the diet. Despite existing strategies, most people in South Africa do not consume the recommended intake of five fruits and vegetables per day, and micronutrient intakes remain low. Aim The aim of this study was to describe underlying factors that influence individual and household fruit and vegetable consumption, in an area of the Mitchells Plain sub-district, by engaging with community members in a participatory manner in accordance with a human rights-based approach. Methodology This study was cross-sectional and descriptive. Data collection was conducted from November 2012 until January 2013, in an area of Mitchells Plain. Focus group discussions were conducted to gain a broad understanding of factors that influence fruit and vegetable consumption in the community and to identify individuals for individual interviews. In-depth interviews were conducted with strategically selected community members considered to be influential in food preparation, distribution or consumption, in order to gain in-depth understanding of specific factors associated with fruit and vegetable consumption. Results Four focus group discussions were conducted with 40 participants in total, allocated to three different groups (18 to 29 year old females, 30 to 70 year old females, 18 to 60 year old males). Fifteen in-depth interviews were conducted with community leaders, individuals involved in food production (kitchen managers) or sale thereof (an informal vendor and a tuck shop owner), individuals involved in health education (a professional nurse) and basic education (a grade one educator), and others. Dominant themes discussed included fruit and vegetable consumption patterns (religious, cultural and traditional dishes, seasonal variation), fruit and vegetable preparation techniques and commonly prepared dishes, fruit and vegetable access (purchasing, vegetable gardens and direct provision) and changes in fruit and vegetable consumption patterns. Barriers to fruit and vegetable consumption included that although most participants considered them to be important, fruit and vegetables were not considered a priority food item (inadequate time and effort is allocated to food purchasing and preparation), negative side-effects of consumption, fruit and vegetables are perishable and benefits of fruit and vegetable consumption are not immediately apparent. Facilitators of fruit and vegetable consumption were personal preference, traditional dishes prepared that include fruit or vegetable ingredients, individuals who sell or grow fruit and vegetables having increased availability, use of convenience fruit and vegetable items, and modelling and discipline in children. Suggestions to improve consumption included education using practical advice such as fruit recipes to improve the appeal of fruit and vegetable dishes, and methods to decrease preparation time and cost. Conclusions Limited fruit and vegetable consumption is not simply determined by limited nutrition knowledge or poor decision-making by households, but rather by a much wider set of social, economic and spatial processes. Creative and innovative behaviour-changing strategies are required that target individuals but also take cognisance of wider structural barriers, and work to create an enabling environment that is supportive of healthy eating and an adequate consumption of fruit and vegetables. / AFRIKAANSE OPSOMMING: Inleiding Voldoende inname van vrugte en groente hou baie gesondheids- en voedingsvoordele in, en kan bydra tot voedingstoereikenheid en kwaliteit van die dieet. Ongeag bestaande strategieë, neem die meeste mense in Suid-Afrika nie die aanbevole vyf vrugte en groente in nie, en mikronutriënt inname bly laag. Doelwit Die doel van hierdie studie was om die onderliggende faktore wat indiwiduele en huishoudelike vrugte- en groenteverbruik in 'n area van die Mitchells Plein subdistrik beïnvloed, te beskryf, deur met lede van die gemeenskap in 'n deelnemende manier betrokke te raak in ooreenstemming met 'n menseregte-gebaseerde benadering. Metodes Hierdie deursnee studie was beskrywend. Data-insameling het vanaf November 2012 tot Januarie 2013 in 'n gedeelte van Mitchells Plein plaasgevind. Fokusgroepbesprekings is gehou om 'n breër begrip van die faktore wat vrugte- en groenteverbruik in die gemeenskap beïnvloed, te bekom en om indiwidue te identifiseer vir indiwiduele onderhoude. In-diepte onderhoude is gevoer met strategies verkose gemeenskapslede wat beskou word as invloedryk in voedselvoorbereiding, verspreiding en verbruik, om 'n dieper begrip van spesifieke faktore wat met vrugte- en groenteverbruik verband hou, te bekom. Resultate Vier fokusgroep-besprekings is gehou met 'n totaal van 40 deelnemers, versprei oor drie verskillende groepe (18 - 29 jarige vroue, 30 - 70 jarige vroue, 18 - 60 jarige mans). Vyftien in-diepte onderhoude is gevoer met gemeenskapsleiers (polities en godsdienstig), indiwidue betrokke by voedselverwerking (kombuisbestuurders) of verkope (informele verkoper en snoepwinkeleienaar), indiwidue betrokke by gesondheidsopvoeding (professionele verpleegster) en basiese onderrig (graad een opvoeder) en andere. Oorheersende temas sluit in vrugte- en groenteverbruikspatrone (godsdienstige, kulturele en tradisionele disse, seisonale wisseling in gebruik), vrugte en groente voorbereidingstegnieke en alledaagse disse, toegang tot vrugte en groente (aankoop, groentetuine en direkte voorsiening) en verandering in vrugte- en groenteverbruikspatrone. Hindernisse tot vrugte- en groenteverbruik sluit in dat hoewel die meeste deelnemers vrugte- en groenteverbruik belangrik ag, word vrugte en groente nie as 'n prioriteitsvoedsel gesien nie. Voldoende tyd en aandag word nie aan voedsel-aankope en -voorbereiding afgestaan nie, daar is negatiewe newe-effekte aan verbruik, vrugte en groente is bederfbaar en die voordele van vrugte en groenteverbruik is nie duidelik waarneembaar nie.Persoonlike voorkeur is bevorderlik vir vrugte- en groenteverbruik, sommige tradisionele disse word met vrugte of groente bestanddele voorberei, asook die groter beskikbaarheid van indiwidue wat vrugte en groente verkoop of kweek, die gebruik van vrugte en groente gemaksitems, en die gedragsmodellering en dissiplinering van kinders. Voorstelle om verbruik te verbeter het ingesluit opvoeding met praktiese raad soos vrugte en groente resepte om die aantreklikheid van vrugte en groente disse te verhoog en metodes om voorbereidingstyd en onkoste te verminder. Gevolgtrekking Beperkte vrugte en groente verbruik word nie net bepaal deur beperkte voeding kennis of swak besluitneming deur huishoudings nie, maar deur 'n veel wyer reeks van maatskaplike, ekonomiese en ruimtelike prosesse. Skeppende en innoverende gedragsveranderende-strategieë wat gemik is op indiwidue is nodig, asook aandag aan wyer strukturele hindernisser. Sodoende kan ‘n bemagtigende omgewing geskep word om gesonde eetgewoontes en die verbruik van voldoende vrugte en groente te ondersteun.