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

Vitamin A deficiency (VAD) is a major public health problem in developing countries, including South Africa. The potential of provitamin A-biofortified maize for use as a complementary strategy to alleviate vitamin A deficiency in developing countries, where maize is the dominant staple food, is currently a subject of research. Although the nutritional composition of white maize is thought to be similar to that of biofortified maize, apart from the differences in provitamin A carotenoid content, the comparative nutritional composition of the two maize types seems not to have been subjected to a comprehensive scientific study. When setting the target level of provitamin A in the provitamin A-biofortified maize, it is important to consider the potential effect of processing on the final provitamin A carotenoid content of the biofortified food products, as the provitamin A carotenoids levels may decrease on processing. Furthermore, the yellow/orange provitamin A-biofortified maize may not be widely accepted by African consumers who are vulnerable to VAD, and are traditional consumers of white maize. This study firstly aimed to evaluate the nutritional composition, including provitamin A composition, and grain quality of provitamin A-biofortified maize varieties, compared to white maize. The second aim was to assess the effect of processing (milling and cooking) on the retention of provitamin A carotenoids and other nutrients in popular South African maize food products prepared with provitamin A-biofortified maize. Thirdly, the study aimed to assess the acceptability of maize food products prepared with provitamin A-biofortified maize by consumers of different age and gender in rural KwaZulu-Natal, South Africa. The grains of the provitamin A-biofortified maize varieties and grain of a white maize variety (control) were analysed for their nutritional composition using standard or referenced methods. The carotenoid content of the grains was analysed by High-Performance Liquid Chromatography (HPLC) and mass spectroscopy. The provitamin A carotenoids β-cryptoxanthin, and trans and cis isomers of β-carotene, and other unidentified cis isomers of β-carotene were detected in varying levels in the provitamin A-biofortified maize varieties. The total provitamin A content in the biofortified maize varieties ranged from 7.3-8.3 μg/g dry weight (DW), with total β-carotene ranging from 3.5-3.6 μg/g DW, and β-cryptoxanthin from 3.7-4.8 μg/g DW, whilst no carotenoids were detected in the white maize variety. Results of the evaluation of the content of other nutrients showed that, when compared with the white maize variety, the provitamin A-biofortified maize varieties had higher levels of starch, fat and protein but were lower in iron. The zinc and phosphorus levels in the white maize and the biofortified maize were comparable. The biofortified maize varieties were better sources of most of the essential amino acids relative to the white maize, but, similar to the white maize, they were deficient in histidine and lysine, indicating that further improvement is required. Selected quality attributes (grain density, susceptibility of kernels to cracking, milling quality and resistance of the kernels to fungal infection) of grains of 32 provitamin A-biofortified maize varieties and a white variety (control) were assessed. Overall, the quality of the grains of the provitamin A-biofortified maize varieties were found to be superior to that of the white maize grain, although the biofortified maize grains showed less resistance to fungi, including mycotoxin-producing types. This indicates that the trait of grain resistance to infection by fungi should also be incorporated in the provitamin A-biofortified maize varieties during breeding. To assess the retention of provitamin A carotenoids and other nutrients in maize food products, three selected provitamin A-biofortified maize varieties and the control (white maize variety) were milled into mealie meal and samp. The milled products were cooked into three products: phutu and thin porridge (from the mealie meal) and cooked samp. Nutrient retention during processing was determined. Milling resulted in either an increase or slight decrease in the provitamin A carotenoid levels, but there was no major decrease in the total provitamin A level. Most of the other nutrients were well retained during milling, but there were substantial losses of fibre, fat and minerals. Provitamin A carotenoid levels decreased on cooking. In phutu 96.6 ± 20.3% β-cryptoxanthin and 95.5 ± 13.6% of the β-carotene was retained after cooking. In thin porridge 65.8 ± 4.6% β-cryptoxanthin and 74.7 ± 3.0% β-carotene; and in samp 91.9 ± 12.0% β-cryptoxanthin and 100.1 ± 8.8% of the β-carotene was retained after cooking, respectively. Provitamin A retention seemed to be influenced by both maize variety and food form, indicating that suitable varieties and food forms should be found. There was generally a high retention of the other nutrients in all the three cooked products, except for the substantial losses of fat in thin porridge and iron and phosphorus in cooked samp. These findings indicate that an optimal delivery of provitamin A to the consumer can be achieved by processing provitamin A-biofortified maize into foods that have a good retention of provitamin A carotenoids, such as phutu and samp. These food products would be recommended in areas where VAD is prevalent. In order to assess consumer acceptability of provitamin A-biofortified maize, a total of 212 subjects aged 3-55 years from Mkhambathini Municipality, in KwaZulu-Natal province, South Africa, participated in the sensory evaluation of phutu, thin porridge and cooked samp prepared with provitamin A-biofortified maize varieties and a white variety (control). Preference for yellow maize food products was negatively associated with an increase in the age of the subjects. Overall, preschool children preferred yellow maize to white maize food products: phutu (81% vs. 19%), thin porridge (75% vs. 25%) and samp (73% vs. 27%). In contrast, primary school children preferred white maize to yellow maize food products: phutu (55% vs. 45%), thin porridge (63% vs. 38%) and samp (52% vs. 48%). Similarly, secondary school children and adults also displayed a similar preference for white maize food products. There was no association between gender and preference for maize variety. Focus group discussions revealed that participants had a negative attitude towards biofortified maize due to its colour, taste, smell and texture. However, the participants expressed a willingness to consume biofortified maize if it was cheaper than white maize and was readily available in local grocery stores. These findings indicate that there is a potential to promote the consumption of provitamin A-biofortified maize and its food products in this part of South Africa, thereby contributing to a reduction in the incidence of VAD. This study has shown that provitamin A-biofortified maize has a good potential to be used as an additional strategy to alleviate VAD in poor communities of South Africa, including similar environments in sub-Saharan Africa. However, the study has revealed that there are still challenges to be overcome in order to achieve the target provitamin A content of 15 μg/g in provitamin A-biofortified maize, set by HarvestPlus, an international challenge program. This may also explain why provitamin A-biofortified maize varieties with this level of provitamin A have been scarcely reported in the literature. Thus, more research is required to achieve the target provitamin A level in maize by conventional breeding. The results of this study indicate that besides provitamin A, the biofortified maize is also a good source of other nutrients including starch, fat, protein and zinc. However, improving the consumer acceptability of the provitamin A-biofortified maize remains a challenge, due to the negative attitudes towards the yellow/orange maize by African consumers. On the other hand, the results of this study indicate that there is an opportunity to promote the consumption of provitamin A-biofortified maize food products by preschool children, a finding which has not been previously reported in the literature. Nutrition education on the benefits of provitamin A-biofortified maize, as well as improved marketing are recommended, in this part of South Africa and also in similar environments in other sub-Saharan countries. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

BACKGROUND: Cystic fibrosis (CF) patients grow poorly and tend to be malnourished. They frequently suffer from lung infections necessitating the repeated use of antibiotics. AIM: This study was conducted to determine whether supplementation with a probiotic Lactobacillus reuteri (L. reuteri) could reduce the incidence and duration of lung infections, and whether this would impact on their anthropometric data. The secondary purpose was to compare the nutritional status of the CF patients attending CF clinics in Kwazulu-Natal (KZN) with CF patients attending CF clinics in Cape Town (CT). METHODS: Twenty three CF patients 6-31 years of age from 2 CF clinics in Kwazulu-Natal started the study although only 16 patients completed it. The study was a randomized, double blind, placebo controlled crossover trial with six months on placebo and six months on probiotic. Weight, height, mid arm circumference (MAC), triceps skin fold thickness (TSF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured, sputum collected and a symptom diary completed over the 12 month period. Anthropometric data of CF patients attending CF clinics in CT was obtained from the publication by Westwood & Saitowitz (1999). RESULTS: Compliance with taking the L. reuteri was poor. Most took only 50% of the required daily dose. Probiotic supplementation showed a slight (non significant) trend to improve FEV1 and FVC, while no significant difference could be seen in the number and duration of the lung infections. Sputum analysis showed a non significant trend towards the probiotic reducing the number of bacteria in the sputum. There was a significant reduction of symptoms for fever, running nose, sore throat and ear ache while on placebo. There was a significant increase in weight gained off probiotic compared to the probiotic period. The changes in height, weight for age (WFA) percentiles, height for age (HFA) percentiles, WFA and HFA Z-scores, percentage expected weight for age and percentage expected height for age all showed no difference whether on or off probiotic. Over half the CF children in the KZN clinics were underweight for their actual height compared to one third in the CT clinics with a higher number of subjects below the 5th percentile for MAC and TSF readings compared to CT. CONCLUSION: Due to a small sample size and poor compliance no firm conclusions could be drawn. However a slight (non significant) improvement could be seen in favour of the probiotic for FEV1, FVC, and sputum analysis. Although all other findings were not significantly different it would be of benefit to carry out further investigation with improved compliance with the probiotic to see if the parameters set out above could be improved. The KZN and CT CF groups were comparable and the nutritional status of CF patients on KZN was well below that of the CT CF clinics and further monitoring would need to be carried out.

Aim: To determine the use and interpretation of the nutrition information on the food label of selected fat spreads by female consumers aged 25 to 45 years, living in Pietermaritzburg. Objectives: This study set out to determine the following objectives regarding the food label: what the demographics of the consumers making use of the label were; how these consumers used the label and their motivation behind this label use and did the use of the label alter the purchase of that product? Method: One hundred and fifty women aged 25-45 years were chosen from an accidental, non-probability sample of consumers shopping at selected supermarkets within Pietermaritzburg. Respondents were presented with a four part questionnaire surrounding the purchase of selected fat spreads. Results: The greatest number of respondents were from the white population group (n = 65), followed by black respondents (n = 46), Indian respondents (n = 29) and then coloured respondents (n = 10). Results showed that the respondent who was most likely to use the nutrition information on the food label had a tertiary education; was a primary food purchaser, lived with other people, had more than R1000 a month to spend on food and was conscious of choosing the healthier option. Fifty five percent of this study sample (n = 82) claimed to use the nutrition information on the label to assist with purchases and 68% (n = 102) found the nutrition information important for purchasing a new product. Of the potential factors that have previously been found to impede the use of the nutrition information label:-inadequate print size, lack of education as well as lack of nutrition information on the food label were found to be factors restricting label use in this study. The most commonly used sources of nutrition information were the media as well as friends and family and the most trusted source was the Health Professional. Discussion: If the nutrition information is to be used both correctly and effectively, there must be a major educational campaign that sets out to meet the needs of the population that are most vulnerable, especially those with an inadequate education. Conclusion: The consumer most likely to use the nutrition information on the food label has a tertiary education, is a primary food purchaser with a large amount of money available for groceries and is conscious of choosing a healthier option. The label is most likely to be used when purchasing a fat spread for the first time. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Adolescent athletes of this era are more pressurized than adolescents of previous generations to perform at an optimum level (Micheli & Jenkins 2001, p49). The importance of winning can result in adolescent athletes developing inappropriate nutritional practices such as neglecting hydration and consuming insufficient carbohydrate (Micheli & Jenkins 2001, p57). Consuming insufficient fluid leads to dehydration which reduces a soccer player’s ability to continue training. Consuming inadequate carbohydrate reduces performance and blood glucose levels during training. This study aimed to determine the hydration status, fluid and carbohydrate intake of male, adolescent soccer players during training. A cross-sectional study was conducted among 122 amateur male, adolescent soccer players (mean age = 15.8 ± 0.8 years; mean BMI = 20.4 ± 2.0 kg/m2). The players’ hydration status before and after training, was measured using urine specific gravity and percent loss of body weight. Their carbohydrate intake, as well as the type and amount of fluid consumed, were assessed before, during and after training. A questionnaire was administered to determine the players’ knowledge regarding the importance of fluid and carbohydrate for soccer training. The study had an 87.1% response rate. The mean environmental conditions did not predispose players to heat illness. However, the players were at risk of developing heat illness during six of the 14 training sessions. Although the mean urine specific gravity indicated that players were slightly dehydrated before and after training, 43.8% of players were very or extremely dehydrated before training and 53.6% after training. A few (3.3%) were extremely hyperhydrated before training and after training (7.0%). On average players lost less than 1% of body weight during training and less than 3% of players dehydrated more than 2%. Players consumed mainly water before (289.17 ± 206.37 ml), during (183.20 ± 158.35 ml) and after (259.09 ± 192.29 ml) training. More than 90% stated that water was the most important fluid to consume before, during and after training. Very few (4.7%) correctly stated that carbohydrate should be consumed before, during and after training. Players were found to be slightly dehydrated before and after training and therefore were not consuming enough fluids during training. Players consumed inadequate amounts and types of fluid and carbohydrate. This not only compromises their performance but also health. Players were not aware of the importance of fluid and carbohydrate for soccer training. This study is unique in that it focused on the carbohydrate and hydration practices of socioeconomically disadvantaged adolescent soccer players during training. The study sample therefore represents a high risk group about which there is limited published data both locally and internationally. This study generated important baseline information which was lacking before on the hydration status, fluid and carbohydrate intake of adolescent soccer players in South Africa. / Thesis (M.Sc.Agric.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Introduction: Micronutrient malnutrition has been identified as a serious health problem globally and is on the rise in South Africa. This is evident from the escalating burden of vitamin A deficiency (VAD) in South Africa. Rural infants are the most affected, as their diets often lack micronutrients. Food fortification, vitamin A supplementation and dietary diversity are the strategies that have been employed in South Africa to alleviate VAD. However, these strategies have not been effective, for various reasons. Biofortification is the production of micronutrient dense staple crops to alleviate micronutrient deficiencies. This strategy could complement existing strategies in the alleviation of VAD in South Africa and in other countries, especially in sub-Saharan Africa (SSA), where VAD is prevalent. Aim: The aim of this study was to investigate the nutritional composition and acceptance of a complementary food (soft porridge) made with provitamin A-biofortified maize by female infant caregivers from the rural areas of Umgungundlovu District of KwaZulu-Natal, South Africa. Objectives: (i) To evaluate the nutritional composition of soft porridge made with provitamin A-biofortified maize compared to non-biofortified white maize porridge; (ii) To assess the sensory acceptability of soft porridge made with the biofortified maize by black African female infant caregivers of varying age; and (iii) To determine the perceptions of the black African infant caregivers about the biofortified maize relative to the non-biofortified white maize. Methods: A cross-sectional study was conducted. Grains of two provitamin A-biofortified maize varieties and one white variety (control) were used. Grain and soft porridge of each variety of maize were analysed for their nutritional composition. The sensory acceptability of the porridges were evaluated by black African female infant caregivers, using a five-point facial hedonic scale. Focus group discussions were conducted, using some of the study subjects, to determine their perceptions about the provitamin A-biofortified maize. Results: The results showed that the grains of the provitamin A-biofortified maize varieties and their soft porridges were more nutritious than the control white variety in terms of energy, fibre, fat, protein, iron, zinc and phosphorus content. The results of the sensory evaluation indicated that there was no significant difference in the sensory acceptability of the biofortified soft porridges and the white maize soft porridge, irrespective of the age of the sensory evaluation panellists. The female caregivers perceived the biofortified maize as nutritious and health-beneficial and thought that infants would like its unique yellow colour and taste. However, the black African female caregivers perceived the provitamin A-biofortified maize as an animal feed or food for the poor. Nevertheless, the female caregivers expressed a willingness to give their infants porridge made with provitamin A-biofortified maize if it was cheap, readily available and health-beneficial. Conclusion: This study suggests that provitamin A-biofortified maize has the potential to be used as a complementary food item. Biofortification of maize with provitamin A could be used as a possible complementary strategy to assist in the alleviation of VAD in SSA. Furthermore, the relatively higher energy, fibre, fat, protein, iron, zinc and phosphorus content of the biofortified maize could contribute to the alleviation of protein-energy malnutrition and mineral deficiencies, respectively, which are prevalent in children of SSA. Although the findings of this study, like other previous studies, indicate that there are some negative perceptions about the provitamin A-biofortified maize, this study shows that provitamin A-biofortified maize soft porridge is as acceptable as white maize soft porridge to female infant caregivers from the rural areas of Umgungundlovu District of KwaZulu-Natal, South Africa. The female caregivers are thus likely to accept the biofortified maize for use as an infant complementary food in the form of soft porridge. Further research is recommended to expand the study area and consumer sample size in order to increase the confidence of inferring these results for large rural populations. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2014.

Introduction: Malnutrition is a health issue directly and indirectly contributing towards high rates of morbidity and mortality globally, particularly in developing countries. South Africa (SA) is faced with a double burden of diseases with a high prevalence of both under and over nutrition. The high prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) in SA worsens undernutrition. HIV/AIDS increases nutrient requirements and inadequate food intake results in malnutrition. Nutrition support through food supplementation is important to combat the high prevalence of malnutrition in sub-Saharan African countries including South Africa. Thus, a groundnut-soya based supplementary paste, Sibusiso, has been produced. However, its nutritional composition and acceptability have not been studied. Objectives: (i) To determine the nutritional composition and physical properties of a ready-to-use supplement, Sibusiso, (ii) To determine the sensory acceptability of Sibusiso among healthy subjects; and sensory acceptability and perceptions of Sibusiso by subjects treated for HIV and HIV/TB. Materials and methods: The nutritional composition, colour and texture of Sibusiso and a commercial peanut butter (control) were analysed following standard procedures. A cross-sectional consumer acceptability test was done using a 5-point facial hedonic scale (healthy control group, n = 68; HIV, n = 88 and HIV-TB co-infection treated, n = 51). A total of six focus group discussion sessions (HIV subjects = 4 sessions and HIV/TB co-infected subjects = 2 sessions) were also conducted. Results and discussions: The protein content of Sibusiso (16 g/100 g) was almost half that of the commercial peanut butter (control), (25 g/100 g). However, Sibusiso contained 1.4 times more ash (4 g/100 g) and almost twice as much carbohydrate (40 g/100 g) compared to the commercial peanut butter (22 g/100 g). The fat (40 g/100 g) and energy (2 624 kJ/ 100 g) content of Sibusiso was not substantially different from that of the commercial peanut butter which was 43 g/100 g and 2 852 kJ/100 g, respectively. The lysine content of Sibusiso (58 mg/g) was about 1.7 times higher than that of the commercial peanut butter. The methionine (11 mg/g) and histidine (35 mg/g) content of Sibusiso was almost twice that of the commercial peanut butter, respectively. The nutrient content of Sibusiso was either similar or slightly more than that of other ready-to-use supplements such as Plumpy’nut®. Sibusiso met the FAO/WHO/UNU recommendations for essential amino acids. The consumption of 50 g of Sibusiso per day may provide approximately 35% of the Estimated Energy Requirements (EER) and 30% of the Recommended Dietary Allowance (RDA) for protein for adults. Sibusiso was brown in colour, similar to the commercial peanut butter. Its textural attributes were found similar to that of the commercial peanut butter but harder and stickier. The acceptability of Sibusiso was significantly associated (p ≤ 0.05) with the health status of consumers. Overall, Sibusiso was liked by 94% of HIV and HIV/TB individuals (mean score: 4) compared to 85% for the healthy group (control). More than 90% of the HIV/TB and HIV treated individuals liked the taste compared to the control group (86%, mean score: 4). The colour and mouthful were rated 'good' by more than 80% of the HIV and HIV/TB group, mean score: 3, with only 68% among the healthy group, mean score: 4.1. Conclusion: Sibusiso is a good source of nutrients and was found to be acceptable to HIV and HIV/TB treated consumers. It may be effective in alleviating disease-related malnutrition among vulnerable individuals such as those infected by HIV and HIV/TB. / Thesis (M.Sc.Hum.Nut.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

The aim of this study was to investigate whether Sibusiso, a Ready Food Supplement (SRFS), developed by the Gift of the Givers Foundation was able to promote weight gain among underweight children between 1 and 10 years of age. The study also aimed to train CAST community workers on how to assess and identify underweight children and to determine the number of underweight children aged 1-10 years who were currently on the CAST food aid program in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal. This non-randomised intervention study was carried out on a total of 19 out of 20 subjects that initially qualified for inclusion into the study. A monitoring tool was used to collect data on anthropometrical measurements, symptoms experienced, disease conditions identified, level of appetite, meal consumption and energy for each subject for a period of three months. Study subjects were from families living in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal, who were part of a food aid programme run by non-governmental organisation Church Alliance of Social Transformation (CAST). SRFS was compared to Recommended Energy Allowances (REA) and Recommended Daily Allowances (RDA) to determine the amount of energy and macronutrients that SRFS provided to subjects in their different age groups. The predominant health conditions and symptoms experienced by the subjects were assessed. General improvement in appetite, meal consumption and energy levels among subjects were monitored during the supplementation period Out of 19 subjects who were supplemented with SRFS over the three month period, it was established that more children from Chesterville than Cato Manor were part of the CAST food parcel programme. SRFS was not able to meet 100% of the RDA and REA for subjects in their different age groups. However, SRFS was able to promote weight among subjects as 50% of subjects were able to achieve normal weight-for-age growth by the third month of supplementation. Human Immunodeficiency Virus (HIV) infection was the predominant disease condition experienced among subjects. A steady decline in the frequency of infection symptoms experienced among subjects was observed. Appetite, meal consumption and energy levels among subjects increased during the three moth supplementation period. In conclusion, SRFS was successful in promoting weight gain among underweight children and was able to improve the overall wellbeing of subjects by alleviating the burden of disease conditions and infection symptoms while improving appetite, meal consumption and energy levels. SRFS therefore was beneficially utilised in the CAST food aid programme. SRFS had beneficial effects on the health and nutritional status of the study subjects during the observed period of its use in the CAST food aid programme and its continued use is recommended. / Thesis (M.Sc.Diet.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Introduction: The aim of this research was to establish the attitudes, knowledge, job satisfaction and professional development of community service dietitians because negative attitudes, poor knowledge, low levels of job satisfaction and poor professional development would be detrimental to the process of community service and ultimately to the provision of health services. Methodology: Three distinct annual intakes of qualified dietitians completing compulsory community service were the subjects of an analytical cross sectional survey conducted biannually for the period 2003-2005. Data collection methods included telephone interviews, mail, emailed questionnaires and focus group discussions. Individual factors: sex, population group, language, university attended; institutional factors: organisation of community service, mentorship rating, hospital manager support type of facility, rural allowance, hospital location, access to resources, working and living conditions and personal safety and other factors: attitude, community nutrition knowledge, job satisfaction and professional development were included in the data set. Management of data: Data were divided into 2003 cohort (n=20) and 2004-2005 cohorts (n=26). Analysis of the demographic details for 2003 and 2004-2005 cohorts were, respectively: mean ages 23.6 (±0.99) and 24.05(±4.96) years, 60 percent and 73 percent white, 90 percent and 96 percent female, 35 percent and 73 percent University of KwaZulu-Natal graduates and 65 percent of both cohorts were placed in rural facilities. Results: Community nutrition knowledge of the 2003 cohort was unacceptable but improved in the 2004-2005 cohort. Subjects had a generally positive attitude towards community service. Community nutrition levels of knowledge of the 2003 ranged between 60 percent at entry and 67 percent at exit and for the 2004-2005 between 72.8 percent and 78.42 percent. The job satisfaction level of the 2003 cohort at exit was 13.65 (±3.573). In the 2004-2005 cohort job satisfaction was 15.75(±3.360) at entry and 15.75 (±3.360) at exit. 85 percent of the 2003 cohort rated their professional development positively whereas 65 percent of the 2004-2005 cohort rated theirs' positively. This decline and associated problems were to some extent shown in the interview responses. The 2004-2005 cohort did however show a tendency for improvement in the professional practitioner ranking (p=0.088). The majority (95%) of the 2004-2005 cohort rated the dietetic services positively. Focus group discussions highlighted problems that the community service dietitian (CSD) encountered such as lack of supervision and support, lack of basic facilities, poor hospital administration, problems with transport, work overload and problem with their professional role in the community and health facility. A model showing the results of the research indicated that the objectives of the Department of Health for improved service in rural areas were obtained but the retention of health professionals and capacity was lost due to annual rotation of subjects. Community service as a strategy to overcome service delivery has merit provided identified problems are addressed. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Aim: To determine whether the tuck shop purchasing habits of Grade 4 learners were contributing towards the development of childhood overweight and obesity. Objectives: To assess the nutritional quality of the food and beverages available for learners to purchase; items regularly purchased from the tuck shop as well as factors influencing the learner’s decision to purchase these items; the anthropometric and socio-demographic characteristics of grade 4 learners as well as their nutrition knowledge related to the tuck shop items purchased. Method: A survey administered to 11 tuck shop managers, a questionnaire administered to 311 Grade 4 learners and two single-sex focus groups of 5 learners each were conducted. Results: Fifty six percent of the sample were female (n=173) and 44% were male (n=138). Twenty seven percent of the study sample was overweight (n = 83) and 27% were obese (n = 85). Eighty six percent of learners (n = 266) claimed to buy from their school tuck shop. Twenty two percent of learners purchased from their tuck shop at least three times per week (n =58). Learners who purchased from the tuck shop had a significantly higher BMI than those who did not (p = 0.020). Learners who purchased from the tuck shop spent on average R8,38 per day with a minimum of R1 and a maximum of R40 (standard deviation R5.39). The most popular reasons for visiting the tuck shop included “this is my favourite thing to eat or drink” (66.5%, n = 177) and “I only have enough money to buy this item” (47.0%, n = 125). Savoury pies were the most popular "lunch" item for all learners for both food breaks (45%, n = 5 schools and 27.3%, n = 3 schools) selling the most number of units (43) per day at eight of the eleven schools (72.7%). Iced popsicles were sold at almost every school, ranked as the cheapest beverage and also sold the most number of units (40.7). Healthy beverages sold included canned fruit juice and water, while healthy snacks consisted of dried fruit, fruit salad, bananas, yoghurt and health muffins. The average healthy snack contained almost half the kilojoules of its unhealthy counterpart (465kJ vs 806kJ). Nutritional analyses of the healthy lunch options revealed total fat contents that exceeded the DRI and South African recommended limit. Perceived barriers to stocking healthy items included cost and refrigeration restrictions. The average score for the food groups was only 33% indicating that learners were not familiar with the Food Based Dietary Guidelines (FBDG). Further analyses showed that the total knowledge scores of those learners that reported to buy from the tuck shop frequently, was significantly lower when compared to the total knowledge scores of those learners who bought from the tuck shop less frequently (13.0 ± 3.9 and 11.6 ± 3.1, respectively; p < 0.05). Logistic regression analysis confirmed that the total knowledge of a learner could be used to predict whether he or she is more likely to make purchases from the tuck shop (significance = 0.017). Focus group results revealed that learners are aware of “healthy” and “unhealthy” tuck shop items. Most learners stated that they would continue to purchase items from their tuck shop if all “unhealthy” items were removed. Conclusion: Primary school tuck shops of well resourced schools in Pietermaritzburg are contributing to childhood overweight and obesity through a combination of factors. These include the poor nutritional quality of the items stocked at the tuck shop as well as the poor tuck shop purchasing practices. Much consultation is required amongst dieticians, school principals and privatised tuck shop managers to overcome barriers to stocking healthy items. School management and government have an important role to play in imposing restrictions on the sale of unhealthy items; along with improving the quality of the nutrition education curriculum to ensure that learners are able to translate their knowledge into healthier purchasing practices. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.