Background: Double burden of malnutrition means co-existence of under- and overnutrition in a community, household or an individual. It is observed in countries undergoing nutrition transition. Research on double burden among Indian children aged under five has been scarce. I therefore aim to studythe prevalence of double burden of malnutrition in this age group. Methods: Cross-sectional population-based data from District Level Household and Facility Survey 4 conducted in 2012-2013 in 23 Indian States and Union Territories were used for the analysis. Prevalence of overweight, stunting and anaemia were examined as main outcomes at the community level. Simultaneous overweight and stunting or anaemia in same child were the main outcomes for individuallevel prevalence. Households with stunted child and overweight adult were also examined. Results: In this sample, 40.1 % of children were stunted, 74.2 % anaemic and 8.2 % overweight. Simultaneous overweight and stunting as well as overweight and anaemia both affected about 5.5 % of children. Stunted children had a higher prevalence of overweight than non-stunted children. No such association was seen for anaemia. At household level, 26.5 % of households had an overweight adult and a stunted child. Discussion: Double burden of malnutrition is emerging among Indian children aged under five and should be included in national nutrition policy. Undernutrition is still bigger concern than overnutrition, but overweight is spreading also to lower wealth quintiles. Further studies should be done to examine this phenomenon at the national level.

Esse trabalho é dedicado ao desenvolvimento de um simulador para sistema de pesagem e embalagem de produto em pó granulado. Tal simulador reproduz a variabilidade de peso dos cartuchos observados em um sistema de embalagem real. Para esse desenvolvimento foram aplicadas técnicas de Identificação de Sistemas para obter o modelo determinístico do processo e conceitos de Processos Estocásticos para reproduzir as perturbações. O simulador tem como objetivo a avaliação de propostas de melhorias nesse sistema de pesagem, visando reduzir o sobrepeso médio e a quantidade de cartuchos rejeitados por subpeso, denominados de scraps, diminuindo consequentemente as perdas monetárias do processo industrial de embalagem de produtos granulados, com grande potencial de reaplicação para outros tipos de produtos industrializados e sistemas de pesagem. O desempenho do simulador é muito bom, uma vez que as oscilações observadas nos pesos dos cartuchos, devido à variação de densidade, são bem reproduzidas. Portanto as principais contribuições desse trabalho são: 1) o uso de uma abordagem estatística e inovadora para modelar as perturbações, evitando o estudo profundo de suas causas, alcançando um modelo preciso, que simula resultados de sobrepeso e número de cartuchos rejeitados bem próximo da realidade; 2) identificação e quantificação de melhorias no sistema de pesagem e embalagem, sem a necessidade de altos investimentos, dando a opção de decisão de quais melhorias realmente serão implementadas; 3) sobrepeso e scrap normalmente estão entre as três principais perdas monetárias das indústrias que produzem produtos embalados por peso e esse simulador representa uma forma de redução significativa dessas perdas, trazendo uma grande vantagem competitiva em um mercado cada vez mais acirrado. / This work describes the development of a simulator for a packing and weighing system of granulated powder. This simulator reproduces the weight variability of observed cartons in a real packing system. In this development, System Identification techniques were used to obtain the deterministic part of the model and Stochastic Processes to reproduce disturbances. Its objective is to evaluate proposed improvements in the packing and weighing system, aiming at reducing the overweight average and the quantity of rejected cartons by underweight, denominated scraps, cutting down consequently the monetary losses of the granulated product packing process in the industry, with great reapplication potential to other kind of industry products and weighing systems. The simulator performance is very satisfactory, once the oscillations observed in the carton weights, due to powder density variability, are well reproduced. Hence, the main contributions of this work are: 1) use of a statistical and innovative approach to model the disturbances, avoiding a deep study of their causes, achieving a model that provided precise simulated overpacking and scrap results when compared to reality; 2) identification and quantification improvements of the weighing and packing system, with no large investment, giving the option of decision of which improvement will be actually implemented; 3) overweight and scrap are among the three main monetary losses in the industries that make products packed in weight and so this simulator of a packing and weighing system of granulated powder represents a way of reducing significantly these losses, bringing a big competitive advantage in a demanding market.

Objetivos: Analisar o ajuste alométrico para MC e altura entre indivíduos menores de 20 anos. Métodos: Dados de indivíduos de 0-20 anos de National Health and Nutrition Examination Survey (NHANES-1999-2013); Pesquisa Nacional de Saúde e Nutrição (PNSN-1989); Encuesta de Salud y Nutrición (2012); England Health Survei (2005-2014) e; Korean National Health and Nutrition Examination Survey (KNHANES-1998-2014). MC e de altura foram convertidos à escala logarítmica e modelados por regressão linear em 24 grupos etários, 2 sexos e os 5 países. O β dessa regressão deu origem ao p valor que foi estimado em 2 etapas. 1) Todos os dados disponíveis nos inquéritos, excluíndo apenas os valores biologicamente implausíveis; e 2) O p foi calculado após a exclusão dos valores não esperados para idade (VNEI) de MC e altura. VNEI foi definido como casos ±2,0 DP(z) do resíduo da regressão de MC pela idade, altura pela idade e MC pela altura. Em seguida, os valores p definidos no pool de dados foram modelados por spline com 5 knots, para definição de um p internacional (ip). Após calculou-se o IA - Indice Alométrico para todos os individuos. Para análise da correlação entre os índices e a massa adiposa foram utilizadas medidas de Densiotometria (DXA), Impedância Bioelétrica (BIA), Circunferência de Cintura (CC) e Dobras Cutâneas (DC). As correlações com os indices foram estimada pelo coeficiente de Pearson(r). Em uma análise de efeitos mistos, estimou-se o coeficiente correlção intraclasses (CCI), entre os diferentes países e as diferentes fenótipos humanos para altura, MC, IMC e IA. Resultados: A exclusão de VNEI (8,5% da amostra) diminuiu a diferença do p entre os países. O p e o ip apresentoram valores próximos a 2 ao nascimento, aumentou para 3 a 3,5 (7 e 11 anos nas meninas e 8 a 12 nos meninos) e regrediu a 2 no final do crescimento. O IA apresentou r próximo de zero em relação a altura contra r proximos de 0,4 para o IMC durante a puberdade. A correlação da massa adiposa para os dois indices foi semelhante, sempre apresentando r acima de 0,85 para todas as formas de análise via DC, BIA, CC e DXA. IA apresentou menor correlação com massa muscular e densidade óssea. O CCI foi maior entre os paises e praticamente nulo entre as fenótipos humanos. A maior variação entre os paises ficou a cargo da altura, seguido da massa corporal e IMC. O IA foi a medida que se apresentou com menor variação entre os paises (3,6%) e entre fenótipos humanos (1,7%). Conclusões: A exclusão VNEI contribuiu para diminuir o efeito do estado nutricional sobre a alometria para se estimar o p valor. O ip mostrou-se uma valor promissor para uso internacional. O IA no conjunto de evidências apresenta uma vantagem em relação ao IMC, uma vez que tem correlção 0 com a altura, e uma correlação equivalente ao IMC com a massa adiposa além de apresentar o menor CCI entre fenótipos humanos e nacionalidades. A maior variação do CCI ficou a cargo do país em relação a altura, justificado pelos difentes contextos epidemiológicos. / Objectives: To analyze the allometric scalling for BM and the height under 20 years old. Methods: Individuals 0-20 years of the National Health and Nutrition Examination Survey (NHANES-1999-2013); Pesquisa Nacional de Saúde e Nutrição (PNSN-1989); Encuesta de Salud y Nutrición (2012); England Health Survei (2005-2014) and; Korean National Health and Nutrition Examination Survey (KNHANES-1998-2014). BM and height were converted to logarithmic scale and modeled by linear regression, in 24 age groups, 2 sexes and 5 countries. The β of this regression gave the estimated p value in 2 steps. 1) All data available in the surveys, excluding only those biologically implausible values; and 2) The value was obtained after the exclusion of values not expected for age (VNEA) of MC and height. VNEA was defined as ± 2.0 SD (z) cases of regression of BM by age, height by age and MC by height. Then, the values were modeled by spline in 5 knots, to define an international (ip). After were calculated the AI - Allometric Index for all individuals. The Pearson correlation (r) between the indices and the fat mass was calculated used data dorm densitometry (DXA), Bioelectrical Impedance (BIA), Waist Circumference (WC) and Skin Folds (SF). In an analysis of mixed effects, was estimated the intraclass correlation coefficient (ICC), between countries and ethnicities for different dimensions for BM, BMI and AI. Results: Exclusion of VNEA (8.5% of the sample) decreased the difference between countries. The p and ip presented values close to 2 at birth, increased to 3 to 3.5 (7 and 11 years in girls and 8 to 12 in boys) and recorded 2 at the end of growth. AI was close to zero in correlation with height and for BMI was r= 0.4 during puberty. The correlation of the adipose mass for the two indices was similar, always presenting r above 0.85 for all forms of analysis via DC, BIA, CC and DXA. AI presented a lower correlation with muscle mass and bone density. ICC is larger among countries and is practically zero among ethnicities. The greatest difference between the groups was the height, the BM and the BMI. AI showed the smallest difference between the countries (3.6%) and between the ethnic groups (1.7%). Conclusions: A VNEA exclusion contributed to decrease the effect of nutritional status on allometry to estimate the p value. The value ip has proved to be a promising value for international use. The IA in the body of evidence has an advantage over BMI, since it has correlation 0 with height, and a correlation equivalent to the BMI with the adipose mass besides presenting the lowest CCI between ethnicities and nationalities. The greatest variation of ICC was borne by the country in relation to height, justified by the different epidemiological contexts.

Thesis (M. Sc.(Physiology)) -- University of Limpopo, 2019 / Aim: The purpose of this study was to assess the prevalence and risk factors associated with malnutrition and nutritional status of rural and urban primary school children aged 6–9 years. Literature background: Malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries, affecting 10.9% of people globally, particularly in Southern Asian (15.7%) and sub-Saharan African (23.2%) countries undergoing urbanisation. Urbanisation affects diet, physical activity levels, body fatness, body composition and socio-economic factors. There is currently a shortage of information on the effect of urbanisation on nutritional status, especially in poor areas such as the Limpopo Province of South Africa. It is important to understand the effects that body fatness and associated risk factors have on stunting, wasting, underweight, and overweight/obesity in urban and rural children. Subjects and design: This was a cross-sectional study including rural (n=106) and urban (n=68) primary school children aged 6–9 years. Anthropometric (weight and height) and skinfold measurements were taken and a 24-hour recall dietary assessment was conducted twice to include a week day and a weekend day. A questionnaire was used to gather demographic, health, dietary and physical activity information. Results: The prevalence of stunting, wasting, underweight, and overweight/obese children in this population was 14%, 6%, 20%, and 26% respectively. Furthermore, the prevalence stunting, wasting, and underweight were higher in rural areas compared to urban areas. Meanwhile, the prevalence of overweight/obesity was higher in urban areas as compared to rural areas. Gender, area (urban/rural) (p=0.0001), birthweight, time spent on sedentary activities, monthly household income (p=0.0210), mode of transport to school, and breastfeeding (p=0.0560) were all found to be significantly associated with malnutrition. Weekday dietary intake of Vitamins A and D was significally associated with BF%, whereas weekend consumption of energy, protein, calcium, iron, phosphorus, and zinc were not significantly associated with BF%. The mean energy and calcium intake between the urban and rural vi population only differed significantly over weekends and not during the week, while vitamin D differed significantly between urban and rural populations during the week only. Conclusions: The current study demonstrates that children in rural areas were significantly more wasted than those residing in urban areas, while those residing in urban areas were significantly more overweight/obese compared to rural areas. All indicators used for undernutrition were associated significantly with gender and the prevalence were higher males compared to females, but this significance disappeared for overnutrition. Families with a higher income tended to have children who were overweight or obese compared to families with a lower income. Children spending a lot of time on sedentary activities were more likely to be overweight or obese, and breastfeeding seemed to protect children from becoming overweight or obese, while low birth weight was associated with stunting. The weekaday and week-end diets indicate that school feeding schemes in the rural areas may be effective in increasing total energy intake in children and this should be further investigated. In this population, stunting, wasting, and underweight were not limited to rural areas, and should still be a health concern in urban areas, despite the fact that overweight/obesity is also prevalent in urban areas. Thus, overweight/obesity in this population can be prevented by promoting breastfeeding and physical activity, while at the same time discouraging children from partaking in too many sedentary activities. / National Research Foundation (NRF)

Thesis (M. Sc. (Physiology)) -- University of Limpopo, 2019 / Aim: The purpose of this study was to assess the prevalence and risk factors associated with malnutrition and nutritional status of rural and urban primary school children aged 6–9 years. Literature background: Malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries, affecting 10.9% of people globally, particularly in Southern Asian (15.7%) and sub-Saharan African (23.2%) countries undergoing urbanisation. Urbanisation affects diet, physical activity levels, body fatness, body composition and socio-economic factors. There is currently a shortage of information on the effect of urbanisation on nutritional status, especially in poor areas such as the Limpopo Province of South Africa. It is important to understand the effects that body fatness and associated risk factors have on stunting, wasting, underweight, and overweight/obesity in urban and rural children. Subjects and design: This was a cross-sectional study including rural (n=106) and urban (n=68) primary school children aged 6–9 years. Anthropometric (weight and height) and skinfold measurements were taken and a 24-hour recall dietary assessment was conducted twice to include a week day and a weekend day. A questionnaire was used to gather demographic, health, dietary and physical activity information. Results: The prevalence of stunting, wasting, underweight, and overweight/obese children in this population was 14%, 6%, 20%, and 26% respectively. Furthermore, the prevalence stunting, wasting, and underweight were higher in rural areas compared to urban areas. Meanwhile, the prevalence of overweight/obesity was higher in urban areas as compared to rural areas. Gender, area (urban/rural) (p=0.0001), birthweight, time spent on sedentary activities, monthly household income (p=0.0210), mode of transport to school, and breastfeeding (p=0.0560) were all found to be significantly associated with malnutrition. Weekday dietary intake of Vitamins A and D was significally associated with BF%, whereas weekend consumption of energy, protein, calcium, iron, phosphorus, and zinc were not significantly associated with BF%. The mean energy and calcium intake between the urban and rural vi population only differed significantly over weekends and not during the week, while vitamin D differed significantly between urban and rural populations during the week only. Conclusions: The current study demonstrates that children in rural areas were significantly more wasted than those residing in urban areas, while those residing in urban areas were significantly more overweight/obese compared to rural areas. All indicators used for undernutrition were associated significantly with gender and the prevalence were higher males compared to females, but this significance disappeared for overnutrition. Families with a higher income tended to have children who were overweight or obese compared to families with a lower income. Children spending a lot of time on sedentary activities were more likely to be overweight or obese, and breastfeeding seemed to protect children from becoming overweight or obese, while low birth weight was associated with stunting. The weekaday and week-end diets indicate that school feeding schemes in the rural areas may be effective in increasing total energy intake in children and this should be further investigated. In this population, stunting, wasting, and underweight were not limited to rural areas, and should still be a health concern in urban areas, despite the fact that overweight/obesity is also prevalent in urban areas. Thus, overweight/obesity in this population can be prevented by promoting breastfeeding and physical activity, while at the same time discouraging children from partaking in too many sedentary activities. / National Research Foundation (NRF)

MPH / Department of Public Health / See the attached abstract below

Background Nutrition is a fundamental pillar of human life. Women have an increased risk of undernutrition than men. Undernutrition can result in adverse pregnancy outcomes and intergeneration cycle of undernutrition. The aim of this study is to determine the prevalence of undernutrition and the associated socio-economic determinants among adult women of reproductive age in Uganda.  Methods A population based cross-sectional survey was conducted and 4,640 non-pregnant and non-post-partum women aged 20 to 49 were analyzed. Two stage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariable logistic regression was used to model the association between socio-economic determinants and stunting and underweight using weighted data in SPSS version 24.  Results The prevalence of underweight and stunting were 6.9% and 1.3% respectively. Women who belonged to middle (aOR = 2.49, 95% CI 1.25-4.99), poorer (aOR = 3.07, 95%CI 1.57–5.97) and poorest wealth index (aOR = 3.60, 95% CI 1.85–7.00) were more likely to be underweight compared to the richest. Belonging to rural residence (aOR = 0.63, 95%CI 0.41–0.96), Western (aOR = 0.30, 95% CI 0.20–0.44), Eastern (aOR = 0.42, 95% CI 0.28–0.63) and Central regions (aOR = 0.42, 95% CI 0.25–0.72) was associated with less odds of being underweight. Region was the only variable significantly associated with stunting. Wealth index was not significantly associated with stunting.  Conclusion The prevalence of undernutrition in Uganda among women is less compared to most of the neighboring countries. There is need to address the socio-economic determinants including poverty, residence and reducing regional inequalities.

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district / Health Studies / M.A. (Public Health)

Le Gabon affiche, paradoxalement à son niveau de PIB par tête élevé, des indicateurs de santépauvres. Fondée sur les données de l’enquête démographique et de santé du Gabon de 2000, laprésente étude a pour objectif d’examiner la relation entre la pauvreté et la santé. Premièrement,l’étude montre que le niveau de mortalité des enfants est préoccupant, et que la pauvreté nonmonétaire en termes d’actifs est associée à cette mortalité. Deuxièmement, les niveaux de retard decroissance et d’insuffisance pondérale des enfants posent problème. A cet égard, on observe que leretard de croissance représente le premier problème nutritionnel. D’ailleurs, les analyses révèlentl’existence d’une relation claire entre la pauvreté non monétaire et le retard de croissance. Par contre,l’impact de la pauvreté non monétaire sur l’insuffisance pondérale dépend du modèle économétriqueutilisé. Troisièmement, le test de Chow pour la mortalité et la malnutrition n’est pas significatif,montrant qu’une analyse économétrique de la relation entre la pauvreté et la santé selon de genre n’estpas justifiée. En d’autres termes, les ménages dirigés par une femme et ceux dirigés par un homme nese comportent pas différemment en matière de soins de santé. Quatrièmement, l’analyse de l’inégalitésocio-économique de la mortalité et celle de la malnutrition suggère quelques commentaires. Toutd’abord, cette inégalité est très forte. Ensuite, alors que l’inégalité de la mortalité est plus élevée enmilieu rural, l’inégalité de la malnutrition est plus prononcée en milieu urbain. Enfin, les disparités deniveau de vie ont un rôle secondaire quant à l’explication du niveau de cette inégalité. / Gabon displays, paradoxically to his high level of GDP per capita, poor health indicators. Based on thedata of the Demographic and Health Survey of Gabon of 2000, the present study had as objective toexamine the relation between poverty and health. Firstly, the study shows that the level of childmortality is worrying, and that the non-monetary poverty in terms of assets is associated with thismortality. Secondly, the levels of child stunting and underweight are problems. In this respect, oneobserves that stunting represents the first nutritional problem. Moreover, the analyses reveal theexistence of a net relationship between non monetary poverty and malnutrition in terms of stunting.On the other hand; the impact of non monetary poverty on the malnutrition in terms of underweightdepends on the econometric model used. Thirdly, the chow test for mortality and malnutrition are notsignificant, showing that an econometric analysis of the relation between poverty and health by genderis not justified. In other words, households headed by a woman and those headed by a man not behavedifferently as regards health care. Fourthly, the study of the socioeconomic inequality of mortality andthose of malnutrition suggests some comments. First of all, this inequality is very strong. Then, whilethe inequality in mortality is stronger in rural area, the inequality in malnutrition is more pronouncedin cities. Lastly, the welfare disparities of the households have a secondary role as for the explanationof the level of this inequality.

A recent Report Card on Physical Activity and Health in South African Children and Youth 2010 states that at least four major factors place young children at risk: tobacco use, poor diet, lack of physical activity and facing weight challenges, this then including being overweight, underweight, obese or stunted for one’s age. One of the areas for action and intervention mentioned in the report card is training of teachers. The aim of this study was to increase knowledge, skill and competence in school teachers (care givers) when dealing with underweight in school children. A training program (train-the-trainer) was designed by the researcher. Under nutrition (underweight) is implicated in more than half of all child deaths worldwide. 25.33% of respondents in this study showed signs of underweight highlighting the importance of such training in schools. Using the above statistical data the research embarked on the development, implementation and evaluation of a training program for care givers on underweight prevalence in children in South African schools. The intervention research model of Thomas and Rothman was used in the design and development of the training program. A descriptive design with a quasi-experiment one group pre-test-post test was used in this study. A non parametric statistical test was utilized as data was measured on an ordinal scale (Wilcoxon signed rank test). The care giver training program was implemented over nine weeks consisting of one and a half hour sessions held once weekly. All Foundation Phase teachers were involved in the training (18 Care Givers). The program was implemented with grade one learners at a traditional primary school in Pretoria with a mixed demography and age groups varying between 6 and 8 years of age. Hundred and fifty learners participated in the pre and post test wherein a non probability sampling method was used. The study found that the training program for care givers had a statistically significant effect on underweight prevalence in young children. FMEA profiling in this study confirmed that enhancing care giver knowledge, skill and competence contributes significantly to the changes experienced in children’s underweight status. BMI levels changed significantly. The percentage underweight children dropped from 25.33% to 15, 33% over time. It is recommended that this intervention program be implemented and facilitated by teachers (care givers) forming part of a multi-disciplinary education approach in many South African schools. AFRIKAANS : ‘n Onlangse verslag getiteld “Report Card on Physical Activity and Health in South African Children and Youth 2010” dui aan dat daar ten minste vier hooffaktore is wat jong kinders se gesondheid aan gesondheidsrisiko’s blootstel. Die faktore sluit in rook, ongesonde eetstyl en dieet, gebrekkige deelname aan fisieke aktiwiteit en gewigsuitdagings. Gewigsuitdagings waarvoor Suid Afrikaanse jeug te staan kom sluit in oorgewigvoorkoms, ondergewigvoorkoms, obesiteit en of groeibeperking (stunting). Een van die areas wat in die verslag as voorkoming vir hierdie gewigsuitdagings voorgestel word is opleiding aan opvoeders. Die doel van die studie was dan om kennis, vaardigheid en bekwaamheidsvlakke in onderwysers te verbeter wanneer hulle met ondergewig kinders in hulle sorg werk te bewerkstellig d.m.v ‘n indiensopleidingsprogram (Train-the–trainer). Tans dra ondergewigvoorkoms by tot meer as die helfte van alle sterftes onder kinders wêrelwyd. In hierdie studie is bevind dat soveel as 25.33% van die kinders in die studie tekens van ondergewig getoon het. Dit beklemtoon die belangrikheid van ‘n opleidingsprogram aan die opvoeders van hierdie kinders. Statistiese data soos hier bo genoem is deur die navorser aangewend in die ontwikkeling, implementering en evaluering van die opleidingsprogram aan opvoeders van ondergewig kinders in die skool. Die intervensie navorsingsmodel van Thomas and Rothman is gebruik in die ontwerp en ontwikkeling van die opleidingsprogram. ‘n Beskrywende ontwerp met kwasi-eksperimente, een groep voortoets-natoets is in die studie gebruik. Nie parametriese statistiese toetsing is aangewend en data is gemeet aan die hand van ‘n ordinale skaal (Wilcoxon signed rank toets). Die opleidingsprogram aan opvoeders is oor ‘n tydperk van nege weke geïmplimenteer. Elke opleidingsessie was een en ‘n half uur lank en een maal per week aangebied. Alle grondsalgfase opvoeders was in die opleiding betrokke (n=18). Die program is getoets op graad een leerders wat skoolgaan in ‘n tradisionele laerskool in Pretoria met ‘n gemengde demografie en ouderdomsgroepe het gewissel tussen ses en agt jaar oud. Een honderd en vyftig leerders het aan die voor en natoetsing deelgeneem en ‘n nie waarskynlike metode van insluiting is gebruik. Die studie het bevind dat die opleidingsprogram aan opvoeders van ondergewig kinders in die skool ‘n beduidende invloed gehad het op die voorkoms van ondergewig. FMEA profiele gedoen in die studie het bevestig dat die verbetering van opvoeder kennis, vaardigheid en bekwaamheidsvlakke beduidend bygedra het tot die verandering in die ondergewig status van die kinders. LMI tellings het gedaal vanaf 25, 33% tot slegs 15, 33% oor verloop van tyd. Die navorser is van mening dat hierdie voorkomingsprogram in werking gestel behoort te word en deur opvoeders in die skool gefasiliteer word; om sodoende deel te word van ‘n multi-dissiplinêre onderwysbenadering in Suid Afrikaanse skole. / Dissertation (MA)--University of Pretoria, 2013. / Biokinetics, Sport and Leisure Sciences / unrestricted