Submitted in fulfillment of the requirements for the Degree in Masters in Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Introduction Malnutrition continues to be a major public health problem, especially in children under 5 years of age. Nutritional status is one of the indicators of overall well-being and human resources development of a nation. Aim of the study The aim of the study was to explore and describe experiences of Community Care Givers regarding the assessment of malnutrition in children under 5 years of age in eThekwini District Health Sub-district North area six. Methodology A qualitative, exploratory, descriptive study was used to conduct the study. Semi-structured individual face to face interviews were conducted with 13 participants. The study was guided by Pender’s Model of Health Promotion. Results The findings of the study revealed that participants were dissatisfied with mid upper arm circumference training. They reported lack of support and supervision in their performance such that mid upper arm circumference was non-prioritized. They were dissatisfied with remuneration and they worked under unsafe conditions. Conclusion In order to combat malnutrition in children under 5 years in the community, Community Care Givers need to be vigorously educated on the rationale of malnutrition assessment of children under 5 years in the communities so that they can have insight into what they are doing. Community Care Givers have multiple roles and may need to prioritize their work; this is not easy and requires specific guidance and training from skilled health professionals. / M

Children have been shown to respond differently to the hurt that they suffer at the hands of others. Some of these responses involve internalised behaviours (i.e., repression of feelings, bodily symptoms, etc.); whilst others hurt manifest as externalised behaviours, such as physical attacks on others. These may include sexualised behaviours. The latter is particularly common amongst (but not restricted to) children who have been sexually abused (The American Psychological Association, 2001). For the purposes of this study a distinction is made between developmentally appropriate sexual behaviour and non normative sexualised behaviour which evoke complaints from and discomfort in those involved in the behaviour. The manifestation of these sexualised behaviours is especially pronounced amongst children in institutional care; and hence, it calls for constructive and effective management by the child care workers who are primarily responsible for their safe care and behaviour modification whilst in the institution. This qualitative study – with an exploratory, descriptive and contextual research design – served to explore how the child care workers’ effective management of such behaviours could be enhanced, so that the emotional wellbeing of both the “offender” and the “perpetrator” of this behaviour can be promoted. A non-probability purposive sampling technique was employed to recruit research participants from three different child and youth care centres in Port Elizabeth. A total number of 10 research participants were involved and data was collected up to the point of data saturation. Thematic content analysis was utilised for the analysis of the data and the necessary strategies were employed to enhance the trustworthiness of the data and to meet all the ethical requirements of the study. The main findings alert to the key requirements of Child and Youth Care Workers; it confirms the occurrence of sexualised behaviours; the urgent need for a consistent approach to the management of such behaviours; and for enhanced team work between the helping professionals in the team. The value of the study is embedded in the contributions it can make to practical interventions for children in institutional care, and to the sparse body of knowledge in this area.

Dissertation submitted in fulfillment of the requirements for the Degree of Magister Technologiae: Consumer Science Food and Nutrition, Durban University of Technology, 2011. / Nutrition plays a fundamental role in the care and support of people living with the Human Immunodeficiency Virus (HIV) and children in particular are affected by HIV and the Acquired Immunodeficiency Syndrome (AIDS) epidemic in Africa in various ways. The epidemic puts children at risk physically, psychologically and economically. Children are indirectly affected by HIV and AIDS when the epidemic has a negative impact on their communities and the services these communities provide. Undernutrition is a major problem in HIV-positive children in South Africa with severe malnutrition as a common finding in HIV-positive children. HIV contributes to an increased incidence and severity of undernutrition and micronutrient deficiency. Low serum levels of vitamins A, E, B6, B12 and C, betacarotene, selenium, zinc, copper and iron deficiencies are frequently documented during all stages of HIV-infection. Malnutrition in turn further weakens the immune system which increases the susceptibility to infections and the duration and the severity of infections. Thus, the immune response is less effective and less vigorous when an individual is undernourished. Although guidelines exist for the treatment and management of HIV-infected children, it is clear from the literature that exceptional measures are needed to ensure the health and well-being of the children are met. Furthermore, residential care should not only be considered as a last resort for children’s care, but also as an intervention that requires more than merely addressing children’s basic physical needs. Nutrition education has been utilised globally and in South Africa to address nutrition related problems. The main purpose of nutrition education is to provide individuals with adequate and accurate information, skills and motivation to buy, produce and consume the correct foods to stay healthy and lead an active life. Aim The purpose of this study was to develop reliable and valid nutrition education material for the child care workers (CCWs) of Immune Compromised children vi resident in Children’s Homes in the Durban area in order to maintain the child’s immune system and to optimise their quality of life. Methodology The FAO framework used for planning, implementing and evaluating a nutrition education programme was followed to develop the nutrition education material in this study. Phase I included a situational analysis of the children homes involved. The residential care settings that participated in this study included three Children’s Homes in Durban. The total purposive sample included: boys (5–19 years) n = 112, girls (5–19 years) n = 38 and CCWs n = 40. The sample of HIV-positive children included boys (5–19 years) n = 3 and girls (5– 19 years) n = 6. The physical measurements obtained for this study to determine nutritional status were weight and height. The anthropometric measurements were captured and analysed by the researcher using the World Health Organisation’s AnthroPlus version 1.0.2. Statistical software. The following indices were included: height-for-age (stunting), weight-for-age (underweight) and BMI-for-age (overweight and wasting). The WHO growth standards for school-aged children and adolescents were used to compare the anthropometric indicators. Dietary intake measurements were done by analysing the cycle menus by means of the Food Finder® Version 3 computer software program and comparing the results with the Dietary Reference Intakes (DRIs), specifically the EAR and AI where the EAR were not available. The data were analysed to determine the adequacy of energy and nutrient intake. Average portion sizes were established by the plate waste studies method as well as observation of practices, interviews with the central buyer and focus group discussions with the CCWs. Nutrition knowledge of the CCWs was determined by a self-administered questionnaire developed and tested for reliability and validity. The problems identified in Phase I through the implementation of the questionnaires and other methods directed the design of messages in Phase II. Once suitable media was selected, nutrition education material was developed based on existing guidelines pertaining to HIV and AIDS. The material developed was then tested for reliability and validity before it was produced. vii Results The anthropometric measurements indicated that the majority of the HIV-negative boys and girls were of normal height-for-age and weight-for-age. The results also showed that possible risk of overweight and overweight were more prevalent in girls whereas underweight was more prevalent in boys. Furthermore, the results indicated that a third (33.0%) of the HIV-positive children were stunted and 16.7% was severely stunted. Findings of the menu analysis indicated that both girls and boys consumed three times more carbohydrates than the recommended intake. The DRIs for girls and boys were met for energy and protein in all the age groups except boys aged 14-18 years did not meet the DRI for energy. However, the comparison of the actual intake of the macro nutrients with the WHO guidelines indicated that the protein (10.78%) and carbohydrate (58.07%) is within the recommendations of 10- 15% and 55–75% respectively. This comparison also showed that the total fat intake of 31.15% was above the recommended intake of 15-30%. None of the age groups met the DRIs for fibre. The comparison of the intake with the WHO guidelines also indicated that the total dietary fibre intake was only 19.67g/day and not 27–40g/day. The actual fruit and vegetable intake was a mere 68.64g/day instead of 400g/day as recommended. None of the groups met the DRIs for calcium and iodine. The results clearly showed that micro nutrient inadequacies were more prevalent in the dietary intake of age groups 9-13 and 14-18 years in both girls and boys. Inadequate intake of magnesium, vitamin A, vitamin C, riboflavin, niacin, vitamin B6, pantothenate, biotin, vitamin E and vitamin K were evident in the age group 14-18 year. Overall, it is evident from the results on nutrition knowledge that although the respondents’ knowledge was fair on general nutrition guidelines, the results of the nutrition knowledge questionnaire indicated that knowledge on the importance of a variety in the diet is lacking. The CCWs displayed a very poor knowledge of the recommended number of fruit and vegetable portions per day as well as correct serving sizes of vegetable portions. A very poor knowledge also existed regarding the role of healthy eating in maintaining and supporting the immune system and a limited knowledge on correct hygiene practices was noted. The fridge magnets developed included five messages relating to nutrition and four messages relating to food safety and hygiene. viii Conclusion This study established that malnutrition is apparent in the children’s homes and that there were many gaps in the nutrition knowledge of the CCWs. These gaps included the role of good nutrition in the support and maintenance of the immune system and the importance of adequate intake of fruit and vegetables daily. The NEM developed in this study will address these gaps.

Many child and youth care organisations in South Africa struggle to implement adequate supervision structures for their child and youth care workers. If supervisors in this field had adequate knowledge and skills, they could enable child and youth care workers to grow and develop competently and provide more professional services to troubled young people in South Africa, This qualitative research sought to identify what knowledge and skills supervisors need in child and youth care settings in South Africa to provide effective supervision to workers. This research confirmed that there are specific skills and knowledge required by supervisors in child and youth care settings in South Africa and while there is an awareness of these in some settings, they are not being fully utilised in organised supervision structures. / Social Work / M.Tech. (Child and Youth Care)

Many child and youth care organisations in South Africa struggle to implement adequate supervision structures for their child and youth care workers. If supervisors in this field had adequate knowledge and skills, they could enable child and youth care workers to grow and develop competently and provide more professional services to troubled young people in South Africa, This qualitative research sought to identify what knowledge and skills supervisors need in child and youth care settings in South Africa to provide effective supervision to workers. This research confirmed that there are specific skills and knowledge required by supervisors in child and youth care settings in South Africa and while there is an awareness of these in some settings, they are not being fully utilised in organised supervision structures. / Social Work / M.Tech. (Child and Youth Care)

Child and youth care workers (CYCWs) provide intervention and support to children and youth in child and youth care centres (CYCCs) The purpose of this study was to investigate CYCWs’ knowledge and perceptions of attachment difficulties of children residing in CYCCs and to provide suggestions for social work support. The study adopted the Attachment Theory and Circle of Courage Theory. Drawing on qualitative methodology, 16 participants employed in CYCCs in the Ekurhuleni Metropolitan region, South Africa were purposively selected for in-depth, qualitative interviews. The eight-step data analysis method by Tesch (in Creswell, 2014:198) was used. To ensure trustworthiness of the findings, the researcher mainly used Guba’s model cited in Krefting (1990:214–222).The researcher adhered to prescribed ethical considerations. The study recommended that child and youth care as a profession should be recognised and supported to ensure quality services to children with attachment difficulties living in CYCCs. / Social Work / M. A. (Social Work)

Many young persons live under difficult circumstances. Factors including HIV/AIDS pandemic, exacerbate the need to place young persons into alternative placements. The new and the unknown can be frightening but carrying a faithful transitional object establishes therapeutic bridge between the old and known and the new and unknown. This study sought to explore South African child and youth care workers' awareness of young persons' objects of significance in residential care settings. The rational was that with greater awareness, important objects may become a more useful option for the promotion of young persons' well-being. The research confirmed that South African child and youth care workers are aware of the existence and importance of significant objects. It further revealed that young persons possess different objects of significance to which workers need to pay careful attention. / Research Institute for Theology and Religion / M.Tech. (Child and Youth Care)

Many young persons live under difficult circumstances. Factors including HIV/AIDS pandemic, exacerbate the need to place young persons into alternative placements. The new and the unknown can be frightening but carrying a faithful transitional object establishes therapeutic bridge between the old and known and the new and unknown. This study sought to explore South African child and youth care workers' awareness of young persons' objects of significance in residential care settings. The rational was that with greater awareness, important objects may become a more useful option for the promotion of young persons' well-being. The research confirmed that South African child and youth care workers are aware of the existence and importance of significant objects. It further revealed that young persons possess different objects of significance to which workers need to pay careful attention. / Research Institute for Theology and Religion / M.Tech. (Child and Youth Care)

Text in Afrikaans / Children in children’s homes often make use of specific behaviour - defined as contact boundary disturbances in Gestalt theory - as a result of their intense emotional needs, but also to protect themselves or to be assertive in their current environment. This qualitative, applied study aimed to determine and describe the way the child care workers of a rural child and youth care centre manage and experience the contact boundary disturbances of children in the children’s home. Semi-structured interviews were conducted with eight child care workers. In conducting the study, the researcher found that the child care workers had inadequate knowledge and insight regarding contact boundary disturbances and how to handle it. It was concluded that the management of children’s homes must ensure that training and support are provided to child care workers so that their needs are addressed in order to prevent burnout. Recommendations that will be valuable with respect to the handling skills and emotional experiences of child care workers were made. / Social Work / M. Diac. (Spelterapie)

The qualitative research approach, applying an explorative, descriptive and contextual strategy of enquiry was used to address the research question formulated, - How do child and youth care workers support child-headed households in the community? In this process the needs, relationships, interactions and encounters which occur between child and youth care workers and young people in child-headed households are described. The research was conducted with children from two child-headed households (12 children in all) and three community child and youth care workers from the Isibindi project in the province of Kwa-Zulu Natal. The findings confirm that the integration of child and youth care work characteristics in the daily life events of the children, contributed to services to children that are therapeutically caring, reclaiming and reflective of the African spirit of Ubuntu – demonstrating a relevant and unique South African expression of child and youth care practice. / Sociology / M. Tech. (Child and Youth Care)