Thesis (MSc)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The Birth to Twenty (BTT) study involves the monitoring of the health status and related factors of urban-born children from birth until age twenty. When the cohort reached age 13 years in 2003, nutrition knowledge assessment was identified as an important new priority and a nutrition knowledge questionnaire was required for these purposes. Subsequently a valid and reliable nutrition knowledge questionnaire was developed for the BTT study. This process started with the development of a conceptual framework of nutrition-related issues facing urban South African adolescents and identification of related nutrition concepts. A pool of potential questionnaire items reflecting the concepts was subsequently developed. These items were evaluated by an expert panel to ensure content and face validity before being structured into a questionnaire. The resulting 88-item questionnaire was completed by adult and adolescent samples, each age group comprising subgroups of those likely to have good nutrition knowledge and those likely to have poor nutrition knowledge. The data obtained from the completion of the questionnaire by these groups was used to refine the questionnaire through the determination of difficulty and discriminatory indices of the items, and the deletion of items that did not meet the stated criteria. The construct validity of the remaining 63 items was assessed using the same data set. To assess the internal consistency reliability (ICR) of the 63-item questionnaire it was completed by an adolescent sample population considered to be representative of the BTT cohort, after which the questionnaire underwent further steps of refinement. The result was a 60-item questionnaire of which the ICR and construct validity was reassessed and found to be satisfactory. However, to ensure the accurate interpretation of scores obtained by testees, the development of a performance-rating scale was necessary. A norm-referenced performance-rating scale (norms) was developed by administering the nutrition knowledge questionnaire to a sample population similar to the BTT cohort (norm group) and transforming their performance scores to z-scores. The z-scores ranges were then categorised into stanines, thereby resulting in a norm-referenced performance-rating scale that can be used to rate the performance of the BTT cohort. The validity of the norms was assessed by administering the nutrition knowledge questionnaire to three validation groups that comprised groups who were expected to obtain different performance-ratings on the questionnaire based on their varying levels of nutrition knowledge. The validation groups performed as expected, with significant differences in performance-rating profiles found among the three groups, indicating the validity of the norms. The study was successful in developing a reliable and valid nutrition knowledge questionnaire for use on the urban adolescents who participate in the BTT study. A norm-referenced performance-rating scale for use with the questionnaire was also successfully developed. The questionnaire and norms will be useful in assessing nutrition knowledge as well as in comparing the changes in knowledge of the BTT cohort as they move from lower to higher school grades. / AFRIKAANSE OPSOMMING: Die “Birth to Twenty” (BTT)-studie behels die monitering van die gesondheidstatus en verwante faktore van kinders wat in stedelike gebiede gebore is van geboorte tot twintigjarige ouderdom. Toe die kohort in 2003 dertienjarige ouderdom bereik het, is die evaluering van die voedingkennis van die kinders as ‘n belangrike nuwe prioriteit geïdentifiseer. ‘n Toepaslike voedingkennisvraelys is vir hierdie doeleindes benodig en gevolglik is ‘n geldige en betroubare vraelys vir gebruik in die BTT-studie ontwikkel. Hierdie proses is begin deur die ontwikkeling van ‘n konseptueleraamwerk oor voedingverwante vraagstukke wat stedelike Suid-Afrikaanse adolessente in die gesig staar, asook die identifisering van verwante voedingkonsepte. ‘n Poel van potensiële vraelysitems wat die konsepte reflekteer is daarna ontwikkel. Die items is eers deur ‘n paneel van kenners evalueer om inhoud- en gesigsgeldigheid te verseker alvorens dit in ‘n vraelys omskep is. Die produk was ‘n vraelys wat 88 items ingesluit het wat vervolgens deur volwasse en adolessente groepe voltooi is. Die groepe het subgroepe ingesluit van diegene met verwagte goeie voedingkennis en diegene met verwagte swak voedingkennis. Die data wat tydens hierdie stap gegenereer is, is gebruik om die vraelys verder te verfyn deur die bepaling van die moeilikheids- en diskriminatoriese-indekse van die items. Die items wat nie aan vooraf gestelde kriteria voldoen het nie, is weggelaat. Die konstrukgeldigheid van die oorblywende 63 items is bepaal deur dieselfde datastel te gebruik. Om die interne-konsekwensie-betroubaarheid (IKB) van die vraelys te bepaal, is dit deur ‘n steekproef van adolessente, wat verteenwoordigend van die BTT-kohort is, voltooi. Hierna is die vraelys verder verfyn. Die uitkoms was ‘n 60-item vraelys waarvan die IBR en konstrukgeldigheid weereens bepaal is. Dit is gevind dat dié twee indikatore van geldigheid en betroubaarheid bevredigend is. Om akkurate interpretasie van die punt wat deur ‘n respondent vir die toets behaal te verseker, is die ideal om ‘n skaal te ontwikkel wat gebruik kan word om dié punt te takseer. ‘n Norm-gebaseerde prestasietakseringskaal is ontwikkel deur die voedingkennisvraelys deur ‘n steekproef wat verteenwoordigend is van die BTT-kohort (normgroep), te laat voltooi. Die prestasiepunte is getransformer na z-tellings wat vervolgens getransformeer is na stanneges, wat ‘n norm-gebaseerde prestasietakseringskaal opgelewer het wat gebruik kan word om die prestasie van die BTT-kohort te takseer. Valideringsgroepe met verskillende vlakke van voedingkennis, wat dus na verwagting verskillend getakseer behoort te word indien die norme toegepas word, het die voedingkennisvraelys voltooi om die geldigheid van die norme te bepaal. Dié valideringsgroepe het soos voorspel presteer, met betekenisvolle verskille in die prestasieprofiele van die verskillende groepe. Hierdie resultate dui daarop dat die norme geldig is. Die ontwikkeling van ‘n geldige en betroubare voedingkennistoets vir gebruik in die BTT-studie is suksesvol in hierdie studie deurgevoer. ‘n Norm-gebaseerde prestasietakseringskaal vir gebruik saam met die vraelys is ook suksesvol ontwikkel. Die vraelys en norme sal van waarde wees vir die evaluering van die voedingkennis van die BTT-kohort. Dit sal ook met sukses gebruik kan word om die verandering in die voedingkennis van die kinders soos wat hulle ouer word, te bepaal.

Thesis (MSc Nutrition Science)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Probiotics (live microbes) and prebiotics (non-digestible food-ingredients) are rapidly gaining interest worldwide as supplements and functional food ingredients but little South African information in this regard is available. Furthermore, the availability of South African produced probiotic concentrates for commercial use is also very limited. The aims of this study therefore were to complete a market and product assessment of probiotic and prebiotic containing products in South Africa and to evaluate probiotic strains for commercial use in South Africa. For the purposes of market and product assessment probiotic and/or prebiotic containing products manufactured in South Africa were identified. The scientific and legal correctness of health and content claims made on the labels of the products were assessed. An exploratory survey was conducted to determine the awareness of South African consumers of probiotics and prebiotics. For the evaluation of probiotic strains for potential commercial use in South Africa, a panel of twelve lactic acid bacteria (LAB) were screened for inhibitory activity against two porcine pathogens and indicator strains from the LMG-panel isolated from the faeces of patients diagnosed with AIDS. The five LAB with the best inhibitory activity were tested for growth in soymilk-base and for the effect of lyophilization on the inhibitory activity thereof. The effect of prebiotics on the growth and inhibitory activity of the strains was tested in vitro. A range of products containing probiotics and prebiotics available on the South African market was identified. Irregulatories concerning health claims on the labels were found, but content claims seemed to be less of a problem. The results also indicate that the proposed South African regulations for the labelling of probiotic and prebiotic containing products need to be revised to include the probiotic and prebiotic related health claims for which sufficient scientific evidence is available. The probiotic strains with potential for commercial use in South Africa that were identified, include Lactobacillus plantarum 423, Lactobacillus casei LHS, Lactobacillus salivarius 241, Lactobacillus curvatus DF38 and Pediococcus pentosaceus 34. These strains were grown successfully in soymilkbase and lyophilization did not have a negative effective on the inhibitory activity thereof. The growth and inhibitory activity of the five LAB were promoted when combined with 1% (w/v) Raftilose® Synergyl . It is concluded that although a variety of probiotic and prebiotic containing products are available on the South African market, the scientific and legislative correctness of especially health related claims is not satisfactory and that South African consumer awareness of these products is low. It is also concluded that a combination of at least three of the five identified LAB and 1% Raftilose® Synergy can be used by South African manufacturers for the production of probiotic and prebiotic containing supplements. / AFRIKAANSE OPSOMMING: Die belangstelling in probiotika (lewendige mikrobe) en prebiotika (onverteerbare voedselbestanddele) as supplemente en funksionele voedselbestanddele is besig om wêreldwyd toe te neem, alhoewel weinig Suid-Arikaanse inligting in hierdie verband beskikbaar is. Die beskikbaarheid van Suid-Afrikaans geproduseerde probiotika konsentrate vir kommersïele gebruik is ook baie beperk. Die doelwitte van hierdie studie was dus om 'n mark- en produkevaluering van probiotika- en prebiotika-bevattende produkte in Suid-Afrika uit te voer en om probiotiese stamme te evalueer vir uiteindelike kommersiële gebruik in Suid-Afrika. Vir die doel van die mark- en produkevaluering is probiotika- en prebiotika-bevattende produkte wat in Suid-Afrika vervaardig word geïdentifiseer. Die wetenskaplike en wetlike korrektheid van die gesondheids- en inhoudsaansprake op die etikette van die produkte is evalueer. 'n Markopname is uitgevoer om die bewustheid van Suid-Afrikaanse verbruikers van probiotika en prebiotika vas te stel. Vir die evaluering van probiotiese stamme vir potensïele kommersiële gebruik in Suid-Afrika is 'n paneel van twaalf melksuurbakteriëe getoets vir inhibitoriese aktiwiteit teen twee patogene geïsoleer uit varke asook teen indikator stamme van die LMG-paneel. Die vyf melksuurbakteriëe met die beste inhibitoriese aktiwiteit is getoets vir groei in sojamelk-basis en ook vir die effek van vriesdroging op die groei en inhibitoriese aktiwiteit van die stamme daarvan. Die effek van prebiotika op die groei en inhibitoriese aktiwiteit van die stamme is in vitro getoets. 'n Reeks van probiotika- en prebiotika-bevattende produkte wat beskikbaar is op die Suid-Afrikaanse mark, is geidentifiseer. Ongeruimdhede met die gesondheidsaansprake op die etikette is gevind, maar inhoudsaansprake was minder problematies. Die resultate dui ook daarop dat die voorgestelde Suid- Afrikaanse regulasies vir die etikettering van probiotika- en prebiotika-bevattende produkte hersien moet word om al die probiotika- en prebiotika-verwante gesondheidsaansprake waarvoor voldoende wetenskaplike bewyse beskikbaar is in te sluit. Die probiotiese stamme met potensiaal vir kommersiële gebruik in Suid-Afrika sluit die volgende in: Lactobacillus plantarum 423, Lactobacillus casei LHS, Lactobacillus salivarius 241, Lactobacillus curvatus DF 38 en Pediococcus pentosaceus 34. Hierdie stamme is suksesvol gekweek in sojamelk-basis en vriesdroging het nie' n negatiewe effek op die groei en inhibitoriese aktiwiteit daarvan gehad me. Die kombinasie van die vyf melksuurbakteriëe met 1% Raftilose® Synergy het die groei en inhibitoriese aktiwiteit daarvan bevorder. Die gevolgtrekking wat gemaak word is dat alhoewel 'n varrasie van probiotika- en prebiotikabevattende produkte beskikbaar is op die Suid-Afrikaanse mark, die wetenskaplike en wetlike korrektheid van spesifiek die gesondheids-verwante aansprake op die etikette daarvan nie bevredigend is nie en dat die bewustheid van die Suid-Afrikaanse verbruikers van hierdie produkte laag is. Die gevolgtrekking kan ook gemaak word dat 'n kombinasie van ten minste drie van die vyf geïdentifiseerde melksuurbakteriëe en 1% Raftilose® Synergy deur Suid-Afrikaanse vervaardigers gebruik kan word vir die vervaardiging van produkte wat probiotika en prebiotika bevat.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The primary objective was to determine whether acidified formulae (pH 3.5 and 4.5) decreased gastric and tracheal colonisation, as well as microbial contamination of the enteral feeding delivery system, compared with a non-acidified control formula (pH 6.8) in critically ill patients. Secondary objectives included tolerance of the trial formulae and mortality in relation to the administration of acidified formulas. DESIGN: The trial was a controlled, double-blinded, randomised clinical trial of three parallel groups at a single centre. METHOD: Sixty-seven mechanically ventilated, medical and surgical critically ill patients were randomised according to their APACHE II scores and included in the trial. Patients received either an acidified (pH 3.5 or 4.5) or control polymeric enteral formula via an 8-Fr nasogastric tube at a continuous rate. Daily samples were taken for microbiologic analyses of the enteral formulae at various stages of reconstitution and at 6-hour and 24-hour intervals during administration thereof (feeding bottle and delivery set). Daily patient samples included nasogastric and tracheal aspirates, haematological evaluation and gastro-intestinal tolerance. The trial period terminated when patients were extubated, transferred from the ICU, enteral nutrition became contraindicated, a patient died, or for a maximum of 21 days. RESULTS: Gastric pH showed no significant difference (p = 0.86) between the 3 feeding groups [pH 3.5 (n = 23), pH 4.5 (n = 23) and pH 6.8 (n = 21)] at baseline prior to the administration of enteral formulae. After initiation of feeds, the gastric pH decreased significantly (p< 0.0001) in the acidified formulae as compared to the control formula during the trial period. Patients who received acidified enteral formulae (pH 3.5 and 4.5) had significantly less (p < 0.0001) contamination from the feeding bottles and delivery systems in respect of Enterobacteriacea, and Enterococcus., The more acidified group (pH 3.5) showed significantly less gastric contamination (p = 0.029) with Enterobacteriacea, , but not for fungi. The 3.5 acidified group also had the lowest gastric growth in terms of colony counts (≤104) of these organisms, but not for fungi, when compared to the control group (≤105). Vomiting episodes were 22% and abdominal distension 12%, with a higher incidence in the control group. Adverse events occurred equally between the groups with a higher, but not significantly different incidence of 37% in the control group and 32% for the acidified groups. There was no evidence of gastro-intestinal bleeding in any patient. Overall, the mortality rate in this trial was 6%, with 6.5% for the acidified groups (n=46) and 4.8% for the control group (n=21), a statistically insignificant difference. CONCLUSION: Acidified enteral formulae significantly decrease gastric colonisation by preserving gastric acidity that decreases the growth of Enterobacteriaceaes organisms. Acidified formulae significantly decrease bacterial contamination of the enteral feeding system (bottle and delivery set) of Enterobacteriaceae and Enterococcus organisms. Acidified formulae are tolerated well in critically ill patients.

Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / Background Critical illness is associated with increased production of reactive oxygen species and oxidative stress, and low levels of most micronutrients with resultant diminished endogenous antioxidant defences. Micronutrient supplementation is thought to be beneficial to the critically ill patient by ameliorating oxidative stress and by improving clinical outcome. Objectives This systematic review assessed the effects of micronutrient supplementation on adults recovering from critical illness. Primary outcomes included clinical endpoints [mortality, infectious complications, length of intensive care unit and hospital stay (LICU and LOS)]. Secondary outcomes included descriptions of practice issues, micronutrient status, morbidity, course of the acute phase response and oxidative stress. Search strategy An electronic bibliographic database search was carried out, bibliographies of retrieved articles were reviewed and personal files searched to obtain additional citations. Databases were searched from inception until 29 February 2008. Selection criteria Randomized controlled trials (RCTs) of micronutrient supplementation (by any route) in adult critically ill patients, given in addition to their routine care, were included. Data collection and analysis Two authors independently extracted data and assessed trial quality. For the primary outcomes the random-effects model was used to estimate overall relative risk / mean difference and effect size due to the presence of study heterogeneity. Selected exploratory analyses were undertaken. Differences at the level of p<0.05 was considered to be statistically significant. The secondary outcomes were sparse and variably recorded such that this data was not formally aggregated. Main results Fifteen RCTs involving 1714 participants and 18 RCTs involving 1849 participants were included for the primary and secondary objectives respectively. The quality of the RCTs, as reported, was disappointing, particularly for allocation concealment. Fourteen trials (n=1468) of micronutrient supplementation showed a statistically significant reduction in overall mortality [relative risk (RR) 0.78, 95% confidence interval (CI) 0.67-0.90, I2=0%, p=0.0009]. An asymmetrical funnel plot necessitates caution when directly interpreting these results. Six RCTs (n=1194) indicated a statistically significant reduction in 28 day mortality (RR 0.75, 95% CI 0.63-0.88, I2=0%, p=0.0006) (symmetrical funnel plot). Micronutrient supplementation in this systematic review was not associated with a reduction in infectious complications, LICU or LOS. In sub-group analyses, single nutrients were associated with borderline statistical significance (RR 0.82, 95% CI 0.66-1.01, I2=0%, p=0.06) in terms of mortality, whist a sensitivity analysis of combined micronutrients indicated a significant reduction in mortality (RR 0.69, 95% CI 0.54-0.90, I2=2%, p= 0.006). This review did not find clear evidence that parenteral is superior to enteral administration in terms of clinical outcomes. The secondary outcomes confirmed that timing, duration and dosing are key factors to ensure optimal clinical benefit. Conclusion This review does suggest potential benefit of micronutrient supplementation in critically ill adults for some clinical outcomes (especially mortality), but also highlights that caution is warranted as nutrient interactions and risk of toxicity are not clearly defined in critical illness. More large multi-centre randomized trials are necessary to assess the effects of different types and doses of micronutrient supplementation in selected groups of patients with different types of critical illness.

Thesis (MSc Nutrition Science)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: First-year female students (FYFS), studying at the University of Stellenbosch were previously identified as a high-risk group for gaining weight. A four-year follow-up of these female students indicated that a large percentage experience weight fluctuations throughout their university careers. The unique weight management needs of the FYFS were also identified in the longitudinal study. The integration of these results with an extensive search and assessment of the weight management literature led to the development of a multidimensional weight-management paradigm for application in the development of weight-management interventions for female students. Subsequently, a self-help weight-management manual, which follows the multidimensional approach proposed in the mentioned paradigm, was developed to address the unique weight-management needs of female students. The aim of the current study was to evaluate the impact of the multidimensional self-help weightmanagement manual (the Manual) on the weight status and associated factors of FYFS at the University of Stellenbosch over an eight-month period. For this purpose a non-randomized quasi-experimental design was used, including purposively selected experimental and control groups. Data were obtained during February (Baseline), May (three months after baseline = Follow-up I) and October 2002 (eight months after baseline = Follow-up 2). All students in the experimental group received the Manual at Baseline for use during the eight-month study period. Because this was a low-intensity intervention programme, no further contact was made with either group during the study period, except when Followup I data were obtained. Measures that were taken and instruments that were completed include the following: weight, height, triceps skinfoid, mid-upper ann circumference, hip circumference, waist circumference, Adolescent Self-Concept Scale (self-concept), Body Shape Questionnaire (body shape concerns), Eating Attitudes Test (eating attitudes and behaviours), General Health Questionnaire (general psychological well-being), 90-item Semi-quantified Food Frequency Questionnaire (dietary intake from nine food groups), and the Baecke Questionnaire of Habitual Physical Activity (physical activity). Additional questions on weight related perceptions and practices, dissatisfaction with body parts, reasons for eating and socio-demographic factors were also included. The Baseline characteristics of the FYFS involved in this study, which did not differ between the experimental and control groups for all key variables, identified them as a typical group of young female adults who are healthy but are not realistic about their weight status and who experience numerous problems related to their weight status. The implementation of the Manual was found to be significantly effective in limiting weight gain among the FYFS in the experimental group. The control group experienced almost a full unit increase in BMI (0.93 kg/m²), while the increase found for experimental group was 0.53 kg/m² (p=0.004). Although the weight of both groups increased initially the experimental group went on to lose weight, while the control group continued to gain weight during the last five months of the intervention. The impact of the Manual is further illustrated by the fact that the FYFS in the experimental group who indicated that they did Lise the Manual extensively experienced a significantly lower rise in their weight (change in BMI over study period = 0.37 kg/m²) than those in the experimental group who indicated that they did not use the Manual (change in BMI over study period = 0.89 kg/m²). Factors that are possibly linked to the success attained with the Manual were identified and include more reasonable weight goals; the use of sound weightreduction methods such as a balanced diet and physical activity; improvements in self-concept; maintenance of physical activity levels, especially during the first three months at university; improvement in general psychological well-being; decreased intake of foods from the "other" (includes mainly high fat, sugar based foods such as doughnuts, cookies, cake, tart), beverage and grains food groups; and possibly less concerns with body shape from the start. Factors for which no link with weight management success could be established include changes in body composition; perceptions of own weight; weight loss attempts; foods from the vegetables, fruit, milk and cheese, meat, fish and chicken, fats and fast foods food groups; physical activity over the total eight-month period; reasons for eating; eating attitudes and behaviour; dissatisfaction with body parts; and body shape concerns. It is recommended that the implementation of the Manual on the campus of the University of Stellenbosch to prevent weight gain of FYFS should be considered, bearing in mind some of the recommendations formulated by the FYFS in the experimental group. / AFRIKAANSE OPSOMMING: Eerstejaar damestudente wat aan die Universiteit van Stellenbosch studeer is voorheen geïdentifiseer as 'n hoë risiko groep vir gewigstoename. 'n Vier-jaar opvolg van hierdie damestudente het aangedui dat 'n groot persentasie vir die duur van hul universiteitsloopbane gewigsfluktuasies ondervind. Die unieke gewigshanteringsbehoeftes van die eerstejaar damestudente is ook tydens die longitudinale studie geïdentifiseer. Die integrasie van hierdie resultate met 'n uitgebreide soektog en ontleding van die literatuur wat betrekking het op gewigshantering het aanleiding gegee tot die ontwikkeling van 'n multidimensionele gewigshanteringsparadigma wat gebruik kan word tydens die ontwikkeling van gewigshanteringsintervensies vir damestudente. As 'n volgende stap is 'n self-help gewigshanterings handleiding, wat die multidimensionele benadering voorgestel in die genoemde paradigma volg, ontwikkelom die unieke gewigshanteringsbehoeftes van damestudente aan te spreek. Die doel van die huidige studie was om die impak van die multidimensionele self-help gewigshanteringshandleiding (die Handleiding) op die gewigstatus en geassosieerde faktore van eerstejaar damestudente aan die Universiteit van Stellenbosch oor 'n tydperk van agt maande, te evalueer. Vir hierdie doeleinde is 'n nie-gerandomiseerde kwasi-eksperimentele ontwerp gebruik, wat doelbewus geselekteerde eksperimentele en kontrole groepe ingesluit het. Data is gedurende Februarie (Basislyn), Mei (drie maande na basislyn = Opvolg-I) en Oktober (agt maande na basislyn = Opvolg-2) 2002 versamel. Alle studente in die eksperimentele group het die Handleiding tydens Basislyn ontvang vir gebruik tydens die agt maande studieperiode. Omdat dit 'n lae-intensiteit intervensie program was, is geen verdere kontak gedurende die studieperiode met beide die groepe gemaak nie, behalwe tydens die versameling van Opvolg-I data. Metings wat geneem is en instrumente wat voltooi is, sluit die volgende in: gewig, lengte, triseps velvou, mid-bo-armomtrek, heupomtrek, middelomtrek, "Adolescent Self- Concept Scale" (self-konsep), "Body Shape Questionnaire" (besorgdheid oor liggaamsvorm), "Eating Attitudes Test" (eetgedrag en -houding), "General Health Questionnaire" (algemene sielkundige welstand), 90-item semi-gekwantifiseerde voedselfrekwensievraelys (dieetinname van nege voedselgroepe), en die "Baecke Questionnaire of Habitual Physical Activity" (fisieke aktiwiteit). Addisionele vrae aangaande gewigsverwante persepsies en praktyke, ontevredenheid met liggaamsdele, redes vir eet en sosio-demografiese faktore is ook ingesluit. Die Basislyn eienskappe van die eerstejaar damesstudente wat aan hierdie studie deelgeneem het, het nie tussen die eksperimentele en kontrole groepe vir alle sleutelveranderlikes verskil nie. Hierdie inligting het ook daarop gedui dat die studente 'n tipiese groep jong vroulike volwassenes is wat gesond is maar, onrealisties is oor hul gewigstatus en baie gewigstatusverwante probleme ondervind. Die resultate toon dat die implementering van die Handleiding beduidend effektief was om die gewigstoename by eerstejaar damestudente in die eksperimentele groep te beperk. Die gewig van die kontrole groep het byna 'n volle LMI eenheid (0.93 kg/m²) toegeneem terwyl die toename vir die eksperimentele groep 0.53 kg/m² was. Alhoewel die gewig van beide groepe aanvanklik toegeneem het, het die eksperimentele groep daarna gewig verloor terwyl die kontrole groep se gewig gedurende die laaste vyf maande van die intervensie verder toegeneem het. Die impak van die Handleiding word verder geïllustreer deur die feit dat die eerstejaar damesstudente in die eksperimentele groep wat aangedui het dat hul wel die Handleiding ekstensief gebruik het, 'n beduidend laer toename in gewig (LMI verandering gedurende studieperiode = 0.37 kg/m²) ondervind het as die studente in die eksperimentele groep wat aangedui het dat hul nie die Handleiding gebruik het nie (LMI verandering gedurende studieperiode = 0.89 kg/m²). Faktore wat moontlik gekoppel kan word aan die sukses verkry met die Handleiding is geïdentifiseer en sluit die volgende in: meer redelike gewigsdoelwitte; die gebruik van veilige gewigsverlies metodes soos 'n gebalanseerde dieet and fisieke aktiwiteit; verbetering van self-konsep; handhawing van fisieke aktiwiteitsvlakke, veral gedurende die eerste drie maande op universiteit; verbetering van algemene sielkundige welstand; verlaagde inname van voedsel van die "ander-" (sluit hoofsaaklik hoë vet, suiker gebasseerde voedsels soos oliebolle, koekies en tert in), drankies- en graanvoedselgroepe; en moontlik minder besorgdheid oor liggaamsvorm van die begin af. Faktore waarvoor geen verband met sukses met gewigshantering gevind is nie sluit die volgende in: liggaamsamestelling; persepsies van gewig; gewigsverliespogings; voedselinname uit die groente-, vrugte-, melk en kaas-, vleis, vis en hoender-, vette- en kitskosse-voedselgroepe; fisieke aktiwiteit gedurende die totale agtmaande periode; redes vir eet; eetgedrag en -houding; ontevredenheid met liggaamsdele; en besorgdheid oor liggaamsvorm. Dit word aanbeveel dat die implementasie van die Handleiding op die kampus van die Univérsiteit van Stellenbosch oorweeg word om gewigstoename van eerstejaar damesstudente te voorkom. Dit word ook aanbeveel dat die aanbevelings van die studente in die eksperimentele groep in hierdie verband, in ag geneem moet word.

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 (MSc (Dietetics))--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The aim of the study was to contribute to the nutritional well-being of 0 - 24 month old children who attend primary health care clinics (PHC) in Duncan Village, an urban slum. This was to be achieved by first formulating essential nutrition-related message topics and second by formulating recommendations for optimising the accessibility of services, including nutrition-related messages, aimed at mothers attending PHC clinics in Duncan Village. In order to formulate targeted and relevant nutrition-related messages for mothers attending the PHC clinics (Phase I of the research) the need for more information on the six focus areas for intervention that were identified in the previous Duncan Village Day Hospital (DVDH) study" was determined. This was done through key-informant interviews and studying other relevant published research. Eleven research questions related to the six focus areas were subsequently formulated to guide further research. Non-scheduled structured interviews were conducted with mothers with children in specific age groups until data saturation was achieved. A total of 31 interviews were thus conducted at the homes of participants and observation data was also collected at the same time. Three focus groups with corresponding participant categories were also conducted to check the information obtained through the interviews. Two focus groups were conducted with grandmothers to serve as a further form of checking research but also to obtain a different perspective on the research questions. The data available for the formulation of the message topics was analysed qualitatively by hand. The focus areas and the research questions gave a specific focus to the analysis process and the unprocessed data was available in these broad predetermined categories. All the information from all sources (DVDH study, the non-scheduled structured interviews with mothers, focus groups with mothers and grandmothers and observation data) was studied, interpreted and integrated for each identified category. During this process key-factors, which need to be addressed in nutrition-related messages essential for the well-being of infants attending PHC clinics in Duncan Village, were identified. The final step in the analysis process was the formulation of message topics based on these key-factors. During the analysis process it became clear that some of the identified key factors were not suitable for the formu lation of nutrition-related message topics but rather give insight into the total context of the mothers attending the clinics in Duncan Village. It was evident that the information contained in the key factors could be used by health workers to identify and assist vulnerable mothers. These key-factors led to the formulation of relevant help topics. Eighteen main message topics and 16 help topics were formulated. The message topics included topics on: self-development, household food security, breastfeeding, good feeding practices, mothers' health and nutrition and hygiene practices. in Phase 2 of the study the accessibility of services, including nutrition-related messages, to mothers attending PHC clinics in Duncan Village was determined. This was done by determining how mothers inDuncan Village experience the clinics where they could be exposed to nutrition-related messages and by determining the experiences of health care workers with mothers as clients as well as with service delivery. This information was obtained through focus group discussions with different participant categories. These categories included mothers with children in the same age groupings as in Phase I who had either attended clinic for all the child's immunisations or who had not attended clinic for all the child's immunisations or who had attended clinics outside Duncan Village for immunisation purposes. Pregnant women who had either attended antenatal clinics or had not attended antenatal clinics were also included. The last participant category involved health workers. This category included health workers from the obstetric unit where mothers from Duncan Village give birth, the primary health care clinics and community health care workers. The data obtained was analysed with ATLAS/ti, computer software specifically designed for qualitative data analysis. Twelve code families were created during the analysis process, each family referring to a specific aspect of accessibility of services provided at the PHC clinics. A detailed description of each code family is presented after which six networks were compiled. The data and networks were used to create a framework for data interpretation. According to the framework it is proposed that the final elements in the process of providing accessible nutrition-related messages to clients at clinics are (1) that the clients must attend the clinic and (2) that appropriate nutrition-related messages must be available. Problems with interpersonal and organisational aspects of service delivery were found to be two of the most important aspects that influence accessibility of clinic services and therefore nutrition-related messages at the clinics. The last phase of the study (Phase 3) involved the formulation of recommendations to the relevant authorities about targeted and relevant nutrition-related message topics to be included in the education of mothers and pregnant women as well as recommendations to optimise accessibility of nutrition-related messages at the three PHC clinics in Duncan Village and the obstetric unit where mothers of Duncan Village give birth. A total of fifteen recommendations were formulated based on the frndings and recommendations of Phase I and Phase 2. These recommendations focus especially on the necessity for the municipality to create a health empowering environment at the clinics, on the provision of appropriate nutrition-related messages at the clinics and on the need to reach vulnerable mothers. The importance of involving the community in these processes was also emphasised in the recommendations. It is concluded that the implementation of the recommendations will contribute to the nutritional well-being of all young children in Duncan Village and could play an important role in realising the rights of children living in the area. / AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n bydrae te maak tot die voedingswelstand van 0-24 maandoue kinders wat prirnere gesondheidsorg (PGS) klinieke in Duncan Village, 'n verarmde stedelike gebied, besoek. am die doel te bereik is daar eerstens beplan om essensiele voedingsverwante boodskappe te formuleer. Tweedens is daar beplan om aanbevelings vir die optimalisering van die toeganklikheid van gesondheidsorgdienste vir rna's wat die klinieke bywoon, insluitend die toeganklikheid van voedinsgverwante boodskappe, te maak. Voordat relevante voedingsverwante boodskappe vir rna's wat die klinieke in Duncan Village besoek, geformuleer kon word, was meer inligting nodig oor die ses fokusareas vir intervensie wat in die vorige Duncan Village Daghospitaal studie bepaal is. Die bepaling van watter inligting nodig was, is gedoen deur sleutelinformantonderhoude en die bestudering van ander relevante gepubliseerde navorsing. Na aanleiding hiervan is elf navorsingsvrae wat verband hou met die ses fokusareas geformuleer. Nie-geskeduleerde, gestruktureerde onderhoude is vervolgens met 111a's met kinders in spesifieke ouderdomsgroepe gehou totdat dataversadiging bereik is. 'n Totaal van 31 onderhoude is met respondente gehou by hul huise, waartydens die onderhoudvoerder ook sekere waamemingsdata ingesamel het. Drie fokusgroepe is ook met rna's met kinders in ooreenstemmende kategoriee gehou om die inligting na te gaan wat deur die onderhoude ingesamel is. Twee fokusgroepe is ook met oumas gehou om die data verder na te gaan maar ook om 'n ander perspektief op die navorsingsvrae te verkry. Die data wat verkry is, is kwalitatief met die hand geanaliseer. Die fokusareas en die navorsingsvrae het 'n spesifieke fokus aan die analiseproses gegee en die ongeprossesseerde data was beskikbaar in hierdie bree vooraf gedetermineerde kategoriee. Die inligting van aile bronne (DVDH-studie, die nie-geskeduleerde gestruktureerde onderhoude met die rna's, die fokusgroepe met die rna's en oumas asook die observasie data) is bestudeer, geinterpreteer en geintegreer vir elke geidentifiseerde kategorie. Gedurende hierdie proses is sleutelfaktore geidentifiseer wat aangespreek moet word in essensiele voedingsverbandhoudende boodskappe wat gemik is om die voedingswelstand van klein kinders wat die PGS-klinieke in Duncan Village besoek te verbeter. Die finale stap in die analiseproses was die formulering van boodskaponderwerpe. Die onderwerpe is gebaseer op die geidentifiseerde sleutelfaktore Dit het duidelik geword tydens die analiseproses dat sommige van die sleutelfaktore nie geskik was vir die formulering van voedingsverbandhoudende boodskaponderwerpe nie, maar dat dit eerder insig verskaf in die totale lewenskonteks van die rna's. Die inligting in hierdie sleutelfaktore kan wei gebruik word deur gesondheidswerkers om kwesbare ma's te identifiseer en by te staan. Hierdie sleutelfaktore het dus tot die formulering van relevante hulpboodskappe gelei. Agtien voedingsverbandhoudende en 16 hulpboodskappe is geformu leer. Die boodskaponderwerpe sluit in onderwerpe oor selfontwikkeling, huishoudelike voedselsekuriteit, borsvoeding, goeie voedingspraktyke, gesondheid van die rna en voeding- en higienepraktyke. Tydens Fase 2 van die studie is die toeganklikheid van PGS dienste, insluitend voedingsverbandhoudende boodskappe vir rna's, bepaal. Dit is gedoen deur te bepaal hoe mas in Duncan Village die kliniekdienste ondervind, waar hulle aan hierdie boodskappe blootgestel kan word asook die ondervindinge van die gesondheidswerkers met die rna's en die diensleweringsproses. Hierdie inligting is deur middel van fokusgroepbesprekings met verskillende deelnemerskategoriee ingesamel. Hierdie kategoriee het rna's ingesluit wat die klinieke in Duncan Village besoek het vir a.l die spesifieke kinders se immunisasies maar ook ma's wat nie kinders geneem het vir al hul immunisasies nie of wat hul kinders na klinieke buite Duncan Village geneem het. Swanger vroue wat die voorgeboortelike klinieke besoek het asook die wat nie die klinieke besoek het nie, is ook ingesluit. Die laaste kategorie wat betrek is, was gesondheidswerkers. Hierdie kategorie het werkers van die kraamafdeling van die nabygelee hospitaaI en die primere gesondheidsorgklinieke ingesluit. Beide professionele verpleegpersoneel en gemeenskapsgesondheids= werkers van die klinieke is betrek. Die data wat verkry is, is met ATLAS/ti, 'n rekenaarprogram spesifiek geskep vir die analise van kwalitatiewe data, ontleed. Twaalf kodefamilies is geskep tydens die analiseproses. Elke familie verwys na 'n spesifieke aspek van toeganklikheid van dienste by die klinieke. 'n Gedetailleerde beskrywing van elke kodefamilie is gegee asook ses netwerke. Die data en die netwerke is gebruik om 'n raamwerk vir data-intepretasie te skep. Die raamwerk postuleer dat die finale elemente in die proses van die verskaffing van toeganklike voedingsverbandhoudende boodskappe by klinieke die volgende is: (1) kliente moet die kliniek besoek en (2) toepaslike voedingsverbandhoudende boodskappe moet beskikbaar wees. Probleme met interpersoonlike en organisatoriese aspekte van dienslewering is geidentifiseer as die twee belangrikste aspekte wat toeganklikheid van kliniekdienste en daarom ook toeganklikheid van voedingsverbandhoudende boodskappe beinvloed. Die laaste fase van die studie (Fase 3) het die formulering van aanbevelings aan die relevante owerhede behels Die aa.nbevelings handel oor die insluiting van toepaslike voedingsverbandhoudende boodskappe by die gesondheidsonderrig van ma's en swanger vroue sowel as aanbevelings oor die optimalisering van toeganklikheid van dienste by die PGS klinieke en die kraamafdeling waar Duncan Village rna's geboorte gee. Vyftien aanbevelings gebaseer op die bevindinge van Fases I en 2 is geformuleer . Die aanbevelings fokus veral op die nocdsaaklikheid vir die plaaslike owerheid om 'n atmosfeer van gesondheidbemagtiging by die klinieke te skep, die nodigheid om toepaslike voedingsverbandhoudende boodskappe by die klinieke te verskaf en die belangrikheid daa.rvan om kwesbare rna's te bereik. Die noodsaaklikheid om die gemeenskap te betrek in hierdie prosesse is ook benadruk. Samevattend kan gese word dat die implementasie van die aanbevelings sal bydra tot die voedingswelstand van alle jong kinders in Duncan Village en dat dit 'n belangrike bydrae kan lewer tot die realisering van die regte van kinders in die area.