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Magister Philosophiae (Land and Agrarian Studies) - MPhil(LAS) / Early childhood has been identified as a critical period for providing nutritional intervention, with nutritional adequacy during the first 1000 days having long term implications for human development. South Africa’s policy environment accordingly aims to support the development of all children through providing services supporting care and nutrition of children so that ‘no one is left behind’. However, the reality is that for the economically marginalised who live in poverty, these services are inaccessible and the whereabouts of many children, especially those under 5, remain unknown to the state. This study looks at township childcare facility as a key intervention point for nutrition provision, documents the obstacles and challenges they face in securing food for the children in their care and describes the strategies they use to combat these challenges. Using a mixed method approach, data were gathered on all ECDs operating in two Cape Town townships – Vrygrond, a semi-formal township, and Sweet Home Farm, a deeply informal settlement – and a typology was developed which represented the differentiation between these informal businesses in terms of a continuum of connectedness and disconnectedness with the regulatory environment.

Introduction: Lack of evidence-based information is an impediment to improve the food security and nutrition status of vulnerable tobacco tenant women and their children on smallholder farms in Malawi. Aim: To assess and describe the food accessibility and nutrition status of the tobacco tenant women of reproductive age and their under-five children on smallholder farms, as well as to determine and report correlational relationships amongst demographic and socio-economic factors, food accessibility measurements and nutrition status indicators. Design: Quantitative cross-sectional descriptive correlational study. Setting: Bwengu, Engucwini and Njuyu Extension Planning Areas, Mzimba North district, Malawi. Sample: 110 women of reproductive age sampled through a proportional systematic random sampling technique, and their 139 under-five children. The sample size was calculated using nQuery version 7 software based on 47% prevalence of malnutrition among under-five children in Malawi, estimated at 95% CI to the accuracy of 10%. Methodology: Data were captured through face-to-face interviews during the hunger season. Food accessibility was captured using the Household Food Insecurity Access Scale (HFIAS), Household Hunger Scale (HHS), Months of Adequate Household Food Provisioning (MAHFP) and Individual Dietary Diversity Scale (IDDS). Nutrition status was measured using anthropometry according to standard protocol. WHO Anthro software was used to compute Z-scores (W/A, H/A, W/H and BMI/A) for children, based on WHO standards. Microsoft Excel was used to calculate BMI for women, based on WHO cut-off points. Stata software was used to compute regression analyses to establish correlational relationships between independent and dependent variables. Ethical approval was obtained from the University of Pretoria, Natural and Agriculture Science Committee (Number EC151215- 028), as well as from the Mzuzu Agriculture Development Division in Malawi. Results: Mean age of the women was 27.3 ± 6 years and 28.8 ± 15 months for the children. The experience of food insecurity access was severe for 75% of the households. Nearly onefifth of households were severely hungry, and had adequate food for only about eight months of the year. The women and their children consumed a mean of two food groups in the previous 24 hours. For the women, 21% were malnourished. For the children, 20% were wasted, 31.3% were stunted and 34% were underweight. More male children were malnourished. For food accessibility measurements, the multivariable linear regression analysis was used. The significant factors influencing the severity of the experience of food insecurity access were loan access (P = 0.015) and household size (P = 0.000). For the prevalence of hunger, the significant factors were food security and nutrition training (P = 0.046), marital status (P = 0.045) and household size (P = 0.000). For the annual prevalence of hunger, the significant factors were labour (P = 0.038), income (P = 0.008) and household size (P = 0.001). For the dietary diversity, the significant factors were labour (P = 0.001), food security and nutrition decisions (P = 0.004), mother’s age (P = 0.033) and income (P = 0.000). Using the multivariable IV regression analysis, the significant factors influencing the BMI of the women were their age (P = 0.054), loan access (P = 0.004), HFIAS scores (P = 0.007) and HHS scores (P = 0.001). For the children’s weight-for-age, the significant factors were the mother’s BMI (P = 0.014), child’s sex (P = 0.005), assets (P = 0.014), mother’s age (P = 0.001) and child’s age (P = 0.015). Using the multivariable random-effects GLS regression analysis, the significant factors influencing the children’s height-for-age were the mother’s age (P = 0.004), child’s sex (P = 0.005), assets (P = 0.028) and HFIAS scores (P = 0.006). For the children’s weight-forheight, the significant factors were the mother’s BMI (P = 0.032), MAHFP scores (P = 0.029), child’s age (P = 0.008) and income (P = 0.001). For the children’s BMI-for-age, the significant factors were the mother’s BMI (P = 0.030), mother’s age (P = 0.029), income (P = 0.002) and assets (P = 0.047). Conclusion: The food accessibility and nutrition status of the tobacco tenant women and their children were seriously poor. The significant factors influencing food accessibility and nutrition status were loan access, household size, food security and nutrition training, marital status, labour, income, assets, food security and nutrition decisions, mother’s BMI, mother’s age, child’s age, child’s sex, HFIAS scores, HHS scores and MAHFP scores. The study findings offer clues to policy makers on where to direct interventions to improve food accessibility and nutrition status of the tobacco tenant women and their children in Malawi. / Dissertation (MSc)--University of Pretoria, 2017. / Human Nutrition / MSc / Unrestricted

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Epidemic obesity in the U.S. has prompted exploration of causal factors related to the built environment. Recent research has noted statistical associations between the spatial accessibility of retail food sources, such as supermarkets, convenience stores, and restaurants, and individual characteristics such as weight, socioeconomic status, and race/ethnicity. These studies typically use residential proximity or neighborhood density to food sources as the measure of accessibility. Assessing food environments in this manner, however, is very limiting. Since most people travel outside of their neighborhood on a daily basis, the retail food sources available to individuals residing in the same area could vary widely. This research developed new techniques for describing food accessibility or food environments based upon individuals’ activity and travel patterns, or their activity spaces. Researchers have previously used travel diaries to study activity and travel behavior, but these are burdensome for participants, and are prone to recall error and other inaccuracies. This study explored use of global positioning system (GPS) to identify participants' activity spaces, and employed a geographic information system (GIS) to assess the retail food sources located within these spaces. This produced ‘activity-based’ measures of individual retail food accessibility that do not rely on areal units, nor require travel diaries. Participants included 121 residents of a census tract in Lexington, Kentucky who agreed to carry GPS trackers for three workdays, and complete surveys regarding weight, socioeconomic and demographic characteristics, and diet and food purchasing habits. The types and relative frequencies of food locations within their activity spaces were compared to those within close proximity to the census tract. Dietary and food purchasing habits were subsequently analyzed in relation to activity-based food environment measures. The results of this study demonstrate substantial potential for misclassification bias in food accessibility research based on residential proximity or neighborhood density. Furthermore, this study observed statistically significant relationships between the new activity-based food accessibility measures and some personal characteristics and food-related behaviors. Despite some limitations, the techniques developed in this research show great potential for future research, which should be explored further in a variety of contexts.

Across Australia and other developed nations, morbidity and mortality follows a socioeconomic gradient whereby the lowest socioeconomic groups experience the poorest health. The dietary practices of low socioeconomic groups, which are comparatively less consistent with dietary recommendations, have been thought to contribute to the excess morbidity and mortality observed among low socioeconomic groups, although this phenomenon is not well understood. Using a socioecological framework, this thesis examines whether the local food retail environment and confidence to cook contribute to socioeconomic differences in fruit and vegetable purchasing. To achieve this, four quantitative analyses of data from two main sources were conducted. The food retail environment was examined via secondary analysis of the Brisbane Food Study (BFS) and confidence to cook was examined in a cross-sectional study designed and carried out by the author. The first three manuscripts were based on findings from the BFS. Briefly, the BFS was a multilevel cross-sectional study, designed to examine determinants of inequalities, that was conducted in Brisbane in the year 2000. A stratified random sample was taken of 50 small areas (census collection districts, CCDs) and 1003 residents who usually shopped for their households were interviewed face-to-face using a schedule that included a measure of fruit and vegetable purchasing and three socioeconomic markers: education, occupation and gross household income. The purchasing measure was based on how often (never, rarely, sometimes nearly always or always) participants bought common fruits and vegetables for their households in fresh or frozen form, when in season. Food shops within a 2.5 km radius of the CCDs in which survey respondents lived were identified and audited to determine their location, type, their opening hours, and their price and availability of a list of food items. The first publication demonstrated there was minimal to no difference in the availability of supermarkets, greengrocers and convenience stores between areas that were most and least disadvantaged, in terms of the number of shops, distance to the nearest shop, or opening hours. Similarly, the second publication showed the most disadvantaged and least disadvantaged areas had no large or significant difference in the price and availability of fruits and vegetables within supermarkets, greengrocers and convenience stores, but small differences were consistently apparent, such that on average, low socioeconomic areas had lower prices but also lesser availability than more advantaged areas. The third submitted manuscript presents results of multilevel logistic regression analyses of the BFS data. While there were some associations between environmental characteristics and fruit and vegetable purchasing, environmental characteristics did not mediate socioeconomic differences in purchasing the fruit and vegetable items since there was no substantial socioeconomic patterning of the price or availability of fruits and vegetables. The fourth submitted manuscript was based on the cross-sectional study of cooking skills. A stratified random sample of six CCDs in Brisbane was taken and 990 household members ‘mostly responsible’ for preparing food were invited to participate. A final response rate of 43% was achieved. Data were collected via a self-completed questionnaire, which covered household demographics, vegetable purchasing (using the same measure employed in the BFS for continuity), confidence to prepare these same vegetables, and confidence to cook vegetables using ten cooking techniques. Respondents were asked to indicate how confident they felt (ranging from not at all- to very- confident) to prepare each vegetable, and to use each technique. This fourth study found respondents with low education and low household income had significantly lower confidence to cook than their higher socioeconomic counterparts, and lower confidence to cook was in turn associated with less household vegetable purchasing. Collectively, the four manuscripts comprising this thesis provide an understanding of the contribution of food accessibility, affordability and cooking skills to socioeconomic differences in fruit and vegetable purchasing, within a socioecological framework. The evidence provided by this thesis is consistent with a contributory role of confidence to cook in socioeconomic differences in fruit and vegetable purchasing, but is not definitive. Additional research is necessary before promoting cooking skills to improve population nutrition or reduce nutritional inequalities. An area potentially useful to examine would be how cooking skills integrate with psychosocial correlates of food and nutrition, and socioeconomic position. For example, whether improvement of cooking skills can generate interest and knowledge, and improve dietary behaviours, and whether a lack of interest in food and nutrition contributes to a lack of both fruit and vegetable consumption and cooking skills. This thesis has demonstrated that an inequitably distributed food retail environment probably does not contribute to socioeconomic variation in fruit and vegetable purchasing, at least in contemporary Brisbane, Australia. Findings are unlikely to apply to other time periods, rural and regional settings, and perhaps other Australian cities as residential and retail development, and the supply and pricing of produce vary substantially across these dimensions. Overall, the main implication for public health is that interventions targeting the food supply in terms of ensuring greater provision of shops, or altering the available food and prices in shops may not necessarily carry a great benefit, at least in major cities similar to Brisbane. Future studies of equitable food access may need to look beyond mapping the distribution of shops and prices, perhaps to more personal and subjective facets of accessibility and affordability that incorporate individuals’ perceptions and ability to access and pay for foods.

The study focused on an evaluation of the impact of food aid on food security in the area of Ngabu in the southern part of Malawi. An evaluation was needed to find out whether the food aid approach to food insecurity was the one best suited to Ngabu and whether the government's approach had produced the intended results. This study showed that food aid, when timely used, has helped to raise the dietary status and nutrition and consumption of many households in Ngabu in times of natural disaster. Food aid, however, has had a negative impact on food security by creating laziness, food aid dependency and low food production since the source of food it offers is easier to come by than that by production. The impact of food aid on the markets of Ngabu, however, has been minimal. / Development Studies / M.Admin. (Development Studies)

The study focused on an evaluation of the impact of food aid on food security in the area of Ngabu in the southern part of Malawi. An evaluation was needed to find out whether the food aid approach to food insecurity was the one best suited to Ngabu and whether the government's approach had produced the intended results. This study showed that food aid, when timely used, has helped to raise the dietary status and nutrition and consumption of many households in Ngabu in times of natural disaster. Food aid, however, has had a negative impact on food security by creating laziness, food aid dependency and low food production since the source of food it offers is easier to come by than that by production. The impact of food aid on the markets of Ngabu, however, has been minimal. / Development Studies / M.Admin. (Development Studies)