Browsing by Author "Kassier, Susanna Maria."

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The accuracy of arm-associated height estimation methods compared to true height in a multi-racial group of young South African adults.
(2015) Lahner, Christen Renée.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Background: Stretch stature is the gold standard for measuring true height, but when this is not possible height estimation methods are used. To date, only two South African studies regarding height estimation techniques have been published. Objective: To investigate the accuracy of arm-associated height estimation methods used for the calculation of true height compared to stretch stature in young South African adults. Design: A cross-sectional descriptive design was employed. Setting: Pietermaritzburg, Westville and Durban, KwaZulu-Natal, South Africa, 2015. Subjects: Convenience sample (N=900) aged 18 to 24 years, which included an equal number of subjects from both genders (n=150 per gender) stratified across race (White, Black and Indian). Results: Highly significant differences exist between genders (p<0.001), where males had larger stretch statures and arm-associated measurements than females (p<0.001). Highly significant differences exist between race groups (p<0.001), where whites had significantly different stretch statures as well as different armassociated measurements compared to Blacks and Indians. Some similarities were found between race groups, especially between Blacks and Indians. Arm-associated height estimation methods can be used as estimates of true height in accordance with the following study findings: (i) among Black African males, the World Health Organisation (WHO)-adjusted equation would seem to be the most appropriate, followed by demi-span male equation; (ii) among Black African females, the demispan female equation would seem to be the most appropriate, followed by total armspan; (iii) among Caucasian males, the total armspan would seem to be the most appropriate, followed by half-armspanx2; (iv) among Caucasian females, the total armspan would seem to be the most appropriate, followed by half-armspanx2; (v) among Indian males, the demi-span male equation would seem to be the most appropriate, followed by the WHO-adjusted equation; and (vi) among Indian females, the WHO-adjusted equation would seem to be the most appropriate, followed by demi-span female equation. Discussion:. The anthropometric variation between genders and race groups was linked to the exposure to secular growth conditions, which influences a subject's physiological ability to achieve their maximal height. The Vitruvius theory was proposed where total armspan potentially represents a subject's maximal height, and the ability for them to reach that height is dependent on exposure to consistent ambient secular growth conditions during the window period and beyond. Conclusion: In conclusion, this study's findings provides a baseline for future height studies to be conducted on the South African population, where each anthropometric method should be validated for each race and gender.
The attitude toward and the prescription of a low carbohydrate, high fat diet by KwaZulu-Natal clinical dieticians.
(2015) Joyner, Stephanie Alexandra.; Wiles, Nicola Laurelle.; Kassier, Susanna Maria.
Aim: To determine the attitude toward and the prescription of a low carbohydrate, high fat (LCHF) diet by KwaZulu-Natal clinical dieticians working in government or private practice. Objectives: The study set out to determine the following objectives: (i) dieticians’ attitudes toward a LCHF diet, (ii) the prescription of this diet in practice and concerns regarding the diet; (iii) to determine if there is a relationship between the socio-demographic characteristics, areas of work and professional interest as well as research involvement of dieticians and the prescription of a LCHF diet in practice; and to (iv) assess whether dieticians would be willing to adapt their practice methods and attitude after hearing a presentation on the LCHF diet. Method: The email addresses for 155 clinical dieticians, working in either government or private practice, were obtained from a data base. The dieticians were emailed a link to a four-part online questionnaire regarding their area of work, main professional interests, practice methods, prescription or non-prescription of a LCHF diet and research involvement. Results: The response rate to the questionnaire was 58% (n=90). The majority of the subjects were female (n=87, 97%) and had qualified at the University of KwaZulu-Natal (n=67, 74%). Patients with non-communicable diseases were the most common condition counselled by the subjects (71.3%). The latter was also the main area of interest for subjects in private practice. Upon analysis of the section pertaining to research involvement, it was found that the majority of subjects scored poorly in the questions related to the most basic of research involvement skills, with an average score of 40%. Overall, there was a negative attitude toward the prescription of the LCHF diet. Only 17% (n=15) of the subjects had prescribed the LCHF diet in practice and it had been prescribed rarely. The most common condition that the diet was prescribed for was weight loss. Subjects working in private practice were more likely to prescribe a LCHF diet for their patients compared to those working in government. More than 80% of the sample reported that they had never prescribed the diet. The most common reason provided was that it was felt there was a lack of supportive evidence for its use. Discussion: The finding that private practicing dieticians are more likely to prescribe a LCHF diet to patients may be because this type of patient is more likely to be able to afford and sustain a LCHF diet compared to the type of patients seen by subjects working in the government sector. These patients are also more likely to be aware of the LCHF diet compared to government health patients. Very few deiticians prescribed a LCHF diet; this may be a reflection of the dieticians practicing evidence evidence-based nutrition and/or it could be related to harm-avoidance. The very low level of research involvement and skill observed in the study is a concern and should be used as a basis for further investigation. Conclusion and recommendations: The low score obtained by subjects in basic research involvement could be interpreted that more emphasis should be placed on this area in undergraduate training and in the continuing professional development of qualified dieticians. More studies need to be done on the long-term safety and efficacy of a LCHF diet for the prevention and management of NCDs. Dietetic authorities should consider a country-wide advertising campaign to encourage the public to consult a Registered Dietician before following a LCHF diet
Body mass index, body image and possible factors related to weight loss practices of female undergraduate students on the Pietermaritzburg campus, University of Kwazulu-Natal.
(2019) Lubisi, Zethembiso Desiree; Kassier, Susanna Maria.; Mkhwanazi, Blessing Nkazimulo.
South Africa is undergoing epidemiological transition, characterized by an increasing prevalence of obesity, especially among women. Among those 15 to 24 years of age, the prevalence of overweight and obesity at 40.9% is cause for concern, as it is associated with the development of non-communicable diseases of lifestyle. However, 18.1% of women in the above age category, indicated that they are unhappy with their current weight. Body image is related to an individual’s perception of the attractiveness of their own body, and has an impact on actual weight and weight management practices. Body image dissatisfaction refers to the negative perceptions and feelings a person has about their body and can be affected by factors such as body shape and appearance, body weight gain attitudes, and cultural norms regarding an ideal body size. In this respect, university students are of particular interest, as they are known to experience a number of stressors during the transition from secondary- to tertiary education that contributes to unhealthy eating habits, a decreased level of physical activity and subsequent weight gain. Objectives To determine the Body Mass Index (BMI), body image and factors related to weight loss practices among female undergraduate students on the Pietermaritzburg (PMB) campus of the University of KwaZulu-Natal (UKZN). Methods A cross sectional descriptive survey of conveniently sampled female undergraduate students on the PMB campus (N=316), UKZN was conducted. Weight and height were measured by trained fieldworkers for the calculation of BMI. Data was collected by means of a self-administered questionnaire to determine the socio-demographic characteristics, physical activity level, nutrition knowledge, body perceptions, weight management practices and dietary diversity of study participants. Results The majority of participants (86.7%), were black African and registered for study within the College of Agriculture, Engineering and Science (45.6 %). The mean age of the study sample was 20 ± 2 years. Participants mainly resided in private accommodation (44.3%), followed by 38.6% living in university residences. The majority (72.7%) were funded by the National Student Financial Aid Scheme (NSFAS). Participants who prepared their own meals, did so 3.7 ± 2.3 times per week, with 84.3% reporting that they prepared their own meals most days of the week. Most consumed take-aways (91.1%), with 61.2% doing so on a weekly basis. Nearly half (48.1%) of the participants had a normal BMI, followed by 19% being overweight. Furthermore, 13.3% were classified as obese class I, while 12.6% were classified as obese class II. Only 4.4% were underweight, while 2.5% were classified as obese class III. The majority (46.8%) could be classified as being moderately physically active, followed by those with a low level of physical activity at 38.6%. Only 14.6% were classified as having a high level of physical activity. A nutrition knowledge score of ≥ 50% was achieved by 63.8% of participants, followed by a third (34.3%) who had a score of less than 50%. The most noteworthy findings were that participants were not aware that starchy foods should form the basis of most meals, and that drinking boiled water does not facilitate weight loss. An assessment of participant weight management practices, revealed that 59.1% weighed themselves, with 61.0% reporting that they do so monthly. Despite the fact that the majority of participants (70.0%) classified their current body weight as normal, 56.4% had attempted weight loss. Of those who had not attempted weight loss, the majority (37.5%) indicated that the reason for not attempting weight loss, was that they were satisfied with their body weight, followed by 35% indicating that they perceived their body weight as normal. The majority of participants who attempted weight loss, resorted to healthy weight loss practices (50.9%), followed by 42.0% who made use of a combination of healthy and unhealthy weight loss practices. In terms of body image perceptions, the difference between perceived (“feel”) and ideal body size was calculated, rendering a Feel Ideal Index (FID) score of 0.4 ± 1.33, indicating that participants desired to be thinner. The majority of participants (45.0%) had a medium dietary diversity as was indicated by the consumption of 6 to 11 food groups, followed by more than a third of participants (35.6%) having a high dietary diversity score due to the consumption of more than 11 food groups. One out of five participants (19.4%) consumed diets that lacked diversity. Conclusion Body image perception and level of body image satisfaction were the most important determinants of whether participants engaged in weight management practices. This was illustrated by participants who had never attempted weight loss, indicating that the reason why they have never attempted weight loss was because they “perceived their current body weight to be normal” and that they are “satisfied with current weight”. An increase in BMI was positively associated with an increase in body image dissatisfaction (BID), resulting in overweight and obese participants attempting to lose weight. It was also noted that a larger proportion of participants indicated that they have attempted weight loss, and did so using healthy weight loss practices such as exercise, diet and reduced portion sizes. Participants desired body sizes that were thinner than their perceived current body size. This was illustrated by a positive mean FID index score of 0.4 ± 1.33. Although those with a high BMI desired a large body size, it was thinner than what they perceived themselves to be. Furthermore, participants living in university residences and private accommodation, had a higher BMI than those who lived at home. Those with a higher physical activity level (PAL), weighed themselves more often when compared to those who were less active. This may suggests that participants were engaged in physical activity to improve appearance. However, it could also be an indicator that participants were physically active for the promotion of health, general wellbeing and for social reasons. Significant relationships between nutrition knowledge score and BMI, as well as dietary diversity score were not documented. However, participants with a good nutrition knowledge score perceived their current weight to be lower than those with a poor nutrition knowledge score.
A comparison between the excess fluid to be removed in chronic haemodialysis patients, estimated by HD unit staff versus the multiple frequency BIA measurement.
(2015) Downs, Jane H.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Abstract in PDF file.
Comparison of body mass index, eating behaviour and eating attitude between dietetic- and non-dietetic female undergraduate students at a South African University.
(2016) Barnard, Jendri Elizabeth.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Abstract available in PDF file.
The current infant feeding practices and related factors of Indian and Zulu mothers with 0-9 month old infants attending well baby clinics in Durban-North.
(2017) Mkhize, Zanele Prudence.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Background: Currently there are no studies that have been conducted regarding infant feeding practices for Indian mothers neither comparing Indian mothers with other race in South Africa. Thus, this may be the first study and further research may be conducted. Objective: The objective of the study was to determine and compare the infant feeding practices and factors influencing these practices of Indian and Zulu mothers with 0-9 month’s old infants attending well-baby clinics in Durban-North of the Ethekwini District, KwaZulu-Natal. Design: A descriptive cross-sectional survey of mothers was performed. Subjects and setting: Four hundred and fifty participants (50%) Indian and (50%) Zulu mothers with infants aged 0-9 months attending Tongaat community health centre, Verulam and Trenance Park Clinics were included in the study conducted between August and October 2016. Outcome measures: A data collection tool included four indicators: (1) socio-demographic characteristics; (2) infant feeding practices (3) mother’s knowledge, attitude, perception and beliefs regarding infant feeding as well as (4) resources that could influence infant feeding practices) which were measured and compared using Chi-square test and independent samples t-test. Results: High prevalence of breastfeeding immediately after delivery was reported by both groups of Indian (95.5%) and Zulu (90.1%) mothers. However, there was a statistically significant difference between race and food/liquids given to infants before six months of age. The exclusive breastfeeding rate was (37.8%) for Indian infants and (64%) for Zulu infants, by the age of six months. The majority of mothers on both groups decided on their own to feed infants other foods and/ or liquids. For Indian mothers, returning back to work was the main reason to feed infants something other than breast milk, whereas the Zulu mothers reported to feel that their infants were hungry. Overall, clinical staff were the predominant source of infant feeding information. Conclusion: This study confirmed that breastfeeding is a universal infant feeding practice. However, there are challenges that influence the practice of appropriate infant feeding.
The current infant feeding practices and related factors of Zulu mothers with 0-6 month old infants attending PMTCT and non-PMTCT clinics in central Durban, KwaZulu-Natal : an exploratory study.
(2005) Kassier, Susanna Maria.; Maunder, Eleni Maria Winifred.
Abstract: Introduction: Exclusive breastfeeding for the first six months of an infant's life is recommended worldwide. In 1998 the South African Demographic and Health Survey (SADHS) showed that only 10% of mothers exclusively breastfeed at three months. As the HIV virus is transmissible via breast milk, UNAIDS (2002) recommends that women in developing countries should be given a choice of feeding method after being counselled on the risks and benefits of breast feeding versus formula feeding. As a result, the Prevention of Mother-to-Child Transmission (PMTCT) programme was launched in KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child Transmission of the HIV virus. However, research has shown that infant feeding practices are influenced by numerous factors. Ultimately mothers will feed their infants in a manner they feel comfortable with, even if it is not always the most appropriate choice. Aim: The aim of this study was to determine and compare current infant feeding practices and some of the factors that influenced these practices among Zulu mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT clinics in Central Durban, KwaZulu-Natal. Methodology: A cross-sectional, descriptive survey was conducted amongst 150 mothers sampled from three non-PMTCT clinics and 150 mothers sampled from three PMTCT clinics. Systematic random sampling of mothers attending the two types of clinics was used to ensure an equal number of mothers· with infants aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number of mothers interviewed per clinic was determined proportionate to clinic size. Interviews were conducted in Zulu by trained fieldworkers according to a structured interview schedule consisting of 87 open- and closed-ended questions. Summary of most important findings and conclusion: Overall, one quarter of the mothers attending non-PMTCT and one third of mothers at PMTCT clinics were practising exclusive breastfeeding at the time of the survey. The general trend was that mothers attending PMTCT clinics were more inclined than those attending non-PMTCT clinics to breastfeed their infants exclusively (34% versus 24% respectively) or to formula feed (16,7% versus 12,7% respectively). Furthermore, there was a significant decline in exclusive breastfeeding and predominant breastfeeding with increasing infant age in both clinic groups. The opposite held true for mixed feeding and formula feeding in that infants were more inclined to mixed feeding or formula feeding with increasing infant age. In both clinic groups, exclusive breastfeeding was the method of choice in the 0 - < 6 week age category, while a preference for mixed feeding was shown in the 6 - < 14 week category. This trend persisted in the 14 week - < 6 month age category, especially in the non-PMTCT clinics, while there was a small but pronounced increase in formula feeding amongst PMTCT mothers. Although these findings can be explained as a result of implementing the PMTCT programme, the positive trends observed in non-PMTCT clinics serve as an indicator that the Integrated Nutrition Programme (INP) and Baby Friendly Hospital initiative have also had an impact on the feeding choices mothers make. Despite the limited duration of the PMTCT programme at the time of the study, indicators of the impact of the intervention include that a lower percentage of PMTCT mothers introduced foods and/or liquids in addition to breast milk to their infants before six months of age compared to non-PMTCT mothers. Furthermore, more mothers attending PMTCT clinics were shown how to breastfeed and were more likely to have received information about formula feeding. Despite these indicators of a positive impact of the PMTCT programme, the mean age for introducing liquids and/or solids in addition to breast milk was about six weeks and the incidence of this practice was very high for both groups. The similar incidence of formula feeding observed between the two clinic groups suggests the presence of constraints to safe infant feeding choices among mothers attending PMTCT clinics. As observed, infant feeding practices were still not ideal in either of the two clinic groups. However, the high level of antenatal clinic attendance documented for both groups serves as evidence that, if opportunities for providing mothers with appropriate infant feeding advice are utilized optimally, the antenatal clinic could serve as an ideal medium through which infant feeding education can take place, especially as the clinic-based nursing staff were cited as the most important source of infant feeding information by both groups of mothers in the antenatal and postnatal phases. The documented infant feeding practices should be interpreted against the backdrop of factors such as socio-demographic characteristics of the mothers, availability of resources such as social support from peers and significant others and reigning infant feeding beliefs that could influence infant feeding decisions. Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were determined by means of multivariate logistic regression analysis. Significant values were obtained for both clinic groups in terms of the infant not having received liquids in addition to breast milk. No additional predictors were found amongst mothers attending non-PMTCT clinics, however predictors amongst mothers attending PMTCT clinics included whether the mother had not visited the clinic since the infant's birth, whether she practiced demand feeding and whether she was experiencing stress at the time of the study. The limited number of predictors of exclusive breastfeeding documented in this study, especially among non-PMTCT mothers may be explained by the fact that infant feeding behaviour is multifactorial by nature and the interaction between factors that influence feeding choice is strong.
Determining the general - and sports-related nutrition knowledge of male adolescent rugby union players attending a secondary, urban government boy's school in Pietermaritzburg, KwaZulu-Natal.
(2014) Stegen, Bridgitte.; Kassier, Susanna Maria.
Walsh, Cartwright, Corish, Sugrue & Wood-Martin (2011) suggest that the need for sound nutritional knowledge regarding both general concepts that pertain to healthy eating habits as well as the dietary principles that should be met for optimal sports performance, is of vital importance. According to Strachan (2009), adolescent sportsrelated nutrition knowledge is an area of great concern and in need of investigation, especially amongst local adolescent rugby players. Rugby is a high contact sport and the popularity of rugby union-related matches has considerably increased on a global scale (Griffiths 2012; Walsh et al 2011; Quarrie, Alsop, Waller, Bird, Marshall & Chalmers 2001). Unfortunately, Webb & Beckford (2013) and Burkhart (2010) recognize that there is limited published research available where an investigation into the general- and sports-related nutrition knowledge of adolescent athletes was conducted. This study aims to determine the general- and sports-related nutrition knowledge of male adolescent rugby players attending a boys only secondary, urban government school in Pietermaritzburg, KwaZulu-Natal. A cross-sectional study was conducted on adolescent rugby players (N= 110) at a local urban, government school in Pietermaritzburg (mean age =15.22 ± 1.430). The players were requested to complete a nutrition knowledge questionnaire developed initially by Whati (2005) for urban South African adolescents. For the purpose of this study the questionnaire was adjusted in accordance with the study objectives using peer-reviewed journals. The results showed that urban, government-level adolescent rugby players have an adequate general- and sports-related nutrition knowledge but lacked knowledge in the field of carbohydrates, understanding of what a well- balanced diet and healthy eating entails as well as the intake and role of protein. Parents and the media were selected as the two major sources of this information. More than half the participants admitted to using a nutritional supplement 3-4 times a week. There was no statistically significant trend in the improvement of knowledge from the under 14 to the open age groups, perhaps emphasizing the lack of sound nutrition education. Several statistically significant trends regarding nutrition practices, such as iii supplement use, were seen when comparing the open age group to the non-open age category; however the nutrition knowledge showed no statistically significant difference. The results of this study correlate to similar published studies regarding nutrition knowledge of adolescent athletes. Due to the lack of locally published research concerning the nutrition knowledge of adolescent rugby players this study forms a reference point to the importance of determining the nutrition knowledge of adolescent athletes in order to understand the need for nutrition knowledge education.
The dietary diversity, household food security status and presence of depression in relation to pregnancy pattern of weight gain and infant birth weight, Pietermaritzburg.
(2017) Madlala, Samukelisiwe Sthokozisiwe.; Kassier, Susanna Maria.
Abstract available in PDF file.
Dietary intake and nutritional status of primary school children participating in the Botswana school feeding programme, South-east District, Botswana.
(2019) Eluya, Malebogo.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Introduction: Optimal nutrition is essential for the growth and development of primary school children. School-based nutrition interventions, especially in resource limited settings, are important for addressing health problems and the improvement of health, as well as nutritional and educational outcomes. The majority of African countries such as Botswana, are currently experiencing nutrition transition. This concept contributes to the double burden of malnutrition (undernutrition and overnutrition) among children. A change in dietary habits, the adopotion of a sedentary lifestyle, and limited dietary diversity are the some of the outcomes linked to the nutrition transition. . Aim: To determine the effect of the Botswana School Feeding Programme (SFP) (all government schools) on the nutritional status of primary school children in the South-east District when compared to non-beneficiaries of the SFP (private schools). Study design: A school-based, comparative cross-sectional study was conducted among primary school children during the school term and immediately after the school holiday (period of no SFP). Setting: This study was conducted in 13 public and private schools located in urban and peri-urban areas in the South-east District, Botswana. Subjects: 392 sampled primary school learners from public and private schools aged 8 – 13 years of age were sampled. Outcome measures: SFP impact was assessed using household food insecurity status (HFIAS), dietary diversity score (DDS) and anthropometric indices such as weight-for-age (WAZ z-scores), height-for-age (HAZ z-scores) and Body Mass Index-for-age (BAZ z-scores). For the calculation of WAZ, the Centre for Disease Control (CDC) tables were used to interpret weight-for-age of learners older than ten years, as WAZ is only available for children up ten years of age on the World Health Organization (WHO) growth standards. Results: Significant differences (p<0.000) were documented for SFP beneficiaries (intervention) versus non-beneficiaries of the SFP (control) for mode of transport to school, HFIAS and DDS. Significant differences (p<0.000) were also found when comparing urban to peri-urban learners for mode of transport to school, HFIAS and DDS. However, a significant difference between beneficiaries of the SFP (intervention) versus non-beneficiaries of the SFP (control) was not documented for Physical Activity Level (PAL), whereas the PAL of peri-urban learners was significantly higher than that of urban learners (p<0.001). Learners participating in the SFP were receiving inadequate energy, macro- and micronutrient from the food rations provided, as they only received 60% of the Dietary Reference Intake (DRI) for energy, 90% of the Recommended Dietary Allowance (RDA) for protein, 46% of the Estimated Average Requiremment (EAR) for vitamin A and 28% of the Adequate Intake (AI) for calcium when comparing the ration scale to 33% of the DRIs. Discussion: The low DDS of learners participating in the SFP indicated that school meals did not make a significant contribution to the DDS of its beneficiaries. When comparing SFP beneficiaries to SFP non-beneficiaries, despite the fact that the majority of learners in both groups had a normal BAZ, the disparity became more evident for those being at risk for becoming overweight. Nearly a third (29.0%) of non-beneficiaries were at risk for become overweight, whereas the same held true for 18.8% of beneficiaries. A similar trend was echoed when comparing the WAZ between the two groups, as the difference was significant. When comparing the WAZ between urban and peri-urban learners, a significant difference was documented, with learners from urban areas having a lower prevalence of normal weight and a higher risk of becoming overweight than their peri-urban counterparts. In addition, recipients of the SFP had a higher prevalence of underweight when compared to non-beneficiaries. A nutrient analysis of the SFP ration scale indicated that it supplied inadequate levels of energy, protein, vitamin A and calcium. Conclusion and Recommendations: The study findings emphasise the need for targeted school feeding and community-based nutrition interventions and public health awareness campaigns to create an awareness of the importance of eating a diverse diet and being aware of the importance of being physically active for the promotion of health and wellbeing, as well as for the prevention of overweight and obesity among primary school learners. Although learners attending public schools in urban and peri-urban areas as well as private schools may face diverse nutritional challenges as a result of differences in socio-economic status and available resources, it is evident that the dietary diversity and prevalence of overweight and obesity among primary school learners attending both public and private schools in the South-east District, Botswana, requires special attention. Participation in the SFP and resultant food security, may have a positive impact on learner anthropometric status as indicated by the low prevalence of undernutrition and stunting documented in this study sample. In addition, as the BAZ categories did not differ significantly.
Effect of malted sorghum-based porridge on nutritional status of moderately malnourished breastfed infants and young children aged 6 to 18 months in Arua, Uganda.
(2019) Kajjura, Richard Stanley Bazibu.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Moderate acute malnutrition (MAM) among infants and young children (IYC) has a negative impact on their immature digestive system and requires an energy rich, nutrient dense supplementary food to reverse the condition and promote catch up growth and development. In this study, a malted sorghum-based porridge (MSBP) was formulated using locally available ingredients. It was subsequently used as a supplementary food in the management of IYC with MAM to determine whether it could serve as an alternative supplementary porridge when compared to fortified corn soy blend (CSB+), the standard care for managing IYC with MAM in Uganda. The effect of MSBP supplementation, in conjunction with nutrition education, on the nutritional status of IYC with MAM was determined. In addition, maternal knowledge regarding appropriate complementary feeding and hygiene practices were determined before the supplementation intervention commenced (baseline), as well as after the completion of the three month intervention period. In addition, the study also determined maternal perceptions regarding the MSBP versus CSB+, as well as perceived barriers encountered in the course of the intervention. Hence the study developed an acceptable energy rich and nutrient dense MSBP for managing MAM. The MSBP was formulated (using estimated values generated by NutVal software) from malted sorghum flour and extruded soy-maize flour. Four formulations estimated to meet the specifications of a supplementary food for treatment of IYC with MAM (in accordance with World Health Organisation criteria), were subsequently assessed for consumer acceptability. Analysis of variance was used to compare the acceptability scores and viscosity level of four different MSBP formulations to test for significant differences between mean scores. The four formulations had significantly different (p<0.05) acceptability scores for flavour, taste, mouth feel, sweetness and overall acceptability. The best formulation had significantly (p<0.05) higher mean acceptability scores. In addition, the best MSBP formulation had a significantly (p<0.05) higher energy and nutrient content than CSB+. At a flour rate of 25%, this formulation also had the best energy density, protein density and viscosity of 1.6kcal/g, 4g/100kcal and 2809cP respectively. The results showed that a quarter sorghum malt mixed with three quarters of extruded soy-maize, produced an energy rich, nutrient dense MSBP with acceptable sensory attributes at optimal viscosity. The best formulated MSBP met the energy, protein and viscosity level requirements for the management of IYC with MAM. To evaluate the efficacy of MSBP in alleviating malnutrition among IYC with MAM, the intervention component of the study established maternal socio-demographic characteristics and associated complementary feeding practices at baseline. A cross sectional community assessment was conducted among 204 randomly sampled breastfeeding mothers of IYC aged 6 to 18 months with MAM in four out of eighteen sub counties in Arua district, Uganda. Multivariate logistic regression analysis showed that maternal level of education as well as that of the head of the household, were significantly associated with IYC minimum meal frequency (p=0.003) and (p=0.023) respectively. In addition, maternal care, determined in terms of the preparation of food such as porridge especially for the IYC, was also significantly associated with minimum meal frequency (p<0.001) and with the IYC food intake meeting that of a minimum acceptable (p=0.004). These findings suggested that optimal complementary feeding practices in terms of minimum dietary diversity, minimum meal frequency and minimum acceptable diet were not met by the majority of IYC with MAM. The baseline study was followed by evaluating the effect of MSBP and CSB+ in combination with nutrition education, on the anthropometric status and blood haemoglobin levels of IYC aged 6 to 18 months diagnosed with MAM. A double blind cluster randomised control trial was conducted with 204 mother-IYC pairs, with a cluster consisting of nine to ten pairs per parish where mothers consented to participate (Appendix B, p197). A daily ration of 150g of either MSBP or CSB+ was fed to IYC for ninety days. Weekly anthropometric measurements (weight, length and mid-upper arm circumference) of IYC were conducted, whereas haemoglobin levels were determined only at baseline and at the end of the study. A comparison between mean anthropometric outcomes namely weight gain, length gain, length-for-age z-scores, weight-for-age z-scores, length-for-weight z-scores, and mean blood haemoglobin levels in the treatment (MSBP) and control (CSB+) groups were determined using the independent t-test. Proportions of the anthropometric and haemoglobin levels in the treatment and control groups were determined using the z-test. At three months, the mean weight-for-age z-score of IYC in the treatment group was significantly higher than in the control group (p=0.01). The change in mean blood haemoglobin levels was significantly smaller in the treatment group when compared to that of the control group (p=0.01). No significant difference was observed in the proportion of IYC who recovered from MAM between the treatment group and control group (p=0.055). Thus, MSBP supplementation of IYC with MAM resulted in comparable recovery rates to CSB+ in terms of weight-for-length and improved blood haemoglobin levels. Therefore, MSBP could be considered as an alternative to CSB+ in the management of breastfed IYC with MAM. The effect of nutrition education on the feeding and hygiene practices of mothers with IYC with MAM being supplemented with either MSBP or CSB+, was also determined. A cross-sequential study using a pre-test-post-test design was used among the 204 mothers in the 24 clusters. Mothers’ knowledge, complementary feeding and hygiene practices were analysed as mean scores before and after the intervention. The paired t-test was used to determine the differences between baseline and end line mean scores for knowledge and practices. Mothers’ mean knowledge scores regarding complementary feeding in terms of dietary diversity and meal frequency were significantly higher at end line compared to baseline (p<0.001). Maternal practices regarding food safety and water quality was significantly higher at end line compared to baseline (p<0.001). Thus, nutrition education of mothers in combination with supplementing their IYC with either MSBP or CSB+, improved meal frequency, dietary diversity, water quality, and food safety. Lastly, maternal perceptions and barriers experienced while using either MSBP or CSB+ to manage their IYC with MAM was determined via qualitative research techniques. A qualitative study using, focus group discussions (FGD) and in depth interviews (IDI) was conducted among mothers a week after completion of the three months supplementation period. One hundred eight mothers were purposively sampled to participate in 12 focus group discussions. This was followed by selecting 48 mothers to participate in IDI. Five FGD were conducted with mothers whose IYC were fed CSB+, while the remaining seven FGD included mothers whose IYC were fed with MSBP. The qualitative data on maternal perceptions and barriers were analysed using an inductive approach. The results showed that both MSBP and CSB+ were perceived as being responsible for IYC weight gain, reduction in illness, improved appetite, glowing healthy skin, and improved active play. Hence, mothers had positive attitudes towards using MSBP and CSB+. Collectively, the perceived barriers mothers encountered during the supplementary feeding intervention included household chores, limited time to feed IYC regularly, limited household income and household food insecurity in addition to minimal social support from household members. Mothers believed in the use of MSBP and CSB+ in the management of their IYC with MAM and were satisfied with the health benefits such as weight gain and improved appetite observed among their IYC. However, factors contributing to maternal stress should be addressed by improving household food security status and the distribution of an even workload among household members so that IYC with MAM can reap maximum benefits from supplementary food interventions. Overall, this study provided an opportunity to gather additional evidence regarding the use of a locally formulated energy rich, nutrient dense supplementary porridge MSBP with suitable consumer acceptability, energy content and nutrient density in the management of IYC with MAM. Nevertheless, nutrition service providers of supplementary foods in the management of IYC with MAM should endeavour to educate mothers on potential barriers they may encounter in the course of intervention strategies for the management of MAM. This should include potential socio-care barriers, in addition to emphasising the health and nutrition benefits of the supplementary foods for their IYC.
The effect of therapeutic feed in the management of severe acute malnutrition in children, South Africa.
Botha, Maria Magdalena.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Globally, 14.3 million infants and young children (IYC) suffer from severe acute malnutrition (SAM), with 75% living in low and low-middle income countries like South Africa (SA). Inpatient management of SAM forms an essential component of SAM treatment among IYC. In SA, the SAM treatment protocol is based on the World Health Organization (WHO) Ten Steps to the Successful Management of SAM. As a result of SA efforts, the SAM mortality rate decreased from 12,7% in 2012 to 8% in 2017, being below the global and national target of 9%. The study aim was to determine if compliance with the national SAM treatment protocol improves SAM treatment outcomes. A multi-centre prospective, descriptive and comparative observational study was employed. IYC hospitalized for SAM treatment (N=245) were conveniently sampled. The study sample comprised of 150 males (61.2%) and 95 females (38.8%) with a mean age of 14.6 ± 8.2 months. Mean admission and discharge weight, heightfor- age and MUAC was 6.63 ± 1.89kg and 7.03 ± 2.02kg; 66.16 ±16.06 cm and 71.29 ± 11.47 cm, and 11.38 ±2.35cm and 11.51±2.35cm. There was a significant difference between mean admission and discharge weight (p= 0.0278) and height-for-age (p= 0.0005), with no significant difference between admission and discharge MUAC (p= 0.6533). Prevalence of mild, moderate and severe oedema was 21.7%, 11.1% and 8.2% respectively. The study sample had a mortality rate of 6.1%. SAM treatment was complicated by LARIs, sepsis, HIV, TB, anaemia, herbal intoxication, vomiting, hypoglyceamia and cerebral palsy. Using the designed scoring tool, overall compliance with the SAM treatment protocol was 63.1%, with 98.6% compliance with admission and 4.4% compliance with discharge standards. Nearly three out of ten (27.2% of households) were food insecure, of which 14.6% were moderately and 10.7% severely food insecure. Food insecurity was associated with delayed recovery from oedema (X2= -0.235; 0.035) and diarrhoea (X2= -0.199; 0.037), inadequate daily weight gain of less than 10g/kg/day (X2= -0.190; 0.003) and IYC mortality (X2= -0.131; 0.522). These associations define HHFIS as a predictable risk factor for poor SAM treatment outcomes, recovery and possible mortality. Compliance with the SAM treatment protocol was average (61.3%), with premature discharge, increasing the risk for relapse, readmission and mortality. A cyclic link between HHFIS and the outcome of inpatient management of SAM should be considered when revising and updating national SAM treatment protocols.
Food gardens, household food security status, socio-economic status and perceived barriers to cultivating : Embo Community, KwaZulu-Natal.
(2015) Akob, Faith Asangha.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Aim: To determine whether food gardens have an impact on household food security status in the Embo community, whether there is a relationship between socio-economic status and cultivating a food garden as well as barriers experienced by members of the community that cultivate food gardens or perceived barriers that prevent them from cultivating food gardens. Objectives: To investigate the impact of food gardens on household food security status by comparing households with food gardens to households without; to determine whether socio-economic status is related to cultivating a food garden; and to investigate why some households cultivate food gardens while others do not, in order to determine the perceived barriers to cultivating food gardens in the Embo community. Method: A cross sectional descriptive survey involving 190 households with and without food gardens was conducted in the Embo community. Data was collected by means of a questionnaire consisting of three sections in order to assess the socio economic status, cultivation of food gardens and Household Food Insecurity Access Scale. Five trained community facilitators employed by The Valley Trust served as field workers for data collection after the survey questionnaire was piloted. Results: Sixty-three percent of households did not have a food garden, while the remaining 37% did. Women were the main cultivators of food gardens, while the main source of household income was the child support grant. Irrespective of whether households had a food garden, electricity was the main source of cooking fuel, while tap water was the main source of water. Government toilets were the ablution facility used by the majority of households, while most households had household appliances such as a cell phone, television, radio and fridge/freezer combination. This was especially prevalent in households without food gardens. The majority of households without food gardens were either moderately food insecure (29%) or severely food insecure (23%) when compared to households with food gardens who were moderately (14%) and severely (12%) food insecure. Most were anxious and uncertain about having sufficient food supply and eating a limited variety of foods. Discussion: Cultivation of food gardens should be encouraged as nearly two thirds (63%) of the 190 households surveyed did not cultivate a food garden. Also, based on socio-economic indicators such as employment status, income, type of household and household appliances, households with a higher socio-economic status did not cultivate a food garden. Households with food gardens had a lower prevalence of food insecurity while households with and without food gardens faced similar challenges related to the cultivation of food gardens. Conclusion: In conclusion, food gardens did have an impact on food security status in Embo as there were more food insecure households without food gardens as compared to households with food gardens. Households with a higher socio economic status tend to not grow their own food. Most of the households that had food gardens experienced the same cultivation barriers and those who did not have gardens had similar reasons. Thus, the cultivation of food gardens should be encouraged by educating households and the community at large regarding the benefits of having a food garden.
Food insecurity and related coping strategies among undergraduate students at the Univeristy of KwaZulu-Natal, Pietermaritzburg campus.
(2015) Poinoosawmy, Padmini Shivani.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Background: As a country, South Africa could be viewed as food secure. However, a substantial number of households in the country are food insecure. Education is commonly viewed as an opportunity for improving human and social resources. However, at 15% per annum, the South African university graduation rate is globally one of the lowest. As a significant number of South African students enrolling in tertiary education come from previously disadvantaged households characterised by social and economic adversity, the relationship between the latter and low university throughout rates cannot be overlooked. Objective: The purpose of this study was to investigate food insecurity and related coping strategies among undergraduate students enrolled at the University of KwaZulu-Natal, Pietermaritzburg campus. Design: A cross-sectional descriptive study design was chosen. Setting: Main, life science and commerce campuses of the University of KwaZulu-Natal, Pietermaritzburg campus were used as setting for the study. Subjects: Subjects included for this study were registered undergraduate students on financial aid and non-recipients of financial aid (N=800). Methods: Data collection was conducted by means of a questionnaire developed for the purpose of the study in addition to a modified version of the HFIAS as well as an adapted version of the Coping Strategy Index. Results: The mean age of the study sample was 20.5± 2.0 years. The gender distribution was 41.1% males and 58.9% females. The mean BMI of the study sample was 24.3(±4.8) kg/m2 with 35.8% of the study sample being overweight and obese. Female students had a higher prevalence of overweight (25.1%) and obesity (19.5%) when compared to males, who had a 16.1% prevalence of overweight and 7.0% obesity rate. Over half (54.3%) of participants were non-recipients of financial aid, while 45.8% students were on financial aid. Of the latter, 72.1% were sponsored by NSFAS. During term, 41.6% students lived at student residence, followed by who 32.5% resided at off campus accommodations and 25.9% living at home. Nearly two thirds (60.0%) of students were trying to find a part time job while studying of which 17.3% found employment. Three quarters (75.9%) received an additional source of income of which, 69.4% were not on financial aid and 30.6% were on financial aid. It was reported that 17.6% of students were assisting their families/friends/partner financially. Of the latter sub-sample, 87.2% were on financial aid. Students’ weekly food expense was R132.96. More than half (57.9%) the students were found being the hungriest at the end of the semester and close to/during exam time and at midday or mid-afternoon, with a higher prevalence of these reports coming from students on financial aid (28.0%). More than four out of ten (43.4%) students reported not having enough money for food of which, 55.0% were on financial aid. It was reported that 77.0% of the students were not able to eat a variety of food due to the lack of financial resources with 54.2% of students reporting this shortage occurring at every month end. As far as students who resided in student residence were concerned, 73.0% had their food stolen. The most frequently consumed foods included starchy food (bread, rice, maize-meal, samp, potato and pasta), fats (cooking oil, margarine and mayonnaise), tea, coffee, breakfast cereals and porridge, chicken, eggs and salty snacks. The frequency of consuming fruit was higher than that of vegetables, despite the consumption of both fruits and vegetables being low. More than seven out of ten (72.4%) students were facing food insecurity. While those on financial aid were more likely to be food insecure when compared to non-recipients of financial aid, 77.6% of the study sample limited the variety of their food consumed. The three most severe conditions of food insecurity (running out of food, going to bed hungry because there is no food and, going the whole day and night without food), were experienced by 12.5% of the students. In order to cope with food insecurity and lack of food, the three most frequently used coping strategies were borrowing money (66.5%), borrowing food (34.5%) and selling assets (19.3%). Significantly more students on financial aid adopted coping strategies when compared to those who were not on financial aid. Conclusion: Overweight and obesity was more prevalent among food insecure females than males. There was a lack of dietary diversity among the study sample; especially students on financial aid who faced a high prevalence of food insecurity. Food insecurity and the concomitant coping strategies adopted by students affect their physical and emotional well-being and this may hinder their academic performance. Hence, sustainable remedial measures should be implemented to address food security among undergraduate students registered for study at the Pietermaritzburg campus of University of KwaZulu-Natal.
Functional health literacy and associated glucose control of black, South African patients, 30 years and older, with type 2 diabetes attending the Diabetes outpatient clinic at Edendale Hospital, Pietermaritzburg, KwaZulu-Natal.
(2017) Burns, René.; Kassier, Susanna Maria.; Veldman, Frederick Johannes.
Abstract available in PDF file.
The hydration status, fluid and carbohydrate intake of male adolescent soccer players during training in Pietermaritzburg, KwaZulu-Natal.
(2012) Gordon, Reno.; Biggs, Chara.; Kassier, Susanna Maria.
Adolescent athletes of this era are more pressurized than adolescents of previous generations to perform at an optimum level (Micheli & Jenkins 2001, p49). The importance of winning can result in adolescent athletes developing inappropriate nutritional practices such as neglecting hydration and consuming insufficient carbohydrate (Micheli & Jenkins 2001, p57). Consuming insufficient fluid leads to dehydration which reduces a soccer player’s ability to continue training. Consuming inadequate carbohydrate reduces performance and blood glucose levels during training. This study aimed to determine the hydration status, fluid and carbohydrate intake of male, adolescent soccer players during training. A cross-sectional study was conducted among 122 amateur male, adolescent soccer players (mean age = 15.8 ± 0.8 years; mean BMI = 20.4 ± 2.0 kg/m2). The players’ hydration status before and after training, was measured using urine specific gravity and percent loss of body weight. Their carbohydrate intake, as well as the type and amount of fluid consumed, were assessed before, during and after training. A questionnaire was administered to determine the players’ knowledge regarding the importance of fluid and carbohydrate for soccer training. The study had an 87.1% response rate. The mean environmental conditions did not predispose players to heat illness. However, the players were at risk of developing heat illness during six of the 14 training sessions. Although the mean urine specific gravity indicated that players were slightly dehydrated before and after training, 43.8% of players were very or extremely dehydrated before training and 53.6% after training. A few (3.3%) were extremely hyperhydrated before training and after training (7.0%). On average players lost less than 1% of body weight during training and less than 3% of players dehydrated more than 2%. Players consumed mainly water before (289.17 ± 206.37 ml), during (183.20 ± 158.35 ml) and after (259.09 ± 192.29 ml) training. More than 90% stated that water was the most important fluid to consume before, during and after training. Very few (4.7%) correctly stated that carbohydrate should be consumed before, during and after training. Players were found to be slightly dehydrated before and after training and therefore were not consuming enough fluids during training. Players consumed inadequate amounts and types of fluid and carbohydrate. This not only compromises their performance but also health. Players were not aware of the importance of fluid and carbohydrate for soccer training. This study is unique in that it focused on the carbohydrate and hydration practices of socioeconomically disadvantaged adolescent soccer players during training. The study sample therefore represents a high risk group about which there is limited published data both locally and internationally. This study generated important baseline information which was lacking before on the hydration status, fluid and carbohydrate intake of adolescent soccer players in South Africa.
Investigating the consumption of processed meat, meat and meat alternatives and related factors affecting their purchases and consumption amongst undergraduate students at the University of KwaZulu-Natal, Pietermaritzburg campus.
(2017) Birkett, Megan Ann.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
Due to the recent publication by the International Agency of Cancer Research (2015a) that indicated that processed meat was carcinogenic and red meat probably carcinogenic, the consumption and knowledge of processed meat in the undergraduate students at University of KwaZulu-Natal was a concern. Due to the limited published research available on the subject, therefore, this study aims to investigate the consumption of processed meat, meat and meat alternatives and related factors affecting their purchases and consumption amongst undergraduate students at the University of KwaZulu-Natal, Pietermaritzburg campus. A cross-sectional study was conducted on undergraduate students at the University of KwaZulu-Natal on the Pietermaritzburg Campus (N=189). The students were requested to complete a questionnaire consisting of socio-demographic questions, socio-economic questions, a food frequency and nutrition knowledge questions. For the purpose of the study, the questionnaire was developed using current literature and expert input from the study supervisor. The results showed that the students consumed eggs and cold meat the most frequently, every day compared to other meat alternatives and meat. Legumes and fast foods were eaten the least by the majority of the participants. They indicated eating it “never or less than once a month” when compared to other meat and meat alternatives. The participants also considered price to be the main factor when deciding which food to purchase, followed by taste. It was also evident that the students had a poor overall level of nutrition knowledge regarding good sources of protein, fat content, salt content and general health of meat, processed meat and meat alternatives. The results of this study show similarities between previously published studies regarding factors when considering purchasing and nutrition knowledge. Due to the lack of locally published research concerning the consumption and knowledge of students regarding meat, processed meat and meat alternatives, this study forms a reference point to the importance of the need of nutrition education in undergraduate students at the University of KwaZulu-Natal.
Nutritional status and quality of life in HIV positive pre- and post- kidney transplant recipients, from HIV positive donors.
(2019) Martin, Claire Juliet.; Kassier, Susanna Maria.
Background: Kidney transplantation from a HIV-positive donor to a HIV-positive recipient is now a treatment option available for patients with ESRD. Impairments in nutritional status are common, and increase the risk of adverse clinical and health-related quality of life (HRQOL) outcomes. Therefore Optimising nutritional status is therefore an important adjunct of medical care that begins with a nutritional status assessment. Aim: To describe the nutritional status and HRQOL of HIV-positive kidney transplant recipients from a HIV-positive donor and candidates on the waiting list to receive one. Objectives: To determine nutritional status through the assessment of body composition, bone mineral density (BMD), dietary intake, biochemical indicators and gastrointestinal symptoms (GIS). To determine HRQOL based on the patient’s perception of their health. Methods: The frequency and severity of GIS was determined using a previously validated questionnaire; the gastrointestinal symptom rating scale (GSRS). BMD and body composition were measured by dual-energy x-ray absorptiometry (DEXA). Dietary intake was evaluated using a 24-hour recall. Biochemical indicators of albumin, prealbumin fasting glucose, lipids and serum 25-hydroxyvitamin D [25(OH)D] were analysed. Adiposity and musculature were determined through anthropometric indices of weight, body mass index (BMI), waist circumference (WC) and mid-arm muscle circumference (MAMC). HRQOL was assessed using a validated questionnaire; the Short form-36 (SF-36) and semi-structured interviews. With the exception of DEXA, all other assessments were done at baseline and at six months. Results: The study sample consisted of 76 participants (n=22 transplant recipients, n=54 transplant candidates), who were predominantly black (93.4 %) and male (60.5%), with a mean age of 43.6 ± 8.1 years. The frequency of GIS was high for both groups. Indigestion was a frequent and severe GIS. Amongst transplant candidates, females had significantly higher GSRS severity scores for selected subscales and the overall global mean score (p=0.030) compared to males. Age and duration of treatment correlated with selected subscales in transplant candidates. WC correlated positively with constipation amongst transplant recipients. BMD was assessed in 56 participants. Osteoporosis was more prevalent amongst transplant recipients (20.0%), while osteopenia was more prevalent amongst transplant candidates (27.8%). T-scores strongly correlated with lean mass at the BMD of the spine (r = 0.707, p = 0.007), and moderately with each side of the total hip (r = 0.455, p = 0.007 and r = 0.420, p = 0.007). Serum 25(OH)D vitamin D levels was low for the group as a whole, with a mean of 22.04 ±12.74 ng/ml, and was not related to BMD. There was a significant positive association between dietary calcium and all BMD sites for transplant recipients. In a subset of participants (n = 34), there was a significant positive association between anthropometry and DEXA derived indices of adiposity. These were BMI and percent body fat (%BF) (r = 0.773, p < 0.001), WC and truncal fat (TF) (r = 0.799, p = 0.00) and visceral adipose tissue (VAT) (r = 0.885, p < 0.001). The indicator of muscularity (MAMC) correlated with appendicular lean mass index (ALMI) (r = 0.511, p = 0.011), establishing these anthropometric indices as suitable proxy measures of overall and regional adiposity (including visceral adipose tissue) as well as musculature. The majority of transplant candidates were overweight (38.5%), or had normal BMI (36.5%) At six months, 62.7% had a statistically significant weight loss t (50) = 2.072, p = 0.043). Metabolic syndrome (MetS) was present in 47.5% and 51.0% of candidates at baseline and six months respectively. The mean daily energy and protein intake were below recommendations for dialysis. The majority of transplant recipients had a normal BMI (71.4%). At six months, 52.4% showed a weight gain trend and a significant increase in WC (t (14) = -2.861, p 0.013). MetS was present in about 35% of transplant recipients. At baseline, weight correlated with total protein (r = 0.609, p = 0.003), animal (r = 0.513, p = 0.017) and plant protein (r = 0.534, p = 0.013) intake. At six months, WC correlated with animal protein (r = 0.517, p = 0.028) intake. 68 patients completed the SF-36 at baseline and 6 months. Transplant candidates had lower HRQOL than recipients. The main mental stressors were income, employment and waiting for a donor. Physical health complaints were body pain and fatigue. In transplant recipients, the composite physical and mental scores were above the average for the general population. Prealbumin, BMI, albumin and MAMC showed positive correlations with selected SF-36 domains. Conclusion: A series of studies showed altered nutritional status and HRQOL in a substantial proportion of transplant candidates and some transplant recipients. These results can be used to improve nutritional status and hence optimise graft and patient outcomes.
Urban black male high school scholar preference for female body shape across the life span, Pietermaritzburg, KwaZulu-Natal.
(2016) Manyathi, Primrose Gcinani.; Kassier, Susanna Maria.
Abstract available in PDF file.