Browsing by Author "Pillay, Kirthee."

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Analysis of the local understanding of food insecurity and the socio-economic causes of food insecurity in Ward three of the Jozini Municipality, KwaZulu-Natal.
(2011) Nyakurimwa, Marvis.; Hendriks, Sheryl Lee.; Pillay, Kirthee.
Although food insecurity is a major problem in South African society, there is limited community level information on what constitutes it and related causative socio-economic factors. This study fills this information gap by analysing food insecurity in Ward 3 of Jozini Local Municipality in uMkhanyakude district in KwaZulu-Natal Province of South Africa. Specifically, the study explored the local understanding of food security and its socio-economic causes. A qualitative study was conducted using Participatory Rural Appraisal (PRA) techniques through a four-day workshop, supplemented with stakeholder interviews. The techniques used were historical timeline, seasonal calendar, focus group discussions, transect walk, problem tree analysis, social and resource mapping and semi-structured interviews. A four-day workshop was conducted with 44 participants that included traditional leadership, adult men and women, and young members of the community. The people of Ward 3 of Jozini Municipality regarded food insecurity as hunger that resulted in many socio-economic effects such as collapse of household unity and stability that enhanced erosion of dignity among household members. Hunger was commonly associated with “not eating enough”. Other effects of hunger included household heads, especially men resorting to alcohol and drug abuse as a way of escaping from indignity. The youth were said to be involved in crime, prostitution and alcohol abuse. As result of hunger, sick people defaulted from taking treatment against tuberculosis and Acquired Immunodeficiency Syndrome (AIDS). Indicators of food secure households were access to funds, ownership of cattle, possession of arable land and access to water. Very irregular emissions of smoke from kitchens of food insecure households indicated that they had nothing to cook and eat. The people of Ward 3, Jozini revealed the choices made in the context of limited income to buy food. The choices included migration to urban areas in search of employment, women resorting to sex work, livelihoods activities such as gardening and craftwork. In the absence of an adult, many child headed households were said to be food insecure. The socio-economic factors causing food insecurity were poverty, the Human Immunodeficiency Virus (HIV) and AIDS pandemic, unemployment, illiteracy, low household food production, limited access to resources such as water and land. The HIV and AIDS pandemic exacerbated food insecurity at household level. Furthermore, poverty forced women into sex work which places them at high risk of contracting HIV and spreading it to their multiple partners. In addition, as a coping mechanism men committed crime such as poaching of animals from game reserves which further expose them to loss of livelihoods and food security options. The socio-economic factors contributing to food insecurity were so intertwined such that an integrated approach is recommended as the best approach for solving the compounded problems. Further local population should be engaged to define solutions to the problems. To enhance self-reliance and self-drive among communities, adult basic education training should be incorporated to reduce the high illiteracy rate. The local leaders should be engaged to bring the large tracts of land owned by old people into full utilisation. The non-government, government and institutions working in the area should strengthen and diversify livelihoods to promote livelihoods sustainability and enable communities to survive shocks by reducing asset poverty.
Anthropometric status and dietary habits of registered nurses, enrolled nurses and enrolled nursing auxilliaries workng at a private hospital in Pietermaritzburg, KwaZulu-Natal.
(2021) Yegambaram, Leah Bianca.; Pillay, Kirthee.
The prevalence of overweight and obesity has been increasing over the years, particularly in South Africa (SA). A major contributor to this is poor lifestyle choices such as unhealthy diets and sedentary lifestyles. The rise in overweight and obesity is alarming as both are major risk factors for non-communicable diseases (NCDs). Overweight and obesity are also becoming more prevalent among healthcare professionals, specifically nurses. However, nurses are expected to lead by example and should be role models to the patients they care for. Nurses are the backbone of healthcare facilities and being overweight or obese impacts both on themselves and on their patients. Factors contributing to overweight and obesity among nurses include consuming meals late, eating during stressful periods, low physical activity levels and working shifts. Aim: This study aimed to investigate the anthropometric status and dietary habits of registered nurses (RNs), enrolled nurses (ENs) and enrolled nursing auxiliaries (ENAs) working at a private hospital in Pietermaritzburg (PMB), KwaZulu-Natal (KZN). Objectives: (i) to determine the anthropometric status of RNs, ENs and ENAs working at a private hospital in PMB, KZN; (ii) to determine the dietary habits of RNs, ENs and ENAs working at a private hospital in PMB, KZN; (iii) to determine the factors contributing to the anthropometric status and dietary habits of RNs, ENs and ENAs working at a private hospital in PMB, KZN; (iv) to determine the prevalence of NCDs among RNs, ENs and ENAs working at a private hospital in PMB, KZN. Method: A cross-sectional descriptive study was conducted on RNs, ENs and ENAs working at a private hospital in PMB, KZN. A self-administered questionnaire was developed to obtain data on demographic characteristics, lifestyle factors, body image and weight and eating habits. Anthropometric status was determined using selected anthropometric indices including weight, height, body mass index (BMI) and waist circumference (WC). Dietary habits was assessed using a food frequency questionnaire (FFQ) and a single 24-hour recall. The 24-hour recall was analysed using the Medical Research Council (MRC) Food Finder software programme version 1.0. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 22. Results: The study sample consisted of 130 nurses; 40.8% (n=53) were RNs, 36.9% (n=48) were ENs, 2.3% (n=3) were midwives, 19.2% (n=25) were ENAs and one was a clinical nurse specialist in the neonatal intensive care unit (NICU). A significant number of the participants were either overweight (25.4%; n=33) or obese class I (29.2%; n=38) (p<0.0005). Most participants did not smoke (82.3%; n=107) or consume alcohol (59.2%; n=77). Only 50% (n=65) of participants exercised. A significant number (63.1%; n=82) indicated that they were not satisfied with their body shape/size and did not feel that they were at a healthy body weight (60%; n=78). The majority of participants underestimated their BMI using the Stunkard figure rating scale (76.9%; n=100). The majority of participants stated they had tried to lose weight before (64.6%; n=84). The most common weight loss methods were cutting down on fast foods/takeaways (67.9%; n=57) (p=0.001) and exercising (63.1%; n=53). A significant number of nurses agreed that they were role models to their patients (70.8%; n=92) and believed it was important for a nurse to have an ideal body weight (92.3%; n=120). The majority of participants skipped meals (83.8%; n=109) with the only significantly skipped meal being breakfast (63.3%; n=69). A significant number of participants prepared their own meals at home (84.6%; n=110). Participants significantly agreed that time [M (mean)=3.98; p<0.0005], cost (M=3.26; p=0.021), emotions/stress (M=3.61; p<0.0005) and convenience (M=3.38; p<0.0005) were factors that influenced their meal choices. There was significant agreement that a lack of time to prepare meals (M=3.69; p<0.0005), lack of time to eat at work (M=4.04; p<0.0005), emotions/stress (M=3.30; p<0.0010) and healthy food not being available to buy at work (M=3.22; p<0.0036), were factors preventing nurses from eating healthily. The most common food item bought at the hospital cafeteria was pies (21.5%; n=17). Fruit (52.3%; n=68), sweets (34.6%; n=45) and sugar-sweetened soft drinks (32.3%; n=42) were consumed at least once a day. The mean BMI for females (33.6 kg/m2) was significantly higher than that for males (28.1 kg/m2) (p=0.043). Most male participants had a WC above 94 cm (63.6%; n=7), while the majority of females (88.2%; n=105) had a WC above 80 cm. The mean BMI for non-smokers (BMI=33.8 kg/m2) was significantly higher than that of smokers (29.6 kg/m2) (p=0.030). A higher BMI was associated with less snacking. The mean BMI for those who skipped supper (36.3 kg/m2) was significantly higher than for those who ate supper (32.0 kg/m2) (p=0.013). The mean BMI for those who skipped meals (33.8 kg/m2) was significantly higher than for those who did not skip meals (29.6 kg/m2) (p=0.005). The FFQ showed that the starches most frequently consumed were brown and white bread/rolls, white rice, phutu (crumbly maize meal porridge) and potatoes without skin. Sweets, chips (crisps), biscuits and chocolates were also frequently eaten. In the meat, poultry, fish, eggs and meat substitutes group, eggs, processed meats and chicken cuts with skin were frequently (n=65) of participants exercised. A significant number (63.1%; n=82) indicated that they were not satisfied with their body shape/size and did not feel that they were at a healthy body weight (60%; n=78). The majority of participants underestimated their BMI using the Stunkard figure rating scale (76.9%; n=100). The majority of participants stated they had tried to lose weight before (64.6%; n=84). The most common weight loss methods were cutting down on fast foods/takeaways (67.9%; n=57) (p=0.001) and exercising (63.1%; n=53). A significant number of nurses agreed that they were role models to their patients (70.8%; n=92) and believed it was important for a nurse to have an ideal body weight (92.3%; n=120). The majority of participants skipped meals (83.8%; n=109) with the only significantly skipped meal being breakfast (63.3%; n=69). A significant number of participants prepared their own meals at home (84.6%; n=110). Participants significantly agreed that time [M (mean)=3.98; p<0.0005], cost (M=3.26; p=0.021), emotions/stress (M=3.61; p<0.0005) and convenience (M=3.38; p<0.0005) were factors that influenced their meal choices. There was significant agreement that a lack of time to prepare meals (M=3.69; p<0.0005), lack of time to eat at work (M=4.04; p<0.0005), emotions/stress (M=3.30; p<0.0010) and healthy food not being available to buy at work (M=3.22; p<0.0036), were factors preventing nurses from eating healthily. The most common food item bought at the hospital cafeteria was pies (21.5%; n=17). Fruit (52.3%; n=68), sweets (34.6%; n=45) and sugar-sweetened soft drinks (32.3%; n=42) were consumed at least once a day. The mean BMI for females (33.6 kg/m2) was significantly higher than that for males (28.1 kg/m2) (p=0.043). Most male participants had a WC above 94 cm (63.6%; n=7), while the majority of females (88.2%; n=105) had a WC above 80 cm. The mean BMI for non-smokers (BMI=33.8 kg/m2) was significantly higher than that of smokers (29.6 kg/m2) (p=0.030). A higher BMI was associated with less snacking. The mean BMI for those who skipped supper (36.3 kg/m2) was significantly higher than for those who ate supper (32.0 kg/m2) (p=0.013). The mean BMI for those who skipped meals (33.8 kg/m2) was significantly higher than for those who did not skip meals (29.6 kg/m2) (p=0.005). The FFQ showed that the starches most frequently consumed were brown and white bread/rolls, white rice, phutu (crumbly maize meal porridge) and potatoes without skin. Sweets, chips (crisps), biscuits and chocolates were also frequently eaten. In the meat, poultry, fish, eggs and meat substitutes group, eggs, processed meats and chicken cuts with skin were frequently consumed. The fruit and vegetables most frequently consumed were non-starchy vegetables, fresh fruit and fruit juice. Full cream milk, sunflower oil, tub/soft margarine and cheddar cheese were the dairy and fats eaten most often. Tea and water were consumed more often than sugar-sweetened beverages. Overall, the most frequently consumed foods were full cream milk, sunflower oil, tea, white sugar, fresh fruit, brown sugar, brown bread/rolls, tub/soft margarine, sweets and white bread/rolls. Conclusion: There was a high prevalence of overweight and obesity among the participants. According to WC, the majority of nurses had an increased risk for metabolic complications. However, most participants were not diagnosed with a NCD. Factors associated with a high BMI included being female, not smoking, skipping meals, skipping supper, less snacking and cost of meals. Nurses consumed both healthy and unhealthy foods. Overall, there was a higher intake of carbohydrates and protein and a lower intake of dietary fibre. Despite the many hours that they spend caring for patients, nurses should also pay attention to their own health and well-being. Nurses should be supported in their efforts to achieve and maintain a healthy weight and lead a healthy lifestyle.
An assessment of the quality and acceptance of a ready-to-use supplement, Sibusiso, by human immunodeficiency virus and human immunodeficiency virus/tuberculosis treated patients in KwaZulu-Natal.
(2013) Mabaso, Prudence Bongekile.; Siwela, Muthulisi.; Pillay, Kirthee.; Amonsou, Eric Oscar.; Veldman, Frederick Johannes.
Introduction: Malnutrition is a health issue directly and indirectly contributing towards high rates of morbidity and mortality globally, particularly in developing countries. South Africa (SA) is faced with a double burden of diseases with a high prevalence of both under and over nutrition. The high prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) in SA worsens undernutrition. HIV/AIDS increases nutrient requirements and inadequate food intake results in malnutrition. Nutrition support through food supplementation is important to combat the high prevalence of malnutrition in sub-Saharan African countries including South Africa. Thus, a groundnut-soya based supplementary paste, Sibusiso, has been produced. However, its nutritional composition and acceptability have not been studied. Objectives: (i) To determine the nutritional composition and physical properties of a ready-to-use supplement, Sibusiso, (ii) To determine the sensory acceptability of Sibusiso among healthy subjects; and sensory acceptability and perceptions of Sibusiso by subjects treated for HIV and HIV/TB. Materials and methods: The nutritional composition, colour and texture of Sibusiso and a commercial peanut butter (control) were analysed following standard procedures. A cross-sectional consumer acceptability test was done using a 5-point facial hedonic scale (healthy control group, n = 68; HIV, n = 88 and HIV-TB co-infection treated, n = 51). A total of six focus group discussion sessions (HIV subjects = 4 sessions and HIV/TB co-infected subjects = 2 sessions) were also conducted. Results and discussions: The protein content of Sibusiso (16 g/100 g) was almost half that of the commercial peanut butter (control), (25 g/100 g). However, Sibusiso contained 1.4 times more ash (4 g/100 g) and almost twice as much carbohydrate (40 g/100 g) compared to the commercial peanut butter (22 g/100 g). The fat (40 g/100 g) and energy (2 624 kJ/ 100 g) content of Sibusiso was not substantially different from that of the commercial peanut butter which was 43 g/100 g and 2 852 kJ/100 g, respectively. The lysine content of Sibusiso (58 mg/g) was about 1.7 times higher than that of the commercial peanut butter. The methionine (11 mg/g) and histidine (35 mg/g) content of Sibusiso was almost twice that of the commercial peanut butter, respectively. The nutrient content of Sibusiso was either similar or slightly more than that of other ready-to-use supplements such as Plumpy’nut®. Sibusiso met the FAO/WHO/UNU recommendations for essential amino acids. The consumption of 50 g of Sibusiso per day may provide approximately 35% of the Estimated Energy Requirements (EER) and 30% of the Recommended Dietary Allowance (RDA) for protein for adults. Sibusiso was brown in colour, similar to the commercial peanut butter. Its textural attributes were found similar to that of the commercial peanut butter but harder and stickier. The acceptability of Sibusiso was significantly associated (p ≤ 0.05) with the health status of consumers. Overall, Sibusiso was liked by 94% of HIV and HIV/TB individuals (mean score: 4) compared to 85% for the healthy group (control). More than 90% of the HIV/TB and HIV treated individuals liked the taste compared to the control group (86%, mean score: 4). The colour and mouthful were rated 'good' by more than 80% of the HIV and HIV/TB group, mean score: 3, with only 68% among the healthy group, mean score: 4.1. Conclusion: Sibusiso is a good source of nutrients and was found to be acceptable to HIV and HIV/TB treated consumers. It may be effective in alleviating disease-related malnutrition among vulnerable individuals such as those infected by HIV and HIV/TB.
Awareness, attitudes and response to the sugar-sweetened beverage tax among consumers in Pietermaritzburg, KwaZulu-Natal.
(2019) Baijnath, Nikita.; Pillay, Kirthee.
Introduction: Obesity and overweight have been identified as serious health problems both globally and in South Africa. One of the contributing factors to this epidemic is the consumption of sugar-sweetened beverages (SSBs), high in sugar and energy. Sugar-sweetened beverages are defined as: ‘beverages that contain added caloric sweeteners such as sucrose, high fructose corn syrup or fruit juice concentrates’ and include soft drinks, fruit drinks, sports/energy drinks, vitamin water drinks, sweetened ice tea and lemonade. The South African Minister of Finance implemented the sugar-sweetened beverage (SSB) tax on 01 April 2018, as part of a multidisciplinary strategy to alleviate the obesity problem. The tax is calculated according to the direct proportion of added sugar at 2.1 cents per gram of sugar that exceeds 4 g per 100 ml, resulting in an approximate 20% increase in the price of SSBs. Given that the SSB tax is relatively new in South Africa, there is a need to assess the awareness, attitudes and responses of South African consumers to the tax. Aim: This study aimed to assess the awareness, attitudes and response to the sugar-sweetened beverage tax among consumers in Pietermaritzburg, KwaZulu-Natal. Objectives: (i) To determine if consumers in Pietermaritzburg, KwaZulu-Natal are aware of the SSB tax (ii) To determine the demographic characteristics of consumers who are aware of the SSB tax in Pietermaritzburg, KwaZulu-Natal (iii) To determine the attitudes of consumers in Pietermaritzburg, KwaZulu-Natal towards the SSB tax (iv) To determine the response of consumers in Pietermaritzburg, KwaZulu-Natal to the SSB tax, in terms of purchasing behaviour. Methods: An observational cross-sectional study was conducted at seven shopping centres in Pietermaritzburg, using a self-administered questionnaire, developed for this study. The questionnaire was used to gather data on demographic characteristics, awareness and response to the SSB tax. Data was analysed using the IBM Statistical Package for Social Science (SPSS) version 23.0. Results: The participants were mostly 18-30 year old Indian or African consumers, with a low income and in possession of a matric certificate or tertiary qualification. A significant number of consumers were aware of the South African SSB tax (58.1%; n=229), however, almost half did not know when it was implemented (47.6%; n=109). Indian and white consumers were significantly more aware of the SSB tax compared to African consumers (p<0.0005). In addition, awareness increased according to income level (more than R40 000 per month) and age (31-50 year olds) (p<0.0005). The consumers were divided in their attitudes towards the SSB tax. Nearly equal amounts of participants were in agreement (35.8%; n=141) or disagreement (37.0%; n=146) with the SSB tax. Furthermore, many believed that it would benefit the country in terms of the economy or health (43.6%; n=100). However, some felt that they could not afford the tax (21.8%; n=50) or felt that the money would go to the government and not benefit the public (12.7%; n=29). Many also believed that the South African economy would be negatively affected in terms of job losses (41.1%; n=162). However, there was neither significant agreement nor significant disagreement that the SSB tax would reduce obesity or consumption rates of SSBs. In addition, many indicated that the government should not interfere with the beverage choices of South Africans (41.9%; n=165). About half of the participants stated that they would make healthier beverage choices, following the implementation of the SSB tax (53.6%; n=211). Moreover, half of the consumers indicated that they would opt for water (50.8%; n=200). Other common alternatives included 100% fruit juice (49.2%; n=194) and milk and milk products (30.2%; n=119). Finally, most participants suggested that they would like the government to help reduce the prevalence of obesity by supporting an increase in nutrition education (27.3%; n=68) and physical activity (22.5%; n=56). Conclusion: This study aimed to assess the awareness, attitudes and response to the SSB tax among consumers in Pietermaritzburg, KwaZulu-Natal. The majority of the consumers were aware of the South African SSB tax; however, almost half did not know when it was implemented. Indian and White consumers, between the ages of 31 and 50 years old, earning more than R40 000 per month, were the most aware of the South African SSB tax. Half of the consumers were in favour of the SSB tax and felt that it would improve health. The same number also indicated that they would choose water as an alternative, if SSBs were no longer affordable to them, followed by 100% fruit juice and milk and milk products. The differences in attitudes towards the SSB tax show that there is a need for consumers to know more about the SSB tax. Hence, more awareness campaigns are required. Future research should investigate the impact of the SSB tax on health, obesity rates and the economy.
Breakfast consumption and the relationship to to socio-demographic and lifestyle factors of undergraduate students in the School of Health Sciences at the University of KwaZulu-Natal.
(2017) Seedat, Raeesa.; Pillay, Kirthee.
Introduction: Breakfast is commonly regarded as the most important meal of the day. The consumption of breakfast has been linked to various health benefits, and is widely acknowledged in available literature. There is improved nutrient intake in those who consume breakfast compared to those who skip breakfast. Consumption of breakfast leads to positive health behaviour, improved stress management, feeling energetic and making less unhealthy snack choices. On the other hand, neglecting breakfast can have negative implications, such as fatigue and decreased concentration. Furthermore, skipping breakfast is positively correlated with obesity risk. The high prevalence of overweight and obesity in South Africa could be linked to poor breakfast consumption habits and requires further investigation. Several studies have illustrated a high prevalence of breakfast skipping amongst the university student population worldwide, due to affordability and time management. It could be assumed that students studying towards qualifications in health sciences would be more inclined towards regular breakfast consumption, as part of a healthy lifestyle; however, further research is required to investigate this. Due to the paucity of data amongst South African university health science students, this study aimed to investigate breakfast consumption and the relationship to socio-demographic and lifestyle factors of undergraduate students in the School of Health Sciences, at the University of KwaZulu-Natal (UKZN). Aim: To investigate breakfast consumption and the relationship to socio-demographic and lifestyle factors of undergraduate students in the School of Health Sciences at UKZN. Objectives: • To investigate breakfast consumption and the factors that influence breakfast consumption in undergraduate students in the School of Health Sciences at UKZN. • To determine the socio-demographic and lifestyle profile of undergraduate students in the School of Health Sciences at UKZN. • To determine if there was a correlation between breakfast consumption, socio-demographic profile, lifestyle indicators and Body Mass Index (BMI) among undergraduate students in the School of Health Sciences at UKZN. Methods: A cross-sectional, descriptive study was conducted on undergraduate students in the School of Health Sciences at UKZN, based at the Westville campus. A self-administered questionnaire consisting mainly of close-ended questions was used to collect data. Weight and height measurements were taken and used to calculate BMI. Results: Most participants were between 19 to 20 years of age, were females, lived at the university residence and were in their first year of study. Most reported their health status to be good or fair, did not smoke or consume alcohol and were physically active. Breakfast was consumed by 82.1% (n=284), however, only 50.5% (n=143) consumed it daily. Breakfast consumption was associated with lower levels of fatigue and higher levels of alertness. Ready to eat or instant breakfast cereals, tea or coffee, eggs and leftovers were popular breakfast choices. Reasons for consuming breakfast included: to satisfy hunger, for energy, to be alert, prevent fatigue and for health reasons. Breakfast was skipped due to a lack of time and a lack of appetite. A significant number of those who did not eat breakfast were in their third year of study, were smokers and consumed fast foods or take-away foods frequently. Daily breakfast intake was found among a significant proportion of Indian and white participants, those who lived at home and those whose parents or family were responsible for purchasing groceries. This study found no relationship between breakfast consumption and BMI. Conclusion: The majority of students at the School of Health Sciences at UKZN consumed breakfast; however, not all consumed it regularly. Breakfast was consumed to achieve satiety, provide energy, be alert, prevent fatigue and for health reasons. Barriers to breakfast consumption included a lack of time and a lack of appetite. There was no relationship between breakfast consumption and BMI. Given its health and nutritional benefits, regular breakfast consumption should be encouraged among university students.
Caregiver and child acceptability of a provitamin A carotenoid, iron and zinc rich complementary food prepared from common bean and pumpkin in Uganda.
(2020) Buzigi, Edward.; Siwela, Muthulisi.; Pillay, Kirthee.
Vitamin A deficiency (VAD), iron deficiency (ID), and zinc deficiency (ZnD) are the three leading micronutrient deficiencies causing morbidity and mortality among children under five years in developing countries, including Uganda. A high prevalence of VAD, ID and ZnD among children in developing countries begins during the period of complementary feeding, which is between the ages of six to 24 months. This is the period when children are fed complementary foods (CFs) prepared from vitamin A, iron, and zinc deficient staple tubers and cereals. To combat VAD, ID, and ZnD, the World Health Organization (WHO) recommends that CFs be diversified with vitamin A, iron and zinc rich food sources, such as animal source foods (ASFs), food supplements and commercially fortified foods. However, ASFs, commercially fortified foods and food supplements are either unaffordable or inaccessible to rural Ugandan caregivers. Therefore, the aim of this study was to prepare a complementary food (CF) rich in provitamin A carotenoids (PVACs), iron and zinc using locally available common bean and pumpkin and to test the acceptability of the CF among caregivers and their children in rural Uganda. The study objectives were to: (i) select one common bean landrace superior in iron and zinc, and one pumpkin landrace superior in PVACs from a variety of local landraces available in the local market; (ii) evaluate the effect of home cooking methods on provitamin A carotenoid (PVAC) retention in the selected pumpkin (superior in PVACs), and iron and zinc retention in the selected common bean (superior in iron and zinc); (iii) assess child acceptability of an innovative CF- a common bean pumpkin blend (BPB) prepared with common bean (superior in iron and zinc) and pumpkin (superior in PVACs); (iv) assess caregiver perceptions and acceptability of the innovative CF (BPB). The study was conducted in rural Kyankwanzi district, Uganda, East Africa. Cross-sectional and randomised control trial designs were used in this study for the consumer acceptability investigations; and a controlled laboratory experiment for the nutrient retention investigation. Three pumpkin landraces on the local market of the study area were screened for PVACs, whilst five common bean landraces also on the local market were screened for iron and zinc content. Iron and zinc content were determined by flame atomic absorption spectrometry (FAAS), whilst PVAC content was determined by high performance liquid chromatography (HPLC). True retention of iron, zinc and PVAC was determined after expert caregivers cooked pumpkin by either boiling or steaming, whilst the common bean was cooked by either boiling with or without prior soaking. Caregivers prepared the test CF and the control according to the consistency (thickness or thinness) fit for child consumption based on the child’s age and stage of development. The test CF (BPB) was prepared by mixing and blending two parts of cooked pumpkin and one part of cooked common bean, whilst the control CF, pumpkin puree (PP) was prepared by mashing one part of cooked pumpkin. Seventy children, aged 6 to 24 months participated in the child acceptability randomised crossover study. In the current study, the CFs test food (BPB) and control (PP) were considered acceptable if the child consumed at least 50 g and more of the 100 g of the CF offered. Mean duration for intake of the CFs and vitamin A, iron and zinc intake were calculated. A paired t-test was used to determine whether there were significant differences in the amount, duration, and micronutrient intake between the BPB and PP. Further, 70 caregivers (whose children participated in the child acceptability study) participated in the caregiver acceptability study. A cross-sectional sensory evaluation study design was used to assess caregiver perceptions and acceptability of the study CFs. Sensory attributes (taste, colour, aroma, texture and general acceptability) of the BPB and PP were rated using a five-point facial hedonic scale (1=very bad, 2=bad, 3=neutral, 4=good, 5=very good). Focus group discussions (FGDs) were also conducted to assess caregiver perceptions about using the BPB as a CF. A chi-square (X2) test was used to detect the proportionate difference for each sensory attribute between BPB and PP, whilst focus group discussions (FGDs) data was analysed by thematic analysis. A p value of 0.05 was considered statistically significant. For objective one (first investigation), β-carotene content in Sweet cream (1 704 μg/100 g) was significantly higher compared to Dulu (1 333 μg/100 g) and Sun fish (1041 μg/100 g) (p<0.0001). The α- carotene content of Sweet cream was significantly lower (46 μg/100 g, p<0.0001) compared to Dulu (77.3 μg/100 g) and Sun fish (79.3 μg/100 g). However, the total retinol activity equivalent (RAE) was highest in Sweet cream (143.9 μg/100 g), compared to Dulu (115.4 μg/100 g) and Sun fish (90.1 μg/100 g). Iron content was highest in Obwelu (7.75 mg/100g), compared to Masavu (6.95 mg/100 g), Nambale (6.55 mg/100g), Kanyebwa (7.15 mg/100 g) and Obwayelo (6.5 mg/100 g). Obwelu had significantly higher iron concentrations than Obwayelo (p<0.05). Zinc content was highest in Obwelu (3.05 mg/100 g), but was not significantly different (p >0.05) compared to the other common bean landraces of Masavu (2.95 mg/100 g), Nambale (2.35 mg/100 g), Kanyebwa (2.9 mg/100 g) and Obwayelo (3.0 mg/100 g). The findings of the first investigation suggested that Sweet cream was superior in PVAC content compared to the other pumpkin landraces, whilst Obwelu was superior in iron and zinc content compared to the other common bean landraces. Therefore, Sweet cream and Obwelu were selected for use in the preparation of a CF rich in PVACs, iron and zinc. For objective two (second investigation), β-carotene, α-carotene, and total provitamin A content in raw pumpkin was 1704 μg/100 g, 46 μg/100 g and 1437 μg/100 g, respectively. Either boiling or steaming pumpkin resulted in over 100% retention of PVACs and total provitamin A. Iron and zinc retention in soaked boiled common bean was 92.2% and 91.3%, respectively. Boiling common bean without soaking resulted in 88.4% and 75.6% retention of iron and zinc, respectively. The findings of the second investigation suggested that there was a high retention of PVACs in pumpkin, Sweet cream after boiling or steaming, and a high retention of iron and zinc in common bean, Obwelu after boiling with prior soaking. For objective three (third investigation), the mean amount of BPB (53.9 g) and the control (PP) (54.4 g) consumed by children was high, but not significantly different from each other (p>0.05). The mean duration for child consumption of BPB was 20.6 minutes and 20.3 minutes for the control and the durations for child consumption were not significantly different from each other (p<0.05). The mean child intake of vitamin A was significantly higher (p<0.05) from the control (PP) (152.5 μgRAE) compared to the test food (BPB) (100.9 μgRAE). The mean iron intake was significantly higher (p<0.05) from BPB (1.1 mg) compared to the control (0.3 mg). Furthermore, zinc intake was significantly higher (p<0.00001) from the (0.58 mg), compared to control (0.13 mg). For objective four (fourth investigation), between 64% and 96% of the caregivers rated both BPB and PP as acceptable (good to very good) for all the sensory attributes. There was no significant difference (p>0.05) in caregiver acceptability for all sensory attributes between BPB and PP (p>0.05). Caregivers had positive perceptions about the taste, texture, aroma, and colour of the BPB. Caregivers were keen to know the specific varieties of common bean and pumpkin used to formulate the PVAC, iron and zinc rich BPB. Findings from this study suggest that a complementary food, BPB, rich in PVACs, iron and zinc prepared from locally available common bean, Obwelu and pumpkin, Sweet cream was acceptable to caregivers and their children who were in the age range of complementary feeding in Uganda. To contribute towards combating child VAD, ID and ZnD, policy makers in Uganda, such as the district nutrition coordination teams should support and promote the cultivation and utilisation of common bean, Obwelu and pumpkin, Sweet cream as major ingredients of CFs. The use of BPB as a CF should not replace other existing nutrition interventions such as micronutrient supplementation, commercial fortification, biofortification programmes and the use of ASFs that aim to combat micronutrient deficiencies during the period of complementary feeding. However, the use of BPB as a CF should be a complementary strategy to these existing nutrition interventions. Future studies should investigate the effect of BPB intake on the vitamin A, iron and zinc status of children.
Dietary intake, diet-related knowledge and metabolic control of children with type 1 diabetes mellitus, aged 6-10 years attending the paediatric diabetic clinics at Grey's Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal.
(2007) Pillay, Kirthee.; Maunder, Eleni.
The aim of this study was to assess the dietary intake, diet-related knowledge and metabolic control in children with Type 1 Diabetes Mellitus between the ages of 6-10 years attending the Paediatric Diabetic Clinics at Grey’s Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal. This was a cross sectional observational study that was carried out in a total of 30 subjects out of a possible 35 subjects that qualified for inclusion in the study from both the Grey’s Hospital clinic (n=8) and IALCH clinic (n=22). The dietary intake was assessed in a total of 25 subjects using a three day dietary record (n=20) and a 24 hour recall of the third day of the record (n=16). Diet-related knowledge was assessed using a multiple choice questionnaire. Metabolic control was assessed using the most recent HbA1c and the mean HbA1c results over the previous 12 months from the date of data collection. Height and weight measurements were also carried out. Information on socioeconomic status and education status of the caregivers was obtained from 22 caregivers through follow-up phone calls. All measurements except for dietary intake were obtained from all subjects participating in the study. The mean percentage contribution of macronutrients to total energy was very similar to the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). The mean percentage contribution of macronutrients to total energy from the 3 day dietary records and the 24 hour recalls were as follows: carbohydrate (52% and 49%); sucrose (2% and 2%); protein (16% and 17%); fat (32% and 34%). Micronutrient intake was adequate for all micronutrients except for calcium and vitamin D which showed low intakes. The mean diet-related knowledge score for the sample was 67% with significantly higher scores in children older than 8 years of age. The latest HbA1c for the sample was 9.7% and the mean HbA1c over the previous 12 months from the date of data collection was 9.6%. There was a significant positive correlation between age of the participant and the latest HbA1c (r = 0.473; p=0.008) and a significant negative correlation between the education level of the caregivers and the latest HbA1c (r = - 0.578; p=0.005) and the mean HbA1c over 12 months (r = - 0.496; p=0.019). Significant differences were found between African and Indian children respectively for HbA1c, with higher values in African children. There was no correlation between BMI for age and latest HbA1c (r = 0.203, p=0.282) or mean HbA1c over 12 months (r = 0.101, p=0.594). Z score for BMI for age was also not correlated with latest HbA1c (r = 0.045, p=0.814) or mean HbA1c over 12 months (r = - 0.012, p=0.951). Children from the Grey’s Hospital Clinic were found to have higher HbA1c values (p=0.001) and lower diet-related knowledge scores as compared to the children from the IALCH Clinic (p=0.038). It should be noted that the ethnic and racial composition of the children attending these two clinics differed. In conclusion the macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while calcium and vitamin D intakes were low. Overall this sample displayed good diet-related knowledge while metabolic control was found to be poor.
Dietary supplement use among dietetics students at the University of KwaZulu-Natal.
(2017) Pillay, Lynelda.; Pillay, Kirthee.
Introduction: A dietary supplement is a product, which aims to add nutritional value to the diet. The use of dietary supplements is favoured among many countries, with a steady increase in use. There are many groups that are known to make use of dietary supplements such as females, the elderly, health professionals, gym goers, pregnant women, children under the age of 18 years and university students. University students are a group that are known to make use of dietary supplements in order to improve their academic performance, increase energy and promote overall general health. It is assumed that students studying towards a nutrition-related degree such as dietetics would be more likely to use dietary supplements, due to their interest in and exposure to nutrition. However, there is a lack of published data investigating the prevalence of dietary supplement use, factors associated with use and reasons for use among South African university students, studying towards a nutrition-related degree. Therefore, this study aimed to assess the use of dietary supplements by dietetics students at the University of KwaZulu-Natal (UKZN). Aim: The aim of the study was to assess the use of dietary supplements by students registered for a Bachelor of Science or a Post Graduate Diploma in Dietetics, at UKZN. Objectives: a) To determine the prevalence of dietary supplement use among dietetics students at UKZN. b) To determine the factors associated with dietary supplement use among dietetics students at UKZN. c) To determine the reasons for use of dietary supplements among dietetics students at UKZN. Methods: A cross-sectional, descriptive study was conducted using students registered for a Bachelor of Science or a Post Graduate Diploma in Dietetics, at UKZN. A self-administered questionnaire consisting of both open and close-ended questions was developed to collect data. The sample comprised of 139 dietetics students. Results: The use of dietary supplements was reported by 23% of the dietetic students. The most commonly used supplement among the students was Centrum (multivitamin) (21.9%, n=7), followed by calcium supplements (15.6%, n=5). There was a significant relationship between use of dietary supplements and gender and race. White and Indian students used dietary supplements more than the other race groups (p<0.05). Females (p=0.018) and students who lived at home were more likely to consume dietary supplements (46.9%; n=15) (p=0.008). Fourth year students (34%) used dietary supplements the most. There was no relationship between dietary supplements and physical activity, eating habits or ability to meet dietary requirements. Common reasons for using dietary supplements were to strengthen the immune system, improve energy levels and enhance health. Expense (32.7%; n=35), adequate diet (22.4%; n=24), deem it unnecessary/waste of money (15.0%; n=16) and unsure about supplements (14.0%; n=15), were statistically significant reasons for not using a dietary supplement (p<0.05). A significant proportion of the sample (72.2%) indicated that their source of information on dietary supplements was the internet (p=0.011), followed by dietetics/nutrition lectures (41.7%). About 73.3% (n=22) of the students who used supplements indicated that they had experienced an overall improvement in physical health after use of dietary supplements (p=0.016). Other results achieved included: more energy (53%; n=16) and better memory/concentration (53.3%; n=16). Furthermore, half of the sample that used supplements (50%; n=15) reported an improved resistance to illness/ability to fight illnesses earlier. Just over half the sample (51.4%) indicated that they planned to use a dietary supplement in the future. Conclusion: There was a low prevalence of use of dietary supplements among dietetics students at UKZN. Factors such as race, gender, residence and year of study influenced the use of dietary supplements. Use of dietary supplements was more common among white and Indian students, females and those in the fourth year of study. Dietary supplements were used to strengthen the immune system, improve energy levels and enhance health. The high cost of supplements was the main deterrent to use of dietary supplements.
Incidence of malnutrition as measured using specific anthropometric and biochemical parameters and its relationship with chemotoxicity in children with nephroblastoma admitted to Inkosi Albert Luthuli Central Hospital between 2004-2012.
(2016) Draper, Kelly Sue.; Pillay, Kirthee.; Wiles, Nicola Laurelle.
Introduction: The prevalence of malnutrition in children with cancer in developing countries is reported to be as high as 69%. Malnutrition is worse in developing countries as the diagnosis of cancer may be delayed due to poor access to health care. The assessment of the nutritional status of paediatric oncology patients on admission to hospital is crucial as nutritional status is known to influence treatment and clinical outcomes. Several studies suggest that concurrent malnutrition and cancer in children leads to reduced chemotherapy delivery due to impaired tolerance and increased toxicity. The influence of malnutrition on the prevalence, frequency and duration of chemotoxicity in South African children with nephroblastoma has not been well researched. Aim: This study aimed to determine the incidence of malnutrition as measured using specific anthropometric and biochemical parameters and its relationship with chemotoxicity in children with nephroblastoma admitted to IALCH between 2004-2012. Objectives: a) To determine the incidence of malnutrition as measured using specific anthropometric and biochemical parameters in children with nephroblastoma admitted to IALCH between 2004-2012. b) To determine the influence of malnutrition as measured using specific anthropometric and biochemical parameters on the prevalence of chemotoxicity. c) To determine the influence of malnutrition as measured using specific anthropometric and biochemical parameters on the frequency and duration of chemotoxicity Methods: Seventy-seven children between the ages of 1-12 years diagnosed with nephroblastoma and admitted to IALCH between 2004 and 2012 were studied prospectively. Nutritional assessment took place before treatment was started and included weight, height, mid upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. The administration of Neupogen® was used as a surrogate for haemotoxicity and the frequency and duration of its use was recorded. Results: When patients were classified by weight for age (WFA), height for age (HFA), weight for height (WFH) and body mass index (BMI) for age, malnutrition was seen in 37.5%, 39.5%, 28.4% and 30.3% of patients respectively. When the parameters MUAC and TSFT were used the prevalence of malnutrition was 56% and 52.7% respectively. There was a significant relationship between the prevalence of toxicity and MUAC. The mean frequency and duration of chemotoxicity was significantly higher in those defined as malnourished using MUAC. Frequency and duration of chemotoxicity were positively correlated. Serum albumin, when used alone, showed that 86% of the cohort had a normal nutritional status. Conclusions: Nutritional assessment in children with solid tumours should include MUAC, TSFT as well as weight and height. This is because the use of weight and height alone could underestimate the prevalence of malnutrition. Children with nephroblastoma who have malnutrition according to their MUAC are more likely to experience more frequent and longer periods of chemotoxicity. Serum albumin should not be used in isolation to identify malnutrition.
Knowledge and counselling practices of healthcare workers related to HIV and infant feeding in Ethekwini.
(2019) Nuns, Kate Abby.; Pillay, Kirthee.
Introduction: Breastfeeding is recognised globally as the single most effective child survival strategy for children under the age of five years. It is associated with much health, cognitive and economic benefits. Thus, the World Health Organization (WHO) recommends exclusive breastfeeding for infants for the first six months of life, followed by the introduction of appropriate complementary foods with continued breastfeeding until two years of age. This recommendation has been adopted and included in the South Africa Infant and Young Child Feeding (IYCF) policy for all mothers, including those living with human immunodeficiency virus (HIV). Although breastfeeding does carry a small risk of HIV transmission, the benefits of breastfeeding far outweigh this risk. With the South African Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme now including the use of maternal antiretroviral therapy (ART), mother-to-child transmission rates have been successfully reduced. However, what has not improved successfully is the rate of breastfeeding in the country, despite recommendations in the IYCF policy. Poor IYCF counselling is a problem in South Africa and is thought to be one of the reasons for the country‟s poor breastfeeding rates. Healthcare workers are responsible for counselling mothers on IYCF practices. While it is very important to update HIV and IYCF guidelines based on new evidence, on-going changes to these guidelines can be confusing and overwhelming for healthcare workers. It can result in inappropriate IYCF counselling and in turn inappropriate IYCF practices by mothers. Mothers living with HIV require accurate and consistent information to make informed feeding decisions. Whether healthcare workers in eThekwini, KwaZulu-Natal (KZN) are knowledgeable and up-to-date with IYCF recommendations in the context of HIV is not known. Aim: To assess the knowledge and counselling practices of healthcare workers, primarily doctors and nurses, employed at eThekwini, KZN regional state hospital antiretroviral (ARV), paediatric and antenatal departments, regarding IYCF in the context of HIV. Objectives: (i) To determine the knowledge of healthcare workers on IYCF in the context of HIV in eThekwini, KZN. (ii) To determine if healthcare workers have attended formal training on IYCF in the context of HIV in eThekwini, KZN. (iii) To determine if healthcare workers feel they require training on IYCF in the context of HIV in eThekwini, KZN. (iv) To determine if antiretroviral (ARV) clinics, antenatal departments and paediatric departments all have a role in IYCF counselling of mothers living with HIV in eThekwini, KZN. (v) To determine the level of confidence that healthcare workers have regarding counselling mothers on IYCF in the context of HIV in eThekwini, KZN. Method: A self-administered questionnaire was developed for this study based on IYCF recommendations included in the National Department of Health South Africa (NDoH) 2013 IYCF policy, the 2017 amendment of the IYCF policy and the 2015 National Consolidated Guidelines for the PMTCT and the Management of HIV in Children, Adolescents and Adults. The questionnaire was administered to 188 healthcare workers, primarily doctors and nurses, working in ARV, antenatal and paediatric departments from three regional hospitals (Addington Hospital, Prince Mshiyeni Memorial Hospital and RK Khan Hospital) in eThekwini, South Africa. Results: The participants in all three departments were not knowledgeable on IYCF in the context of HIV with a mean knowledge score of 51.7% (SD±14.1) for the overall group. The knowledge scores did not differ significantly across departments. Only 47.3% (n=89) of the participants had attended formal training on IYCF in the context of HIV. The vast majority of participants (n=171; 91.4%) felt they required more training. All three departments were found to have a role in IYCF counselling of mothers living with HIV, with antenatal departments counselling pregnant women living with HIV more frequently than ARV and paediatric departments. Overall, the group indicated an above average confidence score regarding the IYCF counselling of mothers living with HIV. Attendance of the training did not equate to improved knowledge scores. Conclusion: This study aimed to assess the knowledge and counselling practices of healthcare workers regarding IYCF in the context of HIV. It was found that healthcare workers across all three departments were not knowledgeable on IYCF in the context of HIV. Less than half of the healthcare workers in the study had attended formal training on IYCF in the context of HIV. The majority of healthcare workers felt they required more training on the topic. The ARV, paediatric and antenatal departments at the three hospitals were all found to be involved in IYCF counselling of mothers living with HIV. Overall, the healthcare workers were confident about counselling mothers living with HIV on IYCF. The findings from this study highlight an urgent need for effective and on-going training of healthcare workers on IYCF in the context of HIV, in order to improve knowledge and to ensure that counselling practices of healthcare workers are in line with the national policies and guidelines that exist.
Knowledge regarding severe acute malnutrition and its treatment among medical officers in the Xhariep District, Free State.
(2016) Ramagoma, Mandla Lackson.; Pillay, Kirthee.
Abstract available in PDF file.
Knowledge, acceptance and barriers to optimal use of iron supplements amongst pregnant women attending Mutare city clinic in Manicaland, Zimbabwe.
Mahundi, Plaxcedia.; Pillay, Kirthee.; Wiles, Nicola Laurelle.
Iron deficiency anaemia (IDA) is a global public health challenge, most prevalent in developing countries, including Zimbabwe. It mostly affects young children and women of childbearing age, particularly pregnant women. In the developing world, unbalanced diets which lack haemiron from animal sources due to high costs, predisposes many pregnant women to IDA. Most women usually enter pregnancy with already depleted iron stores, consequently resulting in high maternal mortality and morbidity, premature deliveries and low birth weight infants. Pregnant women with IDA have a high risk of complications at delivery and are also prone to infections. Therefore, to increase haemoglobin levels and prevent IDA, the World Health Organization (WHO) recommends a daily supplement of 60 mg of iron for all pregnant women for at least six months during pregnancy, until six weeks post-partum. This is meant to complement iron from the diet, because dietary sources of iron alone are inadequate to meet the iron requirements during pregnancy. However, there are many barriers to the acceptance and use of iron supplements among pregnant women. This is also exacerbated by poor knowledge on the importance of iron supplements during pregnancy. Mutare City, in Zimbabwe was chosen as the study site because there is a lack of published data on the use of iron supplements by pregnant women in this area. The aim of this study was to assess the knowledge and acceptance levels of iron supplements among pregnant women, attending Mutare City Clinic, Manicaland, Zimbabwe. The study also aimed to identify possible barriers to optimal use of iron supplements among the pregnant women. In addition, the study aimed to develop and test a nutrition education tool with the aim of creating awareness regarding the importance and use of iron supplements among pregnant women, thus improving acceptance and use of the supplements. The objectives of the study were as follows: (i) To assess knowledge on the importance of iron supplements during pregnancy amongst pregnant women attending Mutare City Clinic, Manicaland, Zimbabwe. (ii) To assess the acceptance levels of iron supplementation given during pregnancy amongst pregnant women attending Mutare City Clinic, as perceived by nurses and pregnant women attending Mutare City Clinic for ante-natal care (ANC). (iii) To identify the barriers to optimal iron supplementation by pregnant women attending Mutare City Clinic. (iv) To ascertain from pregnant women attending Mutare City Clinic, the form of the nutrition education tool to be developed, the importance of the tool, information and language to be used in the tool. (v) To develop a nutrition education tool for pregnant women attending Mutare City Clinic with the purpose of creating awareness of iron supplements. (vi) To test the developed nutrition education tool to determine its user-friendliness and acceptability among pregnant women attending the Mutare City Clinic. A survey was conducted to assess knowledge and acceptance on the importance and use of iron supplements by pregnant women. A total of 103 pregnant women, aged 16-36 years participated in the study and were selected on the basis of being either in their second or third trimesters of pregnancy, and attending Mutare City Clinic for ante-natal care (ANC). It was found that the pregnant women had inadequate nutrition knowledge to motivate them to consistently take iron supplements. Most pregnant women appreciated the importance of iron supplements, but lacked detailed knowledge to substantiate their need for taking them. The study therefore recommends early ANC booking and commencement of iron supplementation, as well as adequate nutrition education for pregnant women. To identify barriers preventing optimal use of iron supplements by pregnant women, eight focus group discussions (FGD) were conducted, with 64 women, aged 17-39 years. Major barriers preventing the optimal use of iron supplements included erratic supplies at healthcare centres, cultural and religious influences and side-effects associated with supplements and poverty. Ignorance due to inadequate nutrition education and poor communication between nurses and pregnant women, were other notable barriers. The erratic availability of iron supplements at the healthcare centre resulted in many women not taking supplements because they could not afford to buy them from private pharmacies. However, in the few instances when supplies were available at healthcare centres, some women collected iron supplements but did not use them, while some managed to use the supplements consistently. Therefore, continuous reinforcement of positive supplementation practices is recommended to motivate for compliance among pregnant women. Adequate nutrition education and counselling is necessary for promoting awareness regarding the importance of iron supplements, dietary diversity and management of side-effects. Improvements in the procurement and delivery system at a national level will help to ensure timeous provision of iron supplements to healthcare centres. Sixty-seven pregnant women in their second and third trimesters were purposively sampled to participate in eight FGDs on the development of a nutrition education tool. Pregnant women gave their views on the nutrition education tool they most preferred and the most appropriate language and information to include. The pregnant women indicated that a pamphlet was the most preferred form of nutrition education tool, with English as the preferred main language of communication, along with some Shona phrases for clarification. Three extra FGDs were conducted with 28 pregnant women to test the developed nutrition education tool for acceptability and user-friendliness by pregnant women. It was found that good use of images which are culturally sensitive, appropriate use of colours, and labelling foods in both English and Shona enhanced the identification of foods, thus improving acceptability of the developed pamphlet. Earlier results obtained from both nurses and pregnant women revealed that most pregnant women did not receive adequate nutrition education on the importance and use of iron supplements during pregnancy, leading to poor compliance. Late ANC bookings at healthcare centres affected the initiation of iron supplementation. Thus, the development of a nutrition education tool for use by pregnant women could enhance knowledge on the importance of iron supplementation, since most women had inadequate nutrition knowledge. Intensive nutrition education programmes, routine iron supplementation and use of the developed nutrition education pamphlet are recommended to reduce the prevalence of IDA among pregnant women in Zimbabwe. This study has shown that issuing iron supplements without an accompanying nutrition education tool may not effectively alleviate maternal IDA. Poor compliance with iron supplementation regimens remains a challenge because of several barriers, which also include inadequate baseline knowledge among pregnant women. Therefore, the development of a nutrition education tool is a positive move towards improving compliance, especially if the tool is offered to pregnant women timeously. The study has indicated that the tool may likely enhance understanding by consolidating nutrition education conducted at healthcare centres and iron supplements given to pregnant women. However, erratic supplies of supplements remains a challenge, as well as delayed ANC bookings by many pregnant women. Thus, this study has shown that offering a nutrition education pamphlet along with iron supplements, has the potential to create awareness and motivate towards compliance with iron supplements. This has the potential to reduce the prevalence of maternal IDA amongst pregnant women in Zimbabwe and sub-Saharan Africa.
Nutritional composition and acceptance of a complimentary food made with provitamin A-biofortified maize.
(2014) Govender, Laurencia.; Pillay, Kirthee.; Siwela, Muthulisi.; Derera, John.
Introduction: Micronutrient malnutrition has been identified as a serious health problem globally and is on the rise in South Africa. This is evident from the escalating burden of vitamin A deficiency (VAD) in South Africa. Rural infants are the most affected, as their diets often lack micronutrients. Food fortification, vitamin A supplementation and dietary diversity are the strategies that have been employed in South Africa to alleviate VAD. However, these strategies have not been effective, for various reasons. Biofortification is the production of micronutrient dense staple crops to alleviate micronutrient deficiencies. This strategy could complement existing strategies in the alleviation of VAD in South Africa and in other countries, especially in sub-Saharan Africa (SSA), where VAD is prevalent. Aim: The aim of this study was to investigate the nutritional composition and acceptance of a complementary food (soft porridge) made with provitamin A-biofortified maize by female infant caregivers from the rural areas of Umgungundlovu District of KwaZulu-Natal, South Africa. Objectives: (i) To evaluate the nutritional composition of soft porridge made with provitamin A-biofortified maize compared to non-biofortified white maize porridge; (ii) To assess the sensory acceptability of soft porridge made with the biofortified maize by black African female infant caregivers of varying age; and (iii) To determine the perceptions of the black African infant caregivers about the biofortified maize relative to the non-biofortified white maize. Methods: A cross-sectional study was conducted. Grains of two provitamin A-biofortified maize varieties and one white variety (control) were used. Grain and soft porridge of each variety of maize were analysed for their nutritional composition. The sensory acceptability of the porridges were evaluated by black African female infant caregivers, using a five-point facial hedonic scale. Focus group discussions were conducted, using some of the study subjects, to determine their perceptions about the provitamin A-biofortified maize. Results: The results showed that the grains of the provitamin A-biofortified maize varieties and their soft porridges were more nutritious than the control white variety in terms of energy, fibre, fat, protein, iron, zinc and phosphorus content. The results of the sensory evaluation indicated that there was no significant difference in the sensory acceptability of the biofortified soft porridges and the white maize soft porridge, irrespective of the age of the sensory evaluation panellists. The female caregivers perceived the biofortified maize as nutritious and health-beneficial and thought that infants would like its unique yellow colour and taste. However, the black African female caregivers perceived the provitamin A-biofortified maize as an animal feed or food for the poor. Nevertheless, the female caregivers expressed a willingness to give their infants porridge made with provitamin A-biofortified maize if it was cheap, readily available and health-beneficial. Conclusion: This study suggests that provitamin A-biofortified maize has the potential to be used as a complementary food item. Biofortification of maize with provitamin A could be used as a possible complementary strategy to assist in the alleviation of VAD in SSA. Furthermore, the relatively higher energy, fibre, fat, protein, iron, zinc and phosphorus content of the biofortified maize could contribute to the alleviation of protein-energy malnutrition and mineral deficiencies, respectively, which are prevalent in children of SSA. Although the findings of this study, like other previous studies, indicate that there are some negative perceptions about the provitamin A-biofortified maize, this study shows that provitamin A-biofortified maize soft porridge is as acceptable as white maize soft porridge to female infant caregivers from the rural areas of Umgungundlovu District of KwaZulu-Natal, South Africa. The female caregivers are thus likely to accept the biofortified maize for use as an infant complementary food in the form of soft porridge. Further research is recommended to expand the study area and consumer sample size in order to increase the confidence of inferring these results for large rural populations.
Nutritional composition and consumer acceptance of a complementary food made with orange-fleshed sweet potato and dried beans.
(2016) Khanyile, Ntuthuko.; Pillay, Kirthee.; Siwela, Muthulisi.
Introduction In South Africa (SA), nutrient deficiencies such as vitamin A, zinc, iron deficiency, and protein energy malnutrition (PEM) are common among children, especially during the complementary feeding stage. This is despite various strategies implemented by the South African Department of Health (DoH) to reduce malnutrition. These strategies include food fortification, micronutrient supplementation and promotion of dietary diversity. Vitamin A deficiency (VAD) is the most common micronutrient deficiency in SA and is regarded as a major public health concern. Biofortification, which involves enhancing the micronutrient content of staple crops, is a new strategy that aims to address micronutrient deficiencies, especially in lowincome areas where commercially fortified foods and micronutrient supplementation are not easily accessible. Orange-fleshed sweet potato (Ipomoea batatas L.) (OFSP) is a biofortified staple crop that contains significant amounts of naturally bioavailable provitamin A carotenoids, that can be converted to vitamin A. Aim The aim of this study was to determine the nutritional composition and consumer acceptance of a complementary food made with OFSP and dried beans (Phaseolus vulgaris L.). Objectives i) To determine the nutritional composition of a complementary food product made with OFSP and dried beans. ii) To assess the consumer acceptance of a complementary food product made with OFSP and dried beans by black African infant caregivers. iii) To determine the perceptions of black African caregivers towards a complementary food made with OFSP and dried beans. Methods This was a cross-sectional study, which involved the assessment of the nutritional composition and consumer acceptance of a complementary food made with OFSP and dried beans, OFSP and white-fleshed sweet potato (WFSP) (control). The complementary foods made with OFSP and dried beans, OFSP and WFSP were all analysed for their nutritional composition using referenced analytical methods. The sensory acceptability of the different complementary foods ii was assessed using a five-point facial hedonic scale. Focus group discussions were used to determine the caregivers’ perceptions towards the complementary food made with OFSP and dried beans. Results The complementary food made with OFSP and dried beans contained statistically significantly higher fat, ash (total mineral content), fibre and zinc contents than found in the complementary food made with OFSP alone, and the complementary food made with WFSP. Furthermore, although not statistically significant, the protein and iron content were higher in the complementary food made with OFSP and dried beans compared to the complementary food made with OFSP alone and the complementary food made with WFSP. The complementary food made with OFSP and dried beans contributed more than 100% of the recommended dietary allowance (RDA) for protein in both age groups studied (8-12 months and 13-24 months). The sensory attribute ratings of the complementary food made with OFSP and dried beans and OFSP alone were not statistically significant from the sensory ratings of the complementary food made with WFSP. The panellists expressed a willingness to purchase OFSP if it had a comparable price to that of WFSP or if it was cheaper. Conclusions The complementary food made with OFSP and dried beans had a superior nutritional composition compared to the complementary foods made with OFSP alone and WFSP alone, respectively. In addition, the complementary food made with OFSP and dried beans was found acceptable to caregivers of children aged 8-24 months in the eThekwini district of KwaZuluNatal. A complementary food prepared with OFSP and dried beans has the potential to improve the nutritional intake of children aged 8-24 months, who are vulnerable to VAD and PEM. However, there is a need to improve the availability and accessibility of the OFSP in order to increase its utilisation.
Nutritional management of adult patients hospitalised with covid-19 by dietitians in KwaZulu-Natal.
(2023) Ebrahim, Naseera.; Pillay, Kirthee.
Background: The outbreak of a novel coronavirus disease (COVID-19) in December 2019, led to a worldwide pandemic. Over the past three years, over 4 million people in South Africa (SA) have been infected with COVID-19, which mainly affects the respiratory system. The presence of existing co-morbidities influences the severity of the illness, and the long-term prognosis. Patients who require hospitalisation for respiratory support are often critically ill and, in most cases, cannot consume enough nutrients. Although dietitians have been involved in the nutritional management of patients hospitalised with COVID-19, there were no guidelines on the nutritional management of COVID-19 available for them to use and they were not trained on its management. There is no consensus on how dietitians managed COVID-19 and which nutritional management guidelines they consulted. Aim: This study aimed to determine how dietitians managed adult patients hospitalised with COVID-19 in KwaZulu-Natal (KZN). Objectives: (i) to determine which nutritional guidelines dietitians used in the management of adult COVID-19 patients; (ii) to identify the challenges that dietitians faced when nutritionally managing adult COVID-19 patients; (iii) to determine whether dietitians took or estimated anthropometric measurements in bed-bound and mobile adult COVID-19 patients; (iv) to determine whether dietitians assessed malnutrition risk in adult COVID-19 patients, and if so, which nutrition screening tools were used; (v) to determine if dietitians recommended unconventional mega-doses of micro- and immunonutrient supplements for the management of adult COVID-19 patients and the reasons for use. Method: A cross-sectional descriptive study, which included dietitians employed in the public and private sectors in KZN was conducted. An electronic self-administered questionnaire was developed and used to collect data via the online platform Google Forms. Initially, the KZN Department of Health (DOH) and the Association for Dietetics in South Africa (ADSA) assisted with distributing the link to the study to dietitians in KZN. However, after an initial poor response, the data collection period was extended and the researcher was granted permission to directly contact and invite dietitians to participate, using publicly-available contact details. Data were collected between 14 August 2022 and 31 March 2023 and analysed using the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the forty-two dietitians who participated in this study, 52.4% (n=22) were KZN DOH-employed dietitians and 31% (n=13) were ADSA members. Seven-percent (n=3) of the dietitians were both KZN DOH-employed dietitians and ADSA members and approximately 10% (n=4) of the dietitians were neither KZN DOH-employed dietitians nor ADSA members. An equal number of dietitians worked in private hospitals (n=16; 38.1%) and in public districtlevel hospitals (n=16; 38.1%). A significant number of dietitians began treating COVID-19 patients from the start of the pandemic or during and/or after the first wave of infection (p=0.001). Just over half of the dietitians were no longer treating any COVID-19 patients at the time of data collection (n=22; 52.4%) (p<0.001). Sixty-nine percent (n=29) of dietitians consulted a nutrition society for recommendations on the nutritional management of COVID-19 patients. The European Society for Parenteral and Enteral Nutrition (ESPEN) expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection were most used in the current study. The most frequently used values for calculating macronutrient requirements were: 25-30 kCal/kg/day for energy, 1.2-1.5 g/kg/day for protein, 30% of the total energy requirement (TER) for fat and 50-60% of TER for carbohydrates. Dietitians also reported using actual body weight (ABW) (n=13; 31.0%) or estimated body weight (n=19; 45.2%) to calculate nutritional requirements (p=0.004). Individual challenges faced by the dietitians were similarly grouped. There was significant disagreement among the dietitians that a lack of support and resources (p<0.001) and nutrition-related external factors were challenges they experienced (p<0.001). Anthropometry was assessed in all patient groups, with the main methods used being estimated weight, height and body mass index (BMI) for patients who were bed-bound and unconscious (n=31; 73.8%) (p=0.003). Actual weight, height and BMI were assessed in patients who were fully mobile (n=35; 83.3%) (p<0.001). There was also a significant agreement amongst the dietitians that COVID-19 patients did not feel well enough to have their anthropometric measurements taken. Half of the dietitians reported using a nutrition screening tool to screen for malnutrition (n=21; 50%) and a significant number of dietitians (n=13; 61.9%) used the Nutrition Risk Screening 2002 (NRS-2002) tool (p<0.001). Only 12 dietitians (28.6%) recommended the use of mega-doses of micro- and immunonutrient supplements in their COVID-19 patients, with an overall significant agreement that mega-doses could benefit the patient (p=0.012). All 12 dietitians who recommended mega-doses of micro and immunonutrient supplements did not report any adverse side-effects in their patients (p<0.001), and most (n=10; 83.3%) noticed an improvement in the condition of their COVID-19 patients (p=0.039). Conclusion: This was one of the first studies in SA to investigate the nutritional management of adult patients hospitalised with COVID-19. Although dietitians were involved in treating COVID-19 patients from the onset of the pandemic, most were not treating any COVID-19 patients at the time of data collection. Most dietitians consulted the ESPEN practical recommendations on the nutritional management of critically ill patients to manage their COVID-19 patients. There was no significant consensus amongst the dietitians that medical conditions and complications were challenges faced by the dietitians. Depending on the degree of mobility of the COVID-19 patient, anthropometry was assessed in COVID-19 patients, either by estimation or actual measurements. The most common malnutrition screening tools used by dietitians were the NRS-2002 and the Malnutrition Universal Screening Tool (MUST). Megadosing of micro- and immunonutrient supplements was not popular among the dietitians in the current study and further studies are needed in this area.
Nutritional quality and consumer acceptability of provitamin A-biofortified maize.
(2011) Pillay, Kirthee.; Siwela, Muthulisi.; Derera, John.; Veldman, Frederick Johannes.
Vitamin A deficiency (VAD) is a major public health problem in developing countries, including South Africa. The potential of provitamin A-biofortified maize for use as a complementary strategy to alleviate vitamin A deficiency in developing countries, where maize is the dominant staple food, is currently a subject of research. Although the nutritional composition of white maize is thought to be similar to that of biofortified maize, apart from the differences in provitamin A carotenoid content, the comparative nutritional composition of the two maize types seems not to have been subjected to a comprehensive scientific study. When setting the target level of provitamin A in the provitamin A-biofortified maize, it is important to consider the potential effect of processing on the final provitamin A carotenoid content of the biofortified food products, as the provitamin A carotenoids levels may decrease on processing. Furthermore, the yellow/orange provitamin A-biofortified maize may not be widely accepted by African consumers who are vulnerable to VAD, and are traditional consumers of white maize. This study firstly aimed to evaluate the nutritional composition, including provitamin A composition, and grain quality of provitamin A-biofortified maize varieties, compared to white maize. The second aim was to assess the effect of processing (milling and cooking) on the retention of provitamin A carotenoids and other nutrients in popular South African maize food products prepared with provitamin A-biofortified maize. Thirdly, the study aimed to assess the acceptability of maize food products prepared with provitamin A-biofortified maize by consumers of different age and gender in rural KwaZulu-Natal, South Africa. The grains of the provitamin A-biofortified maize varieties and grain of a white maize variety (control) were analysed for their nutritional composition using standard or referenced methods. The carotenoid content of the grains was analysed by High-Performance Liquid Chromatography (HPLC) and mass spectroscopy. The provitamin A carotenoids β-cryptoxanthin, and trans and cis isomers of β-carotene, and other unidentified cis isomers of β-carotene were detected in varying levels in the provitamin A-biofortified maize varieties. The total provitamin A content in the biofortified maize varieties ranged from 7.3-8.3 μg/g dry weight (DW), with total β-carotene ranging from 3.5-3.6 μg/g DW, and β-cryptoxanthin from 3.7-4.8 μg/g DW, whilst no carotenoids were detected in the white maize variety. Results of the evaluation of the content of other nutrients showed that, when compared with the white maize variety, the provitamin A-biofortified maize varieties had higher levels of starch, fat and protein but were lower in iron. The zinc and phosphorus levels in the white maize and the biofortified maize were comparable. The biofortified maize varieties were better sources of most of the essential amino acids relative to the white maize, but, similar to the white maize, they were deficient in histidine and lysine, indicating that further improvement is required. Selected quality attributes (grain density, susceptibility of kernels to cracking, milling quality and resistance of the kernels to fungal infection) of grains of 32 provitamin A-biofortified maize varieties and a white variety (control) were assessed. Overall, the quality of the grains of the provitamin A-biofortified maize varieties were found to be superior to that of the white maize grain, although the biofortified maize grains showed less resistance to fungi, including mycotoxin-producing types. This indicates that the trait of grain resistance to infection by fungi should also be incorporated in the provitamin A-biofortified maize varieties during breeding. To assess the retention of provitamin A carotenoids and other nutrients in maize food products, three selected provitamin A-biofortified maize varieties and the control (white maize variety) were milled into mealie meal and samp. The milled products were cooked into three products: phutu and thin porridge (from the mealie meal) and cooked samp. Nutrient retention during processing was determined. Milling resulted in either an increase or slight decrease in the provitamin A carotenoid levels, but there was no major decrease in the total provitamin A level. Most of the other nutrients were well retained during milling, but there were substantial losses of fibre, fat and minerals. Provitamin A carotenoid levels decreased on cooking. In phutu 96.6 ± 20.3% β-cryptoxanthin and 95.5 ± 13.6% of the β-carotene was retained after cooking. In thin porridge 65.8 ± 4.6% β-cryptoxanthin and 74.7 ± 3.0% β-carotene; and in samp 91.9 ± 12.0% β-cryptoxanthin and 100.1 ± 8.8% of the β-carotene was retained after cooking, respectively. Provitamin A retention seemed to be influenced by both maize variety and food form, indicating that suitable varieties and food forms should be found. There was generally a high retention of the other nutrients in all the three cooked products, except for the substantial losses of fat in thin porridge and iron and phosphorus in cooked samp. These findings indicate that an optimal delivery of provitamin A to the consumer can be achieved by processing provitamin A-biofortified maize into foods that have a good retention of provitamin A carotenoids, such as phutu and samp. These food products would be recommended in areas where VAD is prevalent. In order to assess consumer acceptability of provitamin A-biofortified maize, a total of 212 subjects aged 3-55 years from Mkhambathini Municipality, in KwaZulu-Natal province, South Africa, participated in the sensory evaluation of phutu, thin porridge and cooked samp prepared with provitamin A-biofortified maize varieties and a white variety (control). Preference for yellow maize food products was negatively associated with an increase in the age of the subjects. Overall, preschool children preferred yellow maize to white maize food products: phutu (81% vs. 19%), thin porridge (75% vs. 25%) and samp (73% vs. 27%). In contrast, primary school children preferred white maize to yellow maize food products: phutu (55% vs. 45%), thin porridge (63% vs. 38%) and samp (52% vs. 48%). Similarly, secondary school children and adults also displayed a similar preference for white maize food products. There was no association between gender and preference for maize variety. Focus group discussions revealed that participants had a negative attitude towards biofortified maize due to its colour, taste, smell and texture. However, the participants expressed a willingness to consume biofortified maize if it was cheaper than white maize and was readily available in local grocery stores. These findings indicate that there is a potential to promote the consumption of provitamin A-biofortified maize and its food products in this part of South Africa, thereby contributing to a reduction in the incidence of VAD. This study has shown that provitamin A-biofortified maize has a good potential to be used as an additional strategy to alleviate VAD in poor communities of South Africa, including similar environments in sub-Saharan Africa. However, the study has revealed that there are still challenges to be overcome in order to achieve the target provitamin A content of 15 μg/g in provitamin A-biofortified maize, set by HarvestPlus, an international challenge program. This may also explain why provitamin A-biofortified maize varieties with this level of provitamin A have been scarcely reported in the literature. Thus, more research is required to achieve the target provitamin A level in maize by conventional breeding. The results of this study indicate that besides provitamin A, the biofortified maize is also a good source of other nutrients including starch, fat, protein and zinc. However, improving the consumer acceptability of the provitamin A-biofortified maize remains a challenge, due to the negative attitudes towards the yellow/orange maize by African consumers. On the other hand, the results of this study indicate that there is an opportunity to promote the consumption of provitamin A-biofortified maize food products by preschool children, a finding which has not been previously reported in the literature. Nutrition education on the benefits of provitamin A-biofortified maize, as well as improved marketing are recommended, in this part of South Africa and also in similar environments in other sub-Saharan countries.
Nutritional status of children with Wilms' tumour on admission to Inkosi Albert Luthuli Central Hospital in Durban, South Africa and its influence on outcome.
(2016) Lifson, Lauren Frances.; Wiles, Nicola Laurelle.; Pillay, Kirthee.
Introduction: In developing countries the prevalence of malnutrition on admission amongst children with cancer can be as high as 69%. High rates of malnutrition occur due to factors such as poverty, co-morbidities, late presentation and advanced disease process. Weight has been shown to be an inaccurate parameter for nutritional assessment of patients with solid tumours as it is influenced by tumour mass. The importance of nutritional resuscitation and support of children with cancer has been emphasised in the literature, however, nutritional assessment and management of children with cancer is not consistently implemented throughout the centres treating these patients. Malnutrition on admission has been shown to increase the risk of toxicity and infection amongst children with cancer. The influence of malnutrition at the time of admission on outcome has not, however, been conclusively established. Aim: The aims of this study were to determine the prevalence of malnutrition amongst children with Wilms‟ Tumour on admission to hospital, as well as the influence thereof on outcome after two years. Furthermore, it aimed to determine the level of nutritional support that the children received on admission to hospital. Objectives: a) To determine the prevalence of malnutrition using a combination of anthropometric and biochemical markers, defined by the AHOPCA algorithm. b) To determine the influence of nutritional status on admission on the outcome, in terms of overall survival and death, amongst children with Wilms' Tumour admitted to IALCH between 2004 and 2012. c) To determine the level of nutritional support prescribed to children with Wilms‟ Tumour within the first two weeks of admission to IALCH between 2004 and 2012. Methods: Seventy six children diagnosed with Wilms' Tumour and admitted to IALCH between 2004 and 2012 were studied prospectively. Nutritional assessment took place before starting treatment and included weight, height, mid upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. Overall nutritional status was classified using a combination of MUAC, TSFT and albumin. Outcome was determined at two years after the date of admission. Time until commencement of nutritional intervention after admission, and nature thereof, were recorded. Results: Stunting and wasting was evident in 12 and 15% of patients, respectively. By classifying nutritional status using a combination of MUAC, TSFT and albumin, the prevalence of malnutrition was shown to be 67%. Malnourished children did not have significantly larger tumours than those who were well-nourished on admission. Malnutrition was not a predictor of poor outcome at two years after admission. Eighty four percent of patients received nutritional resuscitation within two weeks of admission, in the form of oral supplements, nasogastric feeds, or a combination thereof. Conclusion: When classifying nutritional status, utilisation of weight and height in isolation can lead to underestimation of the prevalence of malnutrition amongst children with Wilms' Tumour. Nutritional assessment and classification of children with solid tumours should include MUAC and TSFT. Malnutrition at the time of admission was not shown to be related to poorer outcome after two years. This may be due to the effects of early aggressive nutritional resuscitation as part of management by a multidisciplinary team.
Nutritional value of bambara groundnut (Vigna subterranea (L.) Verdc.) : a human and animal perspective.
(2014) Gqaleni, Pumlani.; Modi, Albert Thembinkosi.; Pillay, Kirthee.
Bambara groundnut (Vigna subterranea (L) Verdc.) is an indigenous African legume that is reported to have wide adaptation to a range of environments. It is popular among subsistence farmers in sub-Saharan African. However, research on the crop still lags behind that of other established legumes and in most places the crop is still cultivated from landraces, with no locally improved varieties available. The objective of the study was to evaluate the nutritional and agronomic potential of bambara groundnut. Three separate experiments were undertaken, (i) seed quality determination during germination, (ii) controlled environment study to determine yield and nutritional quality under water stress and (iii) field trials to determine the effect of seasons and location on nutrient composition. The results showed that the darker coloured seeds had a faster germination rate. Black speckled seeds had the highest (crude protein) CP after 8 (20.67%), 16 (22.11%), 24 (20.68 %), and 48 hours (20.77%), on the other hand cream seeds had the lowest CP after 16 (19.30%), 24 (18.71%), and 72 hours (19.16 %). The results showed that nutrient composition varied during early imbibition and the variations could be associated with seed colour and duration of imbibition. Under controlled environments, statistically significant differences were observed for plants under 100% ETc when compared with plants under 30% ETc with regards to stomatal conductance. Bambara groundnut landrace selections were able to adapt to the limited water under 30% ETc by closing their stomata. The lower stomatal conductance at 30% ETc relative to 100% ETc demonstrated a regulation of transpirational losses, through effective stomatal control. Under field conditions, the interactions between seasons, location, irrigation systems, sequential harvesting and crop varieties is one that needs sufficient planning so as to maximise nutrient quality and overall crop production. The nutritive value and mineral contents of bambara groundnut landrace selections varied considerably in response to water regimes, sequential harvesting, locations and seasons. These findings suggested that bambara groundnut is a drought resistant crop and can aid as an affordable all year round forage supplement for ruminants during the dry seasons.
Nutritional, sensory and functional properties of a Bhambara groundnut complimentary food.
(2016) Oyeyinka, Adewumi Toyin.; Pillay, Kirthee.; Siwela, Muthulisi.
Abstract available in PDF file.
Perceived barriers to lifestyle modification, motivation, knowledge and service needs of diabetic adults and their health care providers in Chennai, Tamil Nadu, India.
(2017) Stalin, Sharona.; Pillay, Kirthee.
Introduction: Over 415 million people worldwide live with diabetes mellitus, of which 50% live in five countries: China, India, the United States of America, Brazil and Indonesia. The number of people with diabetes is predicted to rise to 552 million by 2030 and may affect up to 79.4 million individuals in India. Diabetes mellitus is a chronic, non-communicable disease resulting in increased blood glucose levels. Poor control of diabetes leads to the development of complications that affect quality of life and health, and may even lead to death. Diabetics face many barriers such as time constraints, lack of knowledge, fear or depression, lack of self-motivation and lack of support from family and medical personnel. Barriers faced by health care providers (HCPs) are inadequate knowledge on treatment and management of diabetes, focusing on acute management rather than the preventive care, delay in clinical response to poor control and competing care demands. Given the fact that a large percentage of the world’s diabetics live in India, more research is needed to investigate the barriers that diabetics and their HCPs face in this unique region. Aim: This study aimed to evaluate the barriers to lifestyle modification, motivation, knowledge and service needs of diabetic adults and their HCPs in Chennai, Tamil Nadu, India. Location: The study was conducted in Apollo Specialty Hospital, Vanagaram, Chennai, India. Objectives: (i) To identify the barriers to lifestyle modification as perceived by South Indian Type 2 diabetic adults. (ii) To identify the barriers to motivation, knowledge and service needs as perceived by South Indian Type 2 diabetic adults. (iii) To identify the challenges as perceived by HCPs in providing education, motivation and services to their diabetic patients. Method: A sample of 50 male and female adults with type 2 diabetes from a private specialty hospital in Chennai were randomly selected to participate in this study. Participants had to be type 2 diabetic, aged between 18 to 70 years; diagnosed for more than one year; with not more than two other co-morbidities, excluding pre-renal or renal failure; latest glycosylated haemoglobin (HbA1c) available and previously been seen by a dietician. For HCPs (n=25) comprising of nurses, doctors and dieticians, the inclusion criteria were that they had to have been practicing for more than a year. Separate questionnaires were developed for the diabetic patients and for the HCPs. The patient questionnaires were conducted in an interview format and in the language (English or Tamil), preferred by the patients. The HCPs completed the questionnaires on their own. Results: The diabetic patients in this study ranged in age between 41 to 68 years and had a mean body mass index (BMI) of 26.8 kg/m2. The mean HbA1c was 8.05% and most patients had hypertension alone, as a comorbidity. In general, patients felt that they had no barriers to glucose monitoring, although 28% indicated that being busy with family was a barrier. Common barriers to exercise were being busy with work or family (72%) as well as fear and pain (44%). The most common barriers to healthy eating were eating away from home (52%; n=26), cost or expense of healthy foods (52%; n=26) and taste of food (46%; n=23). Extrinsic motivation significantly influenced the decision to take medication (p=0.001), check blood glucose levels (p=0.001) and keep health care appointments (p<0.05). Exercise was the only habit this sample followed regularly due to intrinsic motivation (p=0.030). Significantly, 82% of patients indicated that they understood their disease condition (p<0.05), whilst a significant small number reported that they would benefit from a workshop that provided knowledge and skills to help manage their diabetes (p=0.001). Most patients had confidence in treatment and advice obtained from health care providers (p=0.001), and their own skills and knowledge to prepare healthy meals (p<0.05). Most patients understood their disease condition and complications (p<0.05). A higher income (p=0.031) and consuming a mixed diet (p<0.05) was associated with higher HbA1c levels amongst patients. A significant positive correlation was found between BMI and HbA1c, as well as between BMI and income. Patients following a vegetarian diet were found to have a lower HbA1c. Health care providers (HCPs) felt that they had sufficient skills for lifestyle counselling (p=0.001), but also reported that their biggest barrier to counselling was time constraints (p=0.026). Health care providers indicated that patients found following an eating plan the most difficult to maintain (88%), followed by exercise (48%). Health care providers all agreed that patients should be assigned responsibility for self-care (p<0.05), even though healthcare providers indicated that important barriers to lifestyle changes were unwillingness to change (p<0.05), insufficient knowledge on complications (p=0.008) and lack of support from co-workers or bosses (p=0.005). There was a significant positive correlation between the experience level of the healthcare providers and the frequency with which they motivated and supported lifestyle changes (rho = 0.547, p =0.005) and how confident they were that they had the knowledge or skills needed to teach their patients (rho =0.406, p=0.004). The experience level of the HCPs and the frequency with which they referred patients to other team members (rho = 0.767, p <0.05) and how confident they were that they had the skills for lifestyle counselling (rho = 0.577, p =0.003), were also significantly positively correlated. Conclusion: For patients, being busy with family, work or other tasks was a common barrier to glucose monitoring and exercise, while a diet plan was not commonly used to control blood glucose levels. Overall, patients were satisfied with the services provided by their HCPs and were keen to participate in online medical support from health care providers. According to HCPs, patients found following an eating plan and exercise the most difficult to adhere to, while glucose monitoring and taking medication were the least difficult to adhere to. All healthcare providers agreed that patients should be assigned responsibility of self-care. According to HCPs, unwillingness to change, insufficient knowledge on complications and lack of support from co-workers or bosses, were the most important barriers to lifestyle counselling. Time constraints also prevented HCPs from counselling their patients adequately. In general, the more experienced HCPs were more likely to motivate and support lifestyle changes, more confident in their knowledge or skills and more likely to refer patients to other health care team members. It is evident that this sample need to place greater emphasis on dietary management of diabetes. They could benefit from regular information updates on how to effectively manage their diabetes.