Dietetics And Human Nutrition

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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.
The prevalence and degree of dehydration in rural South African forestry workers.
(2008) Biggs, Chara.; Maunder, Eleni Maria Winifred.; Paterson, Marie.
South African forestry workers are predisposed to dehydration due to the heavy physical activity they perform in impermeable regulation safety clothing in hot and often humid environments where the availability of a variety of suitable fluids at reasonable temperatures is limited. As dehydration reduces both physical and mental capacity the potential consequences include decreased productivity and an increased risk for injury. The aim of this cross sectional observational study was to determine the prevalence and severity of dehydration in rural forestry workers in both winter (minimum and maximum daily temperatures 3-22°C) and autumn (minimum and maximum daily temperatures 14-27°C). The convenience sample included 103 workers in autumn (Nelspruit, n=64 males, n=39 females, mean age 37.32 years, mean BMI 22.3 kg/m2) and 79 in winter (Richmond, n=68 males, n=11 females, mean age 25.85 years, mean BMI 22.2 kg/m2). The sample included chainsaw operators, chainsaw operator assistants, debarkers and stackers. The risk of heat illness was moderate in Nelspruit (average daily temperature 21.1°C 67% rh) and low in Richmond (average daily temperature 17.0°C 39% rh). The prevalence of dehydration was determined by urine specific gravity (USG) measurements. Percent loss of body weight in the course of the shift was used to determine the severity of dehydration. In Nelspruit 43% (n=43) and in Richmond 47% (n=37) of the forestry workers arrived at work dehydrated (USG>1.020 g/ml). Pre break this had increased to 49% (n=49) in Nelspruit and 55% (n=33) in Richmond. By the end of shift the number of dehydrated forestry workers had significantly increased to 64% (n=64, p≤0.001) in Nelspruit and 63% (n=42, p=0.043) in Richmond. A minimum of 21% (n=2) in Nelspruit and 23% (n=15) in Richmond of the forestry workers had lost more than 2% of their body weight which could significantly decrease work capacity and work output as well as mental and cognitive ability. Dehydration was not related to season (winter/autumn), gender or job category. In Nelspruit 23% (n=23) and in Richmond 13% (n=10) arrived at work overhydrated (USG<1.013 g/ml). Pre break this had decreased to 14% (n=14) in Nelspruit and 10% (n=6) in Richmond. By the end of shift 4% (n=4) in Nelspruit and 2% (n=1) in Richmond had remained overhydrated and without correcting for fluid and food intake, 5% (n=5) had gained over 2% of their body weight in Nelspruit while none had gained weight in Richmond. Overhydration was not related to season (winter/autumn), gender or job category. Physical symptoms at the end of shift included tiredness (24%), toothache (13%) and headaches (10%) although these did not correlate to end of shift USG readings (p=0.221). The fluid requirements for male workers (n=8) who did not eat or drink across the shift was 439 ml per hour. The contractors were unaware of how much fluid should be supplied to workers and how much fluid they actually supplied. The only fluid provided by the contractors was water at the ambient air temperature which was the main source of fluid for the majority. Some forestry workers brought a limited variety of other fluids including amahewu, tea and cold drinks to work. At least 40% of the work force investigated, started their shift already compromised to work to capacity (USG>1.020 g/ml). The prevalence of dehydration had increased by the break emphasizing the need to begin drinking early on in the shift. The majority of forestry workers were dehydrated at the end of the shift. A significant proportion was dehydrated to the extent (>2%) that both work capacity and mental ability would be significantly compromised. A select group of forestry workers were drinking excessive amounts of fluid and were therefore susceptible to potentially fatal dilutional hyponatremia especially as water was the primary source of fluid. Dehydration in both autumn and winter was identified as being a significant but preventable risk. As a consequence of overhydration, a small group of forestry workers may be susceptible to dilutional hyponatremia. Fluid intake guidelines for males of 450 ml per hour appeared to be safe and were within the recommendations of the American College of Sports Medicine. Fluid guidelines for females need investigation.
Nutrient intakes, dietary diversity, hunger perceptions and anthropometry of children aged 1-3 years in households producing crops and livestock in South Africa : a secondary analysis of national food consumption survey of 1999.
(2006) Bolaane, Lenkwetse.; Maunder, Eleni Maria Winifred.
Children less than five years of age are at a risk of growth failure worldwide. The South African National Food Consumption Survey (NFCS) of 1999 showed that 25.5% of children aged 1 - 3 years were stunted. Poor growth of young children in developing countries (South Africa included) has been associated with multiple micronutrient deficiencies because of the use of starchy plant-based complementary foods with little variety, especially among resource poor households. Dietary diversification through the use of crop and livestock production has been recommended as a strategy to improve the micronutrient intake and food security of households in resource poor settings. This study was a cross sectional secondary analysis of the South African NFCS of 1999 data, designed to investigate the impact of crop and livestock production on nutrient intake, dietary diversity, intake of selected food groups, hunger perceptions and anthropometric status of children aged 1 - 3 years in South Africa. Children from households producing crops only (n=211), crops and livestock (n=110), livestock only (n=93) and non-producers were compared at the national, in rural areas and among households with a total income of less than R12 000.00 per household per year. In rural areas and among households with a total income of less than R12 000.00 per household per year, children in the crops and livestock group had higher nutrient intakes for energy, vitamin 86, calcium and folate than the other groups (p<0.05), while the crops only group had higher nutrient intakes for vitamin A and vitamin C. The majority of children in all the four study groups had less than 67% of the RDAs for vitamin A, vitamin C, folate, calcium, iron and zinc. In addition , children in all the groups had a median dietary diversity score of four out of 13 food groups. In rural areas and among low income households, higher percentages (over 60%) of children in the crops only group consumed vegetables while the non-producers group was the lowest (47.7%). The non-producers group had the highest percentages of children consuming meat and meat products and the crops and livestock and livestock only groups had the lowest percentages. In both rural areas and among households withlow income, the majority of the households in all the study groups were experiencing hunger. In rural areas, one in five households were food secure. Crop and livestock production improved the nutrient intake and the intake of vegetables of children in rural and poor households. However, nutrient intakes were not adequate to meet the recommended nutrient levels. The high levels of food insecurity require support of these households to increase crop and livestock production and, integration of nutrition education to increase the consumption of the produced products.
Professional development of dietitians completing compulsory community service in South Africa with special focus on KwaZulu-Natal.
(2006) Paterson, Marie.; Green, Jannette Maryann.; Maunder, Eleni Maria Winifred.
Introduction: The aim of this research was to establish the attitudes, knowledge, job satisfaction and professional development of community service dietitians because negative attitudes, poor knowledge, low levels of job satisfaction and poor professional development would be detrimental to the process of community service and ultimately to the provision of health services. Methodology: Three distinct annual intakes of qualified dietitians completing compulsory community service were the subjects of an analytical cross sectional survey conducted biannually for the period 2003-2005. Data collection methods included telephone interviews, mail, emailed questionnaires and focus group discussions. Individual factors: sex, population group, language, university attended; institutional factors: organisation of community service, mentorship rating, hospital manager support type of facility, rural allowance, hospital location, access to resources, working and living conditions and personal safety and other factors: attitude, community nutrition knowledge, job satisfaction and professional development were included in the data set. Management of data: Data were divided into 2003 cohort (n=20) and 2004-2005 cohorts (n=26). Analysis of the demographic details for 2003 and 2004-2005 cohorts were, respectively: mean ages 23.6 (±0.99) and 24.05(±4.96) years, 60 percent and 73 percent white, 90 percent and 96 percent female, 35 percent and 73 percent University of KwaZulu-Natal graduates and 65 percent of both cohorts were placed in rural facilities. Results: Community nutrition knowledge of the 2003 cohort was unacceptable but improved in the 2004-2005 cohort. Subjects had a generally positive attitude towards community service. Community nutrition levels of knowledge of the 2003 ranged between 60 percent at entry and 67 percent at exit and for the 2004-2005 between 72.8 percent and 78.42 percent. The job satisfaction level of the 2003 cohort at exit was 13.65 (±3.573). In the 2004-2005 cohort job satisfaction was 15.75(±3.360) at entry and 15.75 (±3.360) at exit. 85 percent of the 2003 cohort rated their professional development positively whereas 65 percent of the 2004-2005 cohort rated theirs' positively. This decline and associated problems were to some extent shown in the interview responses. The 2004-2005 cohort did however show a tendency for improvement in the professional practitioner ranking (p=0.088). The majority (95%) of the 2004-2005 cohort rated the dietetic services positively. Focus group discussions highlighted problems that the community service dietitian (CSD) encountered such as lack of supervision and support, lack of basic facilities, poor hospital administration, problems with transport, work overload and problem with their professional role in the community and health facility. A model showing the results of the research indicated that the objectives of the Department of Health for improved service in rural areas were obtained but the retention of health professionals and capacity was lost due to annual rotation of subjects. Community service as a strategy to overcome service delivery has merit provided identified problems are addressed.
Comparison of indicators of household food insecurity using data from the 1999 national food consumption survey.
(2006) Sayed, Nazeeia.; Maunder, Eleni Maria Winifred.
Information on the present situation of household food insecurity in South Africa is fragmented. There is no comprehensive study comparing different indicators of household food security. Better information on the household food security situation in South Africa would permit relevant policy formulation and better decision-making on the allocation of limited resources. The availability of a national dataset, the first South African National Food Consumption Survey data (1999) , provided the opportunity to investigate some of the issues raised above, and to contribute to knowledge on the measurement of household food security. The aim of this study was to use the data from the 1999 National Food Consumption Survey (NFCS) to : • Determine and compare the prevalence of household food insecurity using different indicators of household food security ; • Determine the overlap of households identified as food insecure by the different indicators (i.e. how many of the same households are identified as food insecure); and to • Investigate whether there was any correlation between the indicators selected . The indicators of household food security selected were: household income, household hunger experienced, and using the index child: energy and vitamin A intake (from 24 Hour Recall (24HR) and Quantified Food Frequency data), dietary diversity (from 24HR data) and anthropometric indicators stunting and underweight. The cut offs to determine food insecure household were those used in the NFCS and the cut off for dietary diversity was exploratory. The main results of the study were as follows : • The prevalence estimates of household food insecurity ranged from 10% (underweight indicator) to 70% (low income indicator). Rural areas consistently had a higher prevalence of household food insecurity than urban areas . The Free State and Northern Cape provinces had higher levels of household food insecurity, with the Western Cape and Gauteng the lower levels of household food insecurity . • Quantified Food Frequency (QFF) data yielded lower prevalence of household food insecurity estimates than 24 hour recall (24HR) data. Household food insecurity as determined by low vitamin A intakes was higher than that determined by low energy intakes for both the 24HR and QFF data . • There was little overlap with the indicators (9-52%), indicating that the same households were not being identified by the different indicators. Low dietary diversity, low income, 24HR low vitamin A intake and hunger had higher overlaps with the other indicators. Only 12 of 2826 households (0.4%) were classified by all nine indicators as food insecure. • The dataset revealed a number of statistically significant correlations. Overall , low dietary diversity, low income, 24HR low energy intake and hunger had the stronger correlations with the other indicators. Food security is a complex, multi-dimensional concept, and from the findings of this study there was clearly no single best indicator of household food insecurity status. Overall , the five better performing indicators (higher overlaps and correlations) were : low income, 24 hour recall low energy intake, 24 hour recall low vitamin A intake, low dietary diversity and hunger; this merits their use over the other selected indicators in this study. The indicator selected should be appropriate for the purpose it is being used for, e.g. estimating prevalence of food insecurity versus monitoring the long term impact of an intervention. There are other important criteria in the selection of an indicator. Income data on a national scale has the advantage of being available annually in South Africa, and this saves time and money. The 24HR vitamin A intake and 24HR energy intake indicators has as its main draw back the skill and time needed to collect and analyse the information, which increases cost and decreases sustainability. Dietary diversity and hunger have the advantage of being simple to understand, and quicker and easier to administer and analyse. It is suggested that a national food security monitoring system in South Africa uses more than one indicator, namely : 1) household income from already existing national data, 2) the potential for including a hunger questionnaire in the census should be explored, and 3) when further researched and validated, dietary diversity could also be used in national surveys.
The effect of Lactobacillus reuteri supplementation on anthropometric measurements, lung function and lung infections in a cystic fibrosis population in KwaZulu-Natal.
(2007) Read, Amanda Jane Price.; Maunder, Eleni Maria Winifred.
BACKGROUND: Cystic fibrosis (CF) patients grow poorly and tend to be malnourished. They frequently suffer from lung infections necessitating the repeated use of antibiotics. AIM: This study was conducted to determine whether supplementation with a probiotic Lactobacillus reuteri (L. reuteri) could reduce the incidence and duration of lung infections, and whether this would impact on their anthropometric data. The secondary purpose was to compare the nutritional status of the CF patients attending CF clinics in Kwazulu-Natal (KZN) with CF patients attending CF clinics in Cape Town (CT). METHODS: Twenty three CF patients 6-31 years of age from 2 CF clinics in Kwazulu-Natal started the study although only 16 patients completed it. The study was a randomized, double blind, placebo controlled crossover trial with six months on placebo and six months on probiotic. Weight, height, mid arm circumference (MAC), triceps skin fold thickness (TSF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured, sputum collected and a symptom diary completed over the 12 month period. Anthropometric data of CF patients attending CF clinics in CT was obtained from the publication by Westwood & Saitowitz (1999). RESULTS: Compliance with taking the L. reuteri was poor. Most took only 50% of the required daily dose. Probiotic supplementation showed a slight (non significant) trend to improve FEV1 and FVC, while no significant difference could be seen in the number and duration of the lung infections. Sputum analysis showed a non significant trend towards the probiotic reducing the number of bacteria in the sputum. There was a significant reduction of symptoms for fever, running nose, sore throat and ear ache while on placebo. There was a significant increase in weight gained off probiotic compared to the probiotic period. The changes in height, weight for age (WFA) percentiles, height for age (HFA) percentiles, WFA and HFA Z-scores, percentage expected weight for age and percentage expected height for age all showed no difference whether on or off probiotic. Over half the CF children in the KZN clinics were underweight for their actual height compared to one third in the CT clinics with a higher number of subjects below the 5th percentile for MAC and TSF readings compared to CT. CONCLUSION: Due to a small sample size and poor compliance no firm conclusions could be drawn. However a slight (non significant) improvement could be seen in favour of the probiotic for FEV1, FVC, and sputum analysis. Although all other findings were not significantly different it would be of benefit to carry out further investigation with improved compliance with the probiotic to see if the parameters set out above could be improved. The KZN and CT CF groups were comparable and the nutritional status of CF patients on KZN was well below that of the CT CF clinics and further monitoring would need to be carried out.
The use and interpretation of the nutrition information on the food label of selected fat spreads by female consumers aged 25-45 years, living in Pietermaritzburg.
(2006) Wiles, Nicola Laurelle.; Paterson, Marie.; Meaker, Jill.
Aim: To determine the use and interpretation of the nutrition information on the food label of selected fat spreads by female consumers aged 25 to 45 years, living in Pietermaritzburg. Objectives: This study set out to determine the following objectives regarding the food label: what the demographics of the consumers making use of the label were; how these consumers used the label and their motivation behind this label use and did the use of the label alter the purchase of that product? Method: One hundred and fifty women aged 25-45 years were chosen from an accidental, non-probability sample of consumers shopping at selected supermarkets within Pietermaritzburg. Respondents were presented with a four part questionnaire surrounding the purchase of selected fat spreads. Results: The greatest number of respondents were from the white population group (n = 65), followed by black respondents (n = 46), Indian respondents (n = 29) and then coloured respondents (n = 10). Results showed that the respondent who was most likely to use the nutrition information on the food label had a tertiary education; was a primary food purchaser, lived with other people, had more than R1000 a month to spend on food and was conscious of choosing the healthier option. Fifty five percent of this study sample (n = 82) claimed to use the nutrition information on the label to assist with purchases and 68% (n = 102) found the nutrition information important for purchasing a new product. Of the potential factors that have previously been found to impede the use of the nutrition information label:-inadequate print size, lack of education as well as lack of nutrition information on the food label were found to be factors restricting label use in this study. The most commonly used sources of nutrition information were the media as well as friends and family and the most trusted source was the Health Professional. Discussion: If the nutrition information is to be used both correctly and effectively, there must be a major educational campaign that sets out to meet the needs of the population that are most vulnerable, especially those with an inadequate education. Conclusion: The consumer most likely to use the nutrition information on the food label has a tertiary education, is a primary food purchaser with a large amount of money available for groceries and is conscious of choosing a healthier option. The label is most likely to be used when purchasing a fat spread for the first time.
The current infant feeding practices and related factors of Zulu mothers with 0-6 month old infants attending PMTCT and non-PMTCT clinics in central Durban, KwaZulu-Natal : an exploratory study.
(2005) Kassier, Susanna Maria.; Maunder, Eleni Maria Winifred.
Abstract: Introduction: Exclusive breastfeeding for the first six months of an infant's life is recommended worldwide. In 1998 the South African Demographic and Health Survey (SADHS) showed that only 10% of mothers exclusively breastfeed at three months. As the HIV virus is transmissible via breast milk, UNAIDS (2002) recommends that women in developing countries should be given a choice of feeding method after being counselled on the risks and benefits of breast feeding versus formula feeding. As a result, the Prevention of Mother-to-Child Transmission (PMTCT) programme was launched in KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child Transmission of the HIV virus. However, research has shown that infant feeding practices are influenced by numerous factors. Ultimately mothers will feed their infants in a manner they feel comfortable with, even if it is not always the most appropriate choice. Aim: The aim of this study was to determine and compare current infant feeding practices and some of the factors that influenced these practices among Zulu mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT clinics in Central Durban, KwaZulu-Natal. Methodology: A cross-sectional, descriptive survey was conducted amongst 150 mothers sampled from three non-PMTCT clinics and 150 mothers sampled from three PMTCT clinics. Systematic random sampling of mothers attending the two types of clinics was used to ensure an equal number of mothers· with infants aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number of mothers interviewed per clinic was determined proportionate to clinic size. Interviews were conducted in Zulu by trained fieldworkers according to a structured interview schedule consisting of 87 open- and closed-ended questions. Summary of most important findings and conclusion: Overall, one quarter of the mothers attending non-PMTCT and one third of mothers at PMTCT clinics were practising exclusive breastfeeding at the time of the survey. The general trend was that mothers attending PMTCT clinics were more inclined than those attending non-PMTCT clinics to breastfeed their infants exclusively (34% versus 24% respectively) or to formula feed (16,7% versus 12,7% respectively). Furthermore, there was a significant decline in exclusive breastfeeding and predominant breastfeeding with increasing infant age in both clinic groups. The opposite held true for mixed feeding and formula feeding in that infants were more inclined to mixed feeding or formula feeding with increasing infant age. In both clinic groups, exclusive breastfeeding was the method of choice in the 0 - < 6 week age category, while a preference for mixed feeding was shown in the 6 - < 14 week category. This trend persisted in the 14 week - < 6 month age category, especially in the non-PMTCT clinics, while there was a small but pronounced increase in formula feeding amongst PMTCT mothers. Although these findings can be explained as a result of implementing the PMTCT programme, the positive trends observed in non-PMTCT clinics serve as an indicator that the Integrated Nutrition Programme (INP) and Baby Friendly Hospital initiative have also had an impact on the feeding choices mothers make. Despite the limited duration of the PMTCT programme at the time of the study, indicators of the impact of the intervention include that a lower percentage of PMTCT mothers introduced foods and/or liquids in addition to breast milk to their infants before six months of age compared to non-PMTCT mothers. Furthermore, more mothers attending PMTCT clinics were shown how to breastfeed and were more likely to have received information about formula feeding. Despite these indicators of a positive impact of the PMTCT programme, the mean age for introducing liquids and/or solids in addition to breast milk was about six weeks and the incidence of this practice was very high for both groups. The similar incidence of formula feeding observed between the two clinic groups suggests the presence of constraints to safe infant feeding choices among mothers attending PMTCT clinics. As observed, infant feeding practices were still not ideal in either of the two clinic groups. However, the high level of antenatal clinic attendance documented for both groups serves as evidence that, if opportunities for providing mothers with appropriate infant feeding advice are utilized optimally, the antenatal clinic could serve as an ideal medium through which infant feeding education can take place, especially as the clinic-based nursing staff were cited as the most important source of infant feeding information by both groups of mothers in the antenatal and postnatal phases. The documented infant feeding practices should be interpreted against the backdrop of factors such as socio-demographic characteristics of the mothers, availability of resources such as social support from peers and significant others and reigning infant feeding beliefs that could influence infant feeding decisions. Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were determined by means of multivariate logistic regression analysis. Significant values were obtained for both clinic groups in terms of the infant not having received liquids in addition to breast milk. No additional predictors were found amongst mothers attending non-PMTCT clinics, however predictors amongst mothers attending PMTCT clinics included whether the mother had not visited the clinic since the infant's birth, whether she practiced demand feeding and whether she was experiencing stress at the time of the study. The limited number of predictors of exclusive breastfeeding documented in this study, especially among non-PMTCT mothers may be explained by the fact that infant feeding behaviour is multifactorial by nature and the interaction between factors that influence feeding choice is strong.
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.
Developing and assessing the appropriateness of the preliminary food-based dietary guidelines for South Africans.
(2002) Love, Penelope Valmai.; Maunder, Eleni Maria Winifred.; Green, Jannette Maryann.; Ross, Fiona.
Aim. The aim of this study was to document and provide a critical analysis of the South African Food-Based Dietary Guidelines (FBDGs) development process, and to assess the appropriateness of the proposed South African FBDGs. To achieve this aim, specific study objectives included the following : (1) To document and critically analyse the South African FBDGs process in relation to the 10-step development process recommended by the FAO/WHO. (2) To assess the appropriateness of the proposed South African FBDGs in terms of consumer comprehension (perceptions, general understanding and specific interpretations), and application of the guidelines (ability to apply the guidelines when planning a typical day' s meals for their families). (3) To assess the compatibility of the proposed South Africa FBDGs in terms of food categorisation as perceived by consumers, and as depicted in the food guides that are commonly used. Methodology. An extensive literature review on the development of international dietary guidelines, the emergence of FBDGs and the FAO/WHO FBDGs process, together with documentation of the South African FBDGs process, was used to critically analyse the process used for developing the proposed South African FBDGs. Focus group discussions (n=15) and structured individual interviews (n=230) were held in ten magisterial districts within KwaZulu Natal (KZN), randomly selected according to settlement strata (rural, urban informal, urban formal) and ethnicity (Black, Indian, White) to reflect the KZN population. Participants were women with no formal nutrition training, who made the food purchasing and preparation decisions in the household. A total of 103 women participated in the focus group discussions and 230 women in the structured individual interviews. Results. The process followed by the SA FBDG Work Group has ensured that the proposed South African FBDGs are country-specific in that each FBDG is evidence-based and relates to specific nutrition-related public health concerns of South Africans. Except for the "Eat healthier snacks" FBDG, participants understood and interpreted the FBDGs as intended by health professionals, and could construct a day's meals to reflect the FBDGs. Only two other FBDGs were identified as confusing in terms of terminology used, namely, "legumes" and "foods from animals". By rewording these guidelines the FBDGs would be highly compatible in terms of personal food categorisation. Use of food guides was low, mainly due to a lack of knowledge about how to use them. In terms of food categorisation as depicted by the reportedly most commonly used food guides (3- and 5- Food Group Guides), these food guides are incompatible with the proposed FBDGs. Conclusions. Within the South African context, the FAO/WHO FBDGs development process was feasible and practical to implement. However, to ensure sustainability of the South African FBDGs process, it is strongly recommended that the Department of Health appoint a representative scientific committee specifically for the purpose of reviewing and reformulating the South African FBDGs. Results indicate that a single set of FBDGs can be appropriate for all South Africans provided that certain guidelines are reworded as suggested; and that all the guidelines are accompanied by explanatory information citing commonly consumed foods/drinks as well as practical examples of how to apply the guidelines in light of perceived barriers. In terms of the appropriateness of food guides commonly used in South Africa, there is a need to either move away from the concept of food groups and/or to develop a new South African food guide that is compatible with the proposed FBDGs.
The tuck shop purchasing practices of grade 4 learners at selected primary schools in Pietermar[it]zburg, South Africa.
(2011) Wiles, Nicola Laurelle.; Green, Jannette Maryann.; Veldman, Frederick Johannes.
Aim: To determine whether the tuck shop purchasing habits of Grade 4 learners were contributing towards the development of childhood overweight and obesity. Objectives: To assess the nutritional quality of the food and beverages available for learners to purchase; items regularly purchased from the tuck shop as well as factors influencing the learner’s decision to purchase these items; the anthropometric and socio-demographic characteristics of grade 4 learners as well as their nutrition knowledge related to the tuck shop items purchased. Method: A survey administered to 11 tuck shop managers, a questionnaire administered to 311 Grade 4 learners and two single-sex focus groups of 5 learners each were conducted. Results: Fifty six percent of the sample were female (n=173) and 44% were male (n=138). Twenty seven percent of the study sample was overweight (n = 83) and 27% were obese (n = 85). Eighty six percent of learners (n = 266) claimed to buy from their school tuck shop. Twenty two percent of learners purchased from their tuck shop at least three times per week (n =58). Learners who purchased from the tuck shop had a significantly higher BMI than those who did not (p = 0.020). Learners who purchased from the tuck shop spent on average R8,38 per day with a minimum of R1 and a maximum of R40 (standard deviation R5.39). The most popular reasons for visiting the tuck shop included “this is my favourite thing to eat or drink” (66.5%, n = 177) and “I only have enough money to buy this item” (47.0%, n = 125). Savoury pies were the most popular "lunch" item for all learners for both food breaks (45%, n = 5 schools and 27.3%, n = 3 schools) selling the most number of units (43) per day at eight of the eleven schools (72.7%). Iced popsicles were sold at almost every school, ranked as the cheapest beverage and also sold the most number of units (40.7). Healthy beverages sold included canned fruit juice and water, while healthy snacks consisted of dried fruit, fruit salad, bananas, yoghurt and health muffins. The average healthy snack contained almost half the kilojoules of its unhealthy counterpart (465kJ vs 806kJ). Nutritional analyses of the healthy lunch options revealed total fat contents that exceeded the DRI and South African recommended limit. Perceived barriers to stocking healthy items included cost and refrigeration restrictions. The average score for the food groups was only 33% indicating that learners were not familiar with the Food Based Dietary Guidelines (FBDG). Further analyses showed that the total knowledge scores of those learners that reported to buy from the tuck shop frequently, was significantly lower when compared to the total knowledge scores of those learners who bought from the tuck shop less frequently (13.0 ± 3.9 and 11.6 ± 3.1, respectively; p < 0.05). Logistic regression analysis confirmed that the total knowledge of a learner could be used to predict whether he or she is more likely to make purchases from the tuck shop (significance = 0.017). Focus group results revealed that learners are aware of “healthy” and “unhealthy” tuck shop items. Most learners stated that they would continue to purchase items from their tuck shop if all “unhealthy” items were removed. Conclusion: Primary school tuck shops of well resourced schools in Pietermaritzburg are contributing to childhood overweight and obesity through a combination of factors. These include the poor nutritional quality of the items stocked at the tuck shop as well as the poor tuck shop purchasing practices. Much consultation is required amongst dieticians, school principals and privatised tuck shop managers to overcome barriers to stocking healthy items. School management and government have an important role to play in imposing restrictions on the sale of unhealthy items; along with improving the quality of the nutrition education curriculum to ensure that learners are able to translate their knowledge into healthier purchasing practices.
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.
A study of the quality and feasibility of Sibusiso, a ready-to-use food.
(2012) Mahlangu, Zodwa Nita.; Siwela, Muthulisi.; Veldman, Frederick Johannes.; Wiles, Nicola Laurelle.
A ready-to-use food (RUF), Sibusiso, has the potential to alleviate protein- energy malnutrition. However, its nutritional composition, physical properties, consumer acceptability, and economic feasibility for use are unknown. This study aimed to determine the nutritional composition and physical properties of a RUF, Sibusiso. As well as to assess the consumer acceptability of Sibusiso to healthy and HIV infected children on antiretroviral (ARV) medication, and the caregiver‟s attitudes towards Sibusiso. The feasibility of using Sibusiso for nutrition rehabilitation was also determined. Methodology: Four samples of Sibusiso and a peanut butter (control) were analysed for their nutritional composition and physical properties. The consumer acceptability of Sibusiso to healthy children and HIV infected children on ARVs (ART group) was determined using a five-point facial hedonic rating scale. Focus group discussions were conducted to assess the attitudes and perceptions of caregivers surrounding Sibusiso. These caregivers had children who were either malnourished or at risk of malnutrition. The financial feasibility of using Sibusiso for nutrition rehabilitation was determined using published data. The results revealed that Sibusiso was a good source of energy (2624 kJ/100 g) and quality protein (15.7 g/100 g). The nutritional composition of Sibusiso met the WHO/WFP/SCN/UNICEF recommendations for RUF. Instrumental colour analysis indicated that both Sibusiso and the peanut butter had a brown colour, although Sibusiso was slightly lighter. Sibusiso had the same spreadability or hardness as the peanut butter, but it was stickier than the peanut butter. Based on the sensory evaluation, Sibusiso was found acceptable to both healthy (n=121) and HIV infected children (n=51). Over 65% of the children in both the healthy and ART group liked the taste, smell and mouthfeel of Sibusiso. The caregivers also found Sibusiso acceptable and were willing to buy it, but at half its current price (60 ZAR/ 500 g). The price of Sibusiso and perception of the caregivers that Sibusiso was a peanut butter were the main factors that affected their willingness to buy the product. Financial feasibility analysis showed that the estimated cost (5.99 ZAR/day) of rehabilitating a child using Sibusiso was higher than the KwaZulu-Natal Department of Health nutrition budget of 0.02 ZAR/day. Sibusiso is a good source of energy and quality protein, and it is fairly acceptable to children with HIV and caregivers. This indicates that Sibusiso has a potential to alleviate protein-energy malnutrition in the targeted groups. Yet, Sibusiso is expensive. There would be a need to somehow reduce the cost of Sibusiso so that it would be financially feasible to use it in nutrition intervention programmes.
Supplementary feeding of South African underweight children between 1 and 10 years of age with ready-to-use food to promote weight gain.
(2012) Maharaj, Kirasha.; Veldman, Frederick Johannes.
The aim of this study was to investigate whether Sibusiso, a Ready Food Supplement (SRFS), developed by the Gift of the Givers Foundation was able to promote weight gain among underweight children between 1 and 10 years of age. The study also aimed to train CAST community workers on how to assess and identify underweight children and to determine the number of underweight children aged 1-10 years who were currently on the CAST food aid program in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal. This non-randomised intervention study was carried out on a total of 19 out of 20 subjects that initially qualified for inclusion into the study. A monitoring tool was used to collect data on anthropometrical measurements, symptoms experienced, disease conditions identified, level of appetite, meal consumption and energy for each subject for a period of three months. Study subjects were from families living in Cato Manor and Chesterville in Durban, Kwa Zulu-Natal, who were part of a food aid programme run by non-governmental organisation Church Alliance of Social Transformation (CAST). SRFS was compared to Recommended Energy Allowances (REA) and Recommended Daily Allowances (RDA) to determine the amount of energy and macronutrients that SRFS provided to subjects in their different age groups. The predominant health conditions and symptoms experienced by the subjects were assessed. General improvement in appetite, meal consumption and energy levels among subjects were monitored during the supplementation period Out of 19 subjects who were supplemented with SRFS over the three month period, it was established that more children from Chesterville than Cato Manor were part of the CAST food parcel programme. SRFS was not able to meet 100% of the RDA and REA for subjects in their different age groups. However, SRFS was able to promote weight among subjects as 50% of subjects were able to achieve normal weight-for-age growth by the third month of supplementation. Human Immunodeficiency Virus (HIV) infection was the predominant disease condition experienced among subjects. A steady decline in the frequency of infection symptoms experienced among subjects was observed. Appetite, meal consumption and energy levels among subjects increased during the three moth supplementation period. In conclusion, SRFS was successful in promoting weight gain among underweight children and was able to improve the overall wellbeing of subjects by alleviating the burden of disease conditions and infection symptoms while improving appetite, meal consumption and energy levels. SRFS therefore was beneficially utilised in the CAST food aid programme. SRFS had beneficial effects on the health and nutritional status of the study subjects during the observed period of its use in the CAST food aid programme and its continued use is recommended.
The hydration status, fluid and carbohydrate intake of male adolescent soccer players during training in Pietermaritzburg, KwaZulu-Natal.
(2012) Gordon, Reno.; Biggs, Chara.; Kassier, Susanna Maria.
Adolescent athletes of this era are more pressurized than adolescents of previous generations to perform at an optimum level (Micheli & Jenkins 2001, p49). The importance of winning can result in adolescent athletes developing inappropriate nutritional practices such as neglecting hydration and consuming insufficient carbohydrate (Micheli & Jenkins 2001, p57). Consuming insufficient fluid leads to dehydration which reduces a soccer player’s ability to continue training. Consuming inadequate carbohydrate reduces performance and blood glucose levels during training. This study aimed to determine the hydration status, fluid and carbohydrate intake of male, adolescent soccer players during training. A cross-sectional study was conducted among 122 amateur male, adolescent soccer players (mean age = 15.8 ± 0.8 years; mean BMI = 20.4 ± 2.0 kg/m2). The players’ hydration status before and after training, was measured using urine specific gravity and percent loss of body weight. Their carbohydrate intake, as well as the type and amount of fluid consumed, were assessed before, during and after training. A questionnaire was administered to determine the players’ knowledge regarding the importance of fluid and carbohydrate for soccer training. The study had an 87.1% response rate. The mean environmental conditions did not predispose players to heat illness. However, the players were at risk of developing heat illness during six of the 14 training sessions. Although the mean urine specific gravity indicated that players were slightly dehydrated before and after training, 43.8% of players were very or extremely dehydrated before training and 53.6% after training. A few (3.3%) were extremely hyperhydrated before training and after training (7.0%). On average players lost less than 1% of body weight during training and less than 3% of players dehydrated more than 2%. Players consumed mainly water before (289.17 ± 206.37 ml), during (183.20 ± 158.35 ml) and after (259.09 ± 192.29 ml) training. More than 90% stated that water was the most important fluid to consume before, during and after training. Very few (4.7%) correctly stated that carbohydrate should be consumed before, during and after training. Players were found to be slightly dehydrated before and after training and therefore were not consuming enough fluids during training. Players consumed inadequate amounts and types of fluid and carbohydrate. This not only compromises their performance but also health. Players were not aware of the importance of fluid and carbohydrate for soccer training. This study is unique in that it focused on the carbohydrate and hydration practices of socioeconomically disadvantaged adolescent soccer players during training. The study sample therefore represents a high risk group about which there is limited published data both locally and internationally. This study generated important baseline information which was lacking before on the hydration status, fluid and carbohydrate intake of adolescent soccer players in South Africa.
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.
The effectiveness of a food based dietary guideline nutrition education game and educator's support material as a supplement to improve retention of knowledge in rural Grade 5 learners, living in Sweetwaters, KwaZulu-Natal.
(2013) Esteves, Rebecca Anne.; Wiles, Nicola Laurelle.; Van Onselen, Annette.
Aim: To determine the effectiveness of a Food Based Dietary Guideline (FBDG) nutrition education game and educator’s support material (ESM) as a supplement to improve retention of knowledge in rural Grade 5 learners, living in Sweetwaters, KwaZulu-Natal. Objectives: To determine: the baseline nutritional knowledge of Grade 5 learners; the effects of the ESM or a nutrition education game on the retention of FBDG knowledge, and the educators’ opinions about using both the ESM and the nutrition education game. Method: An intervention study involving 266 Grade 5 learners in four schools. A pre-test was followed by either an ESM intervention or a nutrition education game intervention. A post-test was conducted to determine the effects of both interventions on FBDG knowledge retention. A second questionnaire was administered to the educators of the learners who participated in the interventions. Results: The sample was made up of 53.8% (n=141) male participants and 46.2% (n=121) females, all between the ages of 8 and 15 years. Results showed very little improvement in the retention of knowledge as a whole. However, questions that asked about familiar concepts showed an improvement compared to those that were completely new. More complicated questions showed an improvement when the game was used, as the pictorial representation helped the learners to remember the answer. For example the average percentage for knowledge of fortification before the game was 1% while post intervention it increased to 29.6%. This showed that simple concepts based on a good pictorial representation were retained better than information that was difficult to conceptualise. All educators found the game useful and beneficial for the learners. The ESM was not as well used as the game as it was perceived to be too time consuming. Conclusion: Learners enjoyed the game and the educators gave positive feedback, however there was no significant retention of knowledge in this study. Further research needs to be done using a game as a tool for nutrition education over a longer period of time and with a greater amount of educator training.
Situational assertiveness of South African registered dietitians.
(2000) Paterson, Marie.; Green, Jannette Maryann.; Basson, Clive James.; Ross, Fiona.
Female dominated professions are lower in status because occupational prestige is higher for men than for women in the science, maths and technology occupations (Farmer, Rotella, Anderson & Wardrop 1998). The female dominated professions are paid less and are viewed as less desirable and less worth (Atwater & Van Fleet 1997). It was hypothesised that the reason why dietetics as a female dominated profession had lower status and the other attributes of a female dominated profession could have been due to decreased levels of assertiveness and increased levels of anxiety when they were dealing with the male dominated professions such as the medical profession. It was theorised that a number of factors affected levels of anxiety and assertiveness and a model, developed from the literature, was presented to describe these effects. A random sample of female dietitians (n=321) and all male dietitians (n=29) who were registered with the Health Professionals Council of South Africa (HPCSA) at the beginning of 1999, were mailed questionnaires which contained questions on demographic information and self-assessment inventories. Of these one hundred and forty-five useable questionnaires from female (n=135) and male (n=10) dietitians were returned. Information received from the HPCSA and analysis of their register revealed that dietetics was a female dominated profession. Of the dietitians registered at the end of 1999(n=1260), 97%(n=1217) were females, and 3% (n= 34) were males. The majority of dietitians in the sample were Afrikaans speaking (n=73), and were from the highest socioeconomic group (n=74). The largest number(n=56) trained at the University of Pretoria. The average age of the dietitians was 32.4(±8.56). Almost a quarter of the sample had post registration qualifications (n=34). The majority had no formal training in assertiveness (n=92). The results of the inventories showed that dietitians had levels of assertiveness and anxiety that were within the norms as noted in the literature. This meant that the lower status of dietetics must be attributable to something else. Levels of self-efficacy were significantly higher than test levels quoted in the literature and this had a positive effect on the levels of assertiveness. Job satisfaction levels were significantly lower than American dentists. This was ascribed to poor pay, and difficulty in obtaining employment as a dietitian. None of the other factors tested for affected the level of assertiveness. An amended model Amended Factors Affecting Assertiveness using the findings of this research project has been presented. This is a simpler concept than the original model.
The attitude toward and the prescription of a low carbohydrate, high fat diet by KwaZulu-Natal clinical dieticians.
(2015) Joyner, Stephanie Alexandra.; Wiles, Nicola Laurelle.; Kassier, Susanna Maria.
Aim: To determine the attitude toward and the prescription of a low carbohydrate, high fat (LCHF) diet by KwaZulu-Natal clinical dieticians working in government or private practice. Objectives: The study set out to determine the following objectives: (i) dieticians’ attitudes toward a LCHF diet, (ii) the prescription of this diet in practice and concerns regarding the diet; (iii) to determine if there is a relationship between the socio-demographic characteristics, areas of work and professional interest as well as research involvement of dieticians and the prescription of a LCHF diet in practice; and to (iv) assess whether dieticians would be willing to adapt their practice methods and attitude after hearing a presentation on the LCHF diet. Method: The email addresses for 155 clinical dieticians, working in either government or private practice, were obtained from a data base. The dieticians were emailed a link to a four-part online questionnaire regarding their area of work, main professional interests, practice methods, prescription or non-prescription of a LCHF diet and research involvement. Results: The response rate to the questionnaire was 58% (n=90). The majority of the subjects were female (n=87, 97%) and had qualified at the University of KwaZulu-Natal (n=67, 74%). Patients with non-communicable diseases were the most common condition counselled by the subjects (71.3%). The latter was also the main area of interest for subjects in private practice. Upon analysis of the section pertaining to research involvement, it was found that the majority of subjects scored poorly in the questions related to the most basic of research involvement skills, with an average score of 40%. Overall, there was a negative attitude toward the prescription of the LCHF diet. Only 17% (n=15) of the subjects had prescribed the LCHF diet in practice and it had been prescribed rarely. The most common condition that the diet was prescribed for was weight loss. Subjects working in private practice were more likely to prescribe a LCHF diet for their patients compared to those working in government. More than 80% of the sample reported that they had never prescribed the diet. The most common reason provided was that it was felt there was a lack of supportive evidence for its use. Discussion: The finding that private practicing dieticians are more likely to prescribe a LCHF diet to patients may be because this type of patient is more likely to be able to afford and sustain a LCHF diet compared to the type of patients seen by subjects working in the government sector. These patients are also more likely to be aware of the LCHF diet compared to government health patients. Very few deiticians prescribed a LCHF diet; this may be a reflection of the dieticians practicing evidence evidence-based nutrition and/or it could be related to harm-avoidance. The very low level of research involvement and skill observed in the study is a concern and should be used as a basis for further investigation. Conclusion and recommendations: The low score obtained by subjects in basic research involvement could be interpreted that more emphasis should be placed on this area in undergraduate training and in the continuing professional development of qualified dieticians. More studies need to be done on the long-term safety and efficacy of a LCHF diet for the prevention and management of NCDs. Dietetic authorities should consider a country-wide advertising campaign to encourage the public to consult a Registered Dietician before following a LCHF diet
A comparative analysis of the nutrition status, nutrition knowledge and food frequency of adolescents attending an urban versus a peri-urban school in Hilton, KwaZulu-Natal.
(2014) Audain, Keiron Arthur.; Veldman, Frederick Johannes.
Adolescence is an important stage in human development. Optimum nutrition is crucial during this period, as additional nutrient requirements are needed to promote growth and maturation. With the nutrition transition in low-to-middle-income countries (LMICs), adolescents are increasingly exposed to energy-dense, nutrient poor foods; however it is not entirely clear the impact of socioeconomic status, in particular household food insecurity, on the consumption frequency of these foods. The impact nutrition knowledge may have on the dietary choices adolescents make is also unclear. Poor food choices among adolescents can contribute towards overweight/obesity and stunting, leading to the susceptibility to both communicable and non-communicable diseases (NCDs) in adulthood. The objective of this study was to determine the prevalence of overweight/obesity and stunting among South African adolescents from different socioeconomic backgrounds, in relation to their nutrition knowledge, household food insecurity status, and frequency of food consumption. The study consisted of a cross-sectional descriptive survey conducted among learners from a high-income, private urban school and a low-income, government peri-urban school in Hilton, KwaZulu-Natal. A total of 98 grade nine to eleven learners from the urban school and 111 grade nine to eleven learners from the peri-urban school volunteered to participate (N= 209). Nutritional status was determined by anthropometric measurements that included weight, height and MUAC. Subsequently BMI was calculated. Nutrition knowledge and food frequency were determined via non-quantified nutrition knowledge and food frequency questionnaires. A socio-demographic questionnaire (SDQ) was used to collect information on parental level of education and employment status. Household food security was determined using the Household Food Insecurity Access Scale (HFIAS). A higher prevalence of overweight and obesity was observed among urban learners compared to their peri-urban counterparts, however only for the boys as peri-urban girls had a notable prevalence of overweight and obesity compared to urban girls. Stunting was present among peri-urban learners but virtually absent in their urban counterparts, which was indicative of a double-burden of overweight/obesity and stunting within the peri-urban group. Peri-urban learners had parents with lower education and employment levels compared to urban learners. Adolescents with mothers that were educated up to tertiary level were associated with a higher nutrition knowledge scores (NKS). Urban learners had a higher mean NKS than peri-urban learners; however it did not necessarily reflect healthier food choices, as urban learners had a high consumption frequency of fatty red and processed meat, white bread and fizzy drinks. Peri-urban learners reported a higher preference for deep-fried, high-fat snacks such as vetkoeks and samosas; which may be related to the high levels of household food insecurity that was noted. Among grade ten peri-urban learners, 50% reported having no food to eat of any kind in the household, with 5% reporting that it occurred often. Poor dietary habits among adolescents in general were observed in this study; although food sources varied between urban and peri-urban learners possibly due to differences in cost and availability of food items. A lower SES was an underlying factor for the consumption of energy-dense foods among peri-urban learners; while a higher SES was associated with the consumption of more expensive fatty foods among urban learners. Thus, the risk of malnutrition (overweight/obesity and stunting) and subsequent disease susceptibility is present in both groups as a result.

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