Masters Degrees (Dietetics And Human Nutrition)

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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 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.
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.
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.
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.
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 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 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.
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.
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.
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.
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.
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.
Determining the general - and sports-related nutrition knowledge of male adolescent rugby union players attending a secondary, urban government boy's school in Pietermaritzburg, KwaZulu-Natal.
(2014) Stegen, Bridgitte.; Kassier, Susanna Maria.
Walsh, Cartwright, Corish, Sugrue & Wood-Martin (2011) suggest that the need for sound nutritional knowledge regarding both general concepts that pertain to healthy eating habits as well as the dietary principles that should be met for optimal sports performance, is of vital importance. According to Strachan (2009), adolescent sportsrelated nutrition knowledge is an area of great concern and in need of investigation, especially amongst local adolescent rugby players. Rugby is a high contact sport and the popularity of rugby union-related matches has considerably increased on a global scale (Griffiths 2012; Walsh et al 2011; Quarrie, Alsop, Waller, Bird, Marshall & Chalmers 2001). Unfortunately, Webb & Beckford (2013) and Burkhart (2010) recognize that there is limited published research available where an investigation into the general- and sports-related nutrition knowledge of adolescent athletes was conducted. This study aims to determine the general- and sports-related nutrition knowledge of male adolescent rugby players attending a boys only secondary, urban government school in Pietermaritzburg, KwaZulu-Natal. A cross-sectional study was conducted on adolescent rugby players (N= 110) at a local urban, government school in Pietermaritzburg (mean age =15.22 ± 1.430). The players were requested to complete a nutrition knowledge questionnaire developed initially by Whati (2005) for urban South African adolescents. For the purpose of this study the questionnaire was adjusted in accordance with the study objectives using peer-reviewed journals. The results showed that urban, government-level adolescent rugby players have an adequate general- and sports-related nutrition knowledge but lacked knowledge in the field of carbohydrates, understanding of what a well- balanced diet and healthy eating entails as well as the intake and role of protein. Parents and the media were selected as the two major sources of this information. More than half the participants admitted to using a nutritional supplement 3-4 times a week. There was no statistically significant trend in the improvement of knowledge from the under 14 to the open age groups, perhaps emphasizing the lack of sound nutrition education. Several statistically significant trends regarding nutrition practices, such as iii supplement use, were seen when comparing the open age group to the non-open age category; however the nutrition knowledge showed no statistically significant difference. The results of this study correlate to similar published studies regarding nutrition knowledge of adolescent athletes. Due to the lack of locally published research concerning the nutrition knowledge of adolescent rugby players this study forms a reference point to the importance of determining the nutrition knowledge of adolescent athletes in order to understand the need for nutrition knowledge education.
The prevalence and practice of geophagia in Mkhanyakude District of KwaZulu-Natal, South Africa.
(2014) Msibi, Agnes Thembisile.; Van Onselen, Annette.; Siwela, Muthulisi.
Geophagia is defined as the practice of eating soil and occurs in the whole world. Literature suggests that there are potential advantages and disadvantages of geophagia, including nutritional benefits and harm to human health, respectively. The suggested effects of geophagia on human nutrition and health seem to vary with type of soil eaten and other factors such as the intensity of the practice. On the other hand, it is not clear whether or not soil consumers are aware of the potential effects of geophagia on their health. Whatever perceptions the soil consumers have with regard to geophagia may depend on several factors, including socio-cultural factors and their level of scientific education. The aim of this study was to investigate the prevalence and practice of geophagia in Mkhanyakude District, and the perceptions of the soil consumers about the practice. A total of 94 women from Mkhanyakude District were interviewed with the aim of investigating the occurrence of geophagia, determining its prevalence and investigating perceptions about the practice. A combination of both qualitative and quantitative study design was used. Qualitative methods (based on literature) were used to enable the understanding of the feelings, values and perceptions that underlie geophagia. Furthermore quantitative methods (expressed by means of statistical data) were used because of the biographical information e.g. gender, age, education level and income that was requested from respondents. Samples of Soil samples used for geophagia were analysed for microbial load and mineral composition. The majority of the respondents were unemployed and single women, with half of them reporting the consumption of soil, which they indicated was motivated by several factors, advice from relatives and pregnancy being the major ones. The frequency of eating soil ranged from 4-10 times per day and the amount eaten per day ranged from 57 g to 88 g. The majority (33.0%) of the soil consumers preferred red, black and brown coloured soils- red soils were the most consumed. The methods of collecting soil reported include digging with a knife and hand hoe, buying from street vendors, collecting from house walls and selective picking by hand. The local name for the soil used for geophagia included umcaka, isiduli, ibomvu, isibomvu, isidaka, umgabadi, ihlabathi and inkwali. The majority (87.2%) of the respondents indicated that they perceived eating soil as not helpful, but as an addiction like smoking, because it had bad consequences like cancer, acute bladder pains, appendicitis, painful heavy bleeding during menstruation, painful defecation, gallstones, fibroids, blood stool, worms and stomach pains. The findings of the study indicated that the microbial content of the soil varied with soil type (9.3x103 cfu/g to 2.4x1010 cfu/g in high clay content soil and low clay content soil, respectively), indicating that high clay soils had the lowest microbial content. Therefore, further studies should be conducted to identify different microbial species present in these soils, especially those that are pathogenic to human health. The soils consumed contained several minerals, including nutrients such as zinc, and mineral composition varied with soil type. Soil samples with the highest zinc content were from Somkhele (15.00 mg/kg), Ibomvu (1.94 mg/kg), Tin town (1.57 mg/kg) and Mbhodla (1.20 mg/kg) had medium zing amounts. The soil samples with low zinc content were from Bhambanana (0.08 mg/kg). However, the mineral nutrients identified in the soils did not meet daily recommended intake. Health education is highly recommended for geophagists to improve their awareness with regard to geophagia. In addition, baking of the soil used for geophagia is also recommended to reduce the risk of microbial infection.
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.
Food security status and related factors of undergraduate students receiving financial aid at the University of KwaZulu-Natal, Pietermaritzburg Campus.
(2014) Job, Nophiwe.; Veldman, Frederick Johannes.
Objectives: To determine the prevalence of food insecurity and related factors among undergraduate recipients of financial aid at the University of KwaZulu-Natal, Pietermaritzburg Campus (UKZN- PMB) and whether there is a relationship between food security status and academic performance. Design: A cross-sectional descriptive survey was conducted assessing the food security status and related factors of students on financial aid. Setting: UKZN-PMB campus, situated in Scottsville, Pietermaritzburg, with a student population of 9 785. Subjects: A sample of 268 students on financial aid was randomly selected. First year and post graduate level students were excluded. Outcome measures: A self-administered questionnaire consisting of the four main sections, including: anthropometric status and socio-demographic information, food frequency questionnaire (FFQ), household food insecurity access scale (HFIAS), nutrition knowledge questionnaire (NKQ) and combined performance index (CPI) scores. Results: The mean BMI of the study sample was 24.4 ± 4.7 kg/m2. A fifth (21.4%) of the sample was overweight and a tenth (12.4%) was obese. An increase in BMI was associated with an increase in food insecurity. The foods consumed „more than once a day‟, included the starch group, fats and coffee and tea. Just over half (53.0%) of the sample received no additional allowance apart from financial aid. The majority (82.4%) of the sample spent most of their money on food. The mean amount of monthly food expenditure was R558.40 ± R211.12. Over a third (34.7%) of the sample was food insecure with another third (33.6 %) being at risk of food insecurity. Almost a tenth (9.7%) of the sample was severely food insecure and just over a fifth (22%) was food secure. The main coping strategy adopted was seeking assistance from friends. The mean NKQ score of the sample was 18.8 ± 3.8 (58.6%) which fell within the “average” range. Food insecure students had a lower mean CPI score than those who are food secure. Conclusion: There was a high prevalence of food insecurity and obesity among the study sample. The diets lacked diversity with a low consumption of fruit and vegetables. Nutrition knowledge seems to have no impact on food choice. Food insecurity impacted negatively on academic performance.
An assessment of the effect of a peanut based ready-to-use nutritional supplement on HIV positive adults on antiretroviral therapy, attending the 1000 Hills Community Helpers Centre, Durban, KwaZulu-Natal.
(2014) Ncwane, Mphilonhle Vuyani Sibongeleni.; Veldman, Frederick Johannes.
Introduction: The aim of this study was to assess the nutritional effect of a peanut based ready-to-use food supplement (RUSF) [Sibusiso®] on HIV positive adults on antiretroviral therapy (ART). Objectives: (1) To determine whether the BMI of HIV positive adults on ART supplemented with RUSF was improved after a three months supplementation period. (2) To determine the most predominant self reported disease symptoms experienced by HIV positive adults on ART at baseline assessment. (3) To determine whether predominant disease symptoms experienced by HIV positive adults in ART improved after supplementation with Sibusiso® RUSF. (4) To determine whether appetite, meal consumption and energy levels improved among HIV positive adults on ART supplemented with Sibusiso® RUSF. (5) To determine if there was any observed changes in body fat distribution in HIV positive adults on ART after being supplemented with Sibusiso® RUSF. Materials and methods: This is a non randomised descriptive study whereby data was collected using a cross-sectional method. It included 50 HIV positive adults (between 20 and 78 years of age) on antiretroviral therapy, attending the 1000 hills community helpers’ centre, Durban, KwaZulu-Natal. A monitoring tool was used to collect data on anthropometrical measurements (weight and height), disease symptoms experienced, disease conditions identified by the researcher/research assistants, level of appetite, meal frequency consumption and energy for each subject for a period of three consecutive months. Twenty participants were interviewed to assess the body fat distribution after using the supplement using a self reporting method. Results and discussions: Study findings suggest that supplementation with RUSF for at least three months has a potential to gradually improve weight gain among HIV-positive adults on ART. The most self reported predominant disease symptom experienced before supplementation was fever, followed by nausea and persistent diarrhoea. This was in keeping with the results from other studies. After supplementation, there was a significant improvement in fever and gastroenteritis and steady but statistically significant decline in vomiting. However there was non-significant improvement in nausea and no change in persistent diarrhoea. RUSF in this study was also found to exert a beneficial effect on appetite, meal consumption and energy levels of participants. The study showed that short-term supplementation with RUSF is highly unlikely to result in lipodystrophy. Conclusion: The administration of the nutrition supplement Sibusiso® RUSF for at least three months, in conjunction with the use of ART, was found to improve nutritional status in HIV patients under the controlled condition. Sibusiso® RUSF was able to improve the episode of fever which was most dominant disease symptom at baseline while improving gastroenteritis and vomiting. However it did not have an impact on reducing the episodes of nausea and persistent diarrhoea. Sibusiso® RUSF was also able to improve appetite, meal consumption and energy of participants after a three month period.
The implementation of an ISO 22000 system into a private hospital food service facility and the impact on patient satisfaction and food safety audit results.
(2015) Warren, Jane Rachael.; Wiles, Nicola Laurelle.
Aim: To determine the impact of the implementation of an ISO 22000 system in the foodservice department of a private hospital on patient satisfaction levels and results of food safety audits conducted. Objectives: To describe the demographics of hospital patients in terms of age, gender, length of hospital stay and type of special diet; to determine the patient satisfaction with the food and food service; to determine the relationship between demographics and patient satisfaction with the food and food service; to determine the impact of ISO 22000 on patient satisfaction; and to determine the impact of ISO 22000 on food safety audit results. Method: A total of one hundred and sixty hospital patients were interviewed during four surveys conducted over a period of approximately one year, during which time the ISO 22000 food safety management system was implemented into the foodservice department of a private hospital facility. Patients were surveyed using a questionnaire which gathered demographic information as well as the responses of patients to various aspects of the food and food service. The results of these surveys were analysed to describe the demographics of the patients, the relationship between demographics and satisfaction levels and satisfaction levels with the food and food service after ISO 22000 implementation. The results were analysed and compared to determine any improvements in audit scores after ISO 22000 implementation. Results: One hundred and sixty patients aged between 13 and 89 participated in the survey. One hundred and nineteen patients were female (74.4%) and forty one were male (25.6%). Most of the patients had been in hospital for between three and seven days and had not been on a special diet whilst in hospital. No statistically significant relationships were found between demographics and patient satisfaction levels with the food and food service. Overall, the responses with regards to food temperature, hygiene and cleanliness, food quality and the overall catering service indicated a generally high level of satisfaction. A statistically significant increase in satisfaction was found for the overall catering service, while a marginally significant increase was found for the food temperature after ISO 22000 implementation. The results of food safety audits improved after ISO 22000 implementation. Discussion: Despite the lack of statistically significant improvements in some areas of patient satisfaction with the food and food service in this study, the improvements that were found in patients’ satisfaction levels as well as the marked improvement in food safety audit results indicate that ISO 22000 does have a positive impact and offers many advantages in a hospital foodservice department. Conclusion: ISO 22000 implementation shows promise to increase patient satisfaction and improve the results of food safety audits. It is therefore recommended that further studies in the South African hospital environment are conducted in order to gain a clearer understanding of the impact that a food safety management system will have on patient satisfaction levels with the hospital food and food service as well as food safety audit results.
A comparison between the excess fluid to be removed in chronic haemodialysis patients, estimated by HD unit staff versus the multiple frequency BIA measurement.
(2015) Downs, Jane H.; Veldman, Frederick Johannes.; Kassier, Susanna Maria.
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