Dissertations / Theses on the topic 'Infants aged 0-6 months'

Philosophiae Doctor - PhD (School of Public Health)<br>Poor water, sanitation and hygiene (WASH) services and practices in communities are known to be responsible for most of the infections occurring among infants and young children in developing countries. A combined effect of disease, poor diet, care practices and other factors among infants/children are known to lead to undernutrition reported in most developing countries. Apart from the reduced growth and productivity potential that malnutrition exhibits on the affected population, it is also an underlying cause to 50% of child mortality in poor communities. In light of this, the primary objective of the study was to evaluate the effect of poor WASH practices on growth and infectious disease incidence in infants and young children aged 6-23 months in the rural district of Monze in Zambia.

The objective of this thesis is to improve our understanding of the epidemiology of diarrhea, particularly to estimate the population-based burden, microbiologic etiology and adverse clinical consequences of moderate-to-severe diarrhea among children 0-59 months of age in a sub-Sahara Africa area to guide public health policy and target appropriate interventions. This thesis is based on a collection of five articles. The first three articles within this thesis present results from a case-control study about the burden of diseases, risk factors, microbiologic etiology and clinical presentation of MSD among children aged 0-59 months between December 2007 and October 2011 in sub-Saharan Africa (Kenya, Mali, Mozambique, The Gambia) and Southeast Asia (Bangladesh, India, Pakistan). The first article describes results of a multicenter analysis of data collected from the seven sites during the first three years of the study. The estimated incidence of moderate-to-severe diarrhea was highest in India, next highest in Kenya and Mali, and lowest in The Gambia, Pakistan, Bangladesh, and Mozambique. The overall annual incidence of moderate-to-severe diarrhea per 100 child-years was 30.8 (95% CI 24.8–36.8) for infants, 23.1 (95% CI 17.2–29.0) for toddlers, and 7.7 (95% CI 3.9–11.5) for children. Most attributable cases of moderate-to-severe diarrhea were due to four pathogens: rotavirus, Cryptosporidium, ETEC ST (ST only or ST/LT) and Shigella. Odds of dying during follow-up were 8.5-fold higher in patients with moderate-tosevere diarrhea than in controls; most deaths (167 [87.9%]) occurred during the first 2 years of life. Pathogens associated with increased risk of case death were ST-ETEC and typical enteropathogenic E coli and Cryptosporidium. The second and third articles describe specific results from Manhiça district, (Mozambique site). The incidence of acute diarrhea has dropped by about 80% over the period 2001-2012. Incidence of moderate-to-severe diarrhea per 100 child years at risk for the period 2007-2011 was 9.85, 7.73 and 2.10 for children aged 0-11, 12-23 and 24-59 months respectively. Most cases of moderate-to-severe diarrhea were again due to rotavirus, Cryptosporidium, ETEC ST (ST only or ST/LT), Shigella and Adenovirus 40/41. Having a caretaker who was not the mother and giving stored water were independent risk factors for moderate-to-severe diarrhea. On the other hand, regular washing hands particularly after handling animals or before preparing baby’s food, and having facilities to dispose child’s stool were protective factors for moderate-to-severe diarrhea. Risk of moderate-to-severe diarrhea was not found to be strongly associated with economic indicators of the households and education level of the caretaker. The fourth paper of this thesis describes the results of two surveys about health services utilization in case of diarrhea performed during the above described case-control study, through interviews conducted with primary caretakers of children aged 0-59 months living in Manhiça district. Of those primary caretakers reporting an episode of diarrhea during the recall period, 65.2% in first survey and 43.8% in second survey reported seeking care at a health facility. The use of health facilities in case of diarrhea was found to be fundamentally associated with the perceived need, lower knowledge of dehydration signs and may have been hampered by the economic status. The last paper of this thesis describes a retrospective analysis of data recorded through the health facility morbidity surveillance system of all malnutrition cases in children aged less than five years of age seen at Manhiça’s District Hospital during the period 2001 to 2010. During this period, 274,813 children were seen at the outpatient clinic of Manhiça’s District Hospital, almost half of which (47.0%) presenting with some indication of malnutrition, and 6% (17,188/274,813) with severe malnutrition. Of these, only 15% (2,522/17,188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteremia, hypoglycemia, oral candidiasis, edema, pallor, deep breathing and acute diarrhea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and increasing age were independently associated with a lower risk of a poor outcome. Overall Minimum Community-based Incidence rates were 15 cases per 1000 child-years, and children aged 12-23 months of age had the highest incidence. This thesis presents important results related to diarrheal disease and malnutrition of which may be of great public health utility for policy makers in order to decrease the unacceptable morbidity and mortality still associated with such diseases.<br>Los cinco artículos de esta tesis surgen de diferentes (pero complementarios) proyectos abarcan desde la investigación social básica de los determinantes del uso de servicios de salud y control de enfermedades en caso de enfermedad diarreica, hasta análisis más específicos de los factores de riesgo y los determinantes microbiológicos de la enfermedad en los niños con edad 0-59 meses en el distrito de Manhiça, Mozambique. La incidencia de diarrea moderada a grave por cada 100 años-niño a riesgo durante el global del período 2007-2011 fue de 9.85, 7.73 y 2.10 para los niños de 0-11, 12-23 y de 24-59 meses, respectivamente. La mayoría de los casos de diarrea moderada a grave fueron debidos a rotavirus, Cryptosporidium, ETEC ST (ST sólo o ST / LT), Shigella y Adenovirus 40/41. Tener un cuidador diferente de la madre y beber agua almacenada fueran factores de riesgo de episodios de diarrea moderada a grave. Por otro lado, lavarse las manos regularmente y tener facilidades para disponer las heces del niño son factores de protección para la diarrea moderada a grave. Los resultados sobre actitudes de utilización de servicios de salud muestran que una importante proporción de los cuidadores que reportaron un episodio de diarrea (65.2% en la primera encuesta y 43.8 % en el segunda encuesta) informaron que acudieron a un centro de salud. Asimismo, el uso de los servicios de salud en caso de diarrea pudo asociarse a una necesidad percibida y a un bajo conocimiento de los signos de deshidratación; pudiendo haber sido obstaculizado, paradójicamente, por la situación económica. Finalmente, durante la vigilancia de 10 años sobre la desnutrición, se verifico que 6% de los 274,813 niños atendidos en las consultas externas del Hospital Distrital de Manhiça, presentó criterios de malnutrición grave. De éstos, sólo el 15% (2,522 /17,188) fueron finalmente admitidos. Las tasas de incidencia mínima comunitarias fueron 15 casos por cada 1000 niños-año a riesgo, y la tasa de letalidad asociada a la malnutrición grave fue del 7% (162/2,274). Esta tesis presenta, por tanto, resultados importantes que son de gran utilidad desde el punto de vista de salud pública, y deberían servir a los responsables políticos para tomar medidas basadas en la evidencia y disminuir así la inaceptable morbi-mortalidad todavía asociada con la enfermedad diarreica y la malnutrición.

Magister Public Health - MPH<br>South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.

The World Health Organization (WHO) recommends exclusive breast-feeding until 6 months of age, where exclusive breast-feeding is defined as giving human breast milk only with no other foods or fluids. This recommendation has since been adopted by many countries. A systematic review of studies in exclusively breast-fed infants by Reilly and colleagues found a mean milk intake at 6 months of age that seemed too low to cover infant energy requirements. However, the evidence was relatively scarce, only from cross-sectional studies and based on the method of test-weighing, which has been criticised for under-estimating milk intake. Furthermore, longitudinal studies indicated no marked increase in milk intake over time, but these studies did not include measurements at 6 months of age. Reilly and Wells proposed the hypothesis that for exclusive breast-feeding to adequately cover infant energy requirements to 6 months of age, either 1) infants had to be unusually small, or 2) breast milk energy content had to be unusually high, or 3) milk intake had to be unusually high. The Reilly-Wells hypothesis was backed up by evidence of a world-wide low prevalence of exclusive breast-feeding to 6 months, and by studies consistently reporting a maternally perceived insufficient milk supply as a major reason for mothers to cease exclusive breast-feeding and introduce either formula supplementation or complementary foods. Based on the Reilly-Wells hypothesis, the research question for the First-Feed study was: To explore how exclusive breast-feeding to 6 months of age is achievable – mainly from an energy balance point of view. The First-Feed study tested the hypothesis that successful exclusive breast-feeding to 6 months of age would include 1) infants that were small and/or growing slowly, 2) milk intakes and/or milk energy content that were higher than literature values and increasing over time, 3) infant energy requirements that were lower than reference values, and/or 4) infant feeding practices that were strained by very frequent and/or very time consuming breast-feeds. The study was designed as the first longitudinal observational study to use an isotopic method to measure milk intake and energy balance in exclusively breast-fed infants to 6 months of age, and it evaluated parts of the methodology employed in the study, in order to appreciate the results in light of the methodological strengths and limitations. The First-Feed study found that infants were overall of normal size and growing well relative to WHO Child Growth Standards. Metabolisable milk intakes were significantly higher than the values obtained by Reilly and colleagues at both 3½ and 6 months of age, and increased significantly over time. Infant energy requirements, determined as metabolisable energy intake, was significantly higher than references for mean energy requirements at 3½ months of age, while it was appropriate at 6 months of age. Breast-feeding practices showed no change over time in feeding frequency, but a significant decrease in time spent on breast-feeds. The First-Feed study had several limitations. Firstly, due to the inclusion criteria of exclusive breast-feeding, the participants were characterised as an affluent and well-supported sample of mother-infant pairs, who were highly motivated to breast-feed. Therefore, the generalisability of the present study to other populations should be accepted with caution. Secondly, the anthropometric measurements were prone to imprecision, as is often the case in field studies. Thirdly, the imprecision of the dose-to-infant procedure for administration of doubly-labelled water considerably reduced the precision of the doubly-labelled water method. This, in addition to the biological variation, increased the variation in some outcome variables. However, the First-Feed study is unique as it is the first to use a more objective method to measure milk intake in a longitudinal design, and on a sample of infants with a very high success rate of exclusive breast-feeding to 6 months of age. The WHO changed the recommendation on exclusive breast-feeding from 4 – 6 months to 6 months (exactly) in 2001. Since then, many resources have been invested in breast-feeding promotion, but rates of initiation, duration and exclusivity is only slowly improving. The present study supports that exclusive breast-feeding can adequately cover infant energy requirements to 6 months of age - even without undue strain on breast-feeding practices and even in mothers where initial breast-feeding problems were very common. However, the present study found a wide variation in both infant size, milk intake and energy requirements. It therefore begs the question if a recommendation based on one age-point (6 months exactly) is appropriate given the vast biological variation in variables that are important for the adequacy of exclusive breast-feeding, or if the recommendation should be adapted to include developmental milestones (e.g. oral motor skills) indicative of readiness for complementary foods.

Thesis (MVoeding)--University of Stellenbosch, 2004.<br>ENGLISH ABSTRACT: Objectives and scope of investigation Following the 1996 recommendations of a FAO/WHO expert panel for the development of food-based dietary guidelines (FBDGs) unique and specific to the needs of the populations of different countries, a South African FBDG Working Group was formed and ultimately also a Paediatric FBDG (PFBDG) Working Group with the task of the latter being the development of FBDGs for children younger than 7 years. A set of preliminary PFBDGs, chosen to address the most pressing paediatric public health issues, namely protein-energy malnutrition, micronutrient deficiencies and infectious diseases, were formulated for each age group sub-category (0-6 months, 6-12 months and 1-7 years). The following set of preliminary PFBDGs for the age group 6-12 months were approved by the Working Group to be subjected to consumer testing: • Enjoy time with your baby • From six months start giving your baby small amounts of solid foods • Gradually increase your baby’s meals to five times a day • Keep breast feeding your baby • Offer your baby clean, safe water regularly • Teach your baby to drink from a cup • Take your baby to the clinic every month Assessment of the consumer’s comprehension, interpretation of the proposed guidelines, and ability to apply them, was considered essential before the PFBDGs could be finalised, disseminated to the consumer, and implemented as an educational tool for health professionals and community workers. This study was also the first in which PFBDGs were tested, and was intended to be a pilot study for further testing of PFBDGs for this age category in other parts of the country, adapted for different circumstances. The investigation was conducted among women who were mothers or caregivers to infants 6-12 months of age in the Afrikaans-, English- and Xhosa-speaking communities of the greater Oudtshoorn area, including Bongulethu, Bridgeton and Toekomsrus and its adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar. Methodology The study was designed to be an observational, descriptive and cross-sectional study. Qualitative data was collected from a sample of 64 volunteers who took part in ten focus group discussions each attended by between 3 and 11 participants. Group discussions were recorded on videotape and quantitative and qualitative questionnaires measured pre-discussion knowledge and comprehension of guidelines, perceived hindrances to compliance with guidelines and perceived importance of guidelines as well as socio-demographic data. Results and conclusions With this study, useful and enlightening information was obtained which met the research objectives. Participants discussed the guidelines in depth and information obtained from the questionnaires were found to support what was said during the discussions. Body language or non-verbal communication as observed, and recorded on videotape, also complemented the information gained from the discussions. Summarily it can be said that the guidelines were well-received and perceived as important by the majority of respondents, although some of the guidelines were initially not well-understood without explanation. Furthermore, the fact that the applicability of the guideline on prolonged breast feeding seems to be the most problematic, is a cause for concern. In view of the results obtained in this study, it can be concluded that PFBDGs will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The findings of this study will be submitted to the PFBDG Working group for consideration before finalisation of the guidelines for the age group 6-12 months.<br>AFRIKAANSE OPSOMMING: Doelwitte en omvang van die studie Na aanleiding van die 1996 aanbevelings van ‘n VLO/WGO paneel van kenners vir die ontwikkeling van voedselgebaseerde dieetriglyne (VGDR) wat uniek en spesifiek gerig is tot die behoeftes van die bevolkings van verskillende lande, is ‘n Suid-Afrikaanse VGDR Werkgroep gevorm en uiteindelik ook ‘n Pediatriese VGDR (PVGDR) Werkgroep met die opdrag van laasgenoemde om VGDRe te ontwikkel vir kinders jonger as 7 jaar. ‘n Stel voorlopige Pediatriese VGDRe, gekies om die mees dringende pediatriese publieke gesondheidsvraagstukke, naamlik proteïn-energie wanvoeding, mikronutriënttekorte en infektiewe siektetoestande aan te spreek, is geformuleer vir elke ouderdomsgroep subkategorie (0-6 maande, 6-12 maande en 1-7 jaar). Die volgende stel voorlopige PVGDRe vir die ouderdomsgroep 6-12 maande is deur die Werkgroep goedgekeur om aan verbruikerstoetsing te onderwerp: • Geniet tyd saam met jou baba • Begin vanaf ses maande om jou baba klein hoeveelhede vaste kos te gee • Vermeerder jou baba se maaltye geleidelik na vyf keer per dag • Hou aan om jou baba te borsvoed • Bied gereeld vir jou baba skoon, veilige drinkwater aan • Leer jou baba om uit ‘n koppie te drink • Neem jou baba elke maand kliniek toe Evaluering van die verbruiker se begrip, interpretasie van die riglyne en die vermoë om die riglyne te implementeer, is as noodsaaklik beskou voordat die PVGDRe gefinaliseer kon word, vrygestel kon word aan die publiek, en aan professionele- en gemeenskapsgesondheidswerkers beskikbaar gestel kon word as ‘n onderrighulpmiddel. Hierdie studie was die eerste waarin PVGDRe getoets is en dit is bedoel as ‘n voorloperstudie vir verdere toetsing van PVGDRe vir hierdie ouderdomskategorie in ander dele van die land en aangepas vir ander omstandighede. Die ondersoek is gedoen onder vroue wat moeders of versorgers van babas van 6-12 maande was in die Afrikaans- Engels- en Xhosasprekende gemeenskappe van die groter Oudtshoorn area wat Bongulethu, Bridgton en Toekomsrus insluit asook die nabygeleë plattelandse gemeenskappe van Dysselsdorp, Calitzdorp, Uniondale, Ladismith en Zoar. Metodiek Die studie is ontwerp om ‘n waarnemende en beskrywende analise van ‘n deursnee van die studiepopulasie moontlik te maak. Kwalitatiewe data is verkry van ‘n proefmonster van 64 vrywilligers wat deelgeneem het aan tien fokusgroep besprekings wat elk deur 3 tot 11 persone bygewoon is. Groepbesprekings is op videoband opgeneem en kwantitatiewe en kwalitatiewe vraelyste het voorbesprekings kennis en begrip van die voorgestelde riglyne, vermeende verhindering tot uitvoering van die riglyne en vermeende belangrikheid van riglyne sowel as sosio-demografiese inligting gemeet. Resultate en gevolgtrekkings Met hierdie studie is bruikbare en verhelderende inligting verkry wat beantwoord het aan die doelwitte van die studie. Deelnemers het die riglyne in diepte bespreek en dit is bevind dat inligting wat van die vraelyste verkry is, ook dit bevestig het wat gedurende die sessies bespreek is. Lyftaal en nie-verbale kommunikasie soos waargeneem en soos op videoband vasgelê, het ook die inligting ondersteun wat van die besprekingsessies verkry is. Opsommend kan gesê word dat die riglyne goed ontvang is en as belangrik beskou is deur die meerderheid van respondente. Sommige van die riglyne was nie vir deelnemers goed verstaanbaar sonder meegaande verduideliking nie. Verder is die feit dat die toepasbaarheid van die riglyn met betrekking tot ‘n verlengde tydperk van borsvoeding voorgekom het as die mees problematiese, ‘n rede tot kommer In die lig van die resultate van hierdie studie, kan daar tot die slotsom gekom word dat PVGDRE ondersteun sal moet word deur omvattende en gepaste onderrigmateriaal om effektief te kan wees wanneer dit aan die publiek bekend bekend gestel word. Die bevindings van hierdie studie sal aan die Pediatriese VGDR Werkgroep voorgelê word vir oorweging voordat riglyne vir die ouderdomsgroep 6-12 maande gefinaliseer word.

Objectives This study aimed to determine the relationship between stunting in children 6 to 36 months old and maternal employment status in Peru. Methods A secondary data analysis was conducted using information from the Demographic and Health Survey (DHS) in Peru. We used a representative sample of 4637 mother-child binomials to determine the association between stunting in children 6 to 36 months of age and the employment status of their mothers. Results The prevalence of stunting among children was 15.9% (95% CI: 13.9–16.7). The prevalence of working mothers was 63.7%. No association was found between maternal employment status and the presence of stunting in children [prevalence ratio (PR) = 1.04; 95% confidence interval (95% CI): 0.9 to 1.2; p = 0.627). However, on multivariate analysis we found that the prevalence of stunting was significantly higher among children of mothers performing unpaid work (12.4%) (PR = 1.38; 95% CI: 1.2–1.6; p < 0.001) compared with those of paid working mothers. Conclusion No significant association was found between maternal employment status and the presence of stunting in children 6 to 36 months of age. However, children of mothers doing unpaid work are at higher risk of stunting. These findings support the implementation of educational programs and labour policies to reduce the prevalence of stunting among children. © 2019 Chávez-Zárate et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.<br>Revisión por pares<br>Revisión por pares

Thesis (MNutr--Stellenbosch University, 2015.<br>ENGLISH ABSTRACT: Introduction Malnutrition, in both adults and children, is a problem worldwide with negative health consequences. The World Health Organization (WHO) and Food and Agricultural Organization (FAO) of the United Nations (UN) therefore initiated the implementation of country-specific food-based dietary guidelines (FBDGs) to be used as an educational tool to address nutrition-related health issues. They further suggested consumer testing to evaluate the comprehension and cultural acceptability thereof prior to the release of country-specific FBDGs. Focus group discussions (FGDs) were recommended for consumer testing. Aim The aim of this study was to assess the comprehension and applicability of the 2007 version of the preliminary South African paediatric food-based dietary guidelines (PFBDGs) for healthy infants aged 6–12 months in Soshanguve and Ga-Rankuwa. Specific objectives included qualitative evaluation of exposure to preliminary PFBDGs, participants’ interpretation thereof, cultural acceptability and practical application of the guidelines. Socio-demographic information was collected to determine whether these factors could potentially exert an influence on the comprehension and applicability of the FBDGs. This study could further inform emerging efforts to update public health initiatives to educate mothers/caregivers of infants. Methodology An observational, cross-sectional study design was followed, incorporating both qualitative and quantitative research methods. FGDs were utilised to assess comprehension of the PFBDGs and gather insight into perceptions, attitudes and appropriateness of the PFBDGs. Quantitative data were collected by means of a questionnaire regarding the socio-demographic profiles of participants. Setting This study focused on two small, densely populated towns, Soshanguve and Ga-Rankuwa, in the north western district of Tshwane in the Gauteng province of South Africa. The areas represent relatively low socio-economic communities that include a mix of formal and informal urban setting. Participants Twenty-seven Northern Sotho-speaking mothers and caregivers of infants aged 6–12 months participated in a total of six FGDs. Each FGD was attended by between three and six participants. Results None of the participants had previous exposure to the PFBDGs, although they were familiar with most of the concepts. Guidelines were generally well received and understood, but a few were misinterpreted; particularly those pertaining to “enjoy time with your baby”, “increase your baby’s meals to five times per day” and “teach your baby to drink from a cup”. These needed further explanation and rephrasing by the investigator to improve their comprehensibility. The guideline pertaining to breastfeeding was the most familiar, well accepted and most generally applied. Quantitative results indicated no significant difference between the socio-demographic profiles of participants in Soshanguve and Ga-Rankuwa. Participants’ education level, employment status and housing conditions were considered a good representation of the population. It appears that socio-demographic circumstances may affect exposure to, and interpretation and application of the PFBDGs. Conclusion Many of the adjustments recommended from this research is consistent with the changes incorporated in the recently published revised PFBDGs. Supportive documentation, educational material and health campaigns tailored to specific socio-demographic groups may further enhance the interpretation of the revised guidelines and their exposure to the public, once tested and adopted.<br>AFRIKAANSE OPSOMMING: Inleiding Wanvoeding onder kinders en volwassenes, is ʼn wêreldwye probleem wat, as dit nie aangespreek word nie, ernstige gesondheidsgevolge kan inhou. Die Wêreldgesondheidsorganisasie (WGO) en die Voedsel-en-landbou-organisasie (VLO) het die implementering van voedselgebaseerde dieetriglyne (VGDR) spesifiek aan elke land geïnisieer sodat dit as opleidingshulpmiddel kan dien om voedselverwante gesondheidsprobleme op te los. Daar is voorgestel dat verbruikers die riglyne in fokusgroepbesprekings (FGBs) evalueer om begrip en die kulturele toepaslikheid van bevolking-spesifieke riglyne te toets voordat dit bekendgestel word. Doel Die doel van die studie was om begrip en die toepassing van die 2007 weergawe van die voorlopige Suid-Afrikaanse pediatriese voedselgebaseerde dieetriglyne (PVGDR) vir gesonde kinders van 6–12 maande te bepaal. Spesifieke doelwitte het kwalitatiewe evaluering ten opsigte van blootstelling, deelnemers se interpretasie, kulturele aanvaarbaarheid en praktiese toepassing van die riglyne ingesluit. Sosiodemografiese inligting is ingesamel om te bepaal of daar ʼn verband bestaan tussen hierdie omstandighede en die begrip en toepassing van PVGDR’s. Hierdie studie kan toekomstige pogings ondersteun om openbare-gesondheidsprogramme by te werk en om moeders en versorgers oor babas in te lig. Ontwerp Die studieontwerp was ’n waarnemende deursnit met kwalitatiewe en kwantitatiewe navorsingsmetodes. FGBs was gebruik om die begrip van die PVGDR’s te bepaal en insigte oor die persepsies, houdings en geskiktheid van die PVGDR’s in te samel. Kwantitatiewe data is ingesamel met ʼn vraelys oor die sosiodemografiese profiele van deelnemers. Omgewing Die studie het gefokus op twee klein, digbevolkte stedelike gebiede, Soshanguve en Ga-Rankuwa in Tshwane, die noord-westelike distrik van die provinsie Gauteng in Suid-Afrika. Die areas verteenwoordig relatief lae sosio-ekonomiese gemeenskappe met ʼn mengsel van formele en informele stedelike nedersettings. Deelnemers Die studiegroep het 27 Noord-Sotho-sprekende moeders en versorgers ingesluit wat aan altesaam 6 FGB’s deelgeneem het. Tussen drie en ses deelnemers het elke FGB bygewoon. Resultate Geen deelnemers was voorheen aan PVGDR’s blootgestel nie, hoewel die meerderheid met meeste van die begrippe bekend was. Die riglyne was oor die algemeen goed aanvaar en verstaanbaar, maar ʼn paar was verkeerd geïnterpreteer; veral “geniet tyd saam met jou baba”, “vermeerder jou baba se maaltye na vyf kere per dag” en “leer jou baba om uit ʼn koppie te drink”. Verduideliking en herformulering was nodig om begrip te verbeter. Die riglyne oor borsvoeding was die bekendste, was die beste aanvaar en was in die algemeen toegepas. Kwantitatiewe resultate het aangedui dat die sosiodemografiese profiel van deelnemers uit Soshanguve en dié uit Ga-Rankuwa nie beduidend verskil nie. Deelnemers se opleidingsvlak, werkloosheidstatus en huislike omstandighede het die populasie goed verteenwoordig. Daar is bevind dat sosiodemografiese omstandighede blootstelling aan en begrip en toepassing van PVGDR’s kan beïnvloed. Gevolgtrekking Baie van die wysigings wat voorgestel is deur hierdie studie, stem ooreen met die verandering wat aangebring is in die onlangs gepubliseerde hersiene PVGDR’s. Ondersteunende dokumente, opvoedkundige materiaal en gesondheidsveldtogte vir spesifieke sosiodemografiese groepe sal die korrekte interpretasie van riglyne asook openbare bewusmaking bevorder. Die riglyne kan, met minimale aanpassings, suksesvol as ʼn voedingsverwante opvoedkundige hulpmiddel in die gemeenskap gebruik word. Baie van hierdie aanpassings is reeds aangebring tydens die ontwikkeling van die veranderde PVGDR’s. Die bevindinge van die studie kan ʼn kernbydrae tot die voorstelle lewer, en aanduidings vir voorstelle vir verdere ontwikkeling en evaluering oplewer.

Parallel increases in many inflammatory diseases including atopy over the last 40 years suggest that common environmental changes may be promoting inflammatory immune responses. Modern diets have become increasingly rich in n-6 polyunsaturated fatty acids (PUFAs) and relatively deficient in n-3 PUFAs. These dietary changes are believed to promote a pro-sensitisation, pro-allergic and pro-inflammatory environment. Exposure to such an environment during pregnancy and in the very early life period is considered to influence subsequent patterns of the immature and developing neonatal immune system, and this may contribute to the increase in allergic disease in early life. As allergic diseases often first manifest in infancy, prevention strategies need to be targeted early, even in utero. Epidemiologic and experimental data provide a plausible link between dietary changes and increased incidence of childhood atopic disease. Although there have been studies examining the potential benefits of giving n-3 PUFA-rich fish oil supplements during pregnancy, there are no studies examining the effects of increased consumption of oily fish in pregnancy on neonatal immune responses and subsequent clinical outcomes. The Salmon in Pregnancy Study (SIPS) is the first randomised controlled trial of oily fish intervention during pregnancy. The hypotheses being investigated in SIPS is that increased intake of salmon, a source of long chain (LC) n-3 PUFAs (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), in pregnancy will a) increase maternal LC n-3 PUFA intake, b) increase maternal and infant blood LC n-3 PUFA status, c) modulate fetal/neonatal immune responses and d) lower the risk of infant atopy determined at 6 months of age. The primary outcome measures of SIPS were the clinical signs of atopy in the offspring. Pregnant women (n=123) at high risk of having atopic offspring, and with low habitual intake of oily fish (≤ 2/month) were randomised at 20 weeks of pregnancy to either consuming 2 portions/week of farmed salmon (n=62) or continuing their habitual diet (n=61) until the end of pregnancy. The woman attended a clinic at 20 (n=123), 34 (n=110) and 38 (n=91) weeks of gestation at which fasting blood was collected and a food frequency questionnaire (FFQ) was administered (at 20 and 34 weeks). At delivery umbilical cord blood was collected (n=101) for fatty acid and immunological analysis. Infants attended a clinic at 6 months of age (n=86) for assessment of allergic sensitisation by skin prick testing (SPT) using various allergen extracts and of atopic dermatitis (SCORAD index). Maternal and cord plasma and cord blood mononuclear cell (CBMC) fatty acid compositions were determined by gas chromatography. Neonatal (cord) immune cell subsets were identified by flow cytometry. Ex-vivo cytokine production by CBMC in response to stimulants (allergen, mitogen, and toll-like receptor (TLR) ligands) was determined by cytometric bead array and flow cytometry. Ex-vivo prostaglandin E2 production by CBMC was determined by enzyme-linked immunosorbent assay. Immunoglobin E concentration was measured in cord blood plasma and in 6 month infant blood plasma. Eating oily fish twice a week during pregnancy resulted in a higher maternal intake of LC n-3 PUFAs (both EPA and DHA) and in higher maternal and cord blood plasma status of LC n-3 PUFAs (both EPA and DHA). LC n-3 PUFA content of CBMC was not significantly affected. CBMC production of interleukins-2, -4, -5, and -10 and tumour necrosis factor-α was lower in the salmon group. There was no effect of salmon on the atopic outcomes assessed at 6 months.

Text in English<br>Breastfeeding is particularly important in resource-poor regions of the world, where limited access to clean water increases the risk of diarrhoeal disease if replacement feeding is used. However, human immunodeficiency virus type 1 (HIV-1) is transmitted through human milk. Purpose of the study The purpose of this study was to describe the determinants contributing to exclusive breastfeeding in HIV-infected mothers of infants aged 0 to 6 months who attend an NGO Health Centre in Elandsdoorn Village. Methods A quantitative research approach using a non-experimental cross-sectional study was undertaken to conduct this study. A self-reported study questionnaire was used to collect data from study participants. Purposive sampling was used to sample 75 mothers from 18 to 45 years of age who were HIV-positive. SPSS version 23 was used to analyse the data. Results The study results indicated that there are determinants contributing to exclusive breastfeeding and a need to establish a more comprehensive approach to educating pregnant women on reproductive health issues, and exclusive breastfeeding in particular. Factors contributing to low levels of exclusive breastfeeding included breast problems, societal influence, maternal health concerns, insufficient support, fear of stigmatisation, and babies’ health concerns. This caused mothers to discontinue exclusive breastfeeding. Conclusions The intention of this study was to reveal the determinants of exclusive breastfeeding affecting mothers who are HIV-infected and breastfeeding their infants.<br>Health Studies<br>M.P.H.

MSCPNT<br>Department of Nutrition<br>Introduction: Iodine is an essential nutrient required by humans for the synthesis of thyroid hormones, which are vital for normal growth and development. Objective: The primary aim of the study was to describe the iodine status of lactating mothers and infants aged from 0 to 6 months in the Vhembe and Mopani Districts. Methods: A cross-sectional study conducted on 246 infant-mother pair, from the Mopani and the Vhembe Districts. Data was gathered using a questionnaire. Breastmilk, mother urine, infant urine, household salt and drinking water were collected to be analysed for iodine content. Results: The median of breastmilk iodine concentration level amongst lactating mothers in the Vhembe District was 101.4 µg/l (IQR 62.9 – 175.1 µg/l) and 154.4 µg/l (IQR 92.6 – 211.8 µg/L) in Mopani. The median UIC of mothers in Vhembe was 98.5 (IQR 57.66 – 153.93), whereas in the Mopani District the median UIC of mothers was 126.08 µg/l (IQR 69.89 – 206.71 µg/L). The median UIC of infants in Vhembe was 220 (IQR 106.67 – 418.43 µg/l) and in the Mopani District was 321.94 µg/l (IQR 167.96 – 482.66 µg/l). Conclusion: The BMIC in the study signifies iodine sufficiency in both the Vhembe and the Mopani Districts. The results of this study suggest that the BMIC be included in studies assessing iodine status in lactating mothers since the UIC only reflects iodine that was consumed recently. The UIC may under estimate the maternal iodine status if it is not complemented by the BMIC data.<br>NRF

Infant-directed singing is a universal phenomenon that has existed and prevailed for centuries. This study explores mothers' perceptions and experiences of singing to their infants and participating in Parent-Child Mother Goose; a community-based parent support program that (among other things) supports the use of infant-directed singing as a means to enhance the mother-infant relationship. A case study approach using both qualitative and quantitative techniques for data collection was used. Five mothers were asked to complete self-administered questionnaires relating to singing to their infants as well as participating in a Parent-Child Mother Goose Program. Each mother participant also completed an interview with the researcher. A cross-case analysis of the data revealed a number of interrelated themes including: 1) experiencing bonding/connection with one's infant. 2) infant-directed singing as a means to regulate infant and maternal emotions and. 3) infant-directed singing as a means to communicate information to one's infant. The mothers also experienced benefits participating in Parent-Child Mother Goose.

Text in English with abstracts in English, Venda and Sepedi<br>Background: Suitable complementary feeding practices in young children can ensure optimal nutrition status and reduce under 5 mortality rates (Jones et al., 2014). Inadequate dietary diversity (DD) of the complementary diet both in quality and quantity is one of the major problems affecting infants and young children worldwide (Ntila et al., 2017). Adequate and appropriate nutrition during infancy and early childhood is vital for the growth and development of every child to reach full human potential (PAHO, 2003; WHO, 2008a; UNICEF, 2016). Nutritional vulnerability increases when other factors are also involved, such as poor breast and complementary feeding practices combined with high rates of infectious diseases (Solomons & Vossenaar, 2013; Ntila et al., 2017). There are pockets of information available on complementary feeding practices and its social determinants from specific areas in South Africa, regarding infant and young child feeding practices beyond six months of age and requires further investigation (Issaka et al., 2015; Seonandan & McKerrow, 2016). Aim: To explore the association between mothers’ socio-cultural environment and the dietary diversity of their children between the ages of 6 and 24 months, who attend the health care clinic in Olievenhoutbosch Township, Gauteng. Methodology: A quantitative cross-sectional explorative study was implemented. Data collection was conducted at Olievenhoutbosch clinic in Gauteng during February and March 2019. Mothers of children aged between 6 and 24 months were included and interviewed. Consecutive sampling was applied. The data collection instruments were a set of structured questions to obtain socio-demographic, nutritional knowledge, maternal attitude and feeding practices data. The infant and young child minimum dietary diversity (IYCMDD) questionnaire adapted from the WHO questionnaire was used to determine the DD of each child. Ethical clearance was obtained from the Ethics Committee of the College of Agriculture and Environmental Sciences (CAES) at the University of South Africa. Descriptive and inferential statistics was applied using SPSS version 25 (SPSS Inc, Chicago, IL, USA). Results: The sample of mothers (n=103) were educated (75% completed matric and 18% completed post-school education), unemployed (73%) and mostly single (53%) which are all factors playing a role in child nutrition. The majority (58%) of children were between the ages of 6 and 11 months while 42% were between the ages of 12 and 24 months. The milk feeding practices differed significantly between the younger and older groups of children with 35% of the younger children receiving breastmilk (in addition to complementary foods), compared to 21% of the older group. Almost half (44%) of the total group reported that maize meal porridge was the first food introduced to their children. Less than half of the mothers (45%) initiated the first foods at the recommended age of 6 months but started as early as one month of age (13%). All children (100%) consumed foods from the “grains, roots and tubers” food group the previous day. Significantly less children from the younger age group were reported to have consumed dairy (38% vs 77%, p<0.001) (other than breast or formula milk), animal flesh foods (31% vs 59%, p=0.014) and legumes (8% vs 24%, p=0.034), compared to the older age group. Significantly more children from the older group met the minimum dietary diversity (MDD) of four food groups compared to the younger group (67% vs 38%, p=0.019). No association was found between most socio-cultural factors (maternal age, marital status, education and employment status) and DD. However, there was an association between maternal ethnicity and DD (𝑥2=16.62, p=0.002). Also, maternal nutrition knowledge and the child’s DD had a significant, positive linear relationship (p=0.026). Lastly, maternal attitude towards feeling confident in not overfeeding the child were associated with meeting the MDD. Conclusion: The diets of young children residing in Olievenhoutbosch, do not meet the criteria for a minimally acceptable diet with only 50% meeting the MDD. Legumes and animal source foods are not consumed in sufficient quantities for complementary feeding. Maternal ethnicity and nutritional knowledge were associated with the child’s DD. More emphasis should be placed on DD for young children.<br>Vhubvo: Maitele o teaho a thikhedzo ya kuṋetshedzele kwa zwiḽiwa kha vhana vhaṱuku a nga khwaṱhisedza vhuimo ha gumofulu ha pfush na u fhungudza phimo ya dzimpfu dza vhana vha fhasi ha miṅwaha ya fhasi ha 5 (Jones na vhaṅwe, 2014). U sa lingana ha u fhambana ha kuḽele (DD) ha nndyo thikhedzi kha ndeme na tshivhalo ndi dziṅwe dza thaidzo khulwane dzi kwamaho dzitshetshe na vhana vhaṱuku u mona na shango (Ntila na vhaṅwe, 2017). Mufusho wo linganaho na wo teaho musi vhe dzitshetshe na kha vhuhana thangeli ndi dza ndeme kha nyaluwo na nyaluso ya ṅwana muṅwe na muṅwe uri a vhe na vhukoni hoṱhe (PAHO, 2003; WHO, 2008a; UNICEF, 2016). U vha khomboni ha mufusho zwi a ṋaṋa musi hu na zwiṅwe zwithu zwi dzhenelelaho, sa maitele a sa fushi a u mamisa na u tikedza zwo ṱangana na phimo ya nṱha ya malwadze a phirela (Solomons & Vossenaar, 2013; Ntila na vhaṅwe., 2017). Haya ndi mafhungo u ya nga zwipiḓa are hone kha maitele a u ḽisa ha thikhedzo na zwivhangi zwa matshilisano u bva kha vhuṅwe vhupo ha Afrika Tshipembe, maelana na u ḽisa dzitshetshe na vhana vho no fhirisaho miṅwedzi ya rathi, naho ṱhoho iyi i tshi ṱoḓa u senguluswa hafhu (Issaka na vhaṅwe, 2015; Seonandan & McKerrow, 2016). Ndivho: U itela u lavhelesa u elana ha vhupo ha zwa matshilisano na ikonomi ha mme na DD ya vhana vhavho vha vhukati ha miṅwedzi ya 6 na 24, vhane vha ya kiḽiniki ya ndondola mutakalo ngei kha Tshikolobulasi tsha Olievenhoutbosch, Gauteng. Ngona: Ngudo dza vhubuḓasia dza ndingedzo dzo shumiswa. Data yo kuvhanganywa ngei kha kiḽiniki ya Olievenhoutbosch kha ḽa Gauteng nga Luhuhi na Ṱhafamuhwe 2019. Vhomme a vhana vha miṅwedzi ya vhukati ha 6 na 24 vho dzheniswa vha vhudziswa. Vhukhethatsumbonanguludzwa ha thevhekano ho shumiswa. Sethe ya mbudziso dzo dzudzanywaho yo shumiswa u wana u phambano dza matshilisano, nḓivho ya mufusho, kusedzele kwa vhomme na data ya phatheni dza kuḽele. Mbudzisombekanywa ya phambano ya gumofulu ya kuḽele kwa dzitshetshe na vhana vhaṱuku (IYCMDD) u bva kha WHO yo shumiswa u vhona DD ya ṅwana muṅwe na muṅwe. Ṱhanziela dza vhuḓifari dzo wanala u bva kha Komiti ya zwa Vhuḓifari ya Khoḽidzhi ya zwa Vhulimi na Saintsi dza zwa Mupo (CAES) kha Yunivesithi ya Afrika Tshipembe. Mbalombalo dza ṱhalutshedzo na dza u sumbedzisa dzo shumiswa nga u shumisa vesheni ya SPSS 25. Mvelelo: Tsumbonanguludzwa dza vhomme (n = 103) vho funzwaho (75% vho fhedza maṱiriki na 18% yo bvelaphanḓa ya fhedza pfunzo ya nṱha ha tshikolo, vha sa shumi ndi (73%) nahone vhanzhi ndi vha tshilaho vhe vhoṱhe (53%), zwi re zwivhumbi zwoṱhe zwine zwa dzhenelela kha mufusho wa ṅwana. Vhunzhi (60%) ya vhana vho vha vhe vhukati ha miṅwedzi ya 6 u ya kha ya 11, 40% vhe vhukati ha ya 12 u ya kha 24. Kumamisele kwo fhambana vhukuma vhukati ha zwigwada zwa vhaswa na zwa vhahulwane, hune 35% ya vhana vhaṱuku vha vha vha khou wana mikando ya vhomme avho (nṱhani ha zwiḽiwa zwa u tikedza), hu tshi vhambedzwa na 21% ya tshigwada tsha vhahulwane. U ṱoḓa u swika kha hafu (44%) ya tshigwada tshoṱhe vho amba uri mukapu wa mugayo ndi zwone zwiḽiwa zwo thomaho u ḓivhadzwa vhana vhavho. Vhomme vha re fhasi ha hafu (45%) vho them zwiḽiwa zwa u thoma kha miṅwedzi yo themendelwaho ya 6 fhedzi vhaṅwe vha thoma u ṱavhanya vhe kha ṅwedzi muthihi (13%). Vhana vhoṱhe (100%) vho vha vho no ḽa ḽiwa zwi fanaho na thoro, midzi na khufhi sa zwigwada zwa zwiḽiwa ḓuvha ḽo fhiraho. Vha si gathi vhukuma kha vhana vha tshigwada tsha vhaṱuku vho pfi vho ḽa zwiḽiwa zwa mafhi (38% i tshi vhambedzwa na 77%, p < 0.001) (zwi si mafhi a mikando kana a boḓelo), zwiḽiwa zwa ṋama ya phukha (31% i tshi vhambedzwa na 59%, p = 0.014) ḽingaṋawa (8% vha tshi vhambedzwa na 24%, p = 0.034), vha tshi vhambedzwa na zwigwada zwa vhahulwane. Vhunzhi ha vhana vha bvaho kha tshigwada tsha vhahulwane vho swikelela phambano ya gumoṱuku ya nndyo (MDD) ya zwigwada zwiṋa zwi tshi vhambedzwa na tshigwada tsha vhaṱuku (67% i tshi vhambedzwa na 38%, p = 0.019). Ahuna u elana ho wanalaho vhukati ha zwivhumbi zwa mvelele na matshilisano (vhukale ha vhomme, vhuimo ha mbingano, pfunzo na vhuimo ha mushumo) na DD. Fhedzi, ho vha na u elana vhukati ha murafho wa vhomme na DD (𝑥2 = 16.62, p = 0.002). Zwiṅwe hafhu, nḓivho ya mufusho ya vhomme na DD ya ṅwana zwo vha na vhushaka, ha ndeme hu elanaho huvhuya (p = 0.026). Tsha u fhedzisela, kusedzele kwa vhomme kha u ḓipfa vhe na vhuḓifulufheli na u sa ḽisa ṅwana u fhira tshikalo zwo elana na u swikelela MDD. Khunyeledzo: Nndyo ya vhana vhaṱuku vha dzulaho ngei Olievenhoutbosch a i swikeleli maga a gumoṱuku a ṱanganedzwaho a nndyo; ho swikelelwa fhedzi 50% ye ya swikelela MDD. Ḽingaṋawa na tshiko tsha zwiḽiwa zwa zwipuka a zwi khou ḽiwa lwo linganaho kha thikhedzo ya kuḽele. Murafho wa vhomme na nḓivho ya mufusho zwo elana na DD ya ṅwana. Ho vha na khwaṱhisedzo hafhu kha DD ya vhana vhaṱuku.<br>Tšweletšo ya taba: ditiro tša maleba tša phepo ya tlaleletšo mo go bana ba bannyane di ka netefatša maemo a godimo a phepo le go fokotša kelo ya mahu mo go bana ba ka fase ga mengwaga ye 5 (Jones et al., 2014). Go fapafapana ga dijo fao go sa lekanago (DD) ga dijo tša tlaleletšo go bobedi boleng le bontši ke ye nngwe ya mathata a magolo ao a amago masea le bana ba bannyane lefase ka bophara (Ntila et al., 2017). Phepo ye e lekanego gape ya maleba nako ya bosea le bonnyane e bohlokwa go kgolo le tlhabollo ya ngwana yo mongwe le yo mongwe go fihlelela bogolo bjo bo feletšego (PAHO, 2003; WHO, 2008a; UNICEF, 2016). Kgolo ya hlaelela ya dijo ge dintlha tše dingwe le tšona di amega, go swana le ditshepedišo tša go fokola le phepo ya tlaleletšo go hlakanywa le malwetši a mantši a go fetela (Solomons & Vossenaar, 2013; Ntila et al., 2017). Go na le dipotla tša tshedimošo tšeo di lego gona go ditiro tša phepo ya tlaleletšo le dikelo tša leago go tšwa mafelong a go ikgetha mo Afrika Borwa, mabapi le masea le bana ba bannyane ka morago ga dikgwedi tše tshela, mme hlogo ye e nyaka dinyakišišo (Issaka et al., 2015; Seonandan & McKerrow, 2016). Nepo: go nyakišiša dikamano gare ga bomme le tikologo ya leago le setšo le DD ya bana ba gare ga dikgwedi tše 6 le tše 24, bao ba tsenetšego kliniki ya tša maphelo ya Olievenhoutbosch Township, Gauteng. Mekgwatshepetšo: thuto ya diphatišišo tša go hlakanela ga dikgao e phethagaditšwe. Kgoboketšo ya tshedimošo e dirilwe kliniking ya Olievenhoutbosch mo Gauteng nakong ya Febereware le Matšhe 2019. Bommago bana ba dikgwedi tša gare ga tše 6 le 24 di akareditšwe le go botšišwa. Sehlopha sa go latelana se šomišitšwe. Sete ya dipotšišo tšeo di hlamilwego di šomišitšwe go hwetša tsebo ya dimokrafi ya leago, dijo, maikemišetšo a bomme le tshedimošo ka ga mekgwa ya go fepa. Masea le mehuta ya go fapana ya dijo tša bana (IYCMDD) letlakalapotšišo go tšwa go WHO le šomišitšwe go ela DD ya ngwana yo mongwe le yo mongwe. Hlakišo ya maitshwaro e hweditšwe go Komiti ya Maitshwaro ya Kholetšhe ya Temo le Disaense tša Tikologo (CAES) mo Yunibesithing ya Afrika Borwa. Dipalopalo tša tlhaloso le taetšo di šomišitšwe ge go diragatšwa mohuta wa SPSS 25. Dipoelo: Sekgao sa bomme (n = 103) ba be go ba rutegile (75% ba phethile mphato wa marematlou le 18% ba tšwetšepele go phetha dithuto tša ka morago ga mphato wa marematlou), ga ba šome (73%) le bontši ga se ba nyalwe (53%), tšeo ka moka e lego dintlha tša go raloka karolo ye kgolo go phepo ya bana. Bontši (60%) bja bana ba magareng ga mengwaga ye 6 le ye 11, le 40% e be e le magareng a dikgwedi tše 12 le tše 24. Ditiro tša go nyantšha di fapana kudu gare ga bana ba bannyane le dihlopha tša bana ba bagolwane, ka 35% tša bana ba bannyane bao ba amogelago maswi a letswele (go tlaleletša dijo tša tlaleletšo), ge go bapetšwa le 21% tša batho ba bagolwane. Go nyaka go ba seripagare (44%) sa palomoka seo se begilego gore bogobe bja mabele ke dijo tša mathomo tšeo di tšweleditšwego go bana ba bona. Ka fase ga seripagare sa bomma (45%) ba thomile dijo tša bona tša mathomo ka mengwaga ye e digetšwego ya dikgwedi tše 6 efela di thomile ka kgwedi ya mathomo (13%). Bana ka moka (100%) ba jele dijo go tšwa go dithoro, medu le sehlopha sa dijo tša digwere mo letšatšing le le fetilego. Palo ye ntši ya bana ba bannyane go tšwa go mengwaga ye mennyane ba begilwe ba jele dijo tša maswi (38% vs 77%, p < 0.001) (ntle le maswi a letswele goba a go rekwa), dijo tša nama ya phoofolo (31% vs 59%, p = 0.014) le dinawa (8% vs 24%, p = 0.034), ge go bapetšwa le batho ba mengwaga ya bagolo. Bontši bja bana go tšwa go sehlopha sa ba bagolo ba kgotsofaditše dinyakwa tša go fapana tša dijo (MDD) ya dihlopha tše nne ge go bapetšwa le dihlopha tše dinnyane (67% vs 38%, p = 0.019). Ga go dikamano tšeo di humanwego gare ga dintlha tše dintši tša leago le setšo (mengwaga ya tswalo, maemo a lenyalo, thuto le maemo a mošomo DD. Le ge go le bjalo, go bile le dikamano gare setšo le DD (𝑥2 = 16.62, p = 0.002). Le, tsebo ya dijo le DD ya bana, tswalano ya maleba ya tatelano (p = 0.026). Sa mafelelo, mmono wa bomme go ikwa ba na le boitshepo ka go se fepe ngwana go feta tekanyo tšeo di amanago le go kopana le MDD. Thumo: Dijo tša bana ba bannyane ba go dula Olievenhoutbosch ga ba kgotsofatše dinyakwa tša dijo tše di amogelegago; fela 50% e kopane le MDD. Dinawa le dijo tša mothopo ya diphoofolo ga di lewe ka bontši bja go lekana go dira dijo tša tlaleletšo. Mohlobo le tsebo ya dijo di be di amane le DD ya ngwana. Kgatelelo ye kgolo e swanetše go bewa go DD go bana ba bannyane.<br>Department of Life and Consumer Science<br>M.A. (Consumer Science)

Masters Research - Master of Philosophy (MPhil)<br>Inappropriate infant and young child feeding (IYCF) practices are one of the major causes of undernutrition, morbidity and mortality among young children in Tanzania and the risk factors associated with inappropriate IYCF practices remain unclear. This information is therefore, vital to identify those at risk of poor feeding practices and who need to be targeted for interventions to improve IYCF practices in Tanzania. The main objective of this thesis was to describe the prevalence of the new World Health Organization IYCF indicators and identify factors associated with inappropriate breastfeeding and complementary feeding practices among children aged 0-23 months in Tanzania. The thesis also compared the trends of key breastfeeding indicators from 1999 to 2010 and complementary feeding indicators from 2004-05 to 2010. This thesis was a secondary analysis of cross-sectional data from the 1999 Tanzania Reproductive and Child Health Survey, the 2004-05 and 2010 Tanzania Demographic and Health Surveys. These surveys used a multi-stage cluster sample of 3,826 households in 1999, 10,312 in 2004-05 and 10,300 in 2010 from eight geographic zones in Tanzania. The sample consisted of 7,603 infants aged 0-23 months (Chapter 2). Results from the analysis of breastfeeding data in Chapter 3 showed that breastfeeding is universal in Tanzania as almost all mothers (98%) breastfed their children as reported in the three surveys. However, breastfeeding was initiated within the first hour of birth in 59.0% of mothers in 2004-05 but reduced to 46.1% in 2010. In infants aged 0-5 months the prevalence of exclusive breastfeeding was 31.8% in 1999 and increased to 41.3% in 2004-05 and further improved to 49.9% in 2010. The proportion of infants aged 0-5 months who were “predominantly breastfed” declined from 59.8% in 1999 to 16.8% in 2010. Most mothers (>91.0%) breastfeed up to 1 year in all surveys, but the proportion decreased to 57.2% , 55.5% and 51.1% at 2 years of age in 1999, 2004-05 and 2010 respectively. The most consistent determinants of suboptimal breastfeeding (delayed initiation of breastfeeding within one hour of birth; non-exclusive breastfeeding and predominant breastfeeding) included young maternal age (< 25 years), lower maternal education, maternal employment, home delivery, inadequate care during and after birth and poor economic status. Chapter 4 presents the findings for the analysis of complementary feeding practices based on data from the 2004-05 and 2010 Tanzania Demographic and Health Surveys because information on complementary feeding practices (i.e. type of foods and frequency of feeding) was not collected in the 1999 survey. It was found that the majority of infants aged 6-8 months were reported to receive soft, semi-solid or solid foods, and the proportion increased from 79.6% in 2004-05 to 92.3% in 2010. However very few children aged 6-23 months met the minimum requirements for indicators for dietary diversity, meal frequency and acceptable diet. The prevalence of minimum dietary diversity showed slight decrease from 39.5% in 2004-05 to 38.0% in 2010, whereas minimum meal frequency and acceptable diet showed significant decline from 45.0% and 18.5% in 2004-05 to 34.7% and 13.4% in 2010 respectively. Lower parental education, poor household economic status, absence of postnatal check-ups after delivery, young child age and rural residence were significant and consistent risk factors associated with inappropriate complementary feeding practices in Tanzania. Based on the above findings, this thesis concluded that levels of breastfeeding and complementary feeding indicators are below national targets of 80% placing millions of children at risk of childhood malnutrition associated with inappropriate feeding (Chapter 6). Tanzania has made significant improvement regarding feeding indicators such as exclusive breastfeeding under six months, continued breastfeeding up to 1 year and introduction of complementary foods at 6-8 months from 1999 to 2010. However, there was significant decline in the prevalence of the indicators for early initiation of breastfeeding within one hour after birth, continued breastfeeding up to two years, minimum dietary diversity, minimum meal frequency and minimum acceptable diet from 2004-05 to 2010. These findings highlight the need for effective national level nutrition programmes to enhance breastfeeding and complementary feeding practices and with a focus on the target groups with sub-optimal practices- including young uneducated mothers and carers with young children who lacked postnatal contacts with health workers, those from poor families and residing in the rural areas.

碩士<br>國立臺灣師範大學<br>人類發展與家庭學系<br>96<br>The primary food source of infants from birth to 6 months is milk, the WHO and The American Academy of Pediatrics recommend exclusive breastfeeding until age of 6 month. However, estimating the breast-fed infants nutrients intake is limited by lack of quantitative data in Taiwan. This study has two purposes, one is to assessment the breast milk intakes by test-weighing for birth to 6 months infants and refer published papers to calculate the daily breast milk consumption by difference month age. The other is to estimated nutrient intakes from breast milk, formula milk and supplemental food, and confer dietary intakes and growth status of different birth weight infants and the affected factors. In the test weighting study, we recruited 15 breas-tfed infants (from birth to 6 months) since Feb 2005 to Aug 2007, then estimate volume of breast milk intake daily. In the cohort study contain two cohorts, we collect feeding data from infants by follow-up questionnaire from birth to 6 months, then we use the data to examine nutrient intakes, growth and development of 264 infants. The study tools contain the baby electronic scales, the Breast-Fed Test Weighting Record and the Monthly Diet and Health Questionnaire. We analyse our data by the software packages of SPSS 12.0 and STATA 8.0. In the test weighting study, the average number of feedings per day are between 7.6 to 9.6 times and decreased with age. Volume of breast milk intakes per feeding are 52 to 112 g and increase with age. For exclusively breastfed infants from birth to 6 months of age, we estimate 530 g, 580 g, 620 g, 670 g, 720 g and 760 g of breast milk per day. There were 33.6%, 29.9%, 28.4%, 25.6% and 24.5% of subjects exclusively fed by breast milk, as well as 36.8%, 45.4%, 49.6%, 54.8% and 59.8% of infants exclusively fed by formula at 2 to 6 months, respectively. The calorie and protein intakes per kilogram for low and high birth weight infants are lower than DRIs (Dietary Reference Intakes), but most nutrient intakes of adequate birth weight infants accomplish DRIs. Weight, length and head circumference of the infants in 6th month are differed significantly in gender. The growth of 6 month infants with different feeding patterns have no significant different. By multiple regression analysis, infants’ gender, birth weight, mothers’ height, and VitB12 intake at 6th month, were positively correlated with infants’ weight at 6th month (p<0.05). The infants’ gender, birth length, and biotin intake at 6th month positively correlated with infants’ length at 6th month (p<0.05). The infants’ gender, birth head circumferences, and fat intake at 6th month positively correlated with infants’ head circumferences at 6th month (p<0.05).

碩士<br>臺灣大學<br>物理治療學研究所<br>98<br>Background and Purpose: Very low birth weight (VLBW) preterm infants (birth weight &amp;lt;1,500 g) sustain an increased risk of developmental and emotional/behavioral disorders in childhood and adolescence. Although previous studies have demonstrated small to moderate benefits of early intervention to the cognitive and motor function in VLBW preterm infants, these studies have rarely examined the socio-emotional outcome. This study was, therefore, aimed to examine the effect of early intervention on emotion regulation in VLBW preterm infants at 6 months of corrected age. Methods: A total of 178 VLBW preterm infants were randomly assigned to the usual care program (UCP), clinic-based intervention program (CBIP) and home-based intervention program (HBIP). Sixty-two full-term infants were also included to serve as the reference group. Early intervention consisted of child- and parent-focused services that began in hospitalization and ended at 12 months of corrected age. Infants were assessed for emotion regulation under the arm restraint procedure at 6 months of corrected age with their behaviors recorded using a video camera and physiological responses by an electrocardiography. The video records were coded for negative reactivity and regulatory behaviors; the heart rate data were analyzed for variability. Results: For infants who returned for follow up and had complete physiological data, full-term, UCP and CBIP groups showed an increase in negative vocalization (all p&amp;lt;0.05); whereas HBIP exhibited no change from the restraint to release period. Furthermore, UCP and CBIP groups manifested higher levels of negative vocalization than full-term and HBIP groups in the release period (all p&amp;lt;0.05). However, regulatory behaviors in response to arm restraint did not vary between groups. Physiologically, CBIP and full-term groups exhibited similar tendency showing an incline in high-frequency power of heart rate variability (lnHF) from the baseline to restraint period, which was followed by an incline from the restraint to release period (both p&amp;lt;0.05). In contrast, HBIP and UCP groups manifested no change in lnHF throughout the procedure. For those exhibiting increased lnHF from the baseline to restraint period, CBIP group showed more mother orientation and full-term group showed more object orientation in self regulation (both p&amp;lt;0.05). Conclusion: Early intervention, specifically CBIP, appeared to favor emotion regulation in VLBW preterm infants at 6 months of corrected age. Physiological regulation was more sensitive to infants’ reactivity to arm restraint procedure than that of behavioral reactivity at 6 months.

M. Tech. (Food Service Management, Dept. of Hospitality and tourism, Faculty of Human Sciences)|, Vaal University of Technology,<br>INTRODUCTION: Caring for children is a challenge that requires a number of resources including knowledge, a reasonable workload, time and social support of the caregiver. Maternal education is an important asset in providing good care giving practices: child feeding practices and the use of preventative health services depend on knowledge more than on household resources. Poverty has been linked with poor childcare and child malnutrition; South African children especially those who are living in informal settlements, are vulnerable to poverty. Appropriate practices by caregivers have enabled them to raise well~ nourished children in a community where there is poverty. This implies that caregiver's attitudes, beliefs and practices in relation to childcare, and proper utilisation of limited resources can make a major difference in their children's health, growth and development. In order to plan appropriate interventions in the Eatonside informal settlement, an improvement in the knowledge of, attitude toward and practice of childcare and care giv1ing is required. OBJECTIVES: To examine the knowledge, attitudes and practices (KAP) of caregivers regarding childcare and care giving behaviours with children aged 0- 60 months and to assess existing types of care arrangements in the study area. STUDY DESIGN: An exploratory study was conducted among 145 randomly selected caregivers of children aged 0-60 months, living in the informal settlement of Eatonside. Knowledge and practices were determined by focus group discussions (FGD); an attitude scale questionnaire was used to determine attitude; and a hygiene and feeding observation checklist was used to determine the hygiene and feeding practices.

Background: Breastfeeding is widely recognised as the ideal approach for improving child survival and feeding new-born babies and young infants. The World Health Organisation (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life with timely introduction of complementary foods at 6 months and continued breastfeeding for up to two years and beyond. The feeding practices of mothers are widely influenced by different factors which may be embedded within different contexts of life. Aim: This study explored the infant feeding practices of mothers and/or caregivers of infants below the age of 6 months. Method: This cross sectional study was conducted in four provinces in South Africa. In total, 40 health facilities were randomly selected in the four provinces and visited including metropolitan and non-metropolitan health facilities over the geographical area of the provinces. Fixed structured interviews were conducted and data on the feeding practices of mothers were collected using a questionnaire which had both open and closed-ended questions. Qualitative data were coded under different themes. The sample size comprised of mothers and/or caregivers of babies aged 6 months and below. A 24-hour recall was completed for all infants. Dietary intake and diversity were assessed using the FAO dietary diversity list consisting of 12 different food groups. Descriptive statistics, crosstabs and Pearson chi-square tests were used. Results: A total of 580 mothers/caregivers of infants below the age of 6 months were interviewed. Ninety-five % (n=551) were biological mothers. A total of 490 (85%) were breastfeeding at the time of the interviews. Ninety % had initiated breastfeeding during the first hour after delivery. At the time of the study, 12% (n=4) of the women were practising exclusive breastfeeding (EBF) for the recommended 6 months. Sixteen % (n=90) were not breastfeeding at the time the interviews were conducted. More than two thirds (64%) had exclusively breastfed their infants but stopped at the time of the interviews and 36% (n=32) did not breastfeed their babies at all. Twelve % (n=4) of the mothers stopped breastfeeding from as early as one month. The most cited reasons by the participants for breastfeeding cessation were the need to return to work or school. Reasons for not breastfeeding at all included the mothers HIV status, poor health and insufficient milk production. Forty-one % (n=239) of the mothers believed that breastfeeding contains adequate nutrients for the child and 5.7% (33) did not know why breastfeeding is important. Nearly half (49%) were giving infant feeding formula. Seventy % (n=220) of the women were giving either infant feeding formula or other liquids in addition to breast milk. The most stated reason for giving other liquids or foods was the belief that breast milk was not enough for the infant. Almost two thirds (56%) of the mothers gave their infants fortified infant feeding formula. Only one infant (0.2%) met the minimum standard of dietary diversity. Complementary food was introduced from as early as one month, and 73% of the women reported that their infants were receiving dietary supplements. Conclusion: Breastfeeding still remains a universal practice in the country. Sustained exclusive breastfeeding is still a cause of concern and 6 month EBF rates remain very low. Both mothers and caregivers had sound understanding of the importance of breastfeeding. Early initiation of complementary foods is still a norm and wide problem in the country. The dietary diversity of complementary diets given to babies was nutritionally inadequate.<br>MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Indiana University-Purdue University Indianapolis (IUPUI)<br>There has been a tremendous influx in the number of Hispanic immigrants into the US over the past couple of decades. Many newcomers have families with small children, and dental needs in this pediatric population are disproportionately high. The purpose of this study was to determine if there was any correlation between the increased prevalence of caries and socioeconomic or cultural factors in Hispanic children ages six months to eight years old. To accomplish this, 127 children were given dental examinations by a calibrated dental examiner, and their parents completed a two-page questionnaire with questions regarding socioeconomic factors, den1ographics, and cultural issues. The bivariate relation between caries status and demographic and cultural variables was examined using chi-square tests or Fisher's exact tests for categorical variables and logistic regression for continuous variables. Bivariate relation between defs and demographic and cultural variables was examined using analysis of variance (ANOVA). The mean defs for children up to age two was 1.53; ages two to five the mean defs was 7.73, and for ages six to eight, 9.18. As the prevalence of caries increases with age, the child is more likely to access dental care, but despite this, there is an overall mean 79 percent of untreated decay (of decayed, missing and filled surfaces). In the permanent dentition, the overall mean DMFS was found to be 2.22. There were several factors found to be statistically significant to the incidence of defs. If the child had dental insurance, the child was more likely to have higher defs. If a child had more siblings, the defs score was higher. If the child was on the bottle at less than age one-and-a-half, the child was less likely to have dental caries. If the child on the bottle was older than age one-and-a-half, the child was much more likely to have dental caries. The older the child is when the child goes off the bottle, the more likely the child will have a higher caries experience. There is an extraordinarily large number of untreated caries found in Hispanic children. The reasons for this are multifactorial, but involve cost, language barriers, being new to the area, and not having seen a dentist yet. Identifying those at high risk such as single mothers, those with increased numbers of siblings, and infants that are still on the bottle, or older children that are at increased jeopardy due to prolonged use of the bottle are important factors in treating those that are underserved. Local dental and community organizations could benefit from being apprised of the unmet dental need of Hispanic children and some of the contributing factors. By further investigating and understanding some of the socioeconomic and cultural issues that present barriers to care, treatment might become more accessible and available. Adverse outcomes such as missed school and opportunities for acculturation, inadequate nutrition, pain, and infection might be avoided or diminished.

This study explores the language and communication development of infant siblings of children with autism, who are at increased risk for impairments in these domains, over the first year of life (Jones et al., 2014). Additionally, maternal communicative input and background factors unique to this population (e.g. mothers' concerns about their infants' development and experience with a previously diagnosed child) werealso examined to determine how these parental and family factors interact with infants' early language and communication development. These issues were examined in the context of a longitudinal study of high risk infant siblings using data collected from 89 high risk infant siblings and 76 low risk infants, with the sample varying across each of three studies. Group differences in maternal and infant communication, scoredfrom both home-based written and video diaries collected over the first year of life,were analyzed using repeated measures ANOVA and non-parametric analyses; correlations analyses compared these scored behaviors to standardized measures collected in the laboratory. The number of infants diagnosed with autism ranges from 5 - 19 infants per study; analyses address both this subset of infants and the larger group of high risksiblings as a whole. Results show that a) mothers of high risk infants have consistent and early-appearing concerns about their infants' development, but these concerns are poorly related to infant symptoms before 9 months, b) delays in language, as evident in consonant production are not readily apparent at 9 months of age, and high and low risk mothers respond equivalently to these early vocalizations, c) at 12 months, high and low risk mothers use similar social-communicative prompting strategies but for high risk mothers these strategies are associated with autism-related concerns about their infant and the symptom severity of the older diagnosed child. These findings support a transactional account of early dyadic interactions, with infant language delays emerging over the first year of life and parental behavior reflecting both these emerging symptoms and unique background factors. These results are discussed in terms of the larger literature on language and communication in early infancy, as well as implications for intervention practices.

This diploma thesis is devoted to the development of body measurements of children 0 to 6 months old being exclusively breastfed until the age of four months and then breastfed with appropriate complementary food. The anthropometrical parameters were the body length, the body weight and the head circumference. The results are shown separately for girls and boys in tables and graphs. The data were compared to the previous surveys of the Czech children. Student's t-test and Z- score were used for comparison. Selected somatic and other characteristics obtained by a questionnaire were taken into the study. The Life Satisfaction Questionnaire was used to evaluate the welfare of primiparas. The breastfed children do not reach lower average values of body length and weight than children of the reference survey CAV, 2001 (Vignerová et al., 2005) and Bláha a kol., 2001 (Bláha et al., 2010) in general. Body lenght, body weight and head circumference of boys and girls until the age of one month positively correlates with the gestation age of an infant. Life satisfaction of primiparas is mostly influenced by financial situation, marriage, partnership and sexuality. Life satisfaction of primiparas from our survey correlates statistically significantly with their health and satisfaction with marriage and partnership. The collected somatic data of infants could be used as a part of the standards for contemporary population of breastfed infants.