Academic literature on the topic 'Malnutrition in infants – South Africa'

Tobacco and alcohol use among mothers is associated with numerous adverse consequences for affected offspring, including poor growth and development. This study determined the association between maternal tobacco and alcohol use, and malnutrition, among infants aged ≤ 12 months (n = 300), in selected health facilities situated in Gauteng, South Africa. Data on alcohol and tobacco use were collected using a validated questionnaire, in addition to mothers’ socio-demographic characteristics and obstetric history. Stunting (low height/length-for-age), underweight (low weight-for-age) and thinness (low body mass index-for-age) were calculated using z-scores based on the World Health Organization child growth standards. The association of tobacco and alcohol use with stunting, underweight and thinness was analysed using logistic regression analysis. The results showed a mean age of 29 years (24.0; 35.0) for mothers and 7.6 ± 3 months for infants, and over half of the mothers were unemployed (63%). Approximately 18.7% of mothers had used tobacco and 3% had used alcohol during pregnancy. The prevalence of current tobacco and alcohol use among mothers were estimated at 14.3% and 49.7%, respectively, and almost three-quarters (67.3%) of them were still breastfeeding during the study period. Stunting (55%) was the most prevalent malnutrition indicator among infants, while underweight was 41.7%, and thinness was 22%. Current tobacco use was associated with increased odds of being thin [OR = 2.40, 95% CI: 1.09–5.45), and after adjusting for confounders, current alcohol use was associated with the likelihood of being underweight [AOR = 1.96, 95% CI: 1.06–3.63] among infants. Future prospective cohort studies that examine growth patterns among infants who are exposed to maternal tobacco and alcohol use from the intrauterine life to infancy are necessary to inform, partly, the public health programmes, to reduce malnutrition among children.

Infants in developing countries are at risk of concurrent micronutrient deficiencies, because the same causative factors may lead to deficiencies of different micronutrients. Inadequate dietary intake is considered one of the major causes of micronutrient deficiencies, especially among poor and underprivileged children in developing countries. Operational strategies and distribution systems are often duplicated when supplementation programs for single micronutrients are implemented at the same time. The International Research on Infant Supplementation (IRIS) trial was conducted in four distinct populations on three continents: Africa, Latin America, and Asia. The participating countries were South Africa, Peru, Vietnam, and Indonesia. The study had a randomized, doubleblind, placebo-controlled design. Each country aimed to enroll at least 70 infants per intervention group (65 + 5 anticipated dropouts). The micronutrient vehicle was in the form of a “foodlet” (food-like tablet) manufactured as chewable tablets, which were easy to break and dissolve, and which had the same taste, color, and flavor for all countries. Children were randomly assigned to one of four 6-month intervention groups: group 1 received a daily foodlet containing multiple micronutrients; group 2 received a daily placebo foodlet containing no micronutrients; group 3 received a weekly foodlet that contained multiple micronutrients (twice the dose of the daily foodlet) and placebo foodlets on the other days of the week; group 4 received a daily foodlet containing only 10 mg of elemental iron. The IRIS Trial aimed to examine the prevalence of multi-micronutrient deficiencies in 6- to 12-month-old infants from rural populations, and to examine the efficacy of multi-micronutrient supplementation in infants from the different countries included in the study. This paper describes the general methodology of the IRIS trial and the operational differences among the country sites.

ABSTRACT Background Few studies have focused on quantitatively analyzing nutrients from infant diets, compromising complementary feeding evaluation and health promotion worldwide. Objectives This study aimed to describe dietary intake in infants from 9 to 24 mo of age, determining nutrient intakes associated with the risk of underweight, wasting, and stunting. Methods Usual nutrient intakes from complementary feeding were determined by 24-h recalls collected when infants were 9–24 mo of age in communities from 7 low- and middle-income countries: Brazil (n = 169), Peru (n = 199), South Africa (n = 221), Tanzania (n = 210), Bangladesh (n = 208), India (n = 227), and Nepal (n = 229), totaling 1463 children and 22,282 food recalls. Intakes were corrected for within- and between-person variance and energy intake. Multivariable regression models were constructed to determine nutrient intakes associated with the development of underweight, wasting, and stunting at 12, 18, and 24 mo of age. Results Children with malnutrition presented significantly lower intakes of energy and zinc at 12, 18, and 24 mo of age, ranging from −16.4% to −25.9% for energy and −2.3% to −48.8% for zinc. Higher energy intakes decreased the risk of underweight at 12 [adjusted odds ratio (AOR): 0.90; 95% CI: 0.84, 0.96] and 24 mo (AOR: 0.91; 95% CI: 0.86, 0.96), and wasting at 18 (AOR: 0.91; 95% CI: 0.83, 0.99) and 24 mo (AOR: 0.83; 95% CI: 0.74, 0.92). Higher zinc intakes decreased the risk of underweight (AOR: 0.12; 95% CI: 0.03, 0.55) and wasting (AOR: 0.19; 95% CI: 0.04, 0.92) at 12 mo, and wasting (AOR: 0.05; 95% CI: 0.00, 0.76) at 24 mo. Conclusions Higher intakes of energy and zinc in complementary feeding were associated with decreased risk of undernutrition in the studied children. Data suggest these are characteristics to be improved in children's complementary feeding across countries.

Background; Early child cognitive development is important throughout one’s life span. It is estimated that more than 200 million children under five years of age fail to achieve full cognitive development in the world and 80% of them are in south Asia and sub-Sahara-Africa. Genetic and environmental factors play a role in early child development (ECD). Most of the ECD occurs in the first 2years of life, but largely during infancy. Malnutrition, poverty and poor health care to children have been found to have association with poor cognitive development and create a vicious cycle of poverty. This study gives the proportion and factors that are associated with infants’ cognitive developmental delay in our setting. Knowing these factors enhance early intervention to break the viscious cycle.This study aimed to determine the proportion and factors associated with cognitive developmental delay among infants attending RCH clinics in Dar es Salaam. Patients/ Material and Methods; This was a health facility based descriptive cross-sectional study conducted by using a structured data collecting tool done in three health centers in Dar es Salaam from July to December 2012. A two- stage sampling technique and Lottery were used to get the health centers. The data were analyzed using SPSS software by Pearson’s chi-square, Fisher exact test and logistic regressions. Results; A total of 350 infants were assessed for cognitive development in a period of six months. Male infants were the majority by 50.6%. Our study Participants aged 1to 12 months with a mean (SD) of 7.26 (3.43) months with their birth weight ranging from 1.3 to 4.6kg with mean (SD) of 3.11(0.50) kg. The Proportion of infants with cognitive developmental delay was 12.3%. Age of the child, caretakers and wasting were significantly associated with cognitive developmental delays even after adjusting for confounders. Infants aged less than 6months were 14 times more likely to have cognitive developmental delay compared to those aged six months and above (adjusted oddis ratio{aOR=14; 95%CI 5.3-38.3, P<0.001}). Infants cared by assistant caretakers especially during day-time, were 12 times more likely to have cognitive developmental delay compared to infants who stayed with their mothers (aOR=12.1; 95%CI 3.0-53, P=0.001). Wasted infants were 4 times more likely to have cognitive developmental delay (aOR=3.9; 95%CI 1.1-13.3, P=0.032) compared to infants with good nutritional status. Conclusion; The proportion of cognitive developmental delay among infants attending Reproductive and Child Health( RCH) clinics in Dar es Salaam was 12.3%. Young age of the child, use of other caretakers in absence of the mother, and wasting were associated with cognitive developmental delays. Infants need Mothers to spend time with them and prevention of malnutrition plays a role in cognitive development.

AbstractObjective:To review current information on under- and over-malnutrition and the consequences of socioeconomic disparities on global nutrition and health.Design:Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions.Setting:The economic gap between the more and less affluent nations is growing. At the same time income disparity is growing within most countries, both developed and developing. Concurrently, epidemiological, demographic and nutrition transitions are taking place in many countries.Results:Fully one-third of young children in the world's low-income countries are stunted because of malnutrition. One-half of all deaths among young children are, in part, a consequence of malnutrition. Forty per cent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birth weight infants. Despite such worrying trends, there have been significant increases in life expectancy in nearly all countries of the world, and continuing improvements in infant mortality rates. The proportion of children malnourished has generally decreased, although actual numbers have not in sub-Saharan Africa and south Asia. Inequalities are increasing between the richest developed countries and the poorest developing countries. Social inequality is an important factor in differential mortality in both developed and developing countries. Many countries have significant pockets of malnutrition and increased mortality of children, while obesity and non-communicable disease (NCDs) prevalences are increasing. Not infrequently it is the poor and relatively disadvantaged sectors of the population who are suffering both. In the industrialized countries. cardiovascular disease incidence has declined, but less so in the poorer socioeconomic strata.conclusions:The apparent contradicitions found represent a particular point in time (population responses generally lag behind social and environmental transitions). They do also show encouraging evidence that interventions can have a positive impact, sometimes despite disadvantageous circumstances. However, it seems increasingly unlikely that food production will continue to keep up with population growth. It is also unlikely present goals for reducing protein-energy malnutrition prevalence will be reached. The coexistence of diseases of undernutrition and NCDs will have an impact on allocation of resources. Action needs to be continued and maintained at the international, national and individual level.

AbstractAimThe aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa.MethodologyNutritional risk status of infants and children < 6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein–Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status.ResultsOne hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P = 0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P < 0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P = 0.003). The weight results of the nurses and the researcher differed significantly (P < 0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P < 0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart.ConclusionsProblems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.

Abstract Objectives To estimate prevalence of breastfeeding (exclusive, predominant, partial, and none) and trends for infants under six months of age for 204 countries and territories from 1990 to 2019. Methods We conducted a systematic review for data on breastfeeding status for children under six months of age. We used survey and food diary data to categorize breastfeeding status into exclusive, predominant, partial, and none. Using a 3-step spatio-temporal Gaussian process regression, we modeled the prevalence of each breastfeeding category in 204 countries and territories, 1990 to 2019. Results Global prevalence of exclusive breastfeeding in infants less than six months of age was 43.5% (95% CI 42.7–44.3) in 2019, up from 34.0% (32.7–35.3) in 1990. Globally, non-exclusive breastfeeding was distributed 30.5% (29.8–31.1) predominant, 16.6% (16.2–17.0) partial, and 9.4% (8.9–10.0) no breastfeeding in 2019. Each of these categories experienced a decline in prevalence since 1990, when non-exclusive breastfeeding was 37.0% (36.0–38.1) predominant, 18.7% (18.1–19.4) partial, and 10.2% (9.5–11.0%) no breastfeeding. Exclusive breastfeeding was highest in Andean Latin America (59.7% [57.4–61.9]), Oceania (56.8% [53.2–60.0]), and South Asia (53.9% [53.2–60.0]). There was marked geographic variation in the distribution of non-exclusive breastfeeding types. Predominant breastfeeding was highest in Western Sub-Saharan Africa (51.5% [49.8–53.2]) and Central Asia (47.2% [45.3–49.0), partial breastfeeding was highest in Southern Latin America (31.1% [28.4–34.0]) and the Caribbean (29.3% [27.6–31.1]), and no breastfeeding was highest in High-income North America (36.7% [31.0–42.5]) and Australasia (32.4% [26.3–36.4]). Conclusions Since 1990, global prevalence of exclusive breastfeeding has increased nearly 10 percentage points. Nonetheless, many countries are not on track to meet the WHO Global Nutrition Target of at least 50% of infants under 6 months exclusively breastfeeding. These cross-nationally comparable estimates of current levels and trends in breastfeeding status provide useful data for targeting interventions to improve breastfeeding practices and to help alleviate the associated global burden of infant malnutrition. Funding Sources Funding for this research was provided by the Bill and Melinda Gates Foundation.

Introduction. Child mortality rate in sub-Saharan Africa is 29 times higher than that in industrialized countries. Anemia is one of the preventable causes of child morbidity. During a humanitarian medical mission in rural South-Eastern Nigeria, the prevalence and risk factors of anemia were determined in the region in order to identify strategies for reduction. Methods. A cross-sectional study was done on 96 children aged 1-7 years from 50 randomly selected families. A study questionnaire was used to collect information regarding socioeconomic status, family health practices, and nutrition. Anemia was diagnosed clinically or by point of care testing of hemoglobin (Hb) levels. Results. 96 children were selected for the study; 90 completed surveys were analyzed (43% male and 57% females). Anemia was the most prevalent clinical morbidity (69%), followed by intestinal worm infection (53%) and malnutrition (29%). Mean age (months) at which breastfeeding was stopped was 11.8 (±2.2) in children with Hb <11mg/dl (severe anemia), 10.5±2.8 in those with Hb = 11-11.9mg/dl (mild-moderate anemia), and 9.4±3.9 in children with Hb >12mg/dl (no anemia) (P=0.0445). Conclusions. The longer the infant was breastfed, the worse the severity of childhood anemia was. Childhood anemia was likely influenced by the low iron content of breast milk in addition to maternal anemia and poor nutrition. A family-centered preventive intervention for both maternal and infant nutrition may be more effective in reducing childhood anemia and child mortality rate in the community.

In 2001, students and professionals from 13 nations were hosted by UNICEF for the International Workshop on Multi-Micronutrient Deficiency Control in the Life Cycle in Lima, Peru, May 30–June 1, 2001. Workshop participants engaged in both narrow and broad discussions of ways to combat multiple micronutrient deficiencies in developing countries. Preliminary data from four common-protocol studies conducted in Peru, South Africa, Indonesia, and Vietnam were presented. Participants also discussed the immediate, preliminary, and interim issues that could guide both policy and planning of future studies of multiple micronutrient deficiency. Among the studies highlighted was the International Research on Infant Supplementation (IRIS) I trial. A review of IRIS I yielded some confirmation of the efficacy using a crushable “foodlet” (i.e., cross between food and tablet) as a supplementation vehicle, as well as concerns about potential adverse consequences of nutrient-nutrient and nutrient-nutriture interactions. Other plenary topics illustrated the practical matters of how the IRIS I logistics and operations were built, and several focused on how to best design follow-up research on infant supplementation. Finally, a series of working groups allowed for in-depth discussions on the topics of community and policy, monitoring and implementation, and research. Researchers continue to try to identify efficient and effective programs suited to the low-income settings in which infant multi-micronutrient malnutrition occurs. The papers in these proceedings elaborate on several aspects of the IRIS study, and they are published in the hope that their analysis by readers will produce wider dissemination of the details of this devastating problem.

Purpose White maize-based porridge is a staple food for about 80 per cent consumers in South Africa and in other sub-Saharan African countries contributing significantly to the diet of rural population in developing countries. White maize is deficient in some amino acids and over-dependency on its porridge may lead to high prevalence of malnutrition-related health conditions. Moringa oleifera (MO) and termite (Macrotermes falciger) are known to contain substantial amount of protein. The purpose of this study was to determine the effect of powders from MO leaves and termite on the nutritional and sensory properties of instant maize porridge. Design/methodology/approach Inclusion of MO and termite powder in instant maize porridge, using different treatments were considered using a completely randomised design. Factor levels were control (maize flour) cooked, blanched and uncooked MO samples. Data were analysed using SPSS version 23. Findings Protein content of fortified instant maize porridge (FMP) significantly increased from 10.0 to 21.2 per cent compared to unfortified porridge, and this could be attributed to the substitution effect, as fresh uncooked MO leaves are reported to be high in protein. Mineral content of FMP was higher in zinc, iron, calcium and magnesium. Calcium values of FMP were higher (276.8 mg/100 g) compared to unfortified porridge (7.1 mg/100 g). Upon the addition of MO leaves and termite powder, the zinc content increased from 3.4 mg/100to 7.6 mg/100 g. Higher iron values (27.9-36.9 mg/100 g) were observed among fortified samples. The sensory result showed that control sample had higher acceptance than the fortified samples (p = 0.02). Sensory analysis showed that among fortified porridges, blanched sample was rated high for colour and texture, cooked sample was higher in taste and uncooked sample was higher for aroma. Control sample had higher acceptance than fortified porridges for taste. The results of this study showed that the addition of MO leaves and termite powder to instant maize porridge has led to a substantial increase in the nutritional value of FMP. Originality/value This study was carried out to develop instant maize porridge fortified with MO leaves and termite powder suitable for infants, pregnant mothers and other maize consumers. The author aimed at improving the nutritional content of instant maize porridge by combining it with MO leaves and termite powders. The results showed that the addition of MO leaves and termite powders to instant maize porridge has led to a substantial increase in the nutritional value of FMP. Therefore, powder from MO leaves and termites could be used in complementary foods to increase protein and mineral contents.

Thesis (Mnutr)--Stellenbosch University, 2003.
ENGLISH ABSTRACT: INTRODUCTION: Malnutrition is a silent emergency. WHO estimates that 55% of all child deaths in developing countries are associated with malnutrition. Inadequate dietary intake and disease are the two immediate causes of malnutrition. The underlying causes are household food insecurity, inadequate maternal and child-care and poor water/ sanitation and inadequate health services. Stunting is a major problem in pre-school children in South Africa. This indicates a long term inadequate dietary intake. Furthermore, the initiation of breastfeeding in South Africa is about 90%, and the duration thereof tends to be less than 3 months after birth. A great majority of children in this country consume a diet deficient in energy and of poor nutrient density to meet their micronutrient requirements. The aim of this study was to identify feeding practices of infants that could contribute to the development of malnutrition. METHOD: This was a cohort study with a prospective experimental design. Forty-four of the original 73 mother-infant pairs that were recruited, were interviewed monthly on feeding practices of the infants. Anthropometric measurements (weight and height of the infants) were measured monthly. RESULTS: Weight-for-age Z-scores dropped significantly with age from around 4 months, when weaning had started. Inadequate dietary intake, more specifically weaning practices and breastfeeding practices, were identified as the immediate cause that could contribute to the development of malnutrition in this community. Except for the positive relationship between the level of education of the father and an increase in HAZ over time, growth was not affected by socio-economic and demographic factors in this community. This is probably because of the fact that there were very small differences in socio-economic and demographic factors. CONCLUSION: Weaning and breastfeeding practices should be addressed in all nutrition education programmes.
AFRIKAANSE OPSOMMING: INLEIDING: Wanvoeding is 'n stil gevaar. Die WGO skat dat daar 'n verband is tussen wanvoeding en ongeveer 55% van alle kindersterftes in ontwikkelende lande. 'n Onvoldoende dieetinname en siekte is die twee onmiddellike oorsake van wanvoeding. Onvoldoende huishoudelike voedselsekuriteit, onvoldoende moeder- en kindsorg en swak sanitasie en watervoorsiening asook onvoldoende gesondheidsorg is die onderliggende oorsake. Dwerggroei is 'n groot probleem in Suid-Afrika onder voorskoolse kinders. Dit dui op 'n langdurige onvoldoende dieetinname. Bydraend hiertoe, is die aanvang van borsvoeding in Suid-Afrika ongeveer 90%, maar die duurte van borsvoeding is minder as 3 maande na geboorte. Die meerderheid van alle kinders in Suid-Afrika se dieet het 'n tekort aan energie en die nutriëntdigtheid van hulle diëte voldoen nie aan hulle daaglikse behoeftes ten opsigte van mikronutriënte nie. Die doel van hierdie studie was om voedingspraktyke te identifiseer wat kan bydra tot die ontwikkeling van wanvoeding. METODE: Dit was 'n kohortstudie met 'n prospektiewe eksperimentele ontwerp. Vier-en-veertig van die oorspronklike aanvanklike moeder-babapare wat gewerf is, is maandeliks ondervra met betrekking tot die voedingspraktyke van die baba en antropometriese metimgs (gewig en lengte van die baba) is maandeliks geneem. RESULTATE: Z waardes van gewig vir ouderdom het beduidend gedaal namate die kinders ouer geword het, veral vanaf 4 maande, toe spening begin het. 'n Onvoldoende dieetinname, meer spesifiek spenings- en borsvoedingspraktyke, is geïdentifiseer as die onmiddellike oorsake wat tot die ontwikkeleing van wanvoeding kan bydra in hierdie gemeenskap. Daar was 'n positiewe verband tussen lengtegroei (Z waardes van lengte vir ouderdom) en die vlak van opvoeding van die vader. Groei is nie deur die ander sosio-ekonomiese en demografiese faktore beïnvloed nie, moontlik as gevolg van die klein verskille in sosio-ekonomiese en demografiese eienskappe van die studie populasie. GEVOLGTREKKING: Spenings- en borsvoedingpraktyke behoort aandag te geniet in alle voedingsvoorligtings-programme.

Thesis (MSc (Dietetics))--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: The aim of the study was to contribute to the nutritional well-being of 0 - 24 month old children who attend primary health care clinics (PHC) in Duncan Village, an urban slum. This was to be achieved by first formulating essential nutrition-related message topics and second by formulating recommendations for optimising the accessibility of services, including nutrition-related messages, aimed at mothers attending PHC clinics in Duncan Village. In order to formulate targeted and relevant nutrition-related messages for mothers attending the PHC clinics (Phase I of the research) the need for more information on the six focus areas for intervention that were identified in the previous Duncan Village Day Hospital (DVDH) study" was determined. This was done through key-informant interviews and studying other relevant published research. Eleven research questions related to the six focus areas were subsequently formulated to guide further research. Non-scheduled structured interviews were conducted with mothers with children in specific age groups until data saturation was achieved. A total of 31 interviews were thus conducted at the homes of participants and observation data was also collected at the same time. Three focus groups with corresponding participant categories were also conducted to check the information obtained through the interviews. Two focus groups were conducted with grandmothers to serve as a further form of checking research but also to obtain a different perspective on the research questions. The data available for the formulation of the message topics was analysed qualitatively by hand. The focus areas and the research questions gave a specific focus to the analysis process and the unprocessed data was available in these broad predetermined categories. All the information from all sources (DVDH study, the non-scheduled structured interviews with mothers, focus groups with mothers and grandmothers and observation data) was studied, interpreted and integrated for each identified category. During this process key-factors, which need to be addressed in nutrition-related messages essential for the well-being of infants attending PHC clinics in Duncan Village, were identified. The final step in the analysis process was the formulation of message topics based on these key-factors. During the analysis process it became clear that some of the identified key factors were not suitable for the formu lation of nutrition-related message topics but rather give insight into the total context of the mothers attending the clinics in Duncan Village. It was evident that the information contained in the key factors could be used by health workers to identify and assist vulnerable mothers. These key-factors led to the formulation of relevant help topics. Eighteen main message topics and 16 help topics were formulated. The message topics included topics on: self-development, household food security, breastfeeding, good feeding practices, mothers' health and nutrition and hygiene practices. in Phase 2 of the study the accessibility of services, including nutrition-related messages, to mothers attending PHC clinics in Duncan Village was determined. This was done by determining how mothers inDuncan Village experience the clinics where they could be exposed to nutrition-related messages and by determining the experiences of health care workers with mothers as clients as well as with service delivery. This information was obtained through focus group discussions with different participant categories. These categories included mothers with children in the same age groupings as in Phase I who had either attended clinic for all the child's immunisations or who had not attended clinic for all the child's immunisations or who had attended clinics outside Duncan Village for immunisation purposes. Pregnant women who had either attended antenatal clinics or had not attended antenatal clinics were also included. The last participant category involved health workers. This category included health workers from the obstetric unit where mothers from Duncan Village give birth, the primary health care clinics and community health care workers. The data obtained was analysed with ATLAS/ti, computer software specifically designed for qualitative data analysis. Twelve code families were created during the analysis process, each family referring to a specific aspect of accessibility of services provided at the PHC clinics. A detailed description of each code family is presented after which six networks were compiled. The data and networks were used to create a framework for data interpretation. According to the framework it is proposed that the final elements in the process of providing accessible nutrition-related messages to clients at clinics are (1) that the clients must attend the clinic and (2) that appropriate nutrition-related messages must be available. Problems with interpersonal and organisational aspects of service delivery were found to be two of the most important aspects that influence accessibility of clinic services and therefore nutrition-related messages at the clinics. The last phase of the study (Phase 3) involved the formulation of recommendations to the relevant authorities about targeted and relevant nutrition-related message topics to be included in the education of mothers and pregnant women as well as recommendations to optimise accessibility of nutrition-related messages at the three PHC clinics in Duncan Village and the obstetric unit where mothers of Duncan Village give birth. A total of fifteen recommendations were formulated based on the frndings and recommendations of Phase I and Phase 2. These recommendations focus especially on the necessity for the municipality to create a health empowering environment at the clinics, on the provision of appropriate nutrition-related messages at the clinics and on the need to reach vulnerable mothers. The importance of involving the community in these processes was also emphasised in the recommendations. It is concluded that the implementation of the recommendations will contribute to the nutritional well-being of all young children in Duncan Village and could play an important role in realising the rights of children living in the area.
AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n bydrae te maak tot die voedingswelstand van 0-24 maandoue kinders wat prirnere gesondheidsorg (PGS) klinieke in Duncan Village, 'n verarmde stedelike gebied, besoek. am die doel te bereik is daar eerstens beplan om essensiele voedingsverwante boodskappe te formuleer. Tweedens is daar beplan om aanbevelings vir die optimalisering van die toeganklikheid van gesondheidsorgdienste vir rna's wat die klinieke bywoon, insluitend die toeganklikheid van voedinsgverwante boodskappe, te maak. Voordat relevante voedingsverwante boodskappe vir rna's wat die klinieke in Duncan Village besoek, geformuleer kon word, was meer inligting nodig oor die ses fokusareas vir intervensie wat in die vorige Duncan Village Daghospitaal studie bepaal is. Die bepaling van watter inligting nodig was, is gedoen deur sleutelinformantonderhoude en die bestudering van ander relevante gepubliseerde navorsing. Na aanleiding hiervan is elf navorsingsvrae wat verband hou met die ses fokusareas geformuleer. Nie-geskeduleerde, gestruktureerde onderhoude is vervolgens met 111a's met kinders in spesifieke ouderdomsgroepe gehou totdat dataversadiging bereik is. 'n Totaal van 31 onderhoude is met respondente gehou by hul huise, waartydens die onderhoudvoerder ook sekere waamemingsdata ingesamel het. Drie fokusgroepe is ook met rna's met kinders in ooreenstemmende kategoriee gehou om die inligting na te gaan wat deur die onderhoude ingesamel is. Twee fokusgroepe is ook met oumas gehou om die data verder na te gaan maar ook om 'n ander perspektief op die navorsingsvrae te verkry. Die data wat verkry is, is kwalitatief met die hand geanaliseer. Die fokusareas en die navorsingsvrae het 'n spesifieke fokus aan die analiseproses gegee en die ongeprossesseerde data was beskikbaar in hierdie bree vooraf gedetermineerde kategoriee. Die inligting van aile bronne (DVDH-studie, die nie-geskeduleerde gestruktureerde onderhoude met die rna's, die fokusgroepe met die rna's en oumas asook die observasie data) is bestudeer, geinterpreteer en geintegreer vir elke geidentifiseerde kategorie. Gedurende hierdie proses is sleutelfaktore geidentifiseer wat aangespreek moet word in essensiele voedingsverbandhoudende boodskappe wat gemik is om die voedingswelstand van klein kinders wat die PGS-klinieke in Duncan Village besoek te verbeter. Die finale stap in die analiseproses was die formulering van boodskaponderwerpe. Die onderwerpe is gebaseer op die geidentifiseerde sleutelfaktore Dit het duidelik geword tydens die analiseproses dat sommige van die sleutelfaktore nie geskik was vir die formulering van voedingsverbandhoudende boodskaponderwerpe nie, maar dat dit eerder insig verskaf in die totale lewenskonteks van die rna's. Die inligting in hierdie sleutelfaktore kan wei gebruik word deur gesondheidswerkers om kwesbare ma's te identifiseer en by te staan. Hierdie sleutelfaktore het dus tot die formulering van relevante hulpboodskappe gelei. Agtien voedingsverbandhoudende en 16 hulpboodskappe is geformu leer. Die boodskaponderwerpe sluit in onderwerpe oor selfontwikkeling, huishoudelike voedselsekuriteit, borsvoeding, goeie voedingspraktyke, gesondheid van die rna en voeding- en higienepraktyke. Tydens Fase 2 van die studie is die toeganklikheid van PGS dienste, insluitend voedingsverbandhoudende boodskappe vir rna's, bepaal. Dit is gedoen deur te bepaal hoe mas in Duncan Village die kliniekdienste ondervind, waar hulle aan hierdie boodskappe blootgestel kan word asook die ondervindinge van die gesondheidswerkers met die rna's en die diensleweringsproses. Hierdie inligting is deur middel van fokusgroepbesprekings met verskillende deelnemerskategoriee ingesamel. Hierdie kategoriee het rna's ingesluit wat die klinieke in Duncan Village besoek het vir a.l die spesifieke kinders se immunisasies maar ook ma's wat nie kinders geneem het vir al hul immunisasies nie of wat hul kinders na klinieke buite Duncan Village geneem het. Swanger vroue wat die voorgeboortelike klinieke besoek het asook die wat nie die klinieke besoek het nie, is ook ingesluit. Die laaste kategorie wat betrek is, was gesondheidswerkers. Hierdie kategorie het werkers van die kraamafdeling van die nabygelee hospitaaI en die primere gesondheidsorgklinieke ingesluit. Beide professionele verpleegpersoneel en gemeenskapsgesondheids= werkers van die klinieke is betrek. Die data wat verkry is, is met ATLAS/ti, 'n rekenaarprogram spesifiek geskep vir die analise van kwalitatiewe data, ontleed. Twaalf kodefamilies is geskep tydens die analiseproses. Elke familie verwys na 'n spesifieke aspek van toeganklikheid van dienste by die klinieke. 'n Gedetailleerde beskrywing van elke kodefamilie is gegee asook ses netwerke. Die data en die netwerke is gebruik om 'n raamwerk vir data-intepretasie te skep. Die raamwerk postuleer dat die finale elemente in die proses van die verskaffing van toeganklike voedingsverbandhoudende boodskappe by klinieke die volgende is: (1) kliente moet die kliniek besoek en (2) toepaslike voedingsverbandhoudende boodskappe moet beskikbaar wees. Probleme met interpersoonlike en organisatoriese aspekte van dienslewering is geidentifiseer as die twee belangrikste aspekte wat toeganklikheid van kliniekdienste en daarom ook toeganklikheid van voedingsverbandhoudende boodskappe beinvloed. Die laaste fase van die studie (Fase 3) het die formulering van aanbevelings aan die relevante owerhede behels Die aa.nbevelings handel oor die insluiting van toepaslike voedingsverbandhoudende boodskappe by die gesondheidsonderrig van ma's en swanger vroue sowel as aanbevelings oor die optimalisering van toeganklikheid van dienste by die PGS klinieke en die kraamafdeling waar Duncan Village rna's geboorte gee. Vyftien aanbevelings gebaseer op die bevindinge van Fases I en 2 is geformuleer . Die aanbevelings fokus veral op die nocdsaaklikheid vir die plaaslike owerheid om 'n atmosfeer van gesondheidbemagtiging by die klinieke te skep, die nodigheid om toepaslike voedingsverbandhoudende boodskappe by die klinieke te verskaf en die belangrikheid daa.rvan om kwesbare rna's te bereik. Die noodsaaklikheid om die gemeenskap te betrek in hierdie prosesse is ook benadruk. Samevattend kan gese word dat die implementasie van die aanbevelings sal bydra tot die voedingswelstand van alle jong kinders in Duncan Village en dat dit 'n belangrike bydrae kan lewer tot die realisering van die regte van kinders in die area.

Background Malnutrition among children in South Africa is a huge issue, which are causing short- and long-term effects for the children suffering from it. In 64 percent of the cases where children die before the age of five, malnutrition is the underlying cause. Therefore there are non-governmental organizations who are doing preventive work to try to diminish malnutrition so all children have the same chance to a good childhood. Aim The aim of the study was to describe the prevention of malnutrition of children in South Africa. Method A qualitative design with semi-structured interviews with non governmental organzations was used for this study. Data was analysed by content analyse. Findings The findings show that one key intervention is nutritional education to empower people on how to best use the scares resources they have. Therefore the non governmental organizations put a lot of emphasis on educating families about nutrition. Furthermore the stigma and mistaken beliefs about breastfeeding is targeted through education, as it is of vital importance to solely breastfeed as a preventive intervention. Conclusion Early interventions are emphasized due to the importance of preventing malnutrition early in a child’s life. The link between HIV positive women and malnourished children is remarkable and the government of South Africa has promoted breastfeeding for all as a solution.

Background Malnutrition among children in South Africa is a substantial public health problem. Especially young children are vulnerable and exposed to malnutrition. Children suffering from malnutrition develop many short- and long-term health-consequences. Effective preventative work against this issue is crucial in order for malnutrition to diminish among the children in South Africa. Aim The aim was to describe how the preventative work against malnutrition is being performed among children aged zero to six in South Africa. Method The method used in this study was a qualitative descriptive study with six semi-structured interviews. Interviews were performed with registered nurses and researchers. The interview-data was analyzed based on a grounded theory through substantive coding where the most relevant codes where found, studied and concluded in the results. Results The results showed that both the registered nurses and researchers considered socioeconomic-factors and lack of knowledge about nutrition to be the most important causes for malnutrition among children, and also impacted heavily on the preventative work. It was found that more effective preventative work is needed, but for this to work it needs to be adapted to the social context in the country. Conclusions The preventative work against malnutrition must be able to break through socioeconomic barriers like poverty, misguided cultural beliefs about nutrition, lacking food security and the fact that many mothers to children are HIV positive, which also is strongly connected to malnutrition among young children. Education about nutrition must be further developed and reach out to more people in the country.

The purpose of this research was to investigate the impact of rural development projects on food insecurity and malnutrition at Siyazama food garden project in Sakhisizwe Municipality. The study followed a qualitative approach which included in-depth interviews of twenty-six (26) Siyazama food garden project members and four (4) municipal officials. The process of collecting data also made use of observations. Data was analyzed qualitatively, using thematic analysis of the content of the data, which employed an interpretative approach, resulting in a presentation of data, which is textual rather than statistical. The study found that the level of food insecurity and malnutrition in the studied area is still regarded as being high as most of the participants reported that they still have a problem in accessing all the vital nutritional elements which constitute a balanced diet. Also, the study also found that although most of the rural development projects like the Siyazama food gardening project have a profound effect in tackling food insecurity and malnutrition on household level, in South Africa there is a debate about the sustainability or such projects in solving this issue. The study found a number of challenges facing the Siyazama Food gardening project which include: theft, poor management, lack of support, lack of agricultural expertise and conflict amongst members. The study concluded by making some recommendations with to view of resolving the above mentioned challenges.

The prevalence of sub-clinical vitamin A deficiency (VAD) and anemia of lactating women (n = 113) and their breastfed infants aged 1--6 months was measured among a peri-urbanite South African sample. Mother's mean hemoglobin (Hb) was 12.4 +/- 1.3 g/dL with 32% anemia (Hb < 12g/dL). Retinol in serum was 49.8 +/- 13.2 mug/dL and 66.0 mug/dL (median) in breast milk; no evidence of sub-clinical VAD. Infants, 62% ≤ 3 months, had mean Hb of 10.9 +/- 1.1 g/dL (with anemia present (<11g/dL), in 50%). Mean infant serum retinol was 26.9 +/- 7.2 mug/dL (10% prevalence of marginal VAD). No infants were exclusively breastfed. Weaning foods and breast milk substitutes were introduced early and infant intake of traditional medicines was common (52%). Our data suggest that anemia was present in both mothers and infants while VAD was evident only in infants. This early occurrence of micronutrient deficiencies may be attributed to less than optimal breastfeeding practices.

The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

This study aimed at exploring the developmental profile of HIV positive/AIDS infants and children (three to 35 months) over a period of 11 months in the Nelson Mandela Metropole, utilising the Revised Extended Griffiths Scales of Mental Development (GSMD). The purpose was to generate information about the development of HIV positive/AIDS infants and children, highlighting developmental strengths and weaknesses to ultimately aid the custodians of these children with their interventions. A non-probability purposive sampling method was applied, and a longitudinal profile was generated as participants were assessed twice. Participants were all outpatients at Kwazakhele Day Clinic, Dora Nginza and Livingstone Hospitals in the Nelson Mandela Metropole, and were located for the study through their caregiver’s attendance of an HIV support groups at the Dora Nginza Hospital. Data was analysed statistically using descriptive statistics and Hotelings-T² tests. Results indicated a significant difference between first and second assessment on the General Quotient and on two of the six subscales, namely Eye-Hand Co-ordination (D) and Practical Reasoning (F). It was deduced that development declined or did not improve as participants aged.

Background: Food insecurity is a major public health concern in most settings where the Human Immunodeficiency Virus (HIV) is prevalent, and it affects women disproportionately. However, the prevalence of food insecurity and associated risk factors for women who are living with HIV (WLH) in South Africa is under researched. Methods: The researcher conducted a secondary, cross-sectional analysis of 346 HIV-infected women aged between 18 and 45, in Gugulethu, Cape Town. All participants were 12 months postpartum and enrolled into the MCH-ART study, a large implementation science study of antiretroviral use in pregnancy. For this study, women completed a 10-item household food security questionnaire that categorised food security status into household-level food insecurity, individual level food insecurity and children hunger. Using this tool, the level of food insecurity was categorised as food insecurity (“yes” to up to four questions), experiencing food insecurity (“yes” to five questions or more) and free from food insecurity (“no” to all questions). Results: Overall, the mean age was 29 years (SD: 5.46); 25 % of the women completed high school; 61 % were unemployed; nearly 66 % were free from food insecurity; and 25 % experienced food insecurity. Women who were employed were less likely to experience food insecurity when compared to those who were not employed (OR=0.54; 95 % CI: 0.32-0.90; p= 0.01). Those who completed high school were associated with food security than the ones who did not complete high school (OR= 0.5; 95 % CI: 0.28-0.97; p= 0.04). After adjusting for maternal age, marital and cohabiting status, education attainment, and parity, employment remained a significant predictor of experiencing food security (AOR= 0.55; 95 % CI: 0.32- 0.95 p=0.03) and educational attainment was no longer associated with food insecurity. Conclusions: The prevalence of food insecurity was relatively low in the urban-based sample of HIV-infected women. However, most of these HIV-infected women were obese and overweight. Thus, there is a clear need for more research to explore issues of food insecurity and nutrition in HIV-infected South African women.

Teething, a common subject of discussion among nursing mothers has been held responsible for a variety of childhood ailments by both health professionals and parents. It appears to be a social construct coined by society to express the experience the child goes through during early days of childhood. Teething to the dental profession is the biological expression of tooth movement, in a predominantly axial direction, from the tooth's developmental position within the jaws to its emergence in the oral cavity. Several studies have reported both health professionals and parents to attribute local and systematic disturbances to the eruption of the primary dentition. The mothers experience and understanding of teeting have not been reported on. The aim of this study was therefore to explore the mothers experience of their child's teething. The objectives of the study were to determine what mothers understood by the term teething
to establish the signs and symptoms mothers associate with teething
to ascertain the treatment sought by mothers for their child's teething
to investigate how mothers in different setting understand and respond to teething.

This book explores the complex interrelationships between food and agriculture, politics, and society. More specifically, it considers the political aspects of three basic economic questions: what is to be produced? how is it to be produced? how it is to be distributed? It also outlines three unifying themes running through the politics of answering these societal questions with regard to food, namely: ecology, technology and property. Furthermore, the book examines the tendency to address the new organization of global civil society around food, its production, distribution, and consequences for the least powerful within the context of the North-South divide; the problems of malnutrition as opposed to poverty, food insecurity, and food shortages, as well as the widespread undernutrition in developing countries; and how biotechnology can be used to ensure a sustainable human future by addressing global problems such as human population growth, pollution, climate change, and limited access to clean water and other basic food production resources. The influence of science and politics on the framing of modern agricultural technologies is also discussed, along with the worsening food crisis in Sub-Saharan Africa, food security and food safety, and the relationship between gender inequality and food security. Other chapters deal with the link between land and food and its implications for social justice; the "eco-shopping” perspective; the transformation of the agrifood industry in developing countries; the role of wild foods in food security; agroecological intensification of smallholder production systems; and the ethics of food production and consumption.

The chapter describes women's roles in home-gardening to ensure household food security in a rural community in Limpopo Province, South Africa. Focus group discussions confirmed the women continue to produce indigenous crops as part of their cultural obligations to provide for household food security. This implies that the women are capable of maintaining the health and welfare of their households by ensuring food availability, accessibility, and utilization, which are important elements of food security. The study has implications for ending hunger and malnutrition as food is produced and preserved for future consumption. The food and preservation practices adopted by the women in the study could be incorporated into climate change mitigation and adaptation policies to address the challenge of poverty and malnutrition as per the United Nations' Sustainable Development Goal 2.

ABSTRACT Background: The importance of screening for HBV infection is to identify the risk of perinatal transmission from infected mothers. People infected with HBV during infancy or childhood are more likely to suffer chronic infection to cirrhosis of the liver and liver cancer. Early detection and prompt treatment are essential for HBV infection. This study aimed to review the factors and management of hepatitis B virus screening in mothers and infants. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selec­tion; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included PubMed, ScienceDirect, Wiley Online Library, and Scopus databases. The inclusion criteria were English/ Indonesian-language and full-text articles (scoping review, meta-analysis, systematic review)/ documents/ reports/ policy brief/ guidelines from WHO/ other organizations published between 2009 and 2019. The data were selected by the PRISMA flow chart. Results: The searched database obtained a total of 27.862 articles. After screening, 27.325 articles were excluded because of unmet the inclusion criteria. After conducting critical appraisal for the remaining 537 articles, only 11 articles were eligible for further review. The selected articles obtained from developing countries (China, South Africa, and Tanzania) and developed countries (Netherlands, Japan, Denmark, Northern Europe, and Canada) with quantitative studies design (cross-sectional, case series, and cohort) met the inclusion criteria. The findings emphasized on four main topics around hepatitis B virus screening in mothers and infants, namely demographic factors, risk factors, post-screening benefit, and challenges in screening uptake. Conclusion: Early detection of HBV infection with prenatal screening reduce the HBV prenatal transmission, especially from infected pregnancy. Screening plays an important role in the administration of universal infant HBV vaccination and postexposure prophylaxis with hepatitis B immune globulin (HBIG) at birth. Keywords: pregnant women, hepatitis B virus, perinatal transmission, screening Correspondence: Setianingsih. Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi (Ringroad Barat) No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: nsetia580@gmail.com. Mobile: 082242081295. DOI: https://doi.org/10.26911/the7thicph.03.67