Dissertations / Theses on the topic 'Malnutrition in infants – South Africa'

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.

Premature births, which are among the leading causes of neonatal mortality and morbidity in South Africa, often result not only in adverse effects on the infant due to the poorly developed organs and systems, but also affect the mother. Much literature exists about the causes of premature birth, clinical manifestations and management of premature infants; but healthcare practitioners, researchers and authors have not reported much on the mothers’ thoughts and feelings while going through the experience of premature labour and birth. This study deals with the experiences of mothers relating to live premature birth and the premature infant at a private hospital in the Nelson Mandela Metropolitan Municipality, an urban area within the Eastern Cape Province. The objectives of the study were to explore and describe the experiences of mothers relating to live premature birth and the premature infant at a private hospital in the Eastern Cape Province and to make recommendations based on the research findings which could be utilised by midwives when caring for mothers who had experienced a premature birth. This study, which is qualitative in nature, utilised an explorative, descriptive and contextual design. The population of the study was mothers between the ages of 18 and 38 years who had had a premature birth and were of a gestational age ranging from 28 to 34 weeks. Data collection took place at a private hospital in the Eastern Cape Province over a period of five months. A private room that was designated for the data collection and was not far from the unit where the neonate was kept, proved to be suitable for data-collection purposes. Semi-structured one-on-one interviews were conducted and recorded with an audio digital taperecorder, with a purposefully selected sample of 12 mothers including the pilot study. Data analysis followed formally after data saturation and the data collected was transcribed verbatim and analysed as recommended by Tesch, namely, data coding. An independent coder was used to verify and finalise the results. Two main themes with three sub-themes each and several categories emerged from the data analysis. The two main themes were that: 1. participants had experienced premature birth as an unexpected and traumatic occurrence; and 2. participants had experienced positive support as a coping mechanism throughout the premature birth. Direct quotations were used from the raw data collected to support the description of experiences and findings of this study. Trustworthiness of the study was maintained by using the criteria of credibility, transferability, dependability and confirmability. Ethical principles such as autonomy, beneficence, non-maleficence and justice were used to ensure that the research was conducted in an ethical manner. A summary of the study including limitations, recommendations and conclusions was provided.

Thesis (MScMedSc)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Despite the decreased rate of HBV horizontal transmission in South Africa (SA) due to the HB vaccine, the risk of perinatal transmission remains of concern, especially in HIV/HBV co-infected women. Loss of HBV immune control, resulting in higher HBV replication and thus increasing the risk of transmission is described in HIV/HBV co-infected women. Chronic hepatitis is a well-recognized risk factor for hepatocellular carcinoma (HCC). The presence of specific HBV mutations has been reported in chronic and HCC patients and is used in algorithms for the prediction of HCC in CHB patients in Asia. While these mutations are extensively described in male patients, little is known regarding the antenatal and paediatric populations. This study aimed to determine the prevalence of HBV infection in HIV-exposed infants and to investigate the presence of HCC-related mutations in pregnant women and HIV-exposed children in SA. Residual samples of infants born to HIV-infected mothers were collected from the P1041 study previously conducted in SA. HBV markers (HBsAg, anti-HBs and anti-HBc) were tested on the Architect (Abbott). HBsAg positive samples were tested for HBV DNA to determine HBV viral loads. HBV strains were characterised by sequencing of the HBsAg gene and genotypes were determined by phylogenetic analysis using HepSEQ (www.hepseq.org.uk). For the HCC-related mutations investigation, samples and data were collected from three HBV-related studies: the NHLS Paediatric Study, an Antenatal Study and the current study. Pre-S, basal core promoter (BCP) and pre-core data was collected from all samples. Multiple alignments were formed and the nucleotide sequences of these extracts were translated into protein sequences. These protein sequences were compared manually to the HBV reference genes to identify HCC-related mutations. Of 850 HIV-exposed infants tested, three infants were positive for both HBsAg and HBV DNA. Two samples show evidence of past, but cleared HBV infection. Sequence analysis showed that the infants were infected with a subgenotype A1. At follow up, only one infant and mother were able to be traced and contacted. The infant was HIV-infected and had been on an ART regimen, including lamivudine for two years. HBV testing showed that the infant was HBsAg positive and had an undetectable viral load. Core sequence analysis showed clustering between mother and infant sequences. Transmission of mutant HBV previously associated with HCC prompted the question of what the prevalence of mutations in the antenatal and paediatric population is. In this investigation of HCC-related mutations study, a higher prevalence of combined pre-S, BCP and pre-core mutations was found in HIV-infected as compared to HIV-uninfected women. This study shows that vertical transmission is occurring in HIV-exposed infants in SA despite HB vaccination. Data described in this study suggests the importance of HB vaccination closer to the time of birth in SA. Moreover, data on the higher prevalence of HCC-related mutations in HIV-infected pregnant women provide a background for further longitudinal studies to confirm these findings and their implications in SA.
AFRIKAANSE OPSOMMING: As gevolg van die beskikbaarheid van die Hepatitis B virus (HBV) entstof , het horisontale transmissie van die virus drasties in Suid-Afrika (SA) verminder. Ten spyte hiervan, is daar steeds ‘n hoë risiko van perinatale transmissie van swanger vroue na hulle babas, dit word veral gesien met MIV/HBV positiewe vroue. Dit is wyd beskryf dat vroue wat mede-besmet is met MIV/HBV gewoonlik beheer verloor oor hulle immuunstelsel, wat lei tot ‘n hoër mate van HBV replikasie en dus ‘n hoër risiko van virus oordrag. Kroniese hepatitis is wel bekend as ‘n hoë risiko faktor vir HCC. Die teenwoordigheid van spesifieke HBV mutasies in kroniese en HCC pasiënte word alreeds in Asië gebruik in sekere algoritmes en formules om infeksie aan te dui en te voorspel. Hierdie mutasies is omvattend beskryf in manlike pasiënte, maar baie min is bekend in voorgeboorte en pediatriese gevalle. In hierdie studie het ons die teenwoordigheid van HCC-verwante mutasies in swanger vroue en MIV-blootgestelde kinders in Suid-Afrika ondersoek. Monsters is verkry van babas gebore van MIV-positiewe moeders van die P1041 studie wat voorheen in SA gedoen is. Die HBV merkers (HbsAg, teen-HBs en teen-HBc) was op die Architect (Abbott) getoets. HBsAg positiewe monsters was getoets vir HBV DNA om die virale lading te bepaal. Die verskeidenheid HBV stamme was gekarakteriseer deur die virus se nukleïensuur volgordes te bepaal. Die verskillende genotipes is bepaal deur filogenetiese analises te doen met behulp van die HepSEQ (www.hepseq.org.uk) program. Vir die HCC-verwante mutasie studie is monsters en data vergelyk met 3 HBV-verwante studies: die NHLS pediatriese studie, ‘n voorgeboorte studie en hierdie spesifieke studie. Voor-S, basale kern promoter en voor-kern data was van alle monsters bekom. ‘n Veelvoudige belyning was gedoen met die nukleïensuur volgordes van die verskeie DNA ekstrakte, wat daarna vertaal is in proteïen volgordes. Hierdie proteïenvolgordes translasie was by hand vergelyk met verwysings gene om die relatiewe HCC mutasies te probeer identifiseer. Van die 850 blootgestelde MIV babas wat getoets is, het 3 positief getoets vir beide HbsAg en HBV DNA. Twee monsters het bewys van verlede , maar vrygestelde HBV infeksie. Data analise bewys dat die babas met subtipe A1 besmet was. Ons kon slegs een moeder en baba paar opvolg en kontak vir verdere toetse. Die baba was MIV-positief en was op antiretrovirale behandeling , insluitend lamivudine, vir ten minste 2 jaar. HBV toetse het gewys dat die baba HbsAg positief is en ‘n onopspoorbare virale lading gehad het. Kern nukleïensuur volgorde analise het groepering getoon tussen die ma en baba se virus monsters . Die transmissie van die mutante HBV wat geassosieer is met HCC het gelei tot die vraag wat die voorkomssyfer is van hierdie spesifieke mutasies in die voorgeboorte en pediatriese populasies in SA. In hierdie studie het ons ‘n hoër gekombineerde voorkomssyfer gevind van die voor-S, basale kern promoter en voor-kern mutasies in MIV-positiewe vroue, in vergelyking met MIV-negatiewe vroue. Hierdie studie bewys dus dat vertikale transmissie van HBV in blootgestelde MIV babas steeds plaasvind, ten spyte van HBV inenting. Die data wat in hierdie studie beskryf was dui daarop dat die belangrikheid van HBV inenting nader aan die tyd van die geboorte in SA gegee moet word.As gevolg van die hoë voorkomssyfer van HCC-verwante mutasies in swanger vroue, is daar verdere longitudinale studies nodig om hierdie bevindinge en hul implikasies in SA te bevestig.

Thesis (MNutr--Stellenbosch University, 2015.
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.
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.

The incidence of Low Birth Weight (LBW) babies born in the Uitenhage Provincial Hospital would seem to be a cause of concern from a public health of view. The incidence of 21% recorded during 1999 is markedly higher than the 7% recorded in the United States of America in 1998 and the average of 17% noted for developing countries. Some health concerns related to LBW babies are Sudden Infant Death Syndrome, scholastic performances later in life, and several chronic diseases in adults associated with them having been born as LBW babies.

>Magister Scientiae - MSc
Micronutrient and trace element deficiencies are a problem affecting nearly two billion people globally. The people affected the most by these deficiencies are those living in poor and rural communities in the developing countries and thus cannot always afford the diverse diet as advocated by WHO and the FAO. Millions of these people living in the poor and developing countries die yearly, either directly or indirectly, as a result of micronutrient and trace element deficiencies. Thus, this study aimed to determine the nutrient content (Co, Cr, F, I, Se and V) of various vegetable based food items collected from the Cape Town area in the Western Cape Province of South Africa. This was done to determine which vegetable crops provided the highest concentrations of essential trace elements, and how much they contribute to the daily recommended intake (DRIs) of these trace elements. It also aimed to assess the effects of the addition of the trace elements (Co, Cr, F, I, Se, Si, Sn and V) on seed germination and root growth under controlled conditions in order to calculate their phytotoxicity, and then to biofortify four vegetable crop species, grown in sand culture, with a composite treatment of the trace elements to determine how the addition of these elements will affect the vegetable crops grown under these experimental conditions. From this study, it was shown that trace element content in vegetable crops in the Western Cape Province of South Africa varied between different geographic locations and that certain trace elements were absent from several items collected from some areas. Although some crop species contained sufficient amounts of certain trace elements to satisfy our daily recommended intakes, most of the crops were found to contain insufficient amounts of many of the trace elements to satisfy our needs. Leafy vegetables and tubers were identified as the better vegetable types to biofortify with essential trace elements as they already contain higher concentrations of several of the essential trace elements and should thus be assessed for their effectiveness as crops to be biofortified. When the trace elements were applied directly to cress and lettuce seeds, it was found that all the trace elements, as well as the composite treatments, exerted phytotoxic effects on cress and/or lettuce seeds when applied at high concentrations. Lettuce was found to be more prone to the effects of these elements. Seed germination was strongly inhibited by fluoride, while several elements affected root growth. When fluoride was left out of the composite treatment, phytotoxicity only occurred at high concentrations. The addition of the trace elements at the high concentrations to already established spinach, cabbage, lettuce and turnip plants were found to affect the uptake of several essential plant nutrients, but the concentrations of the elements affected generally remained higher than the concentrations needed for adequate growth of agricultural crops. Several of the trace elements supplied to the plants were also found to be retained in the roots of the vegetable crops however, as the concentrations supplied to the plants increased, so did the concentrations found in the edible portions of the crops. Agronomic biofortification of vegetable crops with simultaneous additions of multiple trace elements, under these experimental conditions, was thus considered to be a viable option to increase the concentrations of essential mineral nutrients in the edible portions of vegetable crops. However, these modified nutrient fertilizers should only be given to established crops or without the addition of fluoride. Further research on a wider variety of seeds and vegetable crops, as well as research under field conditions is needed to determine whether these findings remain relevant under these conditions.

Research shows that maternal depression has adverse effects on mother-infant attachment and subsequent infant development (Cogill, Caplan, Alexandra, Robson & Kumar, 1986). The mechanisms through which this comes about are unclear. Murray & Cooper (1997) suggest an impaired pattern of mother-infant communication is responsible. Within this, Murray proposes that maternal speech may be a key factor. This study constitutes a preliminary exploration into the mechanisms through which maternal depression effects mother-infant interaction in South Africa. 147 predominantly Xhosa-speaking mother-infant dyads that took part in a broader epidemiological study on post-partum depression in Khayelitsha (Cooper, Tomlinson, Swartz, Woolgar, Murray & Molteno, 1999) made up the subjects. Maternal depression was assessed according to the Structured Clinical Interview for DSMIV (SCID). Maternal speech recorded from standard, five-minute, face-to -face mother-infant interactions was translated and analysed according to a coding system developed by Murray (Murray, Kempton, Woolgar & Hooper, 1993). The speech of depressed mothers to their two month old infants was compared to the speech of non-depressed mothers on dimensions of focus, affect and agency, and the role of infant gender was assessed. Results revealed no significant group differences for depression. Maternal speech to male infants was found to hold significantly less ascription of agency than to female infants. Findings suggest that maternal speech may be too narrow a marker of maternal depression in this context and that broader indices are needed. It is recommended that future research control for measures of social adversity, factor in cultural and language particularities, and consider contextual aspects of mother-infant interaction / attachment processes, in investigating the mechanisms through which post-partum depression leads to negative infant outcome in the developing world.

Qualitative and quantitative research methods were employed to evaluate the acceptability and feasibility of HIV-1 infected, urban South African mothers being able to feed their infants heat-treated expressed breast milk (HTEBM). Nutritional status assessment of HIV-infected breastfeeding mothers (n=84) indicated that maternal status was not compromised; mean body mass index 26.8 (4.0) kg/m2, triceps skinfold 14.8 (5.50) mm and hemoglobin 11.6 (1.49) g/dL. However, severely immunocompromised mothers (CD4 + < 200 cells/mm3) were more likely to be anemic. Breastmilk viral loads were also higher in mothers with lower CD4+ cell counts. Community based inquiry on the acceptability of HTEBM was accomplished through in-depth interviews of participants (n=31), at the individual (mothers), family (partners, grandparents, mothers-in-law) and at the community level (traditional healers, daycare worker, health care counselors). Although an unfamiliar concept for all interviewed, overall, HTEBM was found to be an acceptable feeding choice regardless of respondents' gender, age, maternal status, family or community role. Further, data indicated mothers rarely received quality infant feeding counseling, consequently mixed feeding, a high risk for HIV transmission, was a common practice. In a pilot longitudinal study, using mixed-methods, the feasibility of mothers successfully implementing a modified breastfeeding intervention (6 months exclusive breastfeeding (EBF), cessation of breastfeeding, followed by use of HTEBM with complementary diet) was evaluated. The majority of mothers (36/66) practiced EBF for 6 months, 42% of whom also used HTEBM, expressing a range of approximately, 65 ml to 600 ml of breastmilk daily, for varying durations (2 weeks to 5 months). Mothers did not experience breast pathology. Home visits were highly enabling as was disclosure of HIV status to a partner. This is the first study to demonstrate that use of HTEBM is a feasible infant feeding option for HIV infected women. HTEBM may offer one solution to reduce vertical transmission of HIV and help maintain nutritional adequacy, as a component of complementary feeding.

The World Health Organization (WHO) recommends that of all the live births per year no more than 10-15% of these should be delivered by caesarean section. Despite this recommendation there has been a global increase in the percentage of caesarean section deliveries over the past few decades. In South Africa the percentage is as high as 70% in certain health care institutions which is of concern to midwives. Caesarean section deliveries are needed when the life of the baby, mother or both are at stake. However, this method of delivery bears more disadvantages than advantages to the baby and mother. Despite these disadvantages, some women request a caesarean section in their birth plans while others are influenced by health professionals to request a caesarean section. Therefore, there is a need for labouring women to be guided where possible to have vaginal birth because of its many advantages. This study sought to explore and describe the perceptions of the midwives regarding their role in facilitating the choice of delivery mode for labouring women in public hospitals and midwifery obstetric units (MOUs) of the Nelson Mandela Bay and Sarah Baartman districts. Based on the results of the study, guidelines for midwives in this role were developed. Maputle’sWoman-Centred Childbirth Model (2010) was used as the theoretical lens through which this study was viewed. The researcher selected a quantitative survey design using an explorative, descriptive and contextual research approach. The population consisted of midwives who were working in labour wards at public hospitals and midwife-led MOUs. A non-probability convenience sample was used to collect data using a structured, self-administered questionnaire. The reliability and validity of the data collection instrument were ensured by using various means including a pre-test and an expert panel. Altogether, 300 questionnaires were distributed and 288 were returned. This number excluded the pilot study. Data was collected over a period of three months using the assistance of two fieldworkers. Data was captured and analysed under the supervision of the statistician and supervisors. Analysis was done by means of descriptive analyses that involved the production of frequencies and presented using charts, figures and tables. The major findings of the study are: -The midwives perceived themselves as the main facilitators of a suitable decision by the labouring woman for a safe delivery method - The midwives emphasised the importance of the delivery position preferred by the labouring woman -The midwives indicated that a collaboration between doctors, senior midwives, midwives and midwives in management positions could assist with a decision for a suitable delivery mode option. -The midwives agreed that the culture of the labouring woman should be considered when deciding on a delivery mode and therefore midwifery curriculum should include lessons about cultural diversity. Three principal guidelines were developed, namely: 1. Create an environment that promotes acceptance of a woman’s choice of a delivery mode. 2. Create an environment promoting a collaborative health care relationship 3. Create an environment that is sensitive to cultural needs in the maternity unit Ethical considerations in this study were upheld by maintaining the principles of beneficence, maleficence, autonomy and justice.

This thesis reports on an historical prospective study of three Mamre decadal birth cohorts (1837-1846, 1870-1879, and 1900-1909) constructed retrospectively through existing parish records of the Moravian Mission at Mamre in the Western Cape region of South Africa. Nominative data collection techniques were used to gather information needed to determine the infant mortality rates, quinquennial mortality rates and life expectancies of the three cohorts. Issues related to the quality of data – non-registration and follow-up - were investigated. Birth registration was best for the 1837-46 cohort for males and females, with the 1900-1909 registration being next best. Overall, male registration coverage was substantially better than that for females. Infant death registration was best for males in these 2 cohorts, but were poor for females. Based on these data, the infant mortality rates for the cohorts born in 1837-1846, 1870-1879 and 1900-1909 - 196, 182 and 128 per 1000 respectively for males and 160, 172 and 97 per 1000 respectively for females - appeared to be underestimates. There is some evidence of a downward trend for the infant mortality rates with time for males, but this was not statistically significant. Quinquennial mortality rates for the 3 cohorts did not differ statistically, and are similar to the 1935-37 national 'coloured' figures. The life expectancies also did not differ significantly between cohorts. The life expectancies at birth (range 34- 40 years for males and 32-45 years for females) were probably overestimates due to biased IMR's. The life expectancies at age 1 (range 41-44 for males and 37-49 for females) were more representative figures. Life expectancies at age 20 were fairly stable over time (37-45 years) except for females in the 1900-1909 cohort whose life expectancies were substantially higher than earlier figures. All mortality indices investigated in this study consistently showed a lighter burden of mortality in historical Mamre compared to 'coloureds' in the Cape Colony at the turn of the century. This is probably associated with the better housing, environmental, social, economic and educational conditions at the Mamre mission relative to the rest of the Colony in the century after the emancipation of slaves.

Thesis (MNutr)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Background: Considering the myriad of risk factors causing nutritional deficiency, as well as the prevalence of malnutrition and feeding problems experienced by individuals with intellectual disability (ID), early detection and diagnosis of malnutrition in this population group is essential. Objectives: The main aim and objectives of the study were to determine the degree of malnutrition and body composition in individuals with ID living in a psychiatric hospital (North West Province, South Africa), to determine which degree of ID was more prone to malnutrition, to investigate the different risk factors for malnutrition in this group of individuals, and to use this data to adapt an existing screening tool used to facilitate the easier identification of malnutrition. Methodology: An observational descriptive cross-sectional study, with an analytical component, was conducted. The study consisted of two phases. During the first phase, measurements were taken of individuals with ID to determine body composition and nutritional status. During the second phase, said data, as well as other factors influencing the nutritional status of individuals with ID, were used to adapt an existing screening tool to allow for easier identification of malnutrition in the study population. The adapted screening tool was tested by nursing staff. Results: The anthropometric measurements of 244 individuals with ID were determined. The overall anthropometrical status indicated that half of the study population (52,1%, n=127) had a normal nutritional status, that 38,1% (n=93) was undernourished or at risk of becoming undernourished, and that 10,0% (n=24) was either at risk of becoming or was overnourished . Men were more prone to being undernourished or at risk of becoming undernourished (48,0%, n=73), compared to women (21,7%, n=20). Although no significant difference was found in anthropometrical status across the four severities of ID (Pearson Chi-square test (ρ=0,15)), individuals with mild ID were more likely to become obese (19,4%, n=6), and individuals with profound ID were more prone to being underweight (57,1%, n=8). It was found that 41,8% (n=102) of the total study population had a waist circumference (WC) above the normal values. A significant difference was found between increased WC and severity of ID (Pearson Chi-square test (ρ=0,00)). Other risk factors that can influence nutritional status in said population included medical conditions such as hypertension (13,0%, n=32) and epilepsy (EP) (46,0%, n=112), as well as polypharmacy (71,7%, n=175). An existing malnutrition screening tool for the population with ID was adapted by means of the addition of prevalent factors (WC measurements, presence of EP and use of medications), as well as through adaptation of the scoring system. Conclusion: Using anthropometric measurements and indices for body composition, a high prevalence of malnutrition was identified in the study population of individuals with ID. The adapted screening tool was more sensitive than the original tool in identifying individuals who were at risk of malnutrition, or who were already malnourished in this study population. The research undertaken in this respect can help health care professionals to be more aware of the interaction between the severity of ID and malnutrition.
AFRIKAANSE OPSOMMING: Agtergrond: Wanneer daar gelet word op die magdom faktore wat voedingstekorte veroorsaak en op die voorkoms van wanvoeding en voedingsprobleme onder individue met intellektuele gestremdheid (IG), is dit duidelik dat vroegtydige waarneming en diagnose van wanvoeding noodsaaklik is. Doelwitte: Die hoofdoel en doelwitte van die studie was om die graad van wanvoeding sowel as die liggaamsamestelling van individue met IG te bepaal wat in ’n psigiatriese hospitaal (Noordwes Provinsie, Suid-Afrika) inwoon. Daar is bepaal watter graad van IG individue is meer geneig tot wanvoeding. Verskillende risiko faktore van wanvoeding in hierdie groep individue is ondersoek en die data is gebruik om ’n bestaande siftingshulpmiddel aan te pas om wanvoeding makliker te kan identifiseer. Metodologie: Die studie-ontwerp was ‘n dwarssnitwaarnemingstudie met ‘n analitiese komponent. Die studie het uit twee fases bestaan. Gedurende die eerste fase is antropometriese metings van individue met IG geneem om liggaamsamestelling en voedingstatus te bereken. Gedurende die tweede fase is hierdie data, sowel as ander risiko faktore wat die voedingstatus van individue beïnvloed, gebruik om ’n bestaande siftingshulpmiddel aan te pas wat die identifisering van wanvoeding in hierdie populasie kan vergemaklik. Verpleegpersoneel het die aangepaste siftingshulpmiddel uitgetoets. Resultate: Die antropometriese metings van 244 individue met IG is bepaal. Hulle algemene antropometriese status het aangedui dat die helfte van die studiepopulasie (52,1%, n=127) ’n normale voedingstatus gehad het; 38,1% (n=93) was ondervoed of het ’n risiko gehad vir ondervoeding en 10,0% (n=24) was reeds oorvoed of het ’n risiko gehad vir oorvoeding. Mans (48,0%, n=73) was meer geneig om ondervoed te wees of het ‘n groter risiko tot ondervoeding as vroue (21,7%, n=20). Daar was geen beduidende statistiese verskille in antropometriese status tussen die vier grade van IG nie (Pearson Chi-square-toets, p=0,15), alhoewel individue met matige IG ‘n groter neiging het tot obesiteit (19,35%, n=6), terwyl uitgesproke IG ’n groter neiging tot ondergewig gehad het (57,1%, n=8). Daar is bevind dat 41,8% (n=102) van die totale studiepopulasie ’n verhoogde middelomtrek gehad het. Daar was ʼn beduidende statistiese verskil tussen verhoogde middelomtrek en graad van IG (Pearson Chi-square-toets, p=0,00). Ander risiko faktore wat die voedingstatus van hierdie populasie kan beïnvloed sluit in mediese toestande soos hipertensie (13,0%, n=32) en epilepsie (46,0%, n=112), asook die gebruik van veelvuldige medikasie (71,7%, n=175). ’n Bestaande wanvoedingsiftingshulpmiddel vir die IG populasie is aangepas deur algemene faktore (middelomtrek, voorkoms van epilepsie en gebruik van veelvuldige medikasie) in te sluit en die puntestelsel aan te pas. Gevolgtrekking: Met behulp van antropometriese metings en liggaamsmassa indekse is ’n hoë voorkoms van wanvoeding in die studiepopulasie van individue met IG waargeneem. Die aangepaste siftingshulpmiddel was meer sensitief as die oorspronklike hulpmiddel om individue wat ’n risiko loop vir wanvoeding of wat reeds wangevoed is, te identifiseer in hierdie studie populasie. Hierdie navorsing kan help om gesondheidswerkers meer bewus te maak van die interaksie tussen die graad van IG en wanvoeding.

Thesis (Mnutr)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Objectives: To describe the mothers/ primary caregivers’ (PCGs) and children’ anthropometric status; their household food security and poverty in relation to type of housing; and compare households receiving and not receiving a Child Support Grant (CSG) in relation to mothers/ PCGs’ anthropometric status, their dietary diversity, age, employment, educational level, monthly household income, size, food security and children’s anthropometric status. Design: Cross sectional, descriptive study. Subjects: Mothers/ PCGs (443) and their children from 211 households in Avian Park and 242 Zweletemba in Worcester, Western Cape Province. Methods: Data collected by interviewer administered questionnaires included socio-demographic data, Lived Poverty Index, Household Food Insecurity Access Scale (HFIAS) and dietary diversity score (DDS). Anthropometric measurements included weight, height and waist circumference (WC) of mothers/ PCGS and weight, height and mid-upper-arm circumference of children. Households living in formal (brick houses, town houses, flats) and informal (squatter shacks, huts) houses, and households receiving CSGs and those without CSG, were compared using X2-test for categorical data and the independent t-test for continuous data. Results: Prevalence of stunting, underweight and wasting in children was 20.7%, 5.6% and 1.2% respectively. Overweight and obesity occurred in 27% and 37% of mothers/PCGs respectively and together with a mean WC (89.5 cm; SD 16.7) indicated an increased risk for non-communicable diseases. Food security existed in 63.1% households. Formal households were more food secure than informal households (68% versus 50%; p=0.0004) and fewer mothers/ PCGs of formal households had a DDS < 4 (52.2% versus 64.7%; p = 0.0157). The healthier socio-economic situation in formal households compared to informal households was shown by the higher monthly income (R3 479 versus R2 316; p = 0.0009) and Household Asset Index (2.24 versus –5.31; p <0.0001). Age, marital status, education level and employment status of mothers/primary caregivers in CSG households and non-CSG households were similar. Household size was larger (p<0.0001) in CSG (median = 5 persons) versus non-CSG households (median = 4 persons); CSG households had more people per room (2.7 [SD 1.5] versus 2.3 [SD 1.2]; p=0.0037). CSG households had lower monthly income than non-CSG households (R2 723 [SD R3 297] versus R4 520 [SD R6 464]; p=0.0033). Mean HFIAS scores showed more food insecurity in CSG households than non-CSG (3.55 versus 2.37; p= 0.0178), but dietary diversity was similar. Stunting in children was higher in CSG (34.9%) versus non-CSG (22.7%) households. CSG mothers/PCGs had larger (p = 0.021) waist circumferences (90.0 cm; SD = 16.8) than non-CSG mother/PCGs (88.5 cm; SD = 16.5) Conclusion: Childhood malnutrition and maternal overweight /obesity co-existed. Dietary diversity of all mothers/ PCGs was low. The assessment of type of housing and social security showed children in informal housing households had a poorer socio-economic situation and children in CSG households also experienced more monthly income poverty and household food insecurity. The level of stunting was higher in CSG households. Improving low dietary diversity should be a priority in interventions addressing food insecurity, taking into consideration this may be more difficult to achieve in informal households and CSG households.
AFRIKAANSE OPSOMMING: Doel: Om die antropometriese status van moeders/ primêre versorgers en hul kinders; hul huishoudelike voedselsekerheid en armoede met betrekking tot tipe behuising waarin hul woon, te beskryf; asook om huishoudings wat ‘n kindersorgtoelaag ontvang te vergelyk met die daarsonder in terme van die antropometriese status van moeders/ primêre versorgers, hul dieetdiversiteit, ouderdom, indiensneming/ werkstatus, opvoedkundige vlak, huishoudelike maandelikse inkomste en grootte, voedselsekerheid en die antropometriese status van hul kinders. Ontwerp: ‘n Beskrywende, deursnit studie. Deelnemers: Moeders/ primêre versorgers (447) en hul kinders van 211 huishoudings in Avian Park en 242 in Zweletemba. Metodes: Data-insameling is gedoen met onderhoudvoerder geadministreerde vraelyste insluitend sosio-demografiese inligting, die belewing-van-armoede-indeks, huishoudelike voedselonsekerheid-en-toegangskaal en dieetdiversiteitstelling. Antropometriese metings van moeders/ primêre versorgers het behels gewig, lengte en middelyfomtrek en gewig lengte en bo-armomtrek van kinders. Huishoudings woonagtig in formele (baksteenhuise, meenthuise, woonstelle) en informele huise (plakkershutte), en huishoudings wat die kindersorgtoelaag ontvang en nie, is vergelyk met behulp van die X2-toets vir kategoriese data en ‘n onafhanklike t-toets vir aaneenlopende data. Resultate: Die voorkoms van dwerggroei, ondergewig en uittering in kinders was onderskeidelik 20.7%, 5.6% en 1.2%. Oorgewig en vetsug het onderskeidelik voorgekom by 27% en 37% van moeders/ primêre versorgers en hul gemiddelde middelyfomtrek was 89.5 sentimeter (SA 16.7), wat aanduidend is van ‘n verhoogde risiko vir nie-oordraagbare siektes. Voedselsekerheid het voorgekom in 63.1% van huishoudings. Formele huishoudings het meer voedsekerheid ervaar as informele huishoudings (68% versus 50%; p=0.0004) en minder formele huishouding moeders/ primêre versorgers het ‘n dieetdiversiteitstelling < 4 (52.2% versus 64.7%; p = 0.0157) gehad. Beter sosio-ekonomiese omstandighede van formele huishoudings in vergelyking met informele huishoudings was sigbaar in hul hoër maandelikse inkomste (R3 479 versus R2 316; p = 0.0009) en huishoudelike bates-indeks (2.24 versus –5.31; p <0.0001). Die ouderdom, huwelikstatus, opvoedkundige vlak en werkstatus van moeders/ primêre versorgers in huishoudings wat ‘n kindersorgtoelaag ontvang en die huishoudings daarsonder was soortgelyk. Huishoudingsgrootte was groter (p<0.0001) in kindersorgtoelaag- (mediaan = 5 persone) versus geen-kindersorgtoelaaghuishoudings (mediaan = 4 persone); In kindersorgtoelaaghuishoudings het meer persone ‘n kamer gedeel (2.7 [SA 1.5] versus 2.3 [SA 1.2]; p=0.0037). Die maandelikse inkomste in kindersorgtoelaaghuishoudings was laer as in dié daarsonder (R2 723 [SA R3 297] versus R4 520 [SA R6 464]; p=0.0033). Die huishoudelike voedselonsekerheid-en-toegangskaal-tellings het meer voedselonsekerheid (p = 0.0178) getoon in kindersorgtoelaaghuishoudings as in huishoudings daarsonder (3.55 versus 2.37; p= 0.0178), maar hul dieetdiversiteit was dieselfde. Dwerggroei was meer in kindersorgtoellaagkinders (34.9%) versus geen-kindersorgtoelaagkinders (22.7%). Die gemiddelde middellyfomtrek van kindersorgtoellaagmoeders/ -primêre versorgers was groter (t-toets: p = 0.021) (90.0 cm; SA = 16.8) as die van moeders/ primêre versorgers wat nie ‘n kindersorgtoelaag (88.5 cm; SA = 16.5) ontvang het nie. Samevatting: Wanvoeding in kinders, tesame met oorgewig en obesiteit in moeders/ primêre versorgers is waargeneem Die dieetdiversiteit van die moeders/ primêre versorgers was laag. Die ontleding van die rol van behuising en sosiale sekerheid het getoon dat die sosio-ekonomiese omstandighede van kinders woonagtig in informele behuising, asook die waarvoor moeders/ primêre versorgers ‘n kindersorgtoelaag ontvang het, is blootgestel aan meer inkomste-armoede en voedselonsekerheid in hul huishoudings. Die verbetering van lae dieetdiversiteit moet ‘n prioriteit wees in intervensieprogramme om voedselsekerheid aan te spreek, met inagneming dat die bereiking daarvan moeilker mag wees om in informele en kindersorgtoelaag-huishoudings.

Thesis (M. Tech. (Clinical Technology)) -- Central University of technology, Free State, 2012
Introduction: Reference ranges for cardiac measurement are available for adults, children and term infants but the same cannot be said for preterm or small for gestational age (SGA) infants surviving as a result of modern intensive care units. No published data of reference ranges for preterm infants exists for the South African population. Infants with congenital heart disease are twice as likely to be small for their gestational age and these reference ranges may affect clinical management decisions, therapeutic response and prognosis of these neonates. The aim was thus to establish reference ranges for cardiac dimensions and functional values for preterm and low birth weight infants for central South Africa and compare them with international standards. Methods: A total of 290 infants of less than 34 weeks of age and weighing less than 2500g at birth were examined during a twelve month period by echocardiography during the first 0-28 days of life. The study assessed normative cardiac measurements divided in M-Mode, 2-D and functional measurement for these infants in 3 weight groups. Exclusion criteria were applied to any condition affecting the size and functionality of the cardiac system. The following dimensions were measured: Standard M-Mode values for the left ventricle, 2D measurements of valve mitral and tricuspid orifices, as well as functional assessments including Shortening fraction (SF %), Ejection fraction (EF %), and Muscle performance Index (MPI)-index of the Left and Right ventricle. Measurements were done by the leading edge methodology following the ASE recommendations. A longitudinal study was also done to examine changes in these indices over the first month- on day 14 and day 28 of life. Interobserver differences were calculated for the variability between measurements of a single scan- 25 babies were re-measured and produced good repeatability. Results: 290 infants were included to produce Referance ranges of measurements (means and standard deviations) for 3 weight groups namely: <0.999g, 1000-1499g, and 1500g – 2500g. The gestational age’s ranges between 26-38 weeks with a median of 31 weeks, gender distribution was almost equal with a slight female preponderance. Body surface area ranged from a minimum from 0.076 m² and a maximum of 0.184 m², the body weight ranged between a minimum of 690g and a maximum of 2500g with a median of 1360g. Discussion: The left ventricular diastolic and systolic, interventricular septum, posterior wall, aortic and left atrium dimensions showed a proportionate increase in diameter with an increase in body weight There were no differences in cardiac dimensions between Small for Gestational age” (SGA) versus “Average for Gestational age” (AGA). Gender and race played no role in any functional measurements or with the cardiac sizes. Weight correlated well with BSA and the data suggest that weight only can be used to develop tables for clinical use. Cardiac chambers increased with BSA and weight and functional measurements stayed the same throughout the weight groups. Systolic and global functions were remarkably similar and constant throughout weight categories. . The longitudinal study also confirmed that the values are applicable to all low birth weight infants up to 28 days of age. Differences existed between some of the average South African infant’s cardiac chambers and international values. The Inter Ventricular Septum (IVS) and Posterior Wall (PW) measured thicker and the Left Atrium larger. This could be due to numerous factors that should be investigated further. Conclusion: The study emphasized the profound effect of growth and weight gain on the cardiac structure and that population specific reference values should therefore be developed and used.

Thesis (MNutr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Introduction Breastfeeding is a key child survival strategy. Mixed feeding (predominant and partial breastfeeding as defined by the World Health Organisation) during the first six months of life is associated with childhood morbidity and mortality, especially in resource-limited settings, and carries the highest risk of HIV transmission through breastfeeding. When compared to exclusive breastfeeding, predominant, partial or no breastfeeding increases the risk for pneumonia and diarrhoea-related mortality. National exclusive breastfeeding rates are poor and have not improved significantly over the past fourteen years, supporting investigation into the contextual factors that influence infant feeding practices. Aim The study aimed to determine the feeding practices of primary caregivers of infants (0-5.9 months) and the influencing factors in Avian Park and Zwelethemba in Worcester, in the Western Cape Province of South Africa, in order to make recommendations, where appropriate. Methods The study was conducted from April to August 2011. A cross-sectional community-based survey was performed using a structured questionnaire. Focus group discussions were held with mothers, fathers and maternal and paternal grandmothers of infants younger than six months, and health care workers (formally trained professionals and counsellors) working in child health. Results One hundred and forty primary caregivers were interviewed. All caregivers were the biological mother of the infant. Seventy-seven percent (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four percent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially, and 31% (n=43) did not breastfeed. Ninety percent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were one month old. Forty-four percent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were three months old. Knowledge of the health and economic benefits of breastfeeding supported initiation but several barriers to exclusive breastfeeding remained. The main barriers were 1) the widely-held perception that infants needed water and nonprescription medicines, 2) the concern that milk alone does not satisfy the infant, 3) inadequate infant feeding education and support by the health system, 4) the lack of community-based postnatal support, 5) convention and family influence, 6) mothers separated from their infants and 7) local beliefs about maternal behaviour and breastfeeding. HIV infection exerted a significant influence on infant feeding choice (p<0.001) and none of the HIV-infected mothers breastfed (n=19). Forty-five percent (n=19) of the formula feeding mothers over-diluted the milk, and early supplementation of formula milk with food was common. Health care workers and maternal grandmothers were the key role-players in infant feeding information and support. Conclusion Exclusive breastfeeding during the first six months of life was a rare practice in these communities. Water, formula milk and/or food were introduced at an early age. HIV-infection discouraged breastfeeding and formula feeding practices proved to be poor. Comprehensive education and support at antenatal, intrapartum and postnatal level seemed lacking and community perceptions and convention contributed to mixed feeding practices. Mothers seemed ill equipped to negotiate infant feeding practices with roleplayers at home.
AFRIKAANSE OPSOMMING: Inleiding Borsvoeding is ‘n sleutelstrategie ter ondersteuning van kinderoorlewing. Gemengde voeding (hoofsaaklike en gedeeltelike borsvoeding, soos omskryf deur die Wêreldgesondheidsorganisasie) gedurende die eerste ses maande van lewe, sowel as geen borsvoeding, word geassosieer met kindersiektes and -sterftes, veral in gebiede met beperkte hulpbronne waar babas vatbaar is vir wanvoeding, gastroënteritis en longontsteking. Gemengde voeding dra ook die hoogste risiko vir MIV-oordrag deur borsvoeding. Nasionale eksklusiewe borsvoedingskoerse is swak en het nie oor die laaste veertien jaar verbeter nie. Dit dien as motivering vir die ondersoek na kontekstuele faktore wat babavoedingspraktyke beïnvloed. Doelwit Die doelwit van die navorsingsstudie is om voedingspraktyke van primêre versorgers van babas (0-5.9 maande) en die invloedryke faktore te bepaal in Avian Park en Zwelethemba in Worcester in die Wes-Kaap Provinsie van Suid-Afrika, om sodoende aanbevelings te kan maak waar gepas. Metodes Die studie is uitgevoer van April tot Augustus 2011. ‘n Gemeenskapsgebaseerde deursnee-opname is uitgevoer deur gebruik te maak van ‘n gestruktureerde vraelys. Fokusgroepbesprekings is uitgevoer met moeders, vaders, en oumas (aan moeders- en vaderskant) van babas jonger as ses maande, en gesondheidswerkers (formeel opgeleide werkers en beraders) wat in kindersorg werk. Resultate ‘n Onderhoud is met eenhonderd-en-veertig primêre versorgers gevoer. Al die versorgers was die biologiese moeder van die baba. Sewe-en-sewentig persent (n=108) het borsvoeding begin. Ten tye van die studie het 6% (n=8) eksklusief geborsvoed. Vier-en-negentig persent (n=132) het suboptimale borsvoedingspraktyke beoefen: 36% (n=51) het hoofsaaklik geborsvoed, 27% (n=38) het gedeeltelik geborsvoed en 31% (n=43) het nie geborsvoed nie. Negentig persent (n=126) van die moeders het water gegee, van wie 83% (n=104) dit gedoen het voordat hul babas een maand oud was. Vier-en-veertig persent (n=61) van die moeders het voedsel of formulemelk gegee, van wie 75% (n=46) dit gedoen het voordat hul babas drie maande oud was. Kennis van die gesondheids- en ekonomiese voordele van borvoeding het moeders ondersteun om te begin borsvoed, maar daar was steeds verskeie faktore wat eksklusiewe borsvoeding belemmer het. Die belangrikste hindernisse was 1) die algemene siening dat babas water en nie-voorskrif medisynes benodig, 2) die kommer dat alleenlik melk nie die baba bevredig nie, 3) ontoereikende babavoedingsonderrig en ondersteuning deur die gesondheidstelsel, 4) die gebrek aan gemeenskapsgebaseerde nageboorte-ondersteuning, 5) gebruike en die invloed van gesinslede, 6) moeders geskei van hul babas en 7) plaaslike sienings rakende moeders se gedrag en borsvoeding. MIV-infeksie het ‘n wesenlike invloed op voedingskeuse gehad (p<0.001) en geen van die MIV-positiewe moeders het geborsvoed nie (n=19). Vyf-en-veertig persent (n=19) van die formule voedende moeders het die melk oorverdun en vroeë supplementasie van formulemelk met kos was algemeen. Gesondheidswerkers en oumas was die kernrolspelers ten opsigte van baba-voedingsinligting en ondersteuning. Gevolgtrekking Eksklusiewe borsvoeding gedurende die eerste ses maande van lewe was ‘n seldsame praktyk in hierdie gemeenskappe. Water, formulemelk en/of voedsel is op ‘n vroeë ouderdom bekendgestel. MIV infeksie het borsvoeding ontmoedig en formulevoedingspraktyke was swak. Omvattende opvoeding en ondersteuning op voorgeboorte-, intrapartum- en nageboortevlak het ontbreek, en sienings en gebruike het bygedra tot gemengde voedingspraktyke. Dit het geblyk dat moeders nie toegerus was om oor babavoedingspraktyke met ander belanghebbendes by die huis te onderhandel nie.

Problem: With 20% being infected, South Africa still has the highest HIV prevalence worldwide, implying a large number of children being infected as infant over the past decades. Nowadays, many of these infants are in their teenage years. Little research has been conducted about those adolescents. Due to the disease’s connection to homosexuality and disloyalty as well as many congregations’ rejection of contraceptives, the relation between HIV-positive people and faith communities, as well as religion in general, is ambiguous. Congregations may view people perinatally infected with HIV differently since they were not infected due to potentially ‘immoral behavior,’ but by their mothers. Objective: Scientific literature exists about HIV/AIDS and religion/spirituality for adults, and about mental issues of HIV-positive youth. The connection between those two fields has not been drawn. Therefore, this research focuses on the role of religious congregations in the lives of teenagers perinatally infected with HIV (TPIH). It analyzes to what extent those adolescents have a connection to a congregation, how supportive it is to them, and where support improvement opportunities lie. The main objective is to identify how congregations can provide relevant support for infected adolescents. Methods: A qualitative study using 18 semi-structured interviews with TPIH, religious representatives and other key informants provides a basis for this abductive research. The conceptual framework builds on theories of social stigma as a sub-category of social constructions. Questionnaires concentrate on Szaflarski et al.’s (2010) dimensions of religion/spirituality. Results: TPIH seem to view church and religion positively, but regularly experience or witness stigma by society in general. Although churches have great power to address societal perceptions of HIV/AIDS, they rarely support TPIH. Most existing help focuses on general stigma reduction. While this is necessary, congregations should specifically support TPIH by measures concentrating on individual, group and caregiver support.

Thesis (PhD)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: A community-based growth monitoring (GM) project was established in a rural village in KwaZulu-Natal. The project is an example of community-based activities that were based on a participatory approach of problem assessment and analysis. The first phase of the study comprised of a situation assessment. The aim was to evaluate the nutritional status and related factors of children aged 5 years and younger. It included a cross-sectional survey (questionnaire and anthropometric measurements), focus group discussions and interviews with key informants. From a nutritional point of view, the situation assessment identified a need for regular GM of infants and small children, increased availability of foods rich in micronutrients, and nutrition education. Relevant findings of the situation assessment were used during a project planning workshop that was attended by community representatives. The community's concern about the health of the preschool children and the lack of health facilities, and the need for regular weighing of their children prompted the establishment of a community-based GM project. The GM project was run by nutrition monitors, through home-based centres (named Isizinda). Monthly activities at the Isizinda included GM, nutrition education, and recording of morbidity and mortality data. Children who were either in need of medical attention or showed growth faltering were referred to the nearest clinic. During the latter half of the study, the GM project was integrated with a household food production project and the Isizinda served as promotion and training centres for agricultural activities. Project activities were continuously monitored by reviewing the attendance register, scrutinising the Isizinda files, observation and staff meetings. Community meetings (at least twice a year) allowed for two-way feedback and addressing questions and concerns. Acceptability of the GM activities was measured in terms of attendance and maternal perceptions. The coverage of the Isizinda project was estimated at approximately 90% and at least 60% of these children were adequately covered. The Isizinda data showed an equal distribution of child contacts over the various age categories and was representative of the community. The attendance data suggest that community-based GM is a viable option to be used for screening and nutrition surveillance, and as platform for nutrition education. Most mothers comprehended the growth curve. Positive behavioural changes have been observed in the community and the Isizinda data showed a steady decline in the prevalence of diarrhoea. The Ndunakazi mothers were appreciative towards the Isizinda project because of a better understanding of the benefits of regular GM. They expressed a sense of empowerment regarding the knowledge that they have gained. The community had a strong desire for the project to continue. The Isizinda project showed that community-based GM can provide the infrastructure for developing capacity for agricultural activities within the community. Data from the household food production project showed that maternal knowledge regarding nutritional issues can be improved through nutrition education given at the GM sessions and that, when GM is integrated with agricultural activities, a significant improvement in child malnutrition can be obtained. The Isizinda project falls within the framework of the Integrated Nutrition Programme, and can bridge the gap in areas which lack health facilities.
AFRIKAANSE OPSOMMING: ’n Gemeenskaps-gebaseerde groeimoniteringsprojek is tot stand gebring in ’n landelike gebied in KwaZulu-Natal. Die projek is 'n voorbeeld van gemeenskapsgebaseerde aktiwiteite wat gebaseer was op 'n deelnemende benadering van probleem bepaling en analise. Die eerste fase van die studie was a situasie analise. Die doel was om die voedingstatus en verwante faktore van kinders 5 jaar en jonger te bepaal. Dit het 'n dwarssnit opname (vraelys en antropometriese metinge), fokus groep besprekings en onderhoude met kern persone ingesluit. Uit 'n voedingsoogpunt het die situasie analise 'n behoefte vir gereelde groeimonitoring van babas en klein kinders, verhoogde beskikbaarheid van voedsels ryk in mikronutriente and voedingsvoorligting aangedui. Toepaslike bevindinge van die situasie analise was gebruik tydens ’n beplannings werkswinkel wat deur verteenwoordigers van die gemeenskap bygewoon is. Die gemeenskap se besorgdheid oor die gesondheid van voorskoolse kinders en die gebrek aan gesondheidsfasilitieite, asook hul behoefte om hul kinders gereeld te laat weeg, het aanleiding gegee tot die totstandkoming van ’n gemeenskaps-gebaseerde groeimoniteringsprojek. Die program is gedryf deur monitors deur tuisgebaseerde sentrums (genoem Isizinda). Maandelikse aktiwiteite by die Isizinda het groeimonitering, voedingvoorligting en die insameling van morbiditeit en mortaliteit inligting ingesluit. Kinders wie mediese sorg benodig het of wie groeivertraging getoon het, is na die naaste kliniek verwys. Die groeimoniteringsprojek is tydens die laaste helfte van die studie met ’n huishoudelike voedselproduksieprojek geintegreer en die Isizinda het as promosie- en opleidingsentrum vir die landbou aktiwitiete gedien. Projek aktiwiteite is deurgaans gemonitor deur die bywoningsregister en Isizinda leêrs deur te gaan, waarnemings en personeel vergaderings. Vergaderings met die gemeenskap (ten minste twee per jaar) het voorsiening gemaak vir wedersydse terugvoering en die aanspreek van vrae en besorgdhede. Die aanvaarbaarheid van die groeimoniterings aktiwiteite is gemeet in terme van bywoning en persepsies. Die Isizinda projek het ongeveer 90% van die kinders gedek, van wie ten minste 60% voldoende gemoniteer is. Die Isizinda data het ’n eweredige verspreiding van besoeke oor die verskillende oudersdomgroepe aangetoon. Die Isizinda data was ook verteenwoordigend van die gemeenskap. Die bywoningssyfers dui aan dat gemeenskapsgebaseerde groeimonitoring 'n lewensvatbare opsie is vir sifting en voeding opnames, en as 'n platform vir voedingvoorligting. Meeste moeders kon die groeikaart interpreteer. Positiewe gedragsveranderinge is in die gemeenskap waargeneem en die Isizinda data het ’n geleidelike afname in die voorkoms van diarree getoon. Die Ndunakazi moeders was waarderend teenoor die Isizinda projek as gevolg van 'n beter begrip ten opsigte van die voordele van gereelde groeimonitering. Hulle het 'n gevoel van bemagteging uitgespreek ten opsigte van hul verbeterde kennis. Hulle was mening dat die projek moes voortgaan. Die Isizinda projek het aangetoon dat gemeenskapsgebaseerde groeimonitoring die infrstruktuur kan skep vir die ontwikkeling vir kapasiteit vir landbou aktiwiteite binne die gemeenskap. Inligting van die huishoudelike voedselproduksieprojek het aangetoon dat die moeders se kennis ten opsigte van voedings verwante aspekte verbeter kan word deur voedingvoorligting wat gegee word tydens die groeimonitering sessie en dat, as groeimonitoring geintegreer is met landbou aktwiteite, 'n verbetering in die voedingstatus van die kind verkry kan word. Die Isizinda projek val binne die raamwerk van die Geintegreerde Voedingsprogram en kan die gaping dek in areas waar geen gesondheidsfasilteite is nie.

Birthweight is powerful predictor of infant growth and survival. Premature birth and intrauterine growth retardation of birthweight. Maternal environment is important underlying determinant of birthweight. Common lifestyle risk factors include maternal under-nutrition, smoking, alcohol and social factors and stress. The Winelands/West Coast region has high rates of low birthweight. In addition, alcohol abuse and smoking are major problems in this area. The aim of this quantitative case-control study was to determine the epidemiology of low birthweight, related to lifestyle behaviours in pregnant women, with particular attention to lifestyle factors such as alcohol, smoking, and stress-related factors.

The present study looks at the socio-emotional impact of malnutrition. This is done by comparing infants who are hospitalised for malnutrition, and infants hospitalised for surgical reasons. Twenty infants were selected from the medical ward (malnutrition ward), and twenty from the surgical ward were selected as a control group. Observation was used as a method of collecting data on socio-emotional behaviour. The results of analysis of variance indicated that there was a significant difference between the two groups of children in social and emotional responsiveness. Malnourished children showed less responsiveness, which was suggested by less activity, less affect, and low reactions to situations compared to the control group. The results also indicated that females are more sensitive than males. The results of this study invite possibilities for further investigations.
Thesis (M.A.)-University of Natal, Pietermaritzburg, 1998.

Text in English
The study was conducted to determine the knowledge and to describe attitudes of HIV positive women on exclusive breastfeeding in Mopani District (the Greater Letaba Sub-District, Limpopo), South Africa. A quantitative, exploratory and descriptive design was adopted in this study to describe the knowledge and attitudes of HIV positive women on exclusive breastfeeding. The researcher used a self-developed structured questionnaire to collect data. Descriptive and inferential statistics were used to describe data. The SPSS software version 21.0 was used to analyse data and this were displayed in tables and figures. A total of 123 participants were included in the study. The study concluded that HIV positive women have good knowledge and positive attitude on exclusive breastfeeding.
Health Studies
M.P.H.

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made.
Health Studies
M.A. (Nursing Science)

PhD, Faculty of Health Sciences, University of the Witwatersrand
Background: In low- to middle-income countries, rising levels of overweight and obesity are a result of multiple transitions, in particular, a nutrition transition. Consequently, in these countries, metabolic diseases are contributing increasingly to disease burden, despite the persisting burden of undernutrition and infectious diseases. Understanding the patterns and factors associated with persistent undernutrition and emerging obesity in children and adolescents, and concomitant risk for metabolic disease, is therefore of criticial importance. This should contribute to public health policy on interventions to prevent adult disease. Aims: To better understand the double burden of malnutrition in a poor, high HIV prevalent, transitional society in a middle-income country; In so doing, to inform policies and interventions to address the double burden of malnutrition. Methods: A cross-sectional growth survey was conducted in 2007 targeting 4000 children and adolescents 1-20 years of age living in rural South Africa. The survey was nested within the ongoing Agincourt Health and Socio-demographic Surveillance System, which acted as the sampling frame and also provided data for explanatory variables. Anthropometric measurements were performed on all participants using standard procedures. In addition, HIV testing was done on children aged 1 to 5 years and Tanner pubertal assessment was conducted among adolescents 9-20 years. A one-year follow-up of HIV positive children included a matched control group of HIV negative counterparts. Data collection involved both quantitative and qualitative methods. Growth z-scores were used to determine stunting, underweight and wasting and were generated using the 2006 WHO growth standards for children up to five years and the 1977 NCHS/WHO reference for older children. Overweight and obesity were determined using the International Obesity Task Force cut-offs for BMI for children aged up to 17 years and adult cut offs of BMI =25 and =30 kg/m2 for overweight and obesity respectively for adolescents 18 to 20 years. Waist circumference cut-offs of =94cm for males and =80cm for females, and waist-to-height ratio of 0.5 for both sexes, were used to determine central obesity and hence metabolic disease risk in ix adolescents. Descriptive analysis described patterns of nutritional status by age, sex, pubertal stage and HIV status. Linear and logistic regression was done to determine predictors of nutrional outcomes. A p-value of <0.05 was considered statistically significant. Results: Prevalence of undernutrition, particularly stunting, was substantial: 18% among children aged 1-4 years, with a peak of 32% in children at one year of age. Stunting and underweight were also substantial in adolescent boys, with underweight reaching a peak of 19% at 14 years of age. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was prominent among adolescent girls, increasing with age, and reaching a peak of 25% at 18 years. Risk for metabolic disease using waist circumference cut-offs was substantial among adolescents, particularly girls, increasing with sexual maturation, and reaching a peak of 35% at Tanner stage 5. Prevalence of HIV in children aged 1-4 years was 4.4%. HIV positive children had poorer nutritional outcomes than that of HIV negative children in 2007. The impact of paediatric HIV on nutritional status at community level was, however, not significant. Significant predictors of undernutrition in children aged 1-4 years, documented at child, maternal, household and community levels, included child’s HIV status, age and birth weight; maternal age; age of household head; and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease in adolescents aged 10-20 years, documented at individual/child and household levels included child’s age, sex and pubertal development; and household-level food security, socio-economic status, and household head’s highest education level. There was a high acceptance rate for the HIV test (95%). One year following the test, almost all caregivers had accepted and valued knowing their child’s HIV status, indicating that it enhanced their competency in caregiving. Additionally, nutritional status of HIV positive children had improved significantly within a year of follow-up. Conclusions: The study describes co-existing child stunting and adolescent overweight/obesity and risk for metabolic disease in a society undergoing nutrition transition. While likely that this profile reflects changes in nutrition and diet, variation in infectious disease burden, physical activity patterns, and social influences need to be investigated. The findings are critical in the wake of the rising public health importance of metabolic diseases in low- to middle-income countries, despite the unfinished agenda of undernutrition and infectious diseases. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged. In addition, gender-biased nutritional patterns call for gender-sensitive policies and interventions. The study further documents a significant role of paediatric HIV on nutritional status, and the potential for community-based paediatic HIV testing to ameliorate this. Targeted early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.

MCur
Department of Advanced Nursing Science
Malnutrition is globally considered the key risk factors of illness and death which affect over 90 million children under the age of five. The study aim was to determine the perception of caregivers regarding factors contributing to malnutrition in children under 5 years in the Vhembe District of the Limpopo province. A qualitative approach, explorative, descriptive and contextual design was used in the study. Nine participants were sampled through simple random sampling. Data was collected through in- depth individual interview and was analysed through Tesch‘s analytical approach. Measures to ensure trustworthiness and ethical consideration were adhered to throughout the study. Three themes emerged from study, namely: caregivers perceived contributory factors to malnutrition, financial difficulties and help that were sought from various available resources. In conclusion, feeding practices to most of the participants was a challenge, they had financial difficulties since they were not working and depended on social and child grants for living, and the study recommends the development of strategies to assist caregivers in preventing malnutrition in children.
NRF

Thesis (M.Tech.: Food and Consumer Sciences)- Durban Institute of Technology, 2004 1 v. (various pagings)
This study examines the incidence of malnutrition and the factors influencing malnutrition amongst rural black children aged 0 to 24 months in Umbumbulu, Kwa-Zulu Natal so as to formulate guidelines for the development of a nutrition intervention education programme.

A research thesis submitted for the degree of Doctor of Philosophy in Audiology in the Faculty of Humanities the University of the Witwatersrand March 2016.
Purpose: The main objective of the current study was to explore risk-based new-born hearing screening within a developing country by conducting early hearing detection in high-risk neonates within an academic hospital complex in Gauteng, South Africa. Specific objectives describing the case history factors and audio logical function in a group of high-risk determining the relationship between the case history factors and audio logical establishing the true-positive (TP) and true-negative (TN) results with different combinations of screening measures; establishing the percentage of TP and NT screening results in the total sample; and exploring the factors associated with follow-up return rate for hearing screening and diagnostic audio logical assessment.
GR2017

Information on the present situation of household food insecurity in South Africa is fragmented. There is no comprehensive study comparing different indicators of household food security. Better information on the household food security situation in South Africa would permit relevant policy formulation and better decision-making on the allocation of limited resources. The availability of a national dataset, the first South African National Food Consumption Survey data (1999) , provided the opportunity to investigate some of the issues raised above, and to contribute to knowledge on the measurement of household food security. The aim of this study was to use the data from the 1999 National Food Consumption Survey (NFCS) to : • Determine and compare the prevalence of household food insecurity using different indicators of household food security ; • Determine the overlap of households identified as food insecure by the different indicators (i.e. how many of the same households are identified as food insecure); and to • Investigate whether there was any correlation between the indicators selected . The indicators of household food security selected were: household income, household hunger experienced, and using the index child: energy and vitamin A intake (from 24 Hour Recall (24HR) and Quantified Food Frequency data), dietary diversity (from 24HR data) and anthropometric indicators stunting and underweight. The cut offs to determine food insecure household were those used in the NFCS and the cut off for dietary diversity was exploratory. The main results of the study were as follows : • The prevalence estimates of household food insecurity ranged from 10% (underweight indicator) to 70% (low income indicator). Rural areas consistently had a higher prevalence of household food insecurity than urban areas . The Free State and Northern Cape provinces had higher levels of household food insecurity, with the Western Cape and Gauteng the lower levels of household food insecurity . • Quantified Food Frequency (QFF) data yielded lower prevalence of household food insecurity estimates than 24 hour recall (24HR) data. Household food insecurity as determined by low vitamin A intakes was higher than that determined by low energy intakes for both the 24HR and QFF data . • There was little overlap with the indicators (9-52%), indicating that the same households were not being identified by the different indicators. Low dietary diversity, low income, 24HR low vitamin A intake and hunger had higher overlaps with the other indicators. Only 12 of 2826 households (0.4%) were classified by all nine indicators as food insecure. • The dataset revealed a number of statistically significant correlations. Overall , low dietary diversity, low income, 24HR low energy intake and hunger had the stronger correlations with the other indicators. Food security is a complex, multi-dimensional concept, and from the findings of this study there was clearly no single best indicator of household food insecurity status. Overall , the five better performing indicators (higher overlaps and correlations) were : low income, 24 hour recall low energy intake, 24 hour recall low vitamin A intake, low dietary diversity and hunger; this merits their use over the other selected indicators in this study. The indicator selected should be appropriate for the purpose it is being used for, e.g. estimating prevalence of food insecurity versus monitoring the long term impact of an intervention. There are other important criteria in the selection of an indicator. Income data on a national scale has the advantage of being available annually in South Africa, and this saves time and money. The 24HR vitamin A intake and 24HR energy intake indicators has as its main draw back the skill and time needed to collect and analyse the information, which increases cost and decreases sustainability. Dietary diversity and hunger have the advantage of being simple to understand, and quicker and easier to administer and analyse. It is suggested that a national food security monitoring system in South Africa uses more than one indicator, namely : 1) household income from already existing national data, 2) the potential for including a hunger questionnaire in the census should be explored, and 3) when further researched and validated, dietary diversity could also be used in national surveys.
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

MCur
Department of Advanced Nursing Science
Background: Globally, malnutrition among children is one of the most challenging and critical public health problem, and it remains one of the most common causes of morbidity and mortality among children under the age of 5 years. There is no exception for the Vhembe District. Purpose: The study determined the perceptions of young mothers regarding causes of malnutrition in children under the age of 5 years in the Vhembe District, of the Limpopo Province. Methodology: This study used qualitative, exploratory, descriptive and contextual design to collect data among young mothers regarding causes of malnutrition in children under 5 years. Twelve young mothers were sampled using probability, simple random sampling at selected hospitals population. In-depth individual interviews were used to collect data and analysed using Tesch’s steps. Measures to ensure trustworthiness and ethical consideration were adhered to throughout the study. Results: Three themes emerged from the analysed data, namely: Young mothers’ perceived causes of malnutrition, young mother’s beliefs about malnutrition, and health care seeking actions for a malnourished child. Recommendations: This study recommend a strategies to integrate young mothers into the health promotion regarding their understanding and experiences about malnutrition. Policies on child nutrition should be reviewed regularly in the Vhembe District for prevention and management of malnutrition in children under 5.
NRF

Infant mortality rates are used as indicators of a group or population's well being. A high rate indicates poor access to social services such as health care provision, and other socioeconomic factors. Sub-Saharan Africa has the highest infant mortality rates in tne world. Compared to the region as a whole, South Africa's rates are lower. However, a sudden increase in rates was noted from early 1990s (Department of Health, Medical Research Council, Macro International, 1998). Since household is the first environment that infants are exposed to, it is thus the environment that strongly influences development and survival chances of this group. The study aims at taking a closer look at several aspects of the structure of the household and how they impact on infant mortality. The study is based on data from the South African Demographic and Health Survey (SADHS) administered by the Department of Health in 1998. Aspects of household structure that are viewed as affecting infant mortality are: sex of the household head, his/her age, number of household members, and number of children under 5 years old in a household. Estimating infant mortality rate and its probability by using ordinary life tables and multiple logistic regression modeling respectively, the study found that sex of the household head does no have an impact as a determinant of infant mortality in South Africa. However, other aspects of the household structure (number of household members and number of younger children under 5 years of age) were found to determine the survival of infants. Larger households are better off in securing infant survival than smaller households.
Thesis (M.A.)-University of Natal, Durban, 2002.

This study aimed to investigate teenage mothers’ experiences of motherhood and their internal representations of their infants and the relationship between them. In addition, this study aimed to investigate whether there was a connection between teenage mothers’ experiences of parenting and their internal representations of their infants and the relationship between them. Through the use of semi-structured interviews, adapted from the Parent Development Interview and the Working Model of the Child Interview, four teenage mothers from Alexandra were interviewed. The data collected from these interviews was analysed using narrative analysis through the hermeneutic lens of psychoanalytic attachment theory. From the analysis, this study found that teenage mother’s experiences of motherhood were marked by challenge. The two main challenges faced by these young mothers were the tension they experienced between their identities as teenagers and their identities as mothers, and their struggle to provide for their infants and feel like good enough mothers. In addition, this study found that teenage mother’s internal representations of their infants included a representation of both the good baby and the bad baby, but, with the exception of one mother, their representations tended to remain split and the mothers seemed defended against their representations of the bad baby. In terms of their representations of the relationship between them, this study found that these teenage mothers’ representations of their relationship with their infants was lacking. These representations either consisted of a superficial representation of a good relationship between mother and infant, or no relationship at all. Finally, this study found that teenage mother’s experiences of motherhood and their internal representations of their infants and the relationship between them were connected. A number of factors that were found to influence both their experiences and their internal representations include their own mental states, their memoires of their own childhood and their representations of their caregivers, as well as the levels of social support they received. The study therefore concluded that teenage mothers’ experiences of motherhood and their internal representations of their infants and the relationship between them were connected, however further research is required to establish the causal relationship between these factors.

Thesis (M. Sc.(Physiology)) -- University of Limpopo, 2019
Aim: The purpose of this study was to assess the prevalence and risk factors associated with malnutrition and nutritional status of rural and urban primary school children aged 6–9 years. Literature background: Malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries, affecting 10.9% of people globally, particularly in Southern Asian (15.7%) and sub-Saharan African (23.2%) countries undergoing urbanisation. Urbanisation affects diet, physical activity levels, body fatness, body composition and socio-economic factors. There is currently a shortage of information on the effect of urbanisation on nutritional status, especially in poor areas such as the Limpopo Province of South Africa. It is important to understand the effects that body fatness and associated risk factors have on stunting, wasting, underweight, and overweight/obesity in urban and rural children. Subjects and design: This was a cross-sectional study including rural (n=106) and urban (n=68) primary school children aged 6–9 years. Anthropometric (weight and height) and skinfold measurements were taken and a 24-hour recall dietary assessment was conducted twice to include a week day and a weekend day. A questionnaire was used to gather demographic, health, dietary and physical activity information. Results: The prevalence of stunting, wasting, underweight, and overweight/obese children in this population was 14%, 6%, 20%, and 26% respectively. Furthermore, the prevalence stunting, wasting, and underweight were higher in rural areas compared to urban areas. Meanwhile, the prevalence of overweight/obesity was higher in urban areas as compared to rural areas. Gender, area (urban/rural) (p=0.0001), birthweight, time spent on sedentary activities, monthly household income (p=0.0210), mode of transport to school, and breastfeeding (p=0.0560) were all found to be significantly associated with malnutrition. Weekday dietary intake of Vitamins A and D was significally associated with BF%, whereas weekend consumption of energy, protein, calcium, iron, phosphorus, and zinc were not significantly associated with BF%. The mean energy and calcium intake between the urban and rural vi population only differed significantly over weekends and not during the week, while vitamin D differed significantly between urban and rural populations during the week only. Conclusions: The current study demonstrates that children in rural areas were significantly more wasted than those residing in urban areas, while those residing in urban areas were significantly more overweight/obese compared to rural areas. All indicators used for undernutrition were associated significantly with gender and the prevalence were higher males compared to females, but this significance disappeared for overnutrition. Families with a higher income tended to have children who were overweight or obese compared to families with a lower income. Children spending a lot of time on sedentary activities were more likely to be overweight or obese, and breastfeeding seemed to protect children from becoming overweight or obese, while low birth weight was associated with stunting. The weekaday and week-end diets indicate that school feeding schemes in the rural areas may be effective in increasing total energy intake in children and this should be further investigated. In this population, stunting, wasting, and underweight were not limited to rural areas, and should still be a health concern in urban areas, despite the fact that overweight/obesity is also prevalent in urban areas. Thus, overweight/obesity in this population can be prevented by promoting breastfeeding and physical activity, while at the same time discouraging children from partaking in too many sedentary activities.
National Research Foundation (NRF)

A research report submitted in partial fulfillment of the requirements for the degree Master in Audiology, Department of Speech Pathology and Audiology Faculty of Humanities University of the Witwatersrand September 2018
Newborn hearing screening (NHS) has been successfully implemented in developed countries such as the United States of America and the United Kingdom. This is however not the case in developing countries such as South Africa. The challenges impact on the implementation of such programmes include lack of suitably trained personnel, financial resources for staff and equipment, institutional support and political will. The lack of NHS programmes in South Africa has resulted in the late detection of hearing loss in infants and children and subsequently delayed intervention. In order to address the lack of NHS, a rural clinic-based NHS programme was implemented in July 2014 at three primary health care (PHC) clinics in the Limpopo Province. The main aim of the study was to describe the parental/caregiver perspectives regarding the effectiveness of this rural clinic-based NHS programme. The effectiveness of the programme was also evaluated in terms of meeting national (HPCSA, 2007) and international (JCIH, 2007) benchmarks. A retrospective review of 2 302 audiological records of babies who underwent NHS between July 2014 to June 2015 was conducted. Concurrently, 18 parents of infants who underwent hearing screening as part of the programme were purposefully selected and semistructured interviews were conducted to explore the parental perspectives regarding the programme. The results of the retrospective record review revealed that the mean age of the infants screened during the review period was 112 days (2 – 341; ± 40.26). The overall coverage rate was 87% and the referral rate, 7%. The overall follow-up return rate was 32% and only 15% the infants who failed both the initial and rescreening underwent comprehensive diagnostic assessment to confirm their hearing status. The overall prevalence rate for significant sensorineural hearing loss was 0.4/1000 and 7.8/1000 for middle ear effusion. The parents/caregivers confirmed the perceived effectiveness of the NHS programme. All the participants were satisfied with the programme and confirmed the credibility of the screening programme and screeners. Parents indicated that they were empowered with knowledge regarding the importance of early detection of hearing loss in infants and young children. Accessibility was both a facilitator and a barrier with travel distance and cost the most often cited obstacles to attending follow-up appointments. The findings indicate it is feasible to implement clinic-based NHS programmes that effectively meet the needs of parents/caregivers of infants residing in rural areas of South Africa. Although not all the benchmarks were met within the first year of implementation, the high coverage- and low referral rates are the first steps in improving the outcomes of the screening programme. The study highlight the importance of regular monitoring and evaluation of the NHS programmes to keep track of key outcomes and impacts related to the different components of the programme
MT 2019

Food insecurity remains a major challenge affecting the rural poor households in South Africa. The consumption of green leafy vegetables is important to address micronutrients deficiency in rural communities and, at the same time, it contributes to fibre intake. This study investigated the people’s attitude towards the cultivation and utilisation of ILVs in rural communities. A cross-section survey study was conducted among 1 000 respondents in randomly selected households in communities. The majority of respondents were not willingly consuming ILVs. This is because most consumers were black and of the low-income group. ILVs that are consumed grow mainly in the wild. The regular consumption of these vegetables as indicated in this study is interesting, as this will help in mitigating micronutrient deficiency. Furthermore, these vegetables could be incorporated in formulated food to improve iron and zinc, especially in infant foods formulation. Based on the findings of this study it would be important to find ways of encouraging cultivation of ILVs for both nutrition and as income generating activities.
Business Management
M. Consumer Science

DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENTS FOR A MASTER OF MEDICINE DEGREE IN PAEDIATRICS AND CHILD HEALTH (MMED PAED)
Survival of extremely low birth weight (ELBW) infants in a resource limited public hospital setting is still low in South Africa. The study aimed at establishing the determinants of survival in this weight category of neonates who, due to limited intensive care facilities, were not mechanically ventilated.

A research report submitted to the school of public health, University of the Witwatersrand, Johannesburg, partial fulfillment of the requirements for the degree of Masters of science in biostatistics.
Background: Globally malnutrition is an underlying cause of death and accounts for over 45% of under-5 mortality mainly resulting from diarrhoea and pneumonia. The post-2015 era has seen, more than 25% of Kenya’s population being food insecure, with considerable geographicandtemporaldisparities. Ourprimaryaimwastounderstandthedeterminants ofmalnutritionrelatedmorbidityandmortalityintheruralKilifiHDSS,withaspecialfocus on children admitted in Kilifi County Hospital (KCH) during 2002-2015. Methodology: Our study participants were all the children between the ages of 6 months to 15 years who were admitted two times or more at the KCH. The outcomes were derived from malnutrition-related admissions based on wasting (WHZ<-2) and oedema and the discharge outcome whether alive or died. There were 3114 children with a total of 7620 admissions for children with more than one admission. In the exploratory data analysis, temporality and seasonality were determined using SARIMA time series models. Morans I index was used to investigate for the presence of spatial autocorrelation. SatScan was used to identify the spatial clusters of malnutrition related admissions and mortality. To understand mortality patterns, geo-additive logistic models were fitted to the KCH data. Mixed effects negative binomial models with separate space and temporal random effects were fit using the Maximum Likelihood and Bayesian Estimation procedures. The Bayesian methods were used to estimate the spatial parameters using Markov Chain Monte Carlo (MCMC) assisted with either Metropolis Hastings or Integrated Nested Laplace Approximations (INLA). iii ABSTRACT Results: Therewere17,740childrenobservedovertheperiodofstudyand4.01%ofthosedied. A total of 23,347 admission events were observed of which 7,128 were malnutrition related. Outofthe17,740childrenadmitted, 3,114hadoneormoreadmissionevent. A seasonal hike in the May to July month was identified for malnutrition admission. Children with morethanoneadmission,(7620admissions)~24%(n=1858)hadamalnutritioneventand 6.24%ofthemdied. SpatialhotspotsclusterswereidentifiedintheNorthandSouthofthe creek and areas near Kilifi Town was identified as cold spots. Children with two or more severe diseases are more likely to have a malnutrition admission event and females are less likely to be admitted with malnutrition. There was a protective effect as the children grewolderandalsoastheirbodyweightsincreased.Themaleshadahigherriskofdeath compared to the females and a year increase in age reduced the risk of death by 15%. Conclusion: Abetterunderstandingofthefactorsthatcontributetomalnutritionattributableadmission and mortality can be used to advocate for and develop earlier and more appropriate responses. Additionally, this can provide an indication of future trends and the potential impact of interventions.Importantly, including spatial and temporal random effects biostatistical modelling can help reduce bias reporting and help understand better the patterns of morbidity and mortality. Campaigns providing food and/or vitamin or other supplements can contribute to reducing morbidity and ultimately deaths in Kenyan childrenandbuildingmorehealthfacilitiestoreducethedistanceoftraveltocareishighly recommendable.
GR2018

Hunger and malnutrition remain amongst the most devastating problems facing the world's poor and needy. About 80-90 million people have to be fed yearly and most of them are in developing countries in Africa. The majority of South African families live in poverty with a limited variety of foods available in their homes. Integrated aquaculture-poultry production systems can accommodate the demand for food. Integrated fish farming systems has been shown to can provide the vital animal protein necessary to relieve much of the prevailing problems of malnutrition in rural areas. Commercially orientated integrated aquaculture has been investigated in South Africa over the last two decades and intensive studies were done, yet little is known about the concept of aquaculture-agriculture systems in South African rural populations. Integrated fish-chicken farming has the potential to impact positively on the livelihood of rural populations because it can provide food, employment opportunities and recirculation of waste products for maximum utilization. The production from two farming enterprises integrated together, will therefore contribute much to poverty alleviation and provision of employment or income. The South African rural communities are more commonly involved in layer production with indigenous breeds which produce few eggs compared to commercial breeds. There is however a need to identify a suitable layer breed that can best perform when used in an integrated fish farming system. Since the purpose of promoting this system is to provide food security and regular sources of income to the poor, the best performing layer breed will be able to produce enough eggs for consumption and selling while the fish will be sold to increase profit. The spent hens will also provide meat and an income to the farmer at the end of the production cycle. Three hundred and twenty layer chickens of eight breeds were randomly assigned to either a conventional (control) layer house or a treatment house that was an open-sided layer house constructed over a dam (160 chickens/treatment). The eight layer breeds used were two lines of indigenous breeds (i.e. Potchefstroom Koekoek and Ovambo), dual purpose breeds (i.e. New Hampshire and Black Australorp) and commercial breeds (i.e. Hyline-Silver and Hyline-Brown; Lohmann-Silver and Lohmann-Brown). The design used for the study was a randomized block design. The houses were blocked in five blocks with one replicate per treatment (breed) in each of the blocks. Each replicate comprised of four hens, individually caged in adjacent cages. Parameters measured over the five month trial period were egg production, egg weight, feed intake, feed conversion ratio and hen day production %. Egg quality parameters were also measured i.e. egg shell strength, specific gravity, albumen height, Haugh unit and meat and blood spots. The mortality and economic efficiency of all the layer breeds was calculated over the five months trial period. The commercial breeds produced significantly more eggs, heavier eggs, had better FCR and higher hen day production % than the dual purpose and indigenous breeds in both the house that was constructed over a dam and a conventional house system. However, the feed intake of laying hens did not differ significantly in both the housing systems. The housing systems did not significantly affect egg quality parameters of laying hens. Mortality per breed was higher in the conventional house than the dam house. The commercial breeds showed to be economically viable in an integrated chicken-fish farming system with a high profitability than the dual purpose and indigenous breeds.
Dissertation (MSc(Agric))--University of Pretoria, 2013.
Animal and Wildlife Sciences
unrestricted

Faculty of Health Sciences School of Therapeutic Sciences 0200244h baillieu@therapy.wits.ac.za
In South Africa, a total number of 5.7 – 6.2 million individuals had acquired HIV infection by 2004 (Department of Health, 2004). It is estimated that 3.3 million females, 2.8 million males, and 104 963 babies had been infected with HIV in South Africa by 2004 (Department of Health, 2004). It has been found that HIV-positive children have significantly greater neurological dysfunction in eight domains (activity, language, cranial nerve, fine motor, gross motor, cerebellar, sensory and primitive reflexes) than their HIV negative counterparts (Belman et al, 1996). There has been very little research conducted in Africa regarding the extent of delay of language, motor, and cognitive development in HIV positive infants. The main aim of this study is to determine the extent of delay in acquisition of language, cognitive and motor skills of HIV positive children The Bayley Scales of Infant Development II (BSID II) were used to determine performance in each section of the child’s age group. These results were transferred to the facet scoring section, which analyse in greater detail, with respect to cognitive, language and motor development. Baseline BSID II assessments of HIV infected children currently enrolled in a longitudinal study of neurodevelopmental delay were analysed to determine which facets of development are most delayed. The Mental and Psychomotor Developmental Indices (MDI and PDI) of the BSID II were used to determine the extent of mental and motor delays in this sample. Mean cognitive development was 7.63 months delayed, which was statistically significant (p<0.01) and 97.5% of the sample were functioning below the expected cognitive age. Mean motor development was 9.65 months delayed (p<0.01), and 97.5% of the sample were functioning below expected motor age. Gross motor skills were more affected than fine motor skills, and 85% of the sample demonstrated gross motor delays on descriptive analysis. Language was descriptively analysed, revealing language delays in 82.5% of the sample. The infants in this study demonstrated significant mental and motor delays, as well as delays in language. It is postulated that motor delays may be attributed to decreased strength, as the most adversely affected skill in this sample was gross motor development. The cognitive delays noted may be due to disease progression and structural damage to the brain, as well as socio-economic factors. The language delays noted could be due to neurological impairment, cognitive delay or environmental deprivation. Children with HIV have significant delays in mental and motor development, and language is delayed in most children with HIV. The results of this study are similar to findings in other parts of the world, which indicates a global trend in HIV and neurodevelopmental delay. The results of this study are important, particularly for those involved in motor and language rehabilitation, as an awareness of potential problems in these infants is needed in order to provide them with the best management and care possible.