A stunting profile of children under the age of five visiting Bhisho hospital clinic, part of the umbrella project: a profile of stunting in children under the age of five in food insecure villages in Mqanduli, Ngqushwa and Bhisho hospital, Eastern Cape, South Africa
- Authors: Beyleveld, Janine
- Date: 2020
- Subjects: Children -- growth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/50201 , vital:42066
- Description: Introduction and Background: Stunting is the most prevalent form of childhood malnutrition where about 149 million children under the age of five can be classified as stunted globally. South Africa has one of the highest stunting rates in the world at 27%, causing devastating effects on economic productivity as well as on an individual’s nutritional status. The presence of stunted growth in children is a strong indicator of chronic undernutrition and highlights injustices experienced within communities. Aims and Objectives: The aim of this study is to develop a stunning profile of children under the age of five, visiting BhishoHospital’s gateway clinic in the Eastern Cape, South Africa. The objectives were to determine the prevalence of stunting of the children visiting Bhisho Hospital’s clinic and to identify the drivers of stunting in the area. Methodology: A quantitative study with a descriptive, cross-sectional design was used. The study population included all children under the age of five visiting Bhisho Hospital’s clinic. Data was collected by means of an interview-administered questionnaire. Results: The prevalence of stunting in the area was 47.5%. A significant association was found between the participants' main form of sanitation and stunting category in the group of infants younger than six months (p = 0.007) and the group older than six months(p = 0.040). Discussion: The prevalence of stunting in the area was far higher than the national average of 27%, although the majority of the sample had a normal weight. The use of non-flush toilets was found to be a risk factor for childhood stunting. Recommendation: Financial and political investment in child health needs to be placed as a top priority in South Africa to reduce stunting rates.
- Full Text:
- Date Issued: 2020
- Authors: Beyleveld, Janine
- Date: 2020
- Subjects: Children -- growth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/50201 , vital:42066
- Description: Introduction and Background: Stunting is the most prevalent form of childhood malnutrition where about 149 million children under the age of five can be classified as stunted globally. South Africa has one of the highest stunting rates in the world at 27%, causing devastating effects on economic productivity as well as on an individual’s nutritional status. The presence of stunted growth in children is a strong indicator of chronic undernutrition and highlights injustices experienced within communities. Aims and Objectives: The aim of this study is to develop a stunning profile of children under the age of five, visiting BhishoHospital’s gateway clinic in the Eastern Cape, South Africa. The objectives were to determine the prevalence of stunting of the children visiting Bhisho Hospital’s clinic and to identify the drivers of stunting in the area. Methodology: A quantitative study with a descriptive, cross-sectional design was used. The study population included all children under the age of five visiting Bhisho Hospital’s clinic. Data was collected by means of an interview-administered questionnaire. Results: The prevalence of stunting in the area was 47.5%. A significant association was found between the participants' main form of sanitation and stunting category in the group of infants younger than six months (p = 0.007) and the group older than six months(p = 0.040). Discussion: The prevalence of stunting in the area was far higher than the national average of 27%, although the majority of the sample had a normal weight. The use of non-flush toilets was found to be a risk factor for childhood stunting. Recommendation: Financial and political investment in child health needs to be placed as a top priority in South Africa to reduce stunting rates.
- Full Text:
- Date Issued: 2020
Associations between family history of diseases of lifestyle, lifestyle behaviour and anthropometric nutritional status of pre-school children in ECD centres in the Nelson Mandela Bay Municipality
- Authors: Wilson, Teresa Margaret
- Date: 2020
- Subjects: Nutrition--Evaluation
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46344 , vital:39602
- Description: Introduction: Childhood overweight and obesity is an escalating global health issue. In Africa, overweight and obesity prevalence in children has nearly doubled since 2000(World Health Organisation, 2018).TheSANHANES-1 study (2013) identified that overweight and obesity in were most prevalent in urban informal areas of South Africa, with approximately a quarter of the children classified as overweight or obese (Shisana et al., 2013).In the Nelson Mandela Bay Municipality(NMBM), a double burden of disease was identified in the lower socio-economic population (Phekana et al., 2016). This study and others recommended further study into the contributing factors and behaviours which play a role in the development of overweight and obesity in children. These include household dietary intake, family history of lifestyle diseases, as well as the children’s and parental physical activity and sedentary time (Zhang et al.,2016).Aim: The aim of the study was to determine the associations between family history of diseases of lifestyle, lifestyle behaviour and anthropometric nutritional status of pre-school children in NMBM to describe underlying causes of childhood overweight and obesity.Methods: A cross-sectional design, using a quantitative approach, was used for this study(Ethics approval: H18-HEA-DIET-004). The study population included adult parents and/or caregivers of children from urban areas of Nelson Mandela Bay Municipality attending crèches and schools in these areas, in the age group from birth to 96 months (8 years). Randomised cluster sampling of crèches and schools from an existing database of anthropometrical data of children attending these crèches and schools in the area was done and a final sample of n=155obtained. With the assistance of a trained fieldworker, respondents completed a questionnaire detailing the family history of lifestyle diseases, physical activity levels and sedentary screen time behaviours, and a graphical adjusted version of a household dietary diversity questionnaire. Data about children’s activity levels in the preschool/creche environment was collected by the fieldworker by assessing the ECD centres’daily activity schedules. The anthropometric data of the children of the respondents was accessed from an existing database of these measurements. The data was described using means and standard deviations. Inferential statistics determined any existing associations between these underlying influences of childhood obesity.Results: Only 2% (n=3) of the children were underweight and 12% (n=9) were at risk of becoming underweight as classified by WAZ. HAZ scores identified26% (n=40) of the children at risk of becoming stunted, and 6% (n=9) of the children were already stunted. WHZ classified5% (n=8)of the children as overweight and 5% (n=8)as obese. A further 22% (n=34) of the children were at risk of becoming overweight.BMI/age classificationidentified25% (n=38) of the children as overweight and a further 12% (n=19) as obese. Out of the sample, 12%(n=17) of mothers and 8% (n=7) of fathers were categorised as overweight-to-obese according to the SA specific waist circumference(WC)cut-offs. Out of the children, 15% (n=22) have at least one parent who was overweight-to-obese. Traditional WC categories were classified48% (n=67) of the mothers as overweight-to-obese and at high risk for metabolic syndrome. Of all the lifestyle diseases, hypertension was the most prevalent with 29% (n=41) of households having at least one parent with hypertension. Parental physical activity was grossly overestimated, and the results found to be invalid. The Diet Variety and Frequency score resulted in a mean of 65.00 (n=154, SD=27.37) out of a possible 100 for the households in this sample, and junk food was consumed on three to four occasions per day in 32% (n=49) of households. There were no significant associations found between the parents’ variables and underweight children. Statistically small to medium effect associations were found between parental weight (both SA specific and traditional categories) and overweight children (classified by WHZ and BMI/age). Conclusions and recommendations: The prevalence of overweight and obesity among children in the NMBM was high. The only possible underlying cause of childhood overweight and obesity in pre-school children in the NMBM that could be determined by this study was parents’ weight classified by WC. However, it must be reiterated that due to the cross-sectional nature of the study, an association does not immediately mean causation, and the results are not adequate to rule out other underlying factors influencing childhood obesity. It is recommended that the results of the study are used to incentivise the final implementation of all the intervention targets laid out in the Strategic Plan for the Prevention and Control of Obesity in South Africa 2015-2020 in NMB, and for the development of the future obesity strategy after 2020. The results have shown the necessity for future health interventions to be targeted at the family as a unit.
- Full Text:
- Date Issued: 2020
- Authors: Wilson, Teresa Margaret
- Date: 2020
- Subjects: Nutrition--Evaluation
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46344 , vital:39602
- Description: Introduction: Childhood overweight and obesity is an escalating global health issue. In Africa, overweight and obesity prevalence in children has nearly doubled since 2000(World Health Organisation, 2018).TheSANHANES-1 study (2013) identified that overweight and obesity in were most prevalent in urban informal areas of South Africa, with approximately a quarter of the children classified as overweight or obese (Shisana et al., 2013).In the Nelson Mandela Bay Municipality(NMBM), a double burden of disease was identified in the lower socio-economic population (Phekana et al., 2016). This study and others recommended further study into the contributing factors and behaviours which play a role in the development of overweight and obesity in children. These include household dietary intake, family history of lifestyle diseases, as well as the children’s and parental physical activity and sedentary time (Zhang et al.,2016).Aim: The aim of the study was to determine the associations between family history of diseases of lifestyle, lifestyle behaviour and anthropometric nutritional status of pre-school children in NMBM to describe underlying causes of childhood overweight and obesity.Methods: A cross-sectional design, using a quantitative approach, was used for this study(Ethics approval: H18-HEA-DIET-004). The study population included adult parents and/or caregivers of children from urban areas of Nelson Mandela Bay Municipality attending crèches and schools in these areas, in the age group from birth to 96 months (8 years). Randomised cluster sampling of crèches and schools from an existing database of anthropometrical data of children attending these crèches and schools in the area was done and a final sample of n=155obtained. With the assistance of a trained fieldworker, respondents completed a questionnaire detailing the family history of lifestyle diseases, physical activity levels and sedentary screen time behaviours, and a graphical adjusted version of a household dietary diversity questionnaire. Data about children’s activity levels in the preschool/creche environment was collected by the fieldworker by assessing the ECD centres’daily activity schedules. The anthropometric data of the children of the respondents was accessed from an existing database of these measurements. The data was described using means and standard deviations. Inferential statistics determined any existing associations between these underlying influences of childhood obesity.Results: Only 2% (n=3) of the children were underweight and 12% (n=9) were at risk of becoming underweight as classified by WAZ. HAZ scores identified26% (n=40) of the children at risk of becoming stunted, and 6% (n=9) of the children were already stunted. WHZ classified5% (n=8)of the children as overweight and 5% (n=8)as obese. A further 22% (n=34) of the children were at risk of becoming overweight.BMI/age classificationidentified25% (n=38) of the children as overweight and a further 12% (n=19) as obese. Out of the sample, 12%(n=17) of mothers and 8% (n=7) of fathers were categorised as overweight-to-obese according to the SA specific waist circumference(WC)cut-offs. Out of the children, 15% (n=22) have at least one parent who was overweight-to-obese. Traditional WC categories were classified48% (n=67) of the mothers as overweight-to-obese and at high risk for metabolic syndrome. Of all the lifestyle diseases, hypertension was the most prevalent with 29% (n=41) of households having at least one parent with hypertension. Parental physical activity was grossly overestimated, and the results found to be invalid. The Diet Variety and Frequency score resulted in a mean of 65.00 (n=154, SD=27.37) out of a possible 100 for the households in this sample, and junk food was consumed on three to four occasions per day in 32% (n=49) of households. There were no significant associations found between the parents’ variables and underweight children. Statistically small to medium effect associations were found between parental weight (both SA specific and traditional categories) and overweight children (classified by WHZ and BMI/age). Conclusions and recommendations: The prevalence of overweight and obesity among children in the NMBM was high. The only possible underlying cause of childhood overweight and obesity in pre-school children in the NMBM that could be determined by this study was parents’ weight classified by WC. However, it must be reiterated that due to the cross-sectional nature of the study, an association does not immediately mean causation, and the results are not adequate to rule out other underlying factors influencing childhood obesity. It is recommended that the results of the study are used to incentivise the final implementation of all the intervention targets laid out in the Strategic Plan for the Prevention and Control of Obesity in South Africa 2015-2020 in NMB, and for the development of the future obesity strategy after 2020. The results have shown the necessity for future health interventions to be targeted at the family as a unit.
- Full Text:
- Date Issued: 2020
Change of perspectives and behaviour regarding lifestyle, with emphasis on dietary habits, in a rural community
- Authors: Barnard, Mariska
- Date: 2020
- Subjects: Food habits
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46384 , vital:39565
- Description: Background: The steady increase in deaths due to non-communicable diseases (NCDs) in South Africa is raising concern, as 63% of all deaths worldwide are attributed to NCDs and these diseases cause 36 million deaths each year, with 80 % of incidences occurring in low-and middle-income countries. In rural communities where income is increasing, the prevalence of NCDs are increasing as well. Due to the lack of NCD prevention and treatment in rural communities, it is expected that, if health promotion strategies are not implemented and socio-economic development in South Africa continues, there will soon be an uncontrollable NCD epidemic. It has been found that dietary risks affected people’s healthirrespective of their age, gender or residential sociodemographic development and that dietary improvement might prevent one in every five deaths worldwide.Aim:The aim of this study was to determine the factors that influence the perceptions and behaviour in a rural community with a low socio-economic status regarding dietary habits and to use the knowledge to formulate an effective dietary modification strategy.Designand methodology:For this study,action research with a quantitative and qualitative component was followed.The quantitative component focuses on measureable aspects, and the qualitative component focuses on meaning. Data was collected following the standard operating procedure for anthropometry, blood pressure and blood glucose. Further methods used were questionnaires, 24-hour dietary recalls and focus group discussions. Data were analysed using Microsoft Excel, FoodFinder3 and other calculations.Sample and setting:A convenience sample (n = 16) wasused and this study was undertaken on request of the non-governmental organization, Karoo Angels and included all participants who earn an income and who do not work for themselves, that were willing to participate and living in Rietbron and Vondeling, in the Sarah BaartmanDistrict in the Eastern Cape. Results:Weight changes took place, both the crafters in the mild thinness category gained weight, one gained 3.9 kg and the other 0.5 kg. The three crafters in the normal category did not have to gain or lose weight, but all three ofthem gained an average of 3.6 kg. For the group who had to lose weight, no statistically significant weight change took place from before the intervention (76.08 ±17.67 kg) to after the intervention (75.81 ± 17.81 kg, t(10) = 0.692, p = 0.505). The maximum weight lost ivwas 3.1 kg and the maximum weight gained was 3.2 kg. Changes took place regarding BMI, waist circumference, waist-to-hip ratio and neck circumference. Some positively changed their BMI status.After the implementation of the intervention, there was a slight decrease in frequency of alcohol consumption, but smoking and physical activity remained mostly the same. Hypertension was the most prevalent NCD and is linked to smoking and alcohol consumption which is prevalent in this study. Fruit and vegetable consumption is low, and a slight increase in consumption was evident. A maximum dietary diversityscore of seven and minimum of two, where the mean was 3.81was found. The crafters’ diet did not meet the DASH diet recommendation,the mean energy distribution is of all macronutrients differ with ±4% and none of the participants’ mean micronutrients intake met the recommendations of the DASH diet or RDA. Factors that prevent them from reaching their goals included low income, low availability of fruit, vegetables and transport and no storage for food.Conclusion:It is important to consider the individuals’ living conditions, resources, knowledge, motivation and social group. The environment and resources available have a significant impact on the lifestyle of the individuals. Directing efforts of behaviour change to increase dietary diversity as the main objective, might be a more efficient way to change behaviour.Recommendations:Future studies should consider doing this study over a longer time period. The involvement of a psychologist would also be beneficial to assist the process of behaviour change.
- Full Text:
- Date Issued: 2020
- Authors: Barnard, Mariska
- Date: 2020
- Subjects: Food habits
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46384 , vital:39565
- Description: Background: The steady increase in deaths due to non-communicable diseases (NCDs) in South Africa is raising concern, as 63% of all deaths worldwide are attributed to NCDs and these diseases cause 36 million deaths each year, with 80 % of incidences occurring in low-and middle-income countries. In rural communities where income is increasing, the prevalence of NCDs are increasing as well. Due to the lack of NCD prevention and treatment in rural communities, it is expected that, if health promotion strategies are not implemented and socio-economic development in South Africa continues, there will soon be an uncontrollable NCD epidemic. It has been found that dietary risks affected people’s healthirrespective of their age, gender or residential sociodemographic development and that dietary improvement might prevent one in every five deaths worldwide.Aim:The aim of this study was to determine the factors that influence the perceptions and behaviour in a rural community with a low socio-economic status regarding dietary habits and to use the knowledge to formulate an effective dietary modification strategy.Designand methodology:For this study,action research with a quantitative and qualitative component was followed.The quantitative component focuses on measureable aspects, and the qualitative component focuses on meaning. Data was collected following the standard operating procedure for anthropometry, blood pressure and blood glucose. Further methods used were questionnaires, 24-hour dietary recalls and focus group discussions. Data were analysed using Microsoft Excel, FoodFinder3 and other calculations.Sample and setting:A convenience sample (n = 16) wasused and this study was undertaken on request of the non-governmental organization, Karoo Angels and included all participants who earn an income and who do not work for themselves, that were willing to participate and living in Rietbron and Vondeling, in the Sarah BaartmanDistrict in the Eastern Cape. Results:Weight changes took place, both the crafters in the mild thinness category gained weight, one gained 3.9 kg and the other 0.5 kg. The three crafters in the normal category did not have to gain or lose weight, but all three ofthem gained an average of 3.6 kg. For the group who had to lose weight, no statistically significant weight change took place from before the intervention (76.08 ±17.67 kg) to after the intervention (75.81 ± 17.81 kg, t(10) = 0.692, p = 0.505). The maximum weight lost ivwas 3.1 kg and the maximum weight gained was 3.2 kg. Changes took place regarding BMI, waist circumference, waist-to-hip ratio and neck circumference. Some positively changed their BMI status.After the implementation of the intervention, there was a slight decrease in frequency of alcohol consumption, but smoking and physical activity remained mostly the same. Hypertension was the most prevalent NCD and is linked to smoking and alcohol consumption which is prevalent in this study. Fruit and vegetable consumption is low, and a slight increase in consumption was evident. A maximum dietary diversityscore of seven and minimum of two, where the mean was 3.81was found. The crafters’ diet did not meet the DASH diet recommendation,the mean energy distribution is of all macronutrients differ with ±4% and none of the participants’ mean micronutrients intake met the recommendations of the DASH diet or RDA. Factors that prevent them from reaching their goals included low income, low availability of fruit, vegetables and transport and no storage for food.Conclusion:It is important to consider the individuals’ living conditions, resources, knowledge, motivation and social group. The environment and resources available have a significant impact on the lifestyle of the individuals. Directing efforts of behaviour change to increase dietary diversity as the main objective, might be a more efficient way to change behaviour.Recommendations:Future studies should consider doing this study over a longer time period. The involvement of a psychologist would also be beneficial to assist the process of behaviour change.
- Full Text:
- Date Issued: 2020
Grandmothers’ perceptions regarding breastfeeding following training for breastfeeding support in Nelson Mandela Bay Health District: a qualitative study
- Authors: Manyange, Rumbidzai Lynda
- Date: 2020
- Subjects: Breastfeeding promotion
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46441 , vital:39583
- Description: Rationale: Although there has been active promotion of breastfeeding for the past decades in South Africa, there has been inadequate support from multiple role players. Strategies that do not engage important family members, such as grandmothers in supporting breastfeeding are likely to fail. In many African countries, grandmothers often make critical decisions about early child feeding practices, particularly for first-time mothers. Despite the influence grandmothers have, limited studies have been done in South Africa to assess whether it is possible to change breastfeeding outcomes by empowering grandmothers as well as including them in intervention programmes. Nelson Mandela University, in collaboration with the United Nations Children Education Fund (UNICEF) and a local Non-Governmental Organisation (NGO), recently launched a breastfeeding support programme, Sakha Esethu. The aim was to capacitate both primary and secondary caregivers to enable them to provide optimal breastfeeding support for mothers in various communities. However, it was important to explore the perceptions of grandmothers regarding breastfeeding to assess whether improved breastfeeding knowledge will translate into changed perceptions and therefore improved support for exclusive breastfeeding in communities in Nelson Mandela Bay. Aim: The study aimed to describe and explore the perceptions of grandmothers regarding breastfeeding after participating in a breastfeeding support programme in Nelson Mandela Bay health district (NMBHD). Methodology: The study followed a descriptive-exploratory, contextual study design with a qualitative approach. The four ethical principles that guided the study were: autonomy, non-maleficence, beneficence and justice. The researcher conducted five focus group discussions (FGD) at ECD centres in NMBHD, where 34 grandmothers participated in the study. Participants were chosen using a purposively sampling technique and data was collected using FGD interviews. Verbatim transcription was done after every FGD and data was analysed using the eight steps of Tesch’s analysis technique. An independent coder with experience in qualitative data analysis assisted to verify the codes generated. vi Results: Four major themes and eleven subthemes emerged through data analysis. The identified themes were: (1)Participant knowledge regarding breastfeeding. Participants reflected on poor knowledge on the perceived maternal benefits of breastfeeding, variance on the optimal duration of breastfeeding and recognised myths and cultural taboos related to breastfeeding, such as the use of traditional mixes, “dirty” breastmilk and perceived milk insufficiency; (2) Views on complementary feeding. The subthemes that emerged included: Participants shared their views on the age of introduction for complementary foods and feeding practices for infants; (3) Challenges related to breastfeeding. The challenges identified included: challenges for working mothers and those attending school, lack of family support and societal support for EBF, lack of support from healthcare professionals relating to initiation and continuation of breastfeeding and difficulties coping with breast health. (4) Participants enthused about the impact of being supported to optimise breastfeeding.Participants were able to share on the camaraderie benefits experienced from the Sakha Esethu group as well as on the support grandmothers can provide. Conclusion and Recommendations: This study confirmed that participation of grandmothers in the Sakha Esethu programme had an impact on changes in grandmothers’ perceptions regarding breastfeeding. However, the programme can be further improved by placing more emphasis on aspects i.e. maternal benefits of breastfeeding, during mentor training. Furthermore, there is a need to strengthen healthcare worker support and training, especially with regards to adapting counselling strategies to include breastfeeding challenges and cultural beliefs.
- Full Text:
- Date Issued: 2020
- Authors: Manyange, Rumbidzai Lynda
- Date: 2020
- Subjects: Breastfeeding promotion
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46441 , vital:39583
- Description: Rationale: Although there has been active promotion of breastfeeding for the past decades in South Africa, there has been inadequate support from multiple role players. Strategies that do not engage important family members, such as grandmothers in supporting breastfeeding are likely to fail. In many African countries, grandmothers often make critical decisions about early child feeding practices, particularly for first-time mothers. Despite the influence grandmothers have, limited studies have been done in South Africa to assess whether it is possible to change breastfeeding outcomes by empowering grandmothers as well as including them in intervention programmes. Nelson Mandela University, in collaboration with the United Nations Children Education Fund (UNICEF) and a local Non-Governmental Organisation (NGO), recently launched a breastfeeding support programme, Sakha Esethu. The aim was to capacitate both primary and secondary caregivers to enable them to provide optimal breastfeeding support for mothers in various communities. However, it was important to explore the perceptions of grandmothers regarding breastfeeding to assess whether improved breastfeeding knowledge will translate into changed perceptions and therefore improved support for exclusive breastfeeding in communities in Nelson Mandela Bay. Aim: The study aimed to describe and explore the perceptions of grandmothers regarding breastfeeding after participating in a breastfeeding support programme in Nelson Mandela Bay health district (NMBHD). Methodology: The study followed a descriptive-exploratory, contextual study design with a qualitative approach. The four ethical principles that guided the study were: autonomy, non-maleficence, beneficence and justice. The researcher conducted five focus group discussions (FGD) at ECD centres in NMBHD, where 34 grandmothers participated in the study. Participants were chosen using a purposively sampling technique and data was collected using FGD interviews. Verbatim transcription was done after every FGD and data was analysed using the eight steps of Tesch’s analysis technique. An independent coder with experience in qualitative data analysis assisted to verify the codes generated. vi Results: Four major themes and eleven subthemes emerged through data analysis. The identified themes were: (1)Participant knowledge regarding breastfeeding. Participants reflected on poor knowledge on the perceived maternal benefits of breastfeeding, variance on the optimal duration of breastfeeding and recognised myths and cultural taboos related to breastfeeding, such as the use of traditional mixes, “dirty” breastmilk and perceived milk insufficiency; (2) Views on complementary feeding. The subthemes that emerged included: Participants shared their views on the age of introduction for complementary foods and feeding practices for infants; (3) Challenges related to breastfeeding. The challenges identified included: challenges for working mothers and those attending school, lack of family support and societal support for EBF, lack of support from healthcare professionals relating to initiation and continuation of breastfeeding and difficulties coping with breast health. (4) Participants enthused about the impact of being supported to optimise breastfeeding.Participants were able to share on the camaraderie benefits experienced from the Sakha Esethu group as well as on the support grandmothers can provide. Conclusion and Recommendations: This study confirmed that participation of grandmothers in the Sakha Esethu programme had an impact on changes in grandmothers’ perceptions regarding breastfeeding. However, the programme can be further improved by placing more emphasis on aspects i.e. maternal benefits of breastfeeding, during mentor training. Furthermore, there is a need to strengthen healthcare worker support and training, especially with regards to adapting counselling strategies to include breastfeeding challenges and cultural beliefs.
- Full Text:
- Date Issued: 2020
Older people’s perspectives on the effectiveness of eye movement integration (emi) therapy as treatment intervention for their trauma symptoms
- Authors: Visagie, Andrea
- Date: 2020
- Subjects: Post-traumatic stress disorder in old age
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46389 , vital:39601
- Description: Many research studies propose that we have an ageing population with an increased number of people living past the age of 85 years. Ageing is accompanied by a gradual decline in physical, mental and sensory abilities. Older people may have experienced trauma throughout their lives, and very often, their symptoms of trauma are regarded as part of the ageing process rather than actual symptoms of trauma. In addition, older people often do not seek help throughout their lives for various reasons. While there is research available about older people and trauma, little is known about Eye Movement Integration(EMI)therapy as a treatment intervention in treating symptoms of trauma in older persons. The purpose of this research was an explorative and descriptive study of older people’s responses to EMI therapy as a treatment intervention for their symptoms of trauma. More specifically, the study was designed to determine how older people process their symptoms through EMI therapy and whether they view it as valuable. This qualitative study used an exploratory-descriptive research design with a non-probability, purposive sampling method. The EMI therapy sessions were offered to older adults in the Knysna area who presented with symptoms of trauma. From this group, only those who were able and willing to engage in therapeutic interviews formed part of the research. As part of the study, they consented to the use of their inventories from the EMI sessions as a qualitative document analysis and taking part in qualitative interviews to explore their views on the usefulness of EMI therapy to deal with their trauma. The findings emphasise that older people are not familiar with EMI. However, they view their experience of it in a positive light and regard it as a useful treatment intervention for treating their symptoms. Moreover, EMI seems to be a brief and cost-effective trauma intervention with practical benefits for older adults. The results from this study can assist social work professionals, specifically those working with older people, to address and improve the overall health and emotional wellbeing of older people. Data verification methods ensured the validity of this study
- Full Text:
- Date Issued: 2020
- Authors: Visagie, Andrea
- Date: 2020
- Subjects: Post-traumatic stress disorder in old age
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46389 , vital:39601
- Description: Many research studies propose that we have an ageing population with an increased number of people living past the age of 85 years. Ageing is accompanied by a gradual decline in physical, mental and sensory abilities. Older people may have experienced trauma throughout their lives, and very often, their symptoms of trauma are regarded as part of the ageing process rather than actual symptoms of trauma. In addition, older people often do not seek help throughout their lives for various reasons. While there is research available about older people and trauma, little is known about Eye Movement Integration(EMI)therapy as a treatment intervention in treating symptoms of trauma in older persons. The purpose of this research was an explorative and descriptive study of older people’s responses to EMI therapy as a treatment intervention for their symptoms of trauma. More specifically, the study was designed to determine how older people process their symptoms through EMI therapy and whether they view it as valuable. This qualitative study used an exploratory-descriptive research design with a non-probability, purposive sampling method. The EMI therapy sessions were offered to older adults in the Knysna area who presented with symptoms of trauma. From this group, only those who were able and willing to engage in therapeutic interviews formed part of the research. As part of the study, they consented to the use of their inventories from the EMI sessions as a qualitative document analysis and taking part in qualitative interviews to explore their views on the usefulness of EMI therapy to deal with their trauma. The findings emphasise that older people are not familiar with EMI. However, they view their experience of it in a positive light and regard it as a useful treatment intervention for treating their symptoms. Moreover, EMI seems to be a brief and cost-effective trauma intervention with practical benefits for older adults. The results from this study can assist social work professionals, specifically those working with older people, to address and improve the overall health and emotional wellbeing of older people. Data verification methods ensured the validity of this study
- Full Text:
- Date Issued: 2020
Parents’ perceptions of the content of pre-school lunch boxes following a nutritional programme in Nelson Mandela Bay
- Authors: Midigo, Odwour Erich
- Date: 2020
- Subjects: Children -- Nutrition
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46429 , vital:39587
- Description: Rationale: Lunchboxes that parents prepare for preschool children have been noted to fall short of the recommended paediatrics dietary standards. No research has been done in Nelson Mandela Bay (NMB) to describe the perceptions of parents preparing the lunch boxes, particularly in underprivileged communities, and if nutrition education strategies can improve these practices. This study answered the following research question: How can nutrition education programmes play a role in parents’ perceptions about the content of the lunchboxes of children attending early childhood development centres (ECD) in underprivileged communities of NMB metropole? Aim: The research aimed at describing and exploring parents’ perceptions of the content of pre-school children’s lunch boxes following a nutrition programme.Methods: This descriptive, explorative study adopted a qualitative approach. Twenty-five participants were selected conveniently while five pre-schools were purposively sampled. Following the nutrition programme, data was collected through five Focus Group (FG) discussions and five interviews and was thematically analysed. The ethical principles that guided the study included justice, beneficence and autonomy. Results and Discussion: Five major themes and seventeen sub-themes emerged (1) Participants described the typical foodstuff in children’s lunch boxes which included both high quality and lower-quality foods and fluids; (2) Participants provided views (such as food preferences) on lunch box choices; (3) Principals appraised lunch box rules and the significance of revised rules to improve the lunch boxes;(4) Challenges such as poverty limited healthy food choices; (5) Participants commented on initiatives noted following the nutrition training; for instance, some schools commenced the cultivation of vegetable gardens. Conclusion and Recommendations: The study highlights that specific parent programmes helped to improve healthy lunch box choices in the study population. There is a need for parent programmes tailored to fathers. Dieticians and nutritionists in NMB can train practitioners as change agents in their respective schools.
- Full Text:
- Date Issued: 2020
- Authors: Midigo, Odwour Erich
- Date: 2020
- Subjects: Children -- Nutrition
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46429 , vital:39587
- Description: Rationale: Lunchboxes that parents prepare for preschool children have been noted to fall short of the recommended paediatrics dietary standards. No research has been done in Nelson Mandela Bay (NMB) to describe the perceptions of parents preparing the lunch boxes, particularly in underprivileged communities, and if nutrition education strategies can improve these practices. This study answered the following research question: How can nutrition education programmes play a role in parents’ perceptions about the content of the lunchboxes of children attending early childhood development centres (ECD) in underprivileged communities of NMB metropole? Aim: The research aimed at describing and exploring parents’ perceptions of the content of pre-school children’s lunch boxes following a nutrition programme.Methods: This descriptive, explorative study adopted a qualitative approach. Twenty-five participants were selected conveniently while five pre-schools were purposively sampled. Following the nutrition programme, data was collected through five Focus Group (FG) discussions and five interviews and was thematically analysed. The ethical principles that guided the study included justice, beneficence and autonomy. Results and Discussion: Five major themes and seventeen sub-themes emerged (1) Participants described the typical foodstuff in children’s lunch boxes which included both high quality and lower-quality foods and fluids; (2) Participants provided views (such as food preferences) on lunch box choices; (3) Principals appraised lunch box rules and the significance of revised rules to improve the lunch boxes;(4) Challenges such as poverty limited healthy food choices; (5) Participants commented on initiatives noted following the nutrition training; for instance, some schools commenced the cultivation of vegetable gardens. Conclusion and Recommendations: The study highlights that specific parent programmes helped to improve healthy lunch box choices in the study population. There is a need for parent programmes tailored to fathers. Dieticians and nutritionists in NMB can train practitioners as change agents in their respective schools.
- Full Text:
- Date Issued: 2020
Retrospective analysis of birth HIV PCR testing and follow-up of positive HIV PCR results in Nelson Mandela Bay Health District
- Authors: Makubalo, Nomlindo Princess
- Date: 2020
- Subjects: HIV infections -- South Africa -- Nelson Mandela Bay
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46351 , vital:39580
- Description: BACKGROUND HIV infection contributes significantly to infant morbidity and mortality, especially in high-prevalence, low-income countries. In view of this evidence-based knowledge, South Africa’s National Department of Health, in April 2015, released the National Consolidated Guidelines of Human Immunodeficiency Virus (HIV) stipulating that all HIV-exposed babies should have a HIV Polymer Chain Reaction (PCR) test performed at birth. Early infant diagnosis (EID) means early initiation of combined antiretroviral treatment (cART) and a reduction in the incidence of early infant HIV-related mortality. However, these guidelines can only be successful if implemented properly across all public sector healthcare institutions. Thus,the research question was,“How well has the Nelson Mandela Bay Health District implemented the EID?”AIM The aim of the study was to review the impact of the consolidated HIV guidelines on birth HIV-PCR testing and initiation of treatment in the Nelson Mandela Bay Health District. METHOD A retrospective quantitative longitudinal non-experimental design was used.The study consisted of two components,namely,analysis of NHLS databases, particularly HIV birth PCR results of infants over a three-year period (June 2015 to June 2018),and analysis of feedback received from the primary health care clinics. The feedback focused on infants with a positive-birth PCR test, using a purpose-designed data collection tool that was used by the clinics for the duration of the same three-year period. The paper-based tool documented antenatal care attendance, enrolment into the prevention of mother-to-child transmission (PMTCT) programme and initiation of ART. RESULTS Over the three-year period, there were approximately 13,096 live births to HIV-positive women in the study area, and a total of 11,066 HIV birth PCR tests were done over xiiithe three-year study period (84.5% of HIV-exposed infants). The birth HIV PCR was negative in 10,909 (98.6%) neonates, while 130 (1.2%) of neonates had positive-birth HIV PCR tests,and a further 27 (0.2%) had indeterminate results. The birth HIV PCR positivity rate reduced from 1.4%(2015)to 1%(2018)over the three-year study period. Of the 130 infants with positive-birth HIV PCR, the files of 42 children were excluded, and further analysis conducted on the files of 88 infants. cART was initiated within seven days in only nine of the 88 infants (10.2%). ARV initiation was delayed for 58 infants (65.9%) and 21 neonates (23.9%) were never initiated on cART. Among the 88 mothers of infants, more than one-third (38.6%) of pregnant women did not attend antenatal care, thus,compromising their opportunity to be enrolled on the PMTCT programme. Of those who attended antenatal care, only 39.1% were reported to attend antenatal care before 20 weeks CONCLUSION AND RECOMMENDATIONS The incidence of positive-birth HIV PCR has reduced from 1.4% in 2015 to 1% in 2018 whilst there has been an increase in birth HIV PCR testing. However, initiation of cART within seven days was achieved in only 10.2% of infants with positive-birth HIV PCR test results. Implementation of point-of-care birth HIV PCR testing would ensure that results are immediately available resulting in increasing the proportion of infants initiated on cART within seven days.
- Full Text:
- Date Issued: 2020
- Authors: Makubalo, Nomlindo Princess
- Date: 2020
- Subjects: HIV infections -- South Africa -- Nelson Mandela Bay
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/46351 , vital:39580
- Description: BACKGROUND HIV infection contributes significantly to infant morbidity and mortality, especially in high-prevalence, low-income countries. In view of this evidence-based knowledge, South Africa’s National Department of Health, in April 2015, released the National Consolidated Guidelines of Human Immunodeficiency Virus (HIV) stipulating that all HIV-exposed babies should have a HIV Polymer Chain Reaction (PCR) test performed at birth. Early infant diagnosis (EID) means early initiation of combined antiretroviral treatment (cART) and a reduction in the incidence of early infant HIV-related mortality. However, these guidelines can only be successful if implemented properly across all public sector healthcare institutions. Thus,the research question was,“How well has the Nelson Mandela Bay Health District implemented the EID?”AIM The aim of the study was to review the impact of the consolidated HIV guidelines on birth HIV-PCR testing and initiation of treatment in the Nelson Mandela Bay Health District. METHOD A retrospective quantitative longitudinal non-experimental design was used.The study consisted of two components,namely,analysis of NHLS databases, particularly HIV birth PCR results of infants over a three-year period (June 2015 to June 2018),and analysis of feedback received from the primary health care clinics. The feedback focused on infants with a positive-birth PCR test, using a purpose-designed data collection tool that was used by the clinics for the duration of the same three-year period. The paper-based tool documented antenatal care attendance, enrolment into the prevention of mother-to-child transmission (PMTCT) programme and initiation of ART. RESULTS Over the three-year period, there were approximately 13,096 live births to HIV-positive women in the study area, and a total of 11,066 HIV birth PCR tests were done over xiiithe three-year study period (84.5% of HIV-exposed infants). The birth HIV PCR was negative in 10,909 (98.6%) neonates, while 130 (1.2%) of neonates had positive-birth HIV PCR tests,and a further 27 (0.2%) had indeterminate results. The birth HIV PCR positivity rate reduced from 1.4%(2015)to 1%(2018)over the three-year study period. Of the 130 infants with positive-birth HIV PCR, the files of 42 children were excluded, and further analysis conducted on the files of 88 infants. cART was initiated within seven days in only nine of the 88 infants (10.2%). ARV initiation was delayed for 58 infants (65.9%) and 21 neonates (23.9%) were never initiated on cART. Among the 88 mothers of infants, more than one-third (38.6%) of pregnant women did not attend antenatal care, thus,compromising their opportunity to be enrolled on the PMTCT programme. Of those who attended antenatal care, only 39.1% were reported to attend antenatal care before 20 weeks CONCLUSION AND RECOMMENDATIONS The incidence of positive-birth HIV PCR has reduced from 1.4% in 2015 to 1% in 2018 whilst there has been an increase in birth HIV PCR testing. However, initiation of cART within seven days was achieved in only 10.2% of infants with positive-birth HIV PCR test results. Implementation of point-of-care birth HIV PCR testing would ensure that results are immediately available resulting in increasing the proportion of infants initiated on cART within seven days.
- Full Text:
- Date Issued: 2020
A nutrition education tool for practical application of the food based dietary guidelines for primary school teachers in Nelson Mandela Bay
- Authors: Joubert, Tayla Kate
- Date: 2019
- Subjects: Nutrition -- Education
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/44616 , vital:38152
- Description: Background: The South Africa Food-Based Dietary Guidelines (SAFBDG) was developed to promote better food choices for a healthy lifestyle and are included in the school syllabus. Schools remain viable platforms for nutrition education with teachers playing significant roles, but research has shown that teachers do not necessarily know about the SAFBDG and how to incorporate these into the teaching programme. Aim: The aim of this study was to develop a tool in the form of a nutrition education guide for primary school teachers, aimed at the practical application of the SAFBDG, in order to enhance the nutrition knowledge, attitudes and dietary practices of the teachers. Research design and methodology: A quasi-experimental, one group, quantitative design was employed. Forty-six teachers were conveniently chosen from schools in previously disadvantaged areas of Nelson Mandela Bay. The study design consisted of four phases. Phase one consisted of a pre-test where the teachers’ nutrition knowledge, nutrition attitudes, dietary practices, staff wellness and physical activity were determined by means of a standardised questionnaire. A nutritional assessment was also conducted in phase one. In phase two, the nutrition guide, which was Curriculum Assessment Policy Statement compliant for grades four to seven, was developed. In phase three, the guide was used in a workshop to train the teachers that attended phase one of the study, on how to use the nutrition education guide. In phase four, a post-test was conducted after the training to evaluate the effectiveness of the training and to determine whether there has been an increase in the teachers’ nutrition knowledge. Data from the questionnaires were analysed on Microsoft Excel 2016 MSO (16.0.4639.1000). Ethical approval for this study was obtained from the Faculty Postgraduate Studies Committee (FPGSC) of the Faculty of Health Sciences, Nelson Mandela University (Ethics clearance reference number: H18-HEA-DIET-005) and all ethical principles were upheld according to the Belmont report and the Declaration of Helsinki. Results: Of the 46 teachers who participated 36 (78 %) were obese. The mean waist circumference and waist-to-hip ratio was 109.99 and 0.887 respectively (± 17.32 and ± 0.089). The teachers obtained a relatively high mean overall score in the pre-test of 69 % (± 10.78). Only 42 % of the teachers had heard of the SAFBDG before the study. There was an overall statistical significant increase in knowledge of 6 % (p = 0.03) from the pre-test to the post-test. The dietary practice was obtained through a food frequency questionnaire (FFQ), which showed under-reporting. The most neglected food groups were legumes, dairy and vegetables/ fruit. Hypertension was the highest self-reported condition, with just under a quarter of the teachers having hypertension (high blood pressure). There was no statistical significance between the teachers’ BMI and their nutrition knowledge as well as no statistical significance between their BMI and their physical activity level. Conclusion and recommendations: Even though the teachers obtained a relatively high mean overall score in their pre-test, there were still gaps in their nutrition knowledge. These gaps in the teachers’ knowledge results in insufficient nutrition knowledge being provided to the learners, leading to poor dietary practices and misconceptions regarding different foods among the learners as well as the teachers. By providing training for the teachers, it will not only improve their nutrition knowledge but potentially also help to improve their lifestyle. With enhanced nutrition knowledge, the teachers can communicate sufficient information to their learners. The DoBE need to advocate for a healthier school environment in which the SAFBDG are implemented more extensively in the curriculum as well as part of school food policies.
- Full Text:
- Date Issued: 2019
- Authors: Joubert, Tayla Kate
- Date: 2019
- Subjects: Nutrition -- Education
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/44616 , vital:38152
- Description: Background: The South Africa Food-Based Dietary Guidelines (SAFBDG) was developed to promote better food choices for a healthy lifestyle and are included in the school syllabus. Schools remain viable platforms for nutrition education with teachers playing significant roles, but research has shown that teachers do not necessarily know about the SAFBDG and how to incorporate these into the teaching programme. Aim: The aim of this study was to develop a tool in the form of a nutrition education guide for primary school teachers, aimed at the practical application of the SAFBDG, in order to enhance the nutrition knowledge, attitudes and dietary practices of the teachers. Research design and methodology: A quasi-experimental, one group, quantitative design was employed. Forty-six teachers were conveniently chosen from schools in previously disadvantaged areas of Nelson Mandela Bay. The study design consisted of four phases. Phase one consisted of a pre-test where the teachers’ nutrition knowledge, nutrition attitudes, dietary practices, staff wellness and physical activity were determined by means of a standardised questionnaire. A nutritional assessment was also conducted in phase one. In phase two, the nutrition guide, which was Curriculum Assessment Policy Statement compliant for grades four to seven, was developed. In phase three, the guide was used in a workshop to train the teachers that attended phase one of the study, on how to use the nutrition education guide. In phase four, a post-test was conducted after the training to evaluate the effectiveness of the training and to determine whether there has been an increase in the teachers’ nutrition knowledge. Data from the questionnaires were analysed on Microsoft Excel 2016 MSO (16.0.4639.1000). Ethical approval for this study was obtained from the Faculty Postgraduate Studies Committee (FPGSC) of the Faculty of Health Sciences, Nelson Mandela University (Ethics clearance reference number: H18-HEA-DIET-005) and all ethical principles were upheld according to the Belmont report and the Declaration of Helsinki. Results: Of the 46 teachers who participated 36 (78 %) were obese. The mean waist circumference and waist-to-hip ratio was 109.99 and 0.887 respectively (± 17.32 and ± 0.089). The teachers obtained a relatively high mean overall score in the pre-test of 69 % (± 10.78). Only 42 % of the teachers had heard of the SAFBDG before the study. There was an overall statistical significant increase in knowledge of 6 % (p = 0.03) from the pre-test to the post-test. The dietary practice was obtained through a food frequency questionnaire (FFQ), which showed under-reporting. The most neglected food groups were legumes, dairy and vegetables/ fruit. Hypertension was the highest self-reported condition, with just under a quarter of the teachers having hypertension (high blood pressure). There was no statistical significance between the teachers’ BMI and their nutrition knowledge as well as no statistical significance between their BMI and their physical activity level. Conclusion and recommendations: Even though the teachers obtained a relatively high mean overall score in their pre-test, there were still gaps in their nutrition knowledge. These gaps in the teachers’ knowledge results in insufficient nutrition knowledge being provided to the learners, leading to poor dietary practices and misconceptions regarding different foods among the learners as well as the teachers. By providing training for the teachers, it will not only improve their nutrition knowledge but potentially also help to improve their lifestyle. With enhanced nutrition knowledge, the teachers can communicate sufficient information to their learners. The DoBE need to advocate for a healthier school environment in which the SAFBDG are implemented more extensively in the curriculum as well as part of school food policies.
- Full Text:
- Date Issued: 2019
A nutrition education tool for practical application of the food based dietary guidelines for primary school teachers in Nelson Mandela Bay
- Authors: Joubert, Tayla Kate
- Date: 2019
- Subjects: Malnutrition -- South Africa -- Port Elizabeth , Nutrition—Evaluation Nutrition -- Evaluation Nutrition -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/45019 , vital:38226
- Description: The South Africa Food-Based Dietary Guidelines (SAFBDG) was developed to promote better food choices for a healthy lifestyle and are included in the school syllabus. Schools remain viable platforms for nutrition education with teachers playing significant roles, but research has shown that teachers do not necessarily know about the SAFBDG and how to incorporate these into the teaching programme. The aim of this study was to develop a tool in the form of a nutrition education guide for primary school teachers, aimed at the practical application of the SAFBDG, in order to enhance the nutrition knowledge, attitudes and dietary practices of the teachers. A quasi-experimental, one group, quantitative design was employed. Forty-six teachers were conveniently chosen from schools in previously disadvantaged areas of Nelson Mandela Bay. The study design consisted of four phases. Phase one consisted of a pre-test where the teachers’ nutrition knowledge, nutrition attitudes, dietary practices, staff wellness and physical activity were determined by means of a standardised questionnaire. A nutritional assessment was also conducted in phase one. In phase two, the nutrition guide, which was Curriculum Assessment Policy Statement compliant for grades four to seven, was developed. In phase three, the guide was used in a workshop to train the teachers that attended phase one of the study, on how to use the nutrition education guide. In phase four, a post-test was conducted after the training to evaluate the effectiveness of the training and to determine whether there has been an increase in the teachers’ nutrition knowledge. Data from the questionnaires were analysed on Microsoft Excel 2016 MSO (16.0.4639.1000). Ethical approval for this study was obtained from the Faculty Postgraduate Studies Committee (FPGSC) of the Faculty of Health Sciences, Nelson Mandela University (Ethics clearance reference number: H18-HEA-DIET-005) and all ethical principles were upheld according to the Belmont report and the Declaration of Helsinki. Results of the research 46 teachers who participated 36 (78 %) were obese. The mean waist circumference and waist-to-hip ratio was 109.99 and 0.887 respectively (± 17.32 and ± 0.089). The teachers obtained a relatively high mean overall score in the pre-test of 69 % (± 10.78). Only 42 % of the teachers had heard of the SAFBDG before the study. There was an overall statistical significant increase in knowledge of 6 % (p = 0.03) from the pre-test to the post-test. The dietary practice was obtained through a food frequency questionnaire (FFQ), which showed under-reporting. The most neglected food groups were legumes, dairy and vegetables/ fruit. Hypertension was the highest self-reported condition, with just under a quarter of the teachers having hypertension (high blood pressure). There was no statistical significance between the teachers’ BMI and their nutrition knowledge as well as no statistical significance between their BMI and their physical activity level. Even though the teachers obtained a relatively high mean overall score in their pre-test, there were still gaps in their nutrition knowledge. These gaps in the teachers’ knowledge results in insufficient nutrition knowledge being provided to the learners, leading to poor dietary practices and misconceptions regarding different foods among the learners as well as the teachers. By providing training for the teachers, it will not only improve their nutrition knowledge but potentially also help to improve their lifestyle. With enhanced nutrition knowledge, the teachers can communicate sufficient information to their learners. The DoBE need to advocate for a healthier school environment in which the SAFBDG are implemented more extensively in the curriculum as well as part of school food policies.
- Full Text:
- Date Issued: 2019
- Authors: Joubert, Tayla Kate
- Date: 2019
- Subjects: Malnutrition -- South Africa -- Port Elizabeth , Nutrition—Evaluation Nutrition -- Evaluation Nutrition -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/45019 , vital:38226
- Description: The South Africa Food-Based Dietary Guidelines (SAFBDG) was developed to promote better food choices for a healthy lifestyle and are included in the school syllabus. Schools remain viable platforms for nutrition education with teachers playing significant roles, but research has shown that teachers do not necessarily know about the SAFBDG and how to incorporate these into the teaching programme. The aim of this study was to develop a tool in the form of a nutrition education guide for primary school teachers, aimed at the practical application of the SAFBDG, in order to enhance the nutrition knowledge, attitudes and dietary practices of the teachers. A quasi-experimental, one group, quantitative design was employed. Forty-six teachers were conveniently chosen from schools in previously disadvantaged areas of Nelson Mandela Bay. The study design consisted of four phases. Phase one consisted of a pre-test where the teachers’ nutrition knowledge, nutrition attitudes, dietary practices, staff wellness and physical activity were determined by means of a standardised questionnaire. A nutritional assessment was also conducted in phase one. In phase two, the nutrition guide, which was Curriculum Assessment Policy Statement compliant for grades four to seven, was developed. In phase three, the guide was used in a workshop to train the teachers that attended phase one of the study, on how to use the nutrition education guide. In phase four, a post-test was conducted after the training to evaluate the effectiveness of the training and to determine whether there has been an increase in the teachers’ nutrition knowledge. Data from the questionnaires were analysed on Microsoft Excel 2016 MSO (16.0.4639.1000). Ethical approval for this study was obtained from the Faculty Postgraduate Studies Committee (FPGSC) of the Faculty of Health Sciences, Nelson Mandela University (Ethics clearance reference number: H18-HEA-DIET-005) and all ethical principles were upheld according to the Belmont report and the Declaration of Helsinki. Results of the research 46 teachers who participated 36 (78 %) were obese. The mean waist circumference and waist-to-hip ratio was 109.99 and 0.887 respectively (± 17.32 and ± 0.089). The teachers obtained a relatively high mean overall score in the pre-test of 69 % (± 10.78). Only 42 % of the teachers had heard of the SAFBDG before the study. There was an overall statistical significant increase in knowledge of 6 % (p = 0.03) from the pre-test to the post-test. The dietary practice was obtained through a food frequency questionnaire (FFQ), which showed under-reporting. The most neglected food groups were legumes, dairy and vegetables/ fruit. Hypertension was the highest self-reported condition, with just under a quarter of the teachers having hypertension (high blood pressure). There was no statistical significance between the teachers’ BMI and their nutrition knowledge as well as no statistical significance between their BMI and their physical activity level. Even though the teachers obtained a relatively high mean overall score in their pre-test, there were still gaps in their nutrition knowledge. These gaps in the teachers’ knowledge results in insufficient nutrition knowledge being provided to the learners, leading to poor dietary practices and misconceptions regarding different foods among the learners as well as the teachers. By providing training for the teachers, it will not only improve their nutrition knowledge but potentially also help to improve their lifestyle. With enhanced nutrition knowledge, the teachers can communicate sufficient information to their learners. The DoBE need to advocate for a healthier school environment in which the SAFBDG are implemented more extensively in the curriculum as well as part of school food policies.
- Full Text:
- Date Issued: 2019
Development and characterisation of miconazole nitrate loaded solid lipid nanoparticles for incorporation into a vaginal mucoadhesive system
- Authors: Gwimo, Wimana Alexis
- Date: 2019
- Subjects: Vaginitis , Vagina -- Diseases Sexually transmitted diseases -- Diagnosis Sexually transmitted diseases -- Treatment
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/39632 , vital:35335
- Description: Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis, affecting 75% of women of sexual maturity. The prescribed first line treatment involves the use of locally-acting imidazole creams. These conventional dosage forms possess limitations, such as leakage, messiness and low residence time at the site of application; all which promote poor patient adherence to pharmacotherapy. Poor adherence is then attributed to increased incidence of VVC reoccurrence and the emergence of Candida strains. It was, therefore, speculated that through the use of novel drug delivery systems (NDDS), the pharmacokinetic and antimicrobial characteristics of a model antifungal drug (miconazole nitrate [MNZ]) could be improved. Primary aim: To develop, optimise and characterise a mucoadhesive hydrogel incorporated with MNZ loaded solid lipid nanoparticles (MNZ-SLNs) for the intended treatment of VVC. This study was conducted in three phases, viz. pre-formulation studies, development, optimisation and characterisation of MNZ-SLNs, and the development and characterisation of MNZ-SLN-loaded thermoresponsive hydrogel. An alternative method for the quantification of MNZ was developed through the use of an octyl stationary phase. The method was deemed suitable for its intended use with a linear equation of y = 811214x + 67958 and a respective limit of quantitation (LoQ) and detection of 0.015 mg/ml and 0.052 mg/ml. Differential scanning calorimetry (DSC) studies suggested that cholesterol showed great promise of facilitating high drug entrapment efficiency (EE). MNZ-SLNs were prepared by means of a novel melt- emulsification sonication and low temperature solidification method and optimised statistically by a 13-run-two-factor central composite rotatable design (CCRD). The predicted optimisation parameters were 4% m/v lipid concentration and 260.94 sonication time. Optimal MNZ-SLN formulations were prepared and characterised by means of photon correlation spectroscopy (PCS), transmission electron microscopy (TEM) and centrifugation. PCS revealed uniform particles with a narrow polydispersity index (PDI) and a mean hydrodynamic diameter (z-avg.) of 73.03 nm and zeta potential (ZP) of 38.43 mV. Percent EE was calculated via an indirect method as 75.24%. Furthermore, the MNZ -SLNs were incorporated into a mucoadhesive thermo-responsive hydrogel with a sol-gel transition temperature of 33.33 ± 2.82 °C. In vitro drug release testing (IVDRT) was undertaken with the aid of a Franz diffusion vertical cell (FDVC) apparatus. A % cumulative drug release of 27.94% and 15.87% was obtained for MNZ- SLNs and MNZ-SLN hydrogels, respectively, after eight hours. The resultant data was fitted into various kinetic models with the aid of DDSolverTM (Microsoft Excel® add-ins, 2016) to evaluate which model attained the highest correlation co-efficient (r2). Both formulations attained high r2 of 0.9941 and 0.9945, respectively, with the Korsmeyer- Peppas mathematical model. A high diffusional exponent (n) of >1 was observed, suggesting a super case II drug release mechanism. Finally, a modified Kirby-Bauer disc diffusion assay was used for ascertaining Candida albicans susceptibility to the developed formulations. Controls in the form of unloaded preparations and a commercially available cream were used. MNZ-SLNs and MNZ-hydrogel demonstrated superior antifungal activity to the commercially available cream. These results indicate that the developed MNZ-SLNloaded hydrogel formulation with localised thermo-responsive effect may be a promising carrier for intravaginal delivery of MNZ in the treatment of VVC.
- Full Text:
- Date Issued: 2019
- Authors: Gwimo, Wimana Alexis
- Date: 2019
- Subjects: Vaginitis , Vagina -- Diseases Sexually transmitted diseases -- Diagnosis Sexually transmitted diseases -- Treatment
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/39632 , vital:35335
- Description: Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis, affecting 75% of women of sexual maturity. The prescribed first line treatment involves the use of locally-acting imidazole creams. These conventional dosage forms possess limitations, such as leakage, messiness and low residence time at the site of application; all which promote poor patient adherence to pharmacotherapy. Poor adherence is then attributed to increased incidence of VVC reoccurrence and the emergence of Candida strains. It was, therefore, speculated that through the use of novel drug delivery systems (NDDS), the pharmacokinetic and antimicrobial characteristics of a model antifungal drug (miconazole nitrate [MNZ]) could be improved. Primary aim: To develop, optimise and characterise a mucoadhesive hydrogel incorporated with MNZ loaded solid lipid nanoparticles (MNZ-SLNs) for the intended treatment of VVC. This study was conducted in three phases, viz. pre-formulation studies, development, optimisation and characterisation of MNZ-SLNs, and the development and characterisation of MNZ-SLN-loaded thermoresponsive hydrogel. An alternative method for the quantification of MNZ was developed through the use of an octyl stationary phase. The method was deemed suitable for its intended use with a linear equation of y = 811214x + 67958 and a respective limit of quantitation (LoQ) and detection of 0.015 mg/ml and 0.052 mg/ml. Differential scanning calorimetry (DSC) studies suggested that cholesterol showed great promise of facilitating high drug entrapment efficiency (EE). MNZ-SLNs were prepared by means of a novel melt- emulsification sonication and low temperature solidification method and optimised statistically by a 13-run-two-factor central composite rotatable design (CCRD). The predicted optimisation parameters were 4% m/v lipid concentration and 260.94 sonication time. Optimal MNZ-SLN formulations were prepared and characterised by means of photon correlation spectroscopy (PCS), transmission electron microscopy (TEM) and centrifugation. PCS revealed uniform particles with a narrow polydispersity index (PDI) and a mean hydrodynamic diameter (z-avg.) of 73.03 nm and zeta potential (ZP) of 38.43 mV. Percent EE was calculated via an indirect method as 75.24%. Furthermore, the MNZ -SLNs were incorporated into a mucoadhesive thermo-responsive hydrogel with a sol-gel transition temperature of 33.33 ± 2.82 °C. In vitro drug release testing (IVDRT) was undertaken with the aid of a Franz diffusion vertical cell (FDVC) apparatus. A % cumulative drug release of 27.94% and 15.87% was obtained for MNZ- SLNs and MNZ-SLN hydrogels, respectively, after eight hours. The resultant data was fitted into various kinetic models with the aid of DDSolverTM (Microsoft Excel® add-ins, 2016) to evaluate which model attained the highest correlation co-efficient (r2). Both formulations attained high r2 of 0.9941 and 0.9945, respectively, with the Korsmeyer- Peppas mathematical model. A high diffusional exponent (n) of >1 was observed, suggesting a super case II drug release mechanism. Finally, a modified Kirby-Bauer disc diffusion assay was used for ascertaining Candida albicans susceptibility to the developed formulations. Controls in the form of unloaded preparations and a commercially available cream were used. MNZ-SLNs and MNZ-hydrogel demonstrated superior antifungal activity to the commercially available cream. These results indicate that the developed MNZ-SLNloaded hydrogel formulation with localised thermo-responsive effect may be a promising carrier for intravaginal delivery of MNZ in the treatment of VVC.
- Full Text:
- Date Issued: 2019
Development of a paediatric-friendly formulation intended for the treatment of multi-drug resistant tuberculosis
- Authors: Nkomo, Jethro
- Date: 2018
- Subjects: Drugs -- Dosage , Pediatrics -- Formulae, receipts, prescriptions Multidrug-resistant tuberculosis -- South Africa Primary health care -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/33660 , vital:32962
- Description: Children suffering from multidrug-resistant tuberculosis (MDR-TB) are treated with at least four drugs a day for at least twenty-four months. Approximately 25 000 - 32 000 children worldwide become infected with MDR-TB each year, yet there is a lack of adequate paediatric MDR-TB options for child-friendly dosage forms for the treatment of the condition. The available options are limited to manipulating different dosage forms intended for adults by means of breaking the tablets or otherwise, to deliver the drugs to children. This challenge that is faced by both health care professionals and caregivers subsequently poses drug quality, efficacy, and safety concerns to children being treated for MDR-TB. The objective of this study was to formulate a paediatric-friendly dosage form for the treatment of MDR-TB in children below the age of eight years. A fixed-dose combination (FDC) in form of a dispersible-tablet that contains two core drugs used in treatment of MDR-TB; levofloxacin and pyrazinamide, was developed. Quality by design principles was employed in developing the product. The systematic procedure ensures that quality is built into the product throughout the manufacturing process. It allows for identification of the critical quality attributes and modification of critical process parameters to lie within desired ranges. Preformulation studies were conducted on the active ingredients to investigate potential interactions and compatibility. Some of the analytical techniques employed in the process included an HPLC assay method that was developed to simultaneously separate levofloxacin and pyrazinamide, differential scanning calorimetry (DSC), infrared spectroscopy (IR), thermogravimetric analysis (TGA), and powder density studies. A direct compression tableting process was selected as the method of choice for product formulation. Active ingredients were blended with the excipients and compressed using tableting equipment to successfully produce FDC fast-disintegrating tablets containing 150 mg of levofloxacin and 300 mg pyrazinamide. The product quality was analysed and optimised using mathematical and statistical techniques such as response surface methodology (RSM) and ANOVA, to meet the required standards recommended by the United States Pharmacopoeia. The FDC dispersible tablet containing levofloxacin and pyrazinamide in the potential treatment of MDR-TB in children was successfully formulated, manufactured and evaluated. The tablet dosage form passed all the relevant quality criteria that governed the scope of this study and disintegrate in approximately 37 seconds when placed in water. It is generally a sizeable challenge to manufacture fixed-dose combination drug products due to physicochemical differences of various drugs, however, with adequate resources researchers may still find a way to formulate more child-friendly dosage forms for MDR-TB. This may lead to improved drug efficacy, reduced safety risks and decreased burden on caregivers and healthcare workers who must administer the treatment.
- Full Text:
- Date Issued: 2018
- Authors: Nkomo, Jethro
- Date: 2018
- Subjects: Drugs -- Dosage , Pediatrics -- Formulae, receipts, prescriptions Multidrug-resistant tuberculosis -- South Africa Primary health care -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/33660 , vital:32962
- Description: Children suffering from multidrug-resistant tuberculosis (MDR-TB) are treated with at least four drugs a day for at least twenty-four months. Approximately 25 000 - 32 000 children worldwide become infected with MDR-TB each year, yet there is a lack of adequate paediatric MDR-TB options for child-friendly dosage forms for the treatment of the condition. The available options are limited to manipulating different dosage forms intended for adults by means of breaking the tablets or otherwise, to deliver the drugs to children. This challenge that is faced by both health care professionals and caregivers subsequently poses drug quality, efficacy, and safety concerns to children being treated for MDR-TB. The objective of this study was to formulate a paediatric-friendly dosage form for the treatment of MDR-TB in children below the age of eight years. A fixed-dose combination (FDC) in form of a dispersible-tablet that contains two core drugs used in treatment of MDR-TB; levofloxacin and pyrazinamide, was developed. Quality by design principles was employed in developing the product. The systematic procedure ensures that quality is built into the product throughout the manufacturing process. It allows for identification of the critical quality attributes and modification of critical process parameters to lie within desired ranges. Preformulation studies were conducted on the active ingredients to investigate potential interactions and compatibility. Some of the analytical techniques employed in the process included an HPLC assay method that was developed to simultaneously separate levofloxacin and pyrazinamide, differential scanning calorimetry (DSC), infrared spectroscopy (IR), thermogravimetric analysis (TGA), and powder density studies. A direct compression tableting process was selected as the method of choice for product formulation. Active ingredients were blended with the excipients and compressed using tableting equipment to successfully produce FDC fast-disintegrating tablets containing 150 mg of levofloxacin and 300 mg pyrazinamide. The product quality was analysed and optimised using mathematical and statistical techniques such as response surface methodology (RSM) and ANOVA, to meet the required standards recommended by the United States Pharmacopoeia. The FDC dispersible tablet containing levofloxacin and pyrazinamide in the potential treatment of MDR-TB in children was successfully formulated, manufactured and evaluated. The tablet dosage form passed all the relevant quality criteria that governed the scope of this study and disintegrate in approximately 37 seconds when placed in water. It is generally a sizeable challenge to manufacture fixed-dose combination drug products due to physicochemical differences of various drugs, however, with adequate resources researchers may still find a way to formulate more child-friendly dosage forms for MDR-TB. This may lead to improved drug efficacy, reduced safety risks and decreased burden on caregivers and healthcare workers who must administer the treatment.
- Full Text:
- Date Issued: 2018
Impact of dietary factors on drug adherence and the nutritional status of tuberculosis patients in the Nelson Mandela Bay Health District
- Authors: Human, Wieda
- Date: 2018
- Subjects: Patients -- Nutritional aspects -- South Africa -- Nelson Mandela Bay Municipality , Tuberculosis -- Patients -- Nutritional aspects -- South Africa -- Nelson Mandela Bay Municipality Drug-nutrient interactions Appetite -- Effect of drugs on
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/22265 , vital:29929
- Description: The prevalence of poor adherence by Tuberculosis (TB) patients to their drug regimens poses a major public health problem in South Africa. Many South Africans are the victims of poverty and unemployment and, as a result, may face food insecurity, hunger and have diets lacking diversity. Malnutrition is commonly noted in patients with TB. Poor immunity as a result of TB further compromises the nutritional status of the patient and thus the prognosis. Chronic hunger together with food insecurity and inadequate dietary diversity can lead to poor drug adherence amongst patients. This highlights the fact that dietary factors may pose a threat to TB drug adherence. There is limited information available regarding the impact of dietary factors on drug adherence and the nutritional status in patients with TB, especially in the Eastern Cape. This emphasises the need for more research focusing on the impact that dietary factors have on drug adherence and nutritional status of patients with TB from underprivileged areas. The aim of the study was to describe the impact of dietary factors on drug adherence and the nutritional status of patients with TB from underprivileged areas in the Nelson Mandela Bay Health District (NMBHD) in order to revise current guidelines to standardise the nutrition management in patients with TB who are initiated on treatment. A descriptive, cross-sectional study was conducted using a quantitative approach. Ethical approval was obtained from the Research Ethics Committee (NMU) and the Eastern Cape Department of Health Provincial Research Committee. All participants provided written, informed consent prior to participation. A representative sample was drawn from each of the three sub-districts in the NMBHD to include a total of 256 participants. The following clinics were randomly selected: Max Madlingozi, Tshangana, Soweto clinic (sub-district A), Laetitia Bam, Middle Street, Rosedale (sub-district B) while clinics in sub-district C included Korsten, Walmer, Gelvandale and Helenvale. The population for the study included patients with TB older than 18 years treated at these specific clinics. Patients with Drug- Resistant TB were excluded. A structured interview was conducted by the researcher and three fieldworkers to obtain information on socio-demographics, drug adherence, food insecurity and dietary diversity. Anthropometric measurements (weight and height) were also obtained to determine the nutritional status of participants. The majority of participants were male (59%; n=150). The mean age of participants was 35,03 years (SD=11.97). Of the total sample, 70% (n=179) reported being currently unemployed, while 59% of the total sample were also unemployed prior to TB diagnosis. Fifty percent of participants (n=127) were HIV co-infected, while only a marginal percentage (3%; n=7) had Diabetes Mellitus. Treatment adherence was considered 'good' as 94% (n=240) reported taking their TB treatment daily while 92% (n=121) reported taking their antiretroviral therapy (ART) daily. About a third (32%; n=81) of the total sample experienced low appetite, followed by nausea (21%; n=53) and vomiting (20%; n=50). A large percentage (48%; n=123) of participants experienced severe hunger. The mean individual dietary diversity score (DDS) for this sample was below 3 (2.81/9) and could be classified as being moderately diverse. Forty-three percent (n=110) had a low DDS of 2 or less food groups. Only 2% (n=5) had a high DDS of more than 7 food groups. A statistically significant association was found between employment status and food insecurity and poor DDS. Previous TB infection was also significantly associated with food insecurity and poor DDS. Although so many participants were food insecure, 74% (n=188) reported taking their TB treatment with food. Regarding substance use, 24% (n=88) consumed alcohol weekly, whereas 31% (n=80) of participants smoked cigarettes. The mean BMI value for males was 20.93 kg/m2 (SD=4.19) and for females at 20.91 kg/m2 (SD=5.10). However, 30% (n=76) had BMI values below 18.5 kg/m2 and 16% (n=40) had BMI values above 25 kg/m2. Majority of the participants (91%; n=233) had lost weight prior to data collection. Furthermore, 75% (n=175) reported having experienced involuntary weight loss in the preceding 3 months, while 17% (n=43) reported having lost more than 10% of their body weight in the last 3 months. Almost all participants reported taking their TB treatment as prescribed. However, the study results echo the findings of other studies that a large cohort of participants are currently unemployed and food insecure. Many participants were consuming monotonous diets, consisting primarily of starch with little vegetables and fruits. As a result, the nutritional status of the sample population was compromised. This sample also reflected unhealthy lifestyle habits which included substance use (alcohol and cigarette smoking). As so many participants self-reported adhering to TB treatment, it was challenging to determine the impact that dietary factors have on TB drug adherence. Government, NGO's and other private stakeholders should make nutrition a priority especially in vulnerable groups such as patients with TB. Dietitians and nutritionists should be involved in the care of all patients with TB by providing relevant nutrition counselling. Although malnourished patients with TB are currently receiving nutrition supplementation, the amount and sustainability thereof should be revised. Food gardens may further be a safety net against food insecurity, hunger and inadequate dietary diversity.
- Full Text:
- Date Issued: 2018
- Authors: Human, Wieda
- Date: 2018
- Subjects: Patients -- Nutritional aspects -- South Africa -- Nelson Mandela Bay Municipality , Tuberculosis -- Patients -- Nutritional aspects -- South Africa -- Nelson Mandela Bay Municipality Drug-nutrient interactions Appetite -- Effect of drugs on
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/22265 , vital:29929
- Description: The prevalence of poor adherence by Tuberculosis (TB) patients to their drug regimens poses a major public health problem in South Africa. Many South Africans are the victims of poverty and unemployment and, as a result, may face food insecurity, hunger and have diets lacking diversity. Malnutrition is commonly noted in patients with TB. Poor immunity as a result of TB further compromises the nutritional status of the patient and thus the prognosis. Chronic hunger together with food insecurity and inadequate dietary diversity can lead to poor drug adherence amongst patients. This highlights the fact that dietary factors may pose a threat to TB drug adherence. There is limited information available regarding the impact of dietary factors on drug adherence and the nutritional status in patients with TB, especially in the Eastern Cape. This emphasises the need for more research focusing on the impact that dietary factors have on drug adherence and nutritional status of patients with TB from underprivileged areas. The aim of the study was to describe the impact of dietary factors on drug adherence and the nutritional status of patients with TB from underprivileged areas in the Nelson Mandela Bay Health District (NMBHD) in order to revise current guidelines to standardise the nutrition management in patients with TB who are initiated on treatment. A descriptive, cross-sectional study was conducted using a quantitative approach. Ethical approval was obtained from the Research Ethics Committee (NMU) and the Eastern Cape Department of Health Provincial Research Committee. All participants provided written, informed consent prior to participation. A representative sample was drawn from each of the three sub-districts in the NMBHD to include a total of 256 participants. The following clinics were randomly selected: Max Madlingozi, Tshangana, Soweto clinic (sub-district A), Laetitia Bam, Middle Street, Rosedale (sub-district B) while clinics in sub-district C included Korsten, Walmer, Gelvandale and Helenvale. The population for the study included patients with TB older than 18 years treated at these specific clinics. Patients with Drug- Resistant TB were excluded. A structured interview was conducted by the researcher and three fieldworkers to obtain information on socio-demographics, drug adherence, food insecurity and dietary diversity. Anthropometric measurements (weight and height) were also obtained to determine the nutritional status of participants. The majority of participants were male (59%; n=150). The mean age of participants was 35,03 years (SD=11.97). Of the total sample, 70% (n=179) reported being currently unemployed, while 59% of the total sample were also unemployed prior to TB diagnosis. Fifty percent of participants (n=127) were HIV co-infected, while only a marginal percentage (3%; n=7) had Diabetes Mellitus. Treatment adherence was considered 'good' as 94% (n=240) reported taking their TB treatment daily while 92% (n=121) reported taking their antiretroviral therapy (ART) daily. About a third (32%; n=81) of the total sample experienced low appetite, followed by nausea (21%; n=53) and vomiting (20%; n=50). A large percentage (48%; n=123) of participants experienced severe hunger. The mean individual dietary diversity score (DDS) for this sample was below 3 (2.81/9) and could be classified as being moderately diverse. Forty-three percent (n=110) had a low DDS of 2 or less food groups. Only 2% (n=5) had a high DDS of more than 7 food groups. A statistically significant association was found between employment status and food insecurity and poor DDS. Previous TB infection was also significantly associated with food insecurity and poor DDS. Although so many participants were food insecure, 74% (n=188) reported taking their TB treatment with food. Regarding substance use, 24% (n=88) consumed alcohol weekly, whereas 31% (n=80) of participants smoked cigarettes. The mean BMI value for males was 20.93 kg/m2 (SD=4.19) and for females at 20.91 kg/m2 (SD=5.10). However, 30% (n=76) had BMI values below 18.5 kg/m2 and 16% (n=40) had BMI values above 25 kg/m2. Majority of the participants (91%; n=233) had lost weight prior to data collection. Furthermore, 75% (n=175) reported having experienced involuntary weight loss in the preceding 3 months, while 17% (n=43) reported having lost more than 10% of their body weight in the last 3 months. Almost all participants reported taking their TB treatment as prescribed. However, the study results echo the findings of other studies that a large cohort of participants are currently unemployed and food insecure. Many participants were consuming monotonous diets, consisting primarily of starch with little vegetables and fruits. As a result, the nutritional status of the sample population was compromised. This sample also reflected unhealthy lifestyle habits which included substance use (alcohol and cigarette smoking). As so many participants self-reported adhering to TB treatment, it was challenging to determine the impact that dietary factors have on TB drug adherence. Government, NGO's and other private stakeholders should make nutrition a priority especially in vulnerable groups such as patients with TB. Dietitians and nutritionists should be involved in the care of all patients with TB by providing relevant nutrition counselling. Although malnourished patients with TB are currently receiving nutrition supplementation, the amount and sustainability thereof should be revised. Food gardens may further be a safety net against food insecurity, hunger and inadequate dietary diversity.
- Full Text:
- Date Issued: 2018
Intake of salt and sugar in grade five learners at underprivileged schools in Port Elizabeth compared to the intake at underprivileged schools in Johannesburg
- Authors: Straub, Alycia
- Date: 2018
- Subjects: Children -- Nutrition -- South Africa -- Port Elizabeth , Children -- Nutrition -- South Africa -- Johannesburg , Hypertension , Obesity in children
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/33261 , vital:32614
- Description: The literature clearly indicates that excessive amounts of salt and sugar, compared to the recommended amounts, are consumed by young children, leading to the earlier presentation of lifestyle diseases such as obesity, diabetes mellitus type 2 and hypertension (Lichtenstein et al., 2006; Grimes et al., 2013). The problem to address is that there is insufficient information available on the intake of sugar and salt in South African children, and more specifically in the Johannesburg and Port Elizabeth areas; this information is necessary to determine which prevention strategies should be developed. The aim of this study was to determine the current intake of salt and sugar of grade five learners at a sample of quintile three schools in Johannesburg and Port Elizabeth and to investigate whether there was a relationship between the sugar and salt intake and the BMI (kg/m2) and blood pressure (mmHg) of these learners. A baseline exploratory, quantitative, descriptive, cross-sectional study design was used. A non-random, convenient sampling method was used with a sample size of 220 consenting learners of Johannesburg and 350 of Port Elizabeth. A semi-quantitative adapted food frequency questionnaire was used to determine the current intake of salt and sugar in the learners. The data was analysed using the SPSS version 22 programme. Ethical clearance was obtained from the relevant bodies. The results were as follows: no significant differences were found between the frequency of consumption of any of the food items that were chosen to represent salt and sugar intake and blood pressure and BMI within either Johannesburg or Port Elizabeth. Therefore, no associations between salt and sugar intake and blood pressure and BMI were found within either area. When comparing the learners of Johannesburg with those in Port Elizabeth a few significant differences were found; mostly showing a weak association. However, there was a moderate association for sugar in tea/ coffee between the underweight and overweight/obese learners of Johannesburg compared to Port Elizabeth. Preferences, peer influence and food culture are suggested reasons for this significant difference. Recommendations of the study were the South African Food-based Dietary Guidelines “Use salt and foods high in salt sparingly” and “Use food and drinks that contain sugar sparingly and not between meals” should continue to be encouraged.
- Full Text:
- Date Issued: 2018
- Authors: Straub, Alycia
- Date: 2018
- Subjects: Children -- Nutrition -- South Africa -- Port Elizabeth , Children -- Nutrition -- South Africa -- Johannesburg , Hypertension , Obesity in children
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/33261 , vital:32614
- Description: The literature clearly indicates that excessive amounts of salt and sugar, compared to the recommended amounts, are consumed by young children, leading to the earlier presentation of lifestyle diseases such as obesity, diabetes mellitus type 2 and hypertension (Lichtenstein et al., 2006; Grimes et al., 2013). The problem to address is that there is insufficient information available on the intake of sugar and salt in South African children, and more specifically in the Johannesburg and Port Elizabeth areas; this information is necessary to determine which prevention strategies should be developed. The aim of this study was to determine the current intake of salt and sugar of grade five learners at a sample of quintile three schools in Johannesburg and Port Elizabeth and to investigate whether there was a relationship between the sugar and salt intake and the BMI (kg/m2) and blood pressure (mmHg) of these learners. A baseline exploratory, quantitative, descriptive, cross-sectional study design was used. A non-random, convenient sampling method was used with a sample size of 220 consenting learners of Johannesburg and 350 of Port Elizabeth. A semi-quantitative adapted food frequency questionnaire was used to determine the current intake of salt and sugar in the learners. The data was analysed using the SPSS version 22 programme. Ethical clearance was obtained from the relevant bodies. The results were as follows: no significant differences were found between the frequency of consumption of any of the food items that were chosen to represent salt and sugar intake and blood pressure and BMI within either Johannesburg or Port Elizabeth. Therefore, no associations between salt and sugar intake and blood pressure and BMI were found within either area. When comparing the learners of Johannesburg with those in Port Elizabeth a few significant differences were found; mostly showing a weak association. However, there was a moderate association for sugar in tea/ coffee between the underweight and overweight/obese learners of Johannesburg compared to Port Elizabeth. Preferences, peer influence and food culture are suggested reasons for this significant difference. Recommendations of the study were the South African Food-based Dietary Guidelines “Use salt and foods high in salt sparingly” and “Use food and drinks that contain sugar sparingly and not between meals” should continue to be encouraged.
- Full Text:
- Date Issued: 2018
Weight gain in hospitalised low birth weight (LBW) premature infants receiving breast milk or breast milk with human milk fortifier in the Nelson Mandela Bay Health District
- Authors: Wicomb, Ra-eesa
- Date: 2018
- Subjects: Premature infants -- South Africa -- Nelson Mandela Bay Municipality , Birth weight, Low -- South Africa -- Nelson Mandela Bay Municipality Birth weight -- South Africa -- Nelson Mandela Bay Municipality Infants -- Nutrition Children -- Nutrition -- Research
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/23327 , vital:30529
- Description: Rationale: Worldwide, hospitals with premature units have one generalised objective, i.e. to achieve postnatal growth and body composition similar to that of a normal foetus of similar gestational age. Optimal nutrition leads to optimal neurodevelopment and breastfeeding (BF) is known as the golden standard for infant nutrition. Human breast milk (BM) has significant value for preterm and term infants and is of special benefit to HIV infected mothers. Maternal supplementation is provided as part of the standard protocol in certain hospitals in the Eastern Cape province to those mothers who breastfeed their low birth weight (LBW) infants after delivery. human milk fortifier (HMF) is a nutritional supplement that is added to expressed breast milk for feeding preterm infants in order to meet their high energy and protein needs and therefore supporting the recommended growth velocity of 10g/kg/day-15g/kg/day. Some hospitals within South Africa provide HMF to preterm infants as part of their standard nutritional protocol in order for the infant to gain weight if BM only failed to produce adequate results. To date, little to no South African studies support or discourage the use of HMF for LBW infants. This study aimed to describe the effect of maternal supplementation compared with breast milk with HMF, or a combination of maternal supplementation and breast milk with HMF, on growth velocity in hospitalised LBW premature infants within the Nelson Mandela Bay health district. The proposed study design followed a longitudinal, observational, descriptive study in a cohort of LBW infants. The study was analytical using quantitative empirical data. Study participants were selected, by using convenience sampling, at Dora Nginza Hospital, Zwide between October 2015 and August 2016 (ethics approval: EC_2016RP27_564). Quantitative data on anthropometric measurements was collected from study participants. Primary care givers provided written informed consent. Registered nurses were trained and performed anthropometrical measurements according to standardised methods. A structured questionnaire was completed by the principal reasarcher as a source of data collection. Numerical data was described using means and standard deviations. Chi squares were used to describe the associations between maternal risk factors and birth weight outcomes. ANOVA was used to determine the relationship between growth velocity and the various supplementation groups. A sample size of 91 LBW preterm infants and mother pairs were entered into this study. The majority of mothers, 64% (n=58) fell in the age category of 20-35 years old. Of the total maternal sample (n=88), 35% (n=31) were classified in the at risk age category, i.e. <20years old and >36years old. Out of the total infant sample (n=91), 65% (n=59) was classified as VLBW, 22% was LBW and 22% (n=20) was ELBW. No statistically significant association was found between infant growth velocity and maternal risk factors. The group receiving BM with HMF had a mean growth velocity of 19.75 g/kg/day (SD=6.45) that was statistically significantly (p<0.05) more than the other groups. The maternal supplementation only group and the maternal supplementation and BM fortification group showed mean growth velocities of 12.26 g/kg/day (SD=5.41) and 12.29 g/kg/day (SD=6.97) respectively. A post hoc test was done between growth velocity in the supplementated groups and the length of hospital stay. These results reveal that the group receiving BM with HMF had a significantly (p<0.05) shorter mean length of hospital stay of 11.29 days (SD=7.02), compared with the group on the combination of maternal supplementation and BM with HMF. In this study, infants receiving HMF with BM showed the highest growth velocity with the shortest hospital stay before discharge. In this group, infants were already receiving an adequate BM intake of 150-180 ml/kg/day prior to participation in the study. This meant that the HMF group consisted of more stable preterm infants compared to the rest of the supplementated groups. However, a large proportion of participants in the maternal supplementation group also showed adequate to good growth velocity. The researcher recommends the implementation of maternal supplementation only, as standard of care for all hospitalised lactating women. Furthermore, timeous addition of HMF to expressed BM is necessary for infants with growth velocities <15 g/kg/day. This may save costs to the hospital as the use of HMF allowed for better weight gain and earlier discharge.
- Full Text:
- Date Issued: 2018
- Authors: Wicomb, Ra-eesa
- Date: 2018
- Subjects: Premature infants -- South Africa -- Nelson Mandela Bay Municipality , Birth weight, Low -- South Africa -- Nelson Mandela Bay Municipality Birth weight -- South Africa -- Nelson Mandela Bay Municipality Infants -- Nutrition Children -- Nutrition -- Research
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/23327 , vital:30529
- Description: Rationale: Worldwide, hospitals with premature units have one generalised objective, i.e. to achieve postnatal growth and body composition similar to that of a normal foetus of similar gestational age. Optimal nutrition leads to optimal neurodevelopment and breastfeeding (BF) is known as the golden standard for infant nutrition. Human breast milk (BM) has significant value for preterm and term infants and is of special benefit to HIV infected mothers. Maternal supplementation is provided as part of the standard protocol in certain hospitals in the Eastern Cape province to those mothers who breastfeed their low birth weight (LBW) infants after delivery. human milk fortifier (HMF) is a nutritional supplement that is added to expressed breast milk for feeding preterm infants in order to meet their high energy and protein needs and therefore supporting the recommended growth velocity of 10g/kg/day-15g/kg/day. Some hospitals within South Africa provide HMF to preterm infants as part of their standard nutritional protocol in order for the infant to gain weight if BM only failed to produce adequate results. To date, little to no South African studies support or discourage the use of HMF for LBW infants. This study aimed to describe the effect of maternal supplementation compared with breast milk with HMF, or a combination of maternal supplementation and breast milk with HMF, on growth velocity in hospitalised LBW premature infants within the Nelson Mandela Bay health district. The proposed study design followed a longitudinal, observational, descriptive study in a cohort of LBW infants. The study was analytical using quantitative empirical data. Study participants were selected, by using convenience sampling, at Dora Nginza Hospital, Zwide between October 2015 and August 2016 (ethics approval: EC_2016RP27_564). Quantitative data on anthropometric measurements was collected from study participants. Primary care givers provided written informed consent. Registered nurses were trained and performed anthropometrical measurements according to standardised methods. A structured questionnaire was completed by the principal reasarcher as a source of data collection. Numerical data was described using means and standard deviations. Chi squares were used to describe the associations between maternal risk factors and birth weight outcomes. ANOVA was used to determine the relationship between growth velocity and the various supplementation groups. A sample size of 91 LBW preterm infants and mother pairs were entered into this study. The majority of mothers, 64% (n=58) fell in the age category of 20-35 years old. Of the total maternal sample (n=88), 35% (n=31) were classified in the at risk age category, i.e. <20years old and >36years old. Out of the total infant sample (n=91), 65% (n=59) was classified as VLBW, 22% was LBW and 22% (n=20) was ELBW. No statistically significant association was found between infant growth velocity and maternal risk factors. The group receiving BM with HMF had a mean growth velocity of 19.75 g/kg/day (SD=6.45) that was statistically significantly (p<0.05) more than the other groups. The maternal supplementation only group and the maternal supplementation and BM fortification group showed mean growth velocities of 12.26 g/kg/day (SD=5.41) and 12.29 g/kg/day (SD=6.97) respectively. A post hoc test was done between growth velocity in the supplementated groups and the length of hospital stay. These results reveal that the group receiving BM with HMF had a significantly (p<0.05) shorter mean length of hospital stay of 11.29 days (SD=7.02), compared with the group on the combination of maternal supplementation and BM with HMF. In this study, infants receiving HMF with BM showed the highest growth velocity with the shortest hospital stay before discharge. In this group, infants were already receiving an adequate BM intake of 150-180 ml/kg/day prior to participation in the study. This meant that the HMF group consisted of more stable preterm infants compared to the rest of the supplementated groups. However, a large proportion of participants in the maternal supplementation group also showed adequate to good growth velocity. The researcher recommends the implementation of maternal supplementation only, as standard of care for all hospitalised lactating women. Furthermore, timeous addition of HMF to expressed BM is necessary for infants with growth velocities <15 g/kg/day. This may save costs to the hospital as the use of HMF allowed for better weight gain and earlier discharge.
- Full Text:
- Date Issued: 2018
Adolescent mothers’ breastfeeding experiences in Nelson Mandela Bay health district
- Authors: Fordjour Afriyie, Vera
- Date: 2017
- Subjects: Breastfeeding -- South Africa -- Eastern Cape , Children -- Nutrition -- South Africa -- Port Elizabeth , Teenage mothers -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/13879 , vital:27316
- Description: Rationale: There is limited research available in South Africa that explores the breastfeeding experience among adolescent mothers; most of the studies were conducted in developed countries. One such study relating to the above mentioned developed countries stated that social and commitment factors influence the decision to breastfeed by adolescents. Furthermore, while adolescent mothers appreciate the benefits of breastfeeding, pain, public exposure and perceived complexities related to breastfeeding create barriers for them. The researcher was unable to ascertain if similar ambiguities exist among adolescent mothers in South Africa, and in the Eastern Cape (EC) in particular with its high rates of adolescent pregnancy. In order to attempt to develop age appropriate recommendations to assist adolescent mothers with their breastfeeding journey, the researcher undertook this research study to answer the following question: What are the breastfeeding experiences of adolescent mothers in the Nelson Mandela Bay Heath District (NMBHD)? Aim: The research aim was to determine the experiences of adolescent mothers regarding breastfeeding in NMBHD. Methods: The study implemented a qualitative research approach. To enhance the design, the researcher utilised an explorative, descriptive and contextual research design. The ethical principles that guided this study were autonomy, nonmaleficence, beneficence and justice. Fourteen adolescent mothers, attending PHC facilities in the NMBHD participated in the study. Participants were chosen from a purposive sampling technique and data were collected from semi-structured interviews, compromising of individual interviews. The researcher analysed the data using the using the eight steps of the Tesch analysis technique. Data was also analysed by an independent coder. Results obtained from the Tesch approach were compared to that of the independent coder results. Thereafter, the major themes and sub-themes that related to the study objectives were identified. Results: Three themes and 10 sub-themes were identified. Lack of knowledge and poor adherence to EBF, perceived breastmilk insufficiency, as well as incorrect infant feeding advice given by maternal mothers and grandmothers were associated with early introduction of complementary feeding. Most participants were motivated to breastfeed due to its economic and bonding benefits, as well as seeing their infant‟s progress in growth. Challenges of breastfeeding mentioned by the participants include: lack of support from the fathers of their infants and from health care providers, breast milk leakage, and the foul smell associated with the leaking of breast milk. The participants of the study also had suggestions to help improve the support given to adolescent mothers by health care providers in PHC facilities. Conclusions and recommendations: In conclusion, this study‟s findings revealed that adolescent mothers may need extra age appropriate education and support to assist them in breastfeeding successfully at PHC facilities, the community and schools. Maternal mothers and grandmothers were found to be the primary source of a support network for most adolescent mothers as opposed to health care providers who were categorised as being the secondary source of support. Thus, breastfeeding promotion tailored at maternal mothers and grandmothers would be beneficial in improving their knowledge about the recommended infant feeding practices and consequently aid in providing appropriate support and advice to adolescent mothers. Additionally, training and attitude modification of health care providers is needed to provide adolescent mothers with age-appropriate, effective and sensitive care and counselling.
- Full Text:
- Date Issued: 2017
- Authors: Fordjour Afriyie, Vera
- Date: 2017
- Subjects: Breastfeeding -- South Africa -- Eastern Cape , Children -- Nutrition -- South Africa -- Port Elizabeth , Teenage mothers -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/13879 , vital:27316
- Description: Rationale: There is limited research available in South Africa that explores the breastfeeding experience among adolescent mothers; most of the studies were conducted in developed countries. One such study relating to the above mentioned developed countries stated that social and commitment factors influence the decision to breastfeed by adolescents. Furthermore, while adolescent mothers appreciate the benefits of breastfeeding, pain, public exposure and perceived complexities related to breastfeeding create barriers for them. The researcher was unable to ascertain if similar ambiguities exist among adolescent mothers in South Africa, and in the Eastern Cape (EC) in particular with its high rates of adolescent pregnancy. In order to attempt to develop age appropriate recommendations to assist adolescent mothers with their breastfeeding journey, the researcher undertook this research study to answer the following question: What are the breastfeeding experiences of adolescent mothers in the Nelson Mandela Bay Heath District (NMBHD)? Aim: The research aim was to determine the experiences of adolescent mothers regarding breastfeeding in NMBHD. Methods: The study implemented a qualitative research approach. To enhance the design, the researcher utilised an explorative, descriptive and contextual research design. The ethical principles that guided this study were autonomy, nonmaleficence, beneficence and justice. Fourteen adolescent mothers, attending PHC facilities in the NMBHD participated in the study. Participants were chosen from a purposive sampling technique and data were collected from semi-structured interviews, compromising of individual interviews. The researcher analysed the data using the using the eight steps of the Tesch analysis technique. Data was also analysed by an independent coder. Results obtained from the Tesch approach were compared to that of the independent coder results. Thereafter, the major themes and sub-themes that related to the study objectives were identified. Results: Three themes and 10 sub-themes were identified. Lack of knowledge and poor adherence to EBF, perceived breastmilk insufficiency, as well as incorrect infant feeding advice given by maternal mothers and grandmothers were associated with early introduction of complementary feeding. Most participants were motivated to breastfeed due to its economic and bonding benefits, as well as seeing their infant‟s progress in growth. Challenges of breastfeeding mentioned by the participants include: lack of support from the fathers of their infants and from health care providers, breast milk leakage, and the foul smell associated with the leaking of breast milk. The participants of the study also had suggestions to help improve the support given to adolescent mothers by health care providers in PHC facilities. Conclusions and recommendations: In conclusion, this study‟s findings revealed that adolescent mothers may need extra age appropriate education and support to assist them in breastfeeding successfully at PHC facilities, the community and schools. Maternal mothers and grandmothers were found to be the primary source of a support network for most adolescent mothers as opposed to health care providers who were categorised as being the secondary source of support. Thus, breastfeeding promotion tailored at maternal mothers and grandmothers would be beneficial in improving their knowledge about the recommended infant feeding practices and consequently aid in providing appropriate support and advice to adolescent mothers. Additionally, training and attitude modification of health care providers is needed to provide adolescent mothers with age-appropriate, effective and sensitive care and counselling.
- Full Text:
- Date Issued: 2017
Anthropometric indicators in identifying malnutrition risk among children younger than two years in Motherwell, Nelson Mandela Metropolitan Municipality
- Authors: McLaren, Shawn William
- Date: 2017
- Subjects: Nutrition disorders in children -- South Africa -- Nelson Mandela Bay Municipality , Malnutrition in children -- South Africa -- Nelson Mandela Bay Municipality
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/19256 , vital:28811
- Description: Introduction: South Africa is burdened with a high prevalence of childhood malnutrition. The World Health Organisation (WHO) endorses weight for length (WFL) Z-scores and mid-upper arm circumference (MUAC) as tools for identifying children who are malnourished. The MUAC measurement offers many advantages for its use in community nutrition, and may aid in the early identification of malnourished children. More accurate and comprehensive data on child anthropometric status are needed in the Nelson Mandela Bay Health District (NMBHD), as well as assessment of the efficacy of using a simplified tool such as MUAC to screen for malnutrition. Aim: This study aimed to synthesise a profile of the nutritional status of children younger than two years old in Motherwell, Nelson Mandela Metropolitan Municipality (NMMM) to assess the value of MUAC as a predictor of malnutrition risk and develop malnutrition screening recommendations relevant to this population. Methods: This study followed a cross-sectional design using a quantitative approach. A convenience sample (n=419) of children below 24 months of age was selected from clinics and creches in Motherwell between October 2015 and February 2016 (Ethics approval: H15-HEA-DIET-002). Primary caregivers provided informed written consent for study participation. Trained fieldworkers performed anthropometric measurements according to standardised methods and completed a structured questionnaire. Data was described using means and standard deviations. Linear regression was used to assess relationships within the data. The MUAC’s ability to identify malnutrition was described using sensitivity and specificity probabilities. Results: Only 6% of the sample of children (n=23) were classified as stunted and 3% of the children (n=12) were severely stunted. The WHZ Z-score identified 0% (n=1) child with severe acute malnutrition (SAM), and 1% (n=3) children as MAM. The MUAC identified more children as SAM (2%) and MAM (3%). It was found that 16% of the children (n=65) were overweight or obese according to WHZ. It was found that there is a strong linear relationship between WHZ and MUAC (r=0.739). Using the least squares regression equation, a MUAC cut off value of 13,80cm for males and 13,5cm for females between six and 24 months old was projected. The male cut-off value has a 100% sensitivity and 94,5% specificity for MAM and SAM while the female MUAC cut off had a specificity of 96,4%. Low birth weight children had significantly (p<0.0005) lower mean WAZ and HAZ scores than normal birth weight children. Conclusions and recommendations The prevalence of overweight and obesity among children younger than two years was high in Motherwell, while stunting and wasting prevalence were lower than expected for the population. Raising the MUAC cut-off values from 12,5cm for MAM to 13,80cm for males and 13,47cm for females may increase the number of children younger than two years who are included in nutrition interventions. It is recommended that healthcare workers focus on breastfeeding and appropriate complementary feeding practices to reduce the risk of overweight in infants and young children.
- Full Text:
- Authors: McLaren, Shawn William
- Date: 2017
- Subjects: Nutrition disorders in children -- South Africa -- Nelson Mandela Bay Municipality , Malnutrition in children -- South Africa -- Nelson Mandela Bay Municipality
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/19256 , vital:28811
- Description: Introduction: South Africa is burdened with a high prevalence of childhood malnutrition. The World Health Organisation (WHO) endorses weight for length (WFL) Z-scores and mid-upper arm circumference (MUAC) as tools for identifying children who are malnourished. The MUAC measurement offers many advantages for its use in community nutrition, and may aid in the early identification of malnourished children. More accurate and comprehensive data on child anthropometric status are needed in the Nelson Mandela Bay Health District (NMBHD), as well as assessment of the efficacy of using a simplified tool such as MUAC to screen for malnutrition. Aim: This study aimed to synthesise a profile of the nutritional status of children younger than two years old in Motherwell, Nelson Mandela Metropolitan Municipality (NMMM) to assess the value of MUAC as a predictor of malnutrition risk and develop malnutrition screening recommendations relevant to this population. Methods: This study followed a cross-sectional design using a quantitative approach. A convenience sample (n=419) of children below 24 months of age was selected from clinics and creches in Motherwell between October 2015 and February 2016 (Ethics approval: H15-HEA-DIET-002). Primary caregivers provided informed written consent for study participation. Trained fieldworkers performed anthropometric measurements according to standardised methods and completed a structured questionnaire. Data was described using means and standard deviations. Linear regression was used to assess relationships within the data. The MUAC’s ability to identify malnutrition was described using sensitivity and specificity probabilities. Results: Only 6% of the sample of children (n=23) were classified as stunted and 3% of the children (n=12) were severely stunted. The WHZ Z-score identified 0% (n=1) child with severe acute malnutrition (SAM), and 1% (n=3) children as MAM. The MUAC identified more children as SAM (2%) and MAM (3%). It was found that 16% of the children (n=65) were overweight or obese according to WHZ. It was found that there is a strong linear relationship between WHZ and MUAC (r=0.739). Using the least squares regression equation, a MUAC cut off value of 13,80cm for males and 13,5cm for females between six and 24 months old was projected. The male cut-off value has a 100% sensitivity and 94,5% specificity for MAM and SAM while the female MUAC cut off had a specificity of 96,4%. Low birth weight children had significantly (p<0.0005) lower mean WAZ and HAZ scores than normal birth weight children. Conclusions and recommendations The prevalence of overweight and obesity among children younger than two years was high in Motherwell, while stunting and wasting prevalence were lower than expected for the population. Raising the MUAC cut-off values from 12,5cm for MAM to 13,80cm for males and 13,47cm for females may increase the number of children younger than two years who are included in nutrition interventions. It is recommended that healthcare workers focus on breastfeeding and appropriate complementary feeding practices to reduce the risk of overweight in infants and young children.
- Full Text:
Development of antibiotic loaded liposomal hydrocolloid dressings for application in wound healing
- Authors: Ntsalu, Vuyiseka
- Date: 2017
- Subjects: Wound healing -- South Africa Liposomes Hydrocolloid surgical dressings -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/13957 , vital:27361
- Description: Wound healing, as a normal biological process in the human body, is achieved through four precise and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. However, many factors can interfere with one or more of these phases, thus causing improper or impaired wound healing. Maintaining a moist wound environment is crucial in facilitating the wound-healing process. The beneficial effects of a moist versus a dry wound environment include re-epithelization, tissue granulation, and repair. The use of hydrocolloid occlusive dressings in maintaining a moist wound environment has proven to be a useful adjunct in facilitating wound healing. Although hydrocolloid dressings have been widely used clinically in wound management, bacterial resistance, poor solubility and sustained drug release remain to be a problem for many of the drugs used in wound therapy. In chronic wound management, where patients normally undergo long treatments and frequent dressing changes, a system that delivers drugs into a wound site in a controlled fashion can improve patient compliance and therapeutic outcomes. Liposomes are small phospholipid vesicles that have been widely investigated as drug carriers for the delivery of therapeutic agents. They are spherical lipid vesicles consisting of phospholipid bilayers that improve the efficacy of the drugs by fusing with biological membranes, and eventually releasing their entrapped content into the cells or bacteria. The aim of this study therefore, is to develop a new bacitracin-based controlled release hydrocolloid dressing, with good absorptive properties for improving the efficacy of antibiotics in wound healing. HPLC (high-pressure liquid chromatography) assay of bacitracin was performed for quantification of the drug. Liposomes were prepared using thin film hydration and extrusion methods. Liposomes were also characterized based on their ideal particle size and encapsulation efficiency, and then incorporated into the different ratios of chitosan/gelatin hydrocolloid films. The films were prepared with increase in gelatin concentration and were evaluated for folding endurance, tensile strength, water absorption capacity, morphology, drug release kinetics, antimicrobial activity and stability. The morphology of these films was found to be very smooth and homogeneous proving a good compatibility between the two polymers. With increase in gelatin concentration, folding endurance, water absorption capacity, tensile strength, drug release kinetics and antimicrobial activity were increased. The antibacterial activity against various bacterial species was improved in the bacitracin loaded hydrocolloid films as compared to the blank films. Based on the findings above, it can be concluded that chitosan/gelatin films at 1:3 proportion is a successful wound dressing for wound management with improved wound healing properties than other formulations. This formulation is a potential candidate for the development of alternative pharmaceutical dosage forms, for the treatment of bacterial infected wounds, based on the activity of the eco-friendly chitosan matrix added to the bacitracin activity. In this work, chitosan also demonstrated a great potential as a dressing for advanced wound therapy and confirmed its good biocompatibility and potential to provide, in combination with liposomes, sustained drug release which is highly beneficial for wound treatment. The addition of gelatin improved the water affinity of the films and facilitated water mediated cross-linking process.
- Full Text:
- Date Issued: 2017
- Authors: Ntsalu, Vuyiseka
- Date: 2017
- Subjects: Wound healing -- South Africa Liposomes Hydrocolloid surgical dressings -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/13957 , vital:27361
- Description: Wound healing, as a normal biological process in the human body, is achieved through four precise and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. However, many factors can interfere with one or more of these phases, thus causing improper or impaired wound healing. Maintaining a moist wound environment is crucial in facilitating the wound-healing process. The beneficial effects of a moist versus a dry wound environment include re-epithelization, tissue granulation, and repair. The use of hydrocolloid occlusive dressings in maintaining a moist wound environment has proven to be a useful adjunct in facilitating wound healing. Although hydrocolloid dressings have been widely used clinically in wound management, bacterial resistance, poor solubility and sustained drug release remain to be a problem for many of the drugs used in wound therapy. In chronic wound management, where patients normally undergo long treatments and frequent dressing changes, a system that delivers drugs into a wound site in a controlled fashion can improve patient compliance and therapeutic outcomes. Liposomes are small phospholipid vesicles that have been widely investigated as drug carriers for the delivery of therapeutic agents. They are spherical lipid vesicles consisting of phospholipid bilayers that improve the efficacy of the drugs by fusing with biological membranes, and eventually releasing their entrapped content into the cells or bacteria. The aim of this study therefore, is to develop a new bacitracin-based controlled release hydrocolloid dressing, with good absorptive properties for improving the efficacy of antibiotics in wound healing. HPLC (high-pressure liquid chromatography) assay of bacitracin was performed for quantification of the drug. Liposomes were prepared using thin film hydration and extrusion methods. Liposomes were also characterized based on their ideal particle size and encapsulation efficiency, and then incorporated into the different ratios of chitosan/gelatin hydrocolloid films. The films were prepared with increase in gelatin concentration and were evaluated for folding endurance, tensile strength, water absorption capacity, morphology, drug release kinetics, antimicrobial activity and stability. The morphology of these films was found to be very smooth and homogeneous proving a good compatibility between the two polymers. With increase in gelatin concentration, folding endurance, water absorption capacity, tensile strength, drug release kinetics and antimicrobial activity were increased. The antibacterial activity against various bacterial species was improved in the bacitracin loaded hydrocolloid films as compared to the blank films. Based on the findings above, it can be concluded that chitosan/gelatin films at 1:3 proportion is a successful wound dressing for wound management with improved wound healing properties than other formulations. This formulation is a potential candidate for the development of alternative pharmaceutical dosage forms, for the treatment of bacterial infected wounds, based on the activity of the eco-friendly chitosan matrix added to the bacitracin activity. In this work, chitosan also demonstrated a great potential as a dressing for advanced wound therapy and confirmed its good biocompatibility and potential to provide, in combination with liposomes, sustained drug release which is highly beneficial for wound treatment. The addition of gelatin improved the water affinity of the films and facilitated water mediated cross-linking process.
- Full Text:
- Date Issued: 2017
Dietary diversity amongst adults who buy at shopping malls in the Nelson Mandela Bay area
- Authors: De Bruin, Eunice Mari
- Date: 2017
- Subjects: Nutrition -- South Africa -- Port Elizabeth , Older people -- Nutrition Diet Food security -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/15027 , vital:28114
- Description: Background: Assessing the level of dietary diversity and contributing factors that influence the level of dietary diversity amongst adults can highlight gaps in nutrition interventions, policies and programmes, which aim at combating the double burden of malnutrition. Aim: The aim of this study was to determine which factors and relationships affect the level of dietary diversity of adults in the Nelson Mandela Bay area. Design: An exploratory comparative, cross-sectional, quantitative study design with a qualitative component that was utilised. Both interviewer- and participantadministered questionnaire sections were applied. Data were analysed using IBM SPSS Statistics, Statistica Version 12, Microsoft Office Excel 2007, Spearman rho correlation co-efficient and Pearson’s chi-square test (p-value <0.05). Participants and setting: A convenience-stratified sample (n=480) was used, consisting of adults who reside and shop at shopping centres in the Nelson Mandela area, after obtaining informed consent. Results: The findings indicated that adults in the Nelson Mandela Bay area who shopped at shopping malls had a medium level of dietary diversity. The dietary patterns found were not in line with the South African Food Based Dietary Guidelines. The most consumed food items were ‘cereals' (95%), 'sweetening agents and sweets' (89%) and ‘spices, condiments and beverages’ (87%). Fruit (45,2%) and vegetables (64,8%) were generally poorly consumed. Significance was shown as having an effect on the level of dietary diversity for factors such as ethnicity, level of education, amount of money spent on food purchase per month, distance travelled to purchase food, and nutrition knowledge. Conclusion: The study suggests that adults living in the Nelson Mandela Bay area have a medium level of dietary diversity, with practices that are not in line with the recommended South African Food Based Dietary Guidelines. Strategies, including nutrition education promotion and the implementation of current policies, programmes and interventions, should be implemented and/or strengthened to encourage behaviour change.
- Full Text:
- Date Issued: 2017
- Authors: De Bruin, Eunice Mari
- Date: 2017
- Subjects: Nutrition -- South Africa -- Port Elizabeth , Older people -- Nutrition Diet Food security -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/15027 , vital:28114
- Description: Background: Assessing the level of dietary diversity and contributing factors that influence the level of dietary diversity amongst adults can highlight gaps in nutrition interventions, policies and programmes, which aim at combating the double burden of malnutrition. Aim: The aim of this study was to determine which factors and relationships affect the level of dietary diversity of adults in the Nelson Mandela Bay area. Design: An exploratory comparative, cross-sectional, quantitative study design with a qualitative component that was utilised. Both interviewer- and participantadministered questionnaire sections were applied. Data were analysed using IBM SPSS Statistics, Statistica Version 12, Microsoft Office Excel 2007, Spearman rho correlation co-efficient and Pearson’s chi-square test (p-value <0.05). Participants and setting: A convenience-stratified sample (n=480) was used, consisting of adults who reside and shop at shopping centres in the Nelson Mandela area, after obtaining informed consent. Results: The findings indicated that adults in the Nelson Mandela Bay area who shopped at shopping malls had a medium level of dietary diversity. The dietary patterns found were not in line with the South African Food Based Dietary Guidelines. The most consumed food items were ‘cereals' (95%), 'sweetening agents and sweets' (89%) and ‘spices, condiments and beverages’ (87%). Fruit (45,2%) and vegetables (64,8%) were generally poorly consumed. Significance was shown as having an effect on the level of dietary diversity for factors such as ethnicity, level of education, amount of money spent on food purchase per month, distance travelled to purchase food, and nutrition knowledge. Conclusion: The study suggests that adults living in the Nelson Mandela Bay area have a medium level of dietary diversity, with practices that are not in line with the recommended South African Food Based Dietary Guidelines. Strategies, including nutrition education promotion and the implementation of current policies, programmes and interventions, should be implemented and/or strengthened to encourage behaviour change.
- Full Text:
- Date Issued: 2017
The relationship between selected body composition components and self-efficacy among 12-14 year old rural adolescents in the Eastern Cape Province of South Africa
- Authors: Nkopo, Mandisi, S
- Date: 2017
- Subjects: Child development -- South Africa -- Eastern Cape Children -- Growth Body composition
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10353/4536 , vital:28403
- Description: Body composition changes drastically in both males and females during the adolescent years. The changes may have a negative effect on their physical health as well as psychological well-being, with respect to attributes such as self-efficacy. Being either overweight or obese during adolescence has social, economic and psychological consequences, which include low self-efficacy. However, very few international studies and not a single South African study could be found which measured the relationship of anthropometric body composition components, general self-efficacy levels and actual measured body size among adolescents, particularly among rural adolescents. Consequently, the aim of this study was to investigate the relationship between anthropometric body composition components and self efficacy, by conducting a comparison of self-efficacy levels among normal, overweight and obese 12 to 14-year-old rural adolescents in the Eastern Cape Province of South Africa. The sample consisted of boys (n=49) and girls (n=43) between the ages of 12 and 14 years. The body composition components were body weight, stature, body mass index, sum of 3 skinfolds, percentage body fat and hip-to-waist ratio. The sample was also classified into normal, overweight and obese groups, according to body mass index. A self-administered Self-Efficacy Questionnaire for Children (SEQ-C) which was developed by Muris (2001) was used to measure general self-efficacy. Data were analyzed by means of descriptive statistics, the Pearson correlation matrix and Cohen's effect size for significance (Cohen, 1992) and a Mann-Whitney U Test was used to determine statistical differences. Significance was set at p<0.05. Only 17 percent of the participants in the research sample were found to be overweight or obese. Only emotional self-efficacy showed significant (p=0.02) differences between the participants who were classified as having normal weights and the group which comprised the overweight and the obese groups. Overweight and obese boys and girls still had very high levels of self-efficacy, although their body mass index scores were high. Boys scored higher in social self-efficacy and girls in academic self-efficacy. Only girls presented significantly high correlations between body mass index and emotional self-efficacy (r=0.33, p=0.02), total self-efficacy and hip-to-waist ratio (r=0.44, p=0.00), social self-efficacy and hip-towaist ratio (r=0.39, p=0.01) and emotional self-efficacy and hip-to-waist ratio (r=0.33, p=0.02), while boys presented them only with respect to body weight (r=0.31, p=0.02) and stature (r=0.39, p=0.00). The results suggest that a positive relationship exists between body composition, in terms of hip-to-waist ratio, weight and stature, and self-efficacy among South African rural adolescents. However, girls presented significantly strong and positive correlations between hip-to-waist ratio and self-efficacy, whereas boys presented significant, strong and positive correlations between body weight, stature and self-efficacy. Only emotional self-efficacy showed significant differences between normal weight and overweight or obese South African rural adolescents. It seems likely that cultural beliefs may exert an influence on the psychosocial perceptions of adolescents in relation to body size, consequently affecting self efficacy levels.
- Full Text:
- Date Issued: 2017
- Authors: Nkopo, Mandisi, S
- Date: 2017
- Subjects: Child development -- South Africa -- Eastern Cape Children -- Growth Body composition
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10353/4536 , vital:28403
- Description: Body composition changes drastically in both males and females during the adolescent years. The changes may have a negative effect on their physical health as well as psychological well-being, with respect to attributes such as self-efficacy. Being either overweight or obese during adolescence has social, economic and psychological consequences, which include low self-efficacy. However, very few international studies and not a single South African study could be found which measured the relationship of anthropometric body composition components, general self-efficacy levels and actual measured body size among adolescents, particularly among rural adolescents. Consequently, the aim of this study was to investigate the relationship between anthropometric body composition components and self efficacy, by conducting a comparison of self-efficacy levels among normal, overweight and obese 12 to 14-year-old rural adolescents in the Eastern Cape Province of South Africa. The sample consisted of boys (n=49) and girls (n=43) between the ages of 12 and 14 years. The body composition components were body weight, stature, body mass index, sum of 3 skinfolds, percentage body fat and hip-to-waist ratio. The sample was also classified into normal, overweight and obese groups, according to body mass index. A self-administered Self-Efficacy Questionnaire for Children (SEQ-C) which was developed by Muris (2001) was used to measure general self-efficacy. Data were analyzed by means of descriptive statistics, the Pearson correlation matrix and Cohen's effect size for significance (Cohen, 1992) and a Mann-Whitney U Test was used to determine statistical differences. Significance was set at p<0.05. Only 17 percent of the participants in the research sample were found to be overweight or obese. Only emotional self-efficacy showed significant (p=0.02) differences between the participants who were classified as having normal weights and the group which comprised the overweight and the obese groups. Overweight and obese boys and girls still had very high levels of self-efficacy, although their body mass index scores were high. Boys scored higher in social self-efficacy and girls in academic self-efficacy. Only girls presented significantly high correlations between body mass index and emotional self-efficacy (r=0.33, p=0.02), total self-efficacy and hip-to-waist ratio (r=0.44, p=0.00), social self-efficacy and hip-towaist ratio (r=0.39, p=0.01) and emotional self-efficacy and hip-to-waist ratio (r=0.33, p=0.02), while boys presented them only with respect to body weight (r=0.31, p=0.02) and stature (r=0.39, p=0.00). The results suggest that a positive relationship exists between body composition, in terms of hip-to-waist ratio, weight and stature, and self-efficacy among South African rural adolescents. However, girls presented significantly strong and positive correlations between hip-to-waist ratio and self-efficacy, whereas boys presented significant, strong and positive correlations between body weight, stature and self-efficacy. Only emotional self-efficacy showed significant differences between normal weight and overweight or obese South African rural adolescents. It seems likely that cultural beliefs may exert an influence on the psychosocial perceptions of adolescents in relation to body size, consequently affecting self efficacy levels.
- Full Text:
- Date Issued: 2017
Knowledge, attitudes and experiences of dieticians in relation to tuberculosis at the workplace
- Authors: Oxland, Ingrid Oxley
- Date: 2016
- Subjects: Tuberculosis -- South Africa -- Etiology Disease management -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/12972 , vital:27140
- Description: Tuberculosis (TB) is acknowledged as an epidemic in South Africa. Health care professionals (HCPs), including dieticians, are at an increased risk for TB-infection compared to the general population. Implementation of the World Health Organization (WHO) TB infection control measures can protect HCPs from contracting TB; however, many studies have shown poor adherence to guidelines by HCPs. The aim of the study was to determine dieticians’ knowledge, attitudes and experiences in relation to TB at the workplace. A descriptive quantitative, cross-sectional research design was employed. Convenience sampling was applied. The online survey was conducted between August 2014 and March 2015. Data analysis included descriptive and inferential statistics. Ethical principles were adhered to. The sample consisted of 102 registered dieticians in South Africa. Good knowledge was displayed as two-thirds of dieticians correctly identified the National TB Management Guidelines and the main signs and symptoms of TB. However, a critical knowledge gap regarding TB transmission was identified, as only 42% of dieticians knew that TB could spread by talking. Favourable attitudes towards TB and infection control measures were present, except towards inadequate staffing levels and being worried about TB. The respondents reported that the fear of contracting TB affected patient interaction. Poor adherence to infection control measures was found. Only 45% of dieticians reported having a written TB infection control plan at their workplace, and only 23% were trained on TB infection control measures. Coughing patients were not always triaged and education material was not always available for TB patients. The availability of N-95 respirators was reported by 76% of dieticians. Training on TB infection control measures could influence dieticians’ adherence to infection control measures, ultimately protecting them from contracting TB at the workplace.
- Full Text:
- Date Issued: 2016
- Authors: Oxland, Ingrid Oxley
- Date: 2016
- Subjects: Tuberculosis -- South Africa -- Etiology Disease management -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/12972 , vital:27140
- Description: Tuberculosis (TB) is acknowledged as an epidemic in South Africa. Health care professionals (HCPs), including dieticians, are at an increased risk for TB-infection compared to the general population. Implementation of the World Health Organization (WHO) TB infection control measures can protect HCPs from contracting TB; however, many studies have shown poor adherence to guidelines by HCPs. The aim of the study was to determine dieticians’ knowledge, attitudes and experiences in relation to TB at the workplace. A descriptive quantitative, cross-sectional research design was employed. Convenience sampling was applied. The online survey was conducted between August 2014 and March 2015. Data analysis included descriptive and inferential statistics. Ethical principles were adhered to. The sample consisted of 102 registered dieticians in South Africa. Good knowledge was displayed as two-thirds of dieticians correctly identified the National TB Management Guidelines and the main signs and symptoms of TB. However, a critical knowledge gap regarding TB transmission was identified, as only 42% of dieticians knew that TB could spread by talking. Favourable attitudes towards TB and infection control measures were present, except towards inadequate staffing levels and being worried about TB. The respondents reported that the fear of contracting TB affected patient interaction. Poor adherence to infection control measures was found. Only 45% of dieticians reported having a written TB infection control plan at their workplace, and only 23% were trained on TB infection control measures. Coughing patients were not always triaged and education material was not always available for TB patients. The availability of N-95 respirators was reported by 76% of dieticians. Training on TB infection control measures could influence dieticians’ adherence to infection control measures, ultimately protecting them from contracting TB at the workplace.
- Full Text:
- Date Issued: 2016