A qualitative assessment of the preliminary food-based dietary guidelines for infants 6-12 months of age in the greater Oudtshoorn area

Van der Merwe, Julanda (Stellenbosch : University of Stellenbosch, 2004-12)

Thesis (MVoeding)--University of Stellenbosch, 2004.

Thesis

ENGLISH ABSTRACT: Objectives and scope of investigation Following the 1996 recommendations of a FAO/WHO expert panel for the development of food-based dietary guidelines (FBDGs) unique and specific to the needs of the populations of different countries, a South African FBDG Working Group was formed and ultimately also a Paediatric FBDG (PFBDG) Working Group with the task of the latter being the development of FBDGs for children younger than 7 years. A set of preliminary PFBDGs, chosen to address the most pressing paediatric public health issues, namely protein-energy malnutrition, micronutrient deficiencies and infectious diseases, were formulated for each age group sub-category (0-6 months, 6-12 months and 1-7 years). The following set of preliminary PFBDGs for the age group 6-12 months were approved by the Working Group to be subjected to consumer testing: • Enjoy time with your baby • From six months start giving your baby small amounts of solid foods • Gradually increase your baby’s meals to five times a day • Keep breast feeding your baby • Offer your baby clean, safe water regularly • Teach your baby to drink from a cup • Take your baby to the clinic every month Assessment of the consumer’s comprehension, interpretation of the proposed guidelines, and ability to apply them, was considered essential before the PFBDGs could be finalised, disseminated to the consumer, and implemented as an educational tool for health professionals and community workers. This study was also the first in which PFBDGs were tested, and was intended to be a pilot study for further testing of PFBDGs for this age category in other parts of the country, adapted for different circumstances. The investigation was conducted among women who were mothers or caregivers to infants 6-12 months of age in the Afrikaans-, English- and Xhosa-speaking communities of the greater Oudtshoorn area, including Bongulethu, Bridgeton and Toekomsrus and its adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar. Methodology The study was designed to be an observational, descriptive and cross-sectional study. Qualitative data was collected from a sample of 64 volunteers who took part in ten focus group discussions each attended by between 3 and 11 participants. Group discussions were recorded on videotape and quantitative and qualitative questionnaires measured pre-discussion knowledge and comprehension of guidelines, perceived hindrances to compliance with guidelines and perceived importance of guidelines as well as socio-demographic data. Results and conclusions With this study, useful and enlightening information was obtained which met the research objectives. Participants discussed the guidelines in depth and information obtained from the questionnaires were found to support what was said during the discussions. Body language or non-verbal communication as observed, and recorded on videotape, also complemented the information gained from the discussions. Summarily it can be said that the guidelines were well-received and perceived as important by the majority of respondents, although some of the guidelines were initially not well-understood without explanation. Furthermore, the fact that the applicability of the guideline on prolonged breast feeding seems to be the most problematic, is a cause for concern. In view of the results obtained in this study, it can be concluded that PFBDGs will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The findings of this study will be submitted to the PFBDG Working group for consideration before finalisation of the guidelines for the age group 6-12 months.

AFRIKAANSE OPSOMMING: Doelwitte en omvang van die studie Na aanleiding van die 1996 aanbevelings van ‘n VLO/WGO paneel van kenners vir die ontwikkeling van voedselgebaseerde dieetriglyne (VGDR) wat uniek en spesifiek gerig is tot die behoeftes van die bevolkings van verskillende lande, is ‘n Suid-Afrikaanse VGDR Werkgroep gevorm en uiteindelik ook ‘n Pediatriese VGDR (PVGDR) Werkgroep met die opdrag van laasgenoemde om VGDRe te ontwikkel vir kinders jonger as 7 jaar. ‘n Stel voorlopige Pediatriese VGDRe, gekies om die mees dringende pediatriese publieke gesondheidsvraagstukke, naamlik proteïn-energie wanvoeding, mikronutriënttekorte en infektiewe siektetoestande aan te spreek, is geformuleer vir elke ouderdomsgroep subkategorie (0-6 maande, 6-12 maande en 1-7 jaar). Die volgende stel voorlopige PVGDRe vir die ouderdomsgroep 6-12 maande is deur die Werkgroep goedgekeur om aan verbruikerstoetsing te onderwerp: • Geniet tyd saam met jou baba • Begin vanaf ses maande om jou baba klein hoeveelhede vaste kos te gee • Vermeerder jou baba se maaltye geleidelik na vyf keer per dag • Hou aan om jou baba te borsvoed • Bied gereeld vir jou baba skoon, veilige drinkwater aan • Leer jou baba om uit ‘n koppie te drink • Neem jou baba elke maand kliniek toe Evaluering van die verbruiker se begrip, interpretasie van die riglyne en die vermoë om die riglyne te implementeer, is as noodsaaklik beskou voordat die PVGDRe gefinaliseer kon word, vrygestel kon word aan die publiek, en aan professionele- en gemeenskapsgesondheidswerkers beskikbaar gestel kon word as ‘n onderrighulpmiddel. Hierdie studie was die eerste waarin PVGDRe getoets is en dit is bedoel as ‘n voorloperstudie vir verdere toetsing van PVGDRe vir hierdie ouderdomskategorie in ander dele van die land en aangepas vir ander omstandighede. Die ondersoek is gedoen onder vroue wat moeders of versorgers van babas van 6-12 maande was in die Afrikaans- Engels- en Xhosasprekende gemeenskappe van die groter Oudtshoorn area wat Bongulethu, Bridgton en Toekomsrus insluit asook die nabygeleë plattelandse gemeenskappe van Dysselsdorp, Calitzdorp, Uniondale, Ladismith en Zoar. Metodiek Die studie is ontwerp om ‘n waarnemende en beskrywende analise van ‘n deursnee van die studiepopulasie moontlik te maak. Kwalitatiewe data is verkry van ‘n proefmonster van 64 vrywilligers wat deelgeneem het aan tien fokusgroep besprekings wat elk deur 3 tot 11 persone bygewoon is. Groepbesprekings is op videoband opgeneem en kwantitatiewe en kwalitatiewe vraelyste het voorbesprekings kennis en begrip van die voorgestelde riglyne, vermeende verhindering tot uitvoering van die riglyne en vermeende belangrikheid van riglyne sowel as sosio-demografiese inligting gemeet. Resultate en gevolgtrekkings Met hierdie studie is bruikbare en verhelderende inligting verkry wat beantwoord het aan die doelwitte van die studie. Deelnemers het die riglyne in diepte bespreek en dit is bevind dat inligting wat van die vraelyste verkry is, ook dit bevestig het wat gedurende die sessies bespreek is. Lyftaal en nie-verbale kommunikasie soos waargeneem en soos op videoband vasgelê, het ook die inligting ondersteun wat van die besprekingsessies verkry is. Opsommend kan gesê word dat die riglyne goed ontvang is en as belangrik beskou is deur die meerderheid van respondente. Sommige van die riglyne was nie vir deelnemers goed verstaanbaar sonder meegaande verduideliking nie. Verder is die feit dat die toepasbaarheid van die riglyn met betrekking tot ‘n verlengde tydperk van borsvoeding voorgekom het as die mees problematiese, ‘n rede tot kommer In die lig van die resultate van hierdie studie, kan daar tot die slotsom gekom word dat PVGDRE ondersteun sal moet word deur omvattende en gepaste onderrigmateriaal om effektief te kan wees wanneer dit aan die publiek bekend bekend gestel word. Die bevindings van hierdie studie sal aan die Pediatriese VGDR Werkgroep voorgelê word vir oorweging voordat riglyne vir die ouderdomsgroep 6-12 maande gefinaliseer word.

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