An assessment of the comprehension of the preliminary 2007 version of the South African paediatric food-based dietary guidelines for Northern Sotho infants 6–12 months of age in Soshanguve and Ga-Rankuwa

Pretorius, Adeline (2015-04)

Thesis (MNutr--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: Introduction Malnutrition, in both adults and children, is a problem worldwide with negative health consequences. The World Health Organization (WHO) and Food and Agricultural Organization (FAO) of the United Nations (UN) therefore initiated the implementation of country-specific food-based dietary guidelines (FBDGs) to be used as an educational tool to address nutrition-related health issues. They further suggested consumer testing to evaluate the comprehension and cultural acceptability thereof prior to the release of country-specific FBDGs. Focus group discussions (FGDs) were recommended for consumer testing. Aim The aim of this study was to assess the comprehension and applicability of the 2007 version of the preliminary South African paediatric food-based dietary guidelines (PFBDGs) for healthy infants aged 6–12 months in Soshanguve and Ga-Rankuwa. Specific objectives included qualitative evaluation of exposure to preliminary PFBDGs, participants’ interpretation thereof, cultural acceptability and practical application of the guidelines. Socio-demographic information was collected to determine whether these factors could potentially exert an influence on the comprehension and applicability of the FBDGs. This study could further inform emerging efforts to update public health initiatives to educate mothers/caregivers of infants. Methodology An observational, cross-sectional study design was followed, incorporating both qualitative and quantitative research methods. FGDs were utilised to assess comprehension of the PFBDGs and gather insight into perceptions, attitudes and appropriateness of the PFBDGs. Quantitative data were collected by means of a questionnaire regarding the socio-demographic profiles of participants. Setting This study focused on two small, densely populated towns, Soshanguve and Ga-Rankuwa, in the north western district of Tshwane in the Gauteng province of South Africa. The areas represent relatively low socio-economic communities that include a mix of formal and informal urban setting. Participants Twenty-seven Northern Sotho-speaking mothers and caregivers of infants aged 6–12 months participated in a total of six FGDs. Each FGD was attended by between three and six participants. Results None of the participants had previous exposure to the PFBDGs, although they were familiar with most of the concepts. Guidelines were generally well received and understood, but a few were misinterpreted; particularly those pertaining to “enjoy time with your baby”, “increase your baby’s meals to five times per day” and “teach your baby to drink from a cup”. These needed further explanation and rephrasing by the investigator to improve their comprehensibility. The guideline pertaining to breastfeeding was the most familiar, well accepted and most generally applied. Quantitative results indicated no significant difference between the socio-demographic profiles of participants in Soshanguve and Ga-Rankuwa. Participants’ education level, employment status and housing conditions were considered a good representation of the population. It appears that socio-demographic circumstances may affect exposure to, and interpretation and application of the PFBDGs. Conclusion Many of the adjustments recommended from this research is consistent with the changes incorporated in the recently published revised PFBDGs. Supportive documentation, educational material and health campaigns tailored to specific socio-demographic groups may further enhance the interpretation of the revised guidelines and their exposure to the public, once tested and adopted.

AFRIKAANSE OPSOMMING: Inleiding Wanvoeding onder kinders en volwassenes, is ʼn wêreldwye probleem wat, as dit nie aangespreek word nie, ernstige gesondheidsgevolge kan inhou. Die Wêreldgesondheidsorganisasie (WGO) en die Voedsel-en-landbou-organisasie (VLO) het die implementering van voedselgebaseerde dieetriglyne (VGDR) spesifiek aan elke land geïnisieer sodat dit as opleidingshulpmiddel kan dien om voedselverwante gesondheidsprobleme op te los. Daar is voorgestel dat verbruikers die riglyne in fokusgroepbesprekings (FGBs) evalueer om begrip en die kulturele toepaslikheid van bevolking-spesifieke riglyne te toets voordat dit bekendgestel word. Doel Die doel van die studie was om begrip en die toepassing van die 2007 weergawe van die voorlopige Suid-Afrikaanse pediatriese voedselgebaseerde dieetriglyne (PVGDR) vir gesonde kinders van 6–12 maande te bepaal. Spesifieke doelwitte het kwalitatiewe evaluering ten opsigte van blootstelling, deelnemers se interpretasie, kulturele aanvaarbaarheid en praktiese toepassing van die riglyne ingesluit. Sosiodemografiese inligting is ingesamel om te bepaal of daar ʼn verband bestaan tussen hierdie omstandighede en die begrip en toepassing van PVGDR’s. Hierdie studie kan toekomstige pogings ondersteun om openbare-gesondheidsprogramme by te werk en om moeders en versorgers oor babas in te lig. Ontwerp Die studieontwerp was ’n waarnemende deursnit met kwalitatiewe en kwantitatiewe navorsingsmetodes. FGBs was gebruik om die begrip van die PVGDR’s te bepaal en insigte oor die persepsies, houdings en geskiktheid van die PVGDR’s in te samel. Kwantitatiewe data is ingesamel met ʼn vraelys oor die sosiodemografiese profiele van deelnemers. Omgewing Die studie het gefokus op twee klein, digbevolkte stedelike gebiede, Soshanguve en Ga-Rankuwa in Tshwane, die noord-westelike distrik van die provinsie Gauteng in Suid-Afrika. Die areas verteenwoordig relatief lae sosio-ekonomiese gemeenskappe met ʼn mengsel van formele en informele stedelike nedersettings. Deelnemers Die studiegroep het 27 Noord-Sotho-sprekende moeders en versorgers ingesluit wat aan altesaam 6 FGB’s deelgeneem het. Tussen drie en ses deelnemers het elke FGB bygewoon. Resultate Geen deelnemers was voorheen aan PVGDR’s blootgestel nie, hoewel die meerderheid met meeste van die begrippe bekend was. Die riglyne was oor die algemeen goed aanvaar en verstaanbaar, maar ʼn paar was verkeerd geïnterpreteer; veral “geniet tyd saam met jou baba”, “vermeerder jou baba se maaltye na vyf kere per dag” en “leer jou baba om uit ʼn koppie te drink”. Verduideliking en herformulering was nodig om begrip te verbeter. Die riglyne oor borsvoeding was die bekendste, was die beste aanvaar en was in die algemeen toegepas. Kwantitatiewe resultate het aangedui dat die sosiodemografiese profiel van deelnemers uit Soshanguve en dié uit Ga-Rankuwa nie beduidend verskil nie. Deelnemers se opleidingsvlak, werkloosheidstatus en huislike omstandighede het die populasie goed verteenwoordig. Daar is bevind dat sosiodemografiese omstandighede blootstelling aan en begrip en toepassing van PVGDR’s kan beïnvloed. Gevolgtrekking Baie van die wysigings wat voorgestel is deur hierdie studie, stem ooreen met die verandering wat aangebring is in die onlangs gepubliseerde hersiene PVGDR’s. Ondersteunende dokumente, opvoedkundige materiaal en gesondheidsveldtogte vir spesifieke sosiodemografiese groepe sal die korrekte interpretasie van riglyne asook openbare bewusmaking bevorder. Die riglyne kan, met minimale aanpassings, suksesvol as ʼn voedingsverwante opvoedkundige hulpmiddel in die gemeenskap gebruik word. Baie van hierdie aanpassings is reeds aangebring tydens die ontwikkeling van die veranderde PVGDR’s. Die bevindinge van die studie kan ʼn kernbydrae tot die voorstelle lewer, en aanduidings vir voorstelle vir verdere ontwikkeling en evaluering oplewer.

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