Doctoral Degrees (Human Nutrition)

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Browsing Doctoral Degrees (Human Nutrition) by browse.metadata.advisor "Labadarios, Demetre"

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    Effects of initial nutritional status on the responses to a school feeding programme among school children aged 6 to 13 years in the Millennium Villages Project, Siaya, Kenya
    (Stellenbosch : Stellenbosch University, 2013-12) Masibo, Peninah Kinya; Labadarios, Demetre; Herselman, Marietjie; Ettyang, Grace; Deckelbaum, Richard J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    ENGLISH ABSTRACT: Aim: To assess the effects of initial nutritional status on the responses to a school feeding programme (SFP) among school children in the Millennium Villages Project (MVP), Siaya District, Kenya. Objectives: To establish baseline data on the dietary intake, prevalence of undernutrition, body composition, prevalence of anaemia, body iron stores and vitamin A status in order to assess the impact of the SFP over a 30-month period on the same outcomes. Further, the study assessed the effect of initial nutritional status on the responses to the SFP on growth, the prevalence of anaemia, body iron stores and vitamin A status. Methods: In the MVP, a school meal additional to the children’s usual daily food intake was provided consisting of locally available foods (containing whole fish omena and beef). The meals contributed approximately 25% of the Estimated Energy Requirement (EER), 70% of the Estimated Average Requirement (EAR) for protein, and 18% of EAR for fat. A school meal, additional to the children’s usual daily food intake, was introduced to the control group 6 months into the study as a project scale up initiative. The meal provided 15% EER, 49 % EAR for protein and 10% EAR for fat. A total of 235 children participated in the study and were followed up for 30 months, with 118 in the MVP and 117 in the control group. Statistical analysis included descriptive, Pearson’s chi-square test, repeated measures ANOVA and multivariate logistic regression models. Results: The mean subject age was 7.9 years (2.0 SD) at baseline, and half (51.4%) were boys. More than half of the children (66%) had energy intakes less than the EER. At baseline, the prevalence of stunting, wasting and underweight was 16.9%, 6.0% and 3.6% respectively. Prevalence of linear growth deficit based on height-for-age z-score ≤-1 standard deviation was 48%. Anaemia was higher in the MVP group (82.2%; P < 0.0001) compared to controls (58.1%) while depleted body iron stores was observed in 10.7% of the children. Half of the children in the control group and 30% in the MVP group had an inadequate vitamin A status while 11% of the children had infection/inflammation. At six months after initiation of the intervention, anaemia prevalence was reduced to 41.2% among the controls and 9.3% in the intervention group (P < 0.001). Among the MVP group, children with initial inadequate nutritional status based on weight-for-age z-score WAZ ≤ -1 SD had a higher (P < 0.01) height velocity (2.3 cm/six months) by the 24th month study interval compared to those who had an initial adequate nutritional status based on weight-for-age z-score WAZ > -1 SD. Conclusion: SPF menus were associated with potential for improved growth, gain in lean body mass and reduced anaemia prevalence when inadequate nutritional status was present at baseline.
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    Evaluation of two counseling strategies improving exclusive breastfeeding among HIV-negative mothers in Kibera Slum, Nairobi, Kenya : a randomized controlled trial
    (Stellenbosch : Stellenbosch University, 2008-12) Ochola, Sophie Atieno; Labadarios, Demetre; Nduati, Ruth; Nel, D. G.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    Objectives: To determine the impact of facility-based semi-intensive and home-based intensive counseling strategies to improve exclusive breastfeeding rates and to identify factors associated with exclusive breastfeeding. Methods: This was a randomized trial in which villages in the Kibera slum, Nairobi Kenya were assigned to two intervention groups and a control group. Study participants from among 34-36 week pregnant, HIV-negative women, attending antenatal clinic at Lang’ata health centre, were assigned to study groups and followed up in their homes until 6 months postpartum. Experimental group 1, the Home-Based Intensive Counseling Group (HBICG)] received 7 counseling sessions; 1 prenatally and 6 postnatally. Experimental group 2, the Facility-Based Semi-Intensive Counseling Group (FBSICG) received 1 counseling session prenatally. The control group (Control Group) received irregularly provided health education by health personnel. Information on infant feeding practices, using a validated 24-hour recall questionnaire was collected monthly at participant homes; observations were conducted on a random 10% sub-sample to verify the reported information. Qualitative data from focus group discussions provided information on the rationale for feeding choices. Information on infant morbidity and weight measurements were taken on a monthly basis. Results: At six months, exclusive breastfeeding rate was 23.6% in HBICG; 9.2% in FBSICG; and 5.6% in CG. Mothers from HBICG had a 4.2 increased likelihood to exclusively breastfeed compared to those in the CG (RR=4.20; 95% CI; 1.66-10.64; p=0.002). Cumulative exclusive breastfeeding rate for 6 months was 3.2% in the CG; and 6.9% and 15.6% in the FBSICG and HBICG respectively (p<0.00001). Mothers from HBICG had a 3.4 increased likelihood to practice exclusive breastfeeding for 6 months compared to those in CG (RR=3.4; 95% CI: 1-34-8.80; p=0.010). Exclusive breastfeeding rates in FBSICG were insignificantly higher than those in the CG. The median duration of exclusive breastfeeding was one month in both the CG and FBSICG and three months in the HBICG. The predictors of exclusive breastfeeding were non-giving of post-lacteal feeds; planned long breastfeeding duration; living in smaller households; non-ownership of telephones and televisions; absence of breast health problems; and correct knowledge of breastfeeding duration. The major hindrances to exclusive breastfeeding were: inadequate knowledge of exclusive breastfeeding; cultural perceptions about infant feeding; and absence of mother from home for long periods. The prevalence of acute respiratory infections and diarrhoea were significantly lower among exclusively breastfed infants than those non-exclusively breastfed. The prevalence of underweight was significantly lower among the exclusively breastfed infants than those non-exclusively breastfed at one month (p=0.006) and three months (p=0.005). Conclusions: It is feasible to promote and sustain exclusive breastfeeding for six months in low socioeconomic conditions, using the home-based intensive counseling strategy. Breastfeeding promotion programmes should adopt strategies to allow for wider dissemination of information, targeting both mothers and the community at large, as this study showed family members were major decision-makers in the choice of infant feeding practices. Hospital-based breastfeeding education should offer detailed information on a consistent basis. Breastfeeding promotion messages should be re-packaged to address cultural perceptions in infant feeding practices.
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    Information technology (IT) with a human face : a collaborative research project to improve higher nutrition training in Southern Africa
    (Stellenbosch : Stellenbosch University, 2008-12) Marais, Debbie; Labadarios, Demetre; Ogle, Britta; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
    Various enabling factors are required to incorporate technology in teaching and learning, moving towards a more learner-centred approach. Although efforts are being made to address the situation, the effective incorporation of ICT is not yet the norm in African higher education institutions (HEI). Data is available regarding the situation in African HEI, but very little is known about the situation of nutrition training. This research programme was divided into three phases. Phase I, assessment of the current use, awareness, attitudes and practices of ICT in nutrition training followed a descriptive, cross-sectional approach. A convenience sample of six HEI in South Africa, Malawi, Zambia, Swaziland and Zimbabwe was included. Data were collected from students (N = 591) and lecturing staff (N = 29) in nutrition-related courses using a questionnaire on ICT awareness, attitude and practices. Phase II, development and validation of a purpose-designed e-learning nutrition module followed a descriptive, cross-sectional approach. An e-learning module on Nutrition and HIV/AIDS with eleven sub-modules was developed, using an e-learning platform taking the specific constraints of developing countries into account. It was validated by expert reviewers (N = 27) for content validity and students (N = 175) for face validity. Phase III, to determine the impact of the module on cognitive knowledge followed an experimental before-after approach and used a set of twenty True/False questions for eight of the sub-modules (N = 173). Although there is widespread accessibility to computers, less so to the internet, in nutrition-related courses at Southern African HEI, respondents still felt that more computers should be made available. Computers are not fast enough and lack of finances is the main barrier to home and internet access. Students rate their ICT skills as average to good. Institutional ICT policies and support seem to be lacking, but their attitude to ICT is positive and supportive. Respondents felt that ICT could add a new dimension to nutrition training and are in favour of application of ICT in different modes. Most indicate that the current use of ICT in nutrition training is inadequate. The Nutrition in HIV/AIDS module was validated and found to be useful as an educational tool, being user-friendly, interactive and self-paced. The majority of students reported that their ICT skills were sufficient to complete the e-learning activity. Although generally rated as at least as effective, or more effective than conventional lectures, clearly this mode of elearning should not replace traditional teaching. The content was found to be comprehensive and evidence-based. The depth of the content was sufficient, the level correct for undergraduates and the material relevant to the Southern African context. The interactivity was deemed important, helpful and effective. Most students indicated that they would recommend the Nutrition in HIV/AIDS module to other students, that they enjoyed the presentation and learnt something new. There was an improvement in knowledge scores and/or the number of questions being answered correctly in all but one sub-module. The results confirm previous studies indicating that well-designed elearning modules have the potential to increase the performance of students.