Browsing by Author "Clarke, Megan Janet"
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- ItemRegulations relating to foodstuffs for infants and young children : perspectives from South African dietitians(Stellenbosch : Stellenbosch University, 2018-12) Clarke, Megan Janet; Koen, Nelene; Du Plessis, Lisanne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: Knowledge surrounding the importance of breastfeeding is ever increasing and authorities have long since realised that the inappropriate marketing of breastmilk substitutes (BMS) undermines optimal breastfeeding practices. Many countries have legislated the International Code of Marketing of Breast-milk Substitutes (The World Health Organization [WHO] Code) drafted by the World Health Alliance (WHA) in 1981. South Africa adopted its own legislation (that is, The Regulations Relating to Foodstuffs for Infants and Young Children [R991] [The Regulations]) in December 2012. The perspectives of health care providers (HCPs) on the Regulations are an important factor to consider as they play a pivotal role in the implementation of such Regulations. Objective: The study aimed to determine the knowledge, perceptions, behaviours and practices of dietitians in South Africa regarding the Regulations Relating to Foodstuffs for Infants and Young Children (R991) (The Regulations). Methodology: A mixed method, cross-sectional design was used; including quantitative data by means of an online survey (n = 282) collected throughout South Africa and qualitative data by means of two focus group discussions (n = 12) collected in KwaZulu-Natal. Study participants were dietitians registered with the Health Professions Council of South Africa (HPCSA). Results: Dietitians’ average knowledge score was 64.8% ± 12.5. Those working in infant and young child feeding (IYCF) had a 5% higher knowledge score. Perceptions on the Regulations were generally positive and supportive. Representatives of designated products were mostly supportive and positive towards the Regulations. The majority of dietitians’ practices were compliant with the Regulations. The major barriers to the implementation of the Regulations identified were a lack of awareness among HCPs and the general public and a lack of training for HCPs. The major enablers identified were other breastfeeding promotion initiatives, greater awareness and compliance from industry and awareness creation by the Department of Health (DoH). Knowledge scores were linked to certain perception and practice questions, generally respondents with higher knowledge scores selected more decisive answers. Perceptions and practices seemed to correlate in certain areas; commonly, with more positive perceptions correlating with more compliant practices. The major themes that arose from the focus group discussions included: less knowledge among dietitians and mothers about products controlled under the Regulations, non-compliance of other HCPs, the dietitians’ role in supporting and enforcing the Regulations, the discrepancy between practice in private and public sectors and a lack of enforcement. Conclusion: Dietitians revealed an average knowledge score of 64.8% relating to the Regulations. Perceptions and practices were generally positive and compliant. Higher knowledge scores seemed to be linked to a better ability to practice in accordance with the Regulations and more compliant practices. Many enablers and barriers arose which provided interesting insights into how the Regulations were being established within the country. There are still gaps that need to be addressed in the regulation of IYCF, South Africa has taken the first step in legislating the WHO Code and should upscale programmes to ensure consistent monitoring and enforcing of the Regulations. Research that evaluates the implementation and determines the impact of legislating the WHO Code is important to strengthen weaknesses and provide insights to policy makers going forwards.