Masters Degrees (Human Nutrition)

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Abnormal eating attitudes and weight loss behaviours of girls attending a "traditional" Jewish high school in Johannesburg : an examination of teachers' awareness
(Stellenbosch : University of Stellenbosch, 2011-03) Notelovitz, Talia; Visser, J.; Szabo, C. P.; Fredericks, N.; Harvey, J.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: Background: Eating disorders are an important cause of morbidity and mortality in adolescent and young adult women. There is some evidence that Eating disorders may be more common in Jewish females than in their non-Jewish counterparts. Individuals with abnormal attitudes as defined by the Eating Attitudes Test (26-Item version) (EAT-26) are at increased risk of developing an eating disorder. School teachers are required to take an active role in the currently favoured ecological approach to the prevention of eating disorders. Objectives: The current study sought to determine the prevalence of abnormal eating attitudes and weight loss behaviours in a Jewish female adolescent sample and to investigate school teachers’ awareness of these factors and their attitudes towards a school programme to address these. Methods: A cross-sectional study of girls in grades 8 to 11 and teachers of both genders was undertaken at a “traditional” Jewish high school in Johannesburg, South Africa. A questionnaire consisting of the EAT-26 and a modified section of the United States Youth Risk Behaviour Survey (YRBS) was completed by pupils. A questionnaire developed by the researcher for the study was completed by teachers. Results: Two hundred and twenty pupils (response rate 84.3%) and 38 teachers (52.1%) participated. Twenty percent of pupils (n=43) had EAT-26 scores greater than or equal to 20 and 30.2% were found to require clinical evaluation for a potential eating disorder Thirty two point seven percent (n=72) of girls considered themselves to be overweight. Sixty four percent (n=139) were trying to lose weight at the time of the study and 19.1% (n=42) had engaged in one or more extreme methods of weight loss (fasting, purging or non-prescribed medication) in the past 12 months. Most teachers (81.6%, n=29) underestimated the proportion of girls requiring clinical evaluation and 71.1% (n=27) underestimated the extent of current weight loss attempts. Almost all (97.3%, n=37) the teachers recognised the need to address disordered eating attitudes and patterns in the school but only 34.2% (n=13) viewed the school as the appropriate place, would be prepared to participate and would give up class time. Conclusions: This is the first study to document the presence of abnormal eating attitudes among Jewish adolescent females in South Africa. The prevalence fell within the upper end of the range of rates reported in studies of adolescent girls in South Africa and abroad. Dieting and attempts at weight loss are common in this population and are also in keeping with the findings from international studies. This is the first study to measure teachers’ awareness of the eating attitudes and weight loss behaviours of girls attending the school at which they teach. The teachers participating in this study were not fully aware of the extent to which eating-related issues affect female pupils. Over and above this, there appears to be a resistance to facilitating and participating in a school programme addressing these issues. A qualitative exploration of this could yield valuable insights.
Achievements and challenges of facilities implementing human milk banks in the KwaZulu-Natal province, South Africa
(Stellenbosch : Stellenbosch University, 2021-03) Kadir, Zaheeda; Daniels, Lynette; Boatemaa, Sandra; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY: Purpose: Human milk banks (HMB) (as a supporting mechanism) have a role to play in providing support to vulnerable infants to survive and thrive in the clinical setting. Human milk is better tolerated as it tends to reduce the length of stay in hospital and late onset sepsis, and decreases the risk of necrotising enterocolitis (NEC). With very few milk banks initiated and those that have been initiated struggling for sustainability, this research in the African context should assist in creating awareness of the importance of human milk banks (HMBs). The aim of the study was to analyse the activities of all human milk banks in KZN and to establish challenges and achievements between 2016 and 2019. Study Design: A longitudinal review study, with an analytical component, was conducted. Quarterly and annual reports from HMB in the KZN between 2016 and 2019 were used. Quantitative analysis on the performance indicators reported in the HMB reports and thematic analysis of achievements and challenges using the World Health Organization (WHO) system building blocks were used. Findings: A total of 91 reports were used in this study. New Donors increased from 264 in 2016 to 1 870 in 2019. A specialised facility was cited as having the largest number of infants receiving donor human milk, from 43 in 2016 to 194 in 2019. The amount of pasteurised milk transferred to other facilities was highest in 2016. The main achievement cited by the HMB reports was the increase in number of donors at district, regional, tertiary and specialised levels. The main challenge cited by the HMB reports was the lack of skilled HMB health workers. Conclusion: This study examined the activities of all human milk banks in KZN and established the challenges and achievements between 2016 and 2019. The various achievements such as acceptance of mothers donating human milk, assistance to other facilities that do not have an established HMB, and challenges such as lack of trained skilled staff, lack of consumables and non-functional equipment, should be considered. A national core model for implementation of HMB in South Africa will assist with a more standardised implementation of the HMB.
The adaptation of an appropriate screening tool for the early detection of malnutrition in individuals with intellectual disability (ID) in a psychiatric hospital in North West Province (South Africa)
(Stellenbosch : Stellenbosch University, 2012-12) Nel, Maretha; Marais, Maritha; Potgieter, Sunita; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nutrition.
ENGLISH ABSTRACT: Background: Considering the myriad of risk factors causing nutritional deficiency, as well as the prevalence of malnutrition and feeding problems experienced by individuals with intellectual disability (ID), early detection and diagnosis of malnutrition in this population group is essential. Objectives: The main aim and objectives of the study were to determine the degree of malnutrition and body composition in individuals with ID living in a psychiatric hospital (North West Province, South Africa), to determine which degree of ID was more prone to malnutrition, to investigate the different risk factors for malnutrition in this group of individuals, and to use this data to adapt an existing screening tool used to facilitate the easier identification of malnutrition. Methodology: An observational descriptive cross-sectional study, with an analytical component, was conducted. The study consisted of two phases. During the first phase, measurements were taken of individuals with ID to determine body composition and nutritional status. During the second phase, said data, as well as other factors influencing the nutritional status of individuals with ID, were used to adapt an existing screening tool to allow for easier identification of malnutrition in the study population. The adapted screening tool was tested by nursing staff. Results: The anthropometric measurements of 244 individuals with ID were determined. The overall anthropometrical status indicated that half of the study population (52,1%, n=127) had a normal nutritional status, that 38,1% (n=93) was undernourished or at risk of becoming undernourished, and that 10,0% (n=24) was either at risk of becoming or was overnourished . Men were more prone to being undernourished or at risk of becoming undernourished (48,0%, n=73), compared to women (21,7%, n=20). Although no significant difference was found in anthropometrical status across the four severities of ID (Pearson Chi-square test (ρ=0,15)), individuals with mild ID were more likely to become obese (19,4%, n=6), and individuals with profound ID were more prone to being underweight (57,1%, n=8). It was found that 41,8% (n=102) of the total study population had a waist circumference (WC) above the normal values. A significant difference was found between increased WC and severity of ID (Pearson Chi-square test (ρ=0,00)). Other risk factors that can influence nutritional status in said population included medical conditions such as hypertension (13,0%, n=32) and epilepsy (EP) (46,0%, n=112), as well as polypharmacy (71,7%, n=175). An existing malnutrition screening tool for the population with ID was adapted by means of the addition of prevalent factors (WC measurements, presence of EP and use of medications), as well as through adaptation of the scoring system. Conclusion: Using anthropometric measurements and indices for body composition, a high prevalence of malnutrition was identified in the study population of individuals with ID. The adapted screening tool was more sensitive than the original tool in identifying individuals who were at risk of malnutrition, or who were already malnourished in this study population. The research undertaken in this respect can help health care professionals to be more aware of the interaction between the severity of ID and malnutrition.
Anthropometric status in children aged 6-36 months, born from intended and unintended pregnancies in vulnerable communities from the Western Cape Province
(Stellenbosch : Stellenbosch University, 2019-04) Holm, Adri; Du Plessis, Lisanne; Skinner, Donald; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY : South Africa has a high rate of unintended pregnancies among vulnerable women. There is a growing body of evidence that shows the importance of the first 1000 days of life (namely, from conception to 2 years old). This time period in the life cycle provides a crucial window of opportunity for proper nutrition, which could improve overall health, cognitive capacity and academic performance, leading to improved health and socio-economic circumstances on an individual and national scale in South Africa. Improving the quality of women’s and girls’ pre-conception nutritional intake, as well as their intake during the period of pregnancy, could boost progressive maternal and child health and development outcomes. This cross-sectional study measured the pregnancy intention of mothers (n=72), aged 15 to 43 years old, retrospectively to analyse the impact thereof on their child’s current nutritional status in two vulnerable peri-urban communities in the Western Cape. Other determinants of health and its effects on children’s nutritional status were also investigated. From the sample population, 39% (n=28) of the pregnancies were categorised as “Unplanned”, 46% (n=33) as “Ambivalent” and only 15% (n=11) as “Planned”. Infants born from ambivalent pregnancy intention had a slightly lower birth weight than those of unplanned and planned pregnancy intention. Pregnancy intention and the current anthropometric status of the child were not associated [CI: -1.86 to 1.86]. A non-linear association was found between the ages of the sample population and their anthropometric status. Children aged 12 to 28 months were more prone to malnutrition.Women receiving their main income from the Child Support Grant had a significantly lower pregnancy intention than those women receiving their main income from either family or the child’s father (Prob > F =0.0038). No literature was previously available on whether there is a link between the high rate of unintended pregnancies in vulnerable communities in South Africa, and malnutrition in young children born from such pregnancies. This research concludes that unintended pregnancies did not contribute to malnutrition in the studied vulnerable peri-urban communities. Hence, even though many of the pregnancies were unintended, it seems as if most of the mothers found a way to care for the child. Improving nutritional quality and the emotional wellbeing of all women of childbearing potential, therefore, presents a key opportunity to improve future generations’ health and mitigate the risk of adverse long-term economic outcomes. Future mothers should be empowered to make decisions in the best interest of their children, regardless of whether the pregnancies were planned or unplanned.
Antioxidant intake in paediatric oncology patients
(Stellenbosch : Stellenbosch University, 2011-12) Slegtenhorst, Sonja; Visser, Janicke; Meyer, Rosan; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: Background: The role of antioxidants and adequate nutrition in the prevention and course of cancer treatment is globally recognised in nullifying the effects of free radicals and increasing the nutritional status of children during treatment. Objective: To investigate whether children with cancer meet their Dietary Reference Values and Safe Intakes for antioxidants, energy and protein. Design: Single centre prospective study. Setting: Children were recruited from the East of England Primary Treatment Centre using convenience sampling over 8 months. Forty-two children and adolescents diagnosed with a Solid tumour, Lymphoma or Leukaemia were eligible for data analysis (n=20 male; n=22 female). Method: Data was collected with an Estimated Food Record (EFR) in the 1st (EFR1) and 3rd month (EFR2) post-diagnosis. In the week following EFR completion, parents and/or children were contacted to complete four non-consecutive days of 24-hr food recalls. Data was categorised into diet alone, diet + food supplement (FS), tube feeding (tube) or diet + multi-vitamin-mineral supplementation (VMS). Malnutrition was determined by weight-for-age z-scores. Nutrient intake was compared to the Recommended Nutrient Intake (RNI), the Estimated Average Requirements (EAR) and the Lower Recommended Nutrient Intake (LRNI). Result: The sample consisted of 33% (n=14) diagnosed with Leukaemia, 24% (n=10) with Lymphoma and 43% (n=18) with Solid tumours. Sixty seven percent (n=28) underwent chemotherapy and 33% (n=14) a combination of therapies. Significant correlations were seen between the assessment tools in the diet alone category for both months for; vitamins A, C, E, selenium and protein and for EFR1 for zinc and energy. In both months greater numbers of children achieved ≥100% of requirements for diet + VMS (EFR 1; p<0.05; EFR2 p<0.05) than for other feeding modes. Vitamin C achieved the highest intakes compared to the RNI at 773% (EFR1) and 829% (EFR2). Intakes above 200% of the RNI were seen for vitamins A, C, E, selenium and zinc. No significant differences were seen between modes of feeding in either month for selenium or zinc. Vitamin A (EFR1≤ 100% diet alone p<0.05) and zinc (EFR1≤ 100% diet alone p=0.02) met the least of the LRNI in the 1st month compared to other antioxidants. No statistical significant difference was observed between the number of children attaining their EAR’s between the 3 modes of feeding in the 1st month and 3rd month. In the 1st month 27% (n=8) of participants consumed vitamin and/or mineral supplements, 18% in the 3rd month (n=4). In the 1st month 5% (n=2) of children were moderately malnourished and 10% (n=4) in 3rd month. Conversely in the 1st month 3% (n=1) were overweight and 3% (n=1) obese; the leukaemia group predominant. Conclusion: The research tools showed good correlation. Children using vitamin and/or mineral supplements mostly achieved their RNI’s compared to other feeding modes. Across feeding modes some children achieved antioxidant intakes above 200% RNI. LRNI’s on diet alone were not achieved for vitamin A and zinc. The study showed Leukaemics as having a higher prevalence of obesity. More research is required to determine the clinical implications of these findings.
Aspects of body image perception of preadolescent girls of different ethnic groups in Northeastern Johannesburg, South Africa
(Stellenbosch : University of Stellenbosch, 2010-12) Bruk, Lila; Labadarios, Demetre; Herselman, Marietjie; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: Background: Poor body image perception and body dissatisfaction has been found to be a risk factor for eating disorders. Studies have found that signs of distorted body image perception and body dissatisfaction can be detected in children as young as 8 or 9 years old. Aim: The current study served to assess the extent of this problem in Northeastern Johannesburg, South Africa, in order to allow for the necessary intervention steps (e.g. development of school-based programmes) to deal with this problem to be put in place. Method: The study was a cross-sectional analytical study with a descriptive component. Two hundred and four girls (81.37% Black, 15.20% White and 3.43% Coloured or Indian) aged between 96 and 119 months in primary schools in Northeastern Johannesburg were selected for this study using systematic random sampling. They were required to complete a questionnaire about their body image perception and weight control behaviours, as well as undergo anthropometric measurements (i.e. weight and height). Results: This study found that the subjects placed much importance on being thin, with subjects stating that they thought if a girl was thin she would be more popular (63.96%), have better self esteem (69.63%), be more attractive (69.11%), be more feminine (73.80%) and be healthier (66.84%). When asked to identify the girl from a silhouette drawing that most resembled themselves, 45.00% of the subjects were able to accurately identify which girl’s size most resembled their own, whereas 48.50% saw themselves as thinner than they are and 6.50% saw themselves as fatter than they are. In addition, the majority of subjects (69.61%) said that they were very happy with their weight and the majority (74.88%) classified it as “just right.” However, despite these findings, there was still significant body dissatisfaction evident in the group with 50.25% of the subjects wanting to be thinner, 28.57% wanting to be fatter and only 21.18% not wanting to be thinner or fatter than they currently are. Of the subjects participating in the study, 50.98% had tried to lose weight in the past and 28.71% had tried to gain weight. Also, various factors (i.e. media, cultural, family and peer influences), were shown to have a significant influence on the subjects’ body image perception. Other factors such as socioeconomic status and physical activity level had no significant link with the subjects’ body image perception. Conclusion: There is a significant problem with poor body image perception and resultant weight control behaviours in this age group. Clearly, there is a need for body image improvement programmes to be put in place in primary schools so as to prevent preadolescent girls from moving towards a lifetime of suffering with body dissatisfaction or, even worse, developing a life-threatening eating disorder.
Aspects of knowledge, attitudes and practices of medical practitioners on obesity and weight management in three urban centres in Kenya
(Stellenbosch : University of Stellenbosch, 2005-12) Ojwang, Alice AChieng; Labadarios, D.; Visser, J.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
Objectives: To determine aspects of knowledge, attitudes and practices of Medical Practitioners on obesity and weight management in three urban centres in Kenya. Research methods and procedures: A cross sectional survey of a randomly selected sample of 485 Medical Practitioners (MPs) from three urban centres in Kenya namely Nairobi, Mombasa and Kisumu was carried out. Four hundred and thirty (89% response) questionnaires were fully completed and returned. Data was gathered on the demographics of the study population; knowledge of nutrition and obesity; awareness of obesity as a health problem assessment, management (diet, exercise and pharmacology) and practices regarding obesity as well as if and how the MPs would like their knowledge of obesity improved.
Aspects of nutritional knowledge, attitudes and practices of nurses working at the surgical division at the Kenyatta National Hospital, Kenya
(Stellenbosch : University of Stellenbosch, 2006-12) Kobe, Judith A; Labadarios, D.; Marais, D.; Nel, D. G.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
INTRODUCTION: Adequate nutrition is required for patients to improve and maintain their health. Nurses are in one of the best positions to ensure adequate nutrition because of their holistic caring role. The aim of the study was to determine aspects of the current nutritional knowledge, attitudes and practices of registered nurses towards nutritional management of patients. RESEARCH METHODS: This was a descriptive and observational study. One hundred and one out of 160 Kenyan registered nurses working at the surgical division at Kenyatta National Hospital in Nairobi, Kenya successfully completed the study representing a 63% response rate. The 47-item validated questionnaire consisted of 9 socio-demographic questions, 13 questions on nutrition knowledge, 13 questions on attitude and 12 questions on nurses’ practices. RESULTS: The general performance of the registered nurses on the selected aspects of knowledge, attitudes and practices was overall poor. They contradicted themselves on their beliefs in relation to their practices. They did not know their primary role in nutrition care, neither did they know the role played by dietitians/nutritionists and doctors. Twenty-six percent of the registered nurses strongly agreed that it was the nurses’ responsibility to assess the nutritional status of patients compared to 72% who strongly agreed it was the dietitians’/nutritionists’ responsibility and 24% who strongly agreed it was the doctors' responsibility. Eighty-two percent reported that they would refer patients to a dietitian/nutritionist, 18% that they would discuss diet options with the patients, while none of the registered nurses would consult the doctor if they felt that the patient was not receiving adequate nutrition. Seventy-five percent of them suggested that nutritional care of patients could be improved by adopting a multidisciplinary approach and 18% by catering staff feeding the patients. Only 28% reported that nutritional issues were included in ward rounds. Although 72% of the registered nurses reported that it was important to weigh patients on admission, only 43% reported actually weighing patients, of which 59% weighed patients for medication purposes and only 18% weighed patients for nutritional status assessment. The overall nutritional knowledge score was graded as average (57%). The poorest scores were noted for knowledge on clinical nutrition questions (14%) and the highest scores for knowledge on basic nutrition questions (91%). CONCLUSION: Although the nurses regarded nutritional care of patients as important, their practices seemed to contradict their attitudes. Considering the responsibility the nurses are entrusted with regarding patient nutritional care, their current knowledge, attitudes and practices towards nutritional care is a cause for concern. The results of this study provide a basis for continuous nutrition education, well-designed protocols for nutritional status assessment by registered nurses and efforts directed towards improved clinical practice.
Aspects of the involvement, confidence and knowledge of South African registered dietitians regarding genetics and nutritional genomics
(Stellenbosch : University of Stellenbosch, 2011-03) Oosthuizen, Lizalet; Du Plessis, L. M.; Naude, C. E.; Nel, D. G.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: Introduction: Nutritional genomics is a new and emerging field aimed at investigating the complex interactions between genetics and diet and the joint influence this has on disease prevention and health promotion. Research is accelerating at a rapid pace and although still in its infancy, it is important for registered dietitians (RDs) to be knowledgeable and keep abreast of these developments as it promises to revolutionize dietetic practice. International studies have demonstrated low confidence and involvement as well as poor knowledge of both genetics and nutritional genomics amongst RDs. To date no similar studies have been conducted amongst South African (SA) RDs. Methods: A cross-sectional descriptive study was conducted using a national survey of 1881 dietitians registered with the Health Professions Council of South Africa (HPCSA). Data was collected using an existing and validated questionnaire as developed for use in a similar study amongst RDs in the United Kingdom (UK). The self-administered questionnaire consisted of 4 sections to assess the following aspects: i) involvement and confidence in activities relating to genetics and nutritional genomics ii) knowledge of genetics and nutritional genomics iii) factors associated with knowledge and iv) demographic information. The main method of questionnaire distribution was via email (70%) using the Association of Dietetics in South Africa (ADSA) distribution service and questionnaires were posted to those RDs not registered with ADSA (30%). Results: The response rate was 15.2% (n = 279). Results showed low involvement in activities relating to genetics (n = 47, 17%) and nutritional genomics (n = 72, 25.8%). The majority of respondents indicated low confidence in performing activities relating to genetics (n = 161, 58.7%) and nutritional genomics (n = 148, 53.8%). However, a significant positive association was found between involvement and confidence for all activities (p < 0.001). The mean total knowledge score was 48.5 (±19%) and considered as low, with the mean genetics score of 58.5 (± 24%) being significantly higher than the nutritional genomics score of 31.9 (±23%), p < 0.001. Those respondents who reported involvement in discussing the genetic basis of a disease (p = 0.02); providing guidance to patients with genetic disorders (p = 0.01); providing training or education on human genetics (p = 0.01) and discussing with patients how diet may interact with genes to influence risk (p = 0.03) also had higher total knowledge scores. Factors associated with knowledge were greater genetics content in university studies (p < 0.001); higher qualification (p = 0.01); participating in related continuous professional development (CPD) activities (p <0.001) and considering genetics of greater importance to dietetic practice (p = 0.03). Conclusions: The results of this study indicate that there is overall low involvement, confidence and knowledge of genetics and nutritional genomics amongst SA RDs and this compares well with international studies. Recommendations therefore include the development of a competency framework for genetics and nutritional genomics for undergraduate dietetic education as well as CPD activities in order to provide the driving force for the development of this field in SA.
Assessing the extent and effectiveness of diabetes self-management education in public health care institutions in Harare, Zimbabwe
(Stellenbosch : Stellenbosch University, 2016-12) Nkomani, Sanele; Blaauw, Renee; Rusakaniko, Simba; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY : Introduction: Nutrition focused diabetes self-management education (DSME) provided by a dietitian or diabetes educator considerably improves glycaemic control, reduces the rate of complications, and reduces costs. Little is known about the effectiveness of DSME interventions, despite the rising prevalence of type 2 diabetes (T2DM) in Harare. This study therefore aimed to assess the extent to which existing DSME interventions improve nutrition focused knowledge, attitudes and practices (KAP). Secondly, health facility resoures to support effective DSME were assessed. Methods: A cross sectional survey design was used to determine nutrition focused diabetes KAP for 156 participants with T2DM attending eight public health facilities within the Harare metropole. The final sample size detected an effect size of 0.4 between two groups perceived to differ with regard to DSME received, i.e. central hospital outpatient clinic attendees and city health clinic attendess. Two (out of two) central hospital clinics in Harare were selected and six city health clinics (representing six of nine health districts in Harare) were selected using a multiple stage sampling strategy. Participants were divided equally between the two groups. Mean KAP scores from a reseacher designed questionnaire were compared between clinic groups, consultation with a dietitian and a diabetes educator. Nineteen health professionals involved in diabetes management at the sampled facilities also completed a self assessment on the primary care resources available to deliver quality DSME at their respective clinics. Results: The majority of participants (90.3%, n=139) reported recieving DSME, while fewer had consulted a dietitian (49.0%, n=76) or diabetes educator (52.0%, n=80). Dietitian (χ2=10.61,p=0.01) and diabetes educator (χ2=12.31,p=0.00) led interventions occurred more frequently at central hospitals. Participants showed better knowledge (p<0.01), and attitudes (p<0.00) for other self-care behaviours compared to nutrition knowledge (p<0.01). Significantly higher levels of knowledge were observed for central hospital clinic atendees (p=0.00), consultation with a dietitian (p<0.01) or diabetes educator (p=0.00). However, no differences were observed in attitudes for clinic group (p=0.10), consultation with a dietitian (p=0.30) or diabetes educator (p=0.19). Only those that had consulted a dietitian reported better adherence to dietary guidelines (p=0.00) and physical activity (p=0.02) self-care behaviours. Over half of the health professionals (57.9%, n=19) and (68.4%, n=19) scored resources for patient and organisational support respectively as inconsistent and limited. Health professionals from city health clinics rated their patient (p<0.01) and organisational (p<0.01) support capacity higher than health professionals from central hospital clinics. Conclusion: DSME intervention occurs more frequently at central hospitals, although no evidence of structured DSME programmes exists. Only dietitian led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in city health clinics were very little DSME occurs. Health professional perceived resources for DSME to be inadequate and inconsistent, revealing the need for improved training of health professonals involved in diabetes management.
Assessing the knowledge and perceptions of the Road to Health Booklet by caregivers in Ekurhuleni Metropolitan Municipality, Gauteng, South Africa
(Stellenbosch : Stellenbosch University, 2020-12) Mangena, Sibongile; Koornhof, Hilletjie Elizabeth; Mbhenyane, Xikombiso Gertude; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY: Introduction: Malnutrition, specifically under-nutrition in conjunction with infectious diseases, vitamin A and zinc deficiency, is one of the main causes of death in children under five years of age, globally. The Road to Health Booklet (RtHB) as a tool for Growth Monitoring and Promotion (GMP), empowers caregivers to ensure that infants and young children achieve optimum growth and nutrition. Aim: To assess the knowledge and perceptions of caregivers on the RtHB as a tool for GMP at Primary Healthcare (PHC) facilities in Ekurhuleni Metropolitan Municipality, Gauteng, South Africa. Methods: A cross sectional descriptive study was employed at four different clinics and quantitative-sociodemographic information was collected, through qualitative-in-depth interviews. Audio-recorded data was transcribed and analysed using ATLAS.ti 8 and the socio-demographic data and responses to closed-ended questions were imported into Microsoft Excel 2013 spreadsheets. Results: A total of 170 caregivers were interviewed from four different clinics, the majority (98%, n=66) were female between the ages of 24 and 35 years. Regarding the level of education, the majority (71% n=120) of the caregivers have completed secondary education (Grade 8-12). Many (63%, n=107) of the caregivers were unemployed. The study reported that caregivers were previously educated on the contents of the RtHB at birth or at the first clinic visit, and they found a lot of the information quite valuable and useful to support optimal care and growth of their child. This study also reported that there were some aspects that caregivers did not fully understand, specifically the inclusion of important information such as the HIV status of both the caregiver and child, DNA polymerase chain reaction (PCR) test results, immunisations, and developmental screening of infants and young children. The caregivers understood the importance of being able to understand the contents of the RtHB and most of them who had secondary education were able to interpret the weight-for-age growth chart and are also able understand the length-for -age growth curves adequately. Conclusion: The study reported that caregivers were previously educated on the contents of the RtHB, they found a lot of the GMP information valuable. The caregivers understood the importance of being able to understand the contents of the RtHB and the results that the growth curves present. This study revealed that there was no link between education level and caregivers’ ability to understand and interpret the growth curves, therefore there not need to have an advanced education level but basic literacy along with thorough health education is sufficient.
Assessing the nutrition situation in early childhood development centres in Zandspruit and Orange Farm, Gauteng Province, South Africa
(Stellenbosch : Stellenbosch University, 2018-03) Majaha, James; Koornhof, Hilletjie Elizabeth; Tshitaudzi, Gilbert; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY: Nutrition plays a pivotal role in early childhood development (ECD). The knowledge and practices of practitioners, impact dietary habits and childcare practices at ECD centres and this could cause higher incidences and prevalence of undernutrition, overnutrition, and micronutrient deficiencies. This study focused on the knowledge and practices of ECD practitioners in Orange Farm and Zandspruit. Objectives: To assess the nutrition knowledge and practices of practitioners and describe the anthropometric status of children, 6-59 months old, attending ECD centres. Design: Descriptive and analytical, cross-sectional study. Subjects and Setting: Practitioners were interviewed at 136 randomly selected ECD centres in Orange Farm (n=120) and Zandspruit (n=16), Gauteng Province. Anthropometry was performed on children in 15 ECD centres. Methods: Quantitative data collection included interviews with practitioners using an in-depth questionnaire and dietary diversity (DD) tool. Anthropometric measurements were performed on children. Focus group discussions were conducted to obtain qualitative data. Results: The response rate for Zandspruit was 87.6 % (n=14) and 95.8 % (n=115) for Orange Farm. Prevalence of global acute malnutrition (GAM) was 0.7% (n=3) and GAM by mid-upper arm circumference (MUAC) 0.2% (n=1), with underweight at 8.9% (n=32), overweight at 4.9% (n=21) and 1.2% (n=5) for obesity. Stunting prevalence was 26.7% (n=96), which is similar to the South African national level. Weight-for-age z-scores (WAZ) and weight-for-height z-scores (WHZ) were similar in the two study areas. Only MUAC was significantly lower in Zandspruit compared to Orange Farm (p=0.03). Zandspruit ECD centres charged higher school fees for all age groups when compared to Orange Farm, p<0.0001. There was a significant difference in knowledge of defining the term “balanced diet”, where ECD centres in Orange Farm scored higher compared to Zandspruit (p=0.003). All participants scored poorly on knowledge on anaemia (21.1%, n=26), exclusive breastfeeding (47.2%, n=58) and malnutrition (48.8%, n=60). Inappropriate food preparation methods were noted; 96.7% (n=119) of the ECD centres used improper traditional cooking methods for meat (chicken/beef) and vegetables that included long cooking time, boiling and draining away water before adding oil and other ingredients. ECD centres in Zandspruit provided more diversified diets, in comparison with centres in Orange Farm; the mean DD score was 4.83 (SD=1.030) and 4.67 (SD=1.223) respectively. Sanitation and refuse disposal were significantly poorer in Zandspruit, p=0.014 and p<0.0001 respectively. Conclusion: Based on these findings, similar to available global evidence, it is evident that severe acute malnutrition (wasting) is not a crisis in the country but endemic stunting is a critical problem that requires urgent attention. Stunting in South Africa is a complex phenomenon and communities need a holistic approach to identify the drivers of this condition. Intervention to improve the nutrition knowledge and practices of ECD practitioners is necessary as they can play a role in worsening nutrition situation of children in ECD centres. ECD centres in their own capacities are unable to address the burden of malnutrition. Parents, Department of Social Development and Department of Health need to strengthen and accelerate implementation of ECD policies, change behaviours and continue creating supportive environments to improve the nutritional profile of ECD centres.
Assessing the renal handling of a dietary protein load in patients managed for nephroblastoma
(Stellenbosch : Stellenbosch University, 2014-12) Garrett, Claire Anne; Herselman, M. G.; Hadley, G. P.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Division of Human Nutrition.
ENGLISH ABSTRACT: Introduction and purpose The aim of the study was to determine the renal handling of a once-off bolus dietary protein load in patients treated for nephroblastoma. Patients who have been managed for nephroblastoma always have suboptimal amounts of kidney tissue as a result of their medical management which includes nephrectomies, chemotherapy and or radiotherapy. Little data are available indicating the extent of renal impairment expected in such patients as a result of their disease and management. The study was to determine whether the use of regular screening tests such as serum urea, creatinine and urine microalbumin, in conjunction with a dietary protein load could help detect early progressive deterioration of kidney function in nephroblastoma patients. Methodology The study was a quantitative non-randomised intervention study in which patients served as their own control before and after a protein load. Thirty-four participants were included in the study. Each participant was provided with a supplemental protein drink providing 2 g/kg body weight of protein. Serum creatinine, urea and urine microalbumin were assessed at baseline and four hours after the intervention. These pre- and post intervention biochemical values were then analysed together with descriptive data relating to the participants, such as age, stage of nephroblastoma, aspects of medical management and the period of time since they had been treated for nephroblastoma, and statistical relationships were assessed. Data were collected from May 2010 to November 2010. Results Descriptive statistics indicated that the mean [± Standard deviation (SD)] age of the population was 92 (± 55) months, the mean age at diagnosis was 41 (± 27) months and the mean age from the diagnosis to the time of the study was 51 (± 53) months. There was a statistically significant increase (p = 0.00) in serum urea post intervention; however, no significant difference was noted between pre- and post intervention serum creatinine and urine microalbumin values. The stages of nephroblastoma failed to show a statistical correlation with the response to the dietary protein bolus load in terms of the difference in pre- and post intervention biochemical data. No statistical correlation was found between post-pubescence and response to the protein load. Similiarly, no statistical correlation could be demonstrated for a longer period between the diagnosis and the time of this study, on the one hand, and the prevalence of high values in the biochemical data, on the other. Conclusion The study was unable to demonstrate statistically that participants managed for nephroblastoma had poor renal handling of a once-off dietary protein load in terms of the objectives specified. The study had limitations including a small population with even smaller subgroups of participants, therefore results of the study need to be interpreted in context to the size of the population.
Assessing the use of intergovernmental forums in the Gauteng Province as a means to leverage infant and young child nutrition agendas
(Stellenbosch : Stellenbosch University, 2018-12) Van de Venter, Anzelle; Du Plessis, Lisanne; Drimie, Scott; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY : Introduction: Infant and Young Child Nutrition (IYCN) requires an enabling environment with strong leadership and a conducive political situation to promote nutrition-specific and nutrition-sensitive interventions. The aim of the study was to assess the use of the Intergovernmental Relations Framework Act (IGRFA) and corresponding Gauteng forums as a means to leverage IYCN as an agenda item in the province. Methods: Key-informant in-depth interviews were used to investigate Intergovernmental Forum (IGF) members’ experience of these platforms and their understanding of nutrition as an issue that involves multiple sectors. Results: A total of nine participants consented for an interview to be conducted. Adherence to the stipulations of the IGRFA was perceived to be adequate but did not ensure that the spirit of the Act is carried out in coherent planning and co-operative governance between the different spheres, provincial and local government sphere. Challenges experienced include the operational functioning of the forums and political tension which affect agenda-determination and co-operation between government spheres, particularly between provincial and local structures. Benefits include the opportunity for co-ordination, guidance, and accountability. Most members felt the topics on the agenda and representation at the meetings were adequate. Participants recognized IYCN as a multi-sectoral topic and its relevance for an IGF, but it was rarely on the agenda and ignorance of IYCN remained problematic. Conclusion: The results indicate the importance of knowledge on IYCN for government leaders and the capacity to deal with political influence. The IGFs in Gauteng demonstrated the ability to leverage IYCN by being a platform for coherent planning and governance, but not for an initial introduction to the topic. High-level leadership needs to introduce the topic in order for it to be discussed; the intended route for scaling up topics is rarely followed. Significant advocacy on IYCN needs to target high-level government officials as well as the general public to develop stronger societal influence.
Assessing the value of a South African-developed educational nutrition board game in selected Grade 4 primary school learners and their life orientation educators in the City of Cape Town district
(Stellenbosch : Stellenbosch University, 2014-12) Turner, Anna Jacomina Carolina; Du Plessis, Lisanne Monica; Oldewage-Theron, Wilna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Division of Human Nutrition.
ENGLISH ABSTRACT: Objectives: To measure the impact on nutrition knowledge; to ascertain the opinions and practices related to nutrition and physical activity, tuck shop visits, and dietary quality of Grade 4 learners; as well as the perceptions on and acceptability of the ‗Fun Food Game‘ (FFG) as nutrition education tool as evaluated in selected Grade 4 learners and educators. Design: A before-after, experimental study with analytical components. Setting: A purposive sample of four schools in the City of Cape Town district of the Western Cape province. Schools A and B in a higher socio-economic area served as intervention school (HIS) and control school (HCS), whereas schools C and D were in a lower socio-economic area and served as intervention school (LIS) and control school (LCS). Subjects: Grade 4 English-speaking boys (n=85), girls (n=90) and Life Orientation educators (n=10). Methods: Pre-tested questionnaires were used to determine change in nutrition knowledge, opinions and practices, both related to nutrition and physical activities in a pre-and post-setting, as well as the perceptions on and acceptability of FFG as a nutrition education (NE) tool for Grade 4 learners and educators. A ‗Dietary Diversity Questionnaire‘ was used to establish the ‗Dietary Diversity Score‘ (DDS), and to note tuck shop visits. Questionnaires were pre-tested in a pilot study. Results: Increased nutrition knowledge and improved opinion on nutrition and physical activities were measured in all schools, but practices related to nutrition and physical activities as well as visits to the tuck shop showed mixed results. In the pre- and post-setting, a DDS of 5 was measured in the HIS and HCS, with a DDS of 5 in the pre- and 6 in the post-setting in the LIS and LCS. Fewer learners had a DDS<4 in the post-setting. Consumption of most food groups and eating breakfast were higher in the post-setting. Bringing lunch boxes to school scored lower in the intervention schools. More tuck shop visits were reported in the LIS and LCS. Most (80% n=8) educators indicated a strong need for NE for themselves. All educators indicated self-learning as a means of familiarising themselves with the content of NE. Sources of nutrition advice included magazines (90% n=9), the Internet (80% n=8) and textbooks (70% n=7). A strong need for NE was expressed by all educators; however, they stated that it should not increase their work load. Educators ‗strongly agreed‘ that the educational nutrition board game FFG can be classified as ‗Health Promotion‘. Overall, learners indicated that playing FFG was a positive experience. Conclusion: Playing FFG and/or having an increased awareness regarding nutrition and physical activities at schools could have had a positive impact on nutrition knowledge and behaviour that could have resulted in positive behaviour, but no definite conclusion can be made in this regard. Nutrition behaviour was more positively influenced in the lower socio-economic schools. Implementing the Health Promoting Schools concept, where Nutrition Education Programmes form part of a multi-component strategy, is recommended.
An assessment and analysis of duty- bearers realising the right to food among children under the age of 18 years in Masiphumelele, Cape Town
(Stellenbosch : Stellenbosch University, 2015-03) Vincent, Susan Melanie; Koornhof, Hilletjie Elizabeth; Matji, J. N.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY : Background: The Constitution of the Republic of South Africa, 1996, guarantees the right to food for all. Aligned with this commitment, policies and programmes have been developed by various government and non-governmental sectors. However, despite these interventions, malnutrition and food insecurity remain major problems in South Africa, in particular, for children. For the development of effective interventions to improve the right to food of children as right-holders, it is important and valuable to prioritise the identification of those who have either obligations or responsibilities as duty-bearers to the rights-holders. Objectives: This study aimed to identify relevant duty bearers and determine what and how goods and services relating to specified food security determinants were being provided to children in the local community of Masiphumelele, and how these duty-bearers perceived their role in this context. It also aimed to determine whether collaboration existed between various duty-bearers. Furthermore, the perceived constraints to collaboration by the duty-bearers were explored to obtain information for planning future interventions. Method: A cross-sectional, qualitative study was performed on duty-bearers providing goods and services to children under the age of 18 years in Masiphumelele, a township in the Southern Peninsula of the Western Cape. Goods and services were identified according to food-security determinants. In-depth interviews by way of a semi-structured discussion were conducted with 27 purposively selected duty-bearers in order to explore the types of goods and services provided and how they were being provided. Willingness to collaborate amongst duty-bearers was also explored. Results: Six types of duty-bearers were identified namely 1) the state, 2) non-government organisations, 3) faith-based organisations, 4) welfare organisations, 5) individuals and 6) the private sector. Goods and services provided included: a) assistance in the transfer of public-assisted programmes, b) assistance in food supply, or c) assistance in private food transfer. Goods and services provided were mostly by way of the provision of food: 1) at a cost, 2) at no cost, 3) at a supported cost, 4) on credit, 5) through school feeding, or 6) by aiding the provision of food at no cost. All but one duty-bearer expressed willingness to collaborate. Perceived concerns and constraints to collaboration and issues faced in the context of delivery were numerous and varied. Conclusion: While the state is obligated to fulfil the right to food, opportunities exist for all duty-bearers to build the normative content of the right to food into the daily realisation of this right amongst the children in Masiphumelele. This can be done through focused attention on the availability, accessibility, sustainability, stability and adequacy in the goods or services provided. Parents are to equally recognise their responsibilities, and opportunities exist for the initiation of community-based intervention using the human rights-based approach to development for participation and encouragement.
Assessment and management of severe acute malnutrition in children aged 6–59 months by professional nurses in primary healthcare facilities in the Johannesburg health district, South Africa : a retrospective analysis
(Stellenbosch : Stellenbosch University, 2020-03) Shabangu, Simon Vally; Du Plessis, Lisanne Monica; De Lange, Christel; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY: Introduction: Severe acute malnutrition (SAM) is a public health concern, due to the high mortality rates observed in children with this condition. The correct classification of children with SAM remains a challenge. Children with SAM usually present at primary healthcare (PHC) with other illness and will only be classified and managed for SAM through the correct measurement, plotting and interpretation of anthropometric data. Children identified with SAM should be referred to the hospital and admitted for further management to reduce case-fatality rates. The management of SAM at PHC and hospitals plays a unique role in child survival. Aim: The aim of the study was to evaluate the assessment and the management of SAM in children aged 6–59 months by professional nurses in PHC facilities in the Johannesburg (JHB) health district. Methods: This was an observational study with a cross-sectional, retrospective descriptive study design. Quantitative data collection methods were used to review clinic records of children in the JHB district. Results: Records of 83 children were selected from 35 clinics. Only 81 (98%) of the children’s weights were recorded, 27 (33%) had height and only 20 (24%) of children had mid-upper arm circumference (MUAC) measurements taken. Only 12 (14%) patients had a record of oedema, 58 (66%) patients had no oedema noted while in 16 (19%) patients there were no entries recorded for either the presence or absence of oedema. Nurses assessed 51 (61%) of children for feeding, of which 18 (35%) were still breastfeeding, 49 (96%) were receiving formula milk and 26 (51%) of the children were recorded as receiving solid food. Only 12 (14%) of the children were correctly identified with SAM. Conclusion: The study concludes that the overall assessment, classification and management for children with SAM in JHB district clinics was poor and often did not adhere to the Integrated Management of Childhood Illnesses (IMCI) guidelines. The practices of professional nurses in this district point to poor recognition of the need for accurate assessment and monitoring in order to reduce the risk of death in children with SAM.
Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital
(Stellenbosch : Stellenbosch University, 2017-12) Ramuada, Londolani Goodness; Blaauw, Renee; Veldsman, Lizl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY : Background: Enteral nutrition support plays a vital role in reducing malnutrition in hospitalised patients, and its provision is primarily a nurse’s role. Therefore, nurses need to have adequate knowledge and a positive attitude with regard to enteral nutrition. Objectives: The objectives of this study are to determine the knowledge, attitudes and practices regarding enteral nutrition learnt during the undergraduate qualification of nursing personnel at the nursing college of 1 Military Hospital and to determine differences based on professional rank. Method: A descriptive, cross-sectional design with an analytical component was used to collect data from military nurses through self-administered questionnaires. A score of 80% and above was rated as adequate knowledge, and questions regarding attitude were measured by means of a Likert scale. The data collected was captured using Microsoft Excel. Descriptive statistics were employed to describe the results of the study participants; Chi-Square tests were applied to determine the level of association between groups, and correlations were used to determine relationships between continuous variables. A p-value of <0.05 was used to test the hypothesis. Results: In total, 207 (86.2% response rate) questionnaires were completed and captured. The average knowledge score was 46.3%. Participants scored above 80% in the individual questions relating to enteral nutrition as part of the medical treatment and the definition of EN. More than two-thirds (75.4%) of the participants consider themselves competent to administer enteral nutrition and have protocols in their workplace (29.3%), with 79.6% referring to them once or twice per month. The most common sources of nutrition knowledge are in-service training (24.9%) and the nursing college (20.6%). Participants prefer lectures (45.4%) provided by the dietician to upgrade their nutrition knowledge. No significant differences were found between knowledge and professional rank or in the relationship between knowledge and years of working experience (r = -0.01; p=0.85). Conclusion: Nursing personnel have inadequate enteral nutrition knowledge, irrespective of their professional rank and experience. However, they are perceived to have positive attitudes towards the importance and administration of enteral nutrition. Future research should focus on whether continual in-service training improves the knowledge and practice of enteral nutrition among nurses.
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
(Stellenbosch : Stellenbosch University, 2015-04) Pretorius, Adeline; Bourne, Lesley; Koen, Nelene; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Human Nutrition.
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.
Assessment of the implementation of the peri-operative nutrition ERAS guidelines in elective colorectal surgery patients in a tertiary hospital in South Africa
(Stellenbosch : Stellenbosch University, 2017-03) Kotlowitz, Jessica Rose; Visser, Janicke; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
ENGLISH SUMMARY : Introduction: The ERAS (enhanced recovery after surgery) guidelines recommend a set of perioperative nutritional interventions which optimize recovery and reduce surgical stress. However, traditional perioperative nutritional practices still persist in many settings worldwide, many of which can be detrimental to patient recovery. The extent of compliance with the ERAS guidelines in South Africa has not been studied. Implementation of the guidelines locally has the potential to decrease morbidity, mortality and length of hospital stay, thereby lowering health care costs. This study aimed to evaluate the current practices and barriers to implementation of the ERAS guidelines in South Africa. Methods: An observational descriptive cohort study with an analytical component was conducted at a tertiary academic hospital in South Africa. Thirty adult colorectal surgery patients were observed throughout their surgical journey. Patients completed an interviewer-administered questionnaire to determine pre- and post-operative fasting times and experiences of current fasting practices. Nutritional risk of patients was determined using the NRS-2002 screening tool. A total of 58 health care professionals (HCPs) (29 professional nurses, 13 registered dietitians, three GIT surgery consultants and 13 anaesthesiology consultants) completed a self-administered questionnaire in order to assess knowledge, attitudes, practices and barriers to the implementation of the ERAS guidelines. Results: Twenty-seven percent of patients were nutritionally at risk on admission and 70% were weighed on admission to the ward. In contrast to the ERAS guidelines, patients were fasted preoperatively from solids and liquids for a mean of 19.5 hours (SD 13.2) and 14.92 hours (SD 7.8) respectively. None of the participants received a carbohydrate loading drink preoperatively. The first enteral feed after surgery was commenced at a mean of 13.64 hours (SD 8.6) postoperatively. Knowledge regarding the ERAS guidelines was poor, with HCPs scoring a mean of 36% (SD 27.7). The attitude questionnaire showed good awareness of the importance of nutrition with 93% of HCPs agreeing with the importance of patients being well nourished before surgery. Seventy one percent of HCPs indicated that they did not intend to order a preoperative carbohydrate drink for their patients. Participants reported advising patients to fast from solids and liquids for a mean of 9.59 hours (SD 5.69) and 4.30 hours (SD 4.31), respectively. Postoperatively, 75% of HCPs reported advising their patients to fast for between four and 24 hours, while 91% reported progressing patients slowly to a full oral diet. Lack of co-operation of the multidisciplinary team, resistance to change, the lack of a formal ERAS policy, the unpredictability of the surgical schedule and the lack of education regarding the ERAS guidelines amongst HCPs were identified as major barriers to ERAS implementation. Conclusion: Implementation of the ERAS guidelines in a tertiary hospital in South Africa was found to be poor and traditional perioperative nutrition practices were still largely used. This study provided further motivation for the implementation of ERAS guidelines and an insight into the barriers of such implementation in public hospitals in South Africa. Stakeholders should engage with these identified barriers in order to develop targeted strategies for successful ERAS implementation.