Research Articles (Human Nutrition)

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Abnormal eating attitudes and weight-loss behaviour of adolescent girls attending a “traditional” Jewish high school in Johannesburg, South Africa
(MedPharm Publications, 2014-07) Visser, Janicke; Notelovitz, Talia; Szabo, Christopher P.; Fredericks, Nicolette
Objectives: This study aimed to determine the prevalence of abnormal eating attitudes and weight-loss behaviour in female Jewish adolescents. Teachers’ awareness of these factors and their attitudes towards a school programme to address these were also investigated. Design: A cross-sectional study was conducted. Subjects and setting: Female learners in grades 8-11 (n = 220), attending a “traditional” Jewish high school in Johannesburg were included. Teachers (n = 38) at the relevant school were also recruited. Outcome measures: A questionnaire consisting of the 26-item version of the Eating Attitudes Test (EAT-26) and a modified section of the USA Youth Risk Behavior Survey was completed by learners. Teachers completed a questionnaire designed by the researchers. Results: Twenty per cent of the learners (n = 43) achieved EAT-26 scores ≥ 20, suggestive of a possible eating disorder, while 30.2% (n = 65) required clinical evaluation for a potential eating disorder. Thirty-three per cent (n = 72) of the adolescent girls considered themselves to be overweight, while 64% (n = 139) were trying to lose weight at the time of the study. 19.1% (n = 42) had engaged in one or more extreme methods of weight loss in the past 12 months. Most teachers (81.6%, n = 29) underestimated the proportion of adolescent girls requiring clinical evaluation and 71.1% (n = 27) underestimated the extent of current weight-loss attempts. Almost all of the teachers (97.3%, n = 37) recognised the need to address disordered eating attitudes. However, only 34.2% of the teachers (n = 13) viewed the school as the appropriate place in which to do this, and were also prepared to participate in the programme and sacrifice class time. Conclusion: To date, no published South African literature documents the presence of abnormal eating attitudes in Jewish adolescent females in South Africa. The prevalence fell within the upper end of rates reported in studies on adolescent girls in South Africa and abroad. Teachers who participated in this study were not fully aware of the extent to which eating-related issues affected female learners. A qualitative exploration thereof could yield valuable insights.
Acidified infant formula explained
(Medpharm Publications, 2013) Labuschagne, Irene; Van Niekerk, Evette; Lombard, Martani J.
The development of effective methods to prevent acute gastroenteritis is an important goal for infant health. Exclusive breastfeeding and postponement of complementary foods until the age of six months is recommended for healthy infants. However, at times, infant formula is required. Various types are commercially available. Acidified cow’s milk formula has been found to prevent the growth of pathogenic bacteria and concurring diarrhoeal disease.
Adaptation of the RenalSmart web-based application for the dietary management of patients with diabetic nephropathy
(Medpharm Publications, 2013) Esau, Nazeema; Koen, Nelene; Herselman, Marietjie G.
ENGLISH SUMMARY : Objectives: The aim of this study was to develop and test a web-based application for the dietary management of patients with diabetic nephropathy. Design: Observational descriptive study. Settings and subjects: RenalSmart® is a web-based application used to assist dietitians in clinical practice, from tertiary to primary care, to manage patients with chronic renal failure. The application was adapted and enhanced to include functions for the nutritional assessment of a patient with diabetic nephropathy, the formulation of a dietary prescription and the development of a meal plan and sample menu. It includes a graphical display of anthropometric and biochemical measurements. Quality assurance testing was undertaken throughout the development process by the project team in a pilot study involving generalist dietitians and dietitians who specialise in diabetic and renal nutrition. Nonrandom purposive sampling, including snowball sampling, was used to recruit them. Outcome measures: The application was finally tested for accuracy and acceptability by registered dietitians in South Africa. Results: Thirty-seven dietitians completed the final testing of the application. The mean age of the respondents was 33 years. Thirty-five per cent resided in the Western Cape. The overall acceptability of the application was rated as good to excellent by 81% of respondents. There was a significant difference between dietitians who usually consulted renal patients, compared to those who did not, in their rating of the accuracy of the data-saving function (p-value = 0.02) and the fluid requirements (p-value = 0.03). In this regard, the former group of dietitians was dissatisfied with these functions. Conclusion: The web-based application developed in this study was rated as accurate and acceptable by the majority of respondents. Identified problem areas were addressed in the final version.
An anti-inflammatory approach to the dietary management of multiple sclerosis : a condensed review
(Co-published by Medpharm Publications and Taylor & Francis, 2017) Labuschagne, I. L.; Blaauw, Renee
Multiple sclerosis (MS) is a chronic, inflammatory, neurodegenerative demyelinating disease of the central nervous system (CNS). Inflammation is increased by high-energy Western-style diets, typically high in salt, animal fat, red meat, sugar-sweetened drinks and fried food, and low in fibre, as well as lack of physical exercise. An anti-inflammatory dietary regimen, with or without administration of dietary supplements, supporting the general trend towards an amelioration of inflammatory status, should be considered. Understanding the role of gut microbiota in health and disease can lay the foundation to treat chronic diseases by modifying the composition of gut microbiota through lifestyle choices, including dietary habits and possibly probiotic supplementation. Evidence from experimental, epidemiologic and clinical studies supports the potential association between poor vitamin D status and the risk of developing MS, as well as an adverse disease course. Correcting vitamin D status seems plausible in patients with MS
Application of evidence on probiotics, prebiotics and synbiotics by food industry : a descriptive study
(London : Biomed Central, 2014-10) Mugambi, Mary N.; Young, Taryn; Blaauw, Renee; Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: This study assessed how the food industry applies the knowledge and evidence gained from synbiotics, probiotics or prebiotics research in infants, on the general paediatric population. This study also explored: what happens after the clinical trials using infant formula are completed, data is published or remains unpublished; the effectiveness and type of medium the formula manufacturers use to educate consumers on probiotic, prebiotic or synbiotic infant formula. Findings: This was a descriptive study (a survey) that used a structured questionnaire. All listed companies that manufacture and / or market food products with added probiotics, prebiotics or synbiotics for infants were identified and invited to participate. People responsible for research and development were invited to participate in the survey. A letter of invitation was sent to selected participants and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test, a p < 0.05 was statistically significant. A total of 25 major infant formulas, baby food manufacturers were identified, invited to participate in the survey. No company was willing to participate in the survey for different reasons: failure to take any action 5 (20%), decision to participate indefinitely delayed 2 (8%), sensitivity of requested information 3 (12%), company does not conduct clinical trials 1 (4%), company declined without further information 4 (16%), erroneous contact information 6 (24%), refusal by receptionists to forward telephone calls to appropriate staff 3 (12%), language barrier 3 (12%), company no longer agrees to market research 1 (4%). Conclusion: Due to a poor response rate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants for the benefit of the general paediatric population. More information and greater transparency is needed from the infant formula manufacturers on how they apply the evidence gained from the research on probiotics, prebiotics and synbiotics on infants
Are the attitudes and practices of foodservice managers, catering personnel and students contributing to excessive food wastage at Stellenbosch University?
(Co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis Group, 2017) Marais, M. L.; Smit, Y.; Koen, N.; Lotze, E.
Objective: The aim was to investigate factors contributing to food wastage by Stellenbosch University (SU) students in selected residences, and to determine the attitudes and practices of students and catering personnel impacting on food waste and a sustainable environment. Design: Cross-sectional, descriptive study. Setting: Stellenbosch University, Western Cape. Subjects: Six foodservice managers, 63 catering personnel and 517 students participated in the study. Outcome measures: A weighed-food wastage study was conducted at seven selected residences during lunch and supper on three non-consecutive weekdays. Food service managers (FSMs) and catering personnel completed interviewer-administered questionnaires, while SU students completed an electronic survey. Results: Ninety percent of students preferred the standard menu options, despite a relatively high average plate waste of 16.9%. More production waste was generated during lunch than supper. The male residence generated more plate waste. Even though students requested larger servings of vegetables, the wastage of these items was high. Factors contributing to wastage were the booking system, menus and serving style, meal plan stipulating the serving of dessert and serving of a large starch portion. All FSMs and 88.5% catering personnel considered it important to reduce food wastage to a minimum. Conclusion: Education of catering personnel and students regarding food waste reduction measures is crucial. A representative forum including students, catering companies and faculty management should be involved when seeking solutions to reduce food wastage and improve communication. By implementing these strategies, a university-wide culture of sustainability with a focus on food waste reduction can be developed and nurtured.
Assessing the knowledge and perceptions of medical students from the Western Cape, South Africa, regarding the Millennium Development Goals
(Medpharm Publications, 2012) Yeatman, Toni-Lee; Koen, N.; De Ridder, L.; Fenn, B.; Wormsbacher, L.; Daniels, L.
Background: Health science students are key players in implementing the Millennium Development Goals (MDG). Knowledge and understanding at university level is essential to achieve the goals by 2015. The primary objective of this study was to assess the knowledge and perceptions of fifth-year medical students at Stellenbosch University and the University of Cape Town regarding the MDG. The secondary objectives were to determine the degree to which students are involved in awareness campaigns and implementation of the MDG, and to assess students’ perceptions regarding the need for the MDG in South Africa. Method: This observational, descriptive, cross-sectional study collected quantitative data. A census was carried out. All participants completed a self-administered questionnaire. Results: Of the 176 participants, 61.14% said they had previously heard or read about the MDG. Forty per cent had heard about the MDG through awareness campaigns. More than half (54.86%) claimed to know what the MDG were, but could not name all of the goals. Participants identified a mean of three out of eight MDG correctly. The majority of students considered MDG implementation in South Africa important but ineffective (69.85%), and 85.82% believed that the MDG would not be achieved on time. Conclusion: It was found that fifth-year medical students in the Western Cape were not adequately informed about the MDG and their importance in South Africa. However, their perceptions were positive, in that the majority agreed that the implementation of the MDG in South Africa is important and that more needs to be done in creating awareness about the goals.
Assessing the utilization of a child health monitoring tool
(Health and Medical Publishing Group, 2017) Blaauw, Renee; Daniels, L.; Du Plessis, L. M.; Koen, N.; Koornhof, H. E.; Marais, M. L.; Van Niekerk, E.; Visser, J.
Objective: The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the Road-to-Health Booklet. Caregivers and health care workers knowledge, attitudes and practices were investigated as well as health care workers perceptions of barriers undermining implementation. Methods: A cross-sectional descriptive study was conducted on a proportional sample of randomly selected Primary Health Care facilities across six health districts (35%; n=143) in the Western Cape Province. Health care workers involved in the implementation of the Road-to-Health Booklet, children (0-36 months) and CGs were included. Information was obtained through scrutiny of the Road-to-Health Booklet, observation of consultations and structured questionnaires. Results: A total of 2442 children, 2481 caregivers and 270 health care workers were recruited. Weight (94.7%) measurements were performed routinely. Less than half (40.2%) of caregivers reported that their child’s growth was explained. Sixty-eight percent of health care workers correctly identified criteria for underweight, whereas only 55% and 39% could do so for stunting and wasting respectively. Road-to-Health Booklet sections were completed adequately for immunization (89.3%), vitamin A supplementation (94.6%) but not for deworming (48.8%). Most health care workers (94%) knew the correct regimes for vitamin A supplementation and deworming, but few caregivers knew when treatment was due for vitamin A supplementation (16.4%) and deworming (26.2%). Potential barriers identified related to inadequate training, staff shortages and limited time. Conclusion: Focussed effort and resources should be channelled towards health care workers training and monitoring regarding growth monitoring and promotion to optimize utilization of the Road-to-Health Booklet. Mobilisation of community health workers is needed to strengthen community awareness of preventative health interventions.
Assessment of the realisation of the right to adequate food in the Blue Crane Route (Eastern Cape, South Africa)
(Taylor & Francis, 2022-08-26) Marais, M. L.; Lessing, E.; Frank, T.
Objectives: To assess whether the right to adequate food (RtF) is realised by children and primary caregivers and what actions are required to fully realise this right. Design: A cross-sectional, descriptive study was undertaken using a mixed-methods approach. Setting and subjects: Rural and urban primary caregivers of children (one to five years old) were recruited if they had resided in the Blue Crane Route (Eastern Cape) for at least six months. Purposefully selected key informants (KIs) involved in nutrition and food security, health or governance participated in in-depth interviews. Outcome measures: Primary caregivers responded to interviewer-administered questionnaires (IAQ) (N = 161), which investigated various indicators supporting the realisation of the RtF. Statistical analysis of quantitative data examined relationships between urban and rural participants. Significance was considered at p < 0.05. In-depth interviews with key informants (KIs) examined the perceptions of 11 prominent community leaders. Qualitative data were coded deductively and common themes identified. Results: Based on the IAQ, half (51%) of the caregivers had experienced risk of, or food insecurity in the past month. Common themes indicative of suboptimal realisation of the RtF included insufficient employment opportunities, inadequate policies and programme implementation, and inadequate agrarian practices, while the child support grant partially supported the realisation of the RtF. Caregivers felt disempowered by a sense of inability to realise the right themselves without government assistance but KIs suggested that caregivers needed to take responsibility. Conclusion: The RtF of children and their caregivers is not fully realised in the Blue Crane Route. Concerted, multidisciplinary approaches using a rights-based approach to implement policies and programmes are needed, together with the empowerment of the community with necessary skills and resources to further the realisation of the RtF.
Association between funding source, methodological quality and research outcomes in randomized controlled trials of synbiotics, probiotics and prebiotics added to infant formula : a systematic review
(BioMed Central, 2013-11) Mugambi, Mary N.; Musekiwa, Alfred; Lombard, Martani; Young, Taryn; Blaauw, Renee
Background: There is little or no information available on the impact of funding by the food industry on trial outcomes and methodological quality of synbiotics, probiotics and prebiotics research in infants. The objective of this study was to compare the methodological quality, outcomes of food industry sponsored trials versus non industry sponsored trials, with regards to supplementation of synbiotics, probiotics and prebiotics in infant formula. Methods: A comprehensive search was conducted to identify published and unpublished randomized clinical trials (RCTs). Cochrane methodology was used to assess the risk of bias of included RCTs in the following domains: 1) sequence generation; 2) allocation concealment; 3) blinding; 4) incomplete outcome data; 5) selective outcome reporting; and 6) other bias. Clinical outcomes and authors’ conclusions were reported in frequencies and percentages. The association between source of funding, risk of bias, clinical outcomes and conclusions were assessed using Pearson’s Chi-square test and the Fisher’s exact test. A p-value < 0.05 was statistically significant. Results: Sixty seven completed and 3 on-going RCTs were included. Forty (59.7%) were funded by food industry, 11 (16.4%) by non-industry entities and 16 (23.9%) did not specify source of funding. Several risk of bias domains, especially sequence generation, allocation concealment and blinding, were not adequately reported. There was no significant association between the source of funding and sequence generation, allocation concealment, blinding and selective reporting, majority of reported clinical outcomes or authors’ conclusions. On the other hand, source of funding was significantly associated with the domains of incomplete outcome data, free of other bias domains as well as reported antibiotic use and conclusions on weight gain. Conclusion: In RCTs on infants fed infant formula containing probiotics, prebiotics or synbiotics, the source of funding did not influence the majority of outcomes in favour of the sponsors’ products. More non-industry funded research is needed to further assess the impact of funding on methodological quality, reported clinical outcomes and authors’ conclusions.
The barriers that women face when choosing food for their primary school children : a case study in the Western Cape Province, South Africa
(Health and Medical Publishing Group, 2017) Smit, Y.; Kassier, S.; Nel, D.; Koen, N.
Background. Unhealthy food choices made by mothers can impact negatively on child health and may lead to unhealthy eating behaviours that persist into adulthood. Choosing food is a complex process influenced by many factors. Objectives. To determine the factors that influence mothers’ food choices and to investigate barriers to purchasing healthy food. Methods. A cross-sectional, descriptive study, with an analytical component, was conducted. Mothers (N=476) were recruited from three randomly selected primary schools, from a low, middle and high quintile. A self-administered questionnaire was used to collect data on demographics, knowledge, attitude and practices of mothers. Six focus groups (FG) (two per school) were conducted to investigate the factors that prevent mothers from making healthy dietary decisions. Results. The mean nutrition knowledge score for the group was 68.6%. Nutrition knowledge was significantly lower (p<0.01) in mothers from the lower quintile school (64.0%). Primary factors influencing food purchases were cost (60%), nutritional value (37%) and time constraints (29%). Primary sources of nutrition information included magazines and health professionals at 62% and 44%, respectively. Time constraints resulted in mothers purchasing convenience foods more often (p=0.001). The main barriers identified were mixed media messages, the school environments and supermarket layouts. Conclusion. Nutrition education campaigns should include practical advice, e.g. the preparation of economical, wholesome meals. Policymakers should monitor increasing prices of healthy foods. School and supermarket environments, as well as the food industry, can play a pivotal role in facilitating mothers to make healthy food choices
The basics of prescribing infant formulas
(Medpharm Publications, 2012) Owens, C. J. W.; Labuschagne, I. L.; Lombard, Martani J.
All infant formulas must support the normal growth and development of infants, and this needs to be scientifically demonstrated. Formulas have to contain sufficient amounts of basic nutrients, and so are nutritionally interchangeable, with no evidence indicating that one brand is superior to another.
Body composition and habitual and match-day dietary intake of the FNB Maties Varsity Cup rugby players
(Health & Medical Publishing Group, 2014-06-17) Potgieter, S.; Visser, J.; Croukamp, I.; Markides, M.; Nascimento, J.; Scott, K.
Background. Rugby is a physically demanding body contact sport. Optimising dietary intake and body composition can positively affect the performance of rugby athletes. Objectives. To determine the body composition, habitual and game-specific nutritional practices of FNB Maties Varsity Cup (MVC) rugby players. Methods. A descriptive, cross-sectional study with an analytical component was conducted. Of all the MVC rugby players (N=35), 18 completed the sections on body composition and match-day dietary intake, while 11 completed the habitual dietary intake section. Body composition data were collected by an International Society for the Advancement of Kinanthropometry-accredited biokineticist. Habitual dietary intake data (via a self-administered 7-day food record) and match-day dietary strategies (via telephonic 24-hour recall interview) were collected and compared with nutritional requirements reported by the International Olympic Committee, the American Dietetic Association, the American College of Sports Medicine and the International Society of Sport Nutrition. Results. Forwards had significantly higher weight (p=0.01), sum of seven skinfolds (p=0.01), percentage body fat (p=0.02), fat mass (p=0.01) and fat-free mass (p=0.01) than backs. Compared with current recommendations, group habitual dietary intake (mean (standard deviation)) was inadequate for total energy (45.4 (9.0) kcal/kg body weight (BW)), carbohydrate (4.3 (0.4) g/kg BW), polyunsaturated fatty acids (6.2 (1.7)% of total energy (TE)), calcium:protein ratio (6.5:1 (3.5:1)) and copper (2.3 (0.4) mg), while displaying higher-than-recommended intakes for total protein (2.4 (0.7) g/kg BW), fibre (37.7 (7.3) g/day), total fat (33.8 (4.3)% TE), saturated fatty acids (11.2 (13.1)% TE), cholesterol (766.3 (371.8) mg) and niacin (45.2 (6.9) µg). Habitual supplement use was high at 91% (n=10/11). Nutritional match-day strategies were excessive for protein (1.2 (0.6) g/kg BW) and fat (0.9 (0.4) g/kg BW) in the pre-event meal, inadequate for energy and carbohydrate during the game and excessive for alcohol (54.4 (59.9) g) after the game. Conclusion. Forwards and backs differed significantly in various body composition measurements. In relation to observed practices, habitual dietary intake and nutritional match-day strategies were suboptimal, with high reported supplement use. Players in this sport potentially could benefit from specialist input to optimise dietary strategies and body composition in order to enhance performance.
Body fat distribution as a risk factor for osteoporosis
(Health & Medical Publishing Group, 1996) Blaauw, Renee; Albertse, E. C.; Hough, S.
Objective. The aim of this study was to compare the body fat distribution of patients with osteoporosis (OP) with that of an appropriately matched non-OP control group. Design. Case control study. Setting. Department of Endocrinology and Metabolism, Tygerberg Hospital. Participants. A total of 56 patients with histologically proven idiopathic OP, of whom 39 were women (mean age 61 ± 11 years) and 17 men (49 ± 15 years), were compared with 125 age- and sex-matched non-OP (confirmed by dual energy X-ray absorptiometry) subjects, 98 women (60 ± 11 years) and 27 men (51 ± 16 years). Outcome measures. Anthropometric data, including weight, height, skinfold measurements, mid-upper arm, waist and hip circumferences, as well as elbow breadth. Results. The men and women with OP were significantly shorter (P = 0.04 and P = 0.03 respectively) and of lower body mass (P = 0.04 and P = 0.02 respectively) than the control subjects, although their mean body mass indices were comparable. The OP population had significantly lower skinfold, elbow breadth and arm circumference values, although the majority of subjects in both groups fell within the 15 - 85th percentiles. Despite their lower body mass, both the OP women (P = 0.009) and men (P = 0.002) had significantly higher waist/hip ratios than corresponding controls. Conclusion. Whatever the underlying pathogenesis, this new finding suggests that, should these results be confirmed by larger studies, OP can be added to the list of diseases associated with a waist fat distribution.
Body image and the double burden of nutrition among South Africans from diverse sociodemographic backgrounds : SANHANES-1
(MDPI, 2020-01) Mchiza, Zandile June-Rose; Parker, Whadi-ah; Sewpaul, Ronel; Onagbiye, Sunday Olawale; Labadarios, Demetre
This study investigated the associations between underweight, obesity and body image (BI) among 15+ year-old South Africans with diverse socio-demographic backgrounds. A cross-sectional survey and the analyses of data for 6411 15+ year-old participants in the first South African National Health and Nutrition Examination Survey was undertaken. Body image was compared to body mass index (BMI) and socio-demography. Data were analyzed using SPSS versions 25. Results are in percentages, means, 95% confidence intervals, p-values, and odds ratios. Overall, participants who were obese of which majority: were females, earned ZAR 9601+, completed grade 6, were non-Black men, were married and resided in urban formal areas, were more likely to underestimate their BMI and desire to be lighter. Participants who were underweight of which majority: were males, had no form of income or education, were black men, were not married, resided in less urban and farm areas, were younger than 25 years, were more likely to overestimate their BMI and desire to be heavier. While underweight and obesity were strong determinants of BI, BI was differentiated by socio-demography. These findings have a public health implication that requires special attention to curb the irrepressible underweight and obesity in South Africa. Keywords: body image; body mass index; socio-demography; body size dissatisfaction; body size misreporting; age; household income; ethnicity; gender; education level
Capacity-building for a strong public health nutrition workforce in low-resource countries
(World Health Organization -- WHO, 2017-4) Delisle, Helene; Shrimpton, Roger; Blaney, Sonia; Du Plessis, Lisanne; Atwood, Stephen; Sanders, David; Margetts, Barrie
INTRODUCTION: Neglected for several decades, nutrition is now firmly on the development agenda. Important landmarks are the initiation of the Scaling Up Nutrition movement in 2010; the adoption by the World Health Assembly of the Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition in 2014; and the World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases for 2013–2020. Public health nutrition has to meet multiple new challenges, including the shift from the millennium development goals to the sustainable development goals (SDGs), together with growing issues such as climate change, globalization, urbanization, socioeconomic disparities, migration and wars.
Child development, growth and microbiota : follow-up of a randomized education trial in Uganda
(International Society of Global Health, 2019) Atukunda, Prudence; Muhoozi, Grace K. M.; Van Den Broek, Tim J.; Kort, Remco; Diep, Lien M.; Kaaya, Archileo N.; Iversen, Per O.; Westerberg, Ane C.
Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children’s development, growth and gut microbiota at 36 months of age. Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition. Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups. Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings.
Commitment and capacity for the support of breastfeeding in South Africa : a paediatric food-based dietary guideline
(Medpharm Publications, 2013) Du Plessis, Lisanne M.; Pereira, C.
This paper aims to summarise current evidence and highlight best practices, in order to propose a paediatric food-based dietary guideline (FBDG) on exclusive breastfeeding for South Africa. A literature search was conducted to profile the current nutritional status of children and breastfeeding practices in South Africa, reflect on the commitment and capacity that has been pledged and built for exclusive and continued breastfeeding over the past five years, and highlight the action needed to improve infant and young child feeding practices in the country. From the review, it was clear that the nutritional status of children and breastfeeding practices in South Africa remain unsatisfactory. The evidence base supporting the importance of exclusive and continued breastfeeding on a global and local level has been broadened. There are comprehensive and practical international guidelines to guide the protection, promotion of, and support for breastfeeding. Comprehensive and sound national and provincial policies and guidelines have also been developed in South Africa. The political will to address infant and young child feeding has been advanced and demonstrated, and a supportive environment created through commitment and capacity building. There is a need for focused action addressing adequate monitoring and evaluation of processes during all stages of the implementation of evidence-based and theoretical planning. These actions should drastically improve exclusive and continued breastfeeding and advance the health and survival of children in South Africa. The recent momentum gained in support of improving infant and young child feeding could further be enhanced by the process of reviewing the preliminary South African paediatric FBDG and field testing the following proposed message: “Give only breast milk, and no other foods or liquids, to your baby for the first six months of life”.
Comparison of infant-feeding practices in two health subdistricts with different baby-friendly status in Mpumalanga province
(MedPharm Publications, 2015) Van der Merwe, S.; Du Plessis, L.; Jooste, H.; Nel, D.
Objectives: The objective of the study was to compare the infant-feeding practices of two subdistricts with different baby-friendly status in Mpumalanga province, South Africa. Design: This was a cross-sectional, descriptive, observational study with an analytical component. Eighteen fieldworkers assisted with the data collection, utilising two sets of interviewer-administered questionnaires – one on socio-demographic information and the other on infantfeeding practices. Subjects: Mothers with infants from birth to six months old, attending postnatal care at public sector primary health care facilities in Emalahleni and Mbombela health subdistricts on the days of data collection were included. A total of 435 mother and infant pairs were included in the study. Outcome measures: Five infant-feeding indicators were used, namely the early initiation of breastfeeding, exclusive breastfeeding, exclusive replacement feeding and mixed feeding rates, as well as the age at which complementary food was introduced. Results: There was a significantly higher early initiation of breastfeeding (57% vs. 43%), exclusive breastfeeding rates (60% vs 48%), and a lower exclusive replacement feeding rate (18% vs. 33%) in Emalahleni subdistrict, where all the public sector maternity facilities are accredited as being baby friendly, compared to that in Mbombela subdistrict, where none of the public sector maternity facilities are baby friendly. The mixed feeding rate (19% vs. 15%) and the mean age of the introduction of complementary foods (50 days versus 35 days) did not differ significantly between the two subdistricts. Conclusion: Implementation of the Baby-Friendly Hospital Initiative (BFHI) in a health subdistrict was associated with more optimal infant feeding practices in mothers with infants aged six months and younger. It is concluded that strengthening practices prescribed within the BFHI would improve infant-feeding practices at community level.
Complementary feeding : a critical window of opportunity from six months onwards
(Medpharm Publications, 2013) Du Plessis Lisanne, M.; Kruger, H. S.; Sweet, L.
This paper aims to propose evidence-based, paediatric food-based dietary guidelines on the complementary feeding period, from six to 24 months, of South Africa. A growing body of evidence supports the World Health Organization recommendation that, following six months of exclusive breastfeeding, appropriate and adequate complementary foods should be introduced, with continued breastfeeding for up to two years of age and beyond. A literature search was done by searching electronic databases (PubMed, the Cochrane Library and Sabinet) and hand searching key reference lists from January 2004 to April 2012, including studies published prior to 2004. Relevant international and national documents from normative bodies, global health and infant feeding authorities, professional and scientific societies and government were identified. It has been established that, in South Africa, high levels of stunting, growing concerns about overweight and obesity and the poor intake of certain micronutrients in the critical six- to 24-month period are, in part, a consequence of poor breastfeeding and complementary feeding practices, as well as the poor quality of the complementary diet. The introduction of semi-solid foods before four months of age is a common practice. The typical maize-based feeding pattern is low in food sourced from animals, vegetables and fruit and omega-3 fatty acids. Efforts by mothers to improve the quality of their children’s diets by adding energy-rich food to maize meal improves energy intake, but not micronutrient intake. Low nutrient-dense liquid, such as tea and coffee, energy-dense sugar-sweetened drinks, an excessive intake of fruit juice and high-fat and salty snacks exacerbate poor nutrient intake and displace nutrient-dense food in the diet. Healthcare workers should provide consistent, evidence-based messages and guidelines to caregivers of future generations. Interventions must be implemented and strengthened at a programme level. These could include nutrition education to improve caregiver practices, the use of high-quality, locally available foods, the use of enriched complementary foods, and exceptional support of food-insecure populations.

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