Masters Degrees (Human Nutrition)
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- ItemA qualitative exploration of perceptions of women aged 21 – 55 years from Bhisho townships in the Eastern Cape, on the intake of a diverse nutrient-dense diet(Stellenbosch : Stellenbosch University, 2023-12) Mdlokovana, Mzoxolo Emmanuel; Daniels, Lynette Daniels; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Micronutrient malnutrition continues to persist in South Africa, even though the South African government has implemented various strategies, including the promotion of dietary diversity. Previous research has also found that people who live in low-income neighbourhoods have the lowest dietary diversity scores (DDS) compared to other demographics in South Africa. Women normally play a pivotal role in the gathering and preparation of food for their families; they therefore have a significant influence on the dietary diversity of all members of their households. There is a paucity in the qualitative research domain in South Africa in the area of dietary diversity, particularly perceptions of women concerning dietary diversity. Therefore, the aim of the study was to explore the perceptions of women 21 – 55 years regarding dietary diversity in the townships of Bhisho in the Eastern Cape. A qualitative research study was conducted using focus group discussions (FGDs). The FGD guide was developed by the researcher, guided by the objectives of the study. Purposive sampling was used to recruit the participants, by word of mouth with assistance from identified influential women in the community. The FGDs were audio recorded and the recordings were transcribed by a professional transcriber. Thematic analysis was used to analyse the data. Four FGDs (N=18) were conducted. The participants demonstrated a general understanding of dietary diversity as they associated the concept with eating a balanced diet that consists of a variety of foods which are high in nutrients. The participants also have an awareness of the benefits of consuming a variety of foods high in nutrients. These benefits include optimal immunity, provision of energy for daily activities, as well as growth and development in children. The participants perceived lack of sufficient income due to factors such as unemployment, as the main barrier to achieving a diverse diet. Cultural influences, lack of gardening resources and environmental factors such as drought and poor soil quality, were perceived to be barriers to dietary diversity. Growing their own food in the form of home gardens was perceived as the main enabling factor for dietary diversity. Empowerment of community members with knowledge of healthy eating, encouragement of youth to study and participate in agriculture, and government assistance in matters such as job creation and community empowerment initiatives, were additional perceived enabling factors for dietary diversity. Participant perceptions around dietary diversity indicate an awareness of the challenge of low dietary diversity in poorer communities as well as a willingness to address the challenge. Community members of Bhisho need assistance and encouragement in improving their intake of a varied, nutrient-rich diet and subsequently optimising their nutrition outcomes. Dietary diversity and healthy living in general could be promoted in the community through nutrition education and skills development, home gardening resources, access to arable land for commercial agriculture initiatives, and women's forums for nutrition and healthy lifestyles. To make these initiatives sustainable, there should be a focus on fostering community self-reliance.
- ItemNutrition-related knowledge, perceptions, and practices of caregivers with galactosaemic infants and children following a therapeutic diet in the United Kingdom(Stellenbosch : Stellenbosch University, 2023-03) Blaauw, Giana Francis; van Niekerk, Evette; Dolman-Macleod, Robin Claire; Singini, Isaac; Lombard, Carl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Background and purpose: Classical galactosaemia is a rare but life-threatening inherited disorder of carbohydrate metabolism. There is no cure for the disease and the primary treatment is a lifelong therapeutic (galactose-restricted) diet commenced in infancy. Living with this rare disease and adhering to the restrictive diet can be burdensome on patients and their families. Research exploring caregiver considerations related to the dietary management of galactosaemic infants and children is lacking in the available literature. Aim and objectives: The study aimed to determine quantitatively the nutrition-related knowledge, perceptions, and practices of primary caregivers with infants/children following a therapeutic diet for classical galactosaemia in the United Kingdom. The secondary objective was to determine the perceived challenges (or barriers) faced by caregivers whose infants/children follow a galactose-restricted diet in the United Kingdom. Methodology: A descriptive, cross-sectional study with an analytical component was conducted using a novel online questionnaire. The questionnaire underwent expert peer review to establish the content validity, and a two-week pilot study established the face validity of the instrument prior to the final sampling. Volunteer sampling was used by initially emailing the survey link to 98 eligible members of the Galactosaemia Support Group who were primary caregivers of infants/children from birth to 18 years of age diagnosed with classical galactosaemia and residing in the United Kingdom. The Metabolic Support UK charity also advertised the survey link on its official social media platforms and emailed their eligible members as a supplementary recruitment strategy. Data collection took place between April and July 2022. Results: Forty-three caregivers participated in the study and the response rate was 44%. Most caregivers were mothers (84%) and resided in England (79%). The mean (X̅) age of children with galactosaemia was 8.2 years (SD=4.6) and 59% were diagnosed within the second week after birth. Almost all caregivers were considered to have a high level of dietary knowledge (98%) and perceived themselves to have very good (54%) or good (37%) knowledge about the diet. Caregivers’ knowledge scores (X̅=17.9, SD=1.7) were positively correlated with their education level (r=0.383, p=0.013). Many caregivers had high attitudinal scores (65%) of between 31 and 45 points (X̅=32.5, SD=5.5), indicating that most had an overall positive attitude towards the galactosaemia diet. Almost all caregivers perceived themselves as being confident (42%) or very confident (56%) in managing their child’s galactosaemia diet. Most caregivers had a negative perception towards being unable to feed their child breastmilk (49%), and their perception was significantly associated with their intention to feed their child breastmilk before the diagnosis of galactosaemia (p=0.038). Furthermore, 47% of caregivers felt that their children were excluded in social settings because of their adherence to the galactosaemia diet. Concerns about the safety of the child in other social settings were a barrier for 79% of caregivers, followed by social events involving eating out (53%), and the expense of groceries for the galactosaemia diet (53%). Four or more different barriers to adhering to the galactosaemia diet were reported by the majority of caregivers (54%) and there were significant associations (p<0.001) between the age of the galactosaemic child and the number, as well as the type, of barriers faced by caregivers. Conclusion: Caregiver knowledge and self-perceived confidence related to the galactosaemia diet were high; however, negative perceptions about being unable to feed their child breastmilk and their child’s exclusion in social settings due to their adherence to the diet were evident. Clear barriers for caregivers emerged around social settings, specifically related to the safety of their child, as well as the cost of groceries and eating out. Dietary interventions should focus on exploring the negative perceptions and barriers caregivers experience related to the galactosaemia diet and referrals should be made to relevant services for further support to caregivers, where indicated. Future research is warranted to expand upon these findings and further explore caregivers’ lived experiences of overseeing the therapeutic diet for their child which will help to inform and transform clinical practice to better meet the needs of galactosaemic children and their families.
- ItemMacronutrient and energy composition of breastmilk of HIV-infected mothers receiving ARVs in the Nelson Mandela Bay area(Stellenbosch : Stellenbosch University, 2022-12) Koen, Leandri; van Niekerk, Evette; Steenkamp, Liana; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Inadequate nutrition in early life can have a detrimental effect on an infant’s growth and development. South Africa remains the epicentre of HIV and has low exclusive breastfeeding rates, increasing the risk of malnutrition for infants living in South Africa. While antiretroviral medication (ARVs) is recommended for HIV-positive pregnant and breastfeeding mothers to prevent mother-to-child transmission (MTCT), limited information is available on the macronutrient composition of the breastmilk of mothers on ARVs. Aim and objectives: The principle aim of this study was to assess the macronutrient composition of breastmilk from HIV-positive mothers receiving ARV treatment. Method: The researcher conducted a quantitative study using a descriptive, cross-sectional approach, which included HIV-positive mothers (n = 45) on ARVs. Anthropometrical data, a questionnaire and breastmilk samples were collected from the mothers on day 3 (± 2 days; n = 45) and day 14 (± 2 days; n = 37) of the infant’s life. The macronutrients (carbohydrates, fat, and true protein) and energy of the breastmilk were analysed using the Miris Human Milk Analyzer (mid-infrared spectroscopy). Stellenbosch University’s Division of Epidemiology and Biostatistics generated the statistics using Stata 17 software for the analysis. A one-sample t-test was used to report the inferential (numerical) data. The Pearson correlation test was used to determine whether a relationship existed between the variables and the macronutrients in the milk. Ethical approval was granted by the Stellenbosch University Health Research Ethics Committee (S20/10/280) and the Committee of the Eastern Cape (ec_202102_015). Clinic managers functioned as gatekeepers at each of the clinics. Results: The participants were mostly single (n = 38; 84.4%), unemployed (n = 30; 66.7%) with a monthly income of less than R500 (n = 32; 71.1%), and mostly dependent on government grants (n = 30; 66.7%). Most participants lived in a free-standing house (n = 41; 91.1%) where only one or no adults were working (n = 23; 56.1%). The mean maternal postpartum body mass index (BMI) was in the overweight category (29.84 kg/m2 ± 6.17). The macronutrient and energy content per 100 ml of colostrum from HIV-positive mothers was: protein = 2.22 g (± 0.786), fat = 3.39 g (± 1.809), carbohydrates (CHO) = 7.43 g (± 3.441), and energy = 69.20 kcal (± 20.89). The results for mature HIV-positive milk per 100 ml were: protein = 2.11 g (± 1.016), fat = 4.55 g (± 2.111), CHO = 7.322 g (± 1.92) and energy = 79.357 kJ (± 21.131). All the macronutrients and energy values from the study exceeded the values presented in the literature for breastmilk from HIV-negative mothers. Although a relationship exists between the variables, it may not be of clinical importance and could be spurious. Conclusion: All macronutrients in breastmilk from HIV-positive mothers are elevated compared to HIV-negative mothers.
- ItemFood utilisation in the national school nutrition programme at Quintile 1-3 Schools in the Cape Metro Districts of the Western Cape Province, South Africa : a descriptive cross-sectional study(Stellenbosch : Stellenbosch University, 2022-04) Petersen, Ilse; Beukes, Ronel Annamarie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Introduction: The National Schools Nutrition Programme (NSNP) was implemented in 1994 with the aim to improve educational outcomes through relieving acute hunger relief, and to improve school attendance and learning capacity. The overlooked element of food wastage at school level could be an obstacle to achieve this. Objectives: The aim of this study was to describe the enablers and barriers to food utilisation in the NSNP at Quintile 1-3 schools in the metro districts of the Western Cape Province. The objectives were to determine the feasibility as well as the attitudes of volunteer food handlers (VFHs) towards implementing potential interventions to address the causes of food wastage in the NSNP at Quintile 1-3 schools in the metro districts of the Western Cape. Methods: A cross-sectional study design was used to obtain data to determine the enablers and barriers to food utilisation and the attitude of the VFHs through descriptive analyses. A questionnaire was designed to obtain the perceptions from the VFHs. After approval had been received from the Western Cape Education Department (WCED), a list of schools in the four districts was used to stratify schools across districts and quintiles. The questionnaires, a letter to the school explaining the study, and consent forms were emailed to schools. Participants were requested to return the completed forms via email. Data were captured and analysed by means of Microsoft Excel with the help of a statistician. Descriptive statistics in the form of frequency (%) and pivot tables were used to describe the situation of potential causes of food wastage. A Chi-square test was conducted to examine if there was a relationship between the VFHs’ experience in food service and statements made regarding their perceived perception of learners relating to the food served as well as their own perception of food wastage. Results: Of the final study sample of 48 participants, 56.25% were isiXhosa-speaking, 95.83% women, aged from 35 to 44 with 58.33% with less than a high school certificate, while 27 participants (57.45%) had not worked in food service before but 27 (54.17%) had been VFHs for up to five years. Enablers for food utilisation were identified as sufficient refrigeration, alternate uses for food wastage, and meals served warm, at the same time every day. Twenty-three (47.92%) of the 48 participants said there was not enough working refrigeration to store all fresh food and 31 (64.58%) participants said the expired food was thrown away. The utilisation of food by the VFHs have indicated the possible barriers for food utilisation included insufficient refrigeration, throwing away food, type of food served, and portion size of meals. Conclusions: As suggested by the results, it is possible that food wastage exists. The low response rate of participants resulted in a limited ability to answer the research question. Food utilisation in relation to the prevalence of potential causes of food wastage at schools that implement the NSNP could not be compared between Quintile 1-3 schools. However, the study did create a premise for future studies to determine this.
- ItemCommunication strategies as a tool to address the double burden of malnutrition : an analysis of select interventions in the Western Cape province, South Africa(Stellenbosch : Stellenbosch University, 2022-04) Engelbrecht, Liezel Maryke; Du Plessis, Lisanne Monica; Drimie, Scott; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Background: The increasing prevalence of the double burden of malnutrition (DBM) has led to the development of global, national and provincial policies and strategies to address malnutrition in all its forms. In the Western Cape Province, South Africa, two initiatives, the First Thousand Days (FTD) and WesternCape on Wellness (WoW!), were launched by government to address early-life nutrition and overweight and obesity, and non-communicable diseases (NCDs), respectively. A growing body of evidence support double-duty actions (DDAs) to address the DBM in a more holistic manner. Strategic communication can be key in facilitating this process. Objectives: The primary objectives were to 1) evaluate the success of communication strategies for the FTD and WoW! initiatives based on the awareness, knowledge and behaviour of frontline workers and community members related to the initiatives’ objectives, 2) identify available feedback channels related to initiatives, 3) evaluate the relevance of these initiatives in the study sites, and 4) evaluate whether initiatives leveraged communication opportunities for DDAs. Secondary to this, the research explored whether select non-governmental, nutrition-sensitive initiatives had potential areas of overlap with the FTD and WoW! goals to identify DDA opportunities, examine the relevance of these initiatives in the light of the COVID-19 impact on food and nutrition security, and contribute to data for the Western Cape Department of Health (WCDOH) five-year nutrition plan for addressing the double burden of malnutrition in a holistic manner. Methods: This research was an exploratory-descriptive qualitative study, with an analytical component. A desktop overview of the policy documents and strategies from the Western Cape Government and WCDOH was completed to contextualise the origin and prioritisation of the initiatives. Semi-structured interview guides were used as basis for data collection. The total sample size was 17, which included community members (n=6), frontline workers (n=4), NGO officials (n=4) and key government officials (n=3). Fourteen (14) telephonic interviews were conducted, as well as three written exchanges, complemented by one follow-up telephonic interview. Results: Despite being launched five years ago, and high-level interest in the FTD and WoW! initiatives, there was a lack of awareness and knowledge of the WoW! initiative, and sub-optimal behaviour related to the FTD initiative, even though the initiatives were perceived as relevant. COVID-19 increased the need for and receptiveness of nutrition communication, though opportunities to communicate decreased as result of related restrictions. There were definite areas of overlap of the FTD and WoW! interventions with the nutrition-sensitive interventions included in this study, though there are currently few areas of integration. Conclusion: Communication strategies for the FTD and WoW! initiatives have not been successful according to the criteria for this study. The findings suggest that this may be due to missing necessary elements for successful strategic communication such as sub-optimal multisectoral collaboration, and the lack of adequate funding, sufficient human resources, and accessible training. In addition, there is a lack of integration and relevant communication channels, shortcomings in the feedback mechanisms, and lack of robust evaluation and indicators of success. However, many opportunities for improvement were identified by participants.