- ItemNutrition knowledge and practices of midwives providing maternal health services in Kanye, Kgatleng and South East Health Districts, Botswana(Stellenbosch : Stellenbosch University, 2021-12) Masesane, Anastacia; Dhlamini, Thembelile; Mbhenyan, Xilombiso; Nnyepi, Maria; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.Background: Maternal malnutrition has been identified by the World Health Organisation (WHO) as a global public health concern. Poor nutrition during pregnancy especially at the early developmental stage of the foetus has been proven to cause adverse effects for both the mother and the infant leading to maternal and child mortality. To promote adequate nutrition during pregnancy until postpartum period, midwives have been well positioned to provide antenatal care (ANC) for a positive pregnancy outcome. Therefore, their maternal nutrition knowledge and practices have an impact on the quality of the service provided. The aim of the study was to investigate midwives’ nutrition knowledge and practices and the integration of nutrition care in maternal health services at the health facilities in Kanye, Kgatleng and South East health districts in Botswana. Method: The study employed a cross-sectional descriptive design with an analytic component. Interviewer administered questionnaire and observation checklist were used for quantitative data collection. All midwives within the participating districts who met the inclusion criteria were invited to take part in the study. A total of 124 midwives were targeted to take part in the study. Statistical package for social sciences (SPSS) version 26 was used to capture and analyse the data collected. Adequate maternal nutrition knowledge and good practice were given a score of 80 percent and above each. Pearson’s correlation test was used to test for association while analysis of variance (ANOVA) test was used to test the difference between independent groups. Results: A total of 102 midwives participated in the study, achieving a response rate of 82%. Majority of midwives (89.2%) were females while 10.8% were males. The mean maternal nutrition knowledge score of midwives was 17.78±3.19 out of 34. Midwives mainly depended on their experience as their main source of maternal nutrition information. There was a significantly negative correlation between midwives’ maternal nutrition knowledge and age (p=<0.005). Midwives who were more experienced were not necessarily more knowledgeable than others. Furthermore, the study demonstrated a significantly negative correlation between midwifery experience and their maternal nutrition knowledge (p=<0.028). The mean nutrition practice score of midwives was 19.21±2.54 out of 28. Only a few midwives (10.8%) attended maternal nutrition related courses in the past two years. The findings revealed no significant difference between maternal nutrition knowledge and practices of midwives. Approximately 42.2% of midwives indicated that refresher training was necessary to improve their maternal nutrition knowledge and the quality of their nutrition practice. Conclusion: Midwives had inadequate maternal nutrition knowledge despite their many years of experience. However, nutrition care practice was moderately provided. Providing refresher courses and in-service training might improve midwives’ maternal nutrition knowledge and nutrition care. Future research should focus on exploring strategies for improving midwives’ knowledge and skills on maternal and child nutrition.
- ItemPromoting traditional and indigenous foods in South Africa : a desktop review(Stellenbosch : Stellenbosch University, 2021-12) Bobo, Zizo Nangamso; Beukes, Ronel Annamarie; Sigge, G. O.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : INTRODUCTION: One of the most pressing issues confronting South Africa is ensuring access to sufficient, nutritious, and affordable food that is produced in a sustainable manner. However, a significant proportion of the diverse foods available in our environment have been overlooked in favour of a few commercial staple foods, resulting in a food supply that is too limited. Growing population rates, urbanization, and persistently rising food prices have resulted in a shift in dietary patterns from more traditional to more westernized diets, where healthier food options have become a luxury and highly processed and refined convenience foods are marketed as less expensive options, all of which are contributing to the emergence of a nutrition crisis in SA. This has resulted in the displacement of traditional and indigenous food crops (TIF), as well as a change in the diet of South Africans. Current dietary patterns reflect an increased intake of a small number of domesticated plant staples, while the intake of TIF, which once sustained health and nutritional status, has decreased significantly. The goal of this study is to conduct a literature evaluation on the promotion of TIF in South Africa. METHODOLOGY: This review was conducted using a systematic search of current academic literature from the following databases: Science Direct, Jstor, EBcohost, Bio-med and PubMed, and Google scholar. Abstract, title, keywords, and subject headings specific to each of the identified databases were searched. The review included studies with both analytical and descriptive study designs. RESULTS: Of the 26699 titles and abstracts screened 103 were potentially eligible. The review included five studies that included TIF as part of the intervention strategy after examination of full texts. Of the total 5 studies included in the review, 2 were cross-sectional studies, 2 were randomized control trials and 1 was a pre-test post-test control group design. All of the studies were based in rural communities. All the interventions had children, ages 1-12 years, as the primary benefactors. The studies included in this review have indicated the promotion and consumption of TIFs resulted in improved nutritional status, particularly vitamin A, zinc, and iron status. The inclusion and promotion of TIF in nutrition messages can significantly improve diet quality and ensure dietary diversification. This is attributed to the various components that form part of successful community-based interventions. CONCLUSION: The five studies discussed in the review are generally acknowledged to be successful in their own right. They have shown that the promotion, production and consumption of TIF in conjunction with nutrition messages and health-based caring practices does improve household food and nutrition security, particularly in vulnerable groups.
- ItemAssessing 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.
- ItemAssessment 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.
- ItemComplementary feeding practices and behaviours of positive deviants among caregivers of young children at risk of stunting in Harrismith, Free State Province, South Africa(Stellenbosch : Stellenbosch University, 2020-03) Pilditch, Kerry; Du Plessis Lisanne, Drimie Scott; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Aim: To identify strategies present among positive deviant (PD) caregivers of non-stunted children that influence complementary feeding (CF)1 practices and allow them to function within individual, household and community-level factors to succeed in raising well-nourished children. Design: A mixed-method design using a PD model. Setting: Intabazwe Informal Settlement, Harrismith, Free State, South Africa. Subjects: Caregivers of stunted (non-positive deviant) and non-stunted (positive deviant) children aged 6-18 months. Of the caregivers selected for the quantitative population (n=28), 16 were non-positive deviants (NPD) and 12 were PDs. Six from each category additionally formed the qualitative population. Methodology: Caregivers were purposively selected according to selection criteria. Height-for-age (HAZ) and weight-for-height (WHZ) Z-scores were used to classify children as PDs or NPDs. Quantitative questionnaires were administered to obtain data regarding demographic information, socioeconomic scores and World Health Organisation (WHO) Infant and Young Child Feeding (IYCF) indicators. Caregivers with similar socioeconomic scores, from both NPD and PD categories, were selected for qualitative interviews. The semi-structured interview aimed to gain further insight into feeding behaviours that were not captured by the WHO IYCF tool, various other components related to behaviour (attitude, subjective norms and self-efficacy) and barriers and enablers to intended behaviour. Analysis of both data sets were performed with the aim of identifying possible adaptive and emphasis growth-promoting behaviours of PD caregivers. Results: IYCF Practices: In general, IYCF practices were similar among the two categories with poor exclusive and continued breastfeeding (BF) practices and the early introduction of solids reported. Only 40% (n=10) of the children obtained a minimum acceptable diet. Sixty percent (n=16) of children obtained minimum dietary diversity. The inclusion of gravy or “soup of meat” (instead of ‘flesh’ of meat) was more common among NPDs. Consumption of non-recommended foods and liquids was high and more common amongst NPD children. Responsive feeding (RF) practices were more commonly reported among PD caregivers. Child level: PDs tended to be younger, more likely female and had fewer hospital admissions. NPDs were more likely to have a low birth weight (LBW) and be premature. A strong theme identified amongst NPD caregivers was a child’s preference, often resulting in the exclusion of certain foods. Caregiver Level: Caregivers of PDs were older, more educated and more likely to be living with a partner. NPD caregivers ascribed higher value to foods that provided satiety and to infant foods. PDs more often explicitly expressed value for health care workers (HCWs). The most common advice received by both groups of caregivers pertained to the introduction of solids at six months and discontinuation of BF due to barriers or the mothers’ HIV status. PD caregivers were more likely to report taking action in response to a lack of food or finance or poor appetite. Action was typically in the form of health seeking behaviours or financial strategy. Household/ Community Level: PDs had better living conditions and higher socioeconomic scores. Support was more often expressed by PD caregivers with a warmth and appreciation for the support provided helping to create the perception of truly supportive households. The practice of eating and sharing meals as a family was a common occurrence in PD households. NPDs expressed experiencing isolation and instability in support structures. Discussion: The multifactorial and complex nature of stunting is highlighted by the lack of superior IYCF practices among PDs. Consideration needs to be given to the ability of indicators used to capture IYCF in the context of stunting and the effect of other risk factors, such as the prevalence of prematurity in the population, on nutritional status. Despite these results, adaptive and emphasis growth-promoting behaviours of PD caregivers were identified. Emphasis PD behaviours identified included: more frequent inclusion of proteins, less frequent inclusion of non-recommended liquids and foods, RF practices and health seeking behaviours by caregivers. Adaptive PD strategies encompassed the inclusion of the ‘flesh’ of meats, financial strategies as a coping mechanism of caregivers, and family eating. The presence of social capital among PD caregivers was deemed a ‘true but useless’ behaviour due to the lack of replicability. Conclusion: The poor feeding practices revealed by this study highlight the need for continued advocacy and promotion of BF and CF in South Africa. The presence of risk factors and non-nutritional PD behaviours within the study highlights the need for a multi-sectoral response, beyond the domain of HCWs and the health sector, in order to address stunting risk factors and improve IYCF practices. The identification of these risk factors will aid in identifying and supporting at-risk caregivers. Key health promotional messages based on identified PD IYCF behaviours, such as RF practices and limiting intake of non-recommended foods, should be developed to be used within the community where the research was conducted. These messages are inherent to the South Africa Paediatric Food Based Dietary Guidelines (PFBDG) which should be disseminated to the broader population. Further research is needed to investigate the role of child’s preference and caregivers’ interpretation of feeding cues, and how these impact feeding practices; the influence of improving a caregiver’s financial literacy on stunting; and gain a better understanding of the role of social capital and how it is developed.