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.
- 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.
- ItemAchievements 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.