Regulations relating to foodstuffs for infants and young children : perspectives from South African dietitians

Clarke, Megan Janet (2018-12)

Thesis (MNutr)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Introduction: Knowledge surrounding the importance of breastfeeding is ever increasing and authorities have long since realised that the inappropriate marketing of breastmilk substitutes (BMS) undermines optimal breastfeeding practices. Many countries have legislated the International Code of Marketing of Breast-milk Substitutes (The World Health Organization [WHO] Code) drafted by the World Health Alliance (WHA) in 1981. South Africa adopted its own legislation (that is, The Regulations Relating to Foodstuffs for Infants and Young Children [R991] [The Regulations]) in December 2012. The perspectives of health care providers (HCPs) on the Regulations are an important factor to consider as they play a pivotal role in the implementation of such Regulations. Objective: The study aimed to determine the knowledge, perceptions, behaviours and practices of dietitians in South Africa regarding the Regulations Relating to Foodstuffs for Infants and Young Children (R991) (The Regulations). Methodology: A mixed method, cross-sectional design was used; including quantitative data by means of an online survey (n = 282) collected throughout South Africa and qualitative data by means of two focus group discussions (n = 12) collected in KwaZulu-Natal. Study participants were dietitians registered with the Health Professions Council of South Africa (HPCSA). Results: Dietitians’ average knowledge score was 64.8% ± 12.5. Those working in infant and young child feeding (IYCF) had a 5% higher knowledge score. Perceptions on the Regulations were generally positive and supportive. Representatives of designated products were mostly supportive and positive towards the Regulations. The majority of dietitians’ practices were compliant with the Regulations. The major barriers to the implementation of the Regulations identified were a lack of awareness among HCPs and the general public and a lack of training for HCPs. The major enablers identified were other breastfeeding promotion initiatives, greater awareness and compliance from industry and awareness creation by the Department of Health (DoH). Knowledge scores were linked to certain perception and practice questions, generally respondents with higher knowledge scores selected more decisive answers. Perceptions and practices seemed to correlate in certain areas; commonly, with more positive perceptions correlating with more compliant practices. The major themes that arose from the focus group discussions included: less knowledge among dietitians and mothers about products controlled under the Regulations, non-compliance of other HCPs, the dietitians’ role in supporting and enforcing the Regulations, the discrepancy between practice in private and public sectors and a lack of enforcement. Conclusion: Dietitians revealed an average knowledge score of 64.8% relating to the Regulations. Perceptions and practices were generally positive and compliant. Higher knowledge scores seemed to be linked to a better ability to practice in accordance with the Regulations and more compliant practices. Many enablers and barriers arose which provided interesting insights into how the Regulations were being established within the country. There are still gaps that need to be addressed in the regulation of IYCF, South Africa has taken the first step in legislating the WHO Code and should upscale programmes to ensure consistent monitoring and enforcing of the Regulations. Research that evaluates the implementation and determines the impact of legislating the WHO Code is important to strengthen weaknesses and provide insights to policy makers going forwards.

AFRIKAANSE OPSOMMING : Inleiding: Die onvanpaste bemarking van borsmelk plaasvervangers het ʼn negatiewe impak op optimale borsvoedingspraktyke. Die WHO Kode vir die bemarking van borsmelk plaasvervangers is in werking gestel deur die samewerking van verskeie lande om hierdie negatiewe impak te bekamp en borsvoeding te beskerm. Die Wêreld Gesondheids Alliansie (WGA) het die WHO Kode wettig gemaak in 1981 en Suid-Afrika het die wet aangeneem in Desember 2012 naamlik - ‘Die Regulasies op Voedingstowwe vir Babas en Jong Kinders’. Die perspektiewe van gesondheidswerkers aangaande die Regulasies is ʼn belangrike faktor om te oorweeg aangesien hulle ʼn sleutelrol in die implementasie van die Regulasies speel. Doelstelling: Die doelwit van hierdie studie was om die kennis, persepsies, gedrag en praktyke van dieetkundiges in Suid-Afrika met betrekking tot die Regulasies op Voedingstowwe vir Babas en Jong Kinders te bepaal. Metodologie: ʼn Gemengde metode, dwars deursnit ontwerp was gebruik. Kwantitatiewe data was ingesamel dwarsdeur Suid-Afrika deur middel van ʼn aanlyn opname (n = 282). Kwalitatiewe data is ingesamel in Kwa-Zulu Natal deur middel van twee fokusgroepbesprekings (n = 12). Alle deelnemers was dieetkundiges wat geregistreer is by die ‘Gesondheids Beroepe Raad van Suid-Afrika’ (HPCSA). Resultate: Dieetkundiges se gemiddelde kennis met betrekking tot die Regulasies was 64.8% ±12.5. Die wat met jong kinder en baba voedingspraktyke werk het ʼn 5% hoër kennis gehad. Die algemene gevoel teenoor die Regulasies was positief van aard. Dieetkundiges wat verteenwoordigers was van borsmelk plaasvervanger maatskappye was ook meestal ondersteunend en positief gesind teenoor die Regulasies. Die meerderheid van dieetkundiges se praktyke voldoen aan die Regulasies. Die grootste struikelblokke vir die implementering van die Regulasies is geïdentifiseer as ʼn gebrek aan bewustheid onder gesondheidswerkers en die publiek sowel as ʼn tekort aan opleidingsgeleenthede. Die belangrikste instaatstellers van die Regulasies was bewusmaking deur die Department van Gesondheid (DoG), borsvoedingsinisiatiewe en groter bewusmaking en aanvaarding van die Regulasies deur alle nywerheidsrolspelers. Daar was ʼn positiewe korrelasie tussen positiewe persepsies en praktyke gevind en individue met beter kennis het meer beslissend geantwoord. Die hooftemas wat geïdentifiseer was uit die fokusgroepbesprekings was onderandere – ʼn gebrek aan kennis oor die produkte wat deur die Regulasies beskerm word, gesondheidswerkers wat nie die Regulasies toepas in die praktyk nie, die dieetkundige se rol in die ondersteuning en handhawing van die Regulasies, die verskil in praktyke tussen die privaat- en openbare sektore en die handhawing van die Regulasies. Gevolgtrekking: Dieetkundiges se gemiddelde kennis met betrekking tot die Regulasies was 64.8% ± 12.5 en hul persepsies en praktyke was oor die algemeen positief en voldoende. Dit blyk of beter kennis aangaande die Regulasies lei na beter toepassing van die Regulasies. Daar is verskeie faktore geïdentifiseer wat die suksesvolle implemetering van die WHO Kode in Suid-Afrika verhinder of vergemaklik. Leemtes in die Regulasies moet oorbrug word deur programme aan te bied wat monitoring en handhawing van die WHO Kode versterk. Navorsing wat die suksesvolle implementering en impak van die Kode evalueer is belangrik om sodoende swakpunte te identifiseer en versterk en insig te verskaf aan beleidmakers.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105188
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