Contributing factors to malnutrition among children 0-60 months in Dora Nginza hospital, Eastern Cape

Clarke, Pamela Michelle (2020-03)

Thesis (MNutr)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY: Introduction: South Africa has a high prevalence of malnutrition, presenting as undernutrition and overnutrition in its various forms and affecting children and adults alike. Children within Nelson Mandela Bay (NMB) are affected by malnutrition, especially stunting, while wasting and overweight is also prevalent. A poor nutritional status has long-term consequences on an individual in terms of cognitive development as well as increasing the risk of chronic disease later on. On a larger scale, nutritional deficiencies can influence school performance, increase the cost of medical expenses and therefore affect the economy as a whole. In order to implement interventions within a community, it is necessary to understand what the contributing factors are. More specific and comprehensive data regarding contributing factors to malnutrition is needed in the NMB area. Aim: The aim of the study is to determine the contributing factors to malnutrition in children 0-60 months in Dora Nginza Hospital (DNH) in the Eastern Cape Province in South Africa. Methods: The study followed a cross-sectional design using a quantitative approach. A convenience sample (n=184) of children 0-60 months were included from the DNH Paediatric Outpatient Department (POPD) and collected between May and July 2018 (Ethics approval: S17/10/192). Primary caregivers provided informed consent for themselves and their child for participation. The researcher and a trained research assistant completed a structured questionnaire which included socio-economic factors, health status, dietary patterns, -diversity and household food security as possible contributing factors to malnutrition and anthropometric measurements were performed for both the child and the caregiver according to standardised methods. The anthropometric data of the child was analysed using a World Health Organisation (WHO) anthropometry software programme to obtain z-scores. Relationships were explored between anthropometric measures and possible contributing factors to malnutrition. The questionnaire was developed in such a way to aim to include questions that are related to contributing factors of malnutrition found throughout literature. These include questions regarding socio-economic factors, health factors, dietary patterns, dietary diversity and household food security and the anthropometry of the caregiver was used to explore relationships between the anthropometry of the child. Results: Most caregivers were female and more than half completed high school, yet almost 75% were unemployed. Half of households had an income of less than R2000, which is insufficient to ensure livelihood. A total of 25.6% of children were stunted, 19.8% were underweight for age, 6.4% were either Moderate Acute Malnutrition (MAM) or Severe Acute Malnutrition (SAM) and 7.2% were overweight or obese. Most of the caregivers (58.2%) were either overweight or obese. The Food Frequency Questionnaire (FFQ) showed a poor consumption of meat, dairy, fruit and vegetables and the most consumed foods being soft porridge, margarine, potatoes, white bread and chips. The most consumed dairy product was yoghurt and the most consumed meat was chicken and processed meat (polony). More than half (54%) of participants had an excellent Dietary Diversity Score (DDS) and 21.9% had an adequate DDS and 91% of children met the minimum dietary diversity score. The FFQ has shown that the frequency of consumption is relatively low for a variety of foods. When measuring household hunger, the results showed that only 33.2% of households were food secure, with 66.8% being either at risk of hunger or food insecure. A significant slightly positive correlation was found between the Body Mass Index (BMI) of the caregiver and the size of the child, showing the impact of genes or being exposed to a similar environment; other than the expectation, the double burden of malnutrition was not prevalent within one household. Child Dietary Diversity Score (CDDS) also showed a significant slightly positive relationship between a number of anthropometric indicators, showing nutritional status to improve when a more varied diet is eaten. DDS also showed a slightly positive correlation with the Household Food Insecurity Access Scale (HFIAS), showing that dietary diversity improves with an increase in food security. The Child Dietary Diversity Score (CDDS) also showed a strong positive correlation to the age of the child, meaning that a variety of food intake to increases as the child ages. Conclusion and recommendations: The prevalence of stunting among children at DNH, NMB was high together with higher underweight and wasting than expected in the area. The majority of caregivers were overweight or obese, which showed a slightly positive correlation with WHZ of the child; heavier caregivers showed to have heavier children, which could indicate the influence of genes or residing in a similar environment. As expected, a lack of dietary diversity was correlated with a poorer nutritional status while food insecurity was correlated with a poor diversity of the diet. Poverty was identified as a possible underlying contributing factor to malnutrition; contributing to food insecurity and therefore poor dietary intake. Carbohydrate-rich food was most consumed while the intake of protein, fruit, vegetables and dairy products were poor among most children, this can be explained due to affordability of carbohydrates compared to other food groups. Dietary intake showed to become more diverse with an increase in the age of the child. This can be expected as a child is gradually introduced to new foods, but also emphasizes the importance of teaching caregivers to introduce a variety of food from complementary-feeding age. Even though some nutrition education programs are currently implemented in the Eastern Cape, it is recommended that further education programs are implemented within Dora Nginza Hospital as well as surrounding areas. Dietitians and Nutritionists play a crucial role in terms of nutrition education and it may be necessary to create more jobs in these areas. Other programs to continue and strengthen include the training of selected community members to act as “mentor mothers” in order to provide support and accurate nutrition education information to families. Nutrition education should focus on breastfeeding support in order to improve continuation of breastfeeding, teaching households to grow their own food in order to improve food security as well as suitable complementary feeding practices and optimal nutrition on a limited budget. Social grants should be evaluated regarding the sufficiency of these amounts and possibly be combined with food parcels for the family to improve dietary intake. Further research in a non-hospital environment within the municipalities in order to compare the data to a healthy population is recommended. A National study regarding food consumption in children is also necessary to be repeated for comparison and to plan suitable National nutrition programs according to these results.

AFRIKAANSE OPSOMMING: Inleding: Suid-Afrika het ‘n groot hoeveelheid wanvoeding wat veral voorkom as ondervoeding en oorvoeding in verskillende vorme en dit affekteer grootmense en kinders terselfdertyd. Kinders in die Nelson Mandela Baai (NMB) area word geaffekteer deur wanvoeding, veral dwerggroei, terwyl ondergewig en oorgewig ook voorkom. ‘n Swak voedingstatus het langtermyn gevolge vir ‘n individu in terme van breinontwikkeling en ‘n verhoogde risiko vir kroniese siektes later in hul lewe. Op die langtermyn, kan nutrisionele tekorte skool prestasie beinvloed, die koste van mediese uitgawes verhoog en op ‘n groot skaal, die ekonomie van die land negatief beïnvloed. Vir die doel om intervensies in ‘n gemeenskap te beplan, is dit nodig om te verstaan wat die bydraende faktore tot wanvoeding is. Spesifieke en gedetaileerde data rakend die bydraende faktore tot wanvoeding is nodig binne die NMB area. Doelwit: Die doel van die studie is om vas te stel wat die bydraende faktore is tot wanvoeding in kinders 0-60 maande oud in Dora Nginza Hospitaal in die Oos-Kaap Provinsie in Suid- Afrika. Metode: Die studie het ‘n deursnee-studie ontwerp gevolg deur gebruik te maak van ‘n kwantitiewe benadering. ‘n Geriefliksheid monster van die populasie (N=184) van kinders tussen 0-6 maande was ingesluit vanaf die DNH pediatrie buite-pasient department. Die data was ingesamel tussen Mei en Julie 2018 (Etiese goedkeuring nommer: S17/10/192). Primêre versorgers het ingeligte toestemming verskaf vir deelname aan die studie vir hulself en hul kind. Die navorser en opgeleide navorsings assistent het ‘n gestruktureerde vraelys saam met die versorger voltooi en antropometriese metings was op die versorger en die kind gedoen volgens gestandardiseerde metodes. Antropometriese data van die kind was geanaliseer deur gebruik te maak van ‘n WHO antropometriese sagteware program om die Z-tellings te bekom. Verhoudings tussen antropometriese metings en moontlike bydraende faktore tot wanvoeding was verder ondersoek. Resultate: Die meerderheid van die versorgers was vroulik en meer as die helfte het hoërskool voltooi, tog was meer as 75% werkloos. Die helfte van die huishoudings het ‘n inkomste van minder as R2000 per maand gehad. ‘n Totaal van 25.6% van kinders het dwerggroei gehad, 19.8% was ondergewig vir ouderdom, 6.4% was middelmatig tot erg wangevoed en 7.2% was oorgewig of vetsugtig. Die meerderheid (58.2%) van versorgers was oorgewig of vetsugtig. Die voedsel frekwensie vraelys (FFQ) het gedui op ‘n swak inname van vleis, suiwel produkte, vrugte en groente en die kossoorte wat die meeste geëet was, is sagte pap, magarien, aartappels, witbrood en skyfies. Die suiwelproduk wat die meeste geëet was, is jogurt en die vleis wat die meeste geëet was, is hoender en polonie. Meer as helfte (54%) van die kinders het ‘n uitstekende diverse dieet telling (DDS) gehad en 21.9% het ‘n voldoende DDS gehad. Die voedsel frekwensie vraelys (FFQ) het gedui daarop dat alhoewel ‘n redelike groot verskeidenheid kos geëeet word, dit nie gereeld geëet word nie. Die Huishoudelike voedselsekuriteit is gemeet (deur die HFIAS) en die resultate het daarop gedui dat slegs 33.2% van huishoudings voedselsekuriteit gehad het. ‘n Beduidende effens positiewe verwantskap was teenwoordig tussen die BMI van die versorger en die grootte van die kind, wat daarop kan dui dat gene sowel as ‘n soortgelyke omgewing ‘n invloed mag hê op die grootte van die kind, hoewel ‘n dubbele las van wanvoeding in een huishouding verwag is. Die kinder dieet diversiteit telling (CDDS) het ‘n beduidende effens positiewe verhouding gewys teenoor ‘n aantal antropometriese indikators, wat daarop dui dat voedingstatus kan verbeter wanneer ‘n meer diverse dieet geëet word. Die DDS het ook ‘n effens positiewe beduidende verwantskap gewys met HFIAS, wat daarop dui dat die dieet diversiteit verbeter met ‘n verbetering in voedselsekuriteit. Die CDDS het ook op ‘n sterk positiewe korrelasie tussen die ouderdom van die kind, wat beteken dat die variasie in kos inname toeneem met ‘n toename in ouderdom van die kind. Samevatting en aanbevelings: Die teenwoordigheid van dwerggroei was redelik hoog in kinders by Dora Nginza Hospitaal in Nelson Mandela Baai sowel as ‘n hoër teenwoordigheid van ondergewig en uittering as wat verwag is in die area. Die meeste versorgers was oorgewig of vetsugtig en het ‘n effens positiewe beduidende verwantskap gewys teenoor die gewig-vir-lengte z-telling (WHZ) van die kind, wat kan dui op die invloed van die ouer se gene of die invloed van dieselfde omgewing op die groei van die kind. ‘n Tekort aan ‘n diverse dieet, het gelei tot ‘n swakker nutrisionele status en ‘n tekort aan voedselsekuriteit het ook gelei tot ‘n minder diverse dieet. Armoede was geïdentifiseer as ‘n moontlike onderliggende bydraende faktor tot wanvoeding wat kan bydra tot voedselonsekerheid en daarom ook ‘n suboptimale diet. Koolhidraatryke kossoorte was die meeste geëet, terwyl die inname van protein, vrugte, groente en suiwel swak was in kinders; dit kan bygedra word tot die bekostigbaarheid van koolhidrate in vergelyking met ander voedselgroepe. Die dieetinname van kinders het meer divers geraak soos ‘n kind ouer word, dit kan verwag word, aangesien ‘n kind geleidelik aan nuwe kossoorte voorgestel word, maar dui ook op die belang daarvan om vir versorgers te leer om ‘n verskeidenheid kossoorte aan die kind voor te stel. Alhoewel daar reeds sommige voedingsopvoedings programme in die Oos-Kaap geïmplementeer is, word dit aanbeveel dat daar nog voedingsprogramme in Dora Nginza Hospitaal sowel as omliggende gebiede geïmplementeer word. Dit mag nodig wees om nog poste te skep vir Dieetkundiges en Voedingkundiges om ‘n groter area te dek en die kapasiteit te hê om meer ondersteuning en inligting aan families te verskaf. Huidige suksesvolle programme soos die “mentor moeder” program waar sekere gemeenskapslede opgelei word om voedingsinligting en– ondersteuning aan families te verskaf, moet uitgebrei en versterk word. Voedingsopvoeding moet fokus op borsvoeding ondersteuning om die voortduring van borsvoeding te verbeter, huishoudings moet geleer word om hul eie groente te kweek en sodoende voedselsekuriteit te verbeter en inligting moet verskaf word oor gepaste komplimentére voedingspraktyke en optimale voeding met ‘n klein begroting. Maatskaplike toelae moet ook geêvalueer word op ‘n Nasionale vlak om vas te stel of die bedrag voldoende is en of dit moontlik eerder met ‘n voedselpakkie gekombineer kan word om dieetinname te verbeter. Verdere navorsing in die maatskaplike gebiede buite die hospitaal kan gedoen word om die navorsing resultate te vergelyk met ‘n gesonde populasie. ‘n Nasionale studie moet herhaal word rakende voedselinname in kinders. Die resultate van die studie kan gebruik word om resultate in kleiner gebiede mee te vergelyk en ook om Nasionale voedingsprogramme te beplan volgens die resultate.

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