Masters Degrees (Nutrition and Dietetics)

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Browsing Masters Degrees (Nutrition and Dietetics) by Advisor "Meko, Lucia"

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    Assessing risk of malnutrition in adult patients on hemodialysis in Port Elizabeth
    (University of the Free State, 2016-04) Botha, Angelique; Meko, Lucia
    English: There are currently 737 patients on renal replacement therapy (RRT) in the Eastern Cape (EC) of South Africa (SA) alone. Diseases of lifestyle are major risk factors for the development and/or progression of chronic kidney disease (CKD). CKD is a growing problem in SA, as diseases of lifestyle are becoming more prevalent. The kidneys play a vital role in the body. The kidneys’ functions include: waste removal through the urine; reabsorption of water, glucose and amino-acids; production of hormones such as calcitriol and erythropoietin; production of the enzyme renin; regulation of homeostasis by regulating electrolytes, the acid-base balance and blood pressure. CKD is present when there are abnormalities in the kidneys prevent these functions. The reduced ability of the kidneys to carry out these functions, leads to the need for renal replacement therapy (RRT), such as hemodialysis (HD). The main objective of this study was to determine the risk for malnutrition amongst adults with CKD receiving HD in Port Elizabeth (PE). A total of 68 patients took part in the study. Only 68, 7% (n = 44) patients were from the National Renal Care Dialysis unit, 20.6% (n = 14) patients from the Mercantile Life Dialysis unit and 14.7% (n = 10) from Fresenius Medical Care dialysis unit. These three centres were included for logistical reasons as well as familiarity with the staff and patients. A structured researcher-administered questionnaire was presented to the HD patients. The information collected included socio-demographics, a short-form mini nutrition assessment (SF-MNA) and anthropometrical data. There were 57.4% (n=39) male patients and 42.7% (n= 29) female patients. The majority of patients were married (58.8%); 47.1% had finished high school and an equal percentage of patients had a tertiary education. The largest percentage of patients (63.2%) was older than 50 years with a median age of 54.5 years. Half of the patients were black (n=34), 22.1% (n=15) were coloured, 4.4% (n=3) were Asian/ Indian and 22.1% (n=15) were white. Most patients spoke isiXhosa (41.3%) while only 23.5% spoke English. Just under a third (29.4%) of the patients was unemployed, while just over a quarter (26.5%) was employed on a full time basis. Pensioners made up 32.4% of the sample and only 2 patients were students. Most patients (94.1%) attend the unit 3 times per week and 5.9% (n= 4) attend the unit only twice per week. The majority of patients have been on HD for more than a year, half (48.9%) had been on HD for 1 to 5 years, and 26.5% had been on HD for more than 5 years. Patients who came from areas outside PE, were from Somerset East, Alexandria, Cradock, Port Alfred or Grahamstown. Most of the patients live within PE. Five patients (7.4%) live within 5 km of their dialysis unit, 39.7% within 5 – 10 km from the unit, and six 8.8% (n= 6) more than 50 km from the unit. Patients were classified as at risk for malnutrition if their SF-MNA scores were ≤ 11, and a score of ≥ 12 was considered acceptable. Of the 68 patients, 52.9% (n = 36) were identified as at risk for malnutrition. Significant associations between the risk of malnutrition, and HD duration, loss of appetite (p-value < 0.0001), weight loss (p-value < 0.0001) and psychological stress and/or acute disease (p-value < 0.0001) were found. In conclusion, a large number (52.9%) of patients that were receiving HD in PE at the time of the study, were at risk for malnutrition. Ongoing monitoring of such at-risk patients is therefore important. Detection of loss of appetite, weight loss and psychological stress and/or acute disease should be reason to suspect a risk for malnutrition. Early dietary and psychosocial intervention may improve the nutritional status and thus improve the patient’s quality of life. Psychological, nutritional and medical support during the first few months after HD is started, is important, as a higher risk for malnutrition is seen amongst patients on HD for 0 – 6 months. It is recommended that appropriate supplementation becomes standard practice and form part of the National Therapeutic Programme (NTP) during the first 6 months of HD.
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    ItemOpen Access
    Feeding practices of mothers with infants and children attending preschools in a high socioeconomic area in Johannesburg
    (University of the Free State, 2019-04) Rust, Annica Madeleen; Meko, Lucia
    Breastfeeding is the preferred feeding method, as it is not only nutritionally complete for the first four to six months but will also provide immunological, psychological, physiological, and developmental benefits for the infant. In recognition of the benefits of breastfeeding, the World Health Assembly has set a target of 50% for all infants to be breastfed exclusively from birth up to six months. Despite the well-known benefits of exclusive breastfeeding (EBF), the exclusive breastfeeding rate at six months was 32% in South Africa (ZA) in 2016. The EBF rates mentioned above, published by the South African Department of Health, are said to be representative of the country, but do not distinguish between feeding practices of mothers of different socioeconomic levels. The aim of this study was to determine breastfeeding practices and associations between breastfeeding practices and demographics of mothers in a high socioeconomic area in Johannesburg. To achieve the aim, the following factors were assessed: mother and infant/child’s socio-demographic information, mothers’ feeding practices, and factors affecting feeding practices. The majority of mothers were younger than 35 years of age (58.9%), were married or cohabiting (83.5%), and had an education level higher than Grade 12 (88.8%). Although most of the mothers initiated breastfeeding at birth (n=102, 94%); however, the duration of EBF was short. Thirty-four mothers (31.3%) breastfed their infants at four months, and 64 mothers (58.7%) breastfed their infants at six months. Only two mothers (1.8%) exclusively breastfed their infants at six months. A statistically significant difference was not found between breastfeeding duration at six months and the mothers’ age (p=1.0000), highest level of education (p=1.0000), gross household income (p=0.3368), marital status (p=0.2825), and type of delivery (p=1.0000). In an effort to guide researchers in describing factors affecting breastfeeding practices, Hector and co-workers developed a conceptual framework of factors affecting breastfeeding practices. They categorised these factors as individual-level, group-level and society-level factors. The most common factor (on group level) why mothers with a high socioeconomic status in this study decided not to breastfeed was that formula milk was more convenient when working and less time consuming (63%). The misperception of insufficient milk supply was a common individual-level factor (37%) why mothers in this study decided not to breastfeed. The most common society-level factor why mothers did not breastfeed was that it was culturally unacceptable to breastfeed in public or in front of others (29%). The majority of mothers (60.4%) based their choice of formula on the advice of paediatricians. The most common property that influenced the choice of infant formula used by mothers was the brand name of the infant formula (42.5%). It is evident that advertising of infant formula did not significantly affect mothers’ decisions of formula to use. Rather, 17.6% of mothers indicated that their own research on infant formula influenced their decision of which formula to use. This study supports the literature published that the feeding practices of mothers with different demographics differ from one another. To compare feeding practices among different demographic statuses best, it is recommended that a validated screening tool be developed. Future research should investigate the options to make breastfeeding more convenient and implement interventions for modifiable factors such as breastfeeding intention, social support (including work environment), and expression of breast milk confidently. More research should be conducted on the infant formula information given on websites to determine if manufacturers comply with Article 4.1 of the World Health Organization (WHO) International Code of Marketing of Breast Milk Substitutes.
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    Language matters: exploring the language barriers between dietitians and mothers during nutrition counselling related to the first 1000 days of life
    (University of the Free State, 2023) Jansen, Phozia; Meko, Lucia; van den Berg, Louise
    𝗜𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝘁𝗶𝗼𝗻 South Africa is a rich melting pot of culturally and linguistically diverse citizens. Historically, the development of indigenous South African languages has been stunted while English and Afrikaans were prioritized. There has been a growing concern by healthcare professionals to serve linguistically diverse patients. Dietitians often do not share the same language as their patients. The role of language is particularly important in nutrition education and assists in achieving behavioural change. The double burden of malnutrition is a serious public health concern. The first 1000 days of life refers to the critical period of development between conception and two years of age. Adequate nutritional care is invaluable during this period; without it, poor health outcomes will track into adulthood. Nutrition education is essential in addressing the double burden of malnutrition during the first 1000 days of life. It is well known that language barriers may lead to ineffective communication between dietitians and patients. Therefore, this study aimed to determine the language barriers between dietitians and Sesotho-speaking mothers during dietetic consultations related to the first 1000 days of life. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀 A phenomenological qualitative study design was used. A total of 22 dietitians were interviewed at ten public health institutions in the Free State province. The study involved unpacking the dietitians' lived experiences and collecting data through conversational interviewing techniques. The interviews were voice-recorded and transcribed verbatim. The data was analysed and three major themes, with subthemes, were identified. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 Most participants were White Africans who spoke Afrikaans as their first language; the rest were Black Africans and spoke various indigenous South African languages. Many reported experiencing language barriers, including, amongst others, dietitians lacking proficiency in Sesotho, the predominantly spoken local language. Other issues included mothers lacking proficiency in English or Afrikaans and some Sesotho- speaking mothers' resistance to receiving healthcare services in English. The role of power and privilege in language was also highlighted. Furthermore, the dietitians reported difficulty in explaining nutrition concepts in Sesotho. Strategies were identified to overcome the language barriers, including interpreters, visual aids, codeswitching, language learning and nutritional education in Sesotho. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 Despite the country's eleven official languages, there is limited research on language barriers in healthcare within the South African context. This study provides evidence of language barriers experienced by dietitians and mothers of young children in a Free State public health setting and highlights that practical solutions are crucial to ensure the success of healthcare interventions as language barriers between dietitians and mothers result in communication gaps, which impact nutrition outcomes, particularly in the first 1000 days of life. It is recommended that the research be repeated for different professions and indigenous languages to explore the true complexity of language barriers in the South African healthcare system. The study also highlights the lack of research regarding appropriate Sesotho nutrition and medical terminologies. Therefore, this study provided a rationale for developing a Sesotho nutrition glossary.