Doctoral Degrees (Nutrition and Dietetics)
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Browsing Doctoral Degrees (Nutrition and Dietetics) by Author "Dannhauser, A."
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Item Open Access Food safety indicators in household food security in the Ruralvhembe district, Limpopo province, South Africa(University of the Free State, 2014-07) Nesamvuni, C. N.; Dannhauser, A.; Viljoen, B. C.; Joubert, G.English: Available literature emphasises the importance of food safety in obtaining coordinated and conceptually informed results of food security, with the view to improve intervention programmes to achieve progress in obtaining food security in households. The study was undertaken intending to investigate possible food safety indicators that might possibly contribute towards improved assessment of household food security (HFS) in the rural Vhembe District, Limpopo Province, South Africa. The objectives were to determine HFS and household food safety, as well as the relationship between HFS and food safety, and to develop food safety indicators of HFS. A cross-sectional study was undertaken. Twenty nine villages were randomly selected from the total number of 299 villages in Thulamela local municipality in the Vhembe District. For proportional sampling of households from the selected villages 4 village clusters were created according to their population sizes. Households were randomly selected from villages. The final randomly selected sample consisted of 335 households with at least 1 child (3-5 years of age) and a caregiver. The caregiver could be the mother of the child or any caregiver over the age of 18 years of age who was mostly responsible for food preparation in the household. A structured interview schedule was used, consisting of questionnaires and data/record sheets that were completed during an interview with the respondent of each household. A sociodemographic questionnaire; food availability and access questionnaire; a food inventory; an 8-item hunger scale; a food frequency questionnaire; a food handling practices questionnaire; and a food handling knowledge test; a 24 hour recall and child health status questionnaire; as well as record sheets were included. Five repeatedly trained (for consistency) field workers (all Nutritionists) collected all types of data. Weight and height status were determined and laboratory techniques were used to determine microbiological content of the water and food samples (114 of 335 of households: 34%) and worm content of stool samples (from all 335 children 3-5 years of age). Data was analysed using statistical analysis software (SAS) version 9.2. Frequencies and percentages were used to describe categorical data. Continuous data (symmetric distributions) were expressed using means and standard deviations while medians, lower and upper quartiles as well as minimum and maximum values were used to describe skewed continuous data. Anthropometric data was summarised using Z-scores. Chi-square tests or Fisher’s exact tests in case of small numbers were used to determine associations 229 between the indicators of household food safety and HFS. A statistical reduction process was used to develop the household food safety indicators that can be used in rural HFS assessments. Household food insecurity was indicated by all indicators used, as well as the sociodemographic indicators. Salary, affordability and the presence of protein rich foods, vegetables, milk and fat were significantly related to the household food security status as indicated by the hunger scale. The levels of food security were evenly distributed among the households: food insecure (32.8%), at risk (37%) and food secure (30.2%) households. However, the anthropometric indicators showed that most children (>88%) had an acceptable weight/height status. The dietary intake of the children suggested sufficient energy intake with probable low intake of micronutrients especially β-carotene. Furthermore, the diet seemed to lack variety, with inadequate intake of fruits, vegetables, milk and dairy products. The health status of the children was apparently good as shown by the less than 20% of children with diarrhoeal episodes and 35.2% with reported worm infestations. Stool examination results also showed few cases of children with worm infestation, Ascaris (1.2%), Trichuris (1.9%) and Giardia lambia (5.6%). In general, caregivers had acceptable scores of self-reported food handling practices and knowledge. Water and food used in the households were both likely to pose a food safety risk in the households respectively. Poor microbial quality was detected in more than 94% of water and 75.9% food samples. Hand-washing water had higher bacterial load than stored water. Both stored and hand-washing water had food safety risk levels of total counts (median = 2.3 x 104 & 2.5 x 105 respectively) and coliforms (median = 5.6 x 104 & 1.6 x 105 respectively). Salmonella and Listeria tested negative on food samples however, coliforms exceeded the safety limits. The presence of E. coli in protein rich foods suggested a faecal pollution. Food handling practices and knowledge were not significantly different in food secure and at risk households but were significantly different in the food insecure households. Self-reported and observed food handling practices did not differ. Availability of protein rich foods including milk in the households was linked to food handling practices, while a significant association was observed between worm infestation in children 3 to 5 years and food handling practices. The microbial quality of stored water was significantly associated with that of hand-washing water. Both stored and hand-washing water were significantly linked with poor microbial 230 quality of left over vhuswa (maize meal porridge) but had no association with fresh vhuswa. Poor microbial quality of fresh and left over vhuswa were significantly related to contaminated protein rich foods. A step by step analysis was done during the development process of food safety indicators, in which indicators that did not show significant associations and did not show sufficient variation were eliminated. In the final step the indicators of household food safety to be included in measuring of HFS in rural households were identified. The food safety indicators identified by this study and recommended for use in measuring rural HFS, include use of stored water, communal hand-washing practices and observed food handling practices. It is recommended that these indicators be evaluated and included in the measuring of rural HFS.Item Open Access The health and nutritional status of HIV positive women (25-44 years) in Mangaung(University of the Free State, 2005) Hattingh, Zorada; Walsh, C. M.; Dannhauser, A.; Veldman, F. J.English: Human Immunodeficiency Virus infection causes Acquired Immune Deficiency Syndrome, which has caused millions of deaths, with more expected, particularly in developing countries like South Africa, where poverty is a critical factor. The intake, digestion, absorption and metabolism of food and nutrients emerge as a vicious cycle. The undernourished HIV-infected individual develops micronutrient deficiencies, immunosuppression and oxidative stress, thereby accelerating disease progression. Symptoms include weight loss and wasting, with increased risk of secondary infections. A representative sample of 500 African women (25-34 and 35-44 years) from Mangaung in South Africa’s Free State Province participated in the study. Socio-demographic composition and physical activity levels were determined by questionnaire. Weight, height, circumference (waist and hip) and bioimpedance measurements were used to calculate body mass index and fat distribution and percentage. Dietary intake was determined using a food frequency questionnaire, and nutrient intake was analysed. Biochemical nutritional status was determined through blood samples. Socio-demographic characteristics indicated high unemployment rates. Significantly more HIV positive than HIV negative young women had lived in urban areas for over ten years, and smoked and/or used nasal snuff. Few young women had no education, while more older women had only a primary school or Grade 8-10 education. Significantly more younger and older HIV positive women headed their own households. No significant differences were found in housing conditions, room density and household facilities of younger and older HIV positive and HIV negative women Anthropometric results showed that approximately 50% of all women were overweight/obese. Most women had a gynoid fat distribution and were fat/obese according to fat percentage. However, young HIV positive women had significantly lower body mass index and fat percentage than young HIV negative women. The entire sample had low physical activity levels. Median dietary intakes of energy, macronutrients and cholesterol were high, with young HIV positive women having a significantly higher median energy intake than young HIV negative women. Low median intakes of calcium, total iron, selenium, fat-soluble vitamins, folate and vitamin C, but high median intakes of the B vitamins, were reported overall. Younger women with HIV had significantly higher intakes of calcium, phosphorus, potassium, and vitamins B12, D and E than young HIV negative women. Older HIV positive women had significantly lower intakes of haem iron, nonhaem iron and selenium than older HIV negative women. Although median values for most biochemical parameters were normal, younger HIV positive women had significantly lower median haemoglobin and haematocrit levels, while older HIV positive women had significantly higher serum ferritin and lower transferrin values than their HIV negative counterparts. Significantly more HIV positive younger and older women had low haematocrit values, while significantly more HIV negative older women had low serum iron and high transferrin concentrations. Compared to HIV negative women, younger and older HIV positive women had significantly lower median blood values for total lymphocytes and serum albumin, but significantly higher median blood levels of total serum protein. Plasma fibrinogen and serum insulin concentrations were significantly reduced in young HIV positive women. Older HIV positive women had significantly lower total serum cholesterol values than older HIV negative women. Serum glucose and serum triglycerides did not differ significantly between HIV positive and HIV negative women within both age groups. In younger and older women, increased serum total protein and decreased serum albumin were associated with HIV infection. In younger women, smoking and being unmarried increase the odds of HIV infection, while in older women a higher education level and a decreased non-haem iron intake are associated with HIV infection. An adequate diet, nutritional counselling and active physical activity can improve immune function, quality of life and biochemical nutritional status. Dietary intake alone, however, may be insufficient to correct nutritional deficiencies in this poor community, and the role of food-based approaches and micronutrient supplementation merits further attention. Key words: South Africa; African women; HIV; socio-demographic status; anthropometry; dietary intake; physical activity; iron status; metabolic profileItem Open Access Impact of a nutrition education intervention on nutritional status and nutrition-related knowledge, attitudes, beliefs and practices of Basotho women in urban and rural areas in Lesotho(University of the Free State, 2013) Ranneileng, Mamotsamai; Walsh, C. M.; Dannhauser, A.Abstract not availableItem Open Access Impact of a nutrition education programme on the nutritional status of children aged 3 to 5 years and the nutritional practices and knowledge of their caregivers in rural Limpopo province, South Africa(University of the Free State, 2011-11) Mushaphi, Lindelani Fhumudzani; Dannhauser, A.; Walsh, C. M.; Mbhenyane, X. G.Globally, the prevalence of acute malnutrition and micronutrient deficiency is high in young children, especially in developing countries. This study was undertaken to determine the impact of a nutrition education intervention programme (NEIP) on the nutritional knowledge and practices of caregivers, as well as the nutritional status of children between the ages of three to five years in the Mutale Municipality in Vhembe district, Limpopo Province. A pre-test–post-test control group design was chosen using eight villages (four villages in the experimental group (E); four villages in the control group (C). At baseline, the study population was 125 caregivers and 129 children aged three to five years (E = 66; C = 63 children). After intervention, 86 caregivers and 89 children (E = 40; C = 49 children) were found. Only participants who participated at baseline and postintervention were included for comparison. A valid structured interview schedule was used to determine nutritional practices and knowledge. The nutrient intake was determined by two 24-hour recalls. Weight and height (to determine weight/height status) and blood samples (vitamin A and iron status) were taken using standard techniques. The NEIP was developed by the researcher using South African Food-based Dietary Guidelines (SAFBDGs) and South African Paediatric Food-based Dietary Guidelines (SAPFBDGs) as basis. The NEIP was implemented on the experimental group on two occasions, namely every week during the first three months and then during the last three to four months in a period of 12 months. Data were analysed using Statistical Analysis Software (SAS®) version 9.2 and expressed using median, minimum and maximum values to describe continuous data. Frequencies and percentage were used to describe categorical data and 95% confidence intervals were used for median and percentage differences to determine the impact of the intervention programme. The 24-hour recall data were analysed using Food Finder III version 1.1.3. The study revealed that the socio-demographic information and anthropometric nutritional status of the children did not change after intervention in both groups. Furthermore, at baseline, nearly one third of the children in both groups had marginal vitamin A status. However, after intervention, all children in both groups had adequate to normal vitamin A status, which could be due to the vitamin A supplementation and food fortification programme of the SA Government. The iron indicators were within adequate levels at pre- and post-intervention in both groups. The impact of NEIP was observed in some of the nutritional practices, since the majority of caregivers usually included starchy foods, protein-rich foods and vegetables in the child’s plate daily at baseline in both groups. However, the number of children who were given more than three meals per day showed a tendency towards an increase in the experimental group. The intake of milk and yoghurt improved significantly in the experimental group. The majority of children were eating indigenous foods. However, the intake of black jack, spider flower, wild jute plant, baobab fruit, paw-paw, mopani worms and termites improved significantly in the experimental group. The median carbohydrate and protein intake was adequate when compared to EAR/RDA in both groups at pre- and post-intervention. The median energy, carbohydrate and plant protein intake had increased significantly in the control group. The intake of iron and folate had increased significantly in both groups, while zinc intake increased significantly in the control group. After the intervention, the intake of tshimbundwa (traditional bread made with maize) also increased significantly in the control group. Furthermore, the intake of stinging nettle, meldar, wild peach, pineapple, dovhi, tshigume and thophi had improved significantly in both groups. The nutrition knowledge score was good at baseline, as the majority of caregivers in both groups were aware that children should be given a variety of foods, indigenous foods, starchy foods, protein-rich foods, vegetables and fruit. However, in the experimental group the percentage of caregivers who knew that children should be given full-cream milk and fat increased significantly at post-intervention. On other hand, the percentage of caregivers who knew tshimbundwa increased significantly in the control group. The majority of caregivers were including most of the food items on the child’s plate (starchy, protein-rich foods, vegetables and indigenous) at baseline, which left little room for improvement. However, the impact of NEIP was observed in some nutritional practices. On the other hand, minimal impact of the NEIP on nutrition knowledge was observed, since most of the caregivers had good nutritional knowledge at baseline. It is recommended that the NEIP developed in this study be adapted for the Department of Health (Nutrition Section) so that healthcare workers can present it in different communities using different media so as to increase coverage.Item Open Access The impact of an enzyme-modified enriched maize-based supplement on the anthropometric nutritional status of institutionalised HIV+ children(University of the Free State, 2013-07) Van der Walt, Erika; Dannhauser, A.; Veldman, F. J.English: HIV/AIDS negatively influences the health, quality of life and nutritional status of infected individuals. The negative influence on nutritional status is even worse in children than in adults, due to children’s additional needs for growth. The aim of this study was to determine the impact of an enzyme‐modified, enriched maizebased supplement on the anthropometric nutritional status of children infected with HIV, and residing in or attending day care at institutions for HIV‐infected and affected children in Mangaung. A total of 155 food secure HIV‐infected children aged 1 – 10 years were screened to determine HIV status. HIV‐infection was confirmed in 37 clinically stable, antiretroviral naïve children, who were included in the study sample. The study was a randomised, double blind, clinically controlled, prospective trial. Intervention over a period of 16 weeks consisted of an experimental and control supplement given to the children in the experimental‐ (E) and control (C) groups respectively. Both products were enriched maize/soy blends of exactly the same nutritional value, except that α‐amylase was added to the E‐product. The addition of α‐amylase to starchy foods decreases the viscosity of the mixed product, enabling the individual to consume larger quantities for more energy and nutritional benefit, especially in the case of young children with high nutritional needs but lack of capacity to consume large enough quantities to provide in these needs. Twenty‐nine children completed the intervention. The mean age of the 29 (E=14; C=15) at baseline was 64.1 months (SD 23.6 months). Baseline nutritional status of the children was poor. Underweight for age was identified in 42.9% of both the E‐ and C‐groups. The median Z‐score for WAZ was ‐1.9 for both the E‐ and the C‐group. These findings support findings of other researchers that growth in HIV‐infected children is significantly slower than in noninfected children. A high percentage of stunting was found in both groups: 57.1% in the E‐group and 80% in the C‐group were stunted. The median Z‐scores for HAZ were ‐2.3 for the E‐ and ‐2.9 for the C‐group. This was in accordance with findings of other researchers who reported that HIVinfected children are more often stunted than non‐infected children. The prevalence of stunting in this study is high in comparison to existing national data for children of unknown HIV status. The poor anthropometric nutritional status in children in care centres emphasises the detrimental effect of HIV‐infection on the nutritional status and growth in young children, as well as the importance of extending community based nutrition intervention initiatives to care centres and other facilities taking care of HIV‐infected and HIV‐affected children. Although the data of the intervention phase of this study did not show significant improvement in the anthropometrical nutritional status, other studies using a product with added α‐amylase did show improvement in anthropometrical nutritional status. The practical problems experienced in the present study may have had a negative effect on the outcome of the study. In conclusion, the high prevalence of malnutrition found at baseline, indicate that children infected with or affected by HIV are vulnerable and that being a resident or being registered at a care centre does not necessarily protect them from malnutrition. It is important that children in these facilities are included in routine health and nutritional assessments and that the centres are included in initiatives that target malnutrition. HIV‐infected children in care centres should receive more aggressive nutrition support to make provision for their increased requirements and also to protect them from malnutrition and early disease progression. The inclusion of additional sources of energy dense supplements such as RUTF to current supplementation regimens for malnourished children may be needed to achieve catch‐up growth in malnourished children.