Doctoral Degrees (Nutrition and Dietetics)
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Browsing Doctoral Degrees (Nutrition and Dietetics) by Author "Joubert, G."
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Item Metadata only Development of a nutrition screening tool for the prediction of birth outcomes of women attending the antenatal clinic at Pelonomi hospital(University of the Free State, 2021) Jordaan, Elizabeth Margaretha; Walsh, C. M.; Joubert, G.In countries with limited resources, poor birth outcomes significantly contribute to morbidity and mortality and hold short- and long-term consequences for both the mother and her offspring. Optimal nutrition during pregnancy may lead to improved birth outcomes. Nutrition screening during pregnancy may identify women who are at risk of poor birth outcomes, including premature birth and growth retardation (stunting or wasting). This quantitative, cohort analytical study aimed to develop a nutrition screening tool to identify women at risk of poor birth outcomes among pregnant women attending the high-risk antenatal clinic at Pelonomi Hospital, Bloemfontein. During the first phase, questionnaires were completed for 682 pregnant women in their second or third trimester using structured interviews after which each participant was weighed and measured according to standard techniques. During the interview, information related to socio-demographic and household information, reported health and lifestyle, pregnancy history, household food security (using the Household Food Insecurity Access Scale) and individual dietary intake (using a quantitative food frequency questionnaire and a 24-hour recall) was obtained. Participants were asked to return to Pelonomi Hospital after the delivery to provide the information recorded in the Road to Health Booklet at their babies' birth. A total of 331 mothers returned and, together with their 347 babies, were included in the second phase of the study. Associations between socio-demographic, reported health and lifestyle, and nutrition information and the following individual birth outcomes were investigated, namely method of delivery, gestational age at delivery, birth length-for-age and birth weight-forlength, as well as overall poor birth outcome (defined as prematurity, or birth length-for-age below the -2 SD, or birth weight-for-length below the -2 SD). Separate theme-specific (sociodemographic, reported health and lifestyle and nutrition) logistic regressions with backward selection (p<0.05) were used to select significant independent factors associated with overall birth outcome. Variables with a p-value of < 0.15 on univariate analysis were considered for inclusion in the model. Variables found to be significant in the theme-specific logistic regressions were considered for inclusion in the final logistic regression, which identified variables to be included in the screening tool. The median age of participants was 31.9 years (interquartile range 26.8–36.5 years). Most women had access to basic amenities such as a flush toilet and/or their own tap, inside or outside the house. A concerning percentage of women continued to smoke (30.0%), use snuff or chew tobacco (40.3%), or use alcohol (12.1%) during pregnancy. A large percentage of participants were exposed to various forms of stress during their pregnancy, including not being able to find a job for more than six months (themselves or a close family member) (70.9%) and having so much debt that they did not know how they were going to repay it (36.0%). A high prevalence of overweight and obesity as well as food insecurity was observed. About half of participants returned for phase two of the study. Significant differences were observed in terms of socio-demographic indicators and nutrient intake between women who provided their babies' birth information (responders) compared to those who did not (non responders). Generally, responders were better off, indicating that responders may not have been representative of the population and may be indicative of non-response bias. Most babies were born full-term and by means of caesarean section, with almost one in ten being part of a twin pregnancy. Low birth weight (<2.5 kg) was evident in 14.4%. According to the World Health Organization’s (WHO) Z-scores, 12.6% of neonates were underweight, 18.9% were stunted and 14.5% were wasted at birth. Just over a third of neonates were exposed to Human Immunodeficiency Virus (HIV). Overall, 37.1% of neonates experienced overall poor birth outcome. Several social determinants of health were significantly associated with at least one of the defined birth outcomes. Significant associations between various reported health and lifestyle factors and the individual birth outcomes were also observed, most notably, premature delivery. Significant associations between individual poor birth outcomes and nutrient intakes seem to indicate that improved birth outcomes are associated with improved nutrient intake. The proposed tool included all variables identified in the final logistic regression model of predictors of overall birth outcome namely ownership of a stove, participant’s highest level of education, participant’s employment status, being in real danger of being killed by criminals in the past six months (themselves or a close family member), being diagnosed with or treated for high blood pressure during the current pregnancy, number of babies expected and gestational body mass index (replaced by current body mass index for ease of application in the screening tool). Experiencing weight loss of more than 3 kg during the current pregnancy was added to the tool. A score of two or more was considered as indicative of an overall poor birth outcome since this cut-off gave the best combination of sensitivity and specificity namely. 68.8% and 70.5% respectively, while the positive predictive value was 58.1%, and the negative predictive value was 79.1%. Pregnant women should be educated on the importance of regularly attending antenatal follow-up visits, focusing on the risks associated with poor lifestyle choices during pregnancy and the benefits of following a healthy diet and lifestyle. Pregnant women who regularly attend antenatal visits may be more likely to be screened and referred for specialised nutrition care at an early stage when such interventions can still make a difference to birth outcomes.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 Nutritional factors associated with HIV-infected adults in the Free State(University of the Free State, 2013) Pienaar, Michelle; Walsh, C. M.; Joubert, G.English: HIV-infection has a significant impact on health and quality of life. Nutritional factors can be described as those directly related to food and nutrition (such as diet) and those indirectly related to food and nutrition (such as poverty). Dietary diversity is associated with improved socio-economic status and household food security, both of which impact on nutritional status and health. Poor nutritional status is characterised amongst other indicators, by fatigue, physical inactivity, weight loss and wasting, which are associated with poor prognosis in HIV-infection. All of these factors impact on people living with HIV/AIDS, but remain largely undetermined in the Free State. The objective of the present study was to determine significant independent nutritional factors associated with HIV status in rural and urban communities in the cross-sectional Assuring Health for All (AHA) study, which aimed to determine how living in rural and urban communities can influence lifestyle and health. The AHA study was undertaken in rural Trompsburg, Philippolis and Springfontein during 2007 and in urban Mangaung during 2009. Adults between 25-64 years were eligible to participate. The study was approved by the Ethics Committee of the Faculty of Health Sciences at the University of the Free State (ETOVS 21/07) as well as the Free State Department of Health and local municipalities. The venues where data was collected included stations for the collection of blood and urine samples; a food station; medical examination; as well as anthropometric measurements. Thereafter, questionnaires related to the following were completed: socio-demography (one per household); household food security (one per household); diet (one for each participant); physical activity (one for each participant); and reported health (one for every participant). Logistic regression with forward selection (p < 0.05) was used to select significant independent factors (socio-demography, household food security, dietary diversity, physical activity, anthropometry, reported health) associated with HIV status. Variables with a p-value of < 0.15 were considered for inclusion in the model. Of the 570 rural participants, 567 had HIV results. Of these 97 (17.1%) were HIV-infected. Of the 426 urban participants, 424 had HIV results. Of these 172 (40.6%) were HIV-infected. As expected, in rural areas, HIV-infected participants were significantly younger (median age 40.5 years) than HIV-uninfected participants (median age 51 years) (p = 0.001). The same was found in urban areas, with HIV-infected participants having a median age of 38 years compared to 49 years in HIV-uninfected participants (p = 0.0001). In this sample, the odds of having HIV consistently decreased as age increased. In rural areas more HIV-infected participants were female (73.0%) compared to male (27.0%). The same was found in urban areas where 78.0% of the HIV-infected respondents were women and only 22.0% men. As far as socio-demographic and household food security indicators are concerned, in the rural sample HIV-infection was negatively associated with having a microwave oven (odds ratio 0.15, 95% CI 0.06; 0.42); having access to vegetables from local farmers or shops (odds ratio 0.43, 95% CI 0.21; 0.89); and being married (odds ratio 0.20, 95% CI 0.09; 0.41). On the other hand, HIV-infection was positively associated in the rural sample with spending less than R50 on food per week versus R101+ (odds ratio 3.29, 95% CI 1.58; 6.87) or spending less than R100 on food per week versus R101+ (odds ratio 1.22, 95% CI 0.68; 2.20). In the urban sample, HIV-infection was also negatively associated with being married (odds ratio 0.54, 95% CI 0.33; 0.89), while HIV-infection was positively associated with experiencing periods of food shortages (odds ratio 2.14, 95% CI 0.91; 0.95). In the rural sample, one out of five participants had low and medium dietary diversity scores. HIV-infection was negatively associated with a person consuming no eggs (odds ratio 0.41, 95% CI 0.20; 0.82) and consuming no sweets (odds ratio 0.19, 95% CI 0.04; 0.85). On the other hand, HIV-infection was positively associated with being sedentary versus very active (odds ratio 3.18, 95% CI 1.31; 7.70); low active versus very active (odds ratio 2.27, 95% CI 1.08; 4.77); and active versus very active (odds ratio 2.44, 95% CI 1.31; 4.55). No significant dietary diversity or physical activity factors were identified in the urban sample. As far as anthropometric indicators in the rural sample are concerned, HIV-infection was positively associated with a low versus high body fat percentage (odds ratio 15.56, 95% CI 0.80; 303.81); an acceptable low versus high body fat percentage (odds ratio 4.21, 95% CI 2.13; 8.31); and acceptable high versus high body fat percentage (odds ratio 1.85, 95% CI 0.81; 4.22). In the urban sample, HIV-infection was negatively associated with male gender (odds ratio 0.29, 95% CI 0.15; 0.53) and positively associated with a low or acceptable low versus high body fat percentage (odds ratio 9.18, 95% CI 4.89; 17.23) and acceptable high versus high body fat percentage (odds ratio 2.73, 95% CI 1.46; 5.12). When indicators of reported health and coping strategies were considered, a negative association was found between being a member of a church and HIV-infection [odds ratio 0.22 (95% CI 0.06; 0.76) in the rural sample and odds ratio 0.46 (95% CI 0.23; 0.91) in the urban sample]. In rural areas, HIV-infection was positively associated with losing weight involuntarily (>3kg in the past 6 months) (odds ratio 1.86, 95% CI 1.08; 3.20); ever being diagnosed with TB (odds ratio 2.50, 95% CI 1.18; 5.23); being on TB treatment (odds ratio 3.29, 95% CI 1.00; 10.80); and having experienced death of a spouse during the past year (odds ratio 4.91, 95% CI 2.06; 11.73). In the urban sample, HIV-infection was positively associated with having diarrhoea for at least 3 days in the past 6 months (odds ratio 2.04, 95% CI 1.23; 3.41) and having ever been diagnosed with TB (odds ratio 2.49, 95% CI 1.37; 4.53). When all factors identified above were considered for the final model, the odds of having HIV decreased as age increased. In rural areas, HIV-infection was negatively associated with microwave oven ownership (odds ratio 0.20, 95% CI 0.07; 0.57) and being married (odds ratio 0.17, 95% CI 0.08; 0.36). HIV-infection was positively associated with spending less than R50 per week on food versus R101+ (odds ratio 3.15, 95% CI 1.43; 6.95); having a body fat percentage of <5% versus 25%+ (odds ratio 4.41, 95% CI 1.69; 11.51); or having been diagnosed with tuberculosis (odds ratio 3.81, 95% CI 1.93; 7.52). In the urban sample, HIV-infection was negatively associated with male gender (odds ratio 0.29, 95% CI 0.15; 0.57). On the other hand, HIV-infection was positively associated with experiencing periods of food shortage (odds ratio 2.34, 95% CI 1.26; 4.37) and having a body fat percentage of <15% versus 25%+ (odds ratio 8.62, 95% CI 4.42; 16.84). Lower socio-economic status [spending very little on food (rural); and food shortage (urban)], was positively associated with HIV-infection. Being physically inactive [indicated by being sedentary versus very active; low active versus very active; and active versus very active], was positively associated with HIV-infection in the rural sample of this study, probably because lower levels of physical activity are an outcome of HIV-infection. In addition, HIV-infection was positively associated with decreasing body fat percentage (rural and urban). These results confirm the higher prevalence of opportunistic infection and associated symptoms (such as diarrhoea and weight loss) that are outcomes of HIV-infection. Indicators related to wasting, previous tuberculosis and a lower socio-economic status [indicated by being female (urban) and unmarried (rural); spending very little on food (rural); and food shortage (urban)], were associated with HIV-infection, either as outcomes of the disease or as exposures. A vicious cycle develops, with poverty increasing the likelihood of contracting HIV/AIDS and HIV/AIDS contributing to poverty. Interventions that focus on poverty alleviation can make a significant contribution to addressing HIV in South Africa. Interventions of this nature have the potential to improve food security and nutritional status which in turn will assist in preventing weight loss, promoting physical activity and improving quality of life. The social and moral support offered by organisations such as churches is invaluable in the fight against HIV.