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dc.contributor.advisorWalsh, C. M.
dc.contributor.authorWessels, Janke
dc.date.accessioned2017-08-11T06:13:23Z
dc.date.available2017-08-11T06:13:23Z
dc.date.issued2017-06
dc.identifier.urihttp://hdl.handle.net/11660/6534
dc.description.abstractEnglish: Tuberculosis (TB) is a leading cause of morbidity and mortality, especially in middle- and low-income countries. Globally, an estimated 2 billion people are infected with TB, of which 1 billion are malnourished. TB is strongly influenced by nutritional status, with nutrition interventions being likely to impact on prevalence of active disease, response to drug therapy and quality of life. The aim of this study was to determine the nutritional status of patients with TB and TB/HIV co-infection. A convenience sample of a 100 hospitalised patients in Standerton TB Specialised Hospital, Mpumalanga, were included (60 men and 40 women). Socio-economic status, nutritional status (focusing on eating related side effects, food security, anthropometric measurements, overall risk of malnutrition and biochemical parameters), and lifestyle behaviours (smoking habits and alcohol use), as well as associations between the above were determined. Food security was determined by means of the Community Childhood Hunger Identification Project (CCHIP) tool (that includes questions related to food insecurity, food shortages, perceived food insufficienty or altered food intake due to constraints on resources). Weight and height were obtained to calculate body mass index (BMI), while mid-upper arm circumference (MUAC) and triceps skinfold were taken to determine malnutrition and muscle wasting. The overall risk of malnutrition was determined by means of the Malnutrition Universal Screening Tool (MUST) (which calculates the overall risk of malnutrition by making use of a BMI score, a weight loss score and an acute disease score). Biochemical parameters were recorded from patient files. Socio-economic status included gender, age, marital status, education level, employment status, household income and housing density. Lifestyle factors included smoking habits and alcohol use. These variables were determined by means of a questionnaire completed by the researcher in a structured interview with each participant. The majority of participants (91%) did not complete matric and two thirds (66%) were unemployed. More than one out of ten participants (12%) indicated that they had no monthly income and in 64% of households, only one person contributed to the monthly income. Room density of more than 2.5 persons per room (crowded) was present in 29% of households. Only 26% of participants reported having a household vegetable garden. As far as household food security was concerned, only 3% were classified as food secure with 27% of households being at risk of hunger and 70% being food insecure (hungry). The food related side effects reported most commonly included loss of appetite (59%) followed by dry mouth (48%). According to the MUST, the overall risk for malnutrition was as follows: 70% had a high risk, 22% had a medium risk and 8% had a low risk. Actual unplanned weight loss and percentage of unplanned weight loss were significantly higher in patients with TB and HIV co-infection than in patients with TB only (95% CI [1.5%; 38.2%] and [5.3%; 51.0%] respectively). Median BMI was in the underweight category at 18.3 kg/m². Half of participants (51%) had a MUAC in the low category, while half (49.9%) had triceps skinfold measurements below the 15th percentile, indicating malnutrition. The majority of participants had albumin and haemoglobin values below the normal ranges (79% and 92% respectively). Almost six out of ten participants (58%) indicated that they were former (44%) or current (14%) smokers. The average cigarettes, pipes or cigars smoked by the former and current smokers were 4 with a maximum of 20 per day. The average amount of years that the former or current smokers smoked was 9 years with a minimum of 1 year and a maximum of 30 years. Nearly half of participants (49%) reported that they did use alcohol with 25% drinking alcohol more than three times per week. Statistically significantly more females than males were non-smokers and more men drank alcohol three times or more per week than females. Participants that indicated that they were either former or current smokers had significantly lower levels of education than participants who were non-smokers (95% CI [-26.7%; -2.6%] and [-39.9%; -1.0%] respectively). There were no statistically significant differences in terms of BMI in smokers versus non-smokers. In the present study, the nutritional status of patients with TB and TB/HIV co-infection was found to be poor. They were characterised by poor socio-economic status, high levels of food insecurity, malnutrition (underweight, anaemia and hypoalbuminaemia) and poor lifestyle habits (smoking and alcohol use). Recommendations to address the poor nutritional status of patients with TB and TB/HIV co-infection should include relief of poverty in communities, a focus on relevant and culturally acceptable nutrition education and the establishment of sustainable support networks.en_ZA
dc.description.abstractAfrikaans: Tuberkulose (TB) is ‘n hoofoorsaak van siekte en sterftes, veral in middel en lae inkomste lande. Wêreldwyd het ongeveer 2 biljoen mense TB, waarvan 1 biljoen wangevoed is. TB word sterk beïnvloed deur voedingstatus, dus speel voedingsintervensies heel moontlik ‘n belangrike rol in die voorkoms van aktiewe TB, die reaksie op medikasie en lewenskwaliteit. Die doel van hierdie studie was om die voedingstatus van pasiënte met TB en TB/MIV ko-infeksie te bepaal. ‘n Gerieflikheidsteekproef van 100 gehospitaliseerde pasiënte by Standerton TB Hospitaal is ingesluit (60 mans en 40 vroue). Sosio-ekonomiese status, voedingsstatus (met fokus op newe effekte wat verband hou met voedselinname, voedselsekuriteit, antropometriese inligting, risiko vir wanvoeding en biochemiese merkers), en leefstyl veranderlikes (rookgewoontes en alkoholinname), asook verbande tussen veranderlikes is bepaal. Voedselsekuriteit was bepaal deur middel van die Community Childhood Hunger Identification Project (CCHIP) (wat vrae insluit oor voedselsekuriteit, voedseltekorte, siening oor voedseltekort en verlaagde voedselinname as gevolg van beperkte voedselbronne). Massa en lengte was gemeet om liggaams-massa indeks (LMI) te bepaal en bo-arm omtrek en trisepsvelvou was geneem om wanvoeding en spierwegkwyning te bepaal. Die risiko vir wanvoeding was deur middel van die Malnutrition Universal Screening Tool (MUST) bepaal (bereken die totale risiko vir wanvoeding deur te kyk na die LMI, massaverlies en akute siekte). Biochemiese merkers was geneem vanuit die leêrs van pasiënte. Sosio-ekonomiese status het geslag, ouderdom, huweliksstatus, vlak van opvoeding, werkstatuss, huishouding se inkomste en kamerdigtheid ingesluit. Leefstylfaktore het rookgewoontes en alkoholinname ingesluit. Hierdie veranderlikes is bepaal deur middel van ‘n vraelys wat deur die navorser voltooi is in ‘n gestruktureerde onderhoud met elke deelnemer. Die meerderheid van deelnemers (91%) het nie matriek voltooi nie en twee derdes (66%) was werkloos. Meer as een uit tien deelnemers (12%) het aangedui dat hulle geen maandelikse inkomste het nie en in 64% van huishoudings, dra slegs een persoon tot die maandelikse inkomste by. Kamerdigtheid van meer as 2.5 persone per kamer (oorbevolking) was teenwoordig in 29% van huishoudings. Slegs 26% van deelnemers het aangedui dat hulle ‘n groentetuin by die huis het. Met betrekking tot voedselsekuriteit, was slegs 3% van huishoudings geklassifiseer in die katogorie van voldoende voedselsekuriteit, 27% het ‘n risiko gehad vir swak voedselsekuritiet en 70% het geen voedselsekuriteit gehad nie (honger). Die newe effekte wat veband hou met voedseliname wat die meeste gerapporteer was, was ‘n verlies aan aptyt (59%) gevolg deur ‘n droë mond (48%). Volgens die MUST, was die risiko vir wanvoeding soos volg: 70% het ‘n hoë risiko gehad, 22% ‘n medium risiko en 8% het ‘n lae risiko gehad. Onbeplande massaverlies sowel as die persentasie van opbeplande massaverlies was betekenisvol hoër in pasiënte met TB en MIV ko-infeksie as wat dit in pasiënte met slegs TB was (95% VI [1.5%; 38.2%] en [5.3%; 51.0%] onderskeidelik). Mediaan LMI was in die ondergewig kategorie van 18.3 kg/m². Die helfte van deelnemers (51%) het lae bo-arm omterk afmeetings gehad terwyl die helfte (49.9%) trisepsvelvou-afmeetings van onder die 15de persentiel gehad, wat wanvoeding aandui. Die meerderheid van deelnemers het albumien en hemoglobien waardes onder die normale waardes gehad (79% en 92% onderskeidelik). Naastenby ses uit elke tien deelnemers (58%) het aangedui dat hulle vorige (44%) of huidige (14%) rokers was. Die gemiddelde aantal sigarette of pype wat per dag deur die vorige of huidige rokers gerook was, was 4 met ‘n maksimum van 20. Die gemiddelde aantal jare wat die vorige of huidige rokers gerook het was 9 jaar met ‘n minimum van 1 jaar en’n maksimum van 30 jaar. Bykans die helfte van deelnemers (49%) het aangedui dat hulle alkohol inneem, met 25% wat alkohol meer as drie keer per week inneem. Statisties betekenisvol meer vroue as mans het nie gerook nie en meer mans het alkohol drie of meer keer per week ingeneem as vroue. Deelnemers wat aangedui het dat hulle vorige of huidige rokers was, het betekenisvolle laer vlakke van opvoeding gehad as deelnemers wat aangedui het dat hulle nie rook nie (95% VI [-26.7%; -2.6%] en [-39.9%; -1.0%] onderskeidelik). Daar was geen statistiese betekenisvolle verskil in terme van LMI tussen rokers en nie-rokers nie. Die voedingstatus van pasiënte met TB en TB/MIV ko-infeksie in hierdie studie was oor die algemeen swak. Hulle was gekenmerk deur swak sosio-ekonomiese status, hoë vlakke van swak voedselsekuriteit, wanvoeding (ondermassa, anemie, hipoalbumienemie) en swak leefstylgewoontes (rookgewoontes en alkoholinname). Aanbevelings om die swak voedsingstatus van pasiënte met TB en TB/MIV ko-infeksie aan te spreek sluit verligting van armoede in gemeenskappe, fokus op toepaslike en kulturele aanvaarbaarde voedingsonderrig en die stig van volhoubare ondersteuningsnetwerke in.af
dc.language.isoenen_ZA
dc.publisherUniversity of the Free Stateen_ZA
dc.subjectNutritional statusen_ZA
dc.subjectPovertyen_ZA
dc.subjectFood securityen_ZA
dc.subjectMalnutritionen_ZA
dc.subjectLifestyle habitsen_ZA
dc.subjectTuberculosis -- South Africa -- Mpumalangaen_ZA
dc.subjectDissertation (M.Sc. Dietetics (Nutrition and Dietetics)--University of the Free State, 2017en_ZA
dc.titleNutritional status of patients with tuberculosis and TB/HIV co-infection at Standerton TB specialised hospital, Mpumalangaen_ZA
dc.typeDissertationen_ZA
dc.rights.holderUniversity of the Free Stateen_ZA


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