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dc.contributor.advisorWalsh, C. M.
dc.contributor.authorBotha, Magda (M. M.)
dc.date.accessioned2018-01-25T09:32:54Z
dc.date.available2018-01-25T09:32:54Z
dc.date.issued2008-01
dc.identifier.urihttp://hdl.handle.net/11660/7720
dc.description.abstractEnglish: Globally, Protein-Energy Malnutrition (PEM) is a public health problem that af-fects especially children younger than 5 years. Malnutrition, together with acute respiratory infections, HIV and AIDS and diarrhoeal disease, is one of the lead-ing causes of death amongst infants and young children. In South Africa, the Integrated Nutrition Programme (INP) is implemented na-tionally to assist with the reduction of the prevalence of malnutrition and hunger through various child survival strategies, including health facility-based services and community-based interventions. The Protein-Energy Malnutrition Pro-gramme (PEM Program) forms an essential component of the INP. Currently the PEM Program is implemented at public health facilities to treat and manage clients suffering from malnutrition or those that are at risk of be-coming malnourished. Vulnerable children, orphans, pregnant and lactating women and the elderly benefit from the PEM Program in receiving not only nu-trition education, but also food supplements. Food supplements that are distrib-uted include infant formula, enriched maize meal and a high energy drink. The purpose of this cross-sectional descriptive study was to evaluate the imple-mentation of the PEM Program in primary healthcare (PHC) facilities (n = 51) in the Free State. Randomized proportional sampling was applied to include 30% of the total numbers of primary healthcare facilities in the Free State. A repre-sentative sample of 399 children younger than 5 years was selected from these clinics, of which only 46 children participated in the PEM Program. Question-naires were also administered to dieticians (n = 15), professional nurses (n = 43) and mothers / caretakers (n = 46). The professional nurses, mothers / caretakers and children who were included in the research were those who were available at the healthcare facility on the specific day on which the facility was visited by the researcher and the fieldworkers. The dieticians who were included in the sample included all the district dieticians and community service dieticians. Retrospective data was collected by reviewing clinic records and interviews were undertaken with professional nurses and mothers / caretakers. Questionnaires completed by dietitians were self-administered. Body mass index (BMI) of mothers/ caretakers and weight-for-age of children who were attending the clinic on the day of data collection were also determined. The results of the study generally indicated that the PEM Program was not im-plemented effectively in the Free State, where the PEM Program was mainly the responsibility of professional nurses. Poor recordkeeping of client and program information was identified, resulting in poor management of the client’s pro-gress. Food supplements were not continuously available at PHC facilities for distribution to PEM Program clients, due to logistical challenges in the procure-ment, ordering and delivery of food supplements. PEM Program clients had re-ceived food supplements for approximately 7 months. Food supplements were, however, often shared with family members and were often the only food eaten by the PEM Program clients at home. About 20% of the children included in the study were underweight-for-age (W/A below the 3rd percentile of the NCHS median). The majority of the children (82.41%) that were weighed had gained approximately 1 kilogram since previ-ously being weighed. Twenty two percent of children that did not gain weight were at risk of severe malnutrition and had weights below the 3rd centile. Ac-cording to the BMI half of the mothers / caretakers were overweight or obese (BMI ≥ 25 kg/m2), while only 15% of the mothers / caretakers that accompanied the children to the health facilities were underweight (BMI < 18.5 kg/m2). Almost all the children younger than 5 years had an original copy of the RTHC, but RTHC’s were often not completed in full by healthcare workers and children were often not effectively screened. Mothers / caretakers were requested by healthcare professionals to bring children back to the clinic if the child lost weight. In cases where both the mother and child were underweight, or when a lactating mother and her infant were underweight, both the mother and her child received food supplements. Eighty percent of children had been breastfed for a period of approximately 5 months, but healthcare professionals often advised mothers to end or interrupt breastfeeding for reasons unknown to the mothers. Most of the children partici-pating in the PEM Program had an inadequate food intake for the day. In most cases, the food intake for breakfast and lunch were adequate; however the food intake for supper was mostly inadequate. Health professionals indicated that more training about the PEM Program would improve the implementation of the PEM Program. Staff felt that in-service train-ing should focus on the entry and exit criteria of the program, how to issue and control the food supplementation stock, criteria for identifying underweight children, when to supplement children of HIV positive mothers, HIV and infant feeding, nutrition education to mothers, how to prepare and feed the food sup-plements and recording of the PEM Program.en_ZA
dc.description.abstractAfrikaans: Protein-Energie-Wanvoeding (PEW) is wereldwyd ‘n publieke gesondheidsprob-leem, veral onder kinders jonger as 5 jaar. Wanvoeding, tesame met akute respir-atoriese infeksies, MIV en VIGS en diaree, is een van die hoofoorsake van baba- en kindersterftes. In Suid-Afrika is die Geïntegreerde Voedingsprogram (INP) ontwikkel om die voorkoms van honger en wanvoeding te verlaag deur verskeie kinder-oorlewings-strategië. Die INP is daarop gemik om primêre gesondheidsdienste, sowel as gemeenskapsprogramme te verbeter. Die Protein-Energie Wanvoed-ings-Program (PEW Program) vorm ‘n integrale deel van die INP. Huidiglik word die PEW Program by publieke gesondheidsfasiliteite geimple-menteer om diegene wat aan wanvoeding ly of ‘n risiko het om wangevoed te word, te behandel. Kwesbare kinders, weeskinders, swanger en lakterende vrouens en bejaardes is onder andere van die teikengroepe wat voordeel trek uit die PEW Program. Nie net voedingsonderrig word gegee aan hierdie persone nie, maar ook voedingsupplemente soos baba formule, verrykte mieliepap en ‘n hoë-energie drankie. Die doel van hierdie kruis-seksie beskrywende studie was om die implementer-ing van die PEW Program in primere gesondheid (PGS) fasiliteite (n = 51) in die Vrystaat te evalueer. Ewekansige proporsionele steekproefneming is toegepas om 30% van die totale hoeveelheid PGS fasiliteite in die Vrystaat in te sluit. ‘n Verteenwoordigende steekproef van 399 kinders jonger as 5 jaar was gekies van hierdie klinieke, waarvan slegs 46 kinders deelgeneem het in die PEW Program. Vraelyste is ook uitgedeel aan dieetkundiges (n = 15), professionele verpleegsters (n = 43) en moeders / versorgers (n = 46). Die professionale verpleegsters en moeders / versorgers wat in die studie ingesluit was, was diegene wat beskikbaar was by die kliniek op die spesifieke dag wat die navorser en veldwerkers die fasiliteit besoek het. Al die distrik-dieetkundiges en gemeenskapdiens dieetkun-diges is in die steekproef ingesluit. Retrospektiewe data is ingesamel deur die evaluaering van kliniek rekords en onderhoude wat gevoer is met professionele verpleegsters en moeders / versorg-ers. Die vraelyste wat aan die dieetkundiges uitgedeel is, was selfgeadmin-istreerd. Die liggaam-massa-indeks (LMI) van moeders / versorgers en massa-vir-ouderdom van kinders wat die kliniek besoek het op die dag wat die data in-gesamel is, was ook bepaal. Die algemene resultate van die studie het aangetoon dat die PEW Program nie effektief in die Vrystaat geimplementeer word waar die PEW Program hoofsaak-lik die verantwoordelikheid van die professionale verpleegsters was nie. Swak rekordhouding van kliente en program inligting was geidentifiseer, wat daartoe gelei het dat die klient se vordering swak bestuur is. Voedingsupplemente was nie aaneenlopend beskikbaar by PGS fasiliteite vir verspreiding na PEW Pro-gram kliente nie as gevolg van logistieke probleme met aankope, bestelling en aflewering van die voedingsupplemente. PEW Program kliente het die voeding-supplemente vir ‘n gemiddeld van 7 maande gekry. Voedingsupplemente was dikwels gedeel met gesinslede en ook dikwels die enigste voedsel wat die PEW Program klient by die huis geeet het. Omtrent 20% van die kinders wat in die studie ingesluit is, was ondermassa-vir-ouderdom (massa-vir-ouderdom laer as die 3de persentiel van die NCHS medi-aan). Die oorgrote meerderheid van die kinders (82.41%) wat geweeg is, het omtrent 1 kilogram opgetel vandat die kind ‘n vorige keer geweeg is. Twintig persent van die kinders wat nie massa opgetel het nie, het ‘n risiko gehad vir ernstige wanvoeding met massas onder die 3de sentiel. Volgens die LMI was die helfte van die moeders / versorgers oorgewig (LMI ≥ 25 kg/m2), terwyl slegs 15% van die moeders / versorgers wat die kinders na die klinieke gebring het onder-massa (LMI < 18.5 kg/m2) was. Ongeveer al die kinders onder die ouderdom van 5 jaar het oorspronklike RTHC gehad, maar die RTHC was dikwels nie volledig ingevul deur gesondheidswerk-ers nie en kinders is dikwels nie behoorlik gesif nie. Moeders / versorgers was gevra om hulle kinders terug te bring na die kliniek wanneer die kind massa ver-loor het. In gevalle waar beide die moeder en die kind ondermassa was, of wan-neer ‘n lakterende moeder en haar baba wangevoed was, het beide die moeder en die baba voedingsupplemente ontvang. Tagtig persent van die kinders was geborsvoed vir ‘n gemiddelde periode van 5 maande, maar gesondheidswerkers het moeders dikwels aangemoedig om borsvoeding te staak vir redes onbekend aan die moeders. Meeste van die kinders het voldoende voedselinnames vir die dag gehad; alhoewel in die meeste gevalle was dit slegs die voedselinnames vir ontbyt en middagete wat voldoende was terwyl die voedselinname vir die aand onvoldoende was. Gesondheidswerkers het aangetoon dat meer opleiding daartoe sal bydra dat die implementering van die PEW Program sal verbeter. Personeel het gereken dat indiens opleiding moet fokus op die insluiting en uitsluiting kriteria vir die pro-gram, hoe om die voedingsupplemente te versprei en beheer, kriteria vir die identifisering van ondermassa kinders, wanneer om kinders van MIV positiewe moeders te supplementeer, MIV en babavoeding, hoe om die voedingsupple-mente voor te berei en voer en rekordhouding van die PEW Program inligting op die voorgestelde vorms.af
dc.description.sponsorshipNational Research Foundation (NRF)en_ZA
dc.language.isoenen_ZA
dc.publisherUniversity of the Free Stateen_ZA
dc.subjectMalnutrition in children -- South Africa -- Free Stateen_ZA
dc.subjectInfants -- Nutritionen_ZA
dc.subjectProteins in human nutritionen_ZA
dc.subjectDeficiency diseasesen_ZA
dc.subjectDissertation (M.Sc. (Nutrition and Dietetics))--University of the Free State, 2008en_ZA
dc.titleAn evaluation of the Protein Energy Malnutrition (PEM) program in children < 5 years at primary healthcare facilities in the Free Stateen_ZA
dc.typeDissertationen_ZA
dc.rights.holderUniversity of the Free Stateen_ZA


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