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dc.contributor.advisorWalsh, C. M.
dc.contributor.authorDe Lange, Johanna Christina
dc.date.accessioned2015-08-11T09:37:54Z
dc.date.available2015-08-11T09:37:54Z
dc.date.issued2010-05
dc.identifier.urihttp://hdl.handle.net/11660/805
dc.description.abstractEnglish: INTRODUCTION A wide range of factors, including underlying, immediate and basic factors, play a role in the development of malnutrition. Globally, the prevalence of malnutrition is highest in Sub-Saharan African, with the HIV pandemic further compromising the situation. Both underweight and stunting are threatening the health of children younger than five years old, with the Northern Cape having the highest percentage of stunted children in South Africa. Malnutrition is still the leading cause of mortality and morbidity in children younger than five years old. The main aim of this study was to determine which of the underlying, immediate and basic factors contributing to malnutrition are prevalent in the Northern Cape. METHODS Fifty-four malnourished children 0 to 60 months admitted to Kimberley Hospital Complex and Upington Hospital were included in the study. Inclusion criteria included all malnourished children 0 to 60 months admitted to paediatric or infant care units between August 2007 and July 2008with a weight-for-age below 80% of expected weight, with an RtHC and whose mother/ caregiver was present to sign the informed consent form. The anthropometric measurements of both the child and mother/caregiver were taken. Blood values of the child that were available in the files were consulted. Socio-demographic, household, maternal information, medical history of the child, infant feeding information and adherence to the FBDG were noted on a questionnaire during a structured interview conducted with the mother/caregiver. RESULTS Factors contributing to malnutrition were categorized into the immediate, underlying and basic factors as set out in the UNICEF conceptual framework of the causes of malnutrition. Some of the socio-demographic findings associated with malnutrition included rural households, male children, education level and marital status of the mother. Educated and married mothers were less likely to have a malnourished child. Anthropometric findings showed that low birth weight and the size of the child’s mother were associated with malnutrition, with undernourished and obese mothers having a higher chance of having a malnourished child. Household food insecurity and inadequate nutrition information received on care practices were often contributing factors. Most of the malnourished children included in the study were marasmic. The medical history of the child indicated that even though all the children had an RtHC, the cards were often completed incorrectly. Clinic attendance was poor and the screening for HIV and TB was insufficient as the children’s statuses were mostly unknown. Significantly more children were up to date with their immunizations, but significantly fewer children were up to date on their vitamin A supplementation. The NSP was not accessed effectively and even children that did access the NSP were found to be malnourished after eight months on the programme. Some of the other household and maternal findings related to malnutrition included a big household with more than five family members, a high birth order of more than four children and if the child had any siblings that had died of malnutrition related illnesses. The education levels of the mothers were generally low and health and feeding information given at clinics did not have a significant impact. Information on infant feeding showed that exclusive breastfeeding is still a challenge and mothers are not effectively using milk alternatives when breastfeeding is ceased. Cup feeding was not practiced, and the use of bottles can increase the risk of diarrhoea. Children are either introduced to solid foods too early (before six months) or too late (after six months). When the application of the FBDG was evaluated, the study found that children had high intakes of fats, salt, sugar and sugary foods and tea and low intakes of animal proteins, fruit and vegetables and milk (after breastfeeding was ceased). CONCLUSIONS Inadequate access of available interventions programmes such as the NSP, immunizations, vitamin A supplementation, screening and treatment of diseases such as HIV and TB was noted. Parents were generally uneducated, especially regarding infant and young child feeding and the importance of correct food for the prevention of malnutrition. Household factors were a major challenge, especially in rural areas. Low levels of schooling and poverty are basic factors contributing to malnutrition that are prevalent in the Northern Cape. RECOMMENDATIONS Maternal and community education are some of the most important interventions to combat malnutrition in the Northern Cape. Intervention programmes at facilities should be strengthened to empower health care professionals and the community they serve to prevent and manage severe malnutrition. Detecting malnourished children earlier in the communities by using the MUAC to screen children is recommended. The management of severe malnutrition according to the 10 Steps of the WHO should be implemented at all levels of care.en_ZA
dc.description.abstractAfrikaans: INLEIDING Die oorsake van wanvoeding word deur ‘n wye reeks faktore soos onderliggende, onmiddellike en basies oorsake bepaal. In die wêreld, is die voorkoms van wanvoeding die hoogste in Sub-Sahara Afrika, waar die MIV pandemie die probleem net verder vererger. Ondergewig en groeiinkorting is van die algemeenste probleme wat voorkom onder kinders jonger as five jaar oud, met die Noord Kaap wat die hoogste getal kinders met groeiinkorting het. Wanvoeding bly die hoofoorsaak van mortaliteit en morbiditeit in kinders jonger as vyf jaar oud. Die hoofdoel van die studie was om te bepaal watter onderliggende, onmiddellike en basies oorsake wanvoeding in die Noord Kaap veroorsaak. METHODES Die studie het bestaan uit 54 wangevoede kinders tussen nul en 60 maande wat in die Kimberley Hospitaal Kompleks en Upington Hospitaal opgeneem is. Die insluitingskriteria het ingesluit, al die wangevoede kinders tussen nul en 60 maande wat tussen Augustus 2007 en Julie 2008 opgeneem is in die pediatriese of baba sale met ‘n gewig-virouderdom laer as 80% van die verwagte gewig, met ‘n RtHC en wie se moeder/oppasser beskikbaar was om die toestemmingsbrief te teken. Die antropometriese mates van beide die kind en die moeder/oppasser is bepaal. Die bloedwaardes wat gebruik is, was die wat beskikbaar was in die kind se lêer. Sosio-demografiese en huishoudelike inligting, inligting vanaf die moeder, die mediese geskiedenis van die kind, babavoeding inligting en die vergelyking van voedselinname met die voedselgebaseerde dieetriglyne is deur ‘n onderhoud en vraelys, wat met die moeder/oppasser gevoer is, bepaal. RESULTATE Die oorsake van wanvoeding kan soos bepaal deur die UNICEF konseptuele raamwerk vir die oorsake van wanvoeding, uiteengesit word in onderliggende, onmiddellike en basiese oorsake. Plattelandse huishoudings, seuns en die opleidingsvlak en huwelikstatus van die moeder was van die sosio-demografiese oorsake wat in die studie met wanvoeding verband gehou het. Moeders wat opgevoed en getroud was, se kanse om ‘n wangevoede kind te hê was laer as vir moeders wat onopgelei en ongetroud is. Die antropometriese mates het getoon dat ‘n lae geboortemassa en die grootte van die kind se moeder, met wanvoeding geassosieer word. Beide ondermassa en oormassa moeders het ‘n groter kans gestaan om ‘n wangevoed kind te hê. Van die ander faktore wat bygedra het tot wanvoeding, was huishoudelike voedselonsekerheid en swak kennis in verband met die sorg van kinders. Die meeste kinders in die studie het marasmus gehad. Met die ontleding van die mediese geskiedenis van die kind, is gevind dat alhoewel die kinders RtHC gehad het, was die kaarte meestal onvolledig of verkeerd ingevul. Die kinders is nie gereeld kliniek toe geneem nie en sifting vir MIV en TB was onvoldoende aangesien van die kinders se MIV en TB status onbekend was. Beduidend meer kinders was op datum met hulle immunisasies en beduidend minder kinders was op datum met hulle vitamien A supplementasie. Die nasionale voedselsupplementasie program (NSP) was nie effektief benut nie, aangesien van die wanvoede kinders al vir agt maande op die programme was, sonder enige verbetering. Van die huishoudelike inligting en inligting vanaf die moeder wat verband gehou het met wanvoeding, was groot huishoudings met meer as vyf familielede, ‘n hoë geboortesyfer van vier of meer kinders en die dood van ‘n ander kind as gevolg van voedingverwante siektes. Die moeders was oor die algemeen swak opgelei en die gesondheids- en voedingsinligting wat by klinieke gegee is, was onvoldoende. Die inligting wat vanaf die moeders verkry is, in verband met babavoeding, het gewys dat borsvoeding nogsteeds ‘n probleem is en dat moeders verkeerde melkvervangers gebruik wanneer hulle ophou met borsvoeding. Die moeders het nie koppies gebruik om hulle kinders mee te voed nie en die gebruik van bottels kan die voorkoms van diaree verhoog. Vaste voedsel was te vroeg (voor ses maande) of te laat (na ses maande) aan die kinders bekendgestel. Die voedselinname van die kinders is vergelyk met die voedselgebaseerde dieetriglyne en daar is gevind dat kinders baie vet, sout, suiker en suikerbevattende voedsels en tee inneem en ook dat vrugte, groente, dierlike proteïene en melk (nadat borsvoeding gestop is) onvoldoende ingeneem word. GEVOLGTREKKINGS Die studie het gevind dat intervensie programme soos die nasionale supplementasie program, immunisasies, vitamien A supplementasie en die sifting en behandeling van siektes soos MIV en TB nie toeganklik implimenteer is nie. Ouers was onkundig as dit kom by die voeding van babas en jong kinders en besef nie die belang van goeie en korrekte voedsel vir die voorkoming van wanvoeding nie. Huishoudelike faktore bly ‘n uitdaging, veral in plattelandse areas. Die basiese oorsake van wanvoeding wat in die Noord Kaap voorkom, sluit lae vlakke van opleiding en armoede in. AANBEVELINGS Van die belangrikste intervensies om wanvoeding in the Noord Kaap te voorkom is die opleiding van gemeenskappe en moeders. Die intervensie programme wat by fasiliteite beskikbaar is, moet versterk word sodat die gesondheidswerkers en die gemeenskap kan help met die voorkoming en behandeling van wanvoeding. Kinders met wanvoeding moet vroegtydig, met behulp van bo-arm omtrek mates, deur gemeenskappe geïdentifiseer word. Die behandeling van wanvoeding moet volgens die 10 Stappe vir die behandeling van wanvoeding van die Wêreld Gesondheidsorganisasie by alle vlakke van gesondheidsorg plaasvind.
dc.language.isoenen_ZA
dc.publisherUniversity of the Free Stateen_ZA
dc.subjectMalnutrition in children -- South Africa -- Northern Capeen_ZA
dc.subjectChildren -- Nutritionen_ZA
dc.subjectDiet therapyen_ZA
dc.subjectBreastfeedingen_ZA
dc.subjectStuntingen_ZA
dc.subjectBasic factorsen_ZA
dc.subjectUnderlying factorsen_ZA
dc.subjectImmediate factorsen_ZA
dc.subjectMarasmic kwashiorkoren_ZA
dc.subjectMarasmusen_ZA
dc.subjectKwashiorkoren_ZA
dc.subjectSevere malnutritionen_ZA
dc.subjectDissertation (M.Sc. (Dietetics))--University of the Free State, 2010en_ZA
dc.titleFactors contributing to malnutrition in children 0-60 months admitted to hospitals in the Northern Capeen_ZA
dc.typeDissertationen_ZA
dc.rights.holderUniversity of the Free Stateen_ZA


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