Hospitality, Tourism and Public Relations

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    Development and evaluation of a nutrition education programme for primary school children in the Vaal Triangle
    (2013-07-23) Makanjana, Onwaba; Napier, C.; Oldewage-Theron, W. H.
    Objectives: The aim of this study was to develop and evaluate a nutrition education programme for Setlabotjha Primary School children in order to improve current knowledge. The study included all grade seven learners from two primary schools in one of the poorest areas in the Vaal Triangle. Children form Setlabojha Primary School formed the experimental group, while children from Ekujuleni Primary School formed the control group. Methods: The initial steps involved a baseline survey (Napier 2001 :78), which indicated that malnutrition exists at Setlaboljha Primary School. The baseline survey indicated stunting, wasting, underweight and poor food consumption patterns among the children. A literature survey was conducted, as a result of the findings of malnutrition, poverty and household food insecurity in Eatonside. Pre-tests were undertaken to determine current nutritional knowledge (for both groups) using a nutritional knowledge questionnaire developed by the Medical Research Council. The pre-tests results revealed poor nutritional knowledge and these results were used to develop the nutrition education tool (nutrition education playing cards) based on the South African Food Based Dietary Guidelines. The intervention, which involved the issuing, reading. playing and exchanging of the nutrition education playing cards had taken place over eleven weeks for the experimental group. The control group had received pamphlets and nutrition education lessons. After the intervention had taken place, post-tests were undertaken to compare the difference between the two groups and to determine the effectiveness of the nutrition education programme. Results: In general, the subjects of both groups had a good knowledge regarding sugar, water and salt consumption, as well as 'the key to a healthy way of eating'. Thus the inclusion of fruit and vegetables and variety were in the diet. Poor knowledge was evident in both groups pertaining to pregnancy, the importance of starch in the diet, alcohol consnmption, physical activity, vitamin A-rich foods and the inclusion of pilchards as a calcium-rich source.
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    Evaluating a nutrition education programme for food service assistants in pre-schools in the Vaal Region
    (2010-11) Spillman, Rene.; Dicks, E. G.; Oldewage-Theron, W. H.
    Malnutrition amongst pre-school children age two-to-five-years is a growing world-wide concern. This is mainly due to poverty, diseases and inadequate dietary intake. Malnourished children are also a problem in South Africa. Pre-schools play an important role in the prevention of malnutrition because most young children consume about two thirds of their food and therefore their daily nutritional intake at the pre-schools. There are various factors that affect a child's nutrition in pre-schools, such as food choices, meal plans, the environment and the nutritional knowledge of the caregivers. Pre-schools can only fulfill this responsibility through the proper nutritional knowledge and training. The nutritional education and knowledge of food service assistants/caregivers are very important, because they compile the meal plans and menus for pre-schools. The objectives of this study were to evaluate a Nutrition Education Programme (NEP) to address the lack of nutritional knowledge of service assistants/caregivers who plan the menus in pre-schools in terms of existing menu content and food choices required for children between two to five years of age and by using the existing menus and food choices applied to make recommendations for nutritional skills training. Also in terms of basic nutrition, health and safety, to recommend more appropriate alternatives acceptable to children between two to five years of age. Lastly to integrate recommendations for nutritional skill training with regard to the alternative meal plan, eating habits and food choices for the menu through a NEP that would be implemented and evaluated. The study design was a combination of an exploratory and quantitative-descriptive research design in the form of a survey. A pilot study was used mainly to test the nutrition knowledge questionnaires for content validity. The study population of this research project was randomly selected pre-schools chosen from the Eatonside informal settlement. Procedures for data gathering and the different methods used for data analysis were divided into four phases. Descriptive statistics were used to determine the percentage of pre-schools who answered the questions correctly for selected nutrition knowledge, portion sizes questions and menu planning, as well as food safety and health. Paired t-tests were carried out to measure the statistically significant difference (pS0.05) before and after the implementation of the NEP. The results of the t-test indicate that only nine of the questions in the post-test questionnaire showed a confidence interval of the difference. There is statistical significance in these questions through either increase or decrease. It can be concluded that the Nutrition Education Programme (NEP) was successful, but that more training is needed due to the limitations experienced. The menu analysis tested the respondent's menus in terms of the average daily nutrient intake level given to the pre-school children. The data of the pre- and post-test menus were then compared to EAR in order to determine any change in the menus nutritional values after the NEP was completed. The results showed that there were differences in the post-test results that both decreased and increased.
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    Evaluation of a feeding programme in addressing malnutrition in a primary school
    (2013-07-23) Napier, Catharina Elizabeth; Oldewage-Theron, W. H.
    The main objective of this study was to determine the level of malnutrition in a primary school(children aged six to 13 years old) in an informal settlement and to plan and implement a school-feeding intervention programme. Before and after the intervention blood was drawn from 160 children. Quantitave Food Frequency Questionnaires and 24-hour recall questionnaires were completed in interviews with the parents. Anthropometric measurements included weight-for-age, BMI-for-age and height-for age. The baseline results (QFFQ and 24-hour recall) indicated that zinc (64%), iron (83%) and energy intake levels (59%) were lower than the recommended range for children in this age group when compared to the DRIs (Dietary Reference Intakes). Food most commonly purchased and consumed were maize meal, tea, sugar and oil as indicated by the top 20 foods purchased list With regard to anthropometric indices, 10% were severely underweight (weight-for-age below ≤5th percentile from the reference NCHS median), 15% were severely wasted (BMI-for-age ≤5th percentile) and 15.3% severely stunted (height-for-age ≤5th percentile). A maize meal wholewheat vetkoek was developed that provided 25% of the daily needs of the children for zinc and iron, making use of ingredients from the top 20 list The vetkoek was biochemically tested and optimised to ensure optimal nutritional content The vetkoek was also sensory analysed by a sample of school children (n=30) for acceptability. The vetkoek was administered for seven months, daily except for school holidays and weekends, to 60 randomly selected children forming the experimental group, with 60 other children receiving a fruit as the control group and 40 children receiving the Primary School Nutrition Programme. The post-intervention results indicated that the children in all three groups ignificantly improved in weight and height and their zinc and iron intake also increased significantly. The post-intervention dietary intake results showed that the product contributed significantly to the quality of the diet. The vetkoek group consumed 358% of iron and 176% of zinc when compared to the DRis, with the PSNP group consuming 167% of iron and 99% zinc and the fruit group 200% of iron and 120% of zinc. Although few statistically significant changes occurred biochemically, clinical changes occurred in all three groups. This study proved that any food provision can have a beneficial impact on the growth of a malnourished child.
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    A food multi-mix to address malnutrition amongst primary school children living in Eatonside
    (2006-01) Oosthuizen, Delia; Napier, C.; Oldewage-Theron, Wilna
    The primary objective of this study was to formulate a multi-mix, which could supply at least one-third of the daily requirements of primary school children, aged six to 13 years. The secondary objective was to ensure the adherence to the criteria of multi-mix formulation, which included affordability, convenient, palatability, culturally acceptable and cost effective, whilst providing high nutritional value for the specified target group. The nutritional criteria included the Index Nutrient Quality (INQ) and Energy Density (ED) requirements, for a specific target group. This study was conducted in Eatonside, an informal settlement situated in Gauteng. A situational analysis previously conducted in Eatonside (Napier 2003) showed that the children between the ages of six and 13 years, were 17% underweight (weight-for-age -2SD from the reference NCHS median), 12,7% were wasted (BMI-for-age -2SD) and 18% stunted (height-for-age -2SD). With the nutritional requirements of children and the most consumed food list, the multi-mix formulation began. Foods from the Top 20 list (Napier 2003), were combined with the ingredients most common within the households, and vegetable gardens already established . Estimated nutritional values were calculated using the food composition tables of South Africa. The ingredients were prepared and chemically analysed to determine the experimental nutritional value and to assess if the nutritional objectives were being achieved. The multi-mix was then combined with other commonly consumed ingredients to form recipes and sensory evaluated by professionals and the primary school children to assess the acceptability of the multi-mix and recipes. The multi-mix and recipe products were then sent for shelf life testing to assess its storage time at room temperature. The results from the nutritional analyses showed nutrient values to be above 30 percent of the Estimated Average Requirements (EAR). The INQ of the targeted nutrients was above 1,0 and the ED at 3,7kcal/g, which was within the 3,6-4,5 kcal/g requirements. The sensory evaluation for the multi-mix recipes had proved favourable response to snack items with preference for sweet products. The final evaluation session resulted in scores of 83.9 percent preference to the biscuit with the sweet muffin scoring 94.5 percent liking, whilst the savoury muffin at 73.1 percent. The average scores for all three recipes were above 80 percent. The multi-mix had a shelf life of minimum one-month, the biscuit, seven days and muffins, only 24 hours, at room temperature. The objectives of cultural acceptability had been achieved through the positive response from the use of ingredients within the community. The multi-mix had been cost effective as the final cost of R1.55, was within the R2.90 spent per person per day, for all three meals (Oidewage-Theron eta/. 2005). Further studies need to be conducted in order to implement the multi-mix into an intervention within the community to assess the effect on nutritional status. This study, aimed to reduce the underlying cause of malnutrition, food insecurity, by improving the nutritional status of children aged six to 13 years with the strengthening of food intake, through the combination of various scant ingredients, a multi-mix, providing maximum nutritional value with small quantities. An advantage of the multi-mix is a lower cost when compared with tablet supplementation on the market and versatility in relation to various recipes.
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    Impact of a school feeding programme on nutritional status of primary school children in Orange Farm
    (2013-07-29) Nyathela, Tshinakaho; Oldewage-Theron, W. H.
    Introduction. Most of the children aged between five and 15 around the world live under difficult circumstances, which lead to a high dropout rate from school before the end of the secondary level. Most of them have poor nutrition, are undernourished and are exposed to a large range of harmful, parasitic and infectious diseases (Shariff et al, (2000:265). Purpose. The purpose of this investigation was to analyze the nutritional status of primary school children in Orange Farms informal settlement in terms of their nutritional needs in order to implement a school feeding programme and assess its impact on the nutritional status of these children. Methodology. A cross-sectional baseline survey was conducted two weeks before commencing with the school feeding programme. The measurements taken during this phase were socio-demographic and health by means of a questionnaire, as well as dietary intake and food consumption patterns by means of a quantified food frequency questionnaire and 24-hour recall, weight and height measurements. The anthropometric measurements included height and weight and the biochemical measurements included serum ferritin, C-reactive protein, total protein, albumin, vitamin B 12, folate, glucose, full blood count, haemoglobin, haematocrit, red blood cell count, mean cell volume, white blood cell count, vitamins A, E and zinc. A single matched "placebo" -controlled, parallel group, clinical trial of ten months followed in a randomly selected sample of 100 participants, 50 forming part of the control group receiving a fruit and 50 forming part of the experimental group receiving com-soy blend porridge. After the 10-month period, the same measurements for the baseline survey were repeated, except for the sociodemographic and health measurements. Results. Malnutrition, including under and over nutrition, remains a major problem among primary school children globally. This was also true in both the experimental and control school groups in this study where 18.6 percent, 34.9 percent and 4.7 percent were underweight, stunted and wasted especially in the experimental group compared to 9.1 percent severe underweight, and 9.1 per cent each for severe stunting and wasting in the control group at baseline. A mainly carbohydrate based diet was consumed with limited vegetable and animal protein intakes. The socio-demographic data indicated that household food insecurity contributed to the poor dietary intake of the sample, as the majority of the caregivers were unemployed in both groups. This was further confirmed by the limited monthly household income of less than R 1000 for a relatively large family size of up to 5 members in the control group compared to 5-10 household members in the experimental group. The implementation of a school feeding programme that included a nutritious and acceptable meal in the form of enriched corn-soy blend or a fruit as part of the programme, also proved to be a relatively easy and cost-effective way to address hunger in these primary schools. Furthermore, the dietary intake levels for both groups showed statistically significant improvements for various macro- and micronutrients when compared to DRis. Conclusion Although few statistically significant differences were observed between the groups with regard to dietary intake patterns, biochemical changes and nutritional status indices, positive changes were observed in both groups, indicating that any food provision may have a positive impact on undernourished children. The results of the intervention indicated an improvement in dietary intake which could result in an improved nutritional status, specifically related to micronutrients. However, the anthropometric indices and certain biochemical parameters showed significant improvements in both groups after the intervention. School feeding programmes are a good strategy for addressing malnutrition among primary school children if monitored effectively. However, it does not impact directly on household food security. A long-term clinical intervention trial is recommended to measure the impact of a food-based approach to address specific micronutrient deficiencies prevalent among children in these age groups.
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    The implementation and evaluation of a nutrition education programme developed for caregivers
    (Vaal University of Technology, 2016-08) Ochse, Catharina Elizabeth; Kleynhans, I. C., Prof.; Oldewagen-Theron, W. H.,Prof.
    Background South Africa is one of the developing countries faced with the co-existence of undernutrition and overnutrition, often experienced within the same household. On the one hand, hunger, undernutrition and micronutrient deficiencies are linked to poverty and household food insecurity. Simultaneously, South Africans are exposed to ‘nutrition in transition’, where overweight and chronic diseases of lifestyle, such as diabetes mellitus, cardiovascular diseases and cancer are on the rise as part of the overnutrition profile. Sound nutrition is important throughout the lifecycle to combat under- and overnutrition and nutrition-related diseases. In urban areas, the grandmother or another senior female family member is often responsible for caring for the children in the household during the day. This includes physical, emotional and nutritional care. It is therefore essential for the caregiver to have good nutrition knowledge, to provide not only in her own needs, but also in those of the children. A nutrition education programme is one strategy for improving the nutrition knowledge of caregivers of children. Objective The primary objective in this study was to develop, tailor, implement and evaluate a nutrition education programme (NEP) for Sesotho-speaking females and caregivers of children in the Boipatong Township in the Vaal Region of South Africa and to test its impact in the short and longer term. Nutrition knowledge regarding four South African food-based dietary guidelines (FBDGs) was empirically tested before and after the intervention and then compared to a control group. In addition, dietary intake was assessed to detect any changes after the intervention in the medium term. Methodology In this both quantitative and qualitative methodologies were applied. Two frameworks, the United Nations Children’s Fund (UNICEF) Framework of Malnutrition (2004) and the Food and Agriculture Organisation (FAO) Framework for Nutrition Education (1997), gave structure to the planning, implementation and evaluation of the research project. This study’s nutrition education programme was based on a socio-ecological model to guide behavioural change in terms of healthy food choices. In the preparation phase, a situational analysis was performed by means of a cross-sectional analytical design using descriptive statistics. Socio-demographic and self-reported health information was obtained. Nutrition knowledge, based on the South African food-based dietary guidelines (FBDGs), was measured, and dietary intake was assessed and compared with the estimated average requirements (EARs) for their age categories. Phase two, the formulation phase, used an experimental design. The acceptability and understanding of the existing national nutrition education (NE) material for individuals with low living standards (LSM) was investigated in this phase of the nutrition education programme (NEP). A culturally tailored booklet was developed in English, translated into Sesotho, pilot tested and implemented as part of the nutrition education programme. Lesson plans were developed and pilot tested. A non-randomised control trial was used in the implementation and evaluation phases. The effect of the nutrition education programme on nutrition knowledge was quantitatively measured in a pre- and post-test design at each discussion session in the short term, using paired t-tests in the experimental group of caregivers. The evaluation phase tested the impact of the nutrition education in the longer term. Nutrition knowledge was measured quantitatively in a before-after intervention test design by means of a self-completed structured questionnaire, based on the four South African FDBGs included in the programme. A control group who was not subjected to any intervention was used to complete the same questionnaire before and after the intervention in the same time period as the experimental group. In the experimental group, dietary intake was assessed before and after the intervention to detect changes in dietary intake. No dietary intake was measured in the control group, as changes could be attributed to influences beyond the control of this study. Two randomly selected focus groups of the experimental group were run to provide deeper insight into their perceptions regarding the acceptability and understanding of the NEP and NE material. Results The situational analysis of the preparation phase revealed a poor community that displayed typical patterns of nutrition in transition, at risk of malnutrition. The median age of the sample of caregivers was 44 years (IQR 32-62). Income and consumption poverty was confirmed by 80.5 percent of households spending R300 or less on food, with 75 percent of households having between four and seven people living in the dwelling. Dietary results were indicative of food poverty and poor food choices, possibly due to monetary constraints. A low energy intake (median 5323 kJ/day; IQR 3369-7949), was observed. Only 13.9 percent reached the estimated energy requirement (EER) of 7855 kJ per day for their age category. The overall mean average requirements of the diet was 0.7 but the possiblity of micronutrient deficiencies could not be excluded with a MAR of 0.6 for vitamins and minerals respectively. The median nutrition knowledge was 50 percent (IQR 42-54%) The lowest score was obtained for the FBDG ‘Enjoy a variety of food’ (33.4%; 95% CI 1.1), followed by the FBDG on animal protein (40.3%; 95% CI 1.0). It was decided to augment these two FBDGs with the plant protein FBDG (54.3%; 95% CI 1.8). Despited a relatively good knowledge measured in the caregivers, none of the plant protein food items appeared in the top 20 food items most frequently consumed. The formulation phase included the testing of existing nutrition education material. Messages were well understood (60.5%). However, caregivers found the images contained in the pamphlets and the design of the pamphlets confusing. A definite need was identified for new, culturally acceptable NE material in the caregivers’ home language, Sesotho (74%). During the implementation phase the lectures were presented and the change in the short-term nutrition knowledge of the FBDGs was measured at every session by means of a pre-post-test design. The median age of the caregivers was 63 years (52-78). A significant change in nutrition knowledge was found for each FBDG in terms of the mean number of questions answered correctly by the participants between the results of each pre- and post-test. In the evaluation phase, the impact of the NEP was measured in the Boipatong experimental group and compared, regarding nutrition knowledge, to a control group in the longer term (three months after completion of the intervention). Median nutrition knowledge before the intervention was 49 percent (IQR 46-57) compared to 70 percent (IQR 68-73) after the intervention – an increase of 21 percent. In contrast, the control group showed an increase of only five percent. The results showed that the eating habits of many of the caregivers still fell substantially short of internationally recognised standards (estimated energy requirement (EER) and estimated average requirement (EAR)), and this could contribute to undernutrition as well as to an increased risk of diet-related chronic disease. A median kilojoule intake of 4788 kJ (IQR 3415-6596) per day before and 4651 kJ (IQR 3369-6664) per day after the intervention was registered. Carbohydrate foods remained an important source of energy. Calcium presented a major concern, as none of the participants reached the EAR despite a slight increase in the intake of milk (volume and frequency) after the intervention, as validated by the top 20 food lists and as measured by a nutrient average requirement (NAR) of 0.1 to 0.7 before and after the intervention respectively. The mean average requirements (MAR) remained relatively stable, at 0.7 (median) before the intervention and 0.6 after the intervention. The NEP thus had an insignificant positive effect on dietary intake, except for calcium, iodine and vitamin C intake, which showed significant increases. No relationships could be found between the MAR as an indicator of dietary quality and nutrition knowledge. However, this does not mean that an NEP is not a suitable strategy. Changes in food choices and dietary intake should be measured in the longer term, since lifestyle changes are challenging to adopt when people, especially those in deprived communities, do not have the financial means to make healthy food choices. Conclusion When planning nutrition education strategies to improve the health status of communities in deprived areas, one is faced with the difficulty of households with a low socio-economic status and poor dietary intake, which increases the risk of food and nutrition insecurity. The nutrition education programme, developed, tailored and implemented as an intervention strategy to address an identified need of caregivers, was effective in improving nutrition knowledge. Four of the South African dietary guidelines were used in the nutrition education programme tailored to the specific profile that emerged from the situational analysis and the development of supportive nutrition education material. Lesson plans and the Sesotho and English booklets are available for use in other nutrition education programmes. The study contributed to the understanding of food choices of the urban community of Boipatong as well as of the nutrient inadequacies observed. Nutrition knowledge alone is not enough to bring about changes in food choices when the means to do so are lacking. Poverty and nutrition are closely linked and thus difficult to separate.
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    Sustainability of corn soya blend use in the Orange Farms school feeding programme
    (2013-07-22) Chibe, Mumsy Evidence; Duvenaghe, S. S.; Oldewage-Theron, W. H.
    Most of the world's children between 5 and 15 years of age attend school, though many do so under difficult circumstances. A large percentage of school children is underfed and poorly nourished (Engelbrecht 2005: l; Worsley 2005:135; DoE 2004:1). The aim of the Joint Aid Management (JAM) school-feeding programme was to reduce malnutrition by providing a mid-morning snack to alleviate short-term hunger, support nutrient intake, enhance active learning capacities and improve school attendance (JAM 2004:4). The equivalent of lOOg raw com-soya blend (CSB) was to be provided to the children on a daily basis. The main objective of this study was to determine the sustainability of CSB porridge use in the Orange Farms school-feeding programme. Regulatory compliance and product acceptability over time was addressed. Adjustments to the ratio of ingredients and portion size (83g) of the porridge served were calculated within practical limitations. The South African school feeding guidelines indicated that 25 percent of the energy needs for the 7-1 0 year olds, and 20 percent for the 11-14 year olds should be provided; while JAM indicated that 70 percent of the RDA recommendations (according to UNICEF 2002) should be provided by the product. A comparison between the applicable RDA for gender and age against daily dietary intake (habitual intake plus CSB porridge)revealed that the needs for vitamin A, riboflavin, niacin, folate, iron and zinc have been met, while calcium could not be provided in full. The needs for vitamins C and Bl2 were provided for in full through the CSB intake. Overall, the CSB intake made a substantial contribution to nutritive intake. Both the perceptions for taste (Reitumetse 75-80% and Sinqobile 88-83%) and texture (Reitumetse 74-82% and Sinqobile 71-78%) increased over time. As several learners (25%) consumed second servings twice (34%) but up to five times a week (21%), it can be assumed that the additional nutrient intake benefited the neediest children the most. It is recommended that CSB porridge should be introduced in areas where the dietary intake is compromised.