Andre Dannhauser

The impact of a nutrition education programme on the anthropometric nutritional status of low-income children in South Africa

OBJECTIVE The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years. DESIGN AND SETTING The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined. SUBJECTS Initially 536 children were measured and, after two years of intervention, 815. RESULTS Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area. CONCLUSION The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

Nutritional status of preschool children in informal settlement areas near Bloemfontein, South Africa.

OBJECTIVE To determine the nutritional status and household resources of preschool children. DESIGN A cross-sectional survey. SETTING : Two informal settlement areas, Joe Slovo (JS) and JB Mafora (JBM) in Mangaung, near Bloemfontein, South Africa. SUBJECTS Preschool children (<72 months) of a randomly selected sample of households in JS (experimental) (n = 162) and JBM (control) (n = 186) were included. Standard methods were used to obtain household and care-giver particulars, weight and height measurements, blood and stool samples, and 24-hour dietary recalls. RESULTS Breast-feeding and dietary intake in the two areas were nearly similar; breast-feeding was continued for 12 months and longer. Although the childrens total protein intake was sufficient, their energy intake was low. A low median intake of micronutrients prevailed, including iron, zinc, calcium, niacin, riboflavin, thiamine and vitamins C, B6, A and D. The prevalence of being underweight (JS = 19.8%; JBM = 18.8%), stunted (JS = 29%; JBM = 21. 5%) and wasted (JS = 6.5%; JBM = 3.7%) were fairly similar in both areas, as well as the prevalence of marginal vitamin A deficiency, anaemia, iron deficiency and parasite infestations. No significant associations could be found between household and nutritional status indicators, probably due to the small number of well-nourished children and the generally poor household situation of the participants. CONCLUSIONS The generally poor nutritional status and environmental conditions emphasize the urgency of intervention for these children.

Prevalence of goitre and urinary iodine status of primary-school children in Lesotho

OBJECTIVE To estimate the prevalence of goitre, urinary iodine status, coverage of supplementation of iodized oil capsules, and current use of iodized salt in children in Lesotho. METHODS Cross-sectional study of children from 50 primary schools in Lesotho. Thyroid glands of children aged 8-12 years were measured by palpation and graded according to the WHO, UNICEF, and the International Council for the Control of Iodine Deficiencys (ICCIDD) joint criteria. The use of iodized oil capsules was determined by a structured questionnaire and verified with the childrens health booklets. Iodine content of household salt samples was analysed. Casual urine samples were analysed for urinary iodine. FINDINGS Median urinary iodine concentrations of 26.3 microg/l (range 22.3-47.9 microg/l) indicated moderate iodine deficiency. More children in the mountains than in the lowlands were severely iodine deficient (17.7% vs 1.9%). Adjusted prevalence of goitre (4.9%) increased with age, was higher in girls than boys, and ranged from 2.2% to 8.8% in the different districts; this indicated no public health problem. Overall, 94.4% of salt samples were iodized, and coverage of supplementation with iodized oil capsules was 55.1%. CONCLUSION Mild-to-moderate iodine deficiency exists in Lesotho. Iodine deficiency was more severe in the mountains than the lowlands and is still a concern for public health. Use of iodized salt coupled with iodized oil supplementation effectively controls iodine deficiency disorders. Effective monitoring programmes would ensure the use of adequately iodized salt throughout Lesotho and serve to evaluate progress towards optimal iodine nutrition. Iodized oil capsule supplementation should continue in the mountains.

Body weight, eating practices and nutritional knowledge amongst university nursing students, Eastern Cape, South Africa

Abstract Background Health care workers need to be equipped to deal with the increasing obesity and obesity-related morbidity occurring in developing countries. Objectives To assess weight status, eating practices and nutritional knowledge amongst nursing students at the University of Fort Hare, Eastern Cape. Method A cross-sectional descriptive survey was conducted on 161 undergraduate (51 male and 110 female) students of the Department of Nursing Sciences at the University of Fort Hare. Body mass index, waist and hip circumferences and waist hip ratio were determined. Nutritional knowledge and eating practices were investigated by structured interviewer-administered questionnaires. Results Statically, 49.7% were overweight or obese (58.2% of the females; 31.4% of the males) and 65.2% had waist circumferences putting them at risk for non-communicable diseases. Most did not meet the recommendations for intakes from the vegetable group (97.5% ate <3 servings per day), the fruit group (42.2% ate <2 servings per day), and the dairy group (92.6% ate <2 servings per day); whilst 78.3% ate ≥4 serving per day of sugar or sweets. Most consumed margarine, oil or fat (68.3%), sugar (59.0%) and bread (55.9%) daily, but few reported daily intakes of vegetables (12.4%), fruit (23.6%), fruit juice (21.2%) and milk (15.6%). Fewer than 50% knew the recommended intakes for vegetables, fruit, dairy, starchy foods and meat or meat alternatives. Conclusions These nursing students had a high prevalence of overweight and obesity, poor eating habits and inadequate knowledge on key nutrition issues, which may impact negatively on their efficacy as future health ambassadors to the public.

Nutritional, immune, micronutrient and health status of HIV-infected children in care centres in Mangaung

Abstract Aim: To assess the nutritional, immune, micronutrient and health status of antiretroviral-naïve HIV-infected children. Method: A cross-sectional descriptive study was undertaken between September 2004 and March 2006 amongst HIV-infected children of which none received antiretroviral therapy, in care centres in Mangaung, Free State. Results: The study included 37 clinically stable and food-secure HIV-infected children. Their median age was 5.4 years (range 1.2–10.2 years). Fifteen children (41%) were underweight, 30 (81%) were stunted and one (3%) was wasted. The most commonly observed clinical features were lymphadenopathy (84%), skin rashes (51%), hepatomegaly (32%) and pallor (41%). Eight per cent of children had features of TB, while 19% had a lower respiratory tract infection. The median viral load of the group (n = 35) was 117 000 copies/ml, the median CD4+ cell count was 477 cells/mm3 and the median CD4 percentage was 22.5%. A significant negative correlation could be demonstrated between viral load and nutritional indicators. Children had deficient serum levels relative to normal reference values for glutathione (91% of children), albumin (78%), vitamin A (63%), vitamin D (44%), zinc (38%) and vitamin E (13%). Sixty per cent of the children were anaemic and 30% were iron deficient. Conclusion: A high prevalence of acute and chronic malnutrition and micronutrient deficiencies occurred among HIV-infected children residing in care centres. The study highlights the need to investigate early initiation of antiretroviral therapy and nutrition interventions, including aggressive supplementation, in order to improve the prognosis of these children.

Assessment of the Sustainability of the Iodine-Deficiency Disorders Control Program in Lesotho

Background Evaluation of the sustainability of iodine-deficiency disorders control programs guarantees successful and sustained virtual elimination of iodine deficiency. The Lesotho universal salt iodization legislation was enacted in 2000 as an iodine-deficiency disorders control program and has never been evaluated. Objectives To assess the sustainability of the salt iodization program in Lesotho, 2 years after promulgation of the universal salt iodization legislation. Methods The proportion to population size method of sampling was used in 2002 to select 31 clusters in all ecological zones and districts of Lesotho. In each cluster, 30 women were selected to give urine and salt samples and 30 schoolchildren to give urine samples. The salt samples were analyzed by the iodometric titration method, and the ammonium persulfate method was used to analyze the urine samples. The chairperson of the iodine-deficiency disorders control program was interviewed on programmatic indicators of sustainability. SAS software was used for statistical analysis of the data. Results The urinary iodine concentrations of very few children (10.1% and 21.5%) and women (9.8% and 17.9%) were lower than 50 μg/L and 100 μg/L, respectively. At the household level, 86.9% of the households used adequately iodized salt. Only four indicators of sustainability have been attained by the salt iodization program in Lesotho. Conclusions Iodine-deficiency disorders have been eliminated as a public health problem in Lesotho, but this elimination is not sustainable. Effective regular monitoring of salt iodine content at all levels, with special attention to iodization of coarse salt, is recommended, together with periodic evaluation of the iodization program.

Nutritional status of disabled schoolchildren in Bloemfontein (2002-2003)

Objectives: To assess the nutritional status of disabled schoolchildren using anthropometric measures and dietary intake, and to compare estimated energy expenditure with energy intake and body weight.

Knowledge, attitudes and practices regarding iodine among patients with hyperthyroidism in the Free State, South Africa.

Abstract Objectives: To gather baseline information on the knowledge, attitudes and practices regarding iodine and iodised salt among patients with hyperthyroidism in the Free State. Subjects and Setting: The study was part of a large cohort study that included the first 96 patients aged 13 years or older diagnosed with hyperthyroidism and referred to Universitas Academic Hospital in Bloemfontein, South Africa during 2005. Methods: The patients were interviewed in their language using a structured validated questionnaire. Descriptive statistics were used for data analysis. Results: The majority of the patients (86.9%) did not know what iodine was. Similarly, a higher percentage of patients (76.7%) were unaware of the most important or main source of iodine in the food of South Africans. Regarding knowledge of the most important harmful effect on the health of children if they did not get enough iodine, almost all of the patients (89.1%) did not know what it was. Ninety-five per cent of salt was obtained from the local shops, and only 36.1% of the patients read the labelling on the package during purchase. A very small proportion of patients (1.6%) stored salt in closed containers and away from sunlight, while about half of them (49.2%) stored salt in open containers without lids, 36.1% stored it in rigid plastic containers with holes at the top, and 13.1% stored it in the open plastic bags in which the salt was bought. Conclusions: Patients with hyperthyroidism lacked knowledge of iodine, as well as of the storage of iodised salt, and this could have contributed to the persisting endemic goitre reported in previous studies. An aggressive awareness programme, targeting policy makers and the public, is recommended to ensure sustainable elimination of iodine deficiency disorders in South Africa.

Iodine content of salt 2 years after the introduction of the universal salt iodisation legislation in Lesotho.

The aim of the present study was to assess the impact of the universal salt iodisation legislation on I levels of salt at household, retail and entry level in Lesotho. We used a multistage proportion to population size method to select thirty-one clusters from all the districts and ecological zones of Lesotho. In each cluster, thirty households were randomly selected and salt samples were collected. Six salt samples from two randomly selected retailers in each cluster, and a total of 107 salt samples from all the commercial entry points in the country were also collected. Lesotho does not produce salt and it imports almost all its salt from South Africa. The salt samples were analysed using the iodometric titration method. The median I concentration of salt was 36.2 ppm at entry point, 37.3 ppm at retail level and 38.5 ppm at household level. At household level only 1.6 % used non-iodised salt and 86.9 % used adequately iodised salt. Of all salt collected at household level, 20.4 % was coarse salt, which was significantly less well iodised than fine salt. The study demonstrates a major achievement in the availability of iodised salt as well as household use of adequately iodised salt. Under-iodisation of coarse salt and non-uniformity of salt iodisation at the production site were observed. Therefore, there is a need for enforcement of the salt iodisation legislation especially at entry-point level to ensure that only iodised salt enters the country. During enforcement more emphasis should be given to iodisation of coarse salt.

Agreement between estimated and measured heights and weights in hospitalised patients – a restrospective study

The European Society for Clinical Nutrition and Metabolism (ESPEN) estimates that about 30% of all hospital patients are undernourished and need special nutritional care. ESPEN advises that all patients be screened for nutritional risk on admission. An ideal nutritional risk screening tool should be simple and quick to use by nursing staff when admitting patients to hospital. Tools recommended by ESPEN are the NRS 2002, MUST and MNA – all of which utilise body mass index (BMI = kg/m2) and require accurate recording of a patient’s height and weight.1