Andre Oelofse

African leafy vegetables consumed by households in the Limpopo and KwaZulu-Natal provinces in South Africa

Abstract Objectives: The objectives of this study were to determine the availability of, access to and nutrition-related uses of African leafy vegetables in rural and urban households; and to determine the β-carotene content of the dominant African leafy vegetable. Design: The study consisted of a qualitative explorative phase (field walks, semi-structured interviews with key informants, focus group discussions) at two rural sites; and a quantitative household survey (questionnaire) at two rural and one urban site. Amaranth leaves were analysed for β-carotene content. Setting and subjects: The household survey included households at a rural site in Limpopo province (n = 100); and a rural (n = 101) and urban (n = 391) site in KwaZulu-Natal province, South Africa. Results: A variety of edible plants were identified during field walks at the two rural sites. Focus group discussions narrowed this down to ten plants at the rural Limpopo site and six at the rural KwaZulu-Natal site. The most popular leaves were amaranth (Amaranthus spp), spider plant (Cleome gynandra), wild watermelon (Citrullus lanatus) and blackjack (Bidens spinosa), consumed individually or mixed with other leaves. Rural households procured leaves mostly from the wild whereas urban households relied more on informal markets. In Limpopo, leaves were dried and stored for consumption during winter. KwaZulu-Natal households considered African leafy vegetables food for the poor. Leaves were boiled in salted water, or steamed and then fried in oil. Fried and boiled amaranth leaves contained 627 and 429 µg retinol activity equivalents/100 g respectively. Conclusions: Availability of, access to and nutrition-related uses of African leafy vegetables are context-specific, with inter- and intraprovincial rural/urban differences. Information collected during small studies within a specific area can therefore not be generalised for the overall South-African population. Amaranth can potentially contribute significantly to vitamin A requirements of nutritionally vulnerable communities.

Effect of phytate reduction of sorghum, through genetic modification, on iron and zinc availability as assessed by an in vitro dialysability bioaccessibility assay, Caco-2 cell uptake assay, and suckling rat pup absorption model

Improved iron and zinc availability from sorghum, a commonly consumed staple, will benefit many malnourished communities in rural Africa burdened with high prevalence of iron and zinc deficiency. This research compared the effect of genetic phytate reduction in sorghum on iron and zinc bioaccessibility and uptake measured by in vitro dialysability and Caco-2 cell uptake assays to that of iron and zinc absorption measured by a suckling rat pup model. The phytate reduction (80-86%) in these sorghums significantly increased zinc availability. The Caco-2 cell method, but not the dialysability assay, proved useful in estimating zinc absorption. The measured increase in iron availability differed between the methods, possibly due to the effect of varying mineral (Ca, Fe, Zn, P) contents of the sorghums. This effect was most prominent in the iron uptake results. More research is needed to determine the effect of naturally occurring variations in mineral contents of sorghum on the iron uptake by Caco-2 cells.

Socio-demographic profiles and anthropometric status of 0- to 71-month-old children and their caregivers in rural districts of the Eastern Cape and KwaZulu-Natal provinces of South Africa

Abstract Objectives: To determine the nutritional status of 0- to 71-month-old children and their caregivers, as well as their socio-demographics, in two provinces in South Africa. Design: Cross-sectional baseline survey. Setting: OR Tambo and Alfred Nzo districts in the Eastern Cape (EC), and Umkhanyakude and Zululand (Nongoma and Pongola subdistricts) in KwaZulu-Natal (KZN), South Africa. Subjects: 0- to 71-month-old children and their caregivers (EC 1 794; KZN 1 988). Methods: Questionnaire and anthropometric survey. Results: The prevalence of childhood malnutrition doubled from the first to second year of life and reached high levels in the EC and Nongoma (KZN). Many caregivers were either overweight or obese (EC 55%; KZN 45%). Initiation of breast-feeding was universal. For infants younger than six months, more than 80% were breast-feeding, and 50% received bottle feeds in addition to breast milk in the EC. Breast-feeding was similar in the two provinces up to the age of 18 months, but differed for 18- to 24-month-old children (EC 50%; KZN 33%). Animal products and yellow/orange-fleshed vegetables were not consumed regularly by children aged two to five years. Immunisation coverage up until 10 weeks was approximately 90%; measles immunisation coverage at 18 months was 40 to 43%. Toilet facilities (31 to 96%), tap water (9 to 38%), electricity (8 to 51%), single mothers (29 to 68%) and unemployed husbands (19 to 55%) varied among provinces. Many households relied on grants for income. In Umkhanyakude, 37% of the caregivers had no formal education. Conclusions: Childhood malnutrition and maternal overweight/obesity co-existed. A large proportion of the study population did not have access to basic services. Differences were observed within and between provinces. Nutrition programmes should be flexible, taking into consideration local conditions.

Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal provinces, South Africa

Abstract Objective: To assess primary health care (PHC) facility infrastructure and services, and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Design: Cross-sectional survey. Setting: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). Subjects: PHC facilities and nurses (EC: n = 20; KZN: n = 20), and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). Methods: Structured interviewer-administered questionnaires and anthropometric survey. Results: Of the 40 PHC facilities, 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20%; KZN: 25%); electricity (EC: 45%; KZN: 85%); flush toilets (EC: 40%; KZN: 75%); and operational telephones (EC: 20%; KZN: 5%). According to more than 80% of the nurses, problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41%; KZN: 25%). Social grants were reported as a main source of income (EC: 33%; KZN: 28%). Few households reported that they had enough food at all times (EC: 15%; KZN: 7%). The reported prevalence of diarrhoea was high (EC: 34%; KZN: 38%). Undernutrition in 0 to younger than 6 month-olds was low; thereafter, however, stunting in children aged 6 to 59 months (EC: 22%; KZN: 24%) and 60 to 71 months (EC: 26%; KZN: 31%) was medium to high. Overweight and obese adults (EC: 49%; KZN: 42%) coexisted. Conclusion: Problems regarding infrastructure, basic resources and services adversely affected PHC service delivery and the well-being of rural people, and therefore need urgent attention.

Rat bioassay of the protein nutritional quality of soy-fortified sorghum biscuits for supplementary feeding of school-age children.

BACKGROUND Protein-energy malnutrition (PEM) remains a major deficiency disease among children in developing countries. The protein nutritional quality of soy-fortified sorghum biscuits was evaluated with respect to their potential as a protein-rich supplementary food. Three isonitrogenous diets based on 50:50 ratio decorticated sorghum:defatted soy flour biscuits, 100% sorghum biscuits, casein, and a protein-free diet were fed to male Sprague Dawley weanling rats. RESULTS Protein efficiency ratio (PER) for the sorghum-soy biscuit diet was equivalent to the reference casein diet, and zero for the 100% sorghum diet. Faecal bulk for 100% sorghum diet was 1.5 times higher than sorghum-soy and casein diets. True protein digestibility of the three diets was high-88-95%-agreeing with previous rat studies with sorghum. Biological value and net protein utilization of the sorghum-soy biscuit diet were similar to the casein diet, but lower than the 100% sorghum biscuit diet CONCLUSION Notwithstanding limitations of rat bioassay for assessing sorghum food protein quality, the high PER of defatted soy flour-fortified sorghum biscuits (sorghum:soy 50:50 ratio) indicates they have considerable potential as a supplementary food to young children to alleviate PEM.

Changes in complementary feeding practices and nutrition status in returnee children aged 6-23 months in northern Uganda

Abstract Objectives: Evaluate changes in underweight and wasting, feeding patterns, water use, sanitation, immunisation, disease episodes, deworming and vitamin A supplementation in children aged 6-23 months in returnee villages benefiting from a community-based supplementary feeding programme in northern Uganda. Community perceptions on the causes and effects of childhood malnutrition, the use of community volunteers, the involvement of the men in the promotion of child nutrition and changes in childhood nutrition and feeding practices were also assessed. Design: Programme impact evaluation. Setting: The study was carried out in the districts of Pader and Agago in northern Uganda. Subjects: Children aged 6-23 months (207), and adult men and women. Outcome measures: Weight and mid-upper-arm circumference were used to determine underweight and wasting, respectively. Immunisation, deworming and vitamin A supplementation status was assessed. Oedema and morbidity or disease episodes were also determined. Community perceptions on the quality, utilisation and types of supplementary feeding services offered, understanding of malnutrition and the involvement of the men were also assessed. Finally, the impact of mother care groups and village health teams, as well as changes in child nutrition status and feeding, were assessed. Results: The prevalence of wasting (11.1%) and underweight (22.7%) is higher than the baseline of 11% and 17.8%, respectively. Eighty-six per cent of the children were still breastfeeding. A high percentage (79.2%) of children were exclusively breastfed. The largest proportion of children (42.3%) ate two times a day, and 55.6% of them consumed food from their own plates. Over three quarters (75.8%) and 93.7% of the children had received measles and diphtheria, pertussis and tuberculosis vaccines (DPT3), respectively. Ninety-five per cent and 66.7% had received vitamin A supplements and deworming tablets, respectively. The water usage rate was 19.2 l/person/day. Sixty per cent of the households had their own pit latrines. The programme was perceived to have improved the nutritional knowledge and feeding practices of the community. The use of volunteer mothers for nutrition education encouraged other community members to take childhood nutrition seriously. Conclusion: Childhood wasting and underweight rates have remained high in the two districts, despite an improvement in nutrition-related knowledge and practices. Advances in complementary feeding and related sanitation practices were recorded. An increase in vitamin A supplementation, with reductions in DPT3 immunisation and deworming were observed at the end of this community-based supplementary feeding programme. Community volunteers, through the provision of education and the identification of malnourished children, were pivotal in changing nutrition knowledge and the attitudes of community members. The support of volunteers with savings, loans and seeds were important incentives when promoting nutrition. Given the reliance of the volunteers on incentives from the project, we are sceptical as to whether nutrition education and the screening of acutely malnourished children will continue in these communities post the project.

Effects of aqueous soaking on the phytate and mineral contents and phytate:mineral ratios of wholegrain normal sorghum and maize and low phytate sorghum.

Abstract Soaking of cereal grains has been suggested as a method to reduce their phytate content and hence increase their mineral availability. Whole and milled wholegrain, normal and low phytate sorghum and normal maize were studied. Soaking of unmilled sorghum and maize did not result in substantial reductions in phytate or mineral contents. With milled grains, phytate solubilisation was somewhat greater in maize than in sorghum after a short (1 h) soaking period but not after 6–12 h of soaking when practically all phytate had been solubilised. Also, with milled, low phyate sorghums, phytate solubilisation was not substantially higher than in their null controls. Soaking milled grain substantially reduced mineral contents and Ca × phytate:zinc molar ratios. However, the loss in soluble minerals could have a greater negative effect on mineral availability, compared to the positive effect of the phytate reduction. Thus, soaking does not seem to be a viable household method to improve sorghum and maize mineral availability.