Liana Steenkamp

Associations between selective attention and soil-transmitted helminth infections, socioeconomic status, and physical fitness in disadvantaged children in Port Elizabeth, South Africa: An observational study

Background Socioeconomically deprived children are at increased risk of ill-health associated with sedentary behavior, malnutrition, and helminth infection. The resulting reduced physical fitness, growth retardation, and impaired cognitive abilities may impede children’s capacity to pay attention. The present study examines how socioeconomic status (SES), parasitic worm infections, stunting, food insecurity, and physical fitness are associated with selective attention and academic achievement in school-aged children. Methodology The study cohort included 835 children, aged 8–12 years, from eight primary schools in socioeconomically disadvantaged neighborhoods of Port Elizabeth, South Africa. The d2-test was utilized to assess selective attention. This is a paper and pencil letter-cancellation test consisting of randomly mixed letters d and p with one to four single and/or double quotation marks either over and/or under each letter. Children were invited to mark only the letters d that have double quotation marks. Cardiorespiratory fitness was assessed via the 20 m shuttle run test and muscle strength using the grip strength test. The Kato-Katz thick smear technique was employed to detect helminth eggs in stool samples. SES and food insecurity were determined with a pre-tested questionnaire, while end of year school results were used as an indicator of academic achievement. Principal findings Children infected with soil-transmitted helminths had lower selective attention, lower school grades (academic achievement scores), and lower grip strength (all p<0.05). In a multiple regression model, low selective attention was associated with soil-transmitted helminth infection (p<0.05) and low shuttle run performance (p<0.001), whereas higher academic achievement was observed in children without soil-transmitted helminth infection (p<0.001) and with higher shuttle run performance (p<0.05). Conclusions/Significance Soil-transmitted helminth infections and low physical fitness appear to hamper children’s capacity to pay attention and thereby impede their academic performance. Poor academic achievement will make it difficult for children to realize their full potential, perpetuating a vicious cycle of poverty and poor health. Trial registration ClinicalTrials.gov ISRCTN68411960

Eating, drinking and physical activity in Faculty of Health Science students compared to other students at a South African university

Abstract Objectives: Students studying towards a qualification in Health Sciences should have more knowledge of a healthy lifestyle than other university students. However, it has been questioned whether or not these students apply such knowledge. While studies have been conducted on the lifestyle habits of students in general, few have compared the practices of Health Science students with those of other students. The objectives of this study were to compare the eating patterns, alcohol consumption and physical activity of Health Science students with those of other students. Design: A cross-sectional study design that utilised an electronic self-administered survey was applied. Data were analysed using SPSS® and Pearson’s chi-square test (p-value < 0.050). Subjects and setting: A convenience sample (n = 619), consisting of registered students at Nelson Mandela Metropolitan University, participated, after providing informed consent. Outcomes measures: Dietary patterns and frequency of intake, alcohol consumption and physical activity were measured. Results: A statistical difference was not reported between the eating patterns, alcohol consumption and physical activity of Health Science students and those of other students. Most of the students exhibited poor dietary behaviour. For example, 65% of Health Science students and 67% of students in other faculties consumed less than one fruit per day, 70% of Health Science students and 64% of other students consumed less than one vegetable per day, while 91% of Health Science students and 93% of students in other faculties consumed less than two glasses of milk per day. Although not significant, fewer Health Science students (4%) than students of other faculties (9%) consumed alcohol more than twice a week. Binge drinking was more common in Health Science students. Forty-eight per cent of the Health Science students indicated that they were physically inactive, compared to 49% of students in other faculties. Conclusion: Students studying Health Science do not have a healthier lifestyle than other students. Further theory-based intervention studies to determine the reasons for this behaviour need to be undertaken. Strategies should be developed to encourage behavioural change.

Socio-economic and demographic factors related to HIV status in urban informal settlements in the Eastern Cape, South Africa

The prevalence of HIV&AIDS is embedded in social and economic inequity and the relationship between social determinants and HIV incidence is well established. The aim of this study was to determine which socio-economic and demographic factors are related to HIV status in the age group 18 to 49 years in informal settlements in the Eastern Cape, South Africa. This cross-sectional study was conducted in 3 informal settlements (n = 752) during March 2013 within the Nelson Mandela Bay and Buffalo City districts. A proportional cluster sample was selected and stratified by area and formal plot/squatter households in open areas. Respondents who volunteered to participate had to provide informed written consent before trained, bilingual peer educators interviewed them and completed the structured questionnaire. HIV status was determined and information on demographic and socio-economic variables was included in the bivariate analysis. The prevalence of HIV was higher, at 17.3%, than the 2011 estimated national prevalence among the general population in South Africa. The level of education (χ2 = 5.50, df = 1, p < 0.05), geographical site (χ2 = 7.41, df = 2, p < 0.05), gender (χ2 = 33.10, df = 1, p < 0.0005), household food insecurity (χ2 = 4.77, df = 1, p < 0.05), cooking with cast iron pots (χ2 = 15.0, df = 3, p < 0.05) and availability of perceived ‘wealth’ indicators like mobile telephones and refrigerators (χ2 = 9.67, df = 2, p < 0.05) were significantly associated with HIV-status. No significant associations could be demonstrated between household income, the number of people living in the household and the availability of electricity/water and HIV status. As the observed levels of HIV prevalence underlined gender bias and failure to graduate from high school, future interventions should focus on HIV prevention in female schoolchildren. However, HIV infection is also prevalent among wealthier individuals in informal settlements, which indicates that renewed efforts should be made to improve sexual risk behaviour within this group.

The acceptability and intake of lipid-based pastes as a food supplement in a South African context

Abstract This descriptive study included 103 children aged 12-60 months, 39 older children and 291 adults, and was performed to assess the sensory acceptability of a lipid-based food supplement. Lipid-based pastes were found to be highly acceptable, although concern exists regarding the recommended portion sizes, especially for young children with poor appetite.

Challenges in the implementation of the Infant and Young Child Feeding policy to prevent mother-to-child transmission of human immunodeficiency virus in the Nelson Mandela Bay District

Abstract Objective: To assess the Infant and Young Child Feeding (IYCF) policy implementation among healthcare workers working at the Nelson Mandela Bay District (NMBD) public healthcare facilities. Design: Descriptive survey using quantitative closed structured questionnaires. Setting: Nursing professionals (n = 32) rendering maternal and child health services in 19 permanent NMBD clinics were included in a convenience sample in October 2011. Method: The closed, structured questionnaire was developed based on statements contained within the 2007 IYCF policy and administered by one interviewer. Ethics approval was obtained and respondents had to provide informed written consent. Data were analysed by means of descriptive and differential statistics. Results: Sixty-three per cent of nursing professionals were older than 40 years of age and more than half had already completed the Integrated Management of Childhood Illness (IMCI) and 20-hour IYCF training course. Respondents achieved a high mean score of 8.07 on knowledge of infant feeding in the context of human immunodeficiency virus (HIV). However, no association could be demonstrated between knowledge scores and previous training. Despite high scores on perceptions of the importance of IYCF counselling, 56% of the participants reported that they had never seen the IYCF policy before. Conclusion: Relevant training in IYCF in the context of HIV, the availability of IYCF policy guidelines and monitoring of counselling and training of health professionals and volunteers, are some of the challenges that need to be addressed to improve implementation of IYCF policy in the NMBD district.AbstractObjective: To assess the Infant and Young Child Feeding (IYCF) policy implementation among healthcare workers working at the Nelson Mandela Bay District (NMBD) public healthcare facilities.Design: Descriptive survey using quantitative closed structured questionnaires.Setting: Nursing professionals (n = 32) rendering maternal and child health services in 19 permanent NMBD clinics were included in a convenience sample in October 2011.Method: The closed, structured questionnaire was developed based on statements contained within the 2007 IYCF policy and administered by one interviewer. Ethics approval was obtained and respondents had to provide informed written consent. Data were analysed by means of descriptive and differential statistics.Results: Sixty-three per cent of nursing professionals were older than 40 years of age and more than half had already completed the Integrated Management of Childhood Illness (IMCI) and 20-hour IYCF training course. Respondents achieved a high mean score of 8.07 on...

The quality of life of HIV-infected South African university students: Experiences with the WHOQOL-HIV-Bref

ABSTRACT HIV and AIDS has serious repercussions on psychological, social and physical well-being, and the assessment of Quality of Life (QoL) of people living with HIV and AIDS is essential to gauge how these challenges are met. The WHOQoL-HIV Bref forms part of a suite of instruments developed by the World Health Organisation. The purpose of this paper is to describe the quality of life of a sample of HIV-infected students at a South African university, as well as explain the internal consistency between questions within each of the QoL domains. A descriptive, cross-sectional study design using a quantitative approach was applied. A non-probability, purposive sampling approach was utilized and students enrolled in the antiretroviral therapy or wellness programme were invited to voluntarily participate in this study. The WHOQOL-HIV Bref was self-administered after explanation of the questions by a registered, trained health care professional. A total of 63 students returned completed questionnaires that were included in the analysis. Acceptable to good reliability scores were established for the following domains: Level of Independence; Social Relations; Environment and Spiritual or Personal Beliefs. Assessing QoL in the sample, the lowest score was for “Spirituality” and the highest “Social Relations”. The “Physical” and “Psychological” domain scores for females were significantly lower than the score for males. There was no significant difference between any of the domain scores among participants with CD4 cell counts above or below 350 cells/mm3. In general the performance of this sample is encouraging and it is recommended that the measure be utilized for QoL screening, and further research. The WHOQOL-HIV Bref for students does not contain an academic wellness component which should be added considering the significant effects of HIV on neuropsychological functioning. Also further investigation into the reasons for poor scores obtained in physical and psychological well-being in females should be encouraged.

Use of Mid Upper-Arm Circumference (MUAC) as screening tool in an urban township in the Eastern Cape: Rationale for testing changed cut-off values to identify malnutrition

Introduction Children with a weight-for-height z-score (WHZ) -3 SD of this standard. The WHO therefore recommends the use of a WHZ of below -3 SD to identify children with SAM. The mid-upper arm circumference (MUAC) cut-off values of 11.5 cm and 12.5 cm are used globally as screening tools to identify SAM and MAM, respectively, in children between six and 60 months of age. According to the WHO and UNICEF the WHZ and MUAC may be used interchangeably as a screening tool to identify malnourished infants and children, as they reveal a very similar prevalence of SAM in the field. However, more recent data indicate that there may be little overlap between the children identified with SAM and MAM by WHZ and those identified using the MUAC cut-offs. Therefore, more recently the recommendation is to use WHZ and MUAC measurements as independent but complementary admission criteria for SAM. Methods In this descriptive study with a cross-sectional design, data from a convenience sample of 400 infants and young children younger than 24 months were gathered from five clinics and 15 early childhood development (ECD) centres in Motherwell, Nelson Mandela Bay Health District (NMBHD) from October 2015 to February 2016. The Pearson correlation co-efficient (r) was used to measure the strength or degree of the relationship between variables. Sensitivity and specificity tests were used on the data with the existing recommended MUAC cut-off values as well as new calculated MUAC cut-off values to determine whether the new MUAC cut-off values were more sensitive in the identification of children affected by wasting, without including false negatives (children without SAM or MAM). Results The current WHO MUAC cut-off values to identify MAM have a high specificity, but performed poorly when tested for sensitivity. The r-value (0.78) for the relationship between WHZ and MUAC suggests a dependent relationship between these two indicators. The least squares regression formula (Y = 15.409 + 0.803x (males); Y = 15.13 + 0.83x (females)) was then used to predict where WHZ = -2 is most likely to correspond with a MUAC value in cm. The new predicted MUAC values of 13.8 cm (males) and 13.5 cm (females) were subsequently tested for sensitivity and specificity. The sample was too small to calculate sensitivity for both genders, but 96.4% specificity was achieved for females. A sensitivity of 100% and specificity of 94.5% was achieved with the male MUAC cut-off. Thus, the proposed cut-offs identified all of the wasted children (WHZ < -2), while identifying an acceptably low number of false positives Conclusion The current WHO MUAC cut-off values lacked the sensitivity to identify cases of MAM in a South African urban township population. A revised, single MUAC cut-off value for males and females younger than two years may increase the correct diagnosis of MAM, thus providing health workers the opportunity to prevent SAM. This new cut-off value should be tested in the field with larger samples

Nutritional status and metabolic risk in HIV-infected university students: challenges in their monitoring and management

Objective: This study aims to describe challenges in the management of HIV-infected university students focusing on their nutritional status and metabolic risk. Methods: A cross-sectional, descriptive study design was used to assess the anthropometry, food intake and clinical status of a cohort of known HIV-infected registered students at a South African university. Results: Participants (n = 63) had a mean CD4 cell count of 411 (SD = 219.9) cells/mm3, a mean body mass index (BMI) of 28.05 (SD = 7.9) kg/m2 and only half of the participants (n = 31) were on antiretroviral therapy (ART). A higher BMI (> 25 kg/m2) was significantly (p < 0.05; V = 0.32) associated with higher CD4 cell counts of > 350 cells/mm3. Some 40% (n = 25) of students were at risk for metabolic complications based on their waist circumference and 11% (n = 7) had clinical signs of lipodystrophy. The ‘obese’ group consumed a mean energy intake of 24 kcal/kg bodyweight which was lower than the ‘overweight’ and normal weight groups. Conclusions: In total 51% of HIV-positive students in the sample presented with signs of metabolic complications. Side effects of ART can be prevented and/or treated by regular physical activity, adequate nutritional intake, monitoring of side effects and BMI, combined with optimal care and support.

Dispensing of vitamin products by retail pharmacies in South Africa: Implications for dietitians

Objective: The objective of this study was to analyse the dispensing patterns of vitamins (Anatomical Therapeutic Chemical (ATC) group A11) over a one-year period in a group of community pharmacies in South Africa. Design and setting: A retrospective drug utilisation study was conducted on community pharmacy electronic dispensing records in South Africa recorded in 2013. Outcome measures: All products for ATC subgroup A11 were extracted and analysed. Results: A total of 164 233 vitamin products were dispensed to 84 805 patients (62.64% female patients). Males received on average 2.09 (SD = 2.63) vitamin products per year, compared to 1.84 (SD = 2.13) products for females. Ergocalciferol (A11CC01) was the most often dispensed (37.48% of all vitamin products), followed by plain Vitamin B-complex products (A11EA00) accounting for 32.77%. Ergocalciferol (vitamin D2) is only available on prescription (50 000 IU tablets or 50 000 IU/ml oily drops) in South Africa. Tablets were the preferred dosage form (62.84% of products). Most injections were for Vitamin B1 or Vitamin B combination products. Conclusion: Ergocalciferol and injectable vitamins have recently been rescheduled to prescription-only; it is probable that this has impacted on the usage of these products. It is important to monitor future vitamin supplementation behaviour in community pharmacies since pharmacies are selling many of these products and pharmacists can, by counselling patients, determine the reasons for the use of these products. Furthermore, should dietitians and nutritionists choose to work with this captive audience, supplementation patterns can be monitored to develop and implement appropriate awareness campaigns. Further studies to explore these baseline results are recommended.

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Abstract Objectives: The objective of the study was to describe wasting and stunting in children aged 12–60 months, admitted to targeted supplementary feeding programmes for the treatment of moderate acute malnutrition (MAM) in South Africa. Design: A cross-sectional, descriptive study was performed. Subjects and setting: Children with MAM, managed as outpatients at primary healthcare facilities in three provinces, were included in the study conducted between September 2012 and August 2013. Outcome measures: Weight, height and mid-upper-arm circumference (MUAC) measurements were collected to classify the children as moderately or severely stunted or wasted. Results: Of the total sample (n = 225), 13% (n = 30) were diagnosed as wasted, 58% (n = 131) as stunted, and 21% (n = 47) as both wasted and stunted. MUAC was significantly associated with wasting. However, an association was not found between MUAC and stunting. Of the sample, 32% (n = 72) presented with severe stunting, and 29% (n = 65) with moderate wasting. Food insecurity was associated with wasting, but not with stunting. Conclusion: A low weight-for-age z-score resulted more from stunting than from wasting in this study. Severe stunting presented as a greater health concern than moderate wasting. Without scrutinising wasting and stunting, healthcare professionals may remain unaware of the drivers of underweight for age in children treated at South African primary healthcare facilities. Following this study’s outcomes, the sensitivity of MUAC in screening for moderate malnutrition in South African settings with a high prevalence of stunting is questionable. It is recommended that current nutritional interventions are revisited to explore the efficacy of treating children with wasting, stunting or both.