Dietary and nutrition screening for children seeking curative care in health facilities in Botswana

The extent to which nutrition and dietary screening performed in children seeking curative care in health facilities in Botswana was investigated using a cross-sectional survey design. Dietary screening, illness status, demographic and anthropometric data were obtained from a random sample of 522 children in 13 health facilities through structured interviews and actual anthropometric measurements. Amongst these, caregiversof children seeking curative care (n =174) completed a nutrition and dietaryscreening checklist designed to establish the proportion of ill children screened. Additionally, a self-administered questionnaire was used to examine the knowledge, attitudes, and perceptions of providers in the study clinics about nutrition and dietary screening and the types of indicators routinely used. Data were collected from all providers (n = 39) on duty. The results show that malnutrition was prevalent, with 13. 7%, 11.3 % and 3.9 % of children estimated to be stunted, underweight and wasted respectively. The prevalence of stunting and underweight was higher (p < .05) in olderchildren (37–60 months), children perceived as sickly, or raised in  households with periodic shortage of food compared to children under one year of age, children perceived as healthy or raised in households with adequate amounts of food at all times. Less than 20 % of children who sought curative care were screened for possible compromised dietary intake or nutritional status. Only 18 % of children had their weight measured during consultations. Only 10.8 % of providers were reported to havediscussed the children’s growth indicators with care-givers. Similarly, few providers specifically discussed the feeding recommendations (10.8%) and feeding frequency (7.8 %) of children with care-givers. The providers’ knowledge about nutrition and dietary screening was low. Most providers (70 %) perceived their didactic training to be adequate and over half of them were satisfied with their skill level in assessing the dietary intake (53 %) and nutritional status (57.9 %) of children. Fewer providers wereable to correctly list three indicators of nutritional status (35.9 %) or dietary intake (12.8 %). Study observations show that a large proportion of children seeking curative care in the health clinics are rarely screened for possible compromised dietary intake and nutrition status. Also, a large number of health providers are not satisfied with their skill level in dietary and nutrition screening. Since nutritional problems are often juxtaposed to health problems, efforts should be taken to integrate nutrition screeninginto the medical care for under-fives

Central obesity and diet quality in rural farming women of Ngamiland, Botswana

Rapid economic growth in Botswana like in other countries has led to the emergence of nutrition transition. Overweight/obesity, central adiposity and associated co-morbidities are on the rise, especially amongst women. Urban women have been shown to be more prone to overweight/obesity compared to men. However, the situation in rural women has not been studied. Therefore, this paper assesses the prevalence of central obesity in rural female farmers (N=113) of Ngamiland, Botswana over two years. Estimation of central obesity was made through assessment of waist circumference (WC) and waist hip ratios (WHR). The WHO Indicator cut-off points (WC: low risk= <80 cm; increased= 80-87.9 cm; and substantially increased= >88 cm and WHR: low risk= ≤0.85 and high risk=0.85+) for risk of metabolic complication were used to categorize women according to body fatness levels. A non-quantified dietary diversity questionnaire was also administered to individuals with responsibility over food, to assess the participant’s dietary diversity. Women were assigned dietary diversity scores (DDS) ranging from 0 to 8, depending on the number of food groups represented in their diet in the past 24 hours. The higher the number the more diversified the diet. These measurements were collected in August 2010 and September 2011. Between 2010 and 2011 the mean WC increased from 87±11.8 to 90.2±14.5 while the WHRs in 2010 increased from 0.83±0.1 to 0.86±0.1 respectively. Diets comprised mostly of starchy foods, milk and miscellaneous foods such as fats/oils, sugars, and condiments. Mean DDS for both periods was 3 showing poor quality diet and little change over the two years. Central adiposity was observed amongst the women as shown by a significant increase in WC between 2010 and 2011 (t=2.818, df=112, p=0.006). Contrary to expectations that rural female farmers in Ngamiland Botswana would be healthy compared to their non-farming counterparts, there seems to be an observable similar trend of overweight. Furthermore, quality of traditional diets seems to be deteriorating with less consumption of healthy protective and nutrient dense foods, which are likely to influence a rise in metabolic complications. The authors therefore recommend strategies that will facilitate reduction of waist sizes to 80.0 cm such as farming and consumption of healthier foods such as fruits and vegetables along with the commonly produced ones in the fields. Farming communities should also value and include traditional and wild foods in their diets to increase dietary diversity and reduce the risk of development of chronic diseases.Keywords: Central obesity, Rural Female Farmers, Overweight, Obesity, Ngamiland, Botswan

L&Apos;Influence Des Aliments Compl�Mentaires Sur Les Indicateurs De La Croissance Des Enfants A Gabane, Botswana

This study was conducted to characterise the relationship between complementary foods and the growth of children of ages three to 36 months in Gabane, Botswana. Dietary, anthropometric and socio-demographic data were collected from healthy children attending the monthly Child Welfare Clinic. Most children (92.8%) had adequate birth weights. Ninety-seven percent of children were breastfed. However, exclusive breastfeeding during the first six months of life was rare. Sixty-four point four percent (64.3%) and 44.4% of study children received water and infant formula within their first month of life. The most common complementary foods and fluids in this population were sorghum porridges, ultra high temperature pasteurised (UHT) cow milk, infant formula, tea and other types of milk from domestic animals. Between four and six months of age, sorghum porridges, ultra high temperature pasteurised (UHT) cow milk, and tea were introduced to 78%, 48.7% and 19.7% of children respectively. About 10% of children were introduced to complementary solids between two and three months while 3.4% were introduced to solids after six months of age. Sorghum porridges, which were the most common complementary solids in this population were also associated with lower (p < 0.05) weight-for-age z-scores (WAZ) and weight-for-height z-scores (WHZ). Children of working mothers were more likely (p < 0.001) to receive supplemental infant formula compared to children whose mothers did not have formal employment outside the home. Furthermore, supplementation with infant formula was significantly associated with higher (p < 0.05) WAZ and WHZ. Growth faltering in children became apparent shortly after three months, with the steepest decline in growth occurring between three and 12 months of age. Overall, 9.1%, 12.1%, and 5.3% of children were stunted, underweight, and wasted respectively. The prevalence of stunting, underweight and wasting was comparable in both genders. Children over 24 months of age had poorer (p < 0.05) growth indicators than younger children. Our findings suggest that the choice of complementary foods and fluids significantly influences the child&apos;s WAZ and WHZ, the duration of breastfeeding and the age at which solids are introduced.Cette étude a été effectuée dans le but de caractériser la relation entre les aliments complémentaires et la croissance des enfants âgés de trois à 36 mois à Gabane au Botswana. Des données relatives au régime alimentaire et des données anthropométriques et socio-démographiques ont été collectées chez des enfants en bonne santé présentés chaque mois au Centre médicosocial pédiatrique. La majorité des enfants (92,8%) avaient des poids adéquats à la naissance. Quatre-vingt-dix-sept pour cent (97%) des enfants étaient nourris au sein. Cependant, l&apos;allaitement exclusif pendant les six premiers mois de la vie était rare. Soixante-quatre pour cent (64,3%) et 44,4% des enfants qui ont fait l&apos;objet de cette étude ont reçu de l&apos;eau et du lait maternisé au cours du premier mois de leur vie. Les aliments et fluides complémentaires les plus courants dans cette population étaient des bouillies de sorgho, du lait de vache pasteurisé à une température ultra élevée (TUE), du lait maternisé, du thé et d&apos;autres types de lait d&apos;animaux domestiques. Lorsque les enfants avaient entre quatre et six mois, les bouillies de sorgho, le lait de vache pasteurisé à une température ultra élevée (TUE), et le thé ont été donnés respectivement à 78%, 48,7% et 19,7% des enfants. Près de 10% des enfants ont commencé à recevoir des aliments solides complémentaires entre deux et trois mois tandis que 3,4% ont commencé à les prendre quand ils avaient plus de six mois. Les bouillies de sorgho, qui étaient les aliments solides complémentaires les plus courants dans cette population, étaient également associées à des proportions (z-scores) entre le poids et l&apos;âge (WAZ) moins élevées (p < .05) et à des proportions (z-scores) entre le poids et la taille/hauteur (WHZ). Les enfants des mères qui travaillaient avaient plus de chances (p < .001) de recevoir du lait maternisé supplémentaire par rapport aux enfants dont les mères n&apos;avaient pas d&apos;emploi formel en dehors du domicile. En outre, l&apos;alimentation supplémentaire par du lait maternisé était considérablement associée à des WAZ et WHZ plus élevées (p < .05). Le ralentissement de la croissance chez les enfants est devenu apparent peu après l&apos;âge de trois mois, et la baisse la plus abrupte de la croissance se produisait entre l&apos;âge de trois et 12 mois. En général, 9,1%, 12,1%, et 5,3% des enfants avaient une croissance retardée, avaient un poids insuffisant, et étaient décharnés respectivement. La prévalence du retard de croissance, du poids insuffisant et de la maigreur était comparable chez les garçons et chez les filles. Des enfants âgés de plus de 24 mois avaient des indicateurs d&apos;une croissances plus faible (p < .05) que chez les enfants plus jeunes. Nos résultats suggèrent que le choix des aliments et fluides complémentaires influence considérablement la proportion WAZ et la proportion WHZ de l&apos;enfant, la durée de l&apos;allaitement et l&apos;âge auquel les aliments solides sont introduits

INFLUENCE OF COMPLEMENTARY FOODS ON THE GROWTH INDICATORS OF CHILDREN IN GABANE, BOTSWANA

This study was conducted to characterise the relationship between complementary foods and the growth of children of ages three to 36 months in Gabane, Botswana. Dietary, anthropometric and socio-demographic data were collected from healthy children attending the monthly Child Welfare Clinic. Most children (92.8%) had adequate birth weights. Ninety-seven percent of children were breastfed. However, exclusive breastfeeding during the first six months of life was rare. Sixty-four point four percent (64.3%) and 44.4% of study children received water and infant formula within their first month of life. The most common complementary foods and fluids in this population were sorghum porridges, ultra high temperature pasteurised (UHT) cow milk, infant formula, tea and other types of milk from domestic animals. Between four and six months of age, sorghum porridges, ultra high temperature pasteurised (UHT) cow milk, and tea were introduced to 78%, 48.7% and 19.7% of children respectively. About 10% of children were introduced to complementary solids between two and three months while 3.4% were introduced to solids after six months of age. Sorghum porridges, which were the most common complementary solids in this population were also associated with lower (p < 0.05) weight-for-age z-scores (WAZ) and weight-for-height z-scores (WHZ). Children of working mothers were more likely (p < 0.001) to receive supplemental infant formula compared to children whose mothers did not have formal employment outside the home. Furthermore, supplementation with infant formula was significantly associated with higher (p < 0.05) WAZ and WHZ. Growth faltering in children became apparent shortly after three months, with the steepest decline in growth occurring between three and 12 months of age. Overall, 9.1%, 12.1%, and 5.3% of children were stunted, underweight, and wasted respectively. The prevalence of stunting, underweight and wasting was comparable in both genders. Children over 24 months of age had poorer (p < 0.05) growth indicators than younger children. Our findings suggest that the choice of complementary foods and fluids significantly influences the child's WAZ and WHZ, the duration of breastfeeding and the age at which solids are introduced. Key Words: Complementary foods, Sorghum porridge, Growth faltering, Z-scores, Cow milk L'INFLUENCE DES ALIMENTS COMPLÉMENTAIRES SUR LES INDICATEURS DE LA CROISSANCE DES ENFANTS A GABANE, BOTSWANA Résumé Cette étude a été effectuée dans le but de caractériser la relation entre les aliments complémentaires et la croissance des enfants âgés de trois à 36 mois à Gabane au Botswana. Des données relatives au régime alimentaire et des données anthropométriques et socio-démographiques ont été collectées chez des enfants en bonne santé présentés chaque mois au Centre médicosocial pédiatrique. La majorité des enfants (92,8%) avaient des poids adéquats à la naissance. Quatre-vingt-dix-sept pour cent (97%) des enfants étaient nourris au sein. Cependant, l'allaitement exclusif pendant les six premiers mois de la vie était rare. Soixante-quatre pour cent (64,3%) et 44,4% des enfants qui ont fait l'objet de cette étude ont reçu de l'eau et du lait maternisé au cours du premier mois de leur vie. Les aliments et fluides complémentaires les plus courants dans cette population étaient des bouillies de sorgho, du lait de vache pasteurisé à une température ultra élevée (TUE), du lait maternisé, du thé et d'autres types de lait d'animaux domestiques. Lorsque les enfants avaient entre quatre et six mois, les bouillies de sorgho, le lait de vache pasteurisé à une température ultra élevée (TUE), et le thé ont été donnés respectivement à 78%, 48,7% et 19,7% des enfants. Près de 10% des enfants ont commencé à recevoir des aliments solides complémentaires entre deux et trois mois tandis que 3,4% ont commencé à les prendre quand ils avaient plus de six mois. Les bouillies de sorgho, qui étaient les aliments solides complémentaires les plus courants dans cette population, étaient également associées à des proportions (z-scores) entre le poids et l'âge (WAZ) moins élevées (p < .05) et à des proportions (z-scores) entre le poids et la taille/hauteur (WHZ). Les enfants des mères qui travaillaient avaient plus de chances (p < .001) de recevoir du lait maternisé supplémentaire par rapport aux enfants dont les mères n'avaient pas d'emploi formel en dehors du domicile. En outre, l'alimentation supplémentaire par du lait maternisé était considérablement associée à des WAZ et WHZ plus élevées (p < .05). Le ralentissement de la croissance chez les enfants est devenu apparent peu après l'âge de trois mois, et la baisse la plus abrupte de la croissance se produisait entre l'âge de trois et 12 mois. En général, 9,1%, 12,1%, et 5,3% des enfants avaient une croissance retardée, avaient un poids insuffisant, et étaient décharnés respectivement. La prévalence du retard de croissance, du poids insuffisant et de la maigreur était comparable chez les garçons et chez les filles. Des enfants âgés de plus de 24 mois avaient des indicateurs d'une croissances plus faible (p < .05) que chez les enfants plus jeunes. Nos résultats suggèrent que le choix des aliments et fluides complémentaires influence considérablement la proportion WAZ et la proportion WHZ de l'enfant, la durée de l'allaitement et l'âge auquel les aliments solides sont introduits. AJFAND Vol.4(1) 200

User perceptions of the quality of nutrition care for children under five year in Botswana

No Abstract