Comparison of indicators of household food insecurity using data from the 1999 national food consumption survey.

Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.Information on the present situation of household food insecurity in South Africa is fragmented. There is no comprehensive study comparing different indicators of household food security. Better information on the household food security situation in South Africa would permit relevant policy formulation and better decision-making on the allocation of limited resources. The availability of a national dataset, the first South African National Food Consumption Survey data (1999) , provided the opportunity to investigate some of the issues raised above, and to contribute to knowledge on the measurement of household food security. The aim of this study was to use the data from the 1999 National Food Consumption Survey (NFCS) to : • Determine and compare the prevalence of household food insecurity using different indicators of household food security ; • Determine the overlap of households identified as food insecure by the different indicators (i.e. how many of the same households are identified as food insecure); and to • Investigate whether there was any correlation between the indicators selected . The indicators of household food security selected were: household income, household hunger experienced, and using the index child: energy and vitamin A intake (from 24 Hour Recall (24HR) and Quantified Food Frequency data), dietary diversity (from 24HR data) and anthropometric indicators stunting and underweight. The cut offs to determine food insecure household were those used in the NFCS and the cut off for dietary diversity was exploratory. The main results of the study were as follows : • The prevalence estimates of household food insecurity ranged from 10% (underweight indicator) to 70% (low income indicator). Rural areas consistently had a higher prevalence of household food insecurity than urban areas . The Free State and Northern Cape provinces had higher levels of household food insecurity, with the Western Cape and Gauteng the lower levels of household food insecurity . • Quantified Food Frequency (QFF) data yielded lower prevalence of household food insecurity estimates than 24 hour recall (24HR) data. Household food insecurity as determined by low vitamin A intakes was higher than that determined by low energy intakes for both the 24HR and QFF data . • There was little overlap with the indicators (9-52%), indicating that the same households were not being identified by the different indicators. Low dietary diversity, low income, 24HR low vitamin A intake and hunger had higher overlaps with the other indicators. Only 12 of 2826 households (0.4%) were classified by all nine indicators as food insecure. • The dataset revealed a number of statistically significant correlations. Overall , low dietary diversity, low income, 24HR low energy intake and hunger had the stronger correlations with the other indicators. Food security is a complex, multi-dimensional concept, and from the findings of this study there was clearly no single best indicator of household food insecurity status. Overall , the five better performing indicators (higher overlaps and correlations) were : low income, 24 hour recall low energy intake, 24 hour recall low vitamin A intake, low dietary diversity and hunger; this merits their use over the other selected indicators in this study. The indicator selected should be appropriate for the purpose it is being used for, e.g. estimating prevalence of food insecurity versus monitoring the long term impact of an intervention. There are other important criteria in the selection of an indicator. Income data on a national scale has the advantage of being available annually in South Africa, and this saves time and money. The 24HR vitamin A intake and 24HR energy intake indicators has as its main draw back the skill and time needed to collect and analyse the information, which increases cost and decreases sustainability. Dietary diversity and hunger have the advantage of being simple to understand, and quicker and easier to administer and analyse. It is suggested that a national food security monitoring system in South Africa uses more than one indicator, namely : 1) household income from already existing national data, 2) the potential for including a hunger questionnaire in the census should be explored, and 3) when further researched and validated, dietary diversity could also be used in national surveys

Lockdown-associated hunger may be affecting breastfeeding: Findings from a large sms survey in South Africa

The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27)

Potential Effects of Nutrient Profiles on Nutrient Intakes in the Netherlands, Greece, Spain, USA, Israel, China and South-Africa

Nutrient profiling is defined as the science of categorising foods based on their nutrient composition. The Choices Programme is a nutrient profile system with criteria that determine whether foods are eligible to carry a "healthier option" stamp. The Daily Menu Method which has been developed to evaluate these criteria is described here. This method simulates the change in calculated nutrient intakes which would be the result of consumers changing their diets in favour of food products that comply with the criteria.Average intakes of energy, trans fatty acids (TFA), saturated fatty acids (SAFA), sodium, added sugar and fibre were derived from dietary intake studies and food consumption surveys of 7 countries: The Netherlands, Greece, Spain, the USA, Israel, China and South Africa. For each of the key nutrients, these average intakes were translated into three Typical Daily Menus per country. Average intakes based on these three menus were compared with average intakes from three Choices Daily Menus. To compose the Choices Menus, foods from the Typical Menus that did not comply with the Choices criteria were replaced with foods that did comply and are available on the market.Comparison of intakes from the Choices Menus with the survey data showed that calculated intakes of energy, SAFA, TFA, sodium and added sugar were reduced. Fibre intakes were increased. The size of the effect differed per country.The Daily Menu Method is a useful means to predict the potential effects of nutrient profiles such as the Choices criteria, on daily nutrient intakes. The method can be applied internationally and confirms that the criteria of the Choices Programme are in line with the aim of the programme: to improve nutrient intakes in the direction of the recommendations

Complementary feeding practices and their influences

The global focus on a 1 000 days from conception to 2 years stresses the importance this period has on improving infant health. South Africa has focused on policies and actions to improve breastfeeding rates but specific attention to complementary feeding practices is still lacking. The 2016 South African Demographic and Health Survey indicated an increase in stunting from 8 to 23 months of age – further highlighting the complementary feeding phase as a vulnerable stage for infants. Disaggregated local data on infant feeding practices is required to better inform decision makers on the current infant feeding situation before interventions can be considered. The objectives of this PhD study were to review the current complementary feeding practices in South Africa; to describe and assess the infant feeding practices of 6-11 month-old infants attending the KwaMashu Community Health Centre in KwaZulu-Natal, South Africa; to use Optifoods software to ascertain if infant nutrient requirements can be met with a food-based approach, as well as to identify the nutrients that are difficult to achieve adequate intakes of; and to describe the main influences on mothers’ complementary feeding decisions. A review of complementary feeding practices in South Africa (CHAPTER 1), revealed that despite updated infant feeding policies, in reality, poor infant feeding practices still prevail. In general, foods and liquids are introduced too early. Poor dietary diversity is of major concern. A cross-sectional survey was conducted with mothers and caregivers from the KwaMashu Community Health Centre (CHAPTER 2) to determine the infant feeding practices of 6-11 month-old infants attending the well-baby clinic. One hundred and thirty-four interviews were completed with mothers/caregivers. 80.6% of infants were breastfed, with 63.5% of mothers/caregivers reporting breastfeeding initiation in the first hour after birth. Only 25.4% of mothers/caregivers reported exclusively breastfeeding to the age of 6 months. Almost a third of infants (30.6%) had started solid foods before 3 months of age. Cereals were the main first foods given, with 56.7% of caregivers preparing foods at home and 43.3% using commercial foods. At the time of data collection, 36.6% of the 6-11 month-old infants were breastfeeding, 47.0% were formula feeding and 16.4% received mixed feeding. Soft maize meal porridge and commercial infant cereals were the most popular foods consumed daily. Close to two-thirds of infants (64.9%) had at least one meat food group item and just over two-thirds of infants (68.7%) had eaten eggs in the previous 7 days. It is concerning that just over half of the infants (52.2%) were being given biscuits, two-thirds (66.4%) ate chips, and close to a third (32.8%) consumed sweets or chocolates. The information from the 134 interviews conducted provided the food consumption input for the model using Optifoods software (CHAPTER 3). The objective was to determine if the nutrient requirements of 6-11 month-old infants can be met with a food-based approach, as well as to identify the nutrients that are difficult to achieve adequate intakes of. The results from the modelling exercise revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc, and calcium were identified as the nutrients whose requirements are likely not to be met in the diet of these infants (nutrients of concern). The percentage RNI (Recommended Nutrient Intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the “No pattern” diet but iron and zinc intakes still remained below the RNI. According to the best diets modelled by Optifoods, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy and protein, as well as the desired nutrient intakes for 8 of the 11 micronutrients as long as breastfeeding on demand continues during the complementary feeding phase. In efforts to improve infant feeding practices, knowing what foods infants are currently consuming is important. However, it is equally important to understand why caregivers make certain complementary feeding choices and to identify what influences their behaviour when feeding infants in their care. Four focus group discussions with a total of 19 mothers were held at the KwaMashu Community Health Centre to try to understand some of the factors that affect the infant feeding decisions of mothers more clearly (CHAPTER 4). Mothers in KwaMashu seem to be aware which foods they should provide to their infants, but guidance to them on the frequency of feeding and the amount of food that should be fed to infants was absent. Despite being informed by the clinic and mothers knowing that 6 months was the correct age to introduce the baby to foods, they were uncertain about the age at which foods should be introduced. This matter regarding the age of food introduction is further complicated by the immense societal pressure, in particular from grandmothers in the household, to introduce foods earlier at a much younger age. There are many issues associated with the complementary feeding diets of infants that need attention. The findings of this study call into question the continued food-based focus that is used to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and the continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa. The availability of new tools in nutrition, such as Optifoods, heralds an exciting phase in research and efforts need to be prioritised to train more people to use them and to make these tools available globally. To continue focussing infant nutrition education exclusively on mothers may not be a productive approach. The findings of this study support the inclusion of grandmothers (who in many cases may be the primary caregiver of infants) in education efforts to improve infant feeding practices. Health facilities and provincial Departments of Health should review research findings from accredited research more systematically to make sure that they include these into their action plans. The South African government should consider an accessible repository dedicated to infant nutrition information. Infant feeding practices research requires active encouragement. It is essential for the dialogue between all stakeholders in the infant feeding field to continue with increased transparency and trust.Thesis (PhD (Nutrition))--University of Pretoria, 2020.The authors would like to thank the Department of Science and Technology (DST)/National Research Foundation (NRF) South African Research Chairs Initiative (SARChl) in the National Development Plan Priority Area of Nutrition and Food Security (Unique number: SARCI170808259212). Ms. Sayed is a PhD Nutrition student supported by the DST-NRF Centre of Excellence in Food Security. The grant holders acknowledge that opinions, findings and conclusions or recommendations expressed in any publication generated by NRF-supported research are those of the author(s), and that the NRF accepts no liability whatsoever in this regard. The grant holders acknowledge that opinions, findings and conclusions or recommendations expressed in any publication generated by NRF-supported research are those of the author(s), and that the NRF accepts no liability whatsoever in this regard.Animal and Wildlife SciencesPhD (Nutrition)Unrestricte

The use of linear programming to determine whether breastfed infants can achieve a nutritionally adequate complementary feeding diet: a case study of 6-11-month-old infants from KwaMashu, KwaZulu-Natal, South Africa

OBJECTIVES : The objectives of this study were to ascertain whether the nutrient requirements of 6–11-month-old infants can be met with a food-based approach, and to identify the nutrients of which it is difficult to achieve adequate intakes. DESIGN, SETTING AND SUBJECTSS : A cross-sectional survey and interviews with mothers and caregivers from the KwaMashu Community Health Centre were conducted. One hundred and thirty-four interviews were completed. This information provided the food consumption input for the model using Optifood software. RESULTS : The results revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc and calcium are nutrients whose requirements are likely not to be met in the diet. The percentage RNI (recommended nutrient intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the ‘No pattern’ diet but iron and zinc intakes remained below the RNI. According to the best diets modelled by Optifood, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy, protein, and 8 of the 11 micronutrients, as long as breastfeeding on demand continues during the complementary feeding phase. CONCLUSIONS : This study calls into question the continued food-based focus to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa.The first author was a PhD student and the second author the PhD supervisor. Her thesis "Complementary feeding practices and their influences" is archived at http://hdl.handle.net/2263/75995.The authors acknowledge funding from the Department of Science and Technology (DST)/National Research Foundation (NRF) South African Research Chairs Initiative (SARChI) in the National Development Plan Priority Area of Nutrition and Food Security (Unique number: SARCI170808259212). Ms Sayed’s PhD was supported by the DST-NRF Centre of Excellence in Food Security.The Department of Science and Technology (DST)/National Research Foundation (NRF) South African Research Chairs Initiative (SARChI) in the National Development Plan Priority Area of Nutrition and Food Security. Ms Sayed’s PhD was supported by the DST-NRF Centre of Excellence in Food Security.https://www.tandfonline.com/loi/ojcn20am2023Animal and Wildlife Science

A review of complementary feeding practices in South Africa

INTRODUCTION : Infant health and nutrition in South Africa are a priority, as evidenced by the political commitment and policy development history of the last 25 years. Current efforts focus on improving breastfeeding rates, but the action plan for complementary feeding receives less attention and resourcing. A thorough analysis of the current infant feeding situation is required to assist with policy and targeted programmes associated with complementary feeding. AIM : The aim of this review was to identify and collate all published research in South Africa on the complementary feeding practices of infants and young children, aged 0–24 months. METHODOLOGY : Searches included English-language research published between 2006 and 2017, within PubMed, Scopus, Web of Science and Google Scholar. All papers included in the review had to meet defined eligibility criteria. Papers older than 11 years were excluded. In total 34 papers relevant to South Africa were identified and included in this review. MAIN FINDINGS : Early introduction of foods and liquids other than breast milk is a common practice. Maize porridge is a common first food for infants, but there is also a high reliance on commercial infant cereal. Water and other liquids (e.g. tea, herbal mixtures) are commonly given to infants younger than six months. There is little information on the number of meals per day. The diets of many older infants do not meet the criteria for a minimally acceptable diet. Few animal source foods are used in complementary feeding. There are indications that processed meats, soft drinks, sweets and salty crisps are given regularly to older infants between six months and one year. CONCLUSION : Complementary feeding practices in South Africa are suboptimal and appropriate action is needed to improve this situation. Further investigation is needed on whether older infants and young children can achieve their required dietary intakes from the food that is available to them. If a change in older infant and young child feeding behaviour is desired, then existing methods and approaches need to change.The Department of Science and Technology (DST)/National Research Foundation (NRF) South African Research Chairs Initiative (SARChl) in the National Development Plan Priority Area of Nutrition and Food Security (Unique number: SARCI170808259212). Ms Sayed is a PhD Nutrition student supported by the DST-NRF Centre of Excellence in Food Security.https://www.tandfonline.com/loi/ojcn20am2019Animal and Wildlife Science