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- Volume 26, Issue 4, 2013
South African Journal of Clinical Nutrition - Volume 26, Issue 4, 2013
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Volume 26, Issue 4, 2013
Source: South African Journal of Clinical Nutrition 26 (2013)More Less
An academic scholarly journal cannot exist or excel these days in a printed-only format, based on the belief that everyone who has physically received the journal by post will cite articles from that edition for the duration of his or her academic career. The Internet has forever changed access to academic publications with various access and publishing models. It has also irrevocably altered the way in which we measure the importance of research and journals. In the past, librarians had to rely on basic "shelf statistics", by literally monitoring how many times journals had to be placed back on the shelves to obtain an indication of journal-level usage. This information played a critical role in determining which journals would be on that institution's subscription list. However, in the 1970s, the journal impact factor (JIF) was created by Thomson Reuters as a more accurate tool with which to assist librarians in the purchase of journals. Fundamentally, this index was never designed to measure the quality of scientific research. Despite its many deficiencies, this index is still widely used, at times obsessively, and is "abused" by authors and institutions to validate research output and importance.
Source: South African Journal of Clinical Nutrition 26, pp 166 –167 (2013)More Less
Despite some modest improvements described recently, anaemia remains a significant global public health concern affecting both developed and developing countries. It affects a quarter of the global population, including 293-million (47%) children who are younger than five years of age. A prevalence of 42% and 30% has been described in pregnant and non-pregnant women, respectively. Children and women of reproductive age are at high risk, partly because of physiological vulnerability, followed by the elderly. Africa and Asia are the most heavily affected regions, accounting for 85% of the absolute anaemia burden in high-risk groups. According to the World Health Organization global database on anaemia (1993-2005), this haematological disorder was considered to be a moderate public health problem at the time in South African preschool children, pregnant women and non-pregnant women of reproductive age.
Studies since 2005 on South African primary schoolchildren suggest lower anaemia prevalence in some regions : review articleSource: South African Journal of Clinical Nutrition 26, pp 168 –175 (2013)More Less
The objective of this study was to report on the iron status of South African primary schoolchildren, as reported in independent studies conducted since the last National Food Consumption Survey-Fortification Baseline (NFCS-FB) in 2005. Internet searches were conducted for cross-sectional and randomised controlled trials that reported on the iron status of South African primary schoolchildren, published after the NFCS-FB of 2005. Search engines that were used included Science Direct, Sabinet, PubMed, EBSCOhost (Academic Search Premier, Health Source and Medline) and Web of Knowledge. The search terms in different combinations were "South Africa", "children", "iron", "anaemia", "iron deficiency", "micronutrient", "malnutrition" and "nutritional status". Secondary analysis was carried out on the NFCS-FB data on children aged 7-9 years at provincial level. Outcome measures used were haemoglobin (Hb) and serum ferritin. The search identified four independent studies that were conducted in four different provinces: KwaZulu-Natal, North West, Western Cape and Northern Cape. All four were conducted in low socio-economic areas and selected children with poor iron status for intervention purposes. The studies reported an anaemia prevalence lower than that of the NFCS-FB: 11.5% vs. 14.4%, KwaZulu-Natal; 6.9% vs. 27%, North West; 17.2% vs. 18.8%, Western Cape; and 5.4% vs. 22.2%, Northern Cape. Serum ferritin was more difficult to interpret because different cut-off points were used. Anaemia prevalence, based on Hb concentration in primary schoolchildren, might have improved in some regions since the NFCS-FB. Regular national surveys are recommended to ensure that the iron status of South African primary schoolchildren is kept under surveillance.
Source: South African Journal of Clinical Nutrition 26, pp 176 –180 (2013)More Less
An ethical dilemma describes conflicting opinions by different members of the care team. This article focuses on AJ, a five-year-old child with cerebral palsy, who was born deaf and blind as a result of having contracted rubella in utero. The case is examined against Sokol's four-quadrant analysis of ethical issues, giving a framework designed to facilitate the systematic identification and analysis of clinical ethical problems. The issue is whether the medical team should have palliated AJ, or continued with invasive therapy and feeding. The conclusion is that paediatric palliative care is often difficult, but that the dietitian has a duty to contribute his or her knowledge to benefit the patient.
Glycaemic index of selected staple carbohydrate-rich foods commonly consumed in Botswana : original researchSource: South African Journal of Clinical Nutrition 26, pp 182 –187 (2013)More Less
Objectives : Data on the glycaemic index (GI) of foods commonly consumed in Botswana are lacking. The present study aimed to evaluate the GI of some of the staple carbohydrate-rich foods eaten in Botswana.
Design, setting and subjects : Fifty university student volunteers were divided into five groups. Members of each group consumed different test foods based on wheat, maize, sorghum, millet and morama beans to supply 50 g of available carbohydrate after 10-12 hours of overnight fasting. GI was determined using a standard method with white bread.
Outcome measures : The GI values were calculated after measuring blood glucose levels before and after ingestion at 0, 15, 30, 45, 60, 90 and 120 minutes.
Results : The results showed a clear variation in the GI values for the same food when consumed by different individuals. In addition, variations were observed in the GI values of test foods based on the same material. On average, wheat-based foods exhibited the highest GI values (103.1), followed by millet-based foods (95.3), sorghum-based foods (92.5), maize-based foods (9.1) and morama-based foods (86.4). Of the tested food, mapakiwa (wheat-based) had the highest GI (110.6) whereas roasted morama had the lowest GI (82.8).
Conclusion : These results could form the basis of dietary advice to consumers, and particularly patients with diabetes. Further studies are needed on more of the commonly consumed foods in Botswana.
Food intake and meal pattern of adolescents in school in Ila Orangun, south-west Nigeria : original researchSource: South African Journal of Clinical Nutrition 26, pp 188 –193 (2013)More Less
Objective : This study was designed to assess the food intake and describe the meal pattern of adolescents attending public secondary schools in Ila Orangun, south-west Nigeria.
Design : This was a cross-sectional descriptive study that used a pretested, interviewer-administered, semi-structured questionnaire to collect information on sociodemographic data. A food frequency questionnaire and 24-hour dietary recall was used to collect information on food intake and meal patterns.
Setting : The setting was Ila Orangun town, located in Osun State in south-west Nigeria.
Subjects : The sample (n = 302) comprised adolescents between the ages of 10 and 19 years, attending public schools.
Outcome measures : Socio-demographic characteristics, meal patterns, food intake and frequency of consumption were assessed. Descriptive statistics were used for analysis, and chi-square to test for any association between the variables.
Results : The daily energy intake was higher than that recommended in 66% of the adolescents, carbohydrate intake higher in 62%, and fat and protein intake lower in 51% and 42%, of the adolescents, respectively. Low iron intake was significantly higher in females than in males (p-value < 0.05). One third (38%) skipped breakfast, and while the majority consumed supper, most participants ate snacks instead of lunch. A large proportion consumed fruit and vegetables, as well as milk and milk products, infrequently. The proportion of females who missed breakfast was significantly higher than that of the males (p-value < 0.05).
Conclusion : A high daily energy intake was reported in the adolescents. There was inadequate consumption of calcium and iron. A flawed meal pattern was observed, characterised by skipping breakfast and replacing lunch with snacks. Consuming breakfast, improving fruit and vegetable intake, and eating animal sources of protein should be encouraged in adolescents, and especially in females. This could assist in preventing the development of diseases associated with an inadequate intake of nutritious food.
Food availability and accessibility in the local food distribution system of a low-income, urban community in Worcester, in the Western Cape province : original researchSource: South African Journal of Clinical Nutrition 26, pp 194 –200 (2013)More Less
Objectives : The objective was to understand the local food distribution system in Avian Park, with a focus on food availability and accessibility.
Study design : This was a quantitative food store survey that employed semi-structured interviews and focus group discussions.
Setting : The study was conducted in Avian Park, situated in the Breede Valley, in the Western Cape province.
Subjects : Thirteen spaza shops, three chain supermarkets, three street vendors, two butchers, two wholesalers, a community café and a small, independent supermarket randomly selected from the community were included. Food retail outlet managers and community residents were also included.
Outcome measures : The outcome measures were food prices, availability, and access and quality.
Results : The café stocked 56% of the surveyed food items, spaza shops 66% and the supermarket 69%. Spaza shops stocked sweetened products, basic staples and processed food. A variety of vegetables was available at the café and supermarket, with less variety in the spaza shops. Processed and staple food was most expensive in the spaza shops, while fruit and vegetables were generally cheaper. Food prices were below the national average in all of the food categories, except for bread, cereals, grains, sweets and sugar. Interviews with shop owners indicated that fruit and vegetables were not kept because of spoilage, space limitations, storage issues and lack of transport. Focus group discussions with residents indicated a need for fruit, vegetables and meat outlets within walking distance.
Conclusion : Community food prices were not the main factor inhibiting food accessibility, but rather variety and quality.
Changes in complementary feeding practices and nutrition status in returnee children aged 6-23 months in northern Uganda : original researchSource: South African Journal of Clinical Nutrition 26, pp 201 –211 (2013)More Less
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.
Nutritional management of acute pancreatitis in a human immunodeficiency virus-infected patient : SASPEN case studyAuthor N. OlivierSource: South African Journal of Clinical Nutrition 26, pp 212 –215 (2013)More Less
A 37-year-old male patient was referred from a local clinic with a one-day history of severe abdominal pain and difficulty breathing. In casualty, the patient reported pain in the right and left upper quadrant and the epigastrium, radiating to the back, accompanied by a retrosternal burning sensation. No nausea or vomiting was reported, but he had been constipated for the past three days. He was also known to have human immunodeficiency virus (HIV), and had been on highly active antiretroviral treatment (HAART) since 2008. On examination, the abdomen was distended, rigid and tender.