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- Volume 28, Issue 3, 2015
South African Journal of Clinical Nutrition - Volume 28, Issue 3, 2015
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Volume 28, Issue 3, 2015
Author Demetre LabadariosSource: South African Journal of Clinical Nutrition 28 (2015)More Less
Author Lisanne Du PlessisSource: South African Journal of Clinical Nutrition 28, pp 103 –104 (2015)More Less
The global recommendation on the early initiation of breastfeeding, exclusive breastfeeding (EBF) for six months, and continued breastfeeding for up to two years of age and beyond, remains uncontested. However, the translation of this recommendation into successful practice continues to fall short.
Author A. PrinsSource: South African Journal of Clinical Nutrition 28, pp 105 –115 (2015)More Less
A central venous incident (CVI) is the second leading cause of death worldwide, and is associated with permanent disabilities.There are many nutrition and lifestyle modifiable risk factors for a CVI. These include diabetes, and hypercholesterolaemia and hypertension, all of which are largely preventable, and involve effective, low-cost treatment. Malnutrition in CVI patients ranges from 6-62%, and often worsens during hospitalisation owing to multiple factors, including dysphagia, the inadequate intake of food, inactivity and metabolic changes in the clinical setting. When malnutrition is present in patients who have an acute CVI, the increased risk of poor functional outcomes relates to complications such as gastrointestinal bleeding, pressure ulcers, and urinary tract and respiratory infections. These are associated with higher mortality and increased length of stay in hospital, and contribute to decreased quality of life and impaired rehabilitative outcomes. Screening and nutritional assessment is vital on admission. The Mini Nutritional Assessment and Patient-Generated Subjective Global Assessment have been validated in this patient population. The energy and protein requirements of stroke patients are poorly defined. There is some evidence for the supplementation of antioxidants, but the efficacy thereof depends on their ability to cross the blood-brain-barrier. Large-scale studies are necessary to assess the effect on neurocognitive recovery. Meeting requirements in this patient population is a challenge because of dysphagia, as well as neurological and cognitive deficiencies, and is best achieved with the support of a multidisciplinary team. Early enteral nutrition improves survival, while oral nutrition supplements improve nutrient intake and quality of life.
The effect of a combination of nutrition education, soy and vegetable gardening, and food preparation skill training interventions on dietary intake and diversity in women : a case study from Qwa-Qwa : original researchSource: South African Journal of Clinical Nutrition 28, pp 113 –120 (2015)More Less
Objective: The objective of the study was to determine if an integrated food and nutrition intervention, including home gardening, nutrition education and recipe development and training, would improve dietary diversity in women.
Design: This was a single-system case study.
Setting: The study setting was peri-urban Qwa-Qwa, Free State province, South Africa.
Subjects: Fifty randomly selected women were included in the study from three purposively selected tribes.
Outcome measures: Three 24-hour recall questionnaires were used to determine dietary intake and nutrient adequacy, a dietary diversity questionnaire to calculate the dietary diversity scores (DDSs), and the Radimer-Cornell Hunger Scale questionnaire to ascertain food insecurity.
Results: The median food variety score (FVS) was 23 at baseline, and improved significantly (p-value 0.002) to 29 at follow-up. Micronutrient intake was consistently low, despite the median adequacy ratio (MAR) improving significantly (p-value 0.002) from 0.49 to 0.63 at follow-up.Despite a significantly improved MAR at follow-up, the nutrient adequacy ratio (NAR) for only three nutrients met 100% at follow-up, namely dietary iron, phosphate and vitamin B3. A strong significant positive correlation existed between FVS and the food group diversity score(r = 0.617, p-value 0.000). The FVS and DDS were higher in the food-secure group (n = 16, 32%) than in the food-insecure group (n = 34, 68%), but not significantly. Although most food groups were consumed by the women, limited foods from each group were included.
Conclusion: Women in this resource-poor community lacked a variety of food in their diet, despite a high overall DDS. Thus, they had inadequate micronutrient intake and adequacy. A combination of nutrition education, soy and vegetable gardening, and food preparation skill training interventions, seemed to positively influence the nutrient adequacy and overall dietary diversity of the women participating in this study.
Comparison of infant-feeding practices in two health subdistricts with different baby-friendly status in Mpumalanga province : original researchSource: South African Journal of Clinical Nutrition 28, pp 121 –127 (2015)More Less
Objectives: The objective of the study was to compare the infant-feeding practices of two subdistricts with different baby-friendly status in Mpumalanga province, South Africa.
Design: This was a cross-sectional, descriptive, observational study with an analytical component. Eighteen fieldworkers assisted with the data collection, utilising two sets of interviewer-administered questionnaires - one on socio-demographic information and the other on infant feeding practices.
Subjects: Mothers with infants from birth to six months old, attending postnatal care at public sector primary health care facilities in Emalahleni and Mbombela health subdistricts on the days of data collection were included. A total of 435 mother and infant pairs were included in the study.
Outcome measures: Five infant-feeding indicators were used, namely the early initiation of breastfeeding, exclusive breastfeeding, exclusive replacement feeding and mixed feeding rates, as well as the age at which complementary food was introduced.
Results: There was a significantly higher early initiation of breastfeeding (57% vs. 43%), exclusive breastfeeding rates (60% vs 48%), and a lower exclusive replacement feeding rate (18% vs. 33%) in Emalahleni subdistrict, where all the public sector maternity facilities are accredited as being baby friendly, compared to that in Mbombela subdistrict, where none of the public sector maternity facilities are baby friendly. The mixed feeding rate (19% vs. 15%) and the mean age of the introduction of complementary foods (50 days versus 35 days) did not differ significantly between the two subdistricts.
Conclusion: Implementation of the Baby-Friendly Hospital Initiative (BFHI) in a health subdistrict was associated with more optimal infant feeding practices in mothers with infants aged six months and younger. It is concluded that strengthening practices prescribed within the BFHI would improve infant-feeding practices at community level.
Application of the deuterium-oxide dose-to-mother technique to determine the exclusivity of breastfeeding in women in Kanye, Botswana : original researchSource: South African Journal of Clinical Nutrition 28, pp 128 –133 (2015)More Less
Objective: The objective of the study was to determine breastfeeding exclusivity and impact on the nutritional status of mothers and infants.
Design: This was an observational descriptive study.
Setting: The setting was government clinics in Kanye, Botswana.
Subjects: Women who gave birth to singleton healthy babies participated in the study.
Method: Milk intake and breastfeeding exclusivity were determined by the deuterium-oxide dose-to-mother technique. Nutritional status was assessed using anthropometric measures (height and weight) in 56 mother-infant pairs at six weeks, and again at three and six months postpartum.
Results: Mothers overestimated exclusive breastfeeding rates at all of the time points. However, according to the deuterium-oxide dose-to mother technique, at three months 61% of the mothers were exclusively breastfeeding, 13% were predominantly breastfeeding, and 27% were partially breastfeeding. At six months, none of the mothers were exclusively breastfeeding. The mean body mass index (BMI) and the percentage of body fat of the mothers in all of the groups were within the healthy range of 23.9 kg/m2 and 28.3%, respectively, at six months.Mean infant weight was 6.1 ± 0.95 kg, 7.6 ± 1.28 kg and 8.4 ± 1.22 kg at three, six and nine months, respectively. Infant under nutrition based on weight for age was < - 2 standard deviation. Malnutrition was 5.2% and 1.7% at six weeks and six months, respectively.
Conclusion: Contrary to reported high rates of breastfeeding in Botswana, low rates of exclusive breastfeeding were observed with the deuterium oxide dose-to-mother technique. Therefore, this technique can be applied as a reliable method of validating mothers' reports and their recall of exclusive breastfeeding practices. In future, the application of this method would be helpful to identify challenges in infant feeding practices, policies and programmes, all of which need further prioritisation within the Botswana context.
Constraints to the optimal breastfeeding practices of breastfeeding mothers in the rural communities of Arba Minch Zuria Woreda, Ethiopia : a community-based, cross-sectional study : original researchSource: South African Journal of Clinical Nutrition 28, pp 134 –139 (2015)More Less
Objective: The aim of this study was to identify the constraints and factors associated with breastfeeding practices.
Design: This was a community-based, cross-sectional study.
Subjects and setting: Three hundred and eighty-four breastfeeding mothers of infants aged two years and younger were randomly selected from rural communities in Arba Minch Zuria Woreda.
Outcome measures: Data were collected using structured questionnaires, and from using an observation checklist and in-depth interviews.Quantitative data from binary logistic regression were used to determine the strength of association between the independent and dependent variables using odds ratios and 95% confidence intervals. Multivariate logistic regression analysis was employed to identify predictors of the delayed initiation of breastfeeding and non-exclusive breastfeeding practices.
Results: Breastfeeding is considered to be a natural gift from God in Arba Minch Zuria Woreda. The delayed initiation thereof was common in this study. Only 57% of the mothers initiated breastfeeding within an hour of delivery. Some women rejected their colostrum as they considered it to be an expired substance capable of causing abdominal pain to their infants. The delayed initiation of breastfeeding was positively associated with a lack of education and failure to attend health education sessions. Thirty-one per cent of the mothers did not exclusively breastfeed their infant up to six months of age months. Non-exclusive breastfeeding was significantly associated with having a radio, attending antenatal care and attending health education.
Conclusion: The promotion of strong community-based networks to ensure optimal infant and young child feeding is recommended through both governmental and non-governmental organisations.
Source: South African Journal of Clinical Nutrition 28, pp 140 –045 (2015)More Less
The following case study was discussed during the fourth-year dietetics evaluation process at North-West University, Potchefstroom Campus. It is a reflection of the opinion of the dietitians, students and lecturers involved, describes the actions taken during the nutritional management of the case, and is based on current literature and guidelines relevant to the topic.
Source: South African Journal of Clinical Nutrition 28 (2015)More Less
SASPEN participated in the world's second Dietitian's week held from 8 - 12 June 2015 in collaboration with the British Dietetic Association (BDA). SASPEN participated with the theme, "Feeding those who cannot feed themselves." During dietitian's week SASPEN posted daily resources and case studies aimed at the therapeutic dietitian involved in critical care and artificial nutrition support. SASPEN would like to thank everyone for their participation on our various media platforms and the enthusiasm for the profession! We look forward to participating in this great initiative in years to come.