Doctoral Degrees (Dietetics And Human Nutrition)

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Assessment of mothers and preschool-age children's food and nutrition security status: a cross-sectional case study of North central zone, Nigeria.
(2023) Omachi, Bosede Alice.; Van Onselen, Annette.; Kolanisi, Unathi.
Child and maternal nutrition are essential to any country's food and nutrition security, encompassing all the components of maternal and child growth, well-being, development, and productivity, as contained in the modified UNICEF 2020 conceptual framework on determinants of maternal and child nutrition. According to the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), preschool children are regarded as being between 3 and 5 years old. This period entails intensive cognitive development in children, where developmental milestones that help shape their personality, interpersonal relationships, and thinking patterns are fostered; hence, the need to consume healthy meals following the recommended minimum dietary diversity requirements of at least five to eight food groups per day for children is a bedrock for positive health outcomes. The prevalence of nutrition-related maternal and child morbidity has continued to increase in recent times across many low- and middle-income countries (LMICs) owing to several complex multifactorial and interrelated determinants. The complexity and interconnectedness of the determinants of maternal and child nutrition in developing countries, such as Nigeria, are yet to be well conceptualised and have become a public health issue due to the emerging triple burden of malnutrition (TBM) and the prevalence of diet-related non-communicable diseases ravaging the nation. Therefore, this study assessed the food and nutrition security status of mothers and their preschoolers in North Central Nigeria. A cross-sectional descriptive design and a multi-stage sampling technique were used to recruit 450 mother-child pairs (preschool children aged 3-5 years) across the North South senatorial district in Niger State, North Central Nigeria. Sociodemographic information and biodata of mothers and their preschoolers were collected using semi-structured questionnaires. Feeding patterns of mother-child pairs were assessed using a qualitative food frequency questionnaire based on 24-hour and 7-day dietary recall. The dietary diversity of households, mothers, and children was assessed using the Household Dietary Diversity Score (HDDS), Minimum Dietary Diversity Score for Children (MDD_C), and Minimum Dietary Diversity Score for women of reproductive age (MDD_W), respectively, as recommended by the Food and Agriculture Organization (FAO), Family Health International (FHI) and World Health Organization (WHO). The Household Food Insecurity Access Scale (HFIAS) was used to assess the food insecurity status of the participants. Anthropometric indices of the preschoolers were assessed based on weight-for-age, height-for-age, and weight-for-height indicators, while maternal anthropometry was assessed using body mass index (BMI) and waist/hip ratio. Maternal nutrition knowledge was assessed using a Likert-type scale. Retrieved information was analysed using SPSS version 28. Descriptive statistics are presented in tables and charts, while regression models were used for inferential statistics, with statistical significance being considered at a 95% confidence interval with a p-value of < 0.05. The study was conducted in two phases: the first phase considered an in-depth narrative literature review that evaluated the food and nutrition security status of preschool children in North Central, Nigeria, as well as the food insecurity and vulnerability of the food environment among Nigerian mothers. This study explored the literature using a qualitative approach and an overview of online sources, peer-reviewed articles, books, and other publications and relevant reports from official websites to investigate the concept of the food environment, food acquisition and utilisation complexities among Nigerian women, and the prevalence of food and nutrition insecurity and its determinants among preschool children. This review found that the global prevalence of the Triple Burden of Malnutrition (TBM) is alarming, especially among developing nations, affecting more women than men. Food acquisition and utilisation are important determinants of women’s food and nutritional security status. Full but empty plates have continued to be a dilemma among women from countries undergoing urbanisation and nutrition transitioning; hence, poor nutrient intake has been reported to account for the high risk of maternal morbidity and mortality related to nutritional causes in most developing countries, such as Nigeria. This revealed that the interconnectedness of the food environment to food acquisition and utilisation in addressing food insecurity and malnutrition as an innovative concept is yet to be well understood and explored in many studies across Nigeria. It also elucidates the drivers of poor dietary diversity, meal quality, and food consumption patterns among preschool children and possible health outcomes of compromised feeding patterns and the risk of non-communicable diseases and malnutrition among the study participants. In addition, the review also focused on the drivers of the food environment, food acquisition, nutrient utilisation, and the prevalence of TBM among women across the six geopolitical zones in the country. The high prevalence of malnutrition and diet-related noncommunicable diseases in this study accounts for the high maternal and child morbidity and mortality rates, especially in many rural and poor households across the nation, thus becoming a significant public health concern. Some factors found to significantly impact food utilisation among women were food literacy, poverty, insurgence, lack of support systems, seasonality, and family size. To mitigate these challenges, efforts should be geared towards improving both the community and consumer food environments, thus ensuring the consumption of nutrientdense meals for optimal health outcomes and well-being, especially among women and preschool children living in rural areas, urban slums, and low-income households across the six geopolitical zones of the nation and among other developing nations experiencing food and nutrition insecurity around the world. The second phase was the experimental section and was divided into two parts: the first part explored the socioeconomic status, household food security status using the HFIAS and the feeding patterns of the preschool children using the qualitative 24 hour and 7-day dietary recall. Dietary diversity was assessed using the MDD_C, while the anthropometric indicators for under-five children were used to categorise the children into stunting, wasting, underweight, and normal weight. The results showed that the majority (76.4%) of the preschool children were from rural communities; more than half (51.8%) of the children were from mothers who had only Islamic education (no formal education), and only a few (1.2%) of the children were born to single mothers. Almost all (95.6%) of the children were from Islamic religious homes, and the majority (71.6%) of the mothers were unemployed, while 83.8% of the monthly household income was below N18,000 ($40), which is far below the national minimum income range of N36,000. Most (73.6%) of the children were from male-headed households. The predominant ethnic group was Nupe (68.4%), whereas the least dominant was Gwari (<1%). Most (98.8%) of the preschool children were from food-insecure households, and almost half (42.4% and 40.2%) of the preschool children were either moderately food insecure or severely food insecure, respectively. The severity of food insecurity increased with parity, and its prevalence was higher among children from multiparous and grand multiparous households. The most consumed food group among preschoolers was cereal-based food products, while the least consumed food groups were fruits and vegetables. This study also showed that over half (60.0%) of the preschoolers did not meet the minimum dietary diversity score (MDD_C) recommended for their age. The anthropometric indices of the preschool children showed that half (50.0%) of the children were stunted (height-for-age), 21.0% had wasting (weight-forheight), and 29.0% were underweight (22.2% were severely underweight) (weight-for-age). The logistic regression model showed that the socioeconomic status of mothers, such as education, income, religion, occupation, employment status, means of waste disposal, source of potable water (water suitable for human consumption), and water treatment methods, were associated with the household food insecurity status of the children and were associated with inadequacy in children’s MDD (p < 0.05). The second part of the experiment explored the contribution of maternal nutrition literacy to the nutritional status of mothers in Niger State, North Central Nigeria. The results showed that the majority (63.8%) of the mothers were between 26 and 35 years old. More than half (51.6%) of the mothers did not know what a balanced diet was based on the definitions provided in the questionnaire. Social media or online information was the most explored source of nutritional information among mothers (36.4 %). Fifty-four per cent of the mothers indicated that their nutrition literacy had no positive impact on their dietary quality. The food consumption pattern showed that fruits/vegetables, and dairy products were the least consumed food groups among the mothers (7.1% and 9.1%, respectively). More than half (57.6%) of the mothers were within the normal BMI range, and the mean waist/hip ratio was 0.82 ± 0.08. The regression model showed that place of residence, occupation, source of potable water, and method of waste disposal were significantly associated with adequacy of maternal minimum dietary diversity. Although nutrition knowledge has been reported to influence dietary quality among mothers, this study showed that other intrinsic factors besides nutrition knowledge significantly impacted the dietary quality and nutritional status of mothers in the study area. Therefore, to optimise health outcomes among mothers, stakeholders at all levels must implement programs and policies that address issues such as insurgence, inflation, climate change, disparity in wealth distribution, and seasonal vulnerability. In conclusion, the prevalence of food and nutrition insecurity was high among the participants due to poor socioeconomic status and poor food environment, thereby compromising the meal quality and consumption frequency of mothers and their preschoolers. Most mothers adopted the consumption of ultra-processed foods and beverages as coping strategies to salvage the impact of hunger and starvation, thereby predisposing them to the risk of TBM and NCDs among mothers and their preschool children. To mitigate these challenges, efforts should be geared towards addressing the determinants of food and nutrition insecurity with a multidimensional approach at the grassroots level and involving all stakeholders and policymakers, to enable a sustainable food system through nutrition-sensitive agriculture at the household and community level. Draught resistant and improved variety crops should be used to mitigate climate change impact on food access and affordability and thus, enhance adequate consumption of nutrient-dense meals for optimal health outcomes among the participants and across most food insecure developing nations. IQOQA Ukudla kwezingane nomama kuyisibikezelo sanoma yisiphi isimo sokungavikeleki kokudla ezweni, ifood and nutrition insecurity status (FNIS). Ukuvela komthwalo ophindwe kathathu wokungondleki, itriple burden of malnutrition (TBM); ukusabalala kwezifo ezingatheleleki ezihlobene nokudla kanye nokufa phakathi kwabesimame nezingane zasenkulisa eNigeria kuyinto ekhathaza kakhulu impilo yomphakathi. Lolu cwaningo luhlole isimo sokuphepha kokudla nokudla kwabesimame nezingane zasenkulisa eNorth Central Nigeria. Kwasetshenziswa inqubo yokusampula yezigaba eziningi ukuqasha amabhangqa anga-450 omama nezingane kulo lonke elaseNiger State, eNigeria. Imibuzo ehlelekile kanye nezingxoxo zeqembu lokugxila zasetshenziselwa ukubuyisa ulwazi ngesociodemographic, ibiodata, iphethini yokudla, ukudla kwasendlini isimo sokuphepha, ulwazi lokudla kwabesimame, ukuhlukahluka okuncane kokudla, kanye nezinkomba ze-anthropometric zabomama / abanakekeli kanye nezingane zabo zasenkulisa. Imininingwane eyatholakala yahlaziywa ngokusebenzisa i-SPSS version 28, futhi ukubaluleka kwezibalo kwabekwa kumaphesenti angama-95 kwesikhawu sokuzethemba kanye ne-p-value < 0.05. Lolu cwaningo luveze ukuthi amaphesenti angama-76.4 womama nezingane zabo zasenkulisa bavela emiphakathini yasemaphandleni, kanti amaphesenti angama-83.8% emali abayithola emakhaya ngenyanga ingaphansi kuka-N18 000 ($40). Iningi (98.8%) labahlanganyeli babevela emakhaya angenakudla, futhi cishe isigamu (42.4% no-40.2%) sasinokudla ngokulinganisela okungaphephile noma okungaphephile kakhulu, ngokulandelana. Amaphesenti angamashumi ayisithupha (60.0%) ezinganeni zasenkulisa azizange zihlangabezane nokuhlukahluka okuncane kokudla (MDD_C). Iphethini yokusetshenziswa kokudla kwabahlanganyeli yabonisa ukuthi izithelo / imifino (7.1%) kanye nemikhiqizo yobisi (9.1%) kwakungamaqembu okudla angadliwa kakhulu, kanti ukudla okunesitashi (53.1%) kwakuyikona okungamaqembu okudla okudliwayo. Iningi lomama (57.6%) babengaphakathi kwebanga elijwayelekile le-BMI, kanti amaphesenti angama-50.0 ezingane zaphazamiseka. Amaphesenti angamashumi amahlanu nane (54%) omama babenolwazi oluphansi lokudla okunomsoco. Kwakukhona ukuhlangana okuqinile phakathi kwesimo sezenhlalo nezomnotho somama / abanakekeli kanye nesimo sokungavikeleki kokudla kwasendlini, izinkomba ze-anthropometric kanye nokwanela kwe-MDD yabahlanganyeli (p < 0.05). Ngakho-ke, kumele kuhlolwe izindlela eziningi zokubhekana nesimo sokungavikeleki kokudla nokudla phakathi kwalaba bantu abasengozini.
The potential of provitamin A-biofortified maize and sweet potato, and bambara groundnut for improving the nutritional status of rural communities in KwaZulu-Natal, South Africa.
(2020) Govender, Laurencia.; Pillay, Kirthee.; Siwela, Muthulisi.
The double burden of malnutrition, under- and over-nutrition, is a serious health problem and a leading contributor to the global disease burden. Undernutrition presents as wasting, stunting, underweight and micronutrient deficiencies, such as vitamin A, iron and zinc, while over-nutrition presents as overweight, obesity and several non-communicable diseases. Children under the age of five years and pregnant women are the most affected by malnutrition, especially in rural areas. In developing countries, such as South Africa (SA), the major contributing factors to all forms of malnutrition are poverty, food and nutrition insecurity as well as the shift from traditional diets to more westernised diets. There have been several strategies employed in SA to alleviate malnutrition, especially vitamin A deficiency (VAD), yet it still remains a problem. Provitamin A (PVA)-biofortified crops could be used as a complementary strategy to address VAD; however, there are challenges of poor consumer acceptability. The poor acceptability of PVA-biofortified foods could be improved by combining them with other commonly consumed plant food items and animal food sources such as chicken to produce provitamin A-rich traditional dishes. However, animal food products can be unaffordable to many economically disadvantaged households, thus legumes could be used as an alternative and cheaper protein source. Bambara groundnut is an underutilised indigenous legume that is found in sub-Saharan Africa (SSA). It is a good source of protein and when consumed together with cooked starch-based products, it forms a complementary protein. Therefore, combining PVA-biofortified maize with bambara groundnut could contribute to improving the nutritional status of vulnerable population groups in SSA, including SA. Cream-fleshed sweet potato (CFSP) (Ipomoea batata L.) is a commonly consumed crop in SA and would be ideal for PVA-biofortification to produce orange-fleshed sweet potato (OFSP). Unlike PVA-biofortified maize that showed poor consumer acceptability, OFSP has been found acceptable to consumers. The OFSP has a high PVA carotenoid concentration, therefore it could be used as a food-based approach to address VAD among the economically disadvantaged population groups who are usually at risk of VAD, particularly rural communities. Research conducted on the nutritional composition and consumer acceptability of composite dishes made with PVA-biofortified maize and OFSP is limited, especially in SA. Furthermore, there is paucity of literature on the nutritional composition and consumer acceptance of bambara groundnut combined with cooked PVA-biofortified maize. Thus, this study investigated the potential of PVA-biofortified maize and sweet potato, and bambara groundnut for improving the nutritional status of rural communities in KwaZulu-Natal (KZN), SA. In order to formulate an effective food-based approach to address malnutrition, the nutritional status and dietary patterns of the target population group/s (communities) needed to be determined. Thus, the first study objective was to assess the nutritional status, using selected anthropometric indices and dietary intake methods, of four rural communities in KZN, who had been selected for investigating the proposed food-based nutrition approach. Purposive sampling generated a sample of 50 households each in four rural areas of KZN: Swayimane, Tugela Ferry and Umbumbulu and 21 households at Fountain Hill Estate. Anthropometric [height, weight, mid-upper arm circumference (MUAC), and waist circumference] and dietary intake data (repeated 24-hour recall and food frequency) were collected. The Food Finder 3 software of the Medical Research Council (MRC), SA, was used to analyse dietary intake data, and the Statistical Package for Social Sciences (SPSS, version 25) was used to analyse the other data sets. The Estimated Average Requirement (EAR) cut-point method was used to assess the prevalence of inadequate nutrient intake. The results of the study indicated that 17.9 % (n=7), 30.8% (n=12) and 15.5% (n=6) of the children under five years were underweight, stunted and overweight, respectively. According to the MUAC measurements, 20.5% (n=8) and 5.1% (n=2) of the children under five years had severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively. The Fisher’s Exact test showed that a significant proportion (37.5%; n=3) of those with a MUAC below 11.5 cm had a weight-for-height (WFH) Z-score below -3 standard deviation (SD) of the WHO child growth standards median, indicating severe malnutrition (p=0.046). The majority of the adult participants were either overweight (23.6%; n=76) or obese (29.5%; n=95), with a higher prevalence of overweight and obesity among females than males. According to the Binomial test, a significant number (67.0%; n=213) of adult participants had waist circumference measurements below 88 cm and 102 cm for females and males, respectively (p<0.05). The Chi-square test indicated that there was a significant relationship between gender and waist circumference (p<0.05). A significant proportion of adult males (92.9%; n=105) had a normal waist circumference and were not at risk of obesity-related diseases, whilst a significant proportion (p<0.05) of adult females (47.3%; n=97) were at risk of obesity-related diseases, such as diabetes, high cholesterol and hypertension. Adult participants that were underweight or had a normal body mass index (BMI) were not at risk of co-morbidities and obesity, whilst participants who were classified as obese class I, II and III had a high risk of co-morbidities (p<0.05). Although not statistically significantly different, there was a higher prevalence of over-nutrition than undernutrition at all four research sites for females aged 16-35 years old. There was a significant relationship between BMI and the risk of having a clinically undesirable waist circumference (p<0.05). There was frequent consumption of food items high in carbohydrates (mainly the cereal grain foods), and low intake of micronutrients and fibre by most age groups. The food frequency results indicated that onion, phutu, brown bread, tomato, rice, apple, eggs and chicken were the most commonly consumed food items. Results of analysis by the EAR-cut point method indicated that, among most of the age groups, there was a high prevalence of inadequate intake of several nutrients, including dietary fibre, vitamins, including vitamin A and minerals, including zinc and iron. The second study objective was to determine the effect of replacing white maize and CFSP with PVA-biofortified maize and OFSP, respectively, on the nutritional composition of traditional and indigenous dishes of KZN, SA. The phutu combinations were selected based on a survey conducted in four selected rural study sites in KZN to determine popular dishes in which maize was combined with other food items. Popular indigenous knowledge systems (IKS)-based recipes were collected to determine methods of preparing and processing white maize and CFSP into food products. Phutu (traditional crumbly porridge) was selected as the cooked maize meal dish, curried cabbage as a vegetarian dish and curried chicken as a meat dish. Curried bambara groundnut was selected as an alternative animal protein source. Grains of one PVA-biofortified maize variety and one white variety (control) was cooked into phutu. Both varieties of phutu were served with either curried cabbage, chicken or bambara groundnut. Two types of boiled sweet potato were used in the study; OFSP and CFSP (control). Composite dishes were prepared by combining either PVA-biofortified phutu or white phutu with other food items, separately, i.e. curried cabbage, curried chicken and curried bambara groundnut and the nutritional composition of the dishes were analysed. Generally, the proximate composition of the PVA-biofortified phutu composite dishes were not significantly different from those of white phutu composite dishes (controls) (p>0.05). However, the PVA concentration of PVA-biofortified phutu composite dishes was higher than that of the white phutu composite dishes (controls). The OFSP had a significantly lower protein concentration, but was significantly higher in other nutrients, including PVA relative to the CFSP (p<0.05). The third investigation determined the effect of replacing white maize and CFSP with PVA-biofortified maize and OFSP, respectively, on the sensory properties and consumer acceptance of traditional and indigenous dishes of KZN, SA. The sensory acceptability of the composite dishes and sweet potatoes was evaluated by 60 participants each from the two rural areas (Swayimane and Umbumbulu), using a five-point facial hedonic scale and a paired preference test. Focus group discussions (FGDs) were conducted with 56 participants recruited from the consumer panel to assess consumer perceptions about the composite dishes made with PVA-biofortified phutu and OFSP. The majority of the participants rated the composite dishes containing PVA-biofortified phutu as “good” and the acceptability of the composite dishes varied significantly (p<0.05). Compared to other age groups, the 50-59 year age group showed a higher preference for the white phutu and curried chicken composite dish, whereas the 30-39 year age group showed a higher preference for the PVA-biofortified phutu and curried chicken composite dish. The acceptability of OFSP and CFSP was similar. The FGDs indicated that participants had positive perceptions of the PVA-biofortified phutu when served with curried chicken or cabbage. However, they had mixed perceptions when served with curried bambara groundnut. The older FGD participants perceived that some of the composite dishes, such as phutu and curried bambara groundnut, would not be acceptable to younger consumers as they were not accustomed to bambara groundnut, especially its sensory attributes such as taste, texture and aroma. There were positive responses to the proposal to replace the CFSP with OFSP. Most of the FGD participants perceived the OFSP to be butternut due to its orange colour, sweet taste and visual appeal. The FGD participants expressed a willingness to grow and purchase the PVA-biofortified maize and PVA-biofortified OFSP, if planting materials were made available or if the two types of biofortified crops were available in the local markets for utilisation as staple foods. The study findings show that under- and over-nutrition, and poor dietary diversity are prevalent in rural KZN. There was a low intake of several nutrients, including dietary fibre and several micronutrients. The study findings indicate that there is a need to increase the availability, accessibility, and utilisation of diverse foods through appropriate agricultural and nutritional interventions. Biofortification could be used as a complementary strategy to assist with the alleviation of VAD in SSA. Although, in several studies, PVA-biofortified foods have been found less acceptable compared to counterpart white maize foods, the PVA-biofortified foods investigated in this study were perceived positively by most of the participants. Overall, the study findings suggest that PVA-biofortified maize and OFSP can replace white maize and CFSP, respectively, in selected traditional dishes of the rural communities studied, to alleviate VAD. Further research should be conducted using a larger sample size, larger area and with different PVA-biofortified maize food types and varieties of OFSP, to obtain results for large rural populations in all provinces of SA.

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Browsing Doctoral Degrees (Dietetics And Human Nutrition) by Subject "Food and nutrition security."