Waist circumference percentiles of black South African children aged 10 - 14 years from different study sites

Background. Waist circumference (WC) is a useful predictor of cardiometabolic risk in children. Published data on WC percentiles of children from African countries are limited.Objectives. To describe age- and sex-specific Wpercentiles in black South African (SA) children from different study sites, and compare these percentiles with median WCpercentiles of African-American (AA) children.Methods. Secondary data on WC for 10 - 14-year-old black SA children (N=4 954; 2 406 boys and 2 548 girls) were extracted from the data sets of six studies. Smoothed WC percentile curves for boys and girls were constructed using the LMS method. The 50th percentile for age- and sex-specific WC measurements was compared across study sites and with AA counterparts.Results. Girls had higher WC values than boys from the 50th to 95th percentiles at all ages. The 50th WC percentiles of all groups of SA children combined were lower than those of AA children. When SA groups were considered separately, Western Cape children had median WC values similar to AA children, while rural Limpopo children had the lowest WC values. The 95th percentiles for Western Cape girls exceeded the adult cutoff point for metabolic syndrome (WC ≥80 cm) from age 11years.Conclusions. The differences in WC values for 10 - 14-year-old children across the six study sites highlight the need for nationally representative data to develop age-, sex- and ethnic-specific WC percentiles for black SA children. The results raise concerns about high WC among Western Cape girls

Community-Based Agricultural Interventions in the Context of Food and Nutrition Security in South Africa

Despite South Africa being a food-secure country in terms of aggregate food availability; it is listed by the World Health Organization as one of 36 high-burden countries; home to large numbers of stunted children. Recent findings; in the context of both over- and under-nutrition; have indicated that adult and child malnutrition rates have deteriorated in South Africa. The complementarities and synergies between food availability; access and utilisation need to be aligned in interventions used to address and strengthen food and nutrition security. This is particularly pertinent in the context of the widespread AIDS epidemic which interacts with food insecurity in complex ways. It is against this backdrop that home-grown or small-scale food production is explored as a feasible contributor to food and nutrition security for the rural poor with particular emphasis on contextual and technical factors. By illustrating a few successful models of home gardening;the evidence for addressing micronutrient deficiencies in these types of interventions is presented. The challenges to establish sustainable home gardening practices and the efforts needed to address gender-distinctive issues are discussed. The case is made for community-based agricultural interventions as a critical component of the various interventions used to address food and nutrition security at the household level

Primary Health Care Facility Infrastructure and Services and The Nutritional Status of Children 0 to 71 Months Old and Their Caregivers Attending These Facilities in Four Rural Districts in The Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objective: To assess primary health care (PHC) facility infrastructure and services; and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Design: Cross-sectional survey. Setting: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). Subjects: PHC facilities and nurses (EC: n = 20; KZN: n = 20); and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). Methods: Structured interviewer-administered questionnaires and anthropometric survey. Results: Of the 40 PHC facilities; 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20; KZN: 25); electricity (EC: 45; KZN: 85); flush toilets (EC: 40; KZN: 75); and operational telephones (EC: 20; KZN: 5). According to more than 80of the nurses; problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41; KZN: 25). Social grants were reported as a main source of income (EC: 33; KZN: 28). Few households reported that they had enough food at all times (EC: 15; KZN: 7). The reported prevalence of diarrhoea was high (EC: 34; KZN: 38). Undernutrition in 0 to younger than 6 month-olds was low; thereafter; however; stunting in children aged 6 to 59 months (EC: 22; KZN: 24) and 60 to 71 months (EC: 26; KZN: 31) was medium to high. Overweight and obese adults (EC: 49; KZN: 42) coexisted. Conclusion: Problems regarding infrastructure; basic resources and services adversely affected PHC service delivery and the well-being of rural people; and therefore need urgent attention

Adverse Social; Nutrition and Health Conditions in Rural Districts of Kwazulu-Natal and the Eastern Cape Provinces; South Africa

Objective: This study determined the socio-demographic; nutritional and health status of children and their caregivers in two rural districts in KwaZulu-Natal (KZN) and one rural district in the Eastern Cape (EC); South Africa. Design: A cross-sectional survey was conducted. Setting: The study population resided in Umkhanyakude (sub-district Jozini) and Zululand (sub-district Pongola) in KZN; and in OR Tambo (sub-district Nyandeni) in the EC province. Subjects: Children 0 to 59 months old (Umkhanyakude n = 398; Zululand n = 303; OR Tambo n = 364) and their caregivers were included.Methods: Structured interviewer-administered questionnaires were conducted and height and weight were measured.Results: Households in OR Tambo had less access to services (tap water 3; toilets 33); compared to Umkhanyakude (tap water 50;toilets 82) and Zululand (tap water 74; toilets 98). Wood was the main energy source used to cook food in all three districts ( 75).Grants were a main source of income (Umkhanyakude and Zululand 61; OR Tambo 55). Many households obtained vegetables from their own garden (Umkhanyakude and Zululand 30; OR Tambo 70). The households that reportedly had enough food available at all times (Umkhanyakude and Zululand 25; OR Tambo 17); were in the minority. The diarrhoea prevalence reported by the caregivers was high (Umkhanyakude 35; Zululand 24; OR Tambo 24). The prevalence of stunting was higher for children older than 12 months and varied between 22 and 26. The prevalence of overweight among children 0 to 23 months exceeded the prevalence of underweight. The prevalence of overweight and obesity among caregivers was high (Umkhanyakude 42; Zululand 60; OR Tambo 56).Conclusion: Concerted efforts are needed to address the adverse social; nutrition and health conditions in these districts

Risk Factors of Poor Anthropometric Status in Children Under Five Years of Age Living In Rural Districts of the Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objectives: Factors associated with children's anthropometric status were determined. Design: Secondary analysis was done using data from a cross-sectional survey including children under five years of age (n = 2 485) and their mothers in rural districts of the Eastern Cape and KwaZulu-Natal provinces; South Africa. Methods: Data generated by questionnaire and anthropometric indices were used to construct a logistic regression model; taking into account hierarchical relationships of risk factors to determine the odds of a child being stunted; underweight or overweight. Statistical significance was set at p 0.05. Results: Factors associated with stunting were child of male gender (odds ratio (OR)

Risk Factors of Poor Anthropometric Status in Children Under Five Years of Age Living In Rural Districts of the Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objectives: Factors associated with children's anthropometric status were determined. Design: Secondary analysis was done using data from a cross-sectional survey including children under five years of age (n = 2 485) and their mothers in rural districts of the Eastern Cape and KwaZulu-Natal provinces; South Africa. Methods: Data generated by questionnaire and anthropometric indices were used to construct a logistic regression model; taking into account hierarchical relationships of risk factors to determine the odds of a child being stunted; underweight or overweight. Statistical significance was set at p 0.05. Results: Factors associated with stunting were child of male gender (odds ratio (OR)

A Model for Community-Based Growth Monitoring System

Acting on a request form the community of Ndunakazi; a rural area bordering the Valley of a Thousand Hills; Kwa Zulu-Natal; South Africa; a comprehensive situation analysis was conducted. The results were used in an objective orientated programme planning approach; during a workshop attended by community representatives. One of the outcomes was the establishment of a model for a community-based growth and health monitoring system for pre-school children. As their contribution to the programme; families would make their homes available on a voluntary basis; once or twice a month to be used as community-based centers (called Isizinda). From a nutritional point of view; the programme has a hoslistic approach and is run by nutrition monitors. The programme was initially launched with one centre; but in response to requests received form the community; a further seven centres have been established. Approximately 500 pre-school children are currently being growth-monitored regularly; with an average monthly attendance of around 70 per cent. The nutrition monitors are responsible for conveying health and nutritional messages to the mothers and for collecting morbidity and mortality data. Children who are either not growing well or who are ill are referred to the nearest clinic. When available a community nurse attends to minor illnesses during these sessions. A soup kitchen is run during the winter; providing the mothers and pre-school children with soup and bread. Attitudes of mothers and nutrition monitors towards the programme are assessed regularly; the outcome of skills development that is an integral part of the model. This model falls within the scope of the policy objectives and principles on which the United Health System of South Africa will be based. The National Research Programme for nutritional Intervention (NRPNI) is in eh process of establishing a partnership with the department of Health of KwaZulu-Natal. Should the Department take long-term responsibility as an overall coordinator of these monitoring centers; the sustainability of the project will be increased and could then be extended to other areas