Determinants of diarrhoeal disease in children living in low-income households in a periurban community in Cape Town, South Africa

Background. Water, sanitation and hygiene are critically important in reducing morbidity and mortality from childhood diarrhoeal disease and malnutrition in low-income settings.Objectives. To assess the association of diarrhoeal disease with factors relating to domestic hygiene, the environment, sociodemographic status and anthropometry in children <2 years of age.Methods. This was a case-control study conducted in a periurban community 35 km from the centre of Cape Town, South Africa. The study included 100 children with diarrhoeal disease and 100 age-matched controls without diarrhoea, who were recruited at primary healthcare clinics. Sociodemographic status, environmental factors and domestic hygiene were assessed using a structured questionnaire; anthropometry was assessed using the World Health Organization's child growth standards. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with diarrhoea. Results. The results of the univariate logistic regression showed significant susceptibility to diarrhoea in study cases compared with controls when the caregiver was ≥25 years old (odds ratio (OR) 1.82; 95% confidence interval (CI) 1.02 - 3.23; p=0.042); when children were in day care or cared for by a family member or a relative than when cared for by their mother (OR 1.97; 95% CI 1.06 - 3.65; p=0.032); and when the mothers were employed rather than at home (OR 2.23; 95% CI 1.21 - 4.12; p=0.01). Multivariate logistic regression analysis was used to identify predictors of diarrhoea, which entailed relaxing the inclusion criteria for the univariate analysis variables (p<0.25). The predictors significantly associated with diarrhoea were household problems relating to rat infestation (OR 2.44; 95% CI 1.13 - 5.28; p=0.027); maternal employment (OR 2.47; 95% CI 1.28 - 4.76; p=0.007); and children in day care or cared for by a relative (OR 2.34; 95% CI 1.21 - 4.54; p=0.01). Significantly more of the mothers who were employed than those who were unemployed had children in day care or cared for by a relative. Conclusion. Practices relating to employment, childcare and the domestic environment were significant predictors of diarrhoea. Effective policy implementation on water, sanitation and domestic hygiene could prevent diarrhoeal disease and reduce its impact on children's growth, especially during the annual diarrhoeal surge season in this and similar periurban communities.

Emerging Trends in Non-Communicable Disease Mortality in South Africa; 1997 - 2010

OBJECTIVES:National trends in age-standardised death rates (ASDRs) for non-communicable diseases (NCDs) in South Africa (SA) were identified between 1997 and 2010.METHODS:As part of the second National Burden of Disease Study; vital registration data were used after validity checks; proportional redistribution of missing age; sex and population group; demographic adjustments for registration incompleteness; and identification of misclassified AIDS deaths. Garbage codes were redistributed proportionally to specified codes by age; sex and population group. ASDRs were calculated using mid-year population estimates and the World Health Organization world standard.RESULTS:Of 594 071 deaths in 2010; 38.9% were due to NCDs (42.6% females). ASDRs were 287/100 000 for cardiovascular diseases (CVDs); 114/100 000 for cancers (malignant neoplasms); 58/100 000 for chronic respiratory conditions and 52/100 000 for diabetes mellitus. An overall annual decrease of 0.4% was observed resulting from declines in stroke; ischaemic heart disease; oesophageal and lung cancer; asthma and chronic respiratory disease; while increases were observed for diabetes; renal disease; endocrine and nutritional disorders; and breast and prostate cancers. Stroke was the leading NCD cause of death; accounting for 17.5% of total NCD deaths. Compared with those for whites; NCD mortality rates for other population groups were higher at 1.3 for black Africans; 1.4 for Indians and 1.4 for coloureds; but varied by condition.CONCLUSIONS:NCDs contribute to premature mortality in SA; threatening socioeconomic development. While NCD mortality rates have decreased slightly; it is necessary to strengthen prevention and healthcare provision and monitor emerging trends in cause-specific mortality to inform these strategies if the target of 2% annual decline is to be achieved

Using Different Approaches to Assess the Reproducibility of a Culturally Sensitive Quantified Food Frequency Questionnaire

Objective: To report on the use of different approaches to assess the reproducibility of a culturally sensitive quantified food frequency questionnaire (QFFQ) used for assessment of the habitual dietary intake of Setswana-speaking adults in the North West Province of South Africa.Method: A previously developed and validated QFFQ was completed by trained fieldworkers. Portion sizes were estimated using different methods. Food intake was coded and analysed for nutrient intake per day for each subject. The first interview (n = 1 888) took place during the baseline data collection period. For the second interview (n = 175); a convenient sample from the subjects who had completed the first interview was collected and the interview was conducted within four to six weeks of the first interview.Results: There were good correlations between the first and second QFFQ for all the nutrients (p 0.0001). The Wilcoxon signed-rank test showed that there were no significant differences in the median intake between the two administrations; except for energy and total fat. The Bland-Altman plots showed good agreement. Between 41 and 58 of the subjects were correctly classified into the same quartile; with less than 3 grossly misclassified. The weighted ? statistics showed moderate agreement between the two applications.Conclusion: Our results show that more than one statistical approach is needed to assess the reproducibility of a QFFQ. The reproducibility of this culturally sensitive QFFQ was good

The use of the South African Food Composition Database System (SAFOODS) and its Products in Assessing Dietary Intake Data. Part II

Objectives: This study set out to determine the following in relation to the nutrition information on the food labels of selected fat spreads: the demographic profile of female consumers using the food label; reasons for food label use and whether the use of the food label leads to the purchase of the selected fat spreads. Methods: One hundred and fifty women aged 25 to 45 years were chosen using an accidental; non-probability sample of consumers shopping at selected supermarkets in Pietermaritzburg. Consenting subjects were presented with a questionnaire to determine their demographic characteristics as well as their reasons for purchasing the selected fat spreads. Descriptive statistics and principal component analyses were used to analyse the results of this study. Results: Fifty-five per cent (n = 82) of this study sample reported using the nutrition information label to assist with their purchases and 68(n = 102) found the nutrition information important when purchasing a new product. Conclusions: The female consumer most likely to use the nutrition information on the food label had a tertiary education; was a primary food purchaser; lived with other people; had more money per month to spend on food; and was conscious of choosing the healthier option. Principal component analysis revealed that the purchase of a selected fat spread was influenced by a number of variables reflecting health awareness; the selected fat spread's marketing; presentation and popularity; and familiarity with and cost awareness of the selected fat spread