Coverage of vitamin A supplementation, deworming and immunisations: Associations with nutritional status among urban children younger than 5 years in Nelson Mandela Bay, Eastern Cape Province, South Africa

Background. Even though immunisation coverage is tracked through the district health system in South Africa (SA), limited information is available regarding interventions linked to the Expanded Programme on Immunisation (EPI) and the impact on the nutritional status of children <5 years of age.Objectives. To describe coverage of immunisations, vitamin A supplementation and deworming among children <5 years old in an urban area of Nelson Mandela Bay, Eastern Cape Province, SA. A secondary objective was to investigate whether a history of missed immunisations, vitamin A supplementation or deworming was associated with wasting or stunting in children.Methods. A descriptive study was conducted between September 2015 and February 2016, where cross-sectional anthropometrical data were collected from 1 513 children in 32 pre-schools, together with a retrospective analysis of the participants' Road-to-Health/clinic cards to collect data on immunisation, vitamin A and deworming. Participants were categorised into 3-month age intervals to facilitate data analysis. Ethical approval was obtained from the Nelson Mandela University Research Ethics Committee (Human). Results. Data of 1 496 children were included in the analysis. The prevalence of underweight was 2.5% (n=37), while 11.2% (n=167) were stunted and 1.1% (n=16) were wasted. There were associations between age category and delayed vitamin A supplementation (χ2=32.105; df=19; n=836; p=0.03) and deworming (χ2=45.257; df=17; n=558; p<0.001), but there was no association between delayed vaccinations and age category. There were no significant differences in anthropometrical indicators for children with delayed vitamin A supplementation, deworming and vaccinations compared with children in this sample who were up to date regarding the relevant indicators. However, weight-for-age, height-for-age and weight-for-height z-scores and stunting risk were associated with low birthweight (LBW) (odds ratio (OR) 4.658; p<0.001). Conclusion. Coverage of vitamin A supplementation and deworming but not immunisations was poorer among children in older age categories. A history of delayed vitamin A, deworming and vaccinations was not associated with the anthropometrical status of children. Children with LBW should be considered for more rigorous follow-up, as they are at higher risk of stunting.

Food insecurity, social welfare and low birth weight: Implications for childhood malnutrition in an urban Eastern Cape Province township

Background. Limited information is available regarding the impact of food insecurity, low birth weight (LBW) and the protective effect of the child support grant (CSG) on malnutrition in South Africa (SA).Objectives. To describe malnutrition in the context of food insecurity, CSG and LBW history among children younger than 24 months from an underprivileged urban settlement in the Eastern Cape Province of SA.Methods. A descriptive study using a cross-sectional design was used to collect data from a non-probability sample of 400 young children from October 2015 to February 2016. Inferential statistics included t-tests to compare anthropometric data from different birth weight categories and analysis of covariance (ANCOVA) to allow for the effect of covariates.Results. Of the sample, 9% were stunted, 1% were wasted, 16% were overweight, 23% were food secure, 47% were at risk of hunger, and 31% were classified as hungry. LBW history was significantly associated with stunting but not with wasting. CSG holders and 'hungry'households' children had significantly lower mean height-for-age z-scores (HAZ) than non-CSG holders and food-secure households.Despite these apparent associations, when LBW is considered as a covariate, it becomesapparent that neither the CSG nor CCHIP category is significantly related to any of the anthropometric indicators. Conclusion. The Department of Health has to recognise the significant impact of LBW on the prevalence of stunting and thus the need to prioritise antenatal care. Policymakers could aim to make the CSG available to mothers as close after birth as possible, or during pregnancy,in order to be more effective in reducing the long-term effects of LBW

Nutritional Status of HIV-Infected Adults on Antiretroviral Therapy and the Impact of Nutritional Supplementation in the Northern Cape Province; South Africa

Objectives: The study aimed to describe the nutritional status and determine the impact of current nutrition intervention strategies on weight changes in adult HIV-infected patients on antiretroviral (ARV) therapy.Design: A descriptive; prospective trial was performed. Setting: The investigation was conducted at ARV roll-out centres in Kimberley; Upington; Kuruman; Prieska and Springbok in the Northern Cape Province of South Africa. Subjects: Adult HIV-infected patients receiving ARV therapy were included in the study.Outcome measures: Each participants's body mass index (BMI) was determined before and after a four-month intervention period of nutritional supplementation with an instant; enriched maize product. Results: Data from 98 patients (mean age 39.7 years; standard deviation 8.9 years) were assessed. Prior to intervention; the median BMI was 20 kg/m2 (range 12.6-29.7 kg/m2); the patients from Kuruman had a greater incidence of underweight compared to the other towns; with a median BMI of 17.9 kg/m2. Of the 87 patients assessed during the final week; 49.4experienced weight gain and 40.2lost weight. Eighteen (20.7) patients gained more than 5of their baseline weight; which was significant. Only eight (9.2) patients lost more than 5of their baseline weight. Twenty-two patients who presented with a BMI 18.5 kg/m2 at baseline had a median weight gain of 1.13 kg during the intervention period; while the group with a BMI 18.5 kg/m2 presented with no change in median weight. Conclusions: Nutritional supplementation; provided according to provincial policy and combined with ARVs; nutritionally benefitted about half of the patients in the ARV programme in the Northern Cape

Nutritional Status of HIV-Infected Adults on Antiretroviral Therapy and the Impact of Nutritional Supplementation in the Northern Cape Province; South Africa

Objectives: The study aimed to describe the nutritional status and determine the impact of current nutrition intervention strategies on weight changes in adult HIV-infected patients on antiretroviral (ARV) therapy.Design: A descriptive; prospective trial was performed. Setting: The investigation was conducted at ARV roll-out centres in Kimberley; Upington; Kuruman; Prieska and Springbok in the Northern Cape Province of South Africa. Subjects: Adult HIV-infected patients receiving ARV therapy were included in the study.Outcome measures: Each participants's body mass index (BMI) was determined before and after a four-month intervention period of nutritional supplementation with an instant; enriched maize product. Results: Data from 98 patients (mean age 39.7 years; standard deviation 8.9 years) were assessed. Prior to intervention; the median BMI was 20 kg/m2 (range 12.6-29.7 kg/m2); the patients from Kuruman had a greater incidence of underweight compared to the other towns; with a median BMI of 17.9 kg/m2. Of the 87 patients assessed during the final week; 49.4experienced weight gain and 40.2lost weight. Eighteen (20.7) patients gained more than 5of their baseline weight; which was significant. Only eight (9.2) patients lost more than 5of their baseline weight. Twenty-two patients who presented with a BMI 18.5 kg/m2 at baseline had a median weight gain of 1.13 kg during the intervention period; while the group with a BMI 18.5 kg/m2 presented with no change in median weight. Conclusions: Nutritional supplementation; provided according to provincial policy and combined with ARVs; nutritionally benefitted about half of the patients in the ARV programme in the Northern Cape