Mental distress, food insecurity and university student dropout during the COVID-19 pandemic in 2020: evidence from South Africa.

Background: Student dropout has been a key issue facing universities for many years. The COVID-19 pandemic was expected to exacerbate these trends; however, international literature has produced conflicting findings. Limited literature from Africa has investigated the impact of COVID-19 on student dropout trends, despite the documented devastation, including increased risk of food insecurity and mental distress, caused by the pandemic. Objective: This work seeks to understand the impact of food insecurity and mental distress on student dropout during the COVID-19 pandemic. Methods: Using a cross-sectional research design, first-year undergraduate students from a large South African university were recruited via email to participate in a survey between September and October 2020. The Household Food Insecurity Access Scale (HFIAS) was used to measure food insecurity and the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) was used to measure mental distress. Multivariate regression was used to investigate factors associated with student dropout. Results: The student dropout rate was 10.5% (95% CI: 8.2-13.2). The prevalence of severe food insecurity was 25.7% (95% CI: 22.3-29.4) and the prevalence of severe mental distress symptoms was 26.7% (95% CI: 23.3-30.4). Dropout rates and levels of food insecurity were highest among students residing in remote areas during the lockdown at 19.2% and 43.6%, respectively. The multivariate logistic regression revealed that being male increased the probability of dropout almost three-fold (odds ratio (OR) = 2.70; 95% CI: 1.48-4.89, p =0.001)). Being moderately food insecure increased the odds of dropout more than two-fold (OR=2.50; 95% CI:1.12-5.55, p=0.025), and experiencing severe mental distress symptoms increased the odds of dropout seven-fold (OR=7.08; 95% CI:2.67-18.81, p<0.001). Conclusion: While acknowledging that various factors and complexities contribute to student dropout, the increased vulnerability to food insecurity and mental distress, stemming from issues such as widespread job losses and isolation experienced during the pandemic, may have also had an impact on dropout. This work reiterates the importance of directing additional support to students who are food insecure and those who are experiencing mental distress in order to mitigate university student dropout.

Nutrition knowledge and health vulnerability of mothers of pre-school children in north-central, Nigeria.

OBJECTIVE: This study explores the contribution of nutrition knowledge to the health status of pre-school children's mothers in Niger State, North-Central, Nigeria. DESIGN: The study is a descriptive cross-sectional design using a quantitative data collection method. SETTING/PARTICIPANTS: A multi-stage sampling technique was used to recruit 450 mothers of pre-school children across Niger state, Nigeria. Chi-square and linear regression were used to test the level of statistical significance (at p < 0.05). Socioeconomic and demographic information, anthropometric indices and nutrition knowledge were obtained using semi-structured questionnaires. Feeding patterns were also assessed using a qualitative 7-day dietary recall. RESULT: The results showed that the majority (63.8%) of the mothers were within 26-35 years, and more than half (51.6%) of the mothers lacked knowledge of a "balanced diet". Fruits, vegetables, and dairy products were the least consumed food group among the mothers (7.1% and 9.1%, respectively). Place of residence, occupation, and method of waste disposal were significantly associated with maternal minimum dietary diversity adequacy (p<0.05). Over half (57.6%) of the mothers were within the normal BMI range, and the mean waist/hip ratio was 0.82± 0.08. Social media/online was the most (36.4%) explored source of nutrition information among the mothers. This study shows no significant association between nutrition knowledge and adequacy of minimum dietary diversity among the mothers of preschool children (p = 0.09, χ2 = 13.682). CONCLUSION: Dietary diversity among mothers was associated with the socioeconomic status and BMI of the mothers, which were strong determinants of meal quality and health outcomes in Nigeria and other developing countries experiencing food insecurity.

Mineral Composition and Consumer Acceptability of Amaranthus Leaf Powder Supplemented Ujeqe for Improved Nutrition Security.

Malnutrition, especially micronutrient deficiency, is a widespread health challenge that predominantly affects young children, young ladies who are within the productive age, refugees, and older adults who reside in rural communities and informal settlements in underdeveloped and developing countries. Malnutrition is caused by consuming either too little or too much of one or more food nutrients. Additionally, monotonous dietary lifestyle, especially the over-reliance on staple foods, is identified among the top factors limiting many individuals' intake of essential nutrients. Thus, enriching starchy and cereal-based staple foods including Ujeqe (steamed bread) with fruits and especially leafy vegetables is being suggested as a strategic medium for essential nutrient delivery to malnourished populations and especially the Ujeqe regular consumers. Amaranthus, called pigweed, has been rediscovered as a nutrient-dense multipurpose plant. The seed has been explored as a nutrient-enhancer in staple foods; however, the leaves are underutilized, especially in Ujeqe. This study aims to enhance the mineral content of Ujeqe. An integrated research approach was used where Amaranthus dubius was self-processed into leaf powder. Amaranthus leaf powder (ALP), and the ALP-supplemented wheat flour Ujeqe prototypes 0%, 2%, 4%, and 6% were investigated for their mineral composition. Sensory evaluations of enriched Ujeqe were conducted using 60 panelists on a five-point hedonic scale. Findings show that the moisture contents of the raw materials and the supplemented prototypes were low, indicating a good shelf life of the food ingredient before being used for Ujeqe development. Carbohydrates of raw materials ranged from 41.6-74.3%, fat ranged from 1.58-4.47%, ash ranged from 2.37-17.97%, and protein ranged from 11.96-31.56%. Additionally, fat, protein, and ash content had significant differences at (p < 0.05). The moisture content of enhanced Ujeqe was equally low, connoting keeping quality of the sample. The increase concentration of ALP led to an enriched Ujeqe especially in the ash and protein content. Similarly, calcium, copper, potassium, phosphorus, manganese, and iron content were significantly influenced at (p < 0.05); 2% ALP-supplemented Ujeqe was the most acceptable prototype as the control sample, 6% was the least preferred prototype. Although ALP dubius can enrich staple foods including (Ujeqe), this study declared that higher addition of ALP dubius leads to low consumer acceptability rate of the Ujeqe, which is not statistically significant. Amaranthus is an economical source of fiber, which was not investigated in the study. Therefore, further studies can explore the fiber content of the ALP-supplemented Ujeqe.

Overcoming barriers for people with disabilities participating in income-generating activities: A proposed development framework.

Background: People with disabilities in sheltered workshops are disempowered and face many barriers, adversely affecting their income-generating activities and weakening their competitiveness in the labour market. There is limited evidence on how to overcome these barriers. Objectives: This paper seeks to propose a framework to overcome the barriers experienced by people with disabilities participating in income-generating activities in a sheltered workshop. Method: The qualitative exploratory single case study was done with observations and semi-structured interviews as data collection methods. Purposive sampling was used to select 24 participants between ages 22 and 52 years, and content analysis was done of transcribed interviews. Community-based rehabilitation (CBR) guidelines were used to develop the framework. Results: A proposed framework was developed that outlined intervention strategies to address the barriers experienced by sheltered workshop participants to promote increased participation of people with disabilities in income-generation activities, thereby improving their quality of life. Conclusion: The participation of people with disabilities in income-generating activities is hindered by several barriers. However, the proposed framework overcomes the barriers to effective participation in income-generating activities. Contribution: People with disabilities will benefit from this framework as it will address their challenges and needs for empowerment. It would also inform stakeholders involved about these challenges and strategies.

The Household Food Security and Feeding Pattern of Preschool Children in North-Central Nigeria.

Children's feeding patterns and health outcomes are important determinants of any country's food and nutrition security status. This study assessed the household food security and feeding patterns of preschoolers in Niger State, Nigeria. A cross-sectional descriptive design and a multi-stage sampling technique were employed to analyze 450 preschool children from selected local government areas. Household food security was measured using the HFIAS nine-item questionnaire, and feeding patterns were evaluated using the qualitative food frequency questionnaire (FFQ). The mean age of the preschoolers was 3.71 ± 0.80 years. A majority (61.30%) of the children consumed cereal-based products, while fruits and vegetables were the least consumed (16.40%). More than half (59.80%) of the preschoolers met their minimum dietary diversity. Almost all (98.80%) of the children were from food-insecure households, with 40.3% being severely food insecure. Parity, religion, and having a breadwinner and source of potable water were significantly associated with the adequacy of minimum dietary diversity (MDD) among the preschoolers (F value = 5.528, p ≤ 0.05). The contribution of poor feeding patterns and household food insecurity to the overall health outcome of preschoolers cannot be overlooked. Hence, nations must prioritize improving the availability, accessibility, and utilization of food to better meet the nutritional needs of preschool children.

Grain Quality, Provitamin A Carotenoid Profiles, and Sensory Quality of Provitamin A-Biofortified Maize Stiff Porridges.

Provitamin A-biofortified maize could contribute to the alleviation of vitamin A deficiency (VAD), which is prevalent in sub-Saharan Africa due to a high consumption of starchy, maize-based diets. Four varieties of provitamin A biofortified maize were studied for grain colour, grain texture, thousand kernel weight, and hectolitre mass. Provitamin A biofortified maize stiff porridges were prepared and their retained provitamin A was determined using lutein, zeaxanthin, ß-cryptoxanthin, and ß-carotene (all-trans and cis isomers) as standards. Provitamin A concentration in the biofortified porridges ranged from 2.24 to 3.18 µg/g and retention from 91-105%. Descriptive sensory analysis and the 5-point facial hedonic test were used to evaluate the sensory quality of the porridges. The biofortified maize porridges were described as sticky, fine, with high intensity residual grain, and having a slightly bitter aftertaste with a cooked maize flavour and aroma, whereas the intensities of these attributes were insignificant in white maize porridge. About 33% of the consumer sample (N = 60) liked the porridges and 28% disliked the porridges, whilst approximately 38% of the consumers were neutral. The findings suggest that biofortified maize stiff porridge can deliver a significant amount of provitamin A to targeted consumers, but the acceptance of biofortified maize still needs to be improved on.

Protein Isolate from Parkia biglobosa Seeds Improves Dyslipidaemia and Cardiac Oxidative Stress in Streptozotocin-Induced Diabetic Rats.

Reports from previous studies now provide evidence that dyslipidaemia and oxidative stress play crucial roles in the pathogenesis and progression of diabetes and its related complications. This research is aimed to investigate the potential effects of protein isolate from Parkia biglobosa seeds (PBPI) in streptozotocin (STZ)-induced diabetic rats by measuring blood glucose levels, changes in lipid metabolism and biomarkers of oxidative stress. Diabetic rats were treated orally with graded doses of PBPI, 200 mg/kg bw and 400 mg/kg bw, and 5 U/kg, intraperitoneal (i.p.) of insulin once daily for 28 days with the fasting blood glucose (FBG) monitored weekly. The effect of PBPI on the serum lipid profile was measured while the extent of lipid peroxidation (LPO), as well as antioxidant parameters (superoxide dismutase; SOD, catalase; CAT, glutathione-S-transferase; GST and total glutathione; total GSH), was determined in the cardiac homogenates of diabetic rats. At the tested doses, treatment with PBPI was significantly effective in lowering FBG, serum triglyceride, cholesterol, low-density lipoprotein cholesterol (LDL-c) and very low-density lipoprotein cholesterol (VLDL-c), while concurrently increasing high-density lipoprotein cholesterol (HDL-c). PBPI also significantly decreased the elevations witnessed in LPO levels and restored the biomarkers of oxidative stress in the cardiac homogenate of experimental rats. The results from this study demonstrate that PBPI could improve dyslipidaemia and cardiac oxidative stress in the experimental diabetic animal model possibly by reducing and effectively scavenging reactive oxygen species (ROS) production as well as by increasing antioxidant capacity in combating oxidative stress. Therefore, it can be concluded that PBPI could be explored in the development of a potent cardioprotective supplement or adjuvant therapy towards the management of diabetes and its related complications.

Cardiac autonomic function and its association with cardiometabolic disease risk factors in Black South African children.

OBJECTIVE: This study evaluated the associations between cardiac autonomic nervous system (ANS) activity and cardiometabolic disease (CMD) risk factors among black South African children. DESIGN: The participants included 34 black South African children (11.85 ±â€¯0.89 y). CMD risk factors included waist circumference (WC), hip circumference (HC), body mass index z-score (BMI z-score), blood pressure (SBP, DBP), total cholesterol (TC), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), fasting glucose (FG), fasting insulin (FINS), and vessel stiffness index (SI). Heart rate variability was used to quantify cardiac ANS activity. RESULTS: lnRMSSD, pNN50 and lnSD1 were inversely associated with FINS (r = -0.33, p = 0.05; r = -0.36, p = 0.03; r = -0.41, p = 0.01), WC (r = -0.45, p = 0.01; r = -0.39, p = 0.02; r = -0.45, p = 0.01), and HC (r = -0.41, p = 0.01; r = -0.36, p = 0.03; r = -0.43, p = 0.01). HDL was positively associated with lnRMSSD (r = 0.37; p = 0.03) and lnSD1 (r = 0.37; p = 0.03) while, LDL was negatively associated with HF (r = -0.41; p = 0.01). Regression analysis identified WC as the primary predictor for parasympathetic modulation in time domain (lnRMSSD: r2 = 0.21, p = 0.01; pNN50: r2 = 0.18, p = 0.01) and non-linear domain (lnSD1: r2 = 0.21, p = 0.01). CONCLUSION: Elevated resting parasympathetic activity in children is associated with lower CMD risk factors and an elevation in the protective HDL.

Short-Term High-Intensity Interval Training Is Superior to Moderate-Intensity Continuous Training in Improving Cardiac Autonomic Function in Children.

OBJECTIVES: This study aimed to investigate the impact of 3 isocaloric exercise programs on cardiac autonomic nervous system (ANS) functioning in children. METHODS: One hundred nine children (39% boys and 61% girls) aged 10-13 years (mean 11.07 ± 0.81) were conveniently assigned to 1 of 4 groups as follows: Moderate-intensity continuous training (MICT; n = 29) at 65-70% of the predicted maximum heart rate (MHR), High-intensity interval training (HIIT; n = 29) at > 80% of the predicted MHR, HIIT and MICT combined on alternate weeks (ALT; n = 27), and a control group (n = 24). Morning ANS activity was assessed via analysis of heart rate variability (HRV), with the patient in supine position for 10 min, before and after the exercise intervention. DATA ANALYSIS: A 2-way analysis of variance was used to evaluate the effects of training on all HRV parameters (p < 0.05/4 = 0.0125). RESULTS: After 5 weeks of training, significant improvements were observed for ln of the standard deviation of normal-to-normal intervals (p < 0.0001), ln of the root mean square of successive difference (p < 0.0001), and ln of standard deviation 1 (p < 0.0001), with superior results reported in the HIIT group (effect size [ES] = 2.22, 2.69, and 2.69) compared with the MICT (ES = 1.67, 1.75, and 1.75) and ALT (ES = 0.87, 1.06, and 1.06) groups, respectively. CONCLUSION: Short-term HIIT seems to induce superior alterations in cardiac ANS activity compared to MICT and ALT in children through enhanced vagal activity.

Do Short-Term Exercise Interventions Improve Cardiometabolic Risk Factors in Children?

OBJECTIVES: To explore the impact of short-term exercise of varying intensity on traditional risk factors for cardiometabolic disease. STUDY DESIGN: A total of 109 children (mean age, 11.1 ± 0.8 years) were conveniently assigned to 5 weeks of moderate-intensity continuous training (MICT; n = 29) set at 65%-70% of maximum heart rate, high-intensity interval training (HIIT; n = 29; >80% maximum heart rate), combined training (HIIT + MICT; n = 27), or no training (control; n = 24). Two-way ANOVA (group × time) was used to evaluate the effects of training on all cardiometabolic disease risk factors. Effect sizes were calculated to assess the magnitude of difference. RESULTS: MICT, HIIT, and HIIT + MICT were associated with significantly improved resting heart rate (effect size, -0.4, -1.1, and -1.1, respectively; P < .0001), fasting glucose (effect size, -0.6, -0.9, and -0.1, respectively; P = .0004), peak oxygen consumption (effect size, 0.5, 0.9, and 0.5, respectively; P < .0001), and c-reactive protein (effect size, -0.2, -1.0, and -0.5, respectively; P = .0016). HIIT + MICT was significantly associated with reduced waist circumference (-5.4%; P < .0001) and waist-to-hip ratio (-2.5%; P < .0002) compared with MICT (7.0% and 6.3%, respectively) and HIIT (-0.5% and -1.3%, respectively). CONCLUSION: Short-term HIIT and MICT interventions are useful for improving cardiometabolic health in children. HIIT + MICT may provide superior reductions in central obesity indicators.

The Potential of Integrating Provitamin A-Biofortified Maize in Smallholder Farming Systems to Reduce Malnourishment in South Africa.

Biofortification interventions have the potential to combat malnutrition. This review explored the use of provitamin A-biofortified maize (PVABM) as a vitamin A deficiency (VAD) reduction agricultural-based strategy. Maize has been identified as one of the key staple crops for biofortification to reduce hidden hunger in Africa. Most nutrition interventions have not been successful in reducing hunger because rural communities, who mainly rely on agriculture, have been indirectly excluded. The biofortification intervention proposed here aims to be an inclusive strategy, based on smallholder farming systems. Vitamin A is a micronutrient essential for growth, immune function, reproduction and vision, and its deficiency results in VAD. VAD is estimated to affect more than 250 million children in developing countries. In Africa, especially sub-Saharan Africa, maize is a staple food for rural communities, consumed by most household members. Due to carotenoids, PVABM presents an orange color. This color has been reported to lead to negative perceptions about PVABM varieties. The perceived agronomic traits of this maize by smallholder farmers have not been explored. Adoption and utilization of PVABM varieties relies on both acceptable consumer attributes and agronomic traits, including nutritional value. It is therefore important to assess farmers' perceptions of and willingness to adopt the varieties, and the potential markets for PVABM maize. It is essential to establish on-farm trials and experiments to evaluate the response of PVABM under different climatic conditions, fertilizer levels and soils, and its overall agronomic potential. For the better integration of PVABM with smallholder farming systems, farmer training and workshops about PVABM should be part of any intervention. A holistic approach would enhance farmers' knowledge about PVABM varieties and that their benefits out-compete other existing maize varieties.

An Assessment of the Food and Nutrition Security Status of Weaned 7-12 Months Old Children in Rural and Peri-Urban Communities of Gauteng and Limpopo Provinces, South Africa.

This study assessed the food and nutrition security status of children receiving complementary food in rural and peri-urban communities. A group of 106 mothers from Lebowakgomo village and Hammanskraal Township, respectively, participated in the survey. Additionally, six focus group discussions were conducted per study area to assess the mothers' perceptions about children's food access. The Children's Food Insecurity Access Scale (CFIAS) was used to assess the food security status (access) of the children. The Individual Dietary Diversity Score (IDDS) together with the unquantified food consumption frequency survey were used as a proxy measure of the nutritional quality of the children's diets. The age and weight of the children obtained from the children's clinic health cards were used to calculate Weight-for-Age Z scores (WAZ) in order to determine the prevalence of underweight children. The findings showed that a large percentage of children were severely food-insecure, 87% and 78%, in rural and peri-urban areas, respectively. Additionally, Lebowakgomo children (23.6%) and Hammanskraal children (17.9%) were severely underweight. Overall, children's diets in both study areas was characterized by nutrient-deficient complementary foods. Cheaper foods with a longer stomach-filling effect such as white maize meal and sugar were the most commonly purchased and used. Hence, the children consumed very limited amounts of foods rich in proteins, minerals, and vitamins, which significantly increased the risk of their being malnourished.

Provitamin A retention and sensory acceptability of amahewu, a non-alcoholic cereal-based beverage made with provitamin A-biofortified maize.

BACKGROUND: Vitamin A deficiency is a major public health problem in sub-Saharan Africa. Amahewu is a popular southern African lactic acid fermented non-alcoholic maize-based beverage, which is deficient in vitamin A. In this study, provitamin A retention and sensory acceptability of amahewu processed using provitamin A-biofortified maize and three types of inoculums during fermentation (malted maize, wheat bran and Lactobacillus starter culture) were investigated. RESULTS: The total provitamin A content of amahewu samples, estimated as ß-carotene, ß-cryptoxanthin and α-carotene content, ranged from 3.3 to 3.8 g kg(-1) (dry weight). Provitamin A was substantially retained (79- 90% ß-carotene equivalent) in amahewu after fermentation. Amahewu samples prepared with added starter cultures had the lowest retention of provitamin A. Consumers (approx. 69%) liked provitamin A-biofortified amahewu either moderately or very much. Principal component analysis of amahewu sensory data showed that 71% of variation was due to maize types and 18% of variation could be due to the inoculum used during fermentation. Amahewu samples prepared using provitamin A-biofortified maize were slightly more liked (mean score: 7.0 ± 1.2) compared to those of white maize reference samples. The use of starter culture combined with either malted maize or wheat bran as inoculum during fermentation improved the taste and aroma of amahewu and hence its acceptability. CONCLUSION: Provitamin A is substantially retained in amahewu after fermentation. The slightly high acceptability of amahewu prepared using provitamin A-biofortified maize compared to that of white maize thus suggests that fermented product like amahewu can potentially be used to deliver provitamin A to vulnerable individuals.