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Maize is among the top three grain crops in the world. In Africa, especially Southern Africa, maize is the basic ingredient in fermented soft porridge known as Mahewu. Mahewu is a refreshing drink, produced at the household level using various practices and ingredients as a fermentation enhancer. The underprivileged consume Mahewu as the main meal of the day and hence, Mahewu is a source of dietary nutrients for many populations in Africa and South Africa. The ingredient and practices of making Mahewu differ from one ethnic group to another. However, some of the indigenous practices are not well reported. These practices are fading away, hence, there is limited information on some indigenous practices. This paper reports some traditional practices of making Mahewu in Zulu-based households in Ntambanana, a rural municipality in KwaZulu-Natal, South Africa. An ethnographic research approach was adopted for the study to gain insight into the traditional practices of making Mahewu. Probing of key informants, interviews, and observations were complemented by four focus group discussions, within the range of 10-12 regular consumers of Mahewu. Four focus group discussions were conducted in Buchanana and Luwamba in Ntambanana; findings consistently reveal that Mahewu is popularly known as 'umdokwe' and is consumed by all age groups beginning from four months to the aged. Irish potatoes (Solanum tuberosum), imbiliso, inserting a saucer, or a spoon deep down into the Mahewu container were mentioned and identified as fermentation enhancers which are lacking in other studies. Therefore, indigenous practices are diminishing while some practices are being lost between generations. Inadequate transfer of these practices might make the drink, to soon be accessible only commercially. To prevent this dilemma, the retention of traditional techniques of making Mahewu with sweet potatoes could promote food and nutrition security while retaining the indigenous practices. This study reports the preparation, storage, and utilization of Mahewu, a non-alcoholic maize meal beverage in Ntambanana, South Africa. It is recommended that campaigns promoting indigenous food consumption should form part of health, social development, as well as welfare, hence, food and nutrition interventions should be implemented in rural communities. Key words: Cereal drink, Imbiliso fermentation indigenous, Mahewu, practices, storage Umdokwe, INTRODUCTION Maize constitutes the main ingredient in the diet of most rural dwellers, especially among the underprivileged, developing settings in sub-Saharan African countries, including South Africa. Cereals such as maize [...]

There has been a significant increase in the consumption of instant noodles among the youth, especially students. According to literature, instant noodles are preferred because of their taste, extended shelf life, cheap price as well as convenience, which suit the busy lifestyle of the student population. However, it has been highlighted that instant noodles are not always a healthy food choice. The nutrient quality compromise poses a negative impact on the functioning of the body, which could affect the student's nutrition negatively. The objective of the study was, therefore, to determine the potential of Amaranthus leaf powder in fortifying instant noodles. Articles looking at instant noodle utilization and consumption by students as well as Amaranthus use, perceptions and utilization were used in this narrative review. These were selected and grouped by the authors according to the sub-topics mentioned above. Literature reports that instant noodles can be fortified by substituting wheat flour with Amaranthus grain flour. Studies on Amaranthus snacks and other starch-based foods using the leaf part have been reported but the fortification of noodles with Amaranthus leaf powder is not documented. The findings on the consumer acceptability of Amaranthus leaf powder-fortified foods have reported lower acceptability. This is due to unfamiliar sensory attributes such as a green color and a 'leafy' taste. Amaranthus is still perceived as food for poor and backward people, which contributes to lower acceptability of the plant to the youth. Nevertheless, Amaranthus leaves are considerably nutritious and the incorporation in staple foods could maximise crop utilization. Therefore, incorporation of Amaranthus with the noodles could lead to instant noodle indigenization in South Africa and give a sense of identity to the future generations. Furthermore, Amaranth-fortified noodles could sustain the utilization of traditional foods, promoting local-based food systems and help reduce unemployment among the youth. Key words: instant noodles; consumer acceptability; morogo; fortification; imbuya, underutilized vegetables, INTRODUCTION It is estimated that the demand for instant noodles reached 103 620 million servings per capita consumption globally in 2018 [1]. China leads the statistics at 40 250 million [...]

Maize is among the top three grain crops in the world. In Africa, especially Southern Africa, maize is the basic ingredient in fermented soft porridge known as Mahewu. Mahewu is a refreshing drink, produced at the household level using various practices and ingredients as a fermentation enhancer. The underprivileged consume Mahewu as the main meal of the day and hence, Mahewu is a source of dietary nutrients for many populations in Africa and South Africa. The ingredient and practices of making Mahewu differ from one ethnic group to another. However, some of the indigenous practices are not well reported. These practices are fading away, hence, there is limited information on some indigenous practices. This paper reports some traditional practices of making Mahewu in Zulu-based households in Ntambanana, a rural municipality in KwaZulu-Natal, South Africa. An ethnographic research approach was adopted for the study to gain insight into the traditional practices of making Mahewu. Probing of key informants, interviews, and observations were complemented by four focus group discussions, within the range of 10-12 regular consumers of Mahewu. Four focus group discussions were conducted in Buchanana and Luwamba in Ntambanana; findings consistently reveal that Mahewu is popularly known as "umdokwe" and is consumed by all age groups beginning from four months to the aged. Irish potatoes (Solanum tuberosum), imbiliso, inserting a saucer, or a spoon deep down into the Mahewu container were mentioned and identified as fermentation enhancers which are lacking in other studies. Therefore, indigenous practices are diminishing while some practices are being lost between generations. Inadequate transfer of these practices might make the drink, to soon be accessible only commercially. To prevent this dilemma, the retention of traditional techniques of making Mahewu with sweet potatoes could promote food and nutrition security while retaining the indigenous practices. This study reports the preparation, storage, and utilization of Mahewu, a non-alcoholic maize meal beverage in Ntambanana, South Africa. It is recommended that campaigns promoting indigenous food consumption should form part of health, social development, as well as welfare, hence, food and nutrition interventions should be implemented in rural communities. [ABSTRACT FROM AUTHOR]

Background: In South Africa (SA), there is a reported shift from the consumption of grains, pulses, fruits and vegetables by most households to the consumption of easily accessible, high-energy, ultra-processed foods. Despite their high nutritional value and affordability, indigenous, local, traditional wild and domesticated plant foods abundant in SA are still neglected and less consumed than conventional and exotic foods., Objectives: The purpose of this study is to undertake a scoping/mapping review to evaluate the potential role of underutilised local, indigenous and traditional plant species in addressing (through improving food and nutrition security) the adverse effects of the nutrition transition, which involves increased use of ultra-processed foods, on the health and nutritional status of current households in SA as well as preventing the same adverse affecting future generations., Design: Online databases were used to identify literature published between 2000 and 2022.A total of 88 articles, books, book chapters and literature materials were selected using the Google Scholar search engine, where literature from Sub-Saharan Africa and global that used food and nutrition security, as well as underutilised and indigenous plant species., Results and Conclusion: Evaluation of the gathered literature revealed that the "food security" concept had been measured based on the available quantity of food. In contrast, the quality of food is severely neglected. The literature indicated a strong link between the "food environment" concept, ultra-processed foods and nutrition transition. The shift, especially by the youth, from consuming underutilised plant foods to ultra-processed foods has left older people to be the only consumers of underutilised plant foods. Monotonous preparation, the unavailability of nutritive local traditional and indigenous plant foods at supermarkets and the unappealing packaging methods of such foods were some contributors to the limited or no consumption-these challenges need to be addressed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (© 2023 The Authors.)

The COVID-19 pandemic and associated restrictions could adversely affect long-term HIV care. We evaluated the experiences of people receiving antiretroviral therapy (ART) through a decentralized delivery program in South Africa during the COVID-19 pandemic. We telephoned a random subsample of participants enrolled in a prospective cohort study in KwaZulu-Natal in April and May 2020 and administered a semi-structured telephone interview to consenting participants. We completed interviews with 303 of 638 contacted participants (47%); 66% were female, with median age 36y. The most common concerns regarding the COVID-19 pandemic were food running out (121, 40%), fear of becoming infected with COVID-19 (103, 34%), and being unable to work/losing employment or income (102, 34%). Twenty-five (8%) participants had delayed ART pick-up due to the pandemic, while 212 (70%) had new concerns about ART access going forward. Mental health scores were worse during the pandemic compared to baseline (median score 65.0 vs 80.0, p  < 0.001). Decentralized ART distribution systems have the potential to support patients outside of health facilities during the COVID-19 pandemic, but economic concerns and mental health impacts related to the pandemic must also be recognized and addressed.

Introduction: South Africa's government-led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community- or clinic-based pick-up points intended to increase convenience and decongest clinics. To understand CCMDD pick-up point use among people living with HIV, we evaluated factors associated with uptake of a community- versus clinic-based pick-up point at CCMDD enrolment., Methods: We collected baseline data from October 2018 to March 2020 on adults (≥18 years) who met CCMDD clinical eligibility criteria (non-pregnant, on antiretroviral therapy for ≥1 year and virologically suppressed) as part of an observational cohort in seven public clinics in KwaZulu-Natal. We identified factors associated with community-based pick-up point uptake and fit a multivariable logistic regression model, including age, gender, employment status, self-perceived barriers to care, self-efficacy, HIV-related discrimination, and perceived benefits and challenges of CCMDD., Results and Discussion: Among 1521 participants, 67% were females, with median age 36 years (IQR 30-44). Uptake of a community-based pick-up point was associated with younger age (aOR 1.18 per 10-year decrease, 95% CI 1.05-1.33), being employed ≥40 hours per week (aOR 1.42, 95% CI 1.10-1.83) versus being unemployed, no self-perceived barriers to care (aOR 1.42, 95% CI 1.09-1.86) and scoring between 36 and 39 (aOR 1.44, 95% CI 1.03-2.01) or 40 (aOR 1.91, 95% CI 1.39-2.63) versus 10-35 on the self-efficacy scale, where higher scores indicate greater self-efficacy. Additional factors included more convenient pick-up point location (aOR 2.32, 95% CI 1.77-3.04) or hours (aOR 5.09, 95% CI 3.71-6.98) as perceived benefits of CCMDD, and lack of in-clinic follow-up after a missed collection date as a perceived challenge of CCMDD (aOR 4.37, 95% CI 2.30-8.31)., Conclusions: Uptake of community-based pick-up was associated with younger age, full-time employment, and systemic and structural factors of living with HIV (no self-perceived barriers to care and high self-efficacy), as well as perceptions of CCMDD (convenient pick-up point location and hours, lack of in-clinic follow-up). Strategies to facilitate community-based pick-up point uptake should be tailored to patients' age, employment, self-perceived barriers to care and self-efficacy to maximize the impact of CCMDD in decongesting clinics., (© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)

We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy., (© 2021. The Author(s).)