Search

HRQOL in transplant candidates and recipients who are also infected with HIV and are awaiting a kidney, or have received one from a HIV-positive donor, has not been previously investigated. The HRQOL of 47 HIV-positive kidney transplant candidates and 21 recipients from HIV-positive donors was evaluated using the Short Form-36 (SF-36) and face to face interviews at baseline and at 6 months. The correlation between SF-36 scores and sociodemographic, clinical and nutritional factors was determined. 68 patients completed the SF-36 at baseline and 6 months. Transplant candidates: transplant candidates had lower HRQOL than recipients. The main mental stressors were income, employment and waiting for a donor. Physical health complaints were body pain (BP) and fatigue. Pre-albumin and BMI was positively correlated with general health at baseline (r = 0.401, p = 0.031 and r = 0.338, p = 0.025). Besides a positive association with role physical (RP) and BP, albumin was associated with overall physical composite score (PCS) (r = 0.329, p = 0.024) at 6 months. Transplant recipients: Transplant recipients had high HRQOL scores in all domains. PCS was 53.8 ± 10.0 and 56.6 ± 6.5 at baseline and 6 months respectively. MCS was 51.3 ± 11.5 and 54.2 ± 8.5 at baseline and 6 months respectively. Albumin correlated positively with PCS (r = 0.464, p = 0.034) at 6 months and role emotional (RE) (r = 0.492, p = 0.024). Higher pre-albumin was associated with better RE and RP abilities and MCS (r = 0.495, p = 0.034). MAMC was associated with four domains of physical health and strongly correlated with PCS (r = 0.821, p = 0.000). Strategies to improve HRQOL include ongoing social support, assistance with employment issues and optimising nutritional status.

Introduction: Substituting corn in a fortified corn-soy blend (CSB+) with enzyme-active sorghum malt has the potential to be used as a suitable alternative supplementary porridge in the management of infants and young children (IYC) with moderate acute malnutrition (MAM) in Uganda. Objective: This study aimed to develop acceptable malted sorghum-based supplementary porridge (MSBP) that meets the energy and protein specifications for the management of IYC with MAM, using locally-available ingredients. Methods: MSBP formulations included the use of malted sorghum flour and extruded soy and corn flour. The ratio of the soy to corn ingredients was 3:7 (F617/F593), 1:1 (F892/F940), and 4:1 for CSB+, which is the standard care for the management of IYC with MAM in Uganda. The sorghum malt content for F617/F892 and F593/F940 was 25% and 30%, respectively. F617, F593, F892 and F940 met international specifications for a supplementary porridge. A comparison of the consumer acceptability scores and viscosity levels of these formulations was made, using analysis of variance. Results and Discussion: The scores for flavour, taste, mouth feel, sweetness and overall consumer acceptability differed among the formulations (p Conclusion: Sorghum malt is suitable for the development of an acceptable supplementary porridge (MSBP). It meets the international energy and protein specifications for the management of IYC with MAM, and the F617 formulation meets these specifications.

Background: Inappropriate infant and young child complementary feeding practices related to a lack of maternal knowledge contributes to an increased risk of malnutrition, morbidity, and mortality. There is a lack of data regarding the effect of nutrition education on maternal knowledge, feeding, and hygiene practices as part of a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition in low-income countries like Uganda. Objective: To determine whether nutrition education improves knowledge, feeding, and hygiene practices of mothers with infants and young children diagnosed with moderate acute malnutrition. Methods: A cross-sequential study using a pretest–posttest design included 204 mother–infant pairs conveniently sampled across 24 randomly selected clusters. Weekly nutrition education sessions were embedded in a supplementary porridge intervention for 3 months. Mean scores and proportions for knowledge, feeding, and hygiene practices were determined at baseline and end line. The difference between mean scores at the 2 time points were calculated with the paired t test analysis, while the proportions between baseline and end line were calculated using a z test analysis. Results: Mean scores for knowledge, dietary diversity, and meal frequency were higher at end line compared to baseline ( P < .001). Handwashing did not improve significantly ( P = .183), while boiling water to enhance water quality improved ( P < .001). Conclusion: Nutrition education in conjunction with a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition improved meal frequency, dietary diversity and water quality.

Background There is a paucity of published data regarding maternal socio-demographic characteristics and associated complementary feeding practices of moderately malnourished infants and young children (IYC) in sub-Saharan Africa. In the present study, this association was investigated in Arua, Uganda. Methods A cross-sectional baseline survey was conducted among 204 conveniently sampled mothers of IYC aged 6-18 months with moderate acute malnutrition earmarked for dietary supplementation in four randomly selected sub-counties to determine their socio-demographic characteristics using a validated questionnaire. A 24-h recall was used to evaluate complementary feeding practices in terms of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Associations were determined using multivariate logistic regression analysis. Results The majority (70.1%) of mothers had a primary school education, with 15% having no formal education. Foods especially purchased or prepared for IYC were provided by 42.6% of the mothers. The MDD and MMF of IYC were 13.2% and 41.2%, respectively. MMF and MDD for MAD were met by 6.9% of IYC. Maternal level of education and MMF was significantly associated (P = 0.003), whereas the provision of foods especially purchased or prepared for IYC was significantly associated with MMF (P = 0.003). Maternal care was significantly associated with MAD (P = 0.004). Conclusions Optimal complementary feeding practices were not met by the majority of mothers. Maternal level of education and care of IYC were strong predictors of MMF. Nutrition education and care should be promoted among mothers of IYC with moderate acute malnutrition to improve MDD, MMF and MAD.

HRQOL in transplant candidates and recipients who are also infected with HIV and are awaiting a kidney, or have received one from a HIV-positive donor, has not been previously investigated.The HRQOL of 47 HIV-positive kidney transplant candidates and 21 recipients from HIV-positive donors was evaluated using the Short Form-36 (SF-36) and face to face interviews at baseline and at 6 months. The correlation between SF-36 scores and sociodemographic, clinical and nutritional factors was determined.68 patients completed the SF-36 at baseline and 6 months. Transplant candidates: transplant candidates had lower HRQOL than recipients. The main mental stressors were income, employment and waiting for a donor. Physical health complaints were body pain (BP) and fatigue. Pre-albumin and BMI was positively correlated with general health at baseline (r = 0.401, p = 0.031 and r = 0.338, p = 0.025). Besides a positive association with role physical (RP) and BP, albumin was associated with overall physical composite score (PCS) (r = 0.329, p = 0.024) at 6 months. Transplant recipients: Transplant recipients had high HRQOL scores in all domains. PCS was 53.8 ± 10.0 and 56.6 ± 6.5 at baseline and 6 months respectively. MCS was 51.3 ± 11.5 and 54.2 ± 8.5 at baseline and 6 months respectively. Albumin correlated positively with PCS (r = 0.464, p = 0.034) at 6 months and role emotional (RE) (r = 0.492, p = 0.024). Higher pre-albumin was associated with better RE and RP abilities and MCS (r = 0.495, p = 0.034). MAMC was associated with four domains of physical health and strongly correlated with PCS (r = 0.821, p = 0.000).Strategies to improve HRQOL include ongoing social support, assistance with employment issues and optimising nutritional status.

Little is known about how the use of supplementary foods in the management of children with moderate acute malnutrition (MAM) is perceived by mothers, as well as the barriers they face while using it in Uganda. This study determined maternal perceptions and barriers experienced during the management of children aged 6 to 23 months diagnosed with MAM using either a malted sorghum‐based porridge (MSBP) or fortified corn soy blend (CSB+) as a supplementary porridge. Twelve focus groups and 48 in‐depth interviews were conducted among purposively sampled mothers a week after completing a 3‐month cluster randomised control trial with the two supplementary porridges for the management of their children with MAM in a rural setting of Arua district. All mothers who participated in the trial were eligible for inclusion. Mothers perceived both supplementary porridges as contributing towards weight gain, reducing the prevalence of illness, improving appetite, a healthy skin and improving active play. Barriers to using the supplementary porridges were a lack of time for feeding children due to household chores, maternal hunger as a result of household food insecurity and a lack of social household and community support. Therefore, maternal barriers should be addressed in an attempt to reap maximum benefits from supplementary food interventions for the management of children with MAM, by sensitising household members to the time required to conduct household chores and measure to address food insecurity.

ObjectiveTo investigate the accuracy of arm-associated height estimation methods in the calculation of true height compared with stretch stature in a sample of young South African adults.DesignA cross-sectional descriptive design was employed.SettingPietermaritzburg, Westville and Durban, KwaZulu-Natal, South Africa, 2015.SubjectsConvenience sample (N 900) aged 18–24 years, which included an equal number of participants from both genders (150 per gender) stratified across race (Caucasian, Black African and Indian).ResultsContinuous variables that were investigated included: (i) stretch stature; (ii) total armspan; (iii) half-armspan; (iv) half-armspan ×2; (v) demi-span; (vi) demi-span gender-specific equation; (vii) WHO equation; and (viii) WHO-adjusted equations; as well as categorization according to gender and race. Statistical analysis was conducted using IBM SPSS Statistics Version 21.0. Significant correlations were identified between gender and height estimation measurements, with males being anatomically larger than females (PPConclusionsHeight can be calculated by using arm-associated measurements. Although universal equations for estimating true height exist, for the enhancement of accuracy, the use of equations that are race-, gender- and population-specific should be considered.

Objective: To determine the accuracy of arm-associated anthropometric measurements as estimates of true height.Design: This was a cross-sectional descriptive survey.Setting: The setting was Pietermaritzburg, KwaZulu-Natal, South Africa.Subjects: The study population included a convenience sample (n = 200) of young adults aged 18 to 24 years, which included an equal number (n = 50) of white males and females, and black males and females.Outcome measures: The following measurements were taken in accordance with international standards for anthropometric kinanthropometry: (i) stretch stature; (ii) armspan; (iii) half-armspan; and (iv) demi-span. Adjustment equations used to convert arm-associated measurements to true height included that of the World Health Organization equation, half-armspan multiplied by two and, the demi-span equation.Results: None of the existing height estimation equations accurately predicted true height in the study sample. Significant differences in the accuracy of estimates were also measured between race groups (p < 0.001) and for gender (p < 0.001). In black males the demi-span male-specific equation provided results that did not differ from true height, as was also the case for armspan in white males. Black females and white females had identical outcomes where all height estimates differed significantly from true height.Conclusion: Findings indicate the need for gender and race-specific height estimation methods. It would seem that armspan is suitable for use in white males and demi-span male equation suitable for use in black males. None of the height estimation methods accurately predicted true height in females.Keywords: anthropometry, arm-associated measurements, height estimates, population-specific methodology, stretch stature

Objective: The objective of the study was to make a comparative analysis of the dietary preferences of adolescents attending an urban versus a peri-urban school in KwaZulu-Natal, in order to investigate the association between socio-economic status and food frequency. Design: The design was a cross-sectional descriptive survey. Setting: The setting was an urban and peri-urban high school in Hilton, KwaZulu-Natal. Subjects: One hundred and eleven grade 9-11 learners from a peri-urban school, and 98 grade 9-11 learners from an urban school, volunteered to participate. Outcome measures: A non-quantified food frequency questionnaire was used to assess food frequency. A socio-demographic questionnaire developed for the purpose of this study was utilised to collect information on parental education, employment status and household or accommodation data. A Household Food Insecurity Access Scale questionnaire was used to determine the household food insecurity of the learners. Results: The findings indicated that there was a higher preference for globalised foods (high in fat and sugar), particularly fast food, by learners from the peri-urban school (p-value Conclusion: A high frequency of globalised or energy-dense food intake was associated with low socio-economic status. Although healthy eating habits were generally poor in urban and peri-urban adolescents, food sources varied, possibly owing to cost and availability. The importance of a diverse diet and the inclusion of a wider range of affordable, nutrient-rich foods should be promoted in the school setting, and also to parents, particularly those of a lower socio-economic status.

OBJECTIVES: Developing a profile of weight and health status, body image, eating behavior and psychological well-being of urban overweight/obese Zulu women enrolled in a weight loss intervention. METHODS: Body mass index (BMI) and waist-circumference was determined. The prevalence of metabolic syndrome (MetS) was assessed according to the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. Total energy intake was calculated, based on a three day estimated food record. Eating behavior, presence of depression, self-esteem and general psychological well-being was assessed with the Three-Factor Eating Questionnaire (TFEQ), Beck Depression Inventory (BDI), Rosenberg Self-esteem Scale (RSES), and General Health Questionnaire (GHQ) respectively. RESULTS: The mean ± SD BMI of the group (N = 99) was 37.79 ± 7.47 kg/m(2). The most prevalent MetS risk factor was central obesity, followed by high blood pressure and low HDL levels. MetS was diagnosed in 24% (n = 18) of the group for whom blood samples were available (n = 75). The majority of participants thought that they were currently overweight, however one in ten thought their weight was normal, with a desired BMI being in the overweight range. Daily energy intake was 83% of the Estimated Average Requirement (EAR) for women aged 19–50 years. Depending on the cut-off used, the level of under-reporting ranged from 17.1 to 39.0%. About a quarter of the sample were depressed, with one in ten having a low self-esteem. There were no significant associations between baseline BMI and depression (BDI), self-esteem (RSQ), general psychological well-being and eating behaviour scores (TFEQ). CONCLUSIONS: Potential barriers to compliance with, and remaining in the intervention included a distorted body image, with an underestimation of body weight being the norm. The frequent consumption of high fat foods, energy dense snacks, and a high energy intake over weekends, was documented. Other potential barriers included a low self-esteem and depression. Baseline screening of body image, eating behavior and psychological well being of those enrolled in a weight loss intervention is recommended to curb attrition. FUNDING SOURCES: University of KwaZulu-Natal, Medical Research Council.

OBJECTIVES: An investigation of enabling factors that promote weight loss and barriers to success while enrolled in a weight loss intervention with a duration of 16 weeks. METHODS: An exploratory study design using qualitative research techniques included three focus group discussions and 26 semi-structured in-depth interviews with intervention facilitators (six registered dietitians), participants (26 overweight/obese urban Zulu women enrolled in a weight loss intervention) and non-participants (13 overweight/obese urban Zulu women that have never attempted weight loss). Audio recordings were transcribed verbatim to generate seven qualitative data sets, followed by the development of a coding framework. Microsoft Word files were imported into NVivo software as primary documents for qualitative data analysis. Themes generated by focus group discussions, in-depth interviews and field notes were interpreted in conjunction with available literature. RESULTS: Enabling factors that contributed to enrolment and completion of the weight loss intervention included social support from intervention group members, facilitators, family, friends and colleagues. Other enabling factors included the knowledge gained through intervention facilitators, the weight loss manual used, as well as weight loss. Barriers to weight loss were related to cultural norms of an acceptable body weight, a lack of social support and the stigma associated with weight loss. Other barriers included time constraints, work commitments, family eating habits, an inability to exercise and lack of understanding regarding the concept of increased physical activity to facilitate weight loss, as well as psychological problems such as stress that contribute to an unhealthy lifestyle. CONCLUSIONS: Factors that enable weight loss success include social support, weight loss and knowledge gained in the course of a weight loss intervention. Creating public awareness of the relationship between non-communicable diseases of lifestyle and overweight/obesity among members of the target community through social marketing techniques will not only address the barriers to enrolment in a weight loss intervention, but will increase enrolment and curb drop out. FUNDING SOURCES: University of KwaZulu-Natal, Medical Research Council.

Although standing height is the ideal indicator of a subject’s true height, numerous internal and external factors can have an effect on its accuracy. These factors include measurement error, the clinical environment, growth and a secular change in growth, and age. When the measurement of standing height is not possible estimation methods, such as recumbent length, knee height, ulna length, half arm span, total arm span, demi-span equation and the World Health Organization equation have been used as substitutes. However, the accuracy of these methods is questionable.Keywords: anthropometric measurements, estimates, gender, nutritional status, true height and variability, race

Background Poor hydration compromises performance and heightens the risk of heat stress which adolescents are particularly susceptible to as they produce comparatively larger amount of metabolic heat during exercise. This study determined the hydration status and fluid intake of socio-economically disadvantaged, male adolescent soccer players during training. Methods A pilot study was conducted among 79 soccer players (mean age 15.9 ± 0.8 years; mean BMI 20.2 ± 2.1 kg/m2). Hydration status was determined before and after two training sessions, using both urine specific gravity and percent loss of body weight. The type and amount of fluid consumed was assessed during training. A self-administered questionnaire was used to determine the players’ knowledge regarding fluid and carbohydrate requirements for soccer training. Results Players were at risk of developing heat illness during six of the 14 training sessions (60 - 90 minutes in length). Although on average players were slightly dehydrated (1.023 ± 0.006 g/ml) before and after (1.024 ± 0.007 g/ml) training, some were extremely dehydrated before (24%) and after (27%) training. Conversely some were extremely hyperhydrated before (3%) and after training (6%). The mean percent loss of body weight was 0.7 ± 0.7%. The majority did not consume fluid during the first (57.0%) and second (70.9%) training sessions. An average of 216.0 ± 140.0 ml of fluid was consumed during both training sessions. The majority (41.8%) consumed water, while a few (5.1%) consumed pure fruit juice. More than 90% stated that water was the most appropriate fluid to consume before, during and after training. Very few (5.0%) correctly stated that carbohydrate should be consumed before, during and after training. Conclusions Approximately a quarter were severely dehydrated. Many did not drink or drank insufficient amounts. The players’ beliefs regarding the importance of fluid and carbohydrate consumption did not correspond with their practices. A nutrition education programme is needed to educate players on the importance of fluid and carbohydrate to prevent dehydration and ensure appropriate carbohydrate intake.