Perspectives from South African dietitians on infant and young child feeding regulations.

OBJECTIVE: This study aimed to determine the knowledge, perceptions and practices of dietitians in South Africa regarding the Regulations Relating to Foodstuffs for Infants and Young Children (R991). DESIGN: A mixed methods, cross-sectional design was used. SETTING: Quantitative data were collected using an online survey (n 282) and qualitative data by means of two focus group discussions (n 12). PARTICIPANTS: Participants were dietitians registered with the Health Professions Council of South Africa. RESULTS: Dietitians' average knowledge score was 64·8 % ± 12·5. Those working in infant and young child feeding had a 5 % higher knowledge score (95 % CI 1·4, 8·6, P = 0·01). Perceptions towards the Regulations were generally positive, and the majority of practices were compliant. Positive perceptions seemed to correlate with compliant practices. The most frequently selected enabler to the implementation of the Regulations was 'Increase in other initiatives which support, protect and promote breastfeeding', and the most frequently selected barrier was 'Lack of awareness of the Regulation among health care providers'. The major themes from the focus group discussions comprised: less knowledge among dietitians and mothers about products controlled under the Regulations, non-compliance of other health care providers, the dietitians' role in support and enforcement, the discrepancy between practice in private and public sectors and a lack of enforcement. CONCLUSIONS: South Africa has taken a bold step in legislating the International Code of Marketing of Breast-milk Substitutes and should upscale programmes to ensure consistent monitoring and enforcing of the Regulations.

The development of a single health-endorsement logo for South Africa.

OBJECTIVE: To develop health-endorsement logos (HEL) for food products indicating healthy choices based on the South African nutrient profile model and to pilot test these logos with consumers. DESIGN: Multistage mixed-methods design. SETTING: Cape Town, South Africa. SUBJECTS: Nine focus group discussions (FGD) were conducted with adult consumers to explore what types of HEL are preferred and why. Based on the findings, ten HEL were designed by a graphic design team. A modified Delphi technique, conducted with experts in the fields of nutrition and food science, was employed to eliminate lowest-scoring HEL and to improve the design of the remaining logos. Participants from the initial FGD participated in pilot testing the improved logos. RESULTS: Participants from FGD (n 67) were positive about a single HEL, stating it would make food labelling less confusing as they did not understand the various HEL used. Participants indicated the logo should include wording related to 'healthy choice' or 'better choice' and pictures/symbols related to health and/or food. During two rounds of scoring and comments by experts (n 19), five logos were eliminated and the design of the remaining five improved. Three of five remaining logos received overall rankings of 3·08/5, 3·28/5 and 3·39/5, respectively, during FGD (n 36) in the pilot-testing phase. CONCLUSION: HEL were designed and consumer tested. Three designs were submitted to the national Department of Health to consider for implementation, after further testing, as a tool to assist in addressing the high incidence of non-communicable diseases in South Africa.

The provision of healthy food in a school tuck shop: does it influence primary-school students' perceptions, attitudes and behaviours towards healthy eating?

OBJECTIVE: To investigate students' tuck shop buying behaviour, choices of lunchbox items and healthy eating perceptions and attitudes at a school with a nutritionally regulated tuck shop and a school with a conventional tuck shop. DESIGN: Mixed-methods research comprising a cross-sectional survey and focus groups. SETTING: Bloemfontein, South Africa. SUBJECTS: Randomly selected grade 2 to 7 students from a school with a nutritionally regulated tuck shop (school A; n 116) and a school with a conventional tuck shop (school B; n 141) completed a self-administered questionnaire about perceptions, attitudes, buying behaviours and lunchbox content. Six students per grade (n 72) in each school took part in focus group discussions to further explore concepts pertaining to healthy eating. RESULTS: In school A, older students had a negative attitude towards their 'healthy' tuck shop, while younger students were more positive. School B students were positive towards their conventional tuck shop. In both schools students wanted their tuck shop to allow them to choose from healthy and unhealthy items. School A students mostly bought slushies, iced lollies and baked samoosas, while school B students mostly bought sweets and crisps. The lunchboxes of school A students contained significantly (P<0·05) more healthy items but also significantly more unhealthy items. CONCLUSIONS: A single intervention such as having a nutritionally regulated tuck shop at a primary school cannot advance the healthy school food environment in its totality. A multi-pronged approach is recommended and awareness must be created among all role players, including parents who are responsible for preparing lunchboxes.

A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting.

BACKGROUND AND OBJECTIVES: Nausea and vomiting during pregnancy (NVP) occur commonly. Possible harmful side-effects of conventional medicine to the fetus create the need for alternative options to relieve NVP. This systematic review (SR) investigated current evidence regarding orally administered ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy. METHODS: A comprehensive electronic bibliographic database search was carried out. Randomized controlled trials (RCTs) of the efficacy of orally administered ginger, as treatment for NVP in pregnant women at any stage of pregnancy, published in English, were included. Two researchers independently extracted data and assessed trial quality. RevMan5 software (Cochrane Collaboration) was used for data analysis. p < 0.05 was considered statistically significant. RESULTS: Twelve RCTs involving 1278 pregnant women were included. Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I² = 0%). Ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p = 0.06, I² = 71%). Subgroup analyses seemed to favor the lower daily dosage of <1500 mg ginger for nausea relief. Ginger did not pose a significant risk for spontaneous abortion compared to placebo (RR 3.14, 95% CI 0.65-15.11, p = 0.15; I² = 0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p = 0.19, I² = 40%). Similarly, ginger did not pose a significant risk for the side-effects of heartburn or drowsiness. CONCLUSIONS: This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and low quality of evidence). Ginger did not significantly affect vomiting episodes, nor pose a risk for side-effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42011001237.

Mobile health apps: An assessment of needs, perceptions, usability, and efficacy in changing dietary choices.

OBJECTIVE: The aim of this study was to explore the use of mobile health applications as dietary self-monitoring tools, and their possible role in improving food choices. METHODS: This descriptive, cross-sectional study used self-administered surveys conducted among students (aged 18-25 y) and consisted of two phases. Phase 1 (N = 991; 65.9% women; mean age: 20.78 ± 1.51 y) assessed the need for and perceptions of mobile health applications to serve as dietary assessment tools. Phase 2 (N = 61; 75.4% women) comprised a 3-wk period of using MyFitnessPal; its corresponding survey assessed the application's usability and perceived efficacy in changing dietary choices. Dietary Instrument for Nutrition Education scores (part of both surveys), assessing dietary intake, were compared using a paired t test. P < 0.05 was considered statistically significant. RESULTS: Most participants wanted to improve their diet to be healthier (89.7%) and to improve their weight (74.2%), and actively searched for information on how to accomplish this (55.7%). MyFitnessPal was reported to be easy to use (93.4%); however, difficulties were experienced in the selection of food items (39.3%) and portion sizes (63.9%). Users reported that MyFitnessPal helped them change their dietary intake (91.8%) and advance toward their personal weight and health goals (65.6%). A significant reduction in high-sugar food intake after the use of MyFitnessPal (P = 0.03) was found. CONCLUSION: Most participants searched for information on how to improve their diet. MyFitnessPal, a mobile health app with a diet-tracking feature, was reported to be helpful in changing dietary intake; furthermore, use of the application over a 3-wk period led to a significant reduction in sugary food intake.

Taxation of sugar-sweetened beverages in South Africa: Perspectives of consumers in Cape Town.

Background: Globally, fiscal measures are deemed effective in combating the obesity epidemic at population level. A health promotional levy (HPL) on sugar sweetened beverages (SSBs) was implemented in April 2018 in South Africa to reduce sugar consumption. Design and methods: This cross-sectional, descriptive study investigated consumers' understanding and opinion of the HPL, and impact on consumption of SSBs. Data was collected outside 15 grocery stores, within four health sub-districts of the City of Cape Town. An interviewer-administered questionnaire was completed with literate, adult consumers (N = 696). Results: Participants (46.0%) were aware of the HPL but regarded it insufficient to change purchasing behaviour (55.4%). The lower income group (56.4%) was most affected by the increased price of SSBs. Those who agreed (46.8%) that the levy would help to reduce the prevalence of obesity was significantly more likely to notice a price increase in SSBs (54.5%) (p < 0.01) and had a higher education level (p < 0.01). Overall, self-reported consumption of SSBs decreased by 7.7% since the HPL was enacted. Participants who were aware of the detrimental effect of consuming large amounts of sugar, were more likely to change their behaviour (p < 0.01). Conclusions: Participants were receptive for legislative measures to combat the prevalence of obesity but lacked clarity of the goal and implementation of the HPL. A multipronged approach is crucial to lower sugar intake sustainably and an environment which offers healthy alternatives to SSBs. A higher HPL combined with transparency of how revenue is utilised could enhance the impact of the sugar tax strategy.