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1.
Nutrients ; 11(9)2019 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-31480222

RESUMEN

This study aims to determine the prevalence of risk of malnutrition on admission and discharge in African hospitals, and to identify the association with selected indicators. In this multi-center prospective cohort study, adult patients from hospitals in South Africa, Kenya, and Ghana were screened on admission and discharge and contacted 3 months post-discharge. Relevant morbidity and mortality outcomes were assessed. At risk of malnutrition was indicated if NRS-2002 score ≥3. Adult patients (n = 2126; 43.11 years, IQR: 31.95-55.60; 52.2% female) were screened on admission and 61% were identified as at risk of malnutrition. The proportion of at-risk patients for the three hospitals in Kenya and Ghana (66.2%) were significantly higher than that of the three South African hospitals (53.7%) (Chi2 = 31.0; p < 0.001). Discharge risk of malnutrition was 71.2% (n = 394). Mean length of stay (LOS) was 6.46 ± 5.63 days. During hospitalization, 20.6% lost ≥5% body weight, 18.8% were referred for nutrition support, and discharge BMI (23.87 ± 7.38 kg/m2) was significantly lower than admission BMI (24.3 ± 7.3 kg/m2) (p < 0.001). Admission nutrition risk was associated with lower admission and discharge BMI (p < 0.001), longer LOS (p < 0.001), increased 3-month re-admission rates (Chi2 = 1.35; p = 0.245) and increased mortality (Chi2 = 21.68; p < 0.001). Nearly two-thirds of patients were at risk of malnutrition on admission. This was associated with longer LOS and greater hospital mortality. The nutritional status of patients deteriorated during hospitalization. Routine screening practices with appropriate nutrition support action should be implemented as a matter of urgency.

2.
Artículo en Inglés | MEDLINE | ID: mdl-31126144

RESUMEN

The promotion and support of human milk banks (HMBs) can enhance exclusive breastfeeding rates. The success and sustainability of HMBs depend on the support from relevant healthcare workers and related communities. This study aimed to determine attitudes of key stakeholders, including mothers, healthcare workers and grandmothers, regarding the donation and receipt of human breastmilk. This study was conducted at a public hospital and clinics in the North West Province, South Africa. Eight focus group discussions explored the attitudes regarding donating and receiving human breastmilk: three groups with mothers of infants (n = 13), three with grandmothers (>60 years old) (n = 17) and two with healthcare professionals working with infants (n = 11). Four main themes emerged: perception regarding breast and formula feeding; exposure to the concept of "wet nursing"; breastmilk donation; and utilization and opinions of community members and traditional healers. Specific barriers identified included the processes for donating and receiving milk, safety, human immuno-deficiency virus (HIV) screening and cultural beliefs. Mothers' fears included having insufficient milk for their own infants, changes in the quality of donated milk during pasteurization and transportation and HIV transmission. Despite barriers towards donations to and the use of HMBs, sufficient information could enhance donations by mothers and breastmilk utilization.


Asunto(s)
Abuelos/psicología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Bancos de Leche , Leche Humana , Madres/psicología , Adulto , Lactancia Materna , Femenino , Grupos Focales , Infecciones por VIH/transmisión , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Sudáfrica
3.
J Interprof Care ; 33(3): 298-307, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30777493

RESUMEN

The need for interprofessional education (IPE) in health science disciplines is a current global trend. However, despite international support and demand, IPE is still new to many health professions curricula in South Africa. Furthermore, while ample existing academic literature addresses commonly encountered barriers to IPE, there is still a need to investigate the dynamics and challenges associated with the process of implementing IPE at universities. IPE is not yet part of the formal curriculum at a faculty of health sciences at a South African Higher Education Institute, so a pilot project was conducted to investigate the experiences of an IPE process by students from different health professions toward informing the planning and implementation of IPE in the formal curriculum. To this effect, a multi-layered IPE project was piloted across pharmacy, nursing, social work, psychology, dietetics, and human movement sciences within this Faculty of Health Sciences. The aim of this research was to determine the dynamics between the different health professions by exploring and describing the students' experiences of the IPE process. Theoretical case studies were presented to third-year students, who were grouped into interprofessional teams from the six different health professions at the Higher Education Institute's health sciences faculty. Data were gathered from reflective journals over a five-week period and a questionnaire was administered at the end of the project. Data were analysed and evaluated based on the interprofessional learning domains listed in the IPE framework of the World Health Organization. All participating health professions students felt positive about the project and agreed that it provided them with valuable IPE experiences. However, their long-term participation and commitment presented difficulty in an already demanding curriculum. The interprofessional dynamics were influenced by the relevance of the scenarios presented in the case studies to the different professions, the students' personalities and their previous experiences. Although the nursing students took initial leadership, contributions from the other professions became more prominent as the case studies unfolded. The findings indicated that the inclusion of different health professions in an interprofessional team should be guided by the specific scenarios incorporated to simulate interprofessional cooperation. The availability of the students and their scope of practice at third-year level should also be taken into account.


Asunto(s)
Empleos en Salud/educación , Relaciones Interprofesionales , Curriculum , Proyectos Piloto , Estudiantes del Área de la Salud , Encuestas y Cuestionarios
4.
Matern Child Nutr ; 15(2): e12722, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30316202

RESUMEN

Child mortality is a major public health problem in sub-Saharan Africa and is influenced by nutritional status. A conceptual framework was proposed to explain factors related to undernutrition. Previously proposed conceptual frameworks for undernutrition do not consider child mortality and describe factors related to undernutrition from a qualitative viewpoint only. A structural equation modelling approach was applied to the data from World Bank and FAO databases collected from over 37 sub-Saharan countries from 2000 to the most recent update. Ten food groups, exclusive breastfeeding, poverty and illiteracy rates, and environmental hygiene were investigated in relation to underweight, stunting, low birthweight, and child mortality. Standardized beta coefficient was reported, and graphical models were used to depict the relations among factors related to under-five mortality in sub-Saharan Africa. Child mortality in sub-Saharan Africa ranged between 76 and 127 × 1,000. In the same period, low birthweight rate was about 14%. Poverty and illiteracy are confirmed to affect health resources, which in turn influenced nutritional status and child mortality. Among nutritional factors, exclusive breastfeeding had a greater influence than food availability. Low birthweight, more than underweight and stunting, influenced child mortality. Structural equation modelling is a suitable way to disentangle the complex quantitative framework among factors determining child mortality in sub-Saharan Africa. Acting on poverty at the base appear to be the more effective strategy along with improvement of breastfeeding practice and improvement of hygiene conditions.


Asunto(s)
Mortalidad del Niño , Trastornos de la Nutrición del Niño/epidemiología , Encuestas Nutricionales/estadística & datos numéricos , Estado Nutricional/fisiología , África del Sur del Sahara/epidemiología , Preescolar , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Masculino , Encuestas Nutricionales/métodos , Factores Socioeconómicos
5.
Public Health Nutr ; : 1-9, 2018 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-30526721

RESUMEN

OBJECTIVE: To determine undernutrition prevalence in 0-59-month-old children and its determinants during the period 2000-2015 in sub-Saharan Africa. DESIGN: Ecological study of time series prevalence of undernutrition in sub-Saharan Africa assessed from 2000 to 2015. SETTING: Underweight and stunting prevalence from the World Bank database (2000-2015) were analysed. Mixed models were used to estimate prevalence of underweight and stunting. Country-specific undernutrition prevalence variation was estimated and region comparisons were performed. A meta-regression model considering health and socio-economic characteristics at country level was used to explore and estimate the contribution of different undernutrition determinants.ParticipantsCountries of sub-Saharan Africa. RESULTS: During 2000-2015, underweight prevalence in sub-Saharan Africa was heterogeneous, ranging between 7 and 40 %. On the other hand, stunting prevalence ranged between 20 and 60 %. In general, higher rates of underweight and stunting were estimated in Niger (40 %) and Burundi (58 %), respectively; while lowest rates of underweight and stunting were estimated in Swaziland (7 %) and Gabon (21 %). About 1 % undernutrition prevalence reduction per year was estimated across sub-Saharan Africa, which was not statistically significant for all countries. Health and socio-economic determinants were identified as main determinants of underweight and stunting prevalence variability in sub-Saharan Africa. CONCLUSIONS: Undernutrition represents a major public health threat in sub-Saharan Africa and its prevalence reduction during the period 2000-2015 was inconsistent. Improving water accessibility and number of medical doctors along with reducing HIV prevalence and poverty could significantly reduce undernutrition prevalence in sub-Saharan Africa.

6.
Nutr J ; 15(1): 73, 2016 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-27485319

RESUMEN

BACKGROUND: Not only is glutamine deficiency an independent predictor of mortality in intensive care unit (ICU) patients, but glutamine supplementation is also recommended for its proven outcome benefits. However, recent data suggest that early glutamine supplementation in certain patient groups increase mortality. The aim of this study was to investigate plasma glutamine levels of adult ICU patients in the South African setting and to determine relationships between glutamine levels, gender, diagnostic categories and selected inflammatory markers. The data from this study will be used as baseline measurement to support a large scale study that will be undertaken in the South African ICU population. METHODS: This cross-sectional, analytical study included 60 mixed adult ICU patients within 24 h post ICU admission. Plasma glutamine levels were determined on admission. The relationship between glutamine levels, Interleukin-6 (IL-6) and C-reactive protein (CRP); as well as gender- and diagnosis-related differences in glutamine levels were also investigated. A non-parametric ROC curve was computed to determine the CRP concentration cut-off point above which glutamine becomes deficient. RESULTS: The median plasma glutamine level (497 µmol/L) was in the normal range; however, 38.3 % (n = 23) of patients had deficient (<420 µmol/L) and 6.7 % (n = 4) had supra-normal glutamine levels (>930 µmol/L). No significant difference could be detected between glutamine levels and gender or diagnosis categories as a group. When only the medical and surgical categories were compared, the median plasma glutamine level of the medical patients were significantly lower than that of the surgical patients (p = 0.042). Glutamine showed inverse associations with CRP levels (r = -0.44, p < 0.05) and IL-6 concentrations (r = -0.23, p = 0.08). A CRP cut-off value of 95.5 mg/L was determined above which glutamine levels became deficient. CONCLUSIONS: About a third of patients (38 %) were glutamine deficient on admission to ICU, whereas some presented with supra-normal levels. While glutamine levels correlated inversely with inflammatory markers, and a CRP value of above 95.5 mg/L indicated potential glutamine deficiency, the clinical application of this finding needs further investigation.


Asunto(s)
Glutamina/deficiencia , Unidades de Cuidados Intensivos , Adulto , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Cuidados Críticos , Estudios Transversales , Femenino , Glutamina/sangre , Humanos , Inflamación/sangre , Interleucina-6/sangre , Masculino , Sudáfrica
7.
Nutrients ; 6(11): 5034-50, 2014 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-25393688

RESUMEN

Inflammation, as indicated by C-reactive protein concentrations (CRP), is a risk factor for chronic diseases. Both genetic and environmental factors affect susceptibility to inflammation. As dietary interventions can influence inflammatory status, we hypothesized that dietary effects could be influenced by interactions with single nucleotide polymorphisms (SNPs) in the CRP gene. We determined 12 CRP SNPs, as well as various nutrition status markers in 2010 black South Africans and analyzed their effect on CRP. Interactions were observed for several genotypes with obesity in determining CRP. Lipid intake modulated the pro-inflammatory effects of some SNPs, i.e., an increase in both saturated fatty acid and monounsaturated fatty acid intake in those homozygous for the polymorphic allele at rs2808630 was associated with a larger increase in CRP. Those harboring the minor alleles at rs3093058 and rs3093062 presented with significantly higher CRP in the presence of increased triglyceride or cholesterol intake. When harboring the minor allele of these SNPs, a high omega-6 to -3 ratio was, however, found to be anti-inflammatory. Carbohydrate intake also modulated CRP SNPs, as HbA1C and fasting glucose levels interacted with some SNPs to influence the CRP. This investigation highlights the impact that nutritional status can have on reducing the inherent genetic susceptibility to a heightened systemic inflammatory state.


Asunto(s)
Proteína C-Reactiva/genética , Inflamación/genética , Estado Nutricional , Adulto , Grupo de Ascendencia Continental Africana/genética , Alelos , Glucemia/metabolismo , Presión Sanguínea , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Ingestión de Energía , Ácidos Grasos Insaturados/administración & dosificación , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Genotipo , Hemoglobina A Glucada/análogos & derivados , Hemoglobina A Glucada/metabolismo , Humanos , Estilo de Vida , Persona de Mediana Edad , Actividad Motora , Evaluación Nutricional , Obesidad/genética , Polimorfismo de Nucleótido Simple , Estudios Prospectivos , Factores de Riesgo , Sudáfrica , Triglicéridos/sangre
8.
Public Health Nutr ; 17(8): 1706-16, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23952977

RESUMEN

OBJECTIVE: Urbanization is generally associated with increased CVD risk and accompanying dietary changes. Little is known regarding the association between increased CVD risk and dietary changes using approaches such as diet quality. The relevance of predefined diet quality scores (DQS) in non-Western developing countries has not yet been established. DESIGN: The association between dietary intakes and CVD risk factors was investigated using two DQS, adapted to the black South African diet. Dietary intake data were collected using a quantitative FFQ. CVD risk was determined by analysing known CVD risk factors. SETTING: Urban and rural areas in North West Province, South Africa. SUBJECTS: Apparently healthy volunteers from the South African Prospective Urban and Rural Epidemiological (PURE) study population (n 1710). RESULTS: CVD risk factors were significantly increased in the urban participants, especially women. Urban men and women had significantly higher intakes of both macro- and micronutrients with macronutrient intakes well within the recommended CVD guidelines. While micronutrient intakes were generally higher in the urban groups than in the rural groups, intakes of selected micronutrients were low in both groups. Both DQS indicated improved diet quality in the urban groups and good agreement was shown between the scores, although they seemed to measure different aspects of diet quality. CONCLUSIONS: The apparent paradox between improved diet quality and increased CVD risk in the urban groups can be explained when interpreting the cut-offs used in the scores against the absolute intakes of individual nutrients. Predefined DQS as well as current guidelines for CVD prevention should be interpreted with caution in non-Western developing countries.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Dieta/efectos adversos , Conducta Alimentaria , Evaluación Nutricional , Política Nutricional , Población Urbana , Urbanización , Adulto , Dieta/normas , Ingestión de Energía , Femenino , Humanos , Masculino , Micronutrientes/administración & dosificación , Valores de Referencia , Factores de Riesgo , Factores Sexuales , Sudáfrica , Encuestas y Cuestionarios
9.
Public Health Nutr ; 11(9): 946-54, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18005486

RESUMEN

OBJECTIVES: To investigate the beliefs of South African metropolitan adults regarding the importance of influencing cardiovascular health by eating certain food types, and to compare these beliefs between different race, living standards, age and gender groups. DESIGN: Randomised cross-sectional study. Trained fieldworkers administered questionnaires by conducting face-to-face interviews with consumers. SUBJECTS: Two thousand South Africans (16 years and older) were randomly selected from metropolitan areas in South Africa. The data were weighted to be representative of the total South African metropolitan population (N = 10695000) based on gender, age and race distribution. RESULTS: The majority (94%) of the population indicated that it is important to influence cardiovascular risk-related health issues by eating certain food types, especially the higher LSM (Living Standard Measure) groups within the different race groups. Weight loss was considered the least important (61% indicated that it is important) compared with cholesterol lowering (80%), blood pressure (89%), diabetes (86%) and healthy blood vessels (89%). In the higher LSM groups (7-10) higher proportions of respondents agreed than in the lower LSM groups (2 and 3). No differences were seen in responses between different gender, race and age groups. CONCLUSIONS AND RECOMMENDATIONS: This study shows that the metropolitan South African adult population considers the influence on cardiovascular health by eating certain food types to be important. However, modifying weight loss by eating certain food types was considered less important.


Asunto(s)
Enfermedades Cardiovasculares/psicología , Grupos Étnicos , Conocimientos, Actitudes y Práctica en Salud , Fenómenos Fisiológicos de la Nutrición/fisiología , Pérdida de Peso/fisiología , Adolescente , Adulto , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/prevención & control , Estudios Transversales , Encuestas sobre Dietas , Grupos Étnicos/psicología , Femenino , Alimentos Orgánicos , Indicadores de Salud , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Sudáfrica , Encuestas y Cuestionarios
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