Associations between socio-demographic characteristics of pregnant women and birth outcome: The Nutritional status of Expectant Mothers and their newborn Infants study.

BACKGROUND: Low socio-economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio-demographic variables of pregnant women and birth outcome in their offspring. METHODS: This study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio-demographic information were completed on 682 pregnant women in a structured interview. Post-delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio-demographic variables and birth outcome (defined as premature delivery or low length-for-age or low weight-for-length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p-value of <0.15 on bivariate analysis were considered for inclusion in the model. RESULTS: Poor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02-0.67), and higher for women with grade 8-10 (OR 5.84, 95% CI: 1.90-17.91) or grade 10-12 (OR 4.33, 95% CI: 1.50-12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part-time (OR 2.55, 95% CI: 1.10-5.93) versus full-time and/or self-employed. CONCLUSION: Our findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio-demographic risk factors that may impact on birth outcome is recommended.

Diet quality indexes for use during pregnancy: a scoping review.

AIMS: High diet quality is related to better health outcomes in general. During pregnancy, a high-quality diet is of paramount importance to promote optimal maternal and neonatal outcomes. This is a scoping review of research available on diet quality indexes (DQIs) for use during pregnancy that summarizes the DQIs in terms of development, country of origin, population used, components, scoring and weighting of components, and evaluation. Furthermore, the DQIs are discussed narratively to inform and direct the development of improved and country-specific DQIs for pregnancy. METHODS: The EBSCOhost database was used to identify English-language, peer-reviewed articles published between 2000 and 2023, from which 11 publications were identified that describe the development of pregnancy-specific DQIs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews model. RESULTS: Almost all DQIs (n = 9 of 11) were developed in high-income countries, using dietary intake data from food frequency questionnaires. Several DQIs (n = 5 of 11) used the US Healthy Eating Index as basis and modified it in various ways. Almost all DQIs included both foods and nutrients as components (n = 9 of 11), with vegetables being the most commonly included component alone (n = 8 of 11) or combined with fruit (n = 2 of 11). CONCLUSION: Because most DQIs were developed using dietary guidelines, recommendations, and dietary intake data from high-income countries, it is recommended that pregnancy-specific DQIs be developed and validated to reflect the nutrition guidelines for lower-income and culturally diverse countries.

Household food insecurity in South Africa from 1999 to 2021: a metrics perspective.

OBJECTIVE: To review and synthesize studies on household food security in South Africa. DESIGN: Systematic mapping review of metrics (methodological review). SETTING: Electronic databases, including EBSCOHost, Scopus and Web of Science, were searched for studies and reports on household food security in South Africa, reporting household food security published between 1999 and 2021. Searching, selecting and reporting were performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. PARTICIPANTS: South African households. RESULTS: Forty-eight articles reporting on six national surveys (one repeated annually since 2002) and forty sub-national studies meeting the inclusion criteria were selected. Various metrics, with different recall periods and ways of categorizing food security levels, were identified. Surveys that used similar metrics showed that the percentage of South African households that have experienced food insecurity and hunger has decreased over the review period yet remains concerning. However, the multitude of metrics used to assess the different components and levels of food security limits the comparability of the results to evaluate the scope and scale of the problem. CONCLUSIONS: There is growing support for developing multi-variable approaches for food security research in sub-Saharan Africa. Future research should focus on finding the most appropriate combination of complementary metrics that would allow comparable data while holistically capturing food security and providing insight into the causes and consequences.

Impact of a nutrition education intervention on nutrition-related self-efficacy and locus of control among women in Lesotho.

Introduction: Lesotho is one of the poorest countries in the world with high levels of food insecurity and malnutrition. The aim was to evaluate the impact of a nutrition education intervention informed by self-efficacy and locus of control theories among women in Lesotho. Methods: A randomized pre-test-post-test design was adopted to implement a systematically designed nutrition education intervention in women from Maseru and Berea districts in Lesotho. Women from selected villages were randomly assigned to comparison and intervention groups. Baseline and post assessments were conducted before, and 6 months after the intervention. Nutrition-related self-efficacy and locus of control were assessed using a semi-structured knowledge, attitudes, beliefs, and practices (KABP) questionnaire. Results: At baseline, 444 women aged 19-60 years were included. After the intervention, 259 women in the comparison (n = 105) and intervention groups (n = 154) were interviewed. Self-efficacy beliefs that improved significantly in the intervention group but not in the comparison group included increased confidence that they could eat a healthy diet every day [95% CI for the percentage difference (61.5; 76.7)]; an improved ability to secure several healthy foods in the home; increased confidence in engaging in physical activity [95% CI (29.5; 46.6)]; reducing the amount of salt they used in food [95% CI (2.1; 14.0)]; and compiling a budget for food purchases [95% CI (56.1; 72.1)]. Regarding locus of control, the belief in a personal capacity to take charge of one's health through the production and consumption of healthy food improved in the intervention group [95% CI (12.4; 25.0)] but not in the comparison group [95% CI (15.9; 0.4)]. At follow-up, a significantly larger percentage of participants in the intervention group also believed that they could take control of their health and that they could prevent some illnesses by the food they eat. Conclusion: A nutrition education intervention that is systematically planned and framed on selected theories of health behavior improved nutrition-related beliefs in self-efficacy and locus of control.

Reported health, social support, stress and associations with choline intake in pregnant women in central South Africa: the NuEMI study 2018-2019.

BACKGROUND: The health and well-being of pregnant women can influence pregnancy outcomes and are closely associated with social support and experiences of stress. Poor nutrition predisposes to poor health with choline intake affecting pregnancy outcome. This study determined reported health, social support, and stress and how these factors are associated with choline intake in pregnancy. METHODS: A cross sectional study was performed. Pregnant women in their second and third trimesters attending a high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa, were included. Trained fieldworkers obtained information during structured interviews using standardised questionnaires. Logistic regression with backward selection (p < 0.05) was used to select significant independent factors associated with choline intake. Variables with a p-value < 0.15 in bivariate analysis were considered for inclusion in the model. RESULTS: Median age and gestation in the sample (N = 682) were 31.8 years and 32.0 weeks, respectively. Most participants (84.7%) consumed less than the adequate intake (AI) of 450 mg of choline per day. Most participants (69.0%) were either overweight or obese. One in eight participants (12.6%) reported not having anyone that could help them in times of need, more than one third (36.0%) reported having unpayable debt and one in twelve (8.4%) reported experiencing physical abuse by their partners. Normotensive participants and those using anti-retroviral therapy (ART) (thus HIV-infected), were more likely to consume choline in amounts below the AI (p = 0.042 and p = 0.011, respectively). Logistic regression analysis showed that the odds of consuming choline in amounts below the AI were lower for participants that were not using ART versus those using ART, with an odds ratio of 0.53. CONCLUSION: HIV-infected participants were more likely to consume choline in levels below the AI. This vulnerable group should be the focus of targeted efforts to improve choline intake.

The nutritional status of community-dwelling elderly in Lesotho and factors associated with malnutrition.

Objective: The elderly living in Africa are prone to malnutrition which is complicated by the high prevalence of poverty. This study assessed the nutritional status of the elderly and factors associated with malnutrition. Method: In a cross-sectional survey, the nutritional status of 300 participants aged 65 years and older was determined using the Mini Nutritional Assessment (MNA) questionnaire consisting of 18 questions. Socio-demographic data was obtained using a questionnaire. Results: Sixty-six percent were at risk of malnutrition, while 14.6% (n = 44) were malnourished. Participants that did not use electricity as a fuel for cooking versus those that did, had higher odds of being malnourished/ at risk of malnutrition (OR = 1.85 [1.04; 3.31]). Those that did not experience psychological stress or acute disease versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.33 [0.12; 0.90]). Participants that did not perceive nutritional problems versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.18 [0.09; 0.34]). Similarly, those that did not perceive their health status as poor versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.17 [0.08; 0.34]). Discussion: The findings indicate that the elderly with more resources, less stress, and better actual and perceived health were less likely to be malnourished. In such communities, routine screening in the elderly is required to identify those with compromised health and nutritional status.

Nutrigenomics: Perceptions of South African Dietitians and General Practitioners.

Introduction Although investigations into the emerging field of nutrigenomics are relatively limited and more research in this field is required, experts agree that there is potential for it to be incorporated into health care practice. If health care professionals can promote healthy dietary behaviour based on nutrigenomic testing, it can assist in addressing the health consequences of poor diet and lightening the strain on the South African health care system. Methods Registered dietitians (RDs) and general practitioners (GPs) registered with the Health Professions Council of South Africa (HPCSA) who obtained their qualification in South Africa (SA), were eligible to participate in this cross-sectional study. Participants were identified using convenience and snowball sampling. A self-administered electronic survey using EvaSys Software® was completed by those that agreed to participate. Results Nearly all RDs (97.3%), but less than a third of GPs (30.4%), had heard of the term nutrigenomics. Approximately three-quarters of RDs (74.7%) and GPs (73.9%) had or would personally consider undergoing genetic testing. More than forty percent (43.5%) of RDs ranked direct-to-consumer (DTC) genetic testing companies as the most equipped, while 31.8% of GPs ranked RDs as the most equipped to provide patients with nutrigenomic services. Both RDs and GPs ranked similar reasons as 'strongly agree' for why consumers were motivated to make use of nutrigenomic services, which included 'motivated by a desire to prevent or manage disease' (56.7%), 'prevent a disease based on family history' (65.9%), 'control health outcomes based on family history' (54.9%), and 'improve overall health-related quality of life' (48.6%). Cost concerns were reported as the greatest barrier to implementing nutrigenomic services (75.7%). Other barriers included confidentiality issues (47.8%) and moral concerns (37.3%). Greater individualisation of diet prescription (66.5%), stronger foundations for nutrition recommendations (62.4%), and dietary prescriptions that would manage or prevent certain diseases more effectively (59.0%) were all perceived as benefits of including nutrigenomics in practice. Discussion/Conclusion This study identified perceived consumer motivators and barriers that might affect the willingness to seek nutrigenomic services in SA. In addition, the need for more nutrigenomic training opportunities, including the planning of personalised diets based on genetic testing results and interpretation of results was confirmed. However, both RDs and GPs felt that the emerging field of nutrigenomics needs further development before it can be applied effectively in routine private and public health care in SA.

Sociodemographic Indicators, Household Food Security and Associations with Choline Intake in Pregnant Women: The NuEMI Study.

Higher sociodemographic status is associated with adequate nutrient intake and food security. Adequate choline intake is vital during pregnancy to support fetal development. In this cross-sectional study, information was obtained from 682 pregnant women attending an ante-natal clinic in Bloemfontein, South Africa. Sociodemographic indicators that were bivariately significantly associated with a choline intake below the adequate intake level (AI) included a higher household density ratio, no access to own flush toilets at home, household not owning a refrigerator or microwave, as well as a lower level of education. Approximately one-third of participants were severely food-insecure. Logistic regression analysis, adjusted for energy intake, showed that household overcrowding increased the odds of a choline intake below the AI (OR 1.71).

Adherence to the Mediterranean Diet of Pregnant Women in Central South Africa: The NuEMI Study.

Introduction: The Mediterranean diet (MeD) has been shown to have significant health benefits for adults and children. A mother's diet during pregnancy directly impacts the health of her offspring. This study aimed to investigate the adherence to the MeD of pregnant women attending antenatal care at a Regional Hospital in Bloemfontein, South Africa (SA). Methods: A cross-sectional study was conducted on a consecutive sample of 681 pregnant women who attended the antenatal clinic of a Regional Hospital in Bloemfontein. Socio-demographics included: age, highest level of education, household income, employment status, and income stability. Food group intake was assessed with a quantitative food frequency questionnaire. The adapted Mediterranean Diet Adherence Screener (MeDAS) consisted of 13 of the original 14 questions that measured intake of key food groups (score of ⩽7 poor, 8-9 moderate, ⩾10 good) (wine intake was excluded for pregnant women). Results: A total of 681 pregnant women with a median age of 31.8 years (IQR: 26.8-36.5 years) and a median gestational age of 32.0 weeks at the time of the interview participated in the study. The vast majority showed poor adherence to the MeD (99.6%), with only 0.4% (n = 3) having moderate adherence and 0% good adherence. The median adherence score was 5 points and the maximum 8 points. Of those with poor adherence, only 11.5% had tertiary education, 43.2% earned less than R 3000 (<201 USD) per month, 52.5% were unemployed, and 42.0% did not have a stable income in the past 6 months. Of the 3 participants with moderate adherence, all had grade 11 to 12 education, 2 out of the 3 earned more than R3000 (201 USD), one was unemployed, and 2 had a stable income over the past 6 months. Compared to those with an income ⩽ R3000 (⩽201 USD), those with an income above R3000 were significantly more likely to eat nuts (including peanuts) (2.0% vs 4.6%, P = .05), and adhere to sofrito (similar to tomato and onion relish) intake (9.2% vs 15.6%, P = .02). Compared to those who only had a primary education level up to grade 10 (n = 229), those who had a secondary education level or more (grade 11 and higher, n = 452) were significantly more likely to consume enough olive oil per day (1.3% vs 5.0%, P = .01), and to consume sofrito (6.6% vs 18.0%, P = .02). Conclusion: Pregnant participants showed poor adherence to the MeD. Although almost all women fell in the poor adherence group, secondary education contributed to consuming recommended amounts of olive oil and sofrito and higher income was associated with an adequate intake of nuts and sofrito. Based on the findings, we recommend the development of a contextualized MeDAS tool that includes foods that are typically eaten by most South Africans for similar MeD benefits.

Iodine status of pregnant women residing in the urban Free State Province of South Africa is borderline adequate: The NuEMI study.

Adequate iodine nutrition during pregnancy is essential for optimal fetal development and neonatal outcomes. In South Africa, the iodine status of pregnant women, who have increased iodine requirements, is under-researched. We hypothesized that the iodine status of pregnant women in the Free State Province would be inadequate and may differ between urban and rural areas. This cross-sectional study included 430 urban and 187 rural pregnant women visiting antenatal clinics in the Free State. Urinary iodine concentration (UIC) was determined using the modified Sandell-Kolthoff reaction method, and serum thyroglobulin (Tg) was measured using the Q-Plex™ Human Micronutrient Array. Data on self-reported iodized salt use were collected using a questionnaire. Median (IQR) UIC was 155 (96-248) µg/L; 150 (94-235) µg/L in urban and 161 (106-256) µg/L in rural participants (P= 0.27), indicative of adequate iodine status. Median (IQR) Tg was 11.5 (7.1-20.4) µg/L, and was not significantly associated with UIC, even after controlling for maternal age and gestational age (urban P= 0.14; rural P= 0.48). The proportions of pregnant women who reported to use iodized household salt were 81% in urban and 70% in rural areas. Our results show that despite the widespread use of iodized salt, the median UIC of pregnant women residing in the urban Free State Province indicates only borderline adequate iodine status. A national iodine survey including pregnant women is recommended to determine the effectiveness of the South African salt iodization program in light of the current salt reduction policy.

Choline intake and associations with egg and dairy consumption among pregnant women attending a high-risk antenatal clinic in South Africa: the NuEMI study.

BACKGROUND: The importance of adequate choline intake during pregnancy has been well documented, but low intake is common. Total choline intake, main food sources of choline, as well as associations between choline intake and egg and dairy consumption were determined in a sample of pregnant women attending the high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa. METHODS: A cross-sectional study design was used. Trained fieldworkers collected dietary intake data using a validated quantified food frequency questionnaire (QFFQ), after which all food items were matched to foods in the USDA Database for the Choline Content of Common Foods (Release 2) to quantify choline intake. Logistic regression with backward selection (p < 0.05) was used to determine whether egg and dairy consumption were independently associated with a choline intake below the adequate intake (AI) level. RESULTS: The median daily intake of choline was 275 mg (interquartile range 185 mg - 387 mg) (N = 681). Most participants (84.7%) consumed less than the AI of 450 mg/day for choline. Meat and meat products, cereals, eggs and dairy contributed mostly to choline intake. Food items that contributed most to choline intake included full-cream milk, maize porridge, brown bread, deep-fried potatoes and deep-fried dough (vetkoek). A choline intake below the AI was significantly associated with lower egg and dairy intakes (p < 0.0001 and p = 0.0002 respectively). CONCLUSION: Most pregnant women in the current study had choline intakes below the AI. It is recommended that public health messaging targeted at pregnant women promote the consumption of foods that can significantly contribute to choline intake, such as eggs and dairy.

The Impact of a Household Food Garden Intervention on Food Security in Lesotho.

Food insecurity is a challenge in the developing world, where many are finding healthy food inaccessible due to poverty. A pre-test, post-test design was applied to determine the impact of a vegetable gardening intervention in 25 experimental and 25 control households in Lesotho. Information about sociodemographic conditions and indicators of food security was collected by trained fieldworkers. As evidenced by the Living Poverty Index of 2.5, the sample was characterized by high levels of poverty. Although almost no households were scored very low or low using the Months of Adequate Household Food Provisioning (MAHFP) tool, less than half of households were categorized as food-secure. Household Dietary Diversity (HDD) showed infrequent intake of vegetables and fruits and regular intake of fats and sugar. After intervention, the percentage of households with a low HDD score improved significantly in the intervention group (12%) compared to the control group (40%) (95% CI (2.5%; 50.7%)). Despite this, the percentage of households that consumed vegetables during the previous day was still below 30%. Food gardens have the potential to improve availability of food and frequency of vegetable consumption, but harsh environmental conditions need to be considered.

Obesity, undernutrition and the double burden of malnutrition in the urban and rural southern Free State, South Africa.

This study compared the diet and anthropometric status of adults (25-64 years) in rural and urban South Africa. Anthropometric status of adults and preschool children (<7 years old) from the same households were also determined. A descriptive cross-sectional design was applied. All adults from three towns in the rural southern Free State (n = 553) and a stratified proportional cluster sample from urban Mangaung (n = 419) participated. Anthropometric assessments included body mass index and waist circumference. Trained students administered a qualitative food frequency questionnaire in a structured interview with each participant to assess frequency of consumption of foods. The 35 foods that were included were chosen as a measure of protection or predisposition to obesity and non-communicable diseases. The height-for-age, weight-for-age and weight-for-height of 60 rural and 116 urban children were also assessed. Sugar was the most frequently consumed food item, eaten at least twice per day by all groups. Cooked porridge was the most frequently consumed starchy food (range 47.3-53.2 times a month), followed by bread, consumed at a mean frequency of 20 or more times per month in all groups. Tea was the most frequently consumed fluid (used at least once a day by all). Salt and/or stock was used more than once a day, while margarine, oil and other fats were consumed at least once per day. Fruit and vegetables were consumed at a mean frequency of less than once a day, while milk was consumed less than once daily in urban participants and once per day in rural participants. Chicken or eggs were the most frequently consumed protein-rich food (approximately 10 times per month). Overweight/obesity was identified in 65.6% rural and 66.2% urban women. Fewer men (23.3% rural and 16.0% urban) were overweight/obese. More than 66% of stunted, underweight and wasted children lived with an overweight/obese caregiver. Daily consumption of sugar, salt and fats and inadequate frequency of consumption of vegetables, fruits and milk was confirmed in both rural and urban participants. In addition, a double burden of malnutrition was evident.