Development of a workplace breastfeeding support practice model in South Africa.

BACKGROUND: Globally, mothers have identified work as one of the main obstacles to exclusive and continued breastfeeding. The support a woman receives in her workplace in terms of workplace arrangements can be critical to enable women to continue breastfeeding. This study aimed to develop and assess the face validity of a practice model to support exclusive and continued breastfeeding in workplaces in the Western Cape, South Africa. METHODS: An explanatory, sequential, mixed-method research design, was conducted (June 2017 to March 2019) in three distinct phases. Phase one employed a quantitative, descriptive, cross-sectional study design. Phase 2 used a qualitative, multiple case study. Phase three involved the development and face validity of a practice model to support exclusive breastfeeding in workplaces. The face validity included two Delphi rounds for experts to provide input on the draft practice model. This paper will only report on phase 3 of the study. The practice model was developed, drawing on the analysis of data from phases one and two and using programme theory approaches and a logic model. RESULTS: The practice model was positively perceived. Participants viewed it as informative, well designed and easy to follow, even for those not knowledgeable about the subject. It was viewed as an ideal tool, if accompanied by some training. Participants were positive that the model would be feasible and most commended the tiered approach to implementation. They felt that workplaces would be more open to a step-by-step approach to implementation and if only a few activities are implemented it would be a start to make the work environment more conducive for breastfeeding employees. There were mixed opinions regarding commitment; a few participants mentioned commitment as a challenge they anticipated in the male-dominant environments in which they worked. The provision of space for breastfeeding at the workplace was also highlighted as a potential challenge. CONCLUSIONS: Advocacy around creating an enabling workplace environment for breastfeeding is needed. The practice model has the potential to be internationally relevant, locally applied and may be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support.

Effects of Cucurbita Moschata squash (Butternut) seed paste in improving zinc and iron status in children attending Early Childhood Development centres in Limpopo province, South Africa.

Cucurbita moschata (Butternut squash) seeds are a rich source of nutrition containing nutrients including iron, zinc, copper, calcium, potassium, and phosphorus. The aim of this study was to determine if Cucurbita Moschata squash seed paste improves zinc and iron status, anthropometric status, and dietary intake in preschool children. A pretest-posttest control group trial using cluster randomisation was conducted over 6 months. Four preschools were randomly assigned to receive 100 g of intervention or 100 g of a placebo as the control to enhance iron and zinc status. A total of 276 preschool children were recruited from eight government registered Early Childhood Development centres in Limpopo province, South Africa. The control group consumed Cucurbita moschata flesh twice-weekly, while the intervention group consumed Cucurbita moschata seed paste twice-weekly during a six-month period. Iron (serum iron, transferrin, transferrin saturation, ferritin) and zinc (serum zinc) status and anthropometric indices such as weight, height and mid upper arm circumference for children were evaluated at baseline and the endpoint. Iron and zinc-rich food consumption was measured using a 24-hour dietary recall and food record during the study, and dietary intake was estimated using a food frequency questionnaire which was conducted at the beginning and endpoint. The intervention group significantly improved in the mean serum iron 0.23 µg/dL (95% CI: 0.11;0.33); ferritin 0.21µg/dL (95% CI: 0.13;0.39), transferrin saturation 0.33% (0.23;0.74) and zinc 0.16 µmol/dl (95% CI: 0.13;0.25) at the end of the study. In addition, the intervention group exhibited greater mean weight for age of 0.13 z-score (95% CI: 0.28; 0.34) and weight for height of 0.04 z-score (95% CI: 0.12,0.05), as well as the consumption of iron (p < 0,001), zinc (p < 0,001), and vitamin C (p < 0.001). At the end of the trial, fiber (p < 0.001), riboflavin (p = 0.001), vitamin B6 (p < 0.001), and vitamin B12 (p < 0.001) were significantly higher in the control group. Thus, the inclusion of intervention in the diet of children in an impoverished area of South Africa improved the iron and zinc status of these children. This supplement could be a cost effective and sustainable approach to improve nutrient status in rural South Africa. Trial registration: Pan African Clinical Trial Registry (PACTR202308740458863).

Designing a Contextualized Food-Based Strategy to Improve the Dietary Diversity of Children in Rural Farming Households in Central Uganda.

BACKGROUND: Food-based strategies have a high potential of improving the diet quality and reducing the prevalence of nutrient deficiencies in agriculture-dependent communities. Their design is however complex with trade-offs that are rarely systematically presented to allow replication and efficient contextualization. OBJECTIVE: The systematic design of a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. METHODS: The intervention mapping protocol was used to provide a systematic approach to developing theory-based and evidence-based intervention methods and strategy. RESULTS: The priority behavioral and environmental determinants identified were related to food production, consumption, and efficacy while the personal determinants focused on knowledge, skills, self-efficacy, attitude, and outcome expectations. The aim of the resulting strategy was set to improve the availability, accessibility, and consumption of diverse foods, with a particular focus on production diversity, production practices, market access, and market diversity. Behaviour change methods were selected to enhance ability and self-efficacy, strategic goal setting, and provision of feedback. The strategy focused on household groups for learning, demonstration, practice, and social support. The validation showed that the determinants and actors incorporated in the strategy were important and relevant for improving the productivity, food availability, dietary diversity, livelihoods, and health of rural farming households and communities. CONCLUSION: Application of the protocol yielded a contextualized food-based strategy that can be adjusted for use in other smallholder contexts in developing countries by piloting implementation plans based on the strategy; reassessing the key determinants and implementing the revised strategy; or replicating the whole design process.

Plain language titleDesigning a Food-Based Strategy to Improve the Dietary Diversity of Children in Farming Households in Central UgandaPlain language summaryFood-based strategies have a high potential of improving the diet quality of communities that depend on agriculture for their food and livelihoods. However, the design of food-based strategies is complex and rarely systematically presented to allow replication and efficient contextualization. The intervention mapping protocol was used to systematically design a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. Through this process, the main factors influencing dietary diversity were identified. The factors were related to food production and consumption, knowledge, skills, self-assuredness, attitude, and the expected outcomes. The developed strategy was designed to improve the availability, accessibility, and consumption of diverse foods. The strategy mainly focused on the diversity of foods produced by households, the production practices used, household access to markets, and the diversity of foods available in these markets. Household groups were central to the selected behavior change methods as they would provide an environment for learning, demonstration, practice, and provide social support. The strategy and its development process can be used as per the implementation plan or further adjusted for use in other smallholder settings in developing countries.

A Qualitative Exploratory Study of the Political Commitment for Nutrition Programming: A Case Study of Anambra and Kebbi States of Nigeria.

In Nigeria, varying levels of malnutrition across states present a critical challenge to public health, demanding tailored policy responses. This paper delves into the specific issues and dynamics influencing nutrition programs in the country. Advocating for nutrition-sensitive actions requires analyzing context-specific political commitment. This article presents a case study on two Nigerian states with varying malnutrition profiles to explore the political economy of nutrition. The study used stakeholder analysis, in-depth interviews, and semi-structured interviews through workshops, incorporating the Political Commitment Rapid Assessment Tool. The objective was to measure political commitment, the window of opportunity for action, and stakeholder analysis. The results showed that despite having a significant child malnutrition problem, Kebbi State received a high political commitment to nutrition, with proportions ranging from 0.67 to 1 in each of the six domains measured. On the other hand, Anambra State, where malnutrition was less severe, had varying commitment levels. Institutional commitment was marginally high (0.67), expressed commitment was high (0.71), and budgetary commitment was lower at 0.33. Kebbi had better support for programs dependent on foreign donors than Anambra. Both states need to use media to increase awareness about nutrition issues. When the nutrition situation is severe, foreign donors' influence grows. In conclusion, there are opportunities for strategic framing and advocacy of the nutrition profile of the states. Local state media can be effective, and institutional coordination committees that include various sectors already facilitate commitment to nutrition actions. However, individual, uncoordinated sectoral action can counterbalance the benefits of these committees. Further possibilities to generate political commitment for nutrition in the states are available. This study not only offers insights into the effectiveness of political strategies in addressing malnutrition but also lays the groundwork for future research and provides actionable recommendations for government policymaking.

The Influence of Household and Community Food Environments on Food Insecurity in Limpopo Province, South Africa.

Insufficient access to enough quality food remains a public health challenge in South Africa. This study aimed to report the influence of community and the household environment, food system inventories, and food procurement on household food security. The findings alluded that food insecurity is prevalent among the rural areas in South Africa. Large household sizes and a limited access to and use of water and food storage facilities for food preservation are the major household determinants. A multi-sectoral nutrition-planning approach that accelerates the achievement of the Sustainable Development Goals should be reinforced. We recommend the promotion of food production for consumption in rural communities.

Knowledge, Perception and Consumption of Indigenous Foods in Gauteng Region, South Africa.

Urbanisation in South Africa has led to a nutritional transition from traditional diets (mainly based on indigenous foods) to a Western diet. Currently, the country is one of the most concerned about the prevalence of associated malnutrition and non-communicable diseases. One should, therefore, question the position of indigenous foods (IFs) in the population's eating habits since their nutritional and health value is known. This study aimed to collect updated data on South Africans' true awareness and consumption of indigenous foods, especially in the Gauteng region (the most urbanised province of the country). A quantitative cross-sectional research survey was conducted (n = 746). Among a list of 18 IFs, grain sorghum 32.4% (n = 242), marula 32% (n = 239), pearl millet 21.7% (n = 162), amadumbe 19.3% (n = 144) and cowpea 18.6% (n = 139) were the best known. However, the study noticed a maximum consumption of 19.3% (grain sorghum). Overall, this consumption was seasonal, and its level was significantly defined by race (p < 0.05). Black people consume more IFs compared to coloured people, Indian people and white people. Participants mostly consumed these foods for nutritional and health reasons and pointed out the problem of availability. "Poor image" was rated the lowest by all races (black 5.8%, coloured 4.2%, Indian 7.0% and white 4.1%) regarding the reasons for no or low consumption of IFs. Whatever the race, the desire to increase IF consumption was positive. The promotion of their integration into South African diets should, therefore, be considered as an intervention strategy.

Associations among Food Systems, Food Environments, Food Choices, Food Security, and Nutrition Transition in Limpopo Province, South Africa: A Cross-Sectional Study.

A cross-sectional study was applied to investigate the influence of food systems and food environments on food choices and nutrition transition of households in Limpopo province, South Africa. A sample of 429 households was systematically selected using a paper selection draw from three districts. This paper determines the association among food systems, food environments, food choices, and nutritional measurements of the respondents. A validated questionnaire was used. Most of the respondents responsible for food procurement were females (80.4%). There was a significant association (p < 0.001) between proximity to food stores and dietary diversity of the households. Staple foods such as bread, maize, rice, samp, and mealie rice were available in almost all surveyed households (95.6%). More than half of the households (59.8%) had home gardens in their yards. Almost half of the households (48.4%) had a low Dietary Diversity Score. The study further revealed that 46.0% of households were food secure. Over a third (36.2%) of the respondents were obese, and 32.5% were diabetic. The mean total blood cholesterol was 3.69 ± 0.74 mmol/L. A high percentage of both females (89.6%) and males (91.5%) had normal hemoglobin levels. Almost half of the respondents had normal systolic blood pressure levels (45.6%), and nearly a quarter had high diastolic levels (21.4%). The 25 coping strategies were applied during food shortage periods. Even though the food environments provided both obesogenic and protective foods, the consumption of unhealthy foods was high.

Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa.

The present study assessed dietary diversity and anthropometric status of children attending early development centres in South Africa. In the Vhembe District of Limpopo province, South Africa, 273 children were conveniently chosen from 8 randomly selected early childhood development centres for a cross-sectional study. Data were gathered via a questionnaire administered by the interviewer in June 2021. Height, body weight and mid-upper arm circumference were measured to assess anthropometric status. A 24-h dietary recall was obtained to provide information on dietary diversity. The prevalence of underweight, wasting and stunting was 9, 4 and 26 %, respectively. More than half of the children had a low dietary diversity score, according to the Food and Agriculture Organization scoring system for children. Grains, roots, tubers, dairy products, other fruits and vegetables, and flesh-based foods were the highest consumed food groups. The lowest consumption was for eggs, vitamin A-rich fruits and vegetables, legumes and nuts. Height for age and weight for age were significantly associated with dietary diversity score, but not weight for height. Children who did not meet the reference value of greater than 4 for dietary diversity had a significant risk of being underweight (AOR 0⋅25, 95 % CI 0⋅08, 0⋅75) and stunted (AOR 0⋅32, 95 % CI 0⋅14, 0⋅74). The nutritional status of the children was impacted by a lack of adequate dietary diversity. Young children in rural areas need to receive a wide range of food to promote greater diversification of diets in order to diminish the risk of undernutrition.

The predictors of food security and dietary diversity among internally displaced persons' children (6-59 months) in Bamenda health district, Cameroon.

BACKGROUND: Malnutrition remains a major cause of morbidity and mortality amongst children in displaced settings. Nutrition at this stage is crucial for the growth and development of the child. It is estimated that 41 million children under 5 years are obese/overweight, 159 million are stunted and 50 million are wasted worldwide. This study aimed to determine the prevalence and predictors of food insecurity and dietary diversity among internally displaced persons' children from 6 to 59 months. METHODOLOGY: A cross sectional community-based study was conducted on 395 children aged 6-59 months from May 2021-June 2021. A multistage cluster sampling method was used to select the study participants. A validated structured questionnaire was used to collect data on sociodemographic characteristics, food security and dietary diversity. Predictors of food insecurity and dietary diversity were identified using logistic regression. The outputs were presented using adjusted odd ratio (AOR) with 95% confidence interval (CI). RESULTS: The study results revealed that the level of household food insecurity was 91.6%, at risk of experiencing hunger (3.3%) and food secure (5.5%). Participants had mean dietary diversity score of 3.6 food groups, 51.6% had a low or inadequate dietary diversity and 48.4% had adequate dietary diversity. Children who were from households with monthly income of $101- $200 US dollars and had been displaced just once were 79% (AOR: 0.21, 95%CI: 0.07-0.60) and 84% (AOR: 0.16, 95%CI: 0.05-0.50) less likely to be food insecure compared to their counterparts respectively. While households with participants who Walked ≥ 10 min to fetch drinking water (AOR: 11.61 95%CI: 2.39-52.08) were more likely food insecure. In addition, household monthly income of ≥ $100 US dollars (AOR: 0.20, 95%CI: 0.07-0.56) had a reduced chance of providing low diversified food. Households that had received social grants (AOR: 2.15, 95%CI: 1.38-3.49) and walked ≥ 10 min to fetch drinking water (AOR: 2.43, 95%CI: 1.48-3.98) had a higher chance of providing low diversified food. CONCLUSION: Dietary diversity and household food insecurity was unacceptably low and high respectively among internally displaced children. Policymakers should prioritize strengthening both nutrition sensitive and specific activities that contribute to reduction of food insecurity and consumption of unbalance diet.

Key predictors of undernutrition among children 6-59 months in the Buea Health District of the Southwest region of Cameroon: a cross sectional community-based survey.

BACKGROUND: According to the 2018 Demographic and Health Survey, undernutrition remains a public health problem among Cameroonian children under-five. This varies across the country, greatest in areas with ongoing humanitarian crisis, such as the Southwest region. However, data on the burden of undernutrition in the Southwest region is sparse. This study aimed to assess the prevalence and predictors of undernutrition among children under-five in the Buea health district of the Southwest region of Cameroon. METHODS: This was a community based cross-sectional study of 321 children under-five/caretaker pairs, surveyed from households selected using multistage randomized sampling. Data were collected by trained data collectors, with the aid of a structured, pre-tested questionnaire that captured information on sociodemographic characteristics, food security, dietary diversity and anthropometric measurements. The weight, height/length and mid upper arm circumference (MUAC) were measured using standardized instruments. Stunting, Wasting and Underweight of children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. Data was analysed using SPSS version 27.0. Predictors of malnutrition were obtained using multivariate logistic regression, adjusting for potential confounders. RESULTS: Overall, 31.8% (102/321) of the children were undernourished (26.5% stunted, 1.6% underweight, 3.7% wasted). Drinking water from inappropriate sources (OR: 2.32, 95% CI: 1.30-4.15) and a Dietary Diversity Score < 4 (OR: 2.59, 95%CI: 1.46-4.61) were independently associated with increased risk of stunting. Children of the male sex were more likely to be wasted than females (OR: 5.34, 95%CI: 1.09-26.14). CONCLUSION: Childhood undernutrition, particularly stunting is common in the Buea Health District. Risk factors of undernutrition identified are potentially modifiable, highlighting the need for nutrition specific and sensitive interventions to improve dietary diversity, and the need to improve access to safe drinking water, and educate caretakers on the importance of clean potable water, good sanitation and hygiene for the proper growth and development of their children.

Magnitude and predictors of malnutrition among internally displaced persons' children 6 - 59 months in Bamenda Health District of Cameroon: A community-based cross-sectional study.

Background: A major cause of morbidity and mortality amongst children in displaced settings is malnutrition. Approximately, 45% of deaths are linked to undernutrition among children under 5 years of age. The study aimed to determine the prevalence and associated factors of malnutrition among internally displaced (IDP) children from 6 to 59 months. Methods: A community-based cross-sectional study with an analytical approach was conducted from May to June 2021. A multistage cluster sampling method was used to select mothers/caregivers and administer a structured questionnaire that consisted of three sections: sociodemographic and environmental characteristics, health-related factors and anthropometric measurements) was used to collect data. Data were analysed using SPSS version 27.0. Bivariate analysis was done at p < 0.20 and logistic regression at a 5% level of significance. Results: Overall, 395 children were enrolled with a mean age of 31.4 ± 9.1 months and 59.0% were males. Findings revealed that 52% of children were malnourished; stunted (22.1%), wasted (4.8%), underweight (6.3%) and overweight (35.4%). Independent predictors of overall malnutrition were the age of the mothers/caregivers (AOR: 8.0, 95% CI: 2.0 - 32.1), children who had not taken all their vaccines (AOR: 2.3, 95% CI: 1.4 -3.8), children not dewormed (AOR: 2.9, 95% CI: 1.3-6.3), Children not exclusively breastfed (AOR = 3.3, 95% CI: 1.1-9.6). Conclusion: The prevalence of malnutrition was high among children living in internally displaced households. Thus, there is a need for vaccination and deworming campaigns, and nutritional and educational intervention programmes to improve both forms of malnutrition: undernutrition and over-nutrition.

Fruit and Vegetable Consumption Patterns and Risk of Chronic Diseases of Lifestyle among University Students in Kenya.

This study assesses the fruit and vegetable consumption patterns and risk factors for chronic diseases of lifestyle (CDL) among young adults attending Kenyatta University, Kenya. Four hundred and twenty-three young adults aged 19-30 years participated in the cross-sectional study. Males were 75.0% less likely to be overweight than females (OR = 0.25; 0.13-0.47). The mean overall consumption of fruit and/or vegetables amounted to 3.6 servings in a typical day. Eight in ten participants consumed lower amounts of fruits and vegetables than recommended by the WHO. At least one combined risk factor of CDL was observed among 91.3% of the young adults. About 8.7% of the participants were classified as low risk for CDL (having none of the five risk factors), 48.9% had one risk factor, 32.9% had two risk factors, 8.5% had three risk factors, while 0.9% had four risk factors. A significant relationship between daily fruit consumption and waist circumference was observed. These findings show the dire need to develop public health nutrition activities aimed at increasing the intake of fruit and vegetables and sensitizing young adults, and the general population, to the risk factors of CDL.

Nutrition Knowledge of Caregivers Influences Feeding Practices and Nutritional Status of Children 2 to 5 Years Old in Sekhukhune District, South Africa.

BACKGROUND: The aim of this study was to determine caregivers' nutrition knowledge and its influence on feeding practices and nutritional status on young children. METHODS: A cross-sectional survey was conducted in 120 caregiver-child pairs. A validated questionnaire was used to collect caregivers' nutrition knowledge and feeding practices. Nutritional status was estimated using anthropometric measurements. Z-scores were computed using WHO Antro software. Chi-square test was used to determine the association between caregivers' nutrition knowledge and feeding practices. Significance was set at p <0.05. RESULTS: Forty three percent of caregivers reported health professionals as their source of nutrition information. Almost all children (94.2%) were breastfed at one stage in their lives, with 62.5% introduced to solid foods before six months. Maize meal porridge (87.5%) and bread (54.2%) were consumed daily by most of the children, while 48.3% consumed meat and meat products three to four times per week. One in eight children consumed fruits daily and 5.8% vegetables daily. Forty one percent of children were stunted. Family income showed positive correlation with the nutritional status of children (weight-for-age R = 0.207, p < .05; height-for-age R°=°0.203*, p°= .026). An association was observed between the duration of breastfeeding and alternative food, to milk (R = 0.302**, p = .001), amount of fruit consumed daily (R = 0.197*, p = .031) and number of meals consumed daily (R = 0.284**, p = .048). Conclusion: Nutrition knowledge and feeding practices of the caregivers were not satisfactory.

Caregivers' Knowledge and Food Accessibility Contributes to Childhood Malnutrition: A Case Study of Dora Nginza Hospital, South Africa.

Amongst the problems facing South Africa today are malnutrition and food insecurity, and there is a need for interventions and innovative strategies to address these. The aim of the study was to determine the contribution of caregivers' knowledge of nutrition and household food security among children aged 0 to 60 months. A cross-sectional study design was applied using a quantitative approach. A convenience sample (n = 184) of caregiver-child pairs (for children 0 to 60 months) from the Dora Nginza Hospital Paediatric Outpatient Department was used. A structured questionnaire was applied to collect data on socio-economic factors, health status, household food security, and caregivers' knowledge. In addition, interviews were conducted, and anthropometric measurements of children were taken to determine their nutritional status. The results indicate that most caregivers were female, and more than half completed high school, yet almost 75% were unemployed. Most of the caregivers (58.2%) were either overweight or obese. The results also show that only 33.2% of households were food secure, 29.3% were at risk of hunger, and 37.5% experienced hunger. The prevalence of stunting, underweight, and wasting among children in the study was high. A significant, slightly positive correlation was found between the body mass index of the caregiver and height for age. Poor socio-economic status and food inaccessibility were identified as possible underlying contributing factors to malnutrition, contributing to food insecurity and therefore poor dietary intake.

Socio-cultural beliefs influence feeding practices of mothers and their children in Grand Popo, Benin.

BACKGROUND: Malnutrition is a major public health problem. It contributes to the high death rate among children in developing countries despite the various advocacies of institutions such as WHO and FAO and many other organisations. More research needs to be done in order to contribute to the achievement of the Sustainable Development Goals. The aim of this study was to explore socio-cultural practices and their influence on feeding practices of mothers and their children in Grand Popo, Benin. METHODS: A qualitative research methodology was used with an inductive approach. A pretested discussion guide was used to conduct focus group discussions with participants in their local language. Four focus group discussions were held in 4 villages located in both the rural and the semi-urban areas with each focus group comprising seven to eight participants. The study protocol was approved by the Health Research Ethics Committee of Stellenbosch University. Focus group discussions were recorded, transcribed and translated to English. The data was analysed following the Creswell data analysis steps. RESULTS: All the children were breastfed, and 56.1% of children under 6 months received breast milk exclusively. Children were introduced to family foods at 5 months with very low consumption of animal protein and fruits. Mothers and children had monotonous diets with high consumption of vegetables and maize-based meals. Food taboos, particularly during pregnancy, were revealed. Those cultural beliefs were still followed by some mothers, and food rich in nutrients were pushed aside. CONCLUSIONS: There is a need for educational interventions to raise awareness of the negative impacts of some socio-cultural practices on the health of the mother and child.

The presence of the double burden of malnutrition in children and their mothers in Grand-Popo, Benin.

BACKGROUND: Malnutrition is a public health problem, with 45% of child deaths attributed to undernutrition. AIM: The aim of this study was to investigate the presence of the double burden of malnutrition in children-mother pairs in Benin. METHODS: An analytical cross-sectional approach was used to collect data from 408 randomly selected children aged 0-59 months and their mothers. A pretested questionnaire was used to collect information on demographic and socioeconomic status, and anthropometric measurements were used to estimate the nutritional status of children and body mass indexes of the mothers. The World Health Organization Anthro software was used to estimate Z-scores whereas SPSS version 25 was used for statistical analysis. Descriptive and regression analysis were carried out on the data. RESULTS: The mean age of children was 24.45 ± 14.9 months and 53.2% were girls. The mean age of mothers was 27.99 ± 6.99, 93.1% were married and approximately 91.7% of households had a monthly income of US$60. Prevalence of wasting in children was 9.8% and stunting was 29.7%. The mean waist circumference of mothers was 79.95 ± 10.35 cm and 19.3% were classified as high metabolic risk. Body mass index measurements showed that 16.9% of mothers were overweight and 7.4% obese. CONCLUSIONS: Stunting and wasting were highly prevalent. There is a coexistence of underweight and overweight in Grand-Popo, Benin. The results drew attention to the need for coordination of preventive interventions to focus on the household food distribution.

Nutrition knowledge and care practices of home-based caregivers in Vhembe District, South Africa.

BACKGROUND: Home-based care is provided to clients in their homes to promote and maintain good health, hygiene and nutrition. OBJECTIVE: This study assessed nutrition knowledge and care practices of home-based caregivers in Vhembe District, South Africa. METHODS: The design was cross sectional, descriptive and exploratory using quantitative and qualitative approaches. Multistage sampling was used, with convenient selection of two municipalities from four, eight home-based care agencies randomly selected from 96 agencies, 128 caregivers conveniently selected for interviews, 92 caregivers selected for focus group discussions and 28 caregivers selected for observation during home visits. Demographic characteristics, nutrition knowledge and care practices were evaluated using questionnaires, interview guides and observational checklists. Data were analysed using SPSS 22 and thematic analysis for qualitative data. RESULTS: caregivers (99.2%) were women, 68.7% had secondary education and all had received 59-day training and 64.1% had six to ten years of home-based care experience. Only 0.8% had adequate nutrition knowledge, 45.3% satisfactory knowledge and 53.9% limited to no knowledge. Most care practices reported during the focus group discussions were not observed during home visits. CONCLUSION: Nutrition knowledge and care practices of HBC in Vhembe District were found to be inadequate. The nutrition content in the training package should be improved.

Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria.

BACKGROUND: National programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early childhood education) and in the political economic context (e.g. presence of external funding agencies). Context is shaped by the economy, population, religion, and poverty, which impact everyday lives. Considering these contexts, a roadmap was developed and validated. The aim of this paper is to report expert review and stakeholder validation to determine feasibility of the developed contextualised roadmap for two Nigerian states. METHODS: A validation tool was developed and reviewed using three experts. The content review occurred in two rounds to obtain recommendation and revisions of the developed roadmap and the validation tool. A pilot test of the roadmap and validation tool was done using two stakeholders in South Africa. The roadmap and the validation tool were then sent to the stakeholders and potential end-users in Nigeria using electronic media. Two research assistants were also engaged to deliver and collect hard copies to those who preferred it. RESULTS: Of the ten stakeholders invited, nine responded. All participants showed an adequate understanding of the roadmap as evidenced by the scores given. Responses regarding the translation of the roadmap to implementation varied. The majority (86,6%) either strongly agreed or agreed that the actions were translatable (43.0 and 43.6% respectively). CONCLUSIONS: The final roadmap comprises of actions that are appropriate for the state's context. It is recommended that stakeholders or end-users of any programme must be involved in the validation of such contextual programmes to improve chances of success.

Compliance with the consumption of iron and folate supplements by pregnant women in Mafikeng local municipality, North West province, South Africa.

BACKGROUND: Anaemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries. The aim of the study was to investigate the factors that contribute to compliance to the consumption of iron and folate supplements by pregnant woman in Mafikeng local municipality, North West Province, South Africa. RESEARCH METHODS: A mixed method of descriptive, exploratory and cross-sectional design was used. Ten clinics were used as a sample frame where 57 pregnant women and 10 health workers were purposefully and conveniently selected. Quantitative techniques were used to collect data on attendance, consumption and nutrition knowledge using the self-reported questionnaire by pregnant women, and structured interview for health workers. Qualitative design was used to conduct in - depth focus-group discussions to gather information on compliance to the consumption of supplements by pregnant women. FINDINGS: The findings of the study revealed good antenatal clinic attendance, availability of supplements and 93% compliance to the consumption of iron and folate supplements. RECOMMENDATIONS: High compliance to the consumption of iron and folate supplements by pregnant women was reported, and this should be reinforced.

Development and Implementation of Nutrition Education on Dietary Diversification for Primary School Children.

A quasi-experimental one group pretest/posttest design study was undertaken in two primary schools from two rural villages of Vhembe District in Limpopo Province, South Africa. About 172 children aged 9-14 years in Grades 5 and 6 were recruited for the study. All children in the grades were invited to participate pending written consent from parents and verbal assent from children. Due to school migration and absenteeism, only 154 children were available for posttest evaluation. However, nutrition education was administered to all 172 children. Nutrition education focused on types and health benefits of indigenous foods and was divided into three lessons. Observation and counting was used to note the responses given by children. The results suggest that the nutrition education was effective in imparting knowledge to children as well improving dietary diversification with indigenous foods. It is concluded that nutrition education is a valuable tool to change eating behaviors.