In utero teratogen exposure and cardiometabolic risk in 5-year-old children: a prospective pediatric study.

BACKGROUND: Aorta and carotid intima-media thickness (IMT) is a measure of subclinical atherosclerosis and useful to assess cardiometabolic risk in the young. The in utero milieu may involve cardiometabolic programing and the development of cardiometabolic risk factors in children. Maternal smoking, alcohol consumption, and micronutrient deficiencies during pregnancy influence the development of the cardiovascular system through a process of DNA methylation. AIM: To explore an association between maternal smoking and alcohol consumption during pregnancy and intima media thickness in 5-year-old children for a low-income setting. METHODS: Data were collected from 500 mother-child pairs at antenatal clinic visit, at birth, and at age 5 years. Anthropometric measurements were collected at birth and again at age 5 years. As well as clinical and ultrasound measurements at age 5 years. Clinical measurements, at age 5 years, included blood pressure, mean arterial pressure, and heart rate. Ultrasound measurements of the aorta and carotid arteries IMT were performed at age 5 years. Main outcome of interest was effect of dual teratogen exposure on the ultrasound measures IMT as indication of cardiometabolic risk. RESULTS: cIMT was significantly higher in children exposed to both alcohol and nicotine during pregnancy compared to those not exposed (p = .008). In separate linear models, dual in utero exposure (beta = 0.12; p = .01) and male sex (beta = 0.14; p = .01) were associated with higher right cIMT values (F(6,445) = 5.20; R2 = 0.07, p < .01); male sex (beta = 0.13; p = .01) and low birth weight (beta = 0.07; p = .01) with higher left cIMT value (F(4,491) = 4.49; R2 = 0.04; p = .01); and males sex (beta = 0.11; p = .02) with higher aorta IMT (F(6,459) = 5.63; R2 = 0.07; p < .01). Significant positive correlations between maternal measures of adiposity, maternal MUAC (r = 0.10; p = .03), and maternal BMI (r = 0.12; p < .01) and right cIMT measurements adjusted for the BMI of the child at age 5 years as covariate. Blood pressure measurements at age 5 years were not significantly associated with IMT but, instead, correlated significantly and positively with the BMI of the child at age 5 years (p < .01). CONCLUSION: Children exposed to both maternal smoking and alcohol consumption during pregnancy presented with cardiometabolic risk factors 5 years after birth. In addition, maternal adiposity, male sex, and low birth weight were associated with higher IMT at age 5 years.

The effects of in utero exposure to teratogens on organ size: a prospective paediatric study.

In low-income countries, prospective data on combined effects of in utero teratogen exposure are lacking and necessitates new research. The aim of the present study was to explore the effect of in utero teratogen exposure on the size of the kidneys and pancreas 5 years after birth in a low-income paediatric population. Data was collected from 500 mother-child pairs from a low-income setting. Anthropometric measurements included body weight, (BW) body height, mid-upper arm and waist circumference (WC). Clinical measurements included blood pressure (BP), mean arterial pressure and heart rate. Ultrasound measurements included pancreas, and kidney measurements at age 5 years. The main outcome of interest was the effect of maternal smoking and alcohol consumption on ultrasound measurements of organ size at age 5 years. Left and right kidney length measurements were significantly lower in smoking exposed children compared to controls (p = 0.04 and p = 0.03). Pancreas body measurements were significantly lower in smoking exposed children (p = 0.04). Multiple regression analyses were used to examine the associations between the independent variables (IDVs), maternal age, body mass index (BMI), mid-upper arm circumference (MUAC) and BW of the child, on the dependent variables (DVs) kidney lengths and kidney volumes. Also, the association between in utero exposure to alcohol and nicotine and pancreas size. WC was strongest (r = 0.28; p < 0.01) associated with pancreas head [F (4, 454) = 13.44; R2 = 0.11; p < 0.01] and tail (r = 0.30; p < 0.01) measurements at age 5 years, with in utero exposure, sex of the child and BMI as covariates. Kidney length and pancreas body measurements are affected by in utero exposure to nicotine at age 5 years and might contribute to cardiometabolic risk in later life. Also, findings from this study report on ultrasound reference values for kidney and pancreas measurements of children at age 5 years from a low-income setting.

Molecular identification of Brettanomyces bruxellensis strains isolated from red wines and volatile phenol production.

The spoilage yeast Brettanomyces/Dekkera can persist throughout the winemaking process and has the potential to produce off-flavours that affect the sensory quality of wine. The main objective of this study was to select different strains of Brettanomyces bruxellensis isolated from red wines and to compare their volatile phenol production. From a collection of 63 strains, eight strains of B. bruxellensis were selected for volatile phenol production after the application of molecular techniques such as ISS-PCR, PCR-DGGE and REA-PFGE. All strains showed three large chromosomes of similar size with PFGE. However, unique restriction profiles of the chromosomes were visible after NotI digestion that clearly distinguished the strains. All strains were capable of producing large quantities of 4-ethylphenol and 4-ethylguaiacol from p-coumaric acid and ferulic acid, respectively in synthetic media. However, the diversity among strains for volatile phenol production differed between synthetic media and wine with regard to the maximum production levels of 4-ethylphenol and 4-ethylguaiacol. This study illustrated the diversity of B. bruxellensis strains that occur during winemaking.

Energy expenditure of a noncontact boxing training session compared with submaximal treadmill running.

The aim of this study was to determine the energy expenditure of a 1-h noncontact boxing training session and to compare these results with the energy expenditure of a more conventional recreational activity such as running. Eight healthy males, accustomed to noncontact boxing training, were recruited for the study. Subjects underwent three tests: (i) a boxing training session in the laboratory during which energy expenditure was measured continuously using indirect calorimetry (BOXL), (ii) a boxing training session in a boxing studio during which heart rate was measured continuously (BOXS), and (iii) an incremental running test on the treadmill during which energy expenditure was measured continuously. The energy expenditure during 60 min of BOXL ranged between 2519 and 3079 kJ (2821 +/- 190 kJ). Seven of the 8 subjects had higher heart rates during BOXL compared with those during BOXS, suggesting that the subjects exercised at a slightly higher intensity during BOXL, possibly because of the "one on one" supervision. A typical boxing training session lasting 60 min causes a person to expend 2821 +/- 190 kJ x h(-1), the same amount of energy as someone running about 9 km in 60 min on the treadmill.

Nutritional status of primary school children with endemic goitre in Caprivi, Namibia.

The nutritional status of primary school children living in an endemic goitre area in eastern Caprivi, Namibia, was assessed by means of clinical, biochemical, anthropometrical and dietetic observations. An approximately 20 pc sample, consisting of 380 primary school children, aged six to 18 years and representing eight schools in the Cuando River area of eastern Caprivi, was included in the study. Their goitre prevalence of 34.5 pc has been reported earlier. A significantly lower mean thyroxine level in goitrous compared to non-goitrous children indicated that dietary iodine deficiency was the primary cause of the endemic goitre. The present paper focuses on the nutritional status of these primary school children. Anthropometrically, these children were severely undernourished, as indicated by a high prevalence of low (below the third NCHS percentile) weight and height for age values, ranging from 38.0 pc to 55.9 pc. Dietary analysis revealed a low energy intake as well as dietary deficiencies in folic acid (only girls), ascorbic acid, vitamin A, nicotinic acid, iron, riboflavin and calcium. A high percentage (43.9 pc of boys and 33.7 pc of girls) of the children were biochemically anaemic whilst less than one pc of the children showed clinical signs of anaemia. Nutritional intervention programmes in this area should not only treat and prevent the endemic goitre but also attend to the energy and micro-nutrient deficiencies in these children.

PIP: In Namibia, a nutrition survey was conducted among 380 children aged 6-18 years at 8 primary schools along the Cuando River over about a 100 km stretch, in eastern Caprivi. This is a goiter-endemic area. 34.5% of the children had a goiter, which was the most significant nutritional condition in primary school children. This high prevalence of goiter indicated a dietary iodine deficiency. Iodine deficiency disorder can cause neurological damage ranging from mild intellectual impairment to full-blown cretinism. 38% were underweight and 55.9% were stunted (i.e., 3rd percentile of the National Center for Health Statistics). 2% had clinical signs of either kwashiorkor or marasmus. 43.9% of boys and 33.7% of girls were biochemically anemic, but less than 1% were clinically anemic. Mean standard hemoglobin level was 12.46 for girls and 12.31 for boys. Maize made up most of the diet and was eaten 2.7 times/day/child. Few children ate bread. Caloric intake was poor (39% and 45% of WHO recommendations for boys and girls, respectively). The diet did not contain enough folic acid for girls. Nutritional deficiencies in the diet also included ascorbic acid, nicotinic acid, iron, vitamin A, riboflavin, and calcium. Adequate nutritional intakes were limited to protein, thiamin, and vitamin B12 and, for boys, folic acid. These findings suggest that subsistence farming does not provide these children enough energy to maintain normal growth in children. This goiter-endemic area along the Cuando River needs educational and agricultural intervention programs to reverse endemic goiter and poor nutritional status. They should include treatment and prevention of goiter but also treatment and prevention of energy and nutrient deficiencies.

The nutritional status of a rural community in KwaZulu-Natal, South Africa: the Ndunakazi project.

OBJECTIVES: To assess the nutritional status of six month to 11 year old rural Black children and their mothers as a first phase in a nutrition intervention project. DESIGN: Cross sectional study. SETTING: A rural African community +/- 60 km northwest of Durban, KwaZulu-Natal, South Africa. SUBJECTS: A random sample of 127 mothers and 105 pre-school and 131 primary school children were selected from this community. MAIN OUTCOME MEASURES: Anthropometric (height and weight), biochemical and dietary and socio-demographic information was collected. RESULTS: Among the pre-schoolers anaemia was present in 23.8%, iron deficiency in 19.8%, while marginal vitamin A deficiency was observed in 44.9%. Urinary iodine levels indicated moderate iodine deficiency in 31.8% and severe iodine deficiency in 9.1%. In primary school children the prevalence of anaemia was 22%, while marginal vitamin A deficiency was observed in 50.8%. Moderate iodine deficiency was observed in 37.9% of primary school children while 13.6% presented with severe iodine deficiency. The prevalence of goitre in this group was 22.1%. Almost 22% of mothers were anaemic and 18.9% were iron deficient. Only 1.6% of mothers were marginally vitamin A deficient. An enlarged thyroid was observed in 26.7% of mothers of which 17.3% were palpable and 9.4% visible. Of mothers 43.4% were overweight while 33.8% were obese. CONCLUSION: The rural community in KwaZulu-Natal, showed a high prevalence of anaemia, marginal vitamin A deficiency and iodine deficiency. The information gathered during this cross sectional study served as a basis to plan and implement an intervention study aimed at addressing the nutritional deficiencies.

Preliminary evaluation of infrared spectroscopy for the differentiation of Brettanomyces bruxellensis strains isolated from red wines.

The objective of this study was to evaluate different infrared spectroscopy methods in combination with chemometrics for the differentiation between Brettanomyces bruxellensis strains. These methods of discrimination were applied to intact yeast cells of B. bruxellensis strains and on wines spoiled by the same strains. Eleven wine isolates of B. bruxellensis were evaluated for volatile phenol production in red wine and their genetic diversity was determined by Restriction Endonuclease Analysis-Pulsed Field Gel Electrophoresis (REA-PFGE). Fourier transform mid-infrared (FTMIR) spectroscopy was used to obtain spectral fingerprints of the spoiled wines. Attenuated total reflectance (ATR) was used to obtain spectral fingerprints from the intact cells of the 11 B. bruxellensis strains. The groupings from the genetic fingerprints obtained with REA-PFGE were used as reference firstly for comparison with the groupings observed with the FTMIR spectral fingerprint of the wines and secondly for the FTIR-ATR spectral fingerprints from the whole cells. Results indicated that ATR-IR spectra obtained by scanning whole cells of B. bruxellensis could be useful for rapid strain typing in comparison or complementary to molecular techniques and FTMIR spectra from wines provide a useful resource for the discrimination between B. bruxellensis contaminated wines.

Primary Health Care Facility Infrastructure and Services and The Nutritional Status of Children 0 to 71 Months Old and Their Caregivers Attending These Facilities in Four Rural Districts in The Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objective: To assess primary health care (PHC) facility infrastructure and services; and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Design: Cross-sectional survey. Setting: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). Subjects: PHC facilities and nurses (EC: n = 20; KZN: n = 20); and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). Methods: Structured interviewer-administered questionnaires and anthropometric survey. Results: Of the 40 PHC facilities; 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20; KZN: 25); electricity (EC: 45; KZN: 85); flush toilets (EC: 40; KZN: 75); and operational telephones (EC: 20; KZN: 5). According to more than 80of the nurses; problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41; KZN: 25). Social grants were reported as a main source of income (EC: 33; KZN: 28). Few households reported that they had enough food at all times (EC: 15; KZN: 7). The reported prevalence of diarrhoea was high (EC: 34; KZN: 38). Undernutrition in 0 to younger than 6 month-olds was low; thereafter; however; stunting in children aged 6 to 59 months (EC: 22; KZN: 24) and 60 to 71 months (EC: 26; KZN: 31) was medium to high. Overweight and obese adults (EC: 49; KZN: 42) coexisted. Conclusion: Problems regarding infrastructure; basic resources and services adversely affected PHC service delivery and the well-being of rural people; and therefore need urgent attention

A model for community-based growth monitoring system.

Acting on a request form the community of Ndunakazi, a rural area bordering the Valley of a Thousand Hills, Kwa Zulu-Natal, South Africa, a comprehensive situation analysis was conducted. The results were used in an objective orientated programme planning approach, during a workshop attended by community representatives. One of the outcomes was the establishment of a model for a community-based growth and health monitoring system for pre-school children. As their contribution to the programme, families would make their homes available on a voluntary basis, once or twice a month to be used as community-based centers (called Isizinda). From a nutritional point of view, the programme has a hoslistic approach and is run by nutrition monitors. The programme was initially launched with one centre, but in response to requests received form the community, a further seven centres have been established. Approximately 500 pre-school children are currently being growth-monitored regularly, with an average monthly attendance of around 70 per cent. The nutrition monitors are responsible for conveying health and nutritional messages to the mothers and for collecting morbidity and mortality data. Children who are either not growing well or who are ill are referred to the nearest clinic. When available a community nurse attends to minor illnesses during these sessions. A soup kitchen is run during the winter, providing the mothers and pre-school children with soup and bread. Attitudes of mothers and nutrition monitors towards the programme are assessed regularly, the outcome of skills development that is an integral part of the model. This model falls within the scope of the policy objectives and principles on which the United Health System of South Africa will be based. The National Research Programme for nutritional Intervention (NRPNI) is in eh process of establishing a partnership with the department of Health of KwaZulu-Natal. Should the Department take long-term responsibility as an overall coordinator of these monitoring centers, the sustainability of the project will be increased and could then be extended to other areas.

Body composition of different ethnic groups in South Africa.

South Africa is in a state of nutrition transition. As with other societies this is reflected in the emergence of overfatness, sometimes in conjunction with protein malnutrition. These phenomena may be expressed differently in a multi-ethnic society like South Africa with its major ethnic groups (Blacks, Whites, Coloureds and Indians) having varied socio-economic status. National population-based studies of coronary risk factors between 1979 and 1991 have been accessed for anthropometric data as weight and height. Cut-off points for overweight have been applied, to children to age 10 as weight-for-height greater than two Z scores by NCHS reference standards, and to those older than 15 and up to 64 years of age, BMI >= 25 and < 30, and obese >= 30 kg/m2. Data have been stratified by ethnicity, age, gender and place of residence (urban or rural) Urban Black children seem already to have a problem of overweight with a prevalence of 6-18%. For men, urban Whites have the highest prevalence of both overweight (50% in the 45-54 age group) and obesity (20% in the 55-64 age group) in all age groups except the 55-64 age groups for obesity, where Blacks have the higher prevalence (about 29%). Interestingly, the prevalence of overweight in rural women overall (39-52%) exceeds that for urban women (23-31%), although this is not the case for obesity, (prevalence age 25 and beyond, rural 24-39% and urban, 25-60%) where, indeed, in the 45-54 and 55-64 age groups, the urban prevalence exceeds the rural. This raises questions about the factors which reduce or facilitate the transition from overweight to obesity. Urban Black women seem at particular risk of this overweight-to-obesity shift and are known to have a very energy-dense diet. The extent to which overfatness contributes to other coronary risk factors is worth further investigation, given this appears to be less for Blacks than other ethnic groups.

The lipid and lipoprotein profile of the urban black South Africa population of the Cape Peninsula - the BRISK study.

OBJECTIVE: To determine the lipid and lipoprotein profile of the urban black South African population of the Cape Peninsula. DESIGN: Cross-sectional design. SETTING: The seven black residential areas of the Cape Peninsula. PARTICIPANTS: A stratified proportional sample was drawn from the study area. The sample consisted of 422 men and 544 women aged between 15 and 64 years. OUTCOME MEASURES: Lipid and lipoprotein levels. Risk levels for coronary heart disease (CHD). RESULTS: The total cholesterol (TC level) was low compared with other South African groups studied. Men had a mean TC of 3.98 mmol/l and women 4.15 mmol/l. Low-density lipoprotein cholesterol (LDLC) values for men (2.03 mmol/l) were lower than those for women (2.30 mmol/l). Men (1.35 mmol/l) and women (1.37 mmol/l) had similar high-density lipoprotein cholesterol (HDLC) levels. Both sexes had a prevalence of protective HDL/TC ratios above 30% for all age groups. High HDL3C levels and low HDL2C levels were found in both men and women. Apolipoprotein A and B followed the trends of HDLC and LDLC and showed no difference between the sexes. The plasma triglyceride (TG) levels increased with age in both sexes. Men displayed higher TG levels than women in all age groups. Seventeen per cent of men and 26% of women had a moderate-to-high risk for CHD, given their TC levels. Other lipid-related risk factors indicated low risk for CHD.

Endemic goitre in a rural community of KwaZulu-Natal.

OBJECTIVE: To quantity the prevalence of goitre and iodine deficiency. SETTING: Ndunakazi, a rural community of approximately 8000 people in KwaZulu-Natal. DESIGN: A cross-sectional community-based survey and a school-based survey. PARTICIPANTS: The 127 mothers and 114 children aged 6-11 years, selected during the cross-sectional survey, and 304 children aged 5-14 years, from the school-based survey. METHODS: Urinary iodine levels and thyroid size were determined and categorised according to guidelines proposed jointly by the WHO, UNICEF and the ICCIDD. Z-score anthropometric indicators were calculated, and mid-year exam marks of goitrous and non-goitrous pupils for Zulu and mathematics were compared. RESULTS: In school-aged children, both surveys demonstrated a goitre prevalence in the 20-29.9% range and a median urinary iodine level in the 2-4.9 micrograms/dl range, indicating iodine deficiency of moderate severity. Goitrous subjects scored consistently worse in their Zulu exam papers than those without goitre. Stunting was not more prevalent than in the rest of KwaZulu-Natal. Iodised salt was not available in any of the three community shops. CONCLUSIONS: This level of iodine deficiency in children can adversely affect their neuropsycho-intellectual development. Factors contributing to deficient iodine intake in Ndunakazi are present in many rural areas, and South Africa cannot afforded to be overly confident about the apparent absence of iodine deficiency as a public health problem.

The first 6 years of the Tygerberg Hospital lipid clinic.

The Tygerberg Hospital Lipid Clinic was established in July 1983. The demographic characteristics, lipid abnormalities, coronary risk factor profile, treatment status and 6-month follow-up lipid changes of patients seen during its first 6 years are summarised. During this period 329 patients were seen and complete lipograms were available for 312 of them. This patient population, consisting of 87.2% whites and 12.8% coloureds, represented a wide age range (2-69 years), various occupations and the whole spectrum of educational qualifications. The plasma cholesterol levels of 78.8% of the patients could be described as high risk, according to the cholesterol action limits of the Heart Foundation of Southern Africa, and 33.2% had low high-density lipoprotein cholesterol (less than 1 mmol/l) levels. Approximately 20% of the patients had familial hypercholesterolaemia and 31.1% were already on lipid-lowering medication before registration. The Lipid Clinic succeeded in improving the mean overall plasma cholesterol levels by 8% during the 6 months after registration and provided essential information for the planning of treatment strategies for patients with hypercholesterolaemia.

Endemic goitre among undernourished schoolchildren in eastern Caprivi, Namibia.

A cross-sectional study on a 20% random sample of 380 children, aged 6-18 years, from 8 primary schools in the Cuando River area of eastern Caprivi, Namibia, was done to determine the prevalence of goitre and to investigate related hormonal and nutritional factors. Of the children 34.5% had goitre. Reduced plasma free thyroxine concentrations in the more severely goitrous children, compared with matched non-goitrous children (P = 0.0007), implicated dietary iodine deficiency as the causative factor. Their diet was inadequate in energy and most nutrients according to World Health Organisation criteria. Retarded growth, indicated by their low body weight and height in relation to age, were observed in a large proportion (45.6-73%) of the children. These findings suggest that dietary iodine deficiency was the most likely cause for the endemic goitre in these children, who were predisposed to nutritional disorders by long-term undernourishment.

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants.

The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status, linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape, South Africa. The study was designed as an intervention study. In both the experimental and control groups, serum retinol concentration showed a decline over the intervention period of 6 months. The decline was less pronounced in the experimental group. This resulted in a significantly (P<005) higher serum retinol concentration at 12 months in the experimental group (26.8+/-5.8 microg/dl) compared with the control group (21.4+/-5 microg/dl). Serum iron concentration also declined over the intervention period. The decline was less pronounced in the experimental group. No difference was observed in haemoglobin levels between the groups at 12 months. Serum zinc concentration did not differ significantly between the two groups at follow up. Weight gain over the 6 months period did not differ significantly between the experimental (2.1+/-0.9 kg) and control groups (2.1+/-1.2 kg). There was no difference in linear growth between the experimental (10.0+/-1.5 cm) and control group (10.1+/-2.1 cm) at the end of the follow-up period. Weight and length at 6 months significantly predicted weight and length at 12 months. No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention. Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group. No benefit was observed in serum zinc concentration, linear growth and psychomotor development.

Disadvantaged black and coloured infants in two urban communities in the Western Cape, South Africa differ in micronutrient status.

OBJECTIVES: To determine the nutritional and health status of urban infants in two disadvantaged communities in the Western Cape, South Africa with special reference to micronutrient status. The results of this study will serve to plan an intervention study in these communities in the same age group. DESIGN: Cross-sectional study. SETTING: Two disadvantaged urban black and 'coloured' communities in the Western Cape, South Africa. SUBJECTS: Sixty infants aged 6-12 months from each community. OUTCOME MEASURES: Dietary intake, anthropometric measurements, micronutrient status and psychomotor development. RESULTS: Stunting and underweight were more prevalent in coloured infants (18% and 7%, respectively) than in black infants (8% and 2%, respectively). Anaemia (haemoglobin (Hb) < 11 g dl(-1) was prevalent in 64% of coloured and 83% of black infants. Iron-deficiency anaemia (Hb < 11 g dl(-1) and ferritin < 10 ng ml(-1) was found in 32% of coloured infants and in 46% of black infants. Zinc deficiency was prevalent in 35% and 33% of the coloured and black infants, respectively. Marginal vitamin A deficiency (serum retinol < 20 microg dl(-1) was observed in 23% of black infants compared with 2% of coloured infants. Of black infants, 43% and of coloured infants 6% were deficient in two or more micronutrients. Six per cent of coloured infants had C-reactive protein concentrations above 5 mg l(-1) compared with 38% of the black infants. The dietary intake of micronutrients was in general lower in black infants than in coloured infants. The overall psychomotor development, assessed by the Denver Developmental Screening Test, was different between the two groups. The coloured infants scored higher in three out of the four categories as well as in their overall score. CONCLUSIONS: This study shows that information on stunting and wasting only in urban disadvantaged infants is not sufficient to make recommendations about specific community intervention programmes. Information on the micronutrient status, independent of wasting and stunting, is necessary to design nutrition programmes for different communities. The study also showed a substantially higher prevalence of micronutrient deficiencies among black infants.

A Model for Community-Based Growth Monitoring System

Acting on a request form the community of Ndunakazi; a rural area bordering the Valley of a Thousand Hills; Kwa Zulu-Natal; South Africa; a comprehensive situation analysis was conducted. The results were used in an objective orientated programme planning approach; during a workshop attended by community representatives. One of the outcomes was the establishment of a model for a community-based growth and health monitoring system for pre-school children. As their contribution to the programme; families would make their homes available on a voluntary basis; once or twice a month to be used as community-based centers (called Isizinda). From a nutritional point of view; the programme has a hoslistic approach and is run by nutrition monitors. The programme was initially launched with one centre; but in response to requests received form the community; a further seven centres have been established. Approximately 500 pre-school children are currently being growth-monitored regularly; with an average monthly attendance of around 70 per cent. The nutrition monitors are responsible for conveying health and nutritional messages to the mothers and for collecting morbidity and mortality data. Children who are either not growing well or who are ill are referred to the nearest clinic. When available a community nurse attends to minor illnesses during these sessions. A soup kitchen is run during the winter; providing the mothers and pre-school children with soup and bread. Attitudes of mothers and nutrition monitors towards the programme are assessed regularly; the outcome of skills development that is an integral part of the model. This model falls within the scope of the policy objectives and principles on which the United Health System of South Africa will be based. The National Research Programme for nutritional Intervention (NRPNI) is in eh process of establishing a partnership with the department of Health of KwaZulu-Natal. Should the Department take long-term responsibility as an overall coordinator of these monitoring centers; the sustainability of the project will be increased and could then be extended to other areas