A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria.

OBJECTIVE: The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN: A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING: Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS: ALH. RESULTS: The NEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS: There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.

Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial.

OBJECTIVE: To evaluate the effect of a participant-customised nutrition education programme on glycated Hb (HbA(1c)), blood lipids, blood pressure, BMI and dietary behaviours in patients with type 2 diabetes mellitus. DESIGN: A randomised controlled trial. The control group (n 41) received education materials. The intervention group (n 41) received the same education materials and participated in eight weekly (2-2·5 h) group nutrition education sessions and follow-up sessions. Outcomes were assessed at 6 and 12 months. An intention-to-treat analysis was conducted. ANCOVA compared the groups (adjustments for baseline values, age, sex and clinic). SETTING: Two community health centres, Moretele sub-district (North West Province), South Africa. SUBJECTS: Adults (aged 40-70 years) with type 2 diabetes, HbA(1c) ≥8 %. RESULTS: Differences in HbA(1c) (primary outcome) were -0·64 % (P=0·15) at 6 months and -0·63 % (P=0·16) at 12 months in favour of the intervention group. Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P=0·005) at 6 months and 9·9 v. 11·9 servings/d (P=0·017) at 12 months. Median energy intake was significantly lower in the intervention group at 12 months (5988 v. 6946 kJ/d, P=0·017). No significant group differences in BMI, lipid profile, blood pressure and intakes of macronutrients, vegetables and fruits were observed. CONCLUSIONS: Nutrition education was not efficacious on HbA(1c); however, it improved specific dietary behaviours. Group education and hands-on activities appeared to contribute to the improvement. Optimal goal setting and self-efficacy training/assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in resource-limited settings.

Nutrition education practices of primary school teachers in a resource-constrained community in Gauteng, South Africa.

We investigated the nutrition education (NE) practices of teachers of grade 4‒7 learners in 11 primary schools (85% of total number) of the Bronkhorstspruit district (Gauteng Province) to identify opportunities for improving NE in these schools. A descriptive cross-sectional survey was carried out among a convenient sample of the teachers (N = 73) using a structured nutrition education practice questionnaire. Descriptive data analysis was done. Results showed that the majority of the teachers taught nutrition in about 10% to 20% of their teaching time. Thirty percent had no training to teach nutrition, and most teachers (86%) would like to receive training in nutrition. Teachers mostly taught nutrition as part of the curriculum (67%) and very few (18%) integrated nutrition into other subjects. Needing improvement were adequate classroom time for nutrition education delivery, continuing training in nutrition for teachers, and provision of up-to-date instructional materials for teaching nutrition.

Food security in South Africa: a review of national surveys.

OBJECTIVE: To assess the status of food security--i.e., access to food, food availability and food utilization--in South Africa. METHODS: A systematic search of national surveys that used the Community Childhood Hunger Identification Project (CCHIP) index to measure food security in South Africa over a period of 10 years (1999-2008) was conducted. Anthropometric data for children aged 1-9 years were used to assess food utilization, and household food inventory data were used to assess food availability. FINDINGS: Only three national surveys had used the CCHIP index, namely, the 1999 and 2005 National Food Consumption Surveys (NFCS) and the 2008 South African Social Attitudes Survey. These surveys showed a relatively large decrease in food insecurity between 1999 and 2008. However, the consistent emerging trend indicated that in poorer households women were either feeding their children a poor diet or skipping meals so their children could eat. In terms of food access and availability, the 1999 NFCS showed that households that enjoyed food security consumed an average of 16 different food items over 24 hours, whereas poorer households spent less money on food and consumed fewer than 8 different food items. Moreover, children had low mean scores for dietary diversity (3.58; standard deviation, SD: ± 1.37) and dietary variety (5.52; SD: ± 2.54) scores. In terms of food utilization, the NFCS showed that stunting in children decreased from 21.6% in 1999 to 18% in 2005. CONCLUSION: The South African government must implement measures to improve the undesirably high level of food insecurity in poorer households.

Effectiveness of an adapted diabetes nutrition education program on clinical status, dietary behaviors and behavior mediators in adults with type 2 diabetes: a randomized controlled trial.

PURPOSE: This study evaluated the effectiveness of an adapted social-cognitive theory underpinned diabetes nutrition education program (NEP) on: clinical (HbA1c, BMI, blood lipids, blood pressure) and selected dietary behaviors (starchy foods and energy intake, vegetables and fruit intake) and behavior mediators (knowledge and diabetes management self-efficacy) in patients with type 2 diabetes mellitus (T2DM). METHODS: A tertiary hospital outpatient adults (40-70 years) with poorly controlled (HbA1c ≥ 8 %) T2DM were randomized to either intervention group (n = 39: NEP, 7-monthly group education sessions, bi-monthly follow-up sessions, 15-minute individual session, workbook + education materials) or control group (n = 38: education materials only). NEP aimed to improve clinical status through improved dietary behaviors and behavior mediators. Outcomes and changes in diabetes medication were assessed at six and 12 months. Intention-to-treat analysis was conducted. ANCOVA compared the groups (baseline values, age, sex adjustments). RESULTS: Forty-eight (62.3 %) participants completed the study. Intervention group compared to the control group had lower (-0.53 %), clinically meaningful HbA1c (primary outcome) at 6 months, albeit not sustained at 12 months. Compared to the control group, the intervention group had significantly lower: (i) systolic blood pressure at six and 12 months (ii) diastolic pressure at 12 months, (iii) energy intake at six-months, (iv) up-titration of insulin at six and 12 months and higher diabetes knowledge scores at six months. CONCLUSIONS: NEP had limited effects on HbA1c, targeted dietary behaviors and behavior mediators but showed positive effects on blood pressure. The NEP health cost savings potential supports the need for improving program participation. TRIAL REGISTRATION: ClinicalTrials.gov. number NCT03334773; 7 November 2017 retrospectively registered.

Development, Implementation, and Process Evaluation of a Theory-Based Nutrition Education Programme for Adults Living With HIV in Abeokuta, Nigeria.

Introduction: Healthy diets play a role in the management and care for adults living with HIV/AIDS (ALH). Appropriate nutrition education (NE) is necessary to equip ALH with relevant knowledge and skills for healthy eating. A needs assessment identified the need for a nutrition education programme (NEP) as part of the nutrition service for ALH in Abeokuta, Nigeria. The aim of this study was to design a theory-based NEP and to evaluate the implementation process among ALH attending selected federal and state hospitals in Abeokuta as out-patients. Materials and Methods: An exploratory descriptive needs assessment in the qualitative and quantitative domains was conducted among a convenient sample of ALH (N = 243) at the selected hospitals. The quantitative needs assessment identified needs for improvement in the primary outcome [quality of life (QoL)] and the secondary outcomes [quality of dietary intake, nutrition knowledge, attitudes, and practice (KAP), and anthropometric status]. Participants' perceptions of the NEP were obtained using an interviewer administered questionnaire among 70 ALH who attended the implementation of the NEP and process evaluation thereof at the intervention hospital. Results: The qualitative results identified a lack of knowledge on planning varied meals with limited resources. The identified needs, existing guidelines and literature were integrated with appropriate constructs of the Social Cognitive Theory (SCT) and the Health Belief Model (HBM) into the NEP. The NE manual, participant's work book, flipcharts, and the brochure were tailored to address the identified challenges. Discussion: The process evaluation showed that the NEP was implemented as planned and that the participants' perceptions were positive. The use of the NE manual, participant's work book, flipcharts, and brochure demonstrated the practicality of incorporating behavioral theories in NE for ALH.

A Contextual Nutrition Education Program Improves Nutrition Knowledge and Attitudes of South African Teachers and Learners.

Background: Evaluating the impact of a nutrition education program could provide insight into the effectiveness of an intervention. Researchers tested the hypothesis that a theory-based contextual nutrition education program (NEP) would improve the nutrition knowledge, attitudes, and dietary practices (KAP) of teachers and learners. Methods: Twenty three teachers who taught nutrition in Grades 4-7 (treatment school, n = 12) and 681 learners (treatment school, n = 350) participated in the study. In this quasi-experimental study, two primary schools were randomly selected to implement a contextual NEP. The nutrition KAP were assessed using previously validated questionnaires. The treatment school teachers taught nutrition using a developed nutrition education manual, while the control school teachers taught nutrition in the usual manner. Random effects Generalized Least Squares regression estimated the difference in the teachers' and learners' KAP for the treatment and control schools; p = 0.025 for a one-tailed test. Results: At post-implementation, the treatment school teachers' had higher total nutrition knowledge mean score (85.5% ± 8.2, p = 0.003) compared to the control school. Within the treatment school, total nutrition knowledge mean score of the teachers improved by 14.1%, p ≤ 0.001. Learners in the treatment school had higher total nutrition knowledge (53.2% ± 16.9, p = 0.002) and nutrition attitude (63.9% ± 19.7, p = 0.001) scores compared to learners in the control school. Within the treatment school, learners' total nutrition knowledge and nutrition attitudes scores increased by 4.9%, p ≤ 0.001 and 6.9%, p ≤ 0.001, respectively. The dietary practices of the teachers and the learners, and the nutrition attitudes of the teachers in the treatment school showed no significant within school improvement or in comparison with the control school (p > 0.025). Conclusions: The NEP led to the improvement in the teachers' and the learners' nutrition knowledge and the learners' nutrition attitudes. However, no significant improvement in the dietary practices of either teachers or learners was found.

A Theory-Based Contextual Nutrition Education Manual Enhanced Nutrition Teaching Skill.

Background: A theory-based contextual nutrition education manual (NEM) may enhance effective teaching of nutrition in schools. School nutrition education should lead to the realization of such benefits as improved health, scholarly achievement leading to manpower development and consequently the nation's development. The purpose of the study was to develop a contextual NEM for teachers of Grade 5 and 6 learners in the Bronkhorstspruit district, South Africa, and to assess teachers' perception on the use of the manual for teaching nutrition. Methods: This descriptive case study used an interpretivist paradigm. The study involved teachers (N = 6) who taught nutrition in Life Skills (LS) and Natural Science and Technology (NST) in a randomly selected primary school in the Bronkhorstspruit district. Findings from a nutrition education needs assessment were integrated with the constructs of the Social cognitive theory (SCT) and the Meaningful learning model (MLM) and the existing curriculum of the Department of Basic Education (DoBE) to develop a contextual NEM. The manual was used by the teachers to teach nutrition to Grades 5 and 6 learners during the 2015 academic year as a pilot project. A focus group discussion (FDG) was conducted with teachers to gauge their perceptions of the usefulness of the NEM. Data were analyzed using the thematic approach of the framework method for qualitative research. Results: Teachers described the NEM as rich in information, easy to use and perceived the supporting materials and activities as being effective. The goal setting activities contained in the NEM were deemed to be ineffective. Teachers felt that they did not have enough time to teach all the important things that the learners needed to know. Conclusion: Teachers perceived the NEM as helpful toward improving their nutrition teaching skills.The NEM template may furthermore guide teachers in planning theory-based nutrition lessons.

The relationship between stunting and overweight among children from South Africa: Secondary analysis of the National Food Consumption Survey--Fortification Baseline I.

BACKGROUND: Globally, in children the prevalence of overweight and obesity is increasing, and this is associated with an increased risk of non-communicable diseases in adulthood. There is a need to examine the growing trends of overweight and obesity in children and their consequences in low- and middle-income countries. OBJECTIVES: To describe the prevalence of, and determine the relationship between, stunting and overweight among children in two provinces of South Africa. METHODS: Secondary data analysis was conducted on anthropometric measurements of 36-119-month-old children from Gauteng and Mpumalanga provinces (N=519) participating in the South African National Food Consumption Survey--Fortification Baseline I (2005). The International Obesity Task Force (IOTF) body mass index (BMI) reference percentiles were used to determine overweight and obesity. The World Health Organization standards were used to derive z-scores. RESULTS: The prevalence of overweight was 12.0% (IOTF BMI≥25 kg/m2), including 3.7% obesity (IOTF BMI≥30 kg/m2). The predominantly urban Gauteng Province had a significantly higher prevalence of overweight children (14.1%) compared with Mpumalanga (6.3%) (p=0.0277). The prevalence of stunting was 17.0% (16.5% Gauteng, 18.2% Mpumalanga; p>0.05). There was a significant correlation (r=-0.32) between BMI and height-for-age z-scores (p<0.0001). In the obese group, 68.4% were stunted, while in the normal and underweight group only 13.6% were stunted. CONCLUSIONS: Stunted children were more likely to be obese. Further research is necessary for clarity on the physiological mechanisms of this relationship. In the interim, prevention of stunting requires priority.