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The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa.
Nutritional risk status of infants and children < 6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein–Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status.
One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P = 0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P < 0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P = 0.003). The weight results of the nurses and the researcher differed significantly (P < 0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P < 0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart.
Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.
The aim of this study was to determine the iron status, and the risk factors for iron deficiency (ID) and iron-deficiency anaemia (IDA), of non-pregnant adult women working in a fruit-packing factory.
A cross-sectional analytical study was done on 338 women, 18 to 55 years of age. Information on demographic data, risk factors for ID, smoking, and the consumption of red meat, chicken and fish was collected by questionnaire. Height and weight were measured and the body mass index (BMI) calculated. A non-fasting venous blood sample was analysed for haemoglobin (Hb), serum ferritin (SF), serum iron, serum transferrin and C-reactive protein; transferrin saturation (TFS) was calculated.
Fruit-packing factory in the Western Cape, South Africa.
The mean value for Hb was 13.06 (standard deviation (SD) 1.16) g dl−1 and for SF 48.0 (SD 47.8) μgl−1 (geometric mean 26.44 μgl−1). Women (n = 325) were categorised on the basis of iron status: 60% had a normal iron status (NIS); 12.6% had low TFS (<16%) but normal Hb (≥12 g dl−1) and SF (≥12 μgl−1) concentrations (LTS); and 27.4% had low iron status (LIS), defined as combinations of low SF (<12 μgl−1 or <20 μgl−1), low TFS (<16%) and low Hb (<12 gdl−1). More than 30% of the women were obese (BMI ≥ 30 kgm−2). The risk ratio for LIS (LIS vs. NIS) was 3.8 (95% confidence interval (CI) 1.9–7.6) if women were still menstruating or 3.2 (95% CI 1.6–6.2) if they were pregnant during the past 12 months. Women with LIS consumed significantly smaller portions of red meat, chicken and fish than did women in the other two groups.
IDA (low Hb, SF and TFS) and ID (low SF and TFS) did not seem to be a major problem. Women who were still menstruating or were pregnant during the past 12 months were at greater risk for ID. The consumption of smaller portions of red meat, chicken and fish was related to LIS. A high prevalence of obesity, which demonstrated the coexistence of both under- and overnutrition, was observed.
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