To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
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.
There is a paucity of data on the micronutrient status of low-income, lactating South African women and their infants under 6 months of age. The aim of this study was to elucidate the level of anaemia and vitamin A deficiency (VAD) in peri-urban breast-feeding women and their young infants.
Cross-sectional study including anthropometric, biochemical and infant feeding data.
Peri-urban settlement in Cape Town, South Africa.
Breast-feeding women (n = 113) and their infants (aged 1–6 months) attending a peri-urban clinic.
Mean (standard deviation (SD)) haemoglobin (Hb) of the lactating mothers was 12.4 (1.3) gdl−1, with 32% found to be anaemic (Hb < 12 g dl−1). Maternal serum retinol was 49.8 (SD 13.3) μg dl−1, with 4.5% VAD. Using breast milk, mean (SD) retinol concentration was found to be 70.6 (24.6) μg dl−1 and 15.7 (8.3) μg/g milk fat, with 13% below the cut-off level of <8μg/g fat. There was no correlation found between breast milk retinol and infant serum retinol. Z-scores (SD) of height-for-age, weight-for-age and weight-for-height were –0.69 (0.81), 0.89 (1.01) and 1.78 (0.83), respectively. Mean (SD) infant Hb was 10.9 (1.1) g dl−1, with the prevalence of anaemia being 50%, 33% and 12% using Hb cut-offs below 11 g dl−1, 10.5 g dl−1 and 9.5 g dl−1, respectively. Mean (SD) infant serum retinol was 26.9 (7.2) μg dl−1, with 10% being VAD. None of the infants was exclusively breast-fed, 22% were predominantly breast-fed and 787percnt; received complementary (mixed) breast-feeding. Thirty-two per cent of infants received weaning foods at an exceptionally young age (≤1 month old).
A high rate of anaemia is present in lactating women residing in resource-poor settings. Moreover, their seemingly healthy infants under 6 months of age are at an elevated risk of developing early-onset anaemia and at lower risk of VAD.
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.
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.
Two disadvantaged urban black and ‘coloured’ communities in the Western Cape, South Africa.
Sixty infants aged 6–12 months from each community.
Dietary intake, anthropometric measurements, micronutrient status and psychomotor development.
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 μg 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.
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.
To evaluate the long-term effect on micronutrient status of a β-carotene-, iron- and iodine-fortified biscuit given to primary school children as school feeding.
Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years (n=108); in addition, cross-sectional data from three subsequent surveys conducted in the same school are reported.
A rural community in KwaZulu-Natal, South Africa.
Children aged 6–11 years attending the primary school where the biscuit was distributed.
There was a significant improvement in serum retinol, serum ferritin, haemoglobin, transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention. However, when the school reopened after the summer holidays, all variables, except urinary iodine, returned to pre-intervention levels. Serum retinol increased again during the next 9 months, but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays; this pattern was repeated in two further cross-sectional surveys. Haemoglobin gradually deteriorated at each subsequent assessment, as did serum ferritin (apart from a slight increase at the 42-month assessment at the end of the school year).
This study has shown that fortification of a biscuit with β-carotene at a level of 50% of the Recommended Dietary Allowance (RDA) was enough to maintain serum retinol concentrations from day to day, but not enough to sustain levels during the long school holiday break. Other long-term solutions, such as local food production programmes combined with nutrition education, should also be examined. The choice of the iron compound used as fortificant in the biscuit needs further investigation.
Email your librarian or administrator to recommend adding this to your organisation's collection.