Workforce development in South Africa with a focus on public health nutrition

OBJECTIVES: The present paper aims to review and report on the current and predicted future public health nutrition workforce in South Africa. Additionally, it examines ways in which the Department of Health (DOH) is striving to meet the increasing burden of nutrition-related diseases in South Africa. METHODS: The primary sources of data used for the review were reports from the Census office, South African health reviews, mortality and morbidity statistics, and documents from the Health Professions Council of South Africa. RESULTS: There are fewer than 2000 registered dietitians in South Africa and fewer than 600 of them work in the public health sector. Furthermore, professional nurses - who are the backbone of the primary health-care system and deliver the rudiments of basic nutritional care - are not being trained in sufficient numbers to meet population growth; in 2004 there was only one nurse per 4000 persons. This situation is aggravated by the growing burden of conditions associated with both overnutrition and undernutrition, as well as the enormous demands of the HIV/AIDS epidemic. The DOH is striving to meet these increasing needs by means of the Integrated Nutrition Programme as well as a National Human Resources Plan which includes numerous strategies to improve the quantity and quality of health professionals' training, including dietitians and nutritionists. This plan includes the objective of increasing the public health nutrition workforce to more than 250 newly trained dietitians and nutritionists per annum by 2010.     

Underweight, overweight and obesity among South African adolescents: results of the 2002 National Youth Risk Behaviour Survey

OBJECTIVE: The present paper reports the prevalence of underweight, overweight and obesity by gender, ethnicity and grade, among participants in a 2002 national survey among South African school-going youth that included height and weight measurements. DESIGN: A stratified two-stage sample was used. Nationally representative rates of underweight, overweight and obesity were calculated using weighted survey data and compared using chi2 analysis. SETTING: In all, 9224 grade 8 to grade 11 students, present at school in selected classes within selected South African government-funded schools in all nine provinces, participated in this study. Most of the students were between 13 and 19 years of age. RESULTS: Higher rates of underweight were observed for males than females as well as for black and 'coloured' than white students. Within each gender group, black and 'coloured' students had significantly higher rates of underweight than their white counterparts. Higher percentages of females than males were overweight and obese, overall and among black students. Furthermore, white male students had significantly higher rates of overweight than their black and 'coloured' counterparts. Among females, black and white students had significantly higher rates than 'coloured' students. Students in higher grades showed significantly lower rates of underweight and higher rates of overweight. DISCUSSION: These data confirm that South Africa, a developing nation in socio-economic transition, is experiencing both undernutrition and overnutrition. However, these problems are disproportionately distributed by gender, socio-economics and ethnicity. Continued surveillance of nutritional status may be one important component of a national strategy to prevent and control malnutrition.     

Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa

OBJECTIVES: To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. DESIGN: Prospective cohort study. SETTING: Rural villages in the Central Region of the Limpopo Province, South Africa. SUBJECTS: One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. RESULTS: Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96-4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17-0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46-34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24-38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7-12.10). CONCLUSION: The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.     

Prevalence of overweight and obesity among school-aged children in urban, rural and mountain areas of the Veneto Region, Italy

OBJECTIVE: To define the prevalence of overweight and obesity among school-aged children resident in mountain areas, rural areas and urban areas.Design, setting and subjectsThe sample (n = 12 832; 50.7% boys) included 9- and 11-year-old children of the Veneto Region of north-east Italy. Overweight and obesity status were determined using the International Obesity Task Force cut-off points for body mass index. The prevalence of overweight and obese subjects was calculated with a confidence interval of 95%. The Mantel-Haenszel method was used to compare the combined prevalence of overweight and obesity among children resident in mountain areas, rural areas and urban areas. RESULTS: Among boys the prevalence of overweight was 21.06%, while obesity prevalence was 5.92%; among girls overweight prevalence was 21.30%, while obesity prevalence was 5.15%. The prevalence was higher among 11-year-old boys (odds ratio (OR) = 1.19; 95% confidence interval (CI): 1.06-1.33) and 9-year-old girls (OR = 1.13; 95% CI: 1.01-1.26). Children resident in rural areas presented a higher risk of overweight and obesity compared with children resident in mountain areas (Mantel-Haenszel OR = 1.27; 95% CI: 1.13-1.42; chi2 = 17.55; P < 0.0001) and in urban areas (Mantel-Haenszel OR = 1.18; 95% CI: 1.07-1.31; chi2 = 10.39; P < 0.001). CONCLUSIONS: A relevant prevalence of overweight and obesity was found; the excess weight concerns one child in four. There are differences linked to different geographical areas that must be further investigated.     

Variety and total number of food items recorded by a true longitudinal group of urban black South African children at five interceptions between 1995 and 2003: the Birth-to-Twenty (Bt20) Study

OBJECTIVE: To report on the variety and total number of food items recorded by a true longitudinal group of urban black South African children (n = 143) from the Birth-to-Twenty Study at five interceptions at the ages of 5 (1995), 7 (1997), 9 (1999), 10 (2000) and 13 (2003) years, respectively. METHODS: Dietary intake was assessed using a semi-quantitative food-frequency questionnaire. Frequencies were calculated per week, for each interception and for all five interceptions combined, using SAS. RESULTS: Five hundred and forty-six different individual food items were recorded 23 480 times for all five interceptions combined. The highest of 124 items was recorded in 1999 contributing 23% of the 546 items recorded. Each of the top 10 items (rice, stiff maize-meal porridge, chicken, sugar, sweets, tea, eggs, full-cream milk, carbonated beverages and oil) contributed between 2.5% and 3% and these items were recorded almost 600 times or more for all interceptions combined (n = 23 840). Rice and stiff maize-meal porridge were the top items recorded 684 and 676 times, both contributing 2.87% and 2.84%, respectively. The variety of food items and the ratio of the food groups to the total number of foods recorded in the present study were not significantly different but the denominators decreased over the five interceptions. CONCLUSION: The variety of food items recorded did not vary between 1995 and 2003 - the fact that new items were not added to the questionnaire as the children grew older could have contributed to this phenomenon. However, there was a difference in the ranking of these items that may suggest a change in eating patterns.     

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women

OBJECTIVES: To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image. DESIGN: A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight. SETTING: In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics. SUBJECTS: The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments. RESULTS: Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours. CONCLUSIONS: There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.     

The determinants of overweight and obesity among 10- to 15-year-old schoolchildren in the North West Province, South Africa - the THUSA BANA (Transition and Health during Urbanisation of South Africans; BANA, children) study

AIM: To investigate the determinants of overweight and obesity among 10- to 15-year-old schoolchildren in a population in the transitional phase in the North West Province of South Africa.METHODS: A cross-sectional survey was used to investigate weight status (anthropometric indicators) and determinants of overweight/obesity including dietary intake, physical activity and socio-economic status. A single, random sample (n=1257), stratified for gender, type of school and ethnic group, was used. Data were collected on demographics, family circumstances, habitual physical activity, dietary intake and anthropometry to evaluate weight status and body fat content. One-way analysis of variance, the generalised linear models procedure of SAS and the Tukey post hoc honest significant difference test were used to analyse the data.RESULTS: Few children were overweight or obese (7.8%) according to International Obesity Task Force (IOTF) standards (body mass index (BMI)-for-age). These standards were compared with other accepted standard values. Both Cole's IOTF/BMI-for-age standard and the sum of skinfold thicknesses standard classified normal-weight status similarly at a level of 92% (P<0.01) and were found to be useful in determining overweight/obesity. The prevalence rate was higher in females and white children, and was more apparent in urban areas, smaller households and children of parents with low- or high-income occupations. Boys and pre-menarcheal girls had mean body fat percentage in the normal/optimal range, whereas that of post-menarcheal girls was moderately high. Few variables showed a significant association with high body fat percentage: in boys, only the number of members in the household and physical activity levels over the weekend; in girls, only age. The overweight/obese boys mostly lived in smaller households, and the overweight/obese post-menarcheal girls were most inactive on both weekdays and weekends, and more overweight with increasing age.CONCLUSION: Smaller households, inactivity and increasing age for girls were found to be determinants that influence the development of overweight/obesity, while female gender and age post-menarche were identified as determinants of higher body fat content. For overweight/obesity prevention, the focus should be on pre-menarcheal girls, aged 10-13 years, using these determinants to identify overweight/obesity risk. Preventive programmes should aim to increase the physical activity of children to improve their current and future weight status.     

The effects of marine protected areas on the population dynamics of a South African limpet, Cymbula oculus, relative to the influence of wave action

Populations of a protandric limpet, Cymbula oculus, were compared between two South African Marine Protected Areas (MPAs), Dwesa and Tsitsikamma, and four exploited sites, and between sites exposed to or sheltered from strong wave action. Harvesting is decimating populations of this limpet. Compared with harvested sites, limpets in MPAs were 30-50% larger, adult densities 75% greater and biomass 30-90% greater. The female:male ratio was 0.58:1 inside the MPAs, but 0.11:1 at harvested sites. Growth rate and age-at-maturity were unaffected by harvesting, but survivorship was 10-fold higher inside MPAs, and reproductive output a staggering 80-fold higher. Conversely, recruitment was three times higher in harvested than protected areas, and inversely correlated with adult density. Wave action had negative effects of similar magnitude to harvesting. Limpets at sheltered sites were 65% larger, biomass 80% greater, female proportions 40% higher, survivorship 25% greater and growth 33% greater. Recruitment was, however, 45% greater at wave-exposed sites. All these effects were detected only inside the MPAs, being masked by harvesting elsewhere. The impacts of harvesting and wave action could never have been detected without the existence of MPAs, emphasizing their importance for base-line studies as well as protection. Dwesa MPA is under threat from poaching and demands for access to resources, but a strong case exists for retaining at least a core fully protected area. Our results clearly illustrate the need for MPAs among the tools used for coastal management.     

Energy, macro- and micronutrient intake among a true longitudinal group of South African adolescents at two interceptions (2000 and 2003): the Birth-to-Twenty (Bt20) Study

OBJECTIVE: This study reports on the energy, macro- and micronutrient intakes of a true longitudinal group of 143 urban black South African children from the Birth-to-Twenty (Bt20) study at two interceptions (2000 and 2003) when they were 10 and 13 years old, respectively. METHODS: Subjects resided in the urban Johannesburg/Soweto area of the Gauteng Province in South Africa. Dietary intake was assessed using a semi-quantitative food-frequency questionnaire. The coded data were analysed using SAS. RESULTS: Mean daily intake of energy, all six macronutrients and most micronutrients (17/19) increased from 2000 to 2003. Of the 19 micronutrients investigated, the mean daily intake of eight (calcium, iron, zinc, vitamin A, riboflavin, nicotinic acid, pantothenic acid and biotin) fell below the recommended dietary allowance (RDA) at both interceptions. More than 70% of the children consumed less than the RDA for these same eight nutrients. From 2000 to 2003, there was a decrease in the percentage of children falling below the RDA for energy (from 73 to 59%), but an increase in the percentage of children falling below the RDA for most of the micronutrients. There was a positive percentage change in mean daily intake for all 26 macro- and micronutrients from 2000 to 2003. CONCLUSION: Mean daily intake of nutrients increased from 2000 to 2003, but intakes for most micronutrients were still below the RDA at both interceptions for a large percentage of the children. The study has provided valuable information on the nutrient intake and change in intake over time among a longitudinal group of South African adolescents.     

Using LC-MSMS to assess glutathione levels in South African white grape juices and wines made with different levels of oxygen

The effect of oxygen on the levels of glutathione, an important antioxidant, in must and wine was studied using a novel LC-MSMS method for the analysis of reduced and oxidized glutathione. This study found that the storage of grape juice at high SO2 and ascorbic acid levels at -20 degrees C did not lead to a decrease in reduced glutathione levels. The effect of varying the oxygen levels in South African white grape juices, which included a reductive treatment (less than 0.3 mg/L dissolved O2 added), a control treatment (between 1.0 and 1.5 mg/L dissolved O2 added), and an oxidative treatment (3.5-4 mg/ L dissolved O2 added, without SO2) on reduced glutathione levels in the juice and resulting wine was also investigated. A custom build press was used to press whole bunches of two different Sauvignon Blanc and Colombard grapes. Alcoholic fermentation and oxygen additions to the must led to lower reduced glutathione levels in the wine. Reduced glutathione levels were only significantly higher in the wine made from reductive juice that had the highest initial reduced glutathione levels in the grapes.     

Bioavailability of Silicon from Different Sources and Its Effect on the Yield of Rice in Acidic,Neutral, and Alkaline soils of Karnataka,South India

Several silicon (Si) sources have been reported to be effective in terms of their effectiveness on rice growth and yield. Apart from that, it is crucial to understand the bioavailability of silicon from different silicon sources for adequate plant uptake and its performances in varying types of soils. In this point of view, a pot experiment was conducted to assess the bioavailability of silicon from three Si sources and its effect on yield of rice crop in three contrasting soils. Acidic (pH 5.86), neutral (pH 7.10), and alkaline (pH 9.38) soils collected from different locations in Karnataka were amended with calcium silicate, diatomite, and rice husk biochar (RHB) as Si sources. Silica was applied at 0, 250, and 500 kg Si ha^?1, and the pots were maintained under submerged condition. There was a significant increase in the yield parameters such as panicle number pot^?1, panicle length pot^?1, straw dry weight pot^?1, and grain weight pot^?1 in acidic and neutral soils with the application of Si over no Si treatment, whereas only straw dry weight pot^?1 increased significantly with the application of Si sources over control in alkaline soil. Higher Si content and uptake was noticed in neutral soil followed by acidic and alkaline soils. The bioavailability of Si increased with the application of Si sources but varied based on the types of soil. Application of calcium silicate followed by diatomite performed better in acidic and neutral soils whereas RHB was a better source of Si in alkaline soil. A significant difference in plant-available silicon status of the soil was noticed with the application of Si sources over control in all three studied soils.     

Acculturation, economics and food insecurity among refugees resettled in the USA: a case study of West African refugees

OBJECTIVES: To assess the occurrence and severity of food insecurity, and examine associations between food insecurity and measures of socio-economic status and indicators of acculturation. DESIGN: Structured interviews among a non-probability sample of West African refugees at baseline and 6 months' follow-up.Setting Mid-sized city in north-eastern USA. SUBJECTS: One hundred and one caregivers with children under the age of 5 years and who have been living the USA for fewer than 4 years. RESULTS: Food insecurity was indicated in approximately half of households (53%). The occurrence of food insecurity was associated with measures of socio-economic status such as income, employment status and participation in the Food Stamp Program (P < 0.05). Measures of acculturation such as difficulty in the shopping environment and language difficulty were also associated with the occurrence and severity of food insecurity, as was time lived in the USA (P < 0.05). Among households who had been in the USA for 1 year or less, food insecurity was indicated in 73%, whereas among households who had been in the USA for at least 3 years food insecurity was indicted in 33%. CONCLUSIONS: Refugees are a potentially vulnerable group and our results echo others in suggesting a need for more thorough monitoring of the health and well-being of recently resettled refugees. These results also suggest that reliance on employment as the sole indicator of success in the resettlement process may be too narrow an indicator. Future research should focus on a wider range of measures of health and well-being.