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Title: Development of nutrition education material for caregivers of immune compromised children in children's homes in the Durban area
Authors: Grobbelaar, Hendrina Helena 
Issue Date: 2011
Nutrition plays a fundamental role in the care and support of people living with the
Human Immunodeficiency Virus (HIV) and children in particular are affected by
HIV and the Acquired Immunodeficiency Syndrome (AIDS) epidemic in Africa in
various ways. The epidemic puts children at risk physically, psychologically and
economically. Children are indirectly affected by HIV and AIDS when the epidemic
has a negative impact on their communities and the services these communities
provide. Undernutrition is a major problem in HIV-positive children in South Africa
with severe malnutrition as a common finding in HIV-positive children. HIV
contributes to an increased incidence and severity of undernutrition and
micronutrient deficiency. Low serum levels of vitamins A, E, B6, B12 and C, betacarotene,
selenium, zinc, copper and iron deficiencies are frequently documented
during all stages of HIV-infection. Malnutrition in turn further weakens the immune
system which increases the susceptibility to infections and the duration and the
severity of infections. Thus, the immune response is less effective and less vigorous
when an individual is undernourished. Although guidelines exist for the treatment
and management of HIV-infected children, it is clear from the literature that
exceptional measures are needed to ensure the health and well-being of the children
are met. Furthermore, residential care should not only be considered as a last resort
for children’s care, but also as an intervention that requires more than merely
addressing children’s basic physical needs. Nutrition education has been utilised
globally and in South Africa to address nutrition related problems. The main
purpose of nutrition education is to provide individuals with adequate and accurate
information, skills and motivation to buy, produce and consume the correct foods to
stay healthy and lead an active life.
The purpose of this study was to develop reliable and valid nutrition education
material for the child care workers (CCWs) of Immune Compromised children
resident in Children’s Homes in the Durban area in order to maintain the child’s
immune system and to optimise their quality of life.
The FAO framework used for planning, implementing and evaluating a nutrition
education programme was followed to develop the nutrition education material in
this study. Phase I included a situational analysis of the children homes involved.
The residential care settings that participated in this study included three Children’s
Homes in Durban. The total purposive sample included: boys (5–19 years) n = 112,
girls (5–19 years) n = 38 and CCWs n = 40. The sample of HIV-positive children
included boys (5–19 years) n = 3 and girls (5– 19 years) n = 6. The physical
measurements obtained for this study to determine nutritional status were weight and
height. The anthropometric measurements were captured and analysed by the
researcher using the World Health Organisation’s AnthroPlus version 1.0.2.
Statistical software. The following indices were included: height-for-age (stunting),
weight-for-age (underweight) and BMI-for-age (overweight and wasting). The WHO
growth standards for school-aged children and adolescents were used to compare the
anthropometric indicators. Dietary intake measurements were done by analysing the
cycle menus by means of the Food Finder® Version 3 computer software program
and comparing the results with the Dietary Reference Intakes (DRIs), specifically the
EAR and AI where the EAR were not available. The data were analysed to determine
the adequacy of energy and nutrient intake. Average portion sizes were established
by the plate waste studies method as well as observation of practices, interviews with
the central buyer and focus group discussions with the CCWs. Nutrition knowledge
of the CCWs was determined by a self-administered questionnaire developed and
tested for reliability and validity. The problems identified in Phase I through the
implementation of the questionnaires and other methods directed the design of
messages in Phase II. Once suitable media was selected, nutrition education material
was developed based on existing guidelines pertaining to HIV and AIDS. The
material developed was then tested for reliability and validity before it was produced.
The anthropometric measurements indicated that the majority of the HIV-negative
boys and girls were of normal height-for-age and weight-for-age. The results also
showed that possible risk of overweight and overweight were more prevalent in girls
whereas underweight was more prevalent in boys. Furthermore, the results indicated
that a third (33.0%) of the HIV-positive children were stunted and 16.7% was
severely stunted. Findings of the menu analysis indicated that both girls and boys
consumed three times more carbohydrates than the recommended intake. The DRIs
for girls and boys were met for energy and protein in all the age groups except boys
aged 14-18 years did not meet the DRI for energy. However, the comparison of the
actual intake of the macro nutrients with the WHO guidelines indicated that the
protein (10.78%) and carbohydrate (58.07%) is within the recommendations of 10-
15% and 55–75% respectively. This comparison also showed that the total fat intake
of 31.15% was above the recommended intake of 15-30%. None of the age groups
met the DRIs for fibre. The comparison of the intake with the WHO guidelines also
indicated that the total dietary fibre intake was only 19.67g/day and not 27–40g/day.
The actual fruit and vegetable intake was a mere 68.64g/day instead of 400g/day as
recommended. None of the groups met the DRIs for calcium and iodine. The results
clearly showed that micro nutrient inadequacies were more prevalent in the dietary
intake of age groups 9-13 and 14-18 years in both girls and boys. Inadequate intake
of magnesium, vitamin A, vitamin C, riboflavin, niacin, vitamin B6, pantothenate,
biotin, vitamin E and vitamin K were evident in the age group 14-18 year. Overall, it
is evident from the results on nutrition knowledge that although the respondents’
knowledge was fair on general nutrition guidelines, the results of the nutrition
knowledge questionnaire indicated that knowledge on the importance of a variety in
the diet is lacking. The CCWs displayed a very poor knowledge of the recommended
number of fruit and vegetable portions per day as well as correct serving sizes of
vegetable portions. A very poor knowledge also existed regarding the role of healthy
eating in maintaining and supporting the immune system and a limited knowledge on
correct hygiene practices was noted. The fridge magnets developed included five
messages relating to nutrition and four messages relating to food safety and hygiene.
This study established that malnutrition is apparent in the children’s homes and that
there were many gaps in the nutrition knowledge of the CCWs. These gaps included
the role of good nutrition in the support and maintenance of the immune system and
the importance of adequate intake of fruit and vegetables daily. The NEM developed
in this study will address these gaps.
Dissertation submitted in fulfilment of the requirements for the Degree of Master of
Technology: Consumer Science Food and Nutrition, Durban University of
Technology, Durban, South Africa, 2011.
Appears in Collections:Theses and dissertations (Applied Sciences)

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