Browsing by Author "Bourne, Lesley"

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    Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services
    (2002) Nthangeni, Gladys; Steyn, Nelia P; Alberts, Marianne; Steyn, Krisela; Levitt, Naomi S; Laubscher, Ria; Bourne, Lesley; Dick, Judy; Temple, Norman
    OBJECTIVE: To determine the dietary intake, practices, knowledge and barriers to dietary compliance of black South African type 2 diabetic patients attending primary health-care services in urban and rural areas. DESIGN: A cross-sectional survey. Dietary intake was assessed by three 24-hour recalls, and knowledge and practices by means of a structured questionnaire (n = 133 men, 155 women). In-depth interviews were then conducted with 25 of the patients to explore their underlying beliefs and feelings with respect to their disease. Trained interviewers measured weight, height and blood pressure. A fasting venous blood sample was collected from each participant in order to evaluate glycaemic control. SETTING: An urban area (Sheshego) and rural areas near Pietersburg in the Northern Province of South Africa. SUBJECTS: The sample comprised 59 men and 75 women from urban areas and 74 men and 80 women from rural areas. All were over 40 years of age, diagnosed with type 2 diabetes for at least one year, and attended primary health-care services in the study area over a 3-month period in 1998. RESULTS: Reported dietary results indicate that mean energy intakes were low (< 70% of Recommended Dietary Allowance), 8086-8450 kJ day(-1) and 6967-7382 kJ day(-1) in men and women, respectively. Urban subjects had higher (P < 0.05) intakes of animal protein and lower ratios of polyunsaturated fat to saturated fat than rural subjects. The energy distribution of macronutrients was in line with the recommendations for a prudent diet, with fat intake less than 30%, saturated fat less than 10% and carbohydrate intake greater than 55% of total energy intake. In most respects, nutrient intakes resembled a traditional African diet, although fibre intake was low in terms of the recommended 3-6 g/1000 kJ. More than 90% of patients ate three meals a day, yet only 32-47% had a morning snack and 19-27% had a late evening snack. The majority of patients indicated that they followed a special diet, which had been given to them by a doctor or a nurse. Only 3.4-6.1% were treated by diet alone. Poor glycaemic control was found in both urban and rural participants, with more than half of subjects having fasting plasma glucose above 8 mmol l(-1) and more than 35% having plasma glycosylated haemoglobin level above 8.6%. High triglyceride levels were found in 24 to 25% of men and in 17 to 18% of women. Obesity (body mass index > or = 30 kg m(-2)) was prevalent in 15 to 16% of men compared with 35 to 47% of women; elevated blood pressure (> or = 160/95 mmHg) was least prevalent in rural women (25.9%) and most prevalent in urban men (42.4%). CONCLUSIONS: The majority of black, type 2 diabetic patients studied showed poor glycaemic control. Additionally, many had dyslipidaemia, were obese and/or had an elevated blood pressure. Quantitative and qualitative findings indicated that these patients frequently received incorrect and inappropriate dietary advice from health educators.
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    Evaluating exposure to and perceptions of the Woolworths Healthy Tuck Shop Guide in Cape Town, South Africa
    (2011) Marraccini, Toni; Draper, Catherine; Meltzer, Shelly; Bourne, Lesley
    Both under-nutrition and over-nutrition pose a public health concern, especially for children in South Africa. Several initiatives exist in South Africa in order to promote healthy eating and nutrition at schools. One of them is the Woolworths Making the Difference (MTD) Programme aimed at eliminating barriers to promoting healthy lifestyles that exist at schools, such as the availability of low cost, unhealthy foods either from tuck shops or street vendors. The Healthy Tuck Shop Guide is a recent addition to the MTD programme. The aim of this evaluation is to assess schools’ perceptions of the Woolworths Healthy Tuck Shop Guide as it is being utilized in Woolworths Making the Difference schools.
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    A study of the relationship between maternal obesity and child under-nutrition in African women attending a child health clinic in Khayelitsha, Cape Town
    (1999) Mvo, Ntombizodumo; Hoffmann, Margaret; Bourne, Lesley; Lombard, Carl
    Background: Malnutrition, manifesting as obesity in women and under-nutrition in children, is a major public health problem in South Africa. There is a multitude of epidemiological evidence reflecting the extent and health effects of these problems, specifically among the African communities. However, at a family level, there is a paucity of information regarding the relationship between obesity in mothers and under-nutrition in children. Studies set to explore this relationship and determinants of body size and nutrition from a cultural perspective are long overdue. Such studies would assist in identifying intervention strategies that are appropriate and effective for the population at risk. Objective: This study, therefore, investigated the relationship between the child's nutritional status and that of the mother in a peri-urban African community. It further explored knowledge, attitudes and perceptions of body size as possible determinants of obesity and under-nutrition. This will make information available for further screening and planning of culturally sensitive nutrition interventions for the population under study. Methods: The study was conducted in two phases. The first phase was an exploratory qualitative design used mainly to develop a questionnaire for the second phase. In-depth interviews were conducted with 10 obese African mothers, whose children were categorised on the 'Road-to-Health' card, as underweight. The interviews provided an understanding of the African women's' perceptions of their body sizes and nutrition regarding the child. The second phase utilised a cross-sectional analytic study design to investigate the relationship between the mother's weight and the child's weight. It further investigated the knowledge, attitudes and perceptions found in the first phase in a larger sample using appropriate statistical techniques. A systematic sample of 365 mother-child pairs attending a child health clinic over a two-month period, starting from August 1997, was selected. The sample included women between the ages of 16 and 49 years old and their children between the ages of 2 and 5 years old attending a child health clinic in Khayelitsha, a peri-urban area outside Cape Town. Anthropometric measurements of children and mothers were taken and a structured questionnaire was administered to the mothers. Findings: The qualitative study showed attitudes and perceptions of body size that were tolerant of a 'big' body image. There was a lack of knowledge regarding causes of obesity and effective ways of reducing weight, preventing chronic diseases of lifestyle and what constitutes 'good' nutrition for the child. All these findings were confirmed in the second phase of the study. The main study showed that less than half (42%) of the mothers were able to estimate their body weights. These mothers underestimated their weights, on average, by 5 kg (p=0.0001 CI: 3.5-6.8). In the total sample, 37.3% of the mothers were obese (BMI> 30kg/m2) and 33.4 % were overweight (25 2 weight-for-height. The main finding is that, overall, no relationship was found between the mother's weight and that of the child. The mother's BMI showed a weak positive correlation with the weight-for-age zscore. The relationship between BMI and height-for-age z-score or weight-for-height was not statistically significant. However, most importantly, subgroup analysis showed that mothers' perceptions of their own body size and that of the child were significantly related to BMI and weight-for-age z-scores. Furthermore, a higher proportion of obese mothers (47.1 %) were unhappy about their body size than non-obese mothers (35.4 %). Consequently, a lesser proportion of obese mothers (36%) chose an overweight body image as 'attractive' compared with non-obese mothers (40.2%). Conclusions: Although there was no relationship found between obesity in mothers and under-nutrition in children, this study confirmed the high prevalence of both problems in the study group. Furthermore, it provided new evidence on the relationship between nutritional status of mothers and the resultant attitudes and perceptions to body size. This crucial information could be used in planning appropriate intervention strategies for the study population. More studies of this nature are needed for specific target populations in order to direct effective interventions.