Browsing by Subject "malnutrition"

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    Open Access
    Has Food Security and Nutritional Status Improved in Children 1–<10 Years in Two Provinces of South Africa between 1999 (National Food Consumption Survey) and 2018 (Provincial Dietary Intake Study (PDIS))
    (Multidisciplinary Digital Publishing Institute, 2022-01-18) Steyn, Nelia P.; Nel, Johanna H.; Drummond, Linda; Malczyk, Sonia; Senekal, Marjanne
    The 1999 National Food Consumption Survey in South Africa showed that food insecurity (hunger) was prevalent in households with children aged one to <10 years. A repeat of the survey in two provinces: Gauteng (GTG) and the Western Cape (WC) was undertaken in 2018. Results showed that in all domains (living areas) in GTG, food shortage prevalence decreased between 1999 and 2018, from 55.0% to 29.6% in urban informal areas, from 34.1% to 19.4% in urban formal areas and from 42.1% to 15.6% in rural areas. While the prevalence of food shortage in urban formal areas in the WC remained similar in 2018, prevalence decreased from 81.8% to 35.7% in urban informal areas and from 38.3% to 20.6% in rural areas. Energy and macronutrient intakes improved significantly in GTG between 1999 and 2018 but not in the WC; intakes were significantly higher in the WC at both time points. The only significant change in stunting, wasting, overweight and obesity prevalence was that 7–<10-year-olds in GTG were significantly more likely to be wasted (BAZ < 2SD) in 2018 than in 1999 (20.2% versus 6.9% respectively). In the WC, 1–3-year-olds were significantly more likely to be obese in 2018 than in 1999 (8.1% versus 1.7% respectively) and 7–<10-year-olds were less likely to be stunted (14.5% versus 4.9% respectively). There were significant negative correlations between the hunger score and dietary variables in both provinces in 1999. In GTG in 2018, only the correlation with fat intake remained while there were still several significant correlations in WC in 2018. Changes in top 12 energy contributors reflect a shift to high or moderate energy foods low in nutrients from 1999 to 2018. Nutrient dense (high micronutrients, low energy/g) foods (e.g., fruit) fell off the list in 2018. Logistic regression analyses reflect the importance for food security of having a parent as head of the household and/or caregiver, and parents having grade 12 or higher education and being employed. We conclude that food security nutritional status indicators improved amongst 1–<10-year-old children especially in GTG between 1999 and 2018. However, the shift to poorer food choices and increase in wasting in older children and overweight in younger children are of concern.
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    A Physiologically-Based Pharmacokinetic Framework for Prediction of Drug Exposure in Malnourished Children
    (2021-02-02) Sjögren, Erik; Tarning, Joel; Barnes, Karen I; Jonsson, E Niclas
    Malnutrition in children is a global health problem, particularly in developing countries. The effects of an insufficient supply of nutrients on body composition and physiological functions may have implications for drug disposition and ultimately affect the clinical outcome in this vulnerable population. Physiologically-based pharmacokinetic (PBPK) modeling can be used to predict the effect of malnutrition as it links physiological changes to pharmacokinetic (PK) consequences. However, the absence of detailed information on body composition and the limited availability of controlled clinical trials in malnourished children complicates the establishment and evaluation of a generic PBPK model in this population. In this manuscript we describe the creation of physiologically-based bridge to a malnourished pediatric population, by combining information on (a) the differences in body composition between healthy and malnourished adults and (b) the differences in physiology between healthy adults and children. Model performance was confirmed using clinical reference data. This study presents a physiologically-based translational framework for prediction of drug disposition in malnourished children. The model is readily applicable for dose recommendation strategies to address the urgent medicinal needs of this vulnerable population.
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    The prevalence and predictors of food insecurity among HIV-infected women in Cape Town, South Africa: A cross sectional study
    (2019) Mzimkulu, Olona; Myer, Landon
    Background: Food insecurity is a major public health concern in most settings where the Human Immunodeficiency Virus (HIV) is prevalent, and it affects women disproportionately. However, the prevalence of food insecurity and associated risk factors for women who are living with HIV (WLH) in South Africa is under researched. Methods: The researcher conducted a secondary, cross-sectional analysis of 346 HIV-infected women aged between 18 and 45, in Gugulethu, Cape Town. All participants were 12 months postpartum and enrolled into the MCH-ART study, a large implementation science study of antiretroviral use in pregnancy. For this study, women completed a 10-item household food security questionnaire that categorised food security status into household-level food insecurity, individual level food insecurity and children hunger. Using this tool, the level of food insecurity was categorised as food insecurity (“yes” to up to four questions), experiencing food insecurity (“yes” to five questions or more) and free from food insecurity (“no” to all questions). Results: Overall, the mean age was 29 years (SD: 5.46); 25 % of the women completed high school; 61 % were unemployed; nearly 66 % were free from food insecurity; and 25 % experienced food insecurity. Women who were employed were less likely to experience food insecurity when compared to those who were not employed (OR=0.54; 95 % CI: 0.32-0.90; p= 0.01). Those who completed high school were associated with food security than the ones who did not complete high school (OR= 0.5; 95 % CI: 0.28-0.97; p= 0.04). After adjusting for maternal age, marital and cohabiting status, education attainment, and parity, employment remained a significant predictor of experiencing food security (AOR= 0.55; 95 % CI: 0.32- 0.95 p=0.03) and educational attainment was no longer associated with food insecurity. Conclusions: The prevalence of food insecurity was relatively low in the urban-based sample of HIV-infected women. However, most of these HIV-infected women were obese and overweight. Thus, there is a clear need for more research to explore issues of food insecurity and nutrition in HIV-infected South African women.