Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to make the problems. We investigated the prevelance of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.

Rural village in south-east Nigeria.

Cross-sectional survey.

The studdy included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.

A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (HB), serum iron, transferin saturation and protoporphyrin levels (ZPP) were also measured.

307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml);. median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (p = 0.048), and had longer duration of meneses (p < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.

The level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.

To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1–3-year-old malnourished African children.

A randomised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A, thiamine, riboflavin and pyridoxine, while 23 control children and their families received unfortified maize meal. The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households.

Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics' criteria and aged 1–3 years were randomly assigned to an experimental or control group. Baseline measurements included demographic, socio-economic and dietary data, as well as height, weight, haemoglobin, haematocrit, serum retinol and retinol-binding protein (RBP). Anthropometric, blood and serum variables were measured again after 12 months of intervention. Complete baseline measurements were available for 44 children and end data for only 36. Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests, t-tests and analysis of variances using the SPSS program, controlling for expected weight gain in this age group over 12 months. Relationships between changes in variables were examined by calculating correlation coefficients.

The children in the experimental group had a significantly (P≤0.05) higher increase in body weight than control children (4.6 kg vs. 2.0 kg) and both groups had significant (P≤0.05) but similar increases in height. The children in the experimental group showed non-significant increases in haemoglobin and serum retinol, while the control children had a significant (P = 0.007) decrease in RBP. The change in serum retinol showed a significant correlation with baseline retinol (P = 0.014), RBP (P = 0.007) and weight (P = 0.029), as well as with changes in haemoglobin (P = 0.029).

Despite a small sample size, this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1–3-year-old African children. The study confirmed the relationship between vitamin A and iron status. The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa.

To develop a nutrition screening tool for use in older South Africans.

A cross-sectional validation study in 283 free-living and institutionalised black South Africans (60+ years).

Trained fieldworkers administered a 24-hour recall and the Mini Nutritional Assessment (MNA) screening tool, and performed anthropometric measurements and physical function tests. Cognitive function was assessed using a validated version of the Six-Item Cognitive Impairment Test. Biochemical indicators assessed included serum albumin, haemoglobin, ferritin, vitamin B12, red-blood-cell folate, cholesterol and vitamin C. The MNA was used as the gold standard against which a novel screening tool was developed using a six-step systematic approach, namely: correspondence analysis; identification of key questions; determination of internal consistency; correlational analyses with objective measures; determination of reference cut-off values for categories of nutritional risk; and determination of sensitivity and specificity.

The new screening tool includes nine separate concepts, comprising a total of 14 questions, as well as measurement of mid-upper arm circumference. The new tool score was positively associated with level of independence in either basic activities of daily living (r = 0.472) or the more complex instrumental activities of daily living (r = 0.233). A three-category scoring system of nutritional risk was developed and shown to significantly characterise subjects according to physical function tests, level of independence and cognitive function. The new tool has good sensitivity (87.5%) and specificity (95.0%) compared with the MNA scoring system. It has a very high negative predictive value (99.5%), which means that the tool is unlikely to falsely classify subjects as well nourished/at risk when they are in fact malnourished.

A novel screening tool has been shown to have content-, construct- and criterion-related validity, and the individual items have been shown to have good internal consistency. Further validation of the tool in a new population of elderly Africans is warranted.

To describe how urbanisation influences the nutrition and health transition in South Africa by using data from the THUSA (Transition and Health during Urbanisation of South Africans) study.

The THUSA study was a cross-sectional, comparative, population-based survey.

The North West Province of South Africa.

In total, 1854 apparently healthy volunteers, men and women aged 15 years and older, from 37 randomly selected sites. Pregnant and lactating women, those with diagnosed chronic diseases and taking medication, with acute infections or inebriated were excluded but screened for hypertension and diabetes mellitus. Subjects were stratified into five groups representing different levels of urbanisation in rural and urban areas: namely, deep rural, farms, squatter camps, townships and towns/cities. Outcome measures and methods: Socio-economic and education profiles, dietary patterns, nutrient intakes, anthropometric and biochemical nutrition status, physical and mental health indicators, and risk factors for non-communicable diseases (NCDs) were measured using questionnaires developed or adapted and validated for this population, as well as appropriate, standardised methods for the biochemical analyses of biological samples.

Subjects from the rural groups had lower household incomes, less formal education, were shorter and had lower body mass indices than those in the urban groups. Urban subjects consumed less maize porridge but more fruits, vegetables, animal-derived foods and fats and oils than rural subjects. Comparing women from rural group 1 with the urban group 5, the following shifts in nutrient intakes were observed: % energy from carbohydrates, 67.4 to 57.3; from fats, 23.6 to 31.8; from protein, 11.4 to 13.4 (with an increase in animal protein from 22.2 to 42.6 g day-1); dietary fibre, 15.8 to 17.7 g day-1; calcium, 348 to 512 mg day-1; iron from 8.4 to 10.4 mg day-1; vitamin A from 573 to 1246 μg retinol equivalents day-1; and ascorbic acid from 30 to 83 mg day-1. Serum total cholesterol, low-density lipoprotein cholesterol and plasma fibrinogen increased significantly across groups; systolic blood pressure >140 mmHg was observed in 10.4–34.8% of subjects in different groups and diabetes mellitus in 0.8–6.0% of subjects. Women in groups 1 to 5 had overweight plus obesity rates of 48, 53, 47, 61 and 61%, showing an increase with urbanisation. Subjects from group 2 (farm dwellers) showed the highest scores of psychopathology and the lowest scores of psychological well-being. The same subjects consistently showed the lowest nutrition status.

Urbanisation of Africans in the North West Province is accompanied by an improvement in micronutrient intakes and status, but also by increases in overweight, obesity and several risk factors for NCDs. It is recommended that intervention programmes to promote nutritional health should aim to improve micronutrient status further without leading to obesity. The role of psychological strengths in preventing the adverse effects of urbanisation on health needs to be examined in more detail.

To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes.

Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed.

Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes.

Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services.

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.

Prospective cohort study.

Rural villages in the Central Region of the Limpopo Province, South Africa.

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.

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).

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.

We sought to validate questionnaires concerning body image perception, body size dissatisfaction and weight-related beliefs in multi-ethnic South African mothers and their daughters.

Settings and subjects: Girls attending primary school (ages 9–12 years, n = 333) and their mothers (n = 204) were interviewed regarding their demographics and body image. Weight, height and skinfold thicknesses were measured. Body image questions and body mass index (BMI) were compared with silhouettes adapted from the Pathways Study for girls and Stunkard's body image figures for mothers. A Feel–Ideal Difference (FID) index score was created by subtracting the score of the silhouette selected by the participants as ‘Ideal’ from the one selected as most closely representing their current appearance or ‘Feel’. We hypothesised that a higher FID index score would be associated with greater body size dissatisfaction.

BMI percentiles in girls (r = 0.46, P < 0.05) and BMI in mothers (r = 0.68, P < 0.05) were positively correlated with the selected silhouettes based on size. Participants who reported feelings of being ‘fat’ and those who perceived that their family and friends were more dissatisfied with their body size had significantly higher FID index scores. Scores were lower in black than white girls (all P < 0.05). No differences were found in FID index scores between ethnic groups of mothers. Internal reliability of the ‘thin’ and ‘fat’ belief constructs for girls was demonstrated by standardised Cronbach's α values ≥0.7.

Silhouettes, FID index, ‘fat’ and ‘thin’ belief constructs (in girls) are age-appropriate, culturally sensitive and can be used in further intervention studies to understand body image.

The aim was to contribute to the nutritional well-being of young children living in Duncan Village by investigating factors that influence clinic attendance of mothers and to formulate recommendations for optimisation of accessibility of primary health care (PHC) clinics in the area.

PHC clinic accessibility was evaluated by assessing the experiences of mothers who attended clinics in the area as well as the experiences of health care workers (HCWs) in these clinics of service delivery and its recipients (mothers/children), using the focus group technique. The ATLAS/ti program was used to analyse the data in the following steps: preparation and importing of the data, getting to know and coding the data, retrieval and examination of codes and quotations, creation of families and creation of networks.

Duncan Village, a low socio-economic urban settlement in East London, South Africa.

Focus group discussions (four to seven participants per group) were conducted with four groups of mothers who do not attend PHC clinics, six with mothers who do attend the clinics (including pregnant women) and four groups of HCWs.

Four networks that provide a summary of all the major trends in the data were created. The results clearly indicate that mothers in Duncan Village perceive and/or experience serious problems that make it difficult for them to attend clinic and even prevent them from doing so. These problems include both the way they are treated at the clinics (especially the problem of verbal abuse) as well as the actual services delivered (no medicines, no help, disorganised, long waiting periods, being turned away). The main problem experienced by the HCWs with service delivery seems to be a heavy workload, as well as the fact that many mothers do not come for follow-up visits.

Efforts to increase the accessibility of PHC clinics in Duncan Village should focus on improving the relationship between mothers and HCWs and the heavy workload experienced by these workers.

The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1–9 years old), as well as factors that influence their dietary intake.

This was a cross-sectional survey of a nationally representative sample of all children aged 1–9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information.

Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%.

The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference.

At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1–3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure.

The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.