the nutritional status of - Health Systems Trust

More documents

Recommendations

Info

1.3 EVALUATION OF NUTRITIONAL STATUS The nutritional status of an individual depends on how well requirements for energy and more than 50 different nutrients are met. Requirements and eating behaviour (what, where, when and how often specific foods are eaten) are determined by a large number of physiological, pathological, psychological, cultural and socio-economic factors. Because of this, there is no single measurement that will give comprehensive information on nutritional status. Therefore, a combination of methods, including anthropometric measurements, biochemical analyses, nutrient intakes and clinical signs of malnutrition is usually used. The interpretation of these variables and conclusions reached will depend on the norms or standards used for comparison. 1.4 STRUCTURE OF THIS REVIEW In addition to the executive summary and this introduction, (Chapter 1), the methods used to collect, select, code and integrate the available literature are discussed in Chapter 2. In Chapter 3 the results consisting of 84 tables and 6 figures are given. These are divided into four sections, namely anthropometry, biochemistry, nutrient intakes and clinical signs. Data from these tables and figures are discussed briefly and salient observations highlighted. Reports on the determinants of nutritional status which have been examined in several studies by individual researchers and groups are given in Chapter 4. In Chapter 5, the limited information on how culture influences eating patterns in South Africa is summarised. Cultural influences may be seen as a determinant of nutritional status. However, it is difficult to conclude from the available literature whether it contributes to malnutrition in South Africa. Because it probably should influence dietary recommendations, and also because it should be taken into account in nutrition programming, the available literature on cultural influences on eating patterns is summarised in this separate chapter. Chapter 6 consists of an integrated discussion of the results and some recommendations on how the problem of malnutrition could be tackled. The bibliography and acknowledgements are given in Chapters 7 and 8. 2
METHODS 2.1 COLLECTION AND SELECTION OF STUDIES/DATA CHAPTER 2 Both published and unpublished data are included in this review. Published titles screened for inclusion were obtained from several electronic data bases (MEDLINE, REPORTORIUM), as well as South African medical and nutrition journals not included in these data bases. Articles, books and reports were obtained from the Ferdinand Postma Library in Potchefstroom and its inter-library services. Unpublished manuscripts, dissertations, theses, research reports and other documents (policy and briefing papers, technical reports, etc.) were obtained from the Medical Research Council, several universities, Government Departments, the Health Systems Trust, UNICEF, WHO, FAO and RDP offices, as well as individual colleagues and researchers. It is possible that, despite all these efforts, there may be publications and reports with valuable information on nutritional status of South Africans that were missed. After screening and selecting all available titles, some documents (especially postgraduate theses) could not be traced and are therefore not included in the review. Literature that measured the nutritional status of patients or subjects included in a study because of a specific disease or condition such as kwashiorkor, marasmus, diabetes or hypertension, were not included in the review. 2.2 CODING OF DATA: COMPILATION OF TABLES After collection of the literature, four researchers read the relevant sections and transferred the data to specially designed coding forms for either anthropometry, biochemistry, nutrient intakes or clinical signs. At the same time, short summaries of data pertaining to determinants of nutritional status and eating patterns were made. The coding forms helped to stratify information for date of the study (or published date), province, randomisation of subjects, ethnic group, urban/rural, gender, age, number of subjects, variables measured, means with standard deviations or confidence intervals, percentage of subjects with abnormal values and reference range. These data were then computerised and organised by computer into Tables 1-84. Because of differences in study design, selection of subjects and presentation of results, it was not possible to integrate and combine data on anthropometry, biochemistry and clinical signs of malnutrition in a meta-analysis. These data are therefore summarized in separate tables. Available nutrient intake data were combined in a metaanalysis by SANSS (1994) and are presented as such. For coding, urban and rural classification were used, as reported by the authors. Where appropriate, for example in the prevalence of stunting in preschool children, means from the different individual studies were calculated (without weighting of studies for numbers, etc.) and compared with the recent national surveys. Data from these surveys (SALDRU/World Bank 1994; Department of Health 1994; SAVACG, 1995) were included in the tables where appropriate, or given separately. 2.3 DIETARY DATA Nutrient intake data depends to a large extent on methods used to obtain information on dietary habits and intakes. The 24-hour recall method tends to measure lower intakes than, for example, the diet history and food frequency questionnaire. A survey of the South African literature on dietary intakes (SANSS, 1995) showed that the 24-hour recall method was mostly used in larger surveys while the diet history or food frequency questionnaire methods were used in smaller studies with limited numbers of subjects. Therefore, it was decided to present the 24-hour recall data separately, as explained in Chapter 3.3.1. 2.4 UNCODED DATA Not all sources such as review papers, opinions, editorials and policy or briefing papers gave data in a form that could be coded and included into the tables. If relevant, these were used in Chapters 4 and 5 to describe determinants of nutritional status or mentioned in the brief discussions of the different tables. 3
Page 2 and 3: THE NUTRITIONAL STATUS OF SOUTH AFR
Page 4 and 5: PREFACE In this review, the Nutriti
Page 6 and 7: 6. Recommendations It is suggested
Page 8 and 9: CHAPTER 4 DETERMINANTS OF NUTRITION
Page 13 and 14: RESULTS CHAPTER 3 3.1 ANTHROPOMETRY
Page 15 and 16: distributions of weight-for-age and
Page 17 and 18: Table 17 shows that the Northern Ca
Page 19 and 20: Table 31 indicates that urban black
Page 21 and 22: 3.3 NUTRIENT INTAKES 3.3.1 INTRODUC
Page 23 and 24: FIGURE 1: ENERGY DISTRIBUTION OF TH
Page 25 and 26: 3.3.10 IRON INTAKES Tables 54 (a),
Page 27 and 28: McLaren et al., 1993). In South Afr
Page 29 and 30: CHAPTER 4 DETERMINANTS OF NUTRITION
Page 31 and 32: Not many studies examined the direc
Page 33 and 34: The complexity of the effects of ur
Page 35: 4.3.10 ALCOHOL INTAKE Moderate drin
Page 38 and 39: 5.5 Black South Africans Traditiona
Page 40 and 41: 6.2.2 PRIMARY SCHOOL CHILDREN Preva
Page 42 and 43: References Agenbag S, Matthée V. 1
Page 44 and 45: Coovadia HM. 1993. Overview of maln
Page 46 and 47: Ijsselmuiden CB. 1984. Nutritional
Page 48 and 49: May J, Carter M, Posel D. 1995. The
Page 50 and 51: Richter LM. 1993. Malnutrition and
Page 52 and 53: Steyn NP, Wicht CL, Rossouw JE, Van
Page 54 and 55: Walker ARP, Walker BF, Duvenhage A,

the nutritional status of - Health Systems Trust

Create successful ePaper yourself

Delete template?

Save as template?