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Item Development, validation and implementation of a sustainable, nutrition-sensitive agriculture toolkit to address food and nutrition insecurity in Lesotho(2024-09) Mothepu, Lisebo; Napier, Carin E.; Naicker, Ashika; Duffy, Kevin JanBackground: Global food prices continue to increase because of natural and humaninduced disasterssuch as climate change and war. As a result, poverty remainsrelatively high globally, especially in lower-middle-income countries such as Lesotho. Poverty in Lesotho is rated at 49.7% with a staggering 24% of the population experiencing extreme poverty, and it is mostly prevalent in rural areas. Out of the population of over 2 million, approximately half of the populace survives below the poverty-line, and 58, 000 people continue to experience food insecurity. Lesotho ranks at 121st out of 125 countries with sufficient data to calculate 2023 GHI scores. Thehigherthe rank theworse the hungerindex. The Global Hunger Index recorded Lesotho’s hunger score at 32.4. This is categorised as alarming on the scale ranging from low to extremely alarming. Lesotho has been grappling with chronic food insecurity, with 61% of the population affected living in rural areas and 39% affected living in urban areas due to climate challenges such as heavy rains. In summary, severe food insecurity, decrease agriculture production, poverty, poor nutritional status, and HIV/AIDS decrease the quality of life in Lesotho. Aim: The main aim of the research study was to develop, validate, and implement, a sustainable nutrition-sensitive agriculture toolkit with two programs: sustainable agriculture and sustainable nutrition-sensitive agriculture. The toolkit was developed for rural small-scale female family farmers to provide for household consumption and local small-scale commerce. The study further aimed to introduce and educate female farmers in agri-business and agro- processing through the use of Greenhouse tunnels underpinned by sustainable agriculture, sustainable local community food systems, and sustainable nutrition-sensitive agriculture to address food and nutrition insecurity and attempt to decrease hunger at the community, household, and individual levels. Methodology: The sample size was n=126 females participants residing in rural households in the district of Mohale’s Hoek, Lesotho. The sample population age ranged from 20 to over 60 years. In this randomised control trial (RCT), a combination of quantitative and qualitative methods were used. The quantitative data was used to determine the interaction between socio-economic conditions, nutritional variety, nutritional competence, food consumption patterns, food security status, and agricultural practices. The qualitative data collection used was an observational research method under naturalistic and controlled observation. This approach involved manipulating and controlling the experimental and intervention research variables to determine cause and effect relationships. The control group participants were from Maqoala n=63, and the intervention group participants were from Mpharane n=63. The toolkit was developed using relevant literature for addressing poverty, hunger, food insecurity and nutrition insecurity. In addition, the toolkit was also developed using the results obtained from the study through the administered questionnaires: sociodemographic, household hunger scale and household food insecurity access scale, nutrition knowledge and anthropometry measurements for nutritional assessment, food frequency, 24-hour food recall, agricultural and knowledge practices, preparation, and preservation practices. The toolkit comprised of two programs: sustainable agriculture and sustainable nutrition-sensitive agriculture. The toolkit was validated through the Delphi method. The intervention was run for two years, to target three planting and harvesting seasons in both the control and experimental villages. Both the experimental and control group were allocated Greenhouse tunnels with irrigation systems, temperature control systems, storage facilities and food preparation facilities. The inputs given to each group included the allocation of inputs was seedsthat were certified by the government of Lesotho:round cabbage,spinach (Swiss chard), green beans (snap beans), red beetroot, carrots (Nantes), red bell pepper, tomato (stupice), butternut squash, potato (Vivaldi), and brown onion. The experimental group was given the researcher’s training manual together with the participants training manual. The experimental group was further trained using the manual. The control group, Maqoala, was given the training manuals, without any training. Results: Results indicated that all female participants (n=126) headed the households and were caregivers who resided with other people in the households. The majority of the households (61.9%) had one room, 16.7% had two rooms, and 11.9 % had three rooms with no electricity or running water in the houses. Notably, all participants were unemployed, and experienced anxiety over running out of food before having money to buy more. Almost 44% of the participants often had a shortage of money to buy food, and 45.2% of the participants sometimes had a shortage. The average monthly spending on food for 25.4% of the households was R201 to R300, whilst 36.5% of the households on average spent a between R301 to R400 on food each month. All the participants reported having a change in food intake due to decreased accessibility. Moreover, all the participants indicated that they consumed less food than required and had to cut the size of the food served to children because there was not enough food available. An estimate 89.7% of the participants skipped meals because there was not enough food to eat. The nutrient analysis from the 24-hour food recall indicated dietary inadequacy in energy, protein, calcium, and vitamins A, B6, B12, C, and E. When assessing the dietary diversity, the participants consumed more cereals and starchy foods, as reflected by the high carbohydrate Dietary Reference Intakes (DRIs). The Body Mass Index (BMI) of 4.7% of the participants from Maqoala was in the underweight BMI range compared to 3.1% of participants from Mpharane. The outcomes could also be influenced by a lack of nutrition knowledge as the average knowledge was 52.0%, ranging from 38 to 69% in both Mpharane and Maqoala.The results highlighted high levels of hunger, food insecurity and nutrition insecurity among the participants. The results supported the development, validation, and implementation of the toolkit through the Delphi method. Firstly, the toolkit focused on sustainable agriculture, planting vegetables, selling vegetables to generate money to buy seeds for the subsequent planting phases, and consumption and preservation of vegetables for households in the control and experimental groups. The intervention results indicated that Mpharane (experiment group) participants in phase 1, harvested 468 cabbage heads, sold 278 heads, and preserved 189 heads for household consumption. In phase 2, the number of cabbages increased to 612 heads; the participants sold 422 heads and preserved 189 heads for household consumption. In phase 3, 675 cabbage heads were harvested, 485 heads were sold, and 189 were preserved for household consumption. Mpharane had an increase of 144 heads of cabbage from phase 1, 468 heads of cabbage, to phase 2, 612 heads of cabbage, and in phase 3 (675 heads of cabbage), the increase was very low, with 63 heads of cabbage between phase 2 to phase 3. Maqoala (control group) participants did not sell any of the fresh produce they harvested. Instead, they shared the harvested fresh produce with each other. In phase 1, 567 cabbage heads were harvested, and 567 heads were shared among the n=63 participants for household consumption. In phase 2, the number of cabbage heads harvested increased to 627 heads and all 627 heads were shared among the participantsfor household consumption. In phase 3, 414 cabbage heads were harvested, and 414 heads were shared among the n=63 participants for household consumption. Maqoala produced a total of 1608 heads of cabbage between phases 1, 2 and 3, and Mpharane produced a total of 1755 heads of cabbage between phases 1, 2 and 3, 147 heads of cabbage more than Maqoala. The participants from experimental group harvested 519 bundles of spinach in Phase 1. In Phase 2, 834 bundles were harvested, 329 bundles in Phase 1, 644 bundles in Phase 2 were sold, and 189 bundles were preserved for household consumption. The participants harvested 1238 bundles of spinach in phase 3, and 1048 bundles were sold, whilst 189 were preserved for household consumption. The participants in Maqoala harvested 857 bundles of spinach and used all 857 bundles for household consumption. The experimental group had a vast increase in the bundles of spinach produced in phase 3, with 1238 bundles of spinach compared to phase 1, with 468 bundles, whilst phase 2, produced 612 bundles. The total of the bundles of spinach produced by the experimental group was 2591 bundles between phases 1, 2, and 3, whilst the control group produced 2196 bundles of spinach between phases 1, 2, and 3. The experimental group produced 396 bundles more than the control group. The toolkit introduced and educated the experimental group on agriculture practices, nutrition, and developing market products. At the baseline immediately after the lesson, the participants were assessed and scored 54% in lesson 1, 66% in lesson 2 and 80% in lesson 3. At the endline, the participants were not taught again but were expected to remember the previous lessons and practices they had done during the intervention. There was a decrease in the participants'scores atthe endline. The participantsscored 43% in lesson 1, 32% in lesson 2 and 65% in lesson 3. Conclusion: The findings indicated that poverty contributes to hunger, food and nutrition insecurity, and triple burden of malnutrition: undernutrition and overnutrition, and micronutrient deficiency in Lesotho. Food and nutrition insecurity can be addressed by integrating sustainable agriculture and sustainable nutrition-sensitive agriculture. Agriculture holds significant potential as it can contribute to addressing the primary causes of nutritionrelated problems, enhance worldwide food accessibility and availability and improve family food security, nutritional value, salary, and female empowerment. For these reasons, a sustainable nutrition-sensitive agriculture toolkit for small-scale female farmers with agribusiness and agro-processing components was developed from the Lesotho data and shown to improve household vegetable production and consumption. Agrifood systems contribute to high employment of females worldwide. Agrifood systems also contribute more to the livelihoods of females compared to males, mainly in developing countries. Enriching females and ending genderinequality under agrifood systems can improve the lives of the females and their homes, decrease starvation, increase earnings and strengthen resilience.Item The consumption, product compliance and manufacturer insights of plant-based foods in KwaZulu-Natal(2024-09) Govender, Camilla; Naicker, Ashika; Makanjana, OnwabaBackground: The term plant-based diet focuses predominantly on the consumption of food from plants. A plant-based diet consists mainly of wholegrains, fruits, vegetables, legumes, nuts, seeds and may also include more processed food products made from these ingredients. Food is the single most powerful lever to optimise human health and environmental sustainability. A large body of work has emerged on the environmental impact of various diets. As per the findings of the Environmental Assessment and Reference Tool (EAT)-Lancet Commission, many studies have concluded that a diet rich in plant-based foods (PBFs) has improved health and also environmental benefits. This transition has led to a noteworthy increase in the demand for PBFs globally, and South Africa is no exception. Aim: This study aimed to determine the consumption, product compliance and manufacturer insights of plant-based foods in KwaZulu-Natal (KZN). Methods: This study used a mixed methods approach, namely, qualitative and quantitative research methodology. The first objective of this study was to determine the consumption of PBFs and identify barriers and facilitators influencing the adoption of plant-based diets through a consumer survey. The study's second objective was to document the scope of plant-based products in terms of availability through in-store and online observations that were available in KZN. All products were analysed to determine the scientific and regulatory compliance of plant-based products by analysing food labels according to the Foodstuffs, Cosmetic and Disinfectant Act (Act 54, 1972), R146 Regulation relating to the labelling and advertising of foodstuffs. The qualitative aspect of the study delved into the product development practices, trends and challenges of plant-based manufacturers in South Africa through key informant interviews. The adequacy of the diet among consumers (n=100) who consumed plant-based foods was assessed through two 24-hour food recalls and analysed for dietary adequacy. Results: Three hundred and eighty consumers participated in the online survey, of which 67.7% (n=259) of participants were women and 31.3% (n=120). Regarding the frequency of consumption of PBFs, 47% (n=180) of participants consumed PBFs between 2 to 3 times a week, 27.7% (n=106) of participants consumed PBFs daily, 17.2% (n=66) of participants consumed PBFs once a week, and 4.2% (n=16) of participants consumed PBFs once a month. A significant 63.4% (n=243) of participants indicated that they spend at most R60.00 on plantbased products, p<0.001. Using the binomial test to assess if any response option was selected significantly more than others, a significant number of participants (80% n=307) p<0.001, reported that they consumed PBFs for health reasons, followed by 37% (n=142) who reported that they consumed PBFs due to religious reasons. A significant 64% (n=245) and 58.5% (n=224) of participants reported that the most common format of plant-based meat alternatives that they consumed were burgers and sausages, respectively (p<0.001). The findings of this study also revealed that there are many challenges and barriers that are associated with the adoption of PBFs. This study found that 58.5% of participants (n=224) reported that PBFs were expensive (p<0.001), and 40.5% of participants (n=155) indicated that PBFs were limited and lacked variety. A comprehensive database of plant-based products (n=431) in the South African market was documented through in-store and online observations. Eighty-nine percent (n=386) of the products documented were manufactured in South Africa.. Regarding South Africa's labelling regulation, 95% (n=411) of the plant-based products complied with legislation. Key informant interviews were conducted with manufacturers to understand the market trends and constraints within the South African plant-based food sector. Key themes emerging from the key informant interviews included consumer-centric PBFs, consumer-driven plant-based trends, growth in the plant-based market, dynamic and evolving plant-based product development, challenges in PBF manufacture and marketability, insufficient government support and market-related price of PBFs. Furthermore, the adequacy of plant-based diets was analysed using the 24-hour food recall (n=92). The majority of nutrients fell below the EAR for both males and females. Both groups exhibited dietary inadequacies in specific micronutrients: vitamin D, folate, vitamin B12, and iron. Dietary inadequacy of specific micronutrients was noted for vitamin D, Folate, vitamin B12 and iron in both groups. However, there was notable carbohydrate excess intake across both groups and genders, surpassing the recommended estimate for energy. Conclusion: This study comprehensively examined the consumption patterns, product compliance, and manufacturer insights of PBFs in KZN. The findings reveal a growing interest in flexitarian diets and frequent consumption of PBFs, driven primarily by health motivations but hindered by cost and limited variety. Retail availability of PBFs in KZN is extensive, offering consumers a wide range of choices in both fresh and frozen categories, reflecting the robust state of the plant-based industry in KZN and it can be reasonably generalised to the whole country Regulatory compliance among PBFs is generally high, although small-scale manufacturers occasionally fall short of labelling standards. Manufacturer insights indicate a consumer-driven demand for PBFs that closely mimic meat products, necessitating innovation and regulatory support to stabilise this emerging market. Nutritional assessments of plant-based diets highlight a critical need for dietary supplementation to address deficiencies in essential vitamins and minerals such as B12, iron, and zinc. The study underscores the importance of nutrition education to guide consumers towards healthier food choices within plant-based diets. In conclusion, while the plant-based food sector in KZN is expanding and meeting many consumer needs, there are significant opportunities for improvement in product variety, affordability, regulatory compliance, and nutritional adequacy. Addressing these challenges through coordinated efforts among stakeholders can further enhance the adoption and benefits of plant-based diets. The conclusions drawn from this study can be reasonably generalised to metropolitan areas of the whole country.Item Design of a worksite intervention to lower cardiometabollc risk In South Africa(2023-05) Singh, Shivneta; Naicker, Ashika; Grobbelaar, Hendrina HelenaBackground: Non-communicable diseases (NCDs) continue to increase globally, with an unduly larger impact in low to middle income countries (LMICs). NCDs are the main cause of death worldwide. There is strong evidence that lifestyle changes, such as weight loss, increased physical activity, and improved diet quality can help avert or slow down type 2 diabetes and reduce cardiometabolic risk factors, for example, high blood glucose, plasma lipids, and blood pressure. Regardless of the verification of research data, supporting the use of lifestyle interventions to prevent diabetes (improve glucose tolerance and lower high blood pressure), and implementing interventions in real-life settings has been proven to be difficult. Aim: The purpose of the study was to guide the development of an acceptable, appropriate, and feasible worksite intervention targeting the food environment and behavioural intervention to reduce cardiometabolic risk at a worksite in South Africa (SA). Methodology: In this cross-sectional study both qualitative and quantitative methods were used. The capacity of the built environment was explored through structured observations of the food and physical environment to offer healthy food and promote physical activity. Semi-structured in-depth interviews (IDIs) were conducted with worksite managers and canteen managers to assess the appropriateness, acceptability and feasibility of changes at worksites and explore the perceptions, provisions, facilitators and barriers to healthy eating at the worksite environment. Purposive snowballing sampling was used to recruit worksite managers and canteen managers for the IDIs. Focus Group Discussions (FGDs) were conducted amongst employees to explore the perceptions, provisions, drivers of and barriers to healthy eating at the worksite. An Organisational Readiness to Implement Change (ORIC) questionnaire was administered face to face at the worksite canteens and online through emails to employees aged between 18 to 65 years to determine the worksite readiness to implement changes at the worksite. Canteen staff were approached to rate possible intervention components for the purpose of tailoring the interventions and identifying the best way to deliver the intervention. The interventions were rated by canteen managers or canteen staff on a scale from one to five with regards to the feasibility of implementing different components of the intervention: with one (1) being impossible to implement and five (5) being easy to implement. A scoping review was carried out to gather data from empirical findings on the categorisation of healthy foods through Front of Pack (FOP) labelling schemes and was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) guidelines. Key findings from the formative work were used to select suitable food and physical environment interventions for the worksite. Worksite canteen intervention training was conducted to train canteen managers for the implementation of the food environmental intervention using the training manual that was developed by the researcher. Results: The study was conducted at six Unilever SA worksites, three in KwaZulu-Natal (KZN) and three in Gauteng province. The Unilever worksites comprised of five factories and one Head Office, namely, Unilever Maydon Wharf (Personal Care and Home Care), Unilever Indonsa (Savoury dry food plant - Knorr, Robertson’s, Rajah), Unilever Khanyisa (Home Care), Boksburg (Home care) and Lordsview (Ice cream -Ola) and La Lucia Head Office (Head Office). The study was also conducted at Retailability Head Office, a fashion apparel brand, which borders on the Unilever Head Office, making a total of seven worksites. The findings of the structured observations for the physical environment indicated that walking tracks were demarcated within the worksites; however, there were no signage prompts to encourage walking. Stairwells were clean, well lit, easily visible and accessible at each building; however, the health benefits of using the stairs were not displayed. The food environment was observed at six canteens including La Lucia Head Office and Retailability, Unilever Maydon Wharf, Unilever Indonsa, Unilever Khanyisa and Unilever Boksburg. There were two canteens at La Lucia Head Office: the main canteen and a coffee shop. There was no canteen at Unilever Lordsview, but there was a dining area with packaged food sold at the vending machine. Regarding the observation of the food environment, the worksite canteens offered five subsidised contract dishes among other unsubsidised dishes of which the healthy meal was the most expensive in a four-week menu cycle. Pre-made pre-packaged food options were sold at the canteens and displayed near to the point of sale. Ten semi-structured IDIs were conducted with worksite managers, to assess the appropriateness, acceptability and feasibility of changes at worksites and to explore the perceptions, provisions and facilitators of and the barriers to healthy eating at the worksite environment. Several themes emerged from the IDIs with worksite managers with regards to participation in a lifestyle intervention namely: availability, worksite resources and barriers to participation. Four semi-structured IDIs were conducted with canteen managers to assess the appropriateness, acceptability and feasibility of changes at worksites and barriers to healthy eating at the worksite environment. Numerous themes emerged from the IDIs with canteen managers including the enablement of a healthy food environment, information dissemination, employee preference and canteen enablers. Five FGDs were conducted, each group comprising of 4-6 employees, until data saturation was reached to understand the appropriateness, acceptability and feasibility of a range of possible changes at the worksite. Many themes emerged from the FGDs such as nutrient-dense foods, nutrient-poor foods and energy-dense beverages as well as the food environment and healthy longevity. Worksite readiness to implement change was determined through the ORIC questionnaire. The ORIC statements that Unilever employees agreed with most scored 4.51 on the scale of “I believe this change will benefit our worksite”, followed by 4.49 on the scale of “I am committed to implementing this change” and 4.41 on the scale of “I want to implement this change”. The lowest scores (disagreement) were 3.35 for “I have the equipment we need to implement this change”, 3.37 for “I have the resources we need to implement this change” and 3.46 for “I have the expertise to implement this change”. All statements were significantly different from ‘3’, on average. All mean values were >3 which indicates there was a significant agreement with all the statements. Factor analysis with promax rotation was applied to the 31 statements. A Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) of 0.958 and a significant Bartlett’s test indicated that the data was adequate for successful and reliable extraction. The alpha value for factor 1 and 2 was >.7, therefore indicating reliability. Composite variables were formed by calculating the average of the agreement scores for all items included in a variable. It was observed that there was a significant agreement for commitment (COM) and implementation (IMP) (with agreement that they desired the change and were committed to it being significantly higher than their agreement that they could implement the change). Results from a paired ttest showed agreement that they desired the change and were committed to it and were significantly higher than agreement that they could implement the change, t (299) = 15.229, p<.001. Further analysis to determine differences across worksites was conducted. Analysis from ANOVA showed that there was a significant difference in COM (commitment) across worksites, F (3, 296) = 5.375, p=.001. Post hoc analysis using Tukey’s test indicated that agreement to commitment was significantly higher at Maydon Wharf than at La Lucia Head Office (p=.043) and at Khanyisa (p=.021); and at Indonsa than at La Lucia Head Office (p=.031) and at Khanyisa (p=.021). Furthermore, there was a significant difference in IMP (implementation) across worksites, F (3, 296) = 9.960, p<.001. The ORIC statements that Retailability employees agreed with the most scored 4.58 on the scale: “I am committed to implementing this change”, followed by 4.53 on the scale of “I believe this change will make things better”, 4.50 on the scale of “I feel that implementing this change is a good idea” and 4.50 on the scale of “I feel this change is compatible with our values”. The lowest scores (indicating disagreement) were 3.11 for “I have the equipment we need to implement this change”, 3.24 for “I have the resources we need to implement this change” and 3.46 for “I have the expertise to implement this change.” All statements were significantly different from ‘3’, on average. All mean values were >3 which indicated there was significant agreement to all the statements. Factor analysis with promax rotation was applied to these 31 items. Two factors were extracted which accounted for 72.19% of the variance in the data. A Kaiser-MeyerOlkin Measure of Sampling Adequacy (KMO) of .784 and a significant Bartlett’s test indicated that the data was adequate for successful and reliable extraction. The alpha value for factor 1 and 2 was >.7, therefore indicating reliability. It was observed that there was a significant agreement for commitment (COM) and implementation (IMP) (with agreement that they desired the change and were committed to it being significantly higher than their agreement that they could implement the change). Results from a paired ttest showed that agreement that they desired the change and were committed to it was significantly higher than agreement that they could implement the change, t (37) = 6.727, p<.001. The intervention rating scale was completed by 12 canteen managers and canteen staff using a scale from one to five for the feasibility of implementing different components of the intervention. Interventions that were easy to implement were reported by 100% (n=12) of participants for increasing fruit and vegetable choices, 92% (n=11) for the provision of free water, followed by 75% (n=9) for the addition of a salad bar and ready-to- eat healthy meals. The one-sample t-test was done to determine whether the average ‘implementability’ score differed significantly from the central score of ‘3’. The easiest interventions to implement were reported by 83% (n=10) of participants being the strategic positioning of healthier alternatives to make healthy items more accessible with 75% (n=9) recommending traffic light labelling and healthy option stations. The most difficult to implement was reported by 25% (n=3) of participants for the display of kilojoules of a product translated into the number of minutes to perform a certain physical activity. A scoping review was conducted on FOP labelling schemes to inform the selection of a FOP labelling scheme best suited for canteen foods at worksites in SA. Several articles (n = 2513) were identified and screened after excluding duplicates (n = 2474). Overall, 1347 articles were excluded from the study because their abstracts and titles did not match the qualifying criteria. A total of six articles was used in the qualitative analysis after a full-text review of the remaining articles. It was concluded that grading foods into categories of healthfulness through evidence of key nutritional dimensions is a practical tool to inform food environmental interventions that may assist in public health promotion by influencing consumer choice in workplace canteens and beyond. The results from the observations, IDIs, FGDs, ORIC questionnaire, canteen rating intervention scale and scoping review were used to guide the development of the physical and canteen intervention and canteen staff were capacitated with training to implement the food environment intervention. A list of interventions detailing the tools to be used and responsibilities for executing the six weeks’ intervention with two weeks’ maintenance classes for phase three of the study, titled the South African Pioneer Worksite Multicomponent Lifestyle Intervention Study (WMLIS) was developed by the research team. Conclusion: Interventions are a useful tool that can be used in worksite settings to improve employees' overall occupational well-being. Interventions targeting the food environment and behavioural intervention can promote healthy eating behaviours and reduce cardiometabolic risk. It is important to take into account organisational complexity and the built environment when designing an intervention. In this study, formative research methods were used to engage worksite stakeholders to develop an intervention plan that is both theoretically and practically grounded to foster institutionalisation of the intervention. The findings of this study was used to contextualise and guide the development of acceptable, appropriate and feasible worksite food environment and behavioural intervention to reduce cardiometabolic risk among South African employees. The methods used allows for drawing of general conclusions for the implementation of lifestyle and food environment changes at worksites in SA. It is recommended that the study should be scaled up to other worksites to determine the comparativeness of this study to the response of other worksites regarding the acceptability, appropriateness and feasibility of worksite interventions.Item Development of nutrition, healthy eating and food preparation guidelines for child and youth care centres in KwaZulu-Natal, South Africa(2023-05) Chibe, Mumsy Evidence; Napier, Carin E.Background Child and youth care workers (CYCWs) are human service professionals that have constant contact with the children and youth placed in child and youth care centres (CYCCs). Some CYCWs work with children are uneducated and under-empowered. Childhood and adolescence are critical stages in life when physical, social, cognitive, and behavioural development occur. Methodologies and Results The development of the child nutrition, food preparation, food safety, and healthy eating guidelines in this study was carried out in accordance with the FAO framework used for planning, implementing, and evaluating. Situational analyses of child and youth care workers were part of phase 1 of the project (CYCCs). Nine respondents (two child and youth care managers (CYCMs) and seven CYCWs) from the two CYCCs were chosen. Selfadministration, one-on-one interviews with English-written interview questions that were translated into IsiZulu, weighing food to determine plate waste, and the collection and analysis of microbial samples for surfaces, hands, and water were all used to gather data. Thirty respondents responded to a second survey that was given out in the same CYCCs to determine the preferred learning materials. The outcomes of this phase improved the success of the primary study and helped design the guidelines. The results of this phase showed that all of the respondents had low levels of education, and some had no formal education. The respondents had a high level of work experience, with 44.4% having more than five years of experience in the CYCCs. Additionally, 100% of the respondents lacked training in food safety and hygiene. The observers noticed that food for the older children and adolescents was kept in the oven or stove for longer than 15 minutes before serving. None of the CYCCs had appropriate guidelines or procedures in place, nor did they have written and signed policies and procedures in place for receiving, storing, and serving food, as well as maintaining good hygiene and adhering to administrative practises. Despite a coliform count of 57 in the collected water samples, the CYCCs had access to water for drinking and cleaning utensils. According to the nutrition knowledge results, 88.9% of respondents did not understand the keys to healthy eating. When 77.9% of respondents suggested that starch should not be consumed in most meals, this revealed limited knowledge. Respondents were also unaware of how much water they should drink each day, with 66.9% incorrectly reporting that six or fewer glasses were sufficient. The food served to the children and youths, which included uPhutu and beef served with potatoes, lacked the variety of nutrients recommended by the FBDGs. Guidelines were preferred by 46.7% of respondents. Meanwhile, a sizable proportion of respondents (83.3%) preferred the learning material with drawings, images, photographs, and words written in isiZulu. The guidelines were developed based on the literature and phase one findings and presented to three subject matter experts for content validity. The experts received completed and language-edited guidelines. The guidelines' organisation and content were subjected to expert evaluation. They had two to three weeks to read and comment on the guidelines' content, organisation, structure, and overall aesthetic appeal. Reviews and comments were provided back to the researcher, who used them to update the guidelines based on advice from the experts. The guidelines were then revised, published, and translated. In order to collect data in the two CYCCs from 18 participants (pre-) and 14 participants (post-) implementation in the same study site(s), the behaviour over time was assessed using a three-step approach (pre- implementation (phase three), implementation (phase four), and post-implementation (phase five). the participant's prior knowledge of the guidelines' subject matter (menu planning, nutritious recipes, nutritional guidelines, food handling, and preparation). A behavioural change technique was used in the post-implementation phase to evaluate knowledge change over a ten-month period (the implementation process). Zoom was used for the interviews with the CYCMs and CYCWs. The discussion for this interview was facilitated by a video, which was also recorded with the participants' knowledge and consent. During the 10-month implementation period, participants were reminded once a week via phone and email to incorporate the guidelines into their day-to-day work activities and to ask clarification questions. Data from the pre-and post-implementation phases were transcribed and analysed using thematic analysis. Poor menu planning, failure to prepare nutritious recipes and follow nutritional guidelines due to limited funds, limited nutrition training, and limited knowledge of food handling, storage, and preparation were among the key findings that emerged from the pre-implementation of the guidelines.Guidelines were reported to be useful in the post-implementation phase in terms of menu planning, food handling and preparation taking into account all food groups, handling of cutlery and cutlery, proper washing of hands, hair covering, and food storage. Menu planning, the development of nutritious recipes for children and youths, following nutritional guidelines, food handling and food preparation, sourcing of ingredients, food preparation equipment, and personnel required to prepare the food were reported as lessons learned from the guidelines. Conclusion Poor hygiene and food handling procedures among CYCWs were attributed to a lack of skills training or guidelines prior to implementing the newly developed guidelines. However, there was a positive impact from the developed guidelines' post-implementation phase, where the respondents were discovered to have improved menu planning abilities, nutritional guidelines awareness, and food-handling skills, and could allocate correct portion sizes. The proper implementation of the guidelines developed in this study could reduce the rate of malnutrition and foodborne infections caused by poor food handling and preparation.Item Menu adequacy and nutritional status of children aged 6-19 years residing in child and youth care facilities in Durban(2022) Mbambo, Thembelihle Jessica Sibusisiwe; Napier, Carin E.The primary function of Child and Youth Care Facilities (CYCFs) is to provide a safe and secure environment run by trained and capable child and youth-care workers while the parents may not be capable of taking care of their children for various reasons. For children 6 - 19 years of age, the meals should provide at least 60-100% of the daily nutritional requirements. Studies worldwide have shown that child malnutrition and lack of access to healthy foods is still one of the biggest contributors to child mortality. AIM The main objective of the study was to analyse the nutritional adequacy of the menus, the food variety and the nutritional status of 6–19 year-old children residing in child and youth care facilities in Durban. METHOD Four CYCFs were randomly selected where the sample population consisted of (n=211) children between the ages of 6-19 years. The anthropometric measurements for weight and height were collected to determine BMI-for-age and height-for-age. The researcher also collected menus and recipes for analysis using Food Finder® version 3 and also conducted plate waste studies to analyse food wastage. The sample population consisted of (n=22) Child and Youth Care Workers (CYCWs) who completed the FFQ, the sociodemographic questionnaire and the nutrition knowledge questionnaire. Trained fieldworkers assisted in the interview process and the total sample size resulted in (n=233) participants. RESULTS The anthropometric indices showed a low prevalence (9.3%; n=7) of severely stunted children and stunted (9.3%; n=7) children amongst the boys. None of the children in this study were affected by wasting; however, the study indicated that 15.3% (n=21) of the girls were overweight and 16.7% (n=23) of the girls were obese. The results reported that the children were served an average portion size of 195- 287.41g of starchy foods, and the portion sizes of vegetables were below the recommended daily requirements resulting in poor micronutrient intake. The FVS in the CYCFs indicated that the highest number of individual foods consumed was between 20-40 individual foods and this indicated a medium food variety score. The results of the socio-demographic questionnaire revealed that most of the CYCWs were mothers who were the head of their households. The majority of the CYCWs had not obtained a relevant tertiary education, 72.7% had obtained a standard 10/ matric certification and 22.7% had obtained a college/FET qualification and none of the CYCWs had received training for food preparation at the CYCFs. The nutrition knowledge questionnaires indicated that more than 50% of the CYCWs answered the questions correctly CONCLUSION Overall, the majority of the meals met 100% of the daily nutrient requirements for carbohydrates, protein and fats. The majority of the micronutrients did not meet 100% of DRIs. RECOMMENDATIONS The CYCWs needed relevant training on food preparation and food handling as well as nutrition education to improve their nutrition knowledge. More nutrition interventions should be implemented to help combat nutrition deficiencies.Item Food safety practices, nutrition knowledge and menu adequacy at non-registered Early Childhood Development (ECD) centres in the Ntuzuma Area, Durban, South Africa(2023-05) Shabangu, Gugu Bongiwe; Grobbelaar, Heleen; Napier, Carin; Ijabadeniyi, Oluwatosin AdemolaGlobally, millions of children are deprived of their right to good nutrition which contributes to child development and nurturing while eliminating preventable diseases that could affect them at their early age. According to the World Health Organisation (WHO), food safety has become a health priority over the years with more than 95% of deaths reported globally due to diarrhoea and dehydration and 40% of these being young children. Food safety is the responsibility of every person who is involved in food handling. In general, food handlers’ mistakes include serving contaminated food, inadequate cooking, heating or reheating of food and allowing the consumption of food from unsafe sources. Children spend more than 50% of their day at an Early Childhood Development (ECD) centre therefore centres need to provide adequate meals and snacks in order to provide for the basic nutritional needs of these children. Nutrition remains an essential element of a child’s health care and nutrients are important for optimum growth, which is why regular small healthy meals for young children should include fruit and vegetables, whole grain and cereals, meat and meat alternatives (fish, legumes). The aim of this study was to investigate the food safety and hygiene practices, and evaluate the current nutrition knowledge of food handlers and also assess the nutritional adequacy of the menus at nonregistered ECD centres. This study also aimed to observe the food handling and hygiene practices of the food handlers and also determine the menu adequacy of meals served to the young children in these non-registered ECD centres. The designing of the research is one of the important steps in conducting a research as it helps structure research questions and objectives that have been outlined to provide a solution. This cross sectional study was of a quantitative nature and data was collected through structured research measuring tools that have been tested for their validity and reliability, and ensuring accuracy in measurements. A list of non-registered ECD centres (n=10) based in the Ntuzuma area was provided to the researcher by the Department of Social Development’s (DSD) Durban office. It must be stated that this list consisted of ECD centres that were not registered with DSD at the time of the study but were in the process of complying with the regulations and requirements stated by DSD, to assist in the sampling process. All ten of the centres were approached by the researcher and they all agreed to participate. Questionnaires and the observation checklist were then piloted in a sample group to establish suitability and adapted if necessary in one ECD centre while the remaining ECD centres formed part of the study (n=9). Eleven participants in total, two of whom were food handlers who assisted the managers when they were not available and nine who were both managers and food handlers formed part of the study. The researcher also conducted a plate waste study to determine the consumption patterns during meal times. Food finder version 2019 software was used to analyse the menu adequacy in each ECD centre by comparing it to the DRIs for children younger than five years old. Data collected from this study showed that food handlers were more knowledgeable on certain aspects of food safety as the majority of the food handlers knew that raw and cooked food needed to be placed separately during storage to prevent cross contamination. The vast majority of the centres had adequate space and utensils for cooking but insufficient chopping boards. Furthermore, simple hygiene practices such as washing of hands after a visit to the toilet and before food preparation were demonstrated by most of the food handlers. However, there was no antibacterial soap available for hand washing and no designated hand washing stations. Knowledge on temperature control was poorly demonstrated as all cooked foods should be kept very hot before serving; however, the food handlers kept their food warm by leaving it in pots on the stove with the lid tightly secured during the holding stage. The data gathered from this study was that food handlers at all the non-registered ECD centres needed to attend intensive formal training on food safety and hygiene practices on all the different aspects of food safety Nutrition knowledge questionnaire showed that majority of the FHs were able to correctly answer most of the questions relating to the South African Food Based Dietary Guidelines. However, it was disappointing that most of the food handlers were not aware that an average of 8 glasses of water a day are recommended to be drunk. The dietary analysis indicated that there was a low consumption of fruits and vegetables and dairy products as most meals lacked essential macro and micronutrients, contributing to the poor nutritional status of the young children. The microbial analysis revealed that the occurrence of Staphylococcus aureus and Escherichia coli was visible on the hands of the food handlers, the chopping boards and the preparation surface areas in each centre before washing but no growth was observed after washing, indicating that the cleaning process was effective. The overall observation assessment suggested that food safety compliance was not implemented. This indicates that thorough food safety and hygiene training is urgently needed. This study aimed to determine the food safety, hygiene practices and nutrition knowledge of all the food handlers, while analysing and assessing the nutrition adequacy of the menus offered to the children in these non-registered ECD centres, and lastly, to observe the food safety practices of food handlers and analyse the food workspaces for bacterial count. More research at non-registered ECD centres in other provinces is crucial in order to compare the results to the results obtained in this study. It is also recommended that other government stakeholders such as the Department of Social Development and the Department of Health be engaged in order to supplement existing knowledge and implement further practical improvements.Item The impact of an orange-fleshed sweet potato yoghurt on the nutritional status of pre-school children in Durban, South Africa(2022-03-16) Makanjana, Onwaba Z.; Napier, Carin E.; Naicker, AshikaBackground: Malnutrition exists globally due to various factors including basic, underlying and immediate factors. Goal two of the global targets in the 2030 Agenda for Sustainable Development is to end hunger and ensure that even the poorest people have access to sufficient, nutritious and safe food all year round. The Department of Social Development (DSD) in South Africa identified Early Child Development (ECD) centres as an ideal platform for implementing strategies aimed at improving the wellbeing of children below five years of age. ECD centres are facilities designed to provide early childhood development services and programmes that include good health, proper nutrition and early learning, through a holistic approach in promoting a healthy environment that is conducive for learning and development. Rationale and objectives: The health and nutritional status of young children is a global priority, as indicated in the 2030 Agenda for Sustainable Development. The arguments in favour of promoting the development of children at a very young age are clear and compelling. Effective interventions aimed at the vulnerable groups can make a positive contribution towards the achievement of Sustainable Development Goal (SDG) 2 which aims to end hunger, achieve food security and improved nutrition and promote sustainable agriculture. Inadequate nutrition in young children not only affects physical growth and development, but mental functioning as well. The pre-school years are associated with a phase of rapid growth. Adequate nutrition during the pre-school years is critical as proper nutrition plays an essential role in preventing malnutrition and other childhood-related diseases. Dietary diversification is one of the most effective strategies in preventing malnutrition and it is recommended that it is implemented during the stage of complementary feeding. Diets lacking dietary diversity lead to inadequate intake of vital nutrients such as vitamin A and iron, which may result in micronutrient deficiencies. Vitamin A and iron deficiencies are common among pre-school children in South Africa (SA) and the orange-fleshed sweet potato (OFSP) was identified as a potentially effective strategies to address vitamin A deficiency (VAD). The purpose of the study was to determine the nutrient intake, to develop and test the impact of an OFSP yoghurt on nutritional status of pre-school children in Durban, KwaZulu-Natal, SA, by determining the vitamin A and iron status of preschool children. The objectives of the study were to establish the socio-demographic profile of the children, to take anthropometric measurements (weight and height) to establish their nutritional status, to assess the dietary intake using a 24-hour recall questionnaire, (which was repeated three times) and a Food Frequency Questionnaire (FFQ). Furthermore, the study also aimed to determine the levels of vitamin A and iron in the blood at the time of the study using the finger-prick dried blood spot method, develop a yoghurt using an OFSP, administer the yoghurt as an intervention for three consecutive months and thereafter test the impact of the yoghurt on the nutritional status of the participants. Methodology: In this intervention trial, two ECD centres, an experimental group (EG) and control group (CG) comprising of 116 children aged 24–60 months were randomly selected. In each group, the participants were stratified according to age: 24–47 months and 48–60 months. At baseline, through the caregiver of the child participant, socio-demographic data was captured, and dietary intake was measured through three 24-hour dietary recall questionnaires, which were then analysed using Food Finder® software version 3.0 developed by the South African Medical Research Council (SAMRC). The food frequency questionnaire was used to calculate the food variety and food group diversity scores. Anthropometric measurements (weight and height) were taken and the World Health Organization (WHO) Anthro software® version 3.1 was used to convert these into nutritional data indices. Blood samples were collected through dried blood spot cards in order to determine serum retinol and haemoglobin (Hb) levels, which were assessed using the WHO indicators. A yoghurt with OFSP was developed following the steps of product development. The participants in the EG were given 100g of the developed OFSP yoghurt daily for three months, while the participants in the CG were given 100g of a peach flavoured yoghurt bought from the supermarket daily for three months, excluding weekends. The peach flavour was chosen for the CG as the colour was closest to the developed OFSP yoghurt. After the intervention period, anthropometric measurements were taken, dietary intake was assessed and blood samples were taken to assess impact on serum retinol and Hb levels. Results: Regarding the socio-demographic profile, unemployment was high, as 45.6% (n=36) and 54.1% (n=20) of the participants in the EG and CG respectively, were unemployed. In terms of household characteristics, 45.6% (n=36) of the participants in the EG and 32.4% (n= 12) in the CG had a tap inside the house. Access to a flush/sewage toilet was very limited in both groups, as less than half of participants had a flush toilet (39.2%; n=31) and 40.5% (n=15) in EG and CG, respectively) and more than half of the participants had a pit latrine (60.8%; n=48) in the EG and 59.5% (n= 22) in the CG. At baseline, anthropometric results in the current study showed that 16.6% (n=2) of CG girls 48-60 months of age were stunted. Among boys, 10.5% (n=12) and 36.4% (n=4) of EG and CG boys 48-60 months of age respectively, were stunted. No change was noted among EG boys 24-47 months of age of age, as 4.8% (n=1) were severely stunted at baseline and at endline. At baseline, 8.7% (n=2) of EG girls 24-47 months of age were overweight. In the CG group, 28.6% (n=2) and 16.7% (n=2) of girls 24-47 months of age and 48-60 months of age, respectively, were overweight. Furthermore, 9.5% (n=2) of EG boys and 42.8% (n=3) of CG boys 24-47 months of age were overweight. The prevalence of overweight among boys 48-80 months of age was 10.5% (n=2) and 27.3% (n=3) in the EG and CG, respectively. The prevalence of the risk of overweight increased from 21.7% (n=5) among EG girls 24-47 months of age at baseline to 45.0% (n=9) at endline and from 14.3% (n=1) to 28.6% (n=2) in the CG group. In the CG, an increase in the prevalence of the risk of overweight was noted among boys 48-60 months of age from 36.3% (n=4) at baseline to 54.5% (n=6) at endline. At baseline, the energy intake of girls and boys 24-47 months of age was more than the estimated energy requirement (EER) for both groups, whereas for the 48-60 month age group, it was less than the EER. The mean intake of fibre and calcium was lower than the recommended dietary allowance (RDA) for all groups and most participants consumed less than the RDA for fibre and calcium. The mean fruit and vegetable intake was less than the WHO recommendation of 320g to 480g per day for 24-47 month old children, and 400g to 480g for 48-60 month old children for all participants in the current study, and there was low variety in both groups. When comparing baseline with endline results between age groups within a group, there was a decrease in energy intake in all groups. Significant differences were found among EG girls 24-47 months of age (p=0.008) and CG girls (p=0.003 for 24-47 months and p˂0.001 for 48-60 months) for energy intake. Furthermore, baseline results showed that 2.7% (n=2) and 14.3% (n=3) of participants had low serum retinol levels in the EG and CG, respectively. At endline, serum retinol increased in 5.5% (n=3) of participants in the EG and 4.5% (n=1) in the CG. Low Hb levels were found in 19.2% (n=14) of participants in the EG and 32.1% (n=9) in the CG. At endline, Hb levels increased in 3.7% (n=2) and 9.0% (n=2) of participants in the EG and CG, respectively. Conclusion: Despite the numerous efforts to improve the nutritional status of children, a high prevalence of malnutrition still exists in South Africa. Consumption of the OFSP yoghurt made a small contribution to dietary vitamin A intake for some participants and iron intake levels did not increase from baseline to endline. The intervention period was too short to show an impact on anthropometric measurements such as stunting. The socio-demographic profile indicated that participants were predominantly from low-income households, and deprived of some essential sanitation services. Other issues in the current study population included overcrowding and high unemployment, with some households running out of money to buy food. The diet of the participants, was sub-optimal for optimum growth. Malnutrition, presented through micronutrient deficiencies, stunting, overweight and obesity, co-exist in this vulnerable population.