Research Articles (Human Nutrition)
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Item Evaluation of geneXpert and advanced biological laboratories ultragene HCV diagnostic detection and performance against Roche real time PCR in Myanmar(Elsevier, 2024-04) Pisa, Pedro Terrence; Kinge, Constance Wose; Chasela, Charles; Mothibi, Eula; Thaung, Yin Min; Thwin, Hnin T.; Aung, Nay M.; Chew, Kara W.; Gandhi, Malini M.; Clint, Cavenaugh; Minior, Thomas; Lwin, Aye A.; Freiman, Morgan J.; Kyi, Khin P.; Sein, Yi Y.; Marange, Fadzai; Van der Horst, Charles; Mohamed, Sofiane; Barralon, Matthieu; Sanne, IanBACKGROUND : Developing countries experience limited access to HCV laboratory tests for different reasons. Providing near to real–time HCV testing and results especially to at–risk populations including those in rural settings for timely initiation to treatment is key. Within a rural Myanmar setting, we compared HCV diagnostic detection and quantification of the GeneXpert, and Advanced Biological Laboratories UltraGene–HCV assays against the gold standard and reference method Roche real–time HCV in Myanmar. METHODS : Blood samples from 158 high–risk individuals were assessed using three different methods at baseline. Results were checked for normality and log transformed. Log differences and bias between methods were calculated and correlated. Pearson’s correlation coefficient was used to determine the association of HCV viral loads across all methods. The level of agreement with the standard method (Roche real time HCV) was assessed using Bland–Altman analyses. RESULTS : There was a strong positive correlation coefficient between all three methods with GeneXpert and Roche having the strongest, r = 0.96, (p<0.001). Compared to Roche, ABL (mean difference, 95 % limits of agreement; -0.063 and -1.4 to 1.3 Log10IU/mL) and GeneXpert (mean difference, 95 % limits of agreement; -0.28 and -0.7 to 1.8 Log10IU/mL) showed a good level of agreement with the GeneXpert being slightly superior. CONCLUSION : We demonstrate the excellent performance and no-inferiority, in terms of levels of agreements of both GeneXpert and ABL compared to the Roche platform and supporting the use of the POC assays as alternative a cost-effective methods in HCV detection and diagnosis in developing and low resource settings countries.Item South African dietitians' knowledge and perceptions of food-drug interactions and factors affecting it(Wiley, 2025-02) Megaw, Christie; Olivier, Natascha; Cordier, Werner; werner.cordier@up.ac.zaBACKGROUND : Dietitians ensure that patients receive tailored medical nutrition therapy to integrate with pharmacotherapy safely. Dietitians require a pharmacological understanding to prevent detrimental food-drug interactions (FDIs). The study investigated dietitians' knowledge of FDIs and their information sourcing. METHODS : A cross-sectional online survey was conducted among registered South African dietitians to assess their knowledge of FDIs, the impact of food timing on drugs, and their sources of FDI information. The questionnaire included demographics, a 12-question knowledge assessment, and a qualitative section on information sourcing. Data from 70 valid responses, collected between 2 August and 19 September 2022, were analysed statistically using analysis of variance and chi-square tests to determine whether associations between knowledge scores and demographic factors were present. RESULTS AND DISCUSSION : Out of 70 responses, most participants were female (97.1%) and 47.1% had over 10 years of experience. The participants primarily worked in the areas of dietetics related to chronic and lifestyle-related disorders (75.7%) across various work settings, including in-patient care (32.8%), out-patient care (41.4%), and multi-disciplinary team environments (31.4%). Although not generalisable due to the low response rate (70 out of the 304 required responses for a 5% margin of error), knowledge deficiencies were observed. A cumulative mean knowledge score of 38.3% was observed, with gaps identified for fundamental FDIs. Drug package inserts (55.7%) and clinical websites (68.6%) were primarily used to source information regarding FDIs; however, the former did not always provide sufficient information. Participants proposed that knowledge deficiencies could be overcome with further education, and the development and/or use of mobile applications or summarisations that elaborate on FDIs. CONCLUSION : Knowledge gaps and uncertainties were identified regarding fundamental FDIs; however, further research is needed to pinpoint the specific sources of these deficiencies and the factors influencing them. To improve dietitians' knowledge of FDIs and ensure alignment with their scope and standard of practice, undergraduate curricula should be bolstered and benchmarked to national needs to facilitate graduate development, and additional learning opportunities provided, such as webinars and continuing professional development (CPD), to allow for continuous education for practicing dietitians. SUMMARY : The study provides insights into potential knowledge deficiencies about food-drug interactions in South African registered dietitians. Food-drug interaction information sources, both academic and nonacademic, need to be supplemented with continuous professional development. Package inserts are often not available or feasible as a source of information on food-drug interactions.Item Application of the workload indicators of staffing need (WISN) to assess dietetic workforce needs in South African central and tertiary public hospitals(Nature Portfolio, 2025-01) Naicker, Vertharani Nolene; Muchiri, Jane Wanjiku; Naidoo, Keshan; Legodi, Modiehi HeatherSouth Africa faces both under- and over-nutrition, highlighting the need for prioritizing nutrition services. Registered dietitians are crucial for delivering appropriate and quality nutrition services. Consequently, this case study employs the World Health Organization evidence-based Workload Indicators of Staffing Need to ascertain the requisite dietetic workforce needed at central and tertiary public hospitals in South Africa. Head dietitians from 21 of 22 central and tertiary public hospitals participated in an online survey to provide data and consensus on workload components and activity standards via Delphi technique. Data were analyzed using the World Health Organisation Workload Indicators of Staffing Need software. Dietetic staffing needs were determined based on the difference between existing and required numbers of dietitians. WISN ratio was used as a metric to gauge dietitians’ workload pressure. Majority (95%) of hospitals experienced dietetic staff shortages and few (14%) had requisite staff to cover basic health services. Majority (76%) exhibited a WISN ratio below 0.5, indicating fullfilment of less than 50% of staff requirements. Based on the Workload Indicators of Staffing Need, dietitians in South African central and tertiary public hospitals experience high workload pressures due to extreme understaffing. The results can guide future profession workforce planning to facilitate enhanced nutrition outcomes in South Africa.Item A workload indicators of staffing need (WISN) based framework and implementation tool for dietitians at South African central and tertiary public hospitals(BMC, 2025-01) Naicker, Vertharani Nolene; Muchiri, Jane Wanjiku; Naidoo, Keshan; Legodi, Modiehi HeatherBACKGROUND : Quality nutrition services are dependent upon the accessibility and availability of nutrition professionals. In this study, we used the World Health Organization’s Workload Indicators of Staffing Need (WISN) methodology to develop a dietetic staffing norm framework and implementation tool for South African central and tertiary public hospitals. METHODS : We followed the eight step WISN methodology as a basis for this developmental study. National data on permanently employed dietitians in public hospitals were used to determine the facility type. Available working time (AWT) was determined using WISN calculations and SA labour regulations. Consensus on workload components (WC) and activity standards (AS) was achieved through a Delphi exercise. Steps 5 to 8 ended in determination of dietitian requirements based on WISN software. Similar steps were used to develop the framework and tool. The tool’s calculated outputs were compared against the WISN software. RESULTS : Central and tertiary public hospitals were identified as the target facilities. Dietitians AWT at these facilities was calculated as 1528 h per year. A final list of 45 WC and aligned AS was obtained and provided the necessary contextualization. A WISN based framework, and a Microsoft Excel tool (calculator) resulted. Calculated average dietitians’ requirements were 24.59 and 24.23 for WISN software and the excel tool respectively. CONCLUSION : The WISN methodology is a versatile tool that allows for the development of context and cadre specific staffing norm implementation frameworks and tools. The developed tool is valid and contextualized to determine the specific need for dietitians at SA central and tertiary public hospitals. These results will help policy makers to plan and forecast dietetic staffing needs at a macro level.Item Dietary intake and growth of HIV exposed and unexposed 6-12 months old infants in South Africa(Wiley, 2025-01) Tshiambara, Phumudzo; Hoffman, Marinel; Legodi, Heather; Balakrishna, Yusentha; Feucht, Ute Dagmar; phumudzo.mamphwe@up.ac.zaFactors affecting the growth of HIV‐exposed‐uninfected (HEU) children are multi‐factorial, with limited information available on the dietary intake from 6 months. This study compared the dietary intake, micronutrient composition of breastmilk, and growth of HEU and HIV‐unexposed‐uninfected (HUU) infants aged 6 and 12 months in an urban setting. A repeated cross‐sectional study used structured questionnaires to collect socio‐demographic, dietary intake, food group data, and anthropometric measurements in the Siyakhula study. The HEU (48%) and HUU (52%) infants were included (total n = 181). At 6 months, HEU infants had lower weight‐for‐age z‐scores (WAZ) (−0.6 ± 1.1 vs. 0.1 ± 1.2; p < 0.001), length‐for‐age z‐scores (−0.8 ± 1.4 vs. −0.1 ± 1.2; p < 0.001), and mid‐upper‐arm circumference‐forage z‐scores (MUACAZ) (0.5 ± 1.1 vs. 1.0 ± 0.9; p < 0.001) than HUU infants. At 12 months, HEU infants had lower WAZ, MUACAZ, and weight‐for‐length z‐scores compared to HUU infants (p < 0.05). Stunting was found at 6 (15%) and 12 (12%) months in HEU infants. The micronutrient composition of breastmilk fed to both groups was similar. Breastfeeding rates were lower in HEU than in HUU infants at 6 (49% vs. 64%; p = 0.005) and 12 (24% vs. 46%; p = 0.002) months. Less than 3% of HEU and HUU infants achieved minimal dietary diversity scores at 12 months. Dietary intake of fat was similar in all breastfed infants, but iron and vitamin B12 were higher in non‐breastfed HEU infants at 12 months. HEU infants had lower breastfeeding rates than HUU infants. A lack of dietary diversity was found in all infants. Nutrition education and counselling in the complementary feeding phase are essential for optimal growth.Item The application of the food insulin index in the prevention and management of insulin resistance and diabetes : a scoping review(MDPI, 2024-03) Strydom, Hildegard; Delport, Elizabeth; Muchiri, Jane Wanjiku; White, Zelda; jane.muchiri@up.ac.zaThe food insulin index (FII) is a novel algorithm used to determine insulin responses of carbohydrates, proteins, and fats. This scoping review aimed to provide an overview of all scientifically relevant information presented on the application of the FII in the prevention and management of insulin resistance and diabetes. The Arksey and O’Malley framework and the PRISMA Extension for Scoping Reviews 22-item checklist were used to ensure that all areas were covered in the scoping review. Our search identified 394 articles, of which 25 articles were included. Three main themes emerged from the included articles: 1. the association of FII with the development of metabolic syndrome, insulin resistance, and diabetes, 2. the comparison of FII with carbohydrate counting (CC) for the prediction of postprandial insulin response, and 3. the effect of metabolic status on the FII. Studies indicated that the FII can predict postprandial insulin response more accurately than CC, and that a high DII and DIL diet is associated with the development of metabolic syndrome, insulin resistance, and diabetes. The FII could be a valuable tool to use in the prevention and management of T1DM, insulin resistance, and T2DM, but more research is needed in this field.Item Dairy intake screener as web-based application is reliable and valid(Wiley, 2024-08) Piderit, Monique Cruz; White, Zelda; Becker, Piet J.; Wenhold, Friedeburg Anna Maria; u28020945@tuks.co.zaThe “Dairy Diary” is a user-friendly web-based dairy intake screener. The reliability and validity are unknown. We aimed to evaluate the screener in terms of test–retest reliability and comparative validity. In a diagnostic accuracy study, a purposefully recruited sample of 79 (age: 21.6 ± 3.8 years) undergraduate dietetics/nutrition students from three South African universities completed 3 non-consecutive days of weighed food records (reference standard) within a seven-day period (comparative validity), followed by two administrations, 2 weeks apart, of the screener (index test) (reliability). For the four dairy product serving scores (PSSs) and the summative dairy serving scores (DSSs) of the screener and the food records, t-tests, correlations, Bland– Altman, Kappa, McNemar's, and diagnostic accuracy were determined. For reliability, mean PSSs and DSSs did not differ significantly (p> .05) between the screener administrations. The mean PSSs were strongly correlated: milk (r= .69; p< .001), maas (fermented milk) (r= .72; p< .001), yoghurt (r= .71; p< .001), cheese (r= .74; p< .001). For DSSs, Kappa was moderate (k= 0.45; p< .001). Non-agreeing responses suggest symmetry (p= .334). For validity, the PSSs of the screener and food records were moderately correlated [milk (r= .30; p= .0129), yoghurt (r= .38; p< .001), cheese (r= .38; p< .001)], with k= 0.31 (p= .006) for DSS. Bland–Altman analyses showed acceptable agreement for DSSs (bias: −0.49; 95% CI: −0.7 to −0.3). Categorized DSSs had high sensitivity (81.4%) and positive predictive value (93.4%), yet low specificity (55.6%) and negative predictive value (27.8%). The area under the receiver operating characteristic curve (0.7) was acceptable. The “Dairy Diary” is test–retest reliable with moderate comparative validity to screen for dairy intake of nutrition-literate consumers.Item One-year anthropometric follow-up of South African preterm infants in kangaroo mother care : which early-life factors predict malnutrition?(Wiley, 2024-04) Nel, Sanja; Wenhold, Friedeburg Anna Maria; Botha, Tanita; Feucht, Ute Dagmar; sanja.nel@up.ac.zaBACKGROUND : Preterm infants often have poor short- and long-term growth. Kangaroo mother care supports short-term growth, but longer-term outcomes are unclear. METHODS : This study analysed longitudinally collected routine clinical data from a South African cohort of preterm infants (born <37 weeks gestation) attending the outpatient follow-up clinic of a tertiary-level hospital (Tshwane District, South Africa) for 1 year between 2012 and 2019. At 1 year, small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) infants were compared with regard to agecorrected anthropometric z-scores (weight-for-age [WAZ], length-for-age [LAZ], weight-for-length [WLZ] and BMI-for-age [BMIZ]) and rates of underweight (WAZ < 2), stunting (LAZ < 2), wasting (WLZ < 2) and overweight (BMIZ> + 2). Multiple regression analysis was used to investigate associations between maternal/infant characteristics and rates of underweight, stunting, wasting and overweight. RESULTS : At 1 year, compared with AGA infants (n = 210), SGA infants (n = 111) had lower WAZ (1.26 ± 1.32 vs. 0.22 ± 1.24, p < 0.001), LAZ (1.50 ± 1.11 vs. 0.60 ± 1.06, p < 0.001), WLZ (0.66 ± 1.31 vs. 0.11 ± 1.24, p < 0.001) and BMIZ (0.55 ± 1.31 vs. 1.06 ± 1.23, p < 0.001), despite larger WAZ gains from birth (+0.70 ± 1.30 vs. +0.05 ± 1.30, p < 0.001). SGA infants had significantly more stunting (34.2% vs. 9.1%; p < 0.001), underweight (31.2% vs. 7.2%; p < 0.001) and wasting (12.6% vs. 4.3%, p = 0.012), with no difference in overweight (4.5% vs. 7.7%, p = 0.397). In multiple regression analysis, birth weight-for-GA z-score more consistently predicted 1-year malnutrition than SGA. CONCLUSION : Preterm-born SGA infants remain more underweight, stunted and wasted than their preterm-born AGA peers at 1 year, despite greater WAZ gains. Interventions for appropriate catch-up growth especially for SGA preterm infants are needed.Item Lived experience of people with cryptococcal meningitis : a qualitative study(AOSIS, 2024-05-29) Legare, Neo A.; Quan, Vanessa C.; Govender, Nelesh; Muchiri, Jane W.BACKGROUND : The high burden of cryptococcal meningitis (CM) among people living with HIV persists despite widespread access to antiretroviral therapy. Efforts to prevent CM among people living with HIV could be hindered by a limited understanding of their lived experiences of CM and its diagnosis. OBJECTIVES : To explore and describe the experiences of people diagnosed with HIV-associated CM in routine care. Two public healthcare facilities in Johannesburg, South Africa. METHOD : This was a qualitative-methods exploratory, descriptive, phenomenological study. We conducted semi-structured, individual in-depth interviews with nine purposively sampled participants (comprising 5 men and 4 women). Data were analysed using the Moustakas phenomenological approach. RESULTS : Five themes and several sub-themes emerged from the data. Participants described their experiences of being diagnosed, which were marked by intense headaches. Diagnosis of CM led to reduced quality of life, fear of death, and loss of income. Participants described their CM treatment experience and health-seeking behaviour including self-medication, seeking help from traditional healers and general practitioners and utilising public health facilities as a last resort. Barriers to care included negative healthcare workers’ attitudes, unhealthy lifestyles, and poor knowledge of CM. CONCLUSION : People with HIV-associated CM face negative impacts prior to and after diagnosis. These patients struggled to access timely quality healthcare. Patients starting or restarting antiretroviral therapy, and thus at risk for CM, should receive CM education as part of HIV counselling.Item Trends in COVID-19 admissions and deaths among people living with HIV in South Africa : analysis of national surveillance data(Elsevier, 2024-02) Jassat, Waasila; Mudara, Caroline; Ozougwu, Lovelyn Uzoma; Welch, Richard; Arendse, Tracy; Masha, Maureen; Blumberg, Lucille Hellen; Kufa, Tendesayi; Puren, Adrian; Groome, Michelle J.; Govender, Nevashan; Pisa, Pedro Terrence; Govender, Sharlene; Sanne, Ian; Brahmbhatt, Heena; Parmley, Lauren; Wolmarans, Milani; Rousseau, Petro; Selikow, Anthony; Burgess, Melissa; Hankel, Lauren; Parker, Arifa; Cohen, Cheryl; pedro.pisa@up.ac.zaBACKGROUND : In 2021, the HIV prevalence among South African adults was 18% and more than 2 million people had uncontrolled HIV and, therefore, had increased risk of poor outcomes with SARS-CoV-2 infection. We investigated trends in COVID-19 admissions and factors associated with in-hospital COVID-19 mortality among people living with HIV and people without HIV. METHODS : In this analysis of national surveillance data, we linked and analysed data collected between March 5, 2020, and May 28, 2022, from the DATCOV South African national COVID-19 hospital surveillance system, the SARS-CoV-2 case line list, and the Electronic Vaccination Data System. All analyses included patients hospitalised with SARS-CoV-2 with known in-hospital outcomes (ie, who were discharged alive or had died) at the time of data extraction. We used descriptive statistics for admissions and mortality trends. Using post-imputation random-effect multivariable logistic regression models, we compared characteristics and the case fatality ratio of people with HIV and people without HIV. Using modified Poisson regression models, we compared factors associated with mortality among all people with COVID-19 admitted to hospital and factors associated with mortality among people with HIV. FINDINGS : Among 397 082 people with COVID-19 admitted to hospital, 301 407 (75·9%) were discharged alive, 89 565 (22·6%) died, and 6110 (1·5%) had no recorded outcome. 270 737 (68·2%) people with COVID-19 had documented HIV status (22 858 with HIV and 247 879 without). Comparing characteristics of people without HIV and people with HIV in each COVID-19 wave, people with HIV had increased odds of mortality in the D614G (adjusted odds ratio 1·19, 95% CI 1·09–1·29), beta (1·08, 1·01–1·16), delta (1·10, 1·03–1·18), omicron BA.1 and BA.2 (1·71, 1·54–1·90), and omicron BA.4 and BA.5 (1·81, 1·41–2·33) waves. Among all COVID-19 admissions, mortality was lower among people with previous SARS-CoV-2 infection (adjusted incident rate ratio 0·32, 95% CI 0·29–0·34) and with partial (0·93, 0·90–0·96), full (0·70, 0·67–0·73), or boosted (0·50, 0·41–0·62) COVID-19 vaccination. Compared with people without HIV who were unvaccinated, people without HIV who were vaccinated had lower risk of mortality (0·68, 0·65–0·71) but people with HIV who were vaccinated did not have any difference in mortality risk (1·08, 0·96–1·23). In-hospital mortality was higher for people with HIV with CD4 counts less than 200 cells per μL, irrespective of viral load and vaccination status. INTERPRETATION : HIV and immunosuppression might be important risk factors for mortality as COVID-19 becomes endemic.Item Statistical assessment of reliability of anthropometric measurements in the multi-site South African National Dietary Intake Survey 2022(Nature Research, 2024-11) Nel, Sanja; De Man, Jeroen; Van den Berg, Louise; Wenhold, Friedeburg Anna MariaBACKGROUND : Anthropometric data quality in large multicentre nutrition surveys is seldom adequately assessed. In preparation for the South African National Dietary Intake Survey (NDIS-2022), this study assessed site leads’ and fieldworkers’ intra- and inter-rater reliability for measuring weight, length/height, mid-upper arm circumference (MUAC), waist circumference (WC) and calf circumference (CC). METHODS : Standardised training materials and measurement protocols were developed, and new anthropometric equipment was procured. Following two training rounds (12 site lead teams, 46 fieldworker teams), measurement reliability was assessed for both groups, using repeated measurements of volunteers similar to the survey target population. Reliability was statistically assessed using the technical error of measurement (TEM), relative TEM (%TEM), intra-class correlation coefficient (ICC) and coefficient of reliability (R). Agreement was visualised with Bland-Altman analysis. RESULTS : By %TEM, the best reliability was achieved for weight (%TEM = 0.260–0.923) and length/height (%TEM = 0.434–0.855), and the poorest for MUAC by fieldworkers (%TEM = 2.592–3.199) and WC (%TEM = 2.353–2.945). Whole-sample ICC and R were excellent ( > 0.90) for all parameters except site leads’ CC inter-rater reliability (ICC = 0.896, R = 0.889) and fieldworkers’ inter-rater reliability for MUAC in children under two (ICC = 0.851, R = 0.881). Bland-Altman analysis revealed no significant bias except in fieldworkers’ intra-rater reliability of length/height measurement in adolescents/adults ( + 0.220 (0.042, 0.400) cm). Reliability was higher for site leads vs. fieldworkers, for intra-rater vs. inter-rater assessment, and for weight and length/height vs. circumference measurements. CONCLUSION : NDIS-2022 site leads and fieldworkers displayed acceptable reliability in performing anthropometric measurements, highlighting the importance of intensive training and standardised measurement protocols. Ongoing reliability assessment during data collection is recommended.Item Prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga Province, South Africa(MDPI, 2024-04) Mudau, Rodney; Voyi, Kuku; Shirinde, Joyce; rodney.mudau@up.ac.zaBACKGROUND : This study aimed to investigate the prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality. METHODS : In this study, parents/caregivers of preschool children (n = 3145) completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Data were analysed using multiple logistic regression models. RESULTS : The overall prevalence of Wheeze Ever was 15.14%, with a higher prevalence in urban preschoolers than rural preschoolers (20.71% vs. 13.30%, p < 0.000). Moreover, the total prevalence of Asthma Ever was 2.34%. The prevalence was greater in urban preschoolers than in rural preschoolers (3.92% vs. 1.81%, p < 0.001). In the final adjusted model, both urban- and rural-area children who lived with one or more people who smoked in the same household (WE: OR 1.44, 95% CI 1.11–1.86) (CW: OR 2.09, 95% CI 1.38–3.16) and (AE: OR 2.49, 95% CI 1.12–5.54) were found to have an increased likelihood of having Wheeze Ever, Current Wheeze, and Asthma Ever as compared to those who lived with non-smokers. CONCLUSIONS : The implementation of smoking limits and prohibition is crucial in areas that are frequented or utilized by children. Hence, it is imperative for healthcare providers to actively champion the rights of those who do not smoke within the society, while also endorsing legislative measures aimed at curtailing the extent of tobacco smoke exposure.Item Costs of the COVID-19 vaccination programme : estimates from the West Rand district of South Africa, 2021/2022(BMC, 2024-07) Edoka, Ijeoma; Matsela, Lineo M.; Modiba, Khumo; Luther, Yolandie; Govender, Sharlene; Maotoe, Thapelo; Brahmbhatt, Heena; Pisa, Pedro Terrence; Meyer‑Rath, Gesine; Miot, JacquiBACKGROUND: The COVID-19 vaccination programme in South Africa was rolled out in February 2021 via five delivery channels- hospitals, primary healthcare (PHC), fixed, temporary, and mobile outreach channels. In this study, we estimated the financial and economic costs of the COVID-19 vaccination programme in the first year of roll out from February 2021 to January 2022 and one month prior, in one district of South Africa, the West Rand district. METHODS: Financial and economic costs were estimated from a public payer’s perspective using top-down and ingredient-based costing approaches. Data were collected on costs incurred at the national level and from the West Rand district. Total cost and cost per COVID-19 vaccine dose were estimated for each of the five delivery channels implemented in the district. In addition, we estimated vaccine delivery costs which we defined as total cost exclusive of vaccine procurement costs. RESULTS: Total financial and economic costs were estimated at US$8.5 million and US$12 million, respectively; with a corresponding cost per dose of US$15.31 (financial) and US$21.85 (economic). The two biggest total cost drivers were vaccine procurement which contributed 73% and 51% to total financial and economic costs respectively, and staff time which contributed 10% and 36% to total financial and economic costs, respectively. Total vaccine delivery costs were estimated at US$2.1 million (financial) and US$5.7 million (economic); and the corresponding cost per dose at US$3.84 (financial) and US$10.38 (economic). Vaccine delivery cost per dose (financial/economic) was estimated at US$2.93/12.84 and US$2.45/5.99 in hospitals and PHCs, respectively, and at US$7.34/20.29, US$3.96/11.89 and US$24.81/28.76 in fixed, temporary and mobile outreach sites, respectively. Staff time was the big‑ gest economic cost driver for vaccine delivery in PHCs and hospitals while per diems and staff time were the big‑ gest economic cost drivers for vaccine delivery in the three outreach delivery channels. CONCLUSION: This study offers insights for budgeting and planning of COVID-19 vaccine delivery in South Africa’s public healthcare system. It also provides input for cost-effectiveness analyses to guide future strategies for maximizing vaccination coverage in the country.Item Prevalence of osteoporosis and factors associated with bone density in HIV-positive kidney transplant candidates and recipients from an HIV-positive donor(NISC (Pty) Ltd and Informa UK Limited (trading as the Taylor & Francis Group), 2024) Martin, Claire J.; Gwetu, T.; Labadarios, D.; Muller, E.; Veldman, F.J.; Ellis, C.; Kassier, S.M.; claire.martin@up.ac.zaBACKGROUND : Studies show a high prevalence of osteoporosis and fracture risk in kidney transplant candidates and recipients. However, little is known about the prevalence of osteoporosis among transplant recipients and candidates living with HIV. OBJECTIVE : To determine the prevalence of osteopenia and osteoporosis and investigate the socio-demographic and nutritional factors associated with BMD in HIV-positive transplant candidates and recipients from an HIV-positive donor. METHODS : In this cross-sectional study, 20 HIV- positive transplant recipients and 36 transplant candidates on haemodialysis (HD) and awaiting transplantation had BMD and body composition measured by dual-energy X-ray absorptiometry (DEXA). Vitamin D status was measured using serum 25-hydroxyvitamin D [25(OH)D]. Dietary Vitamin D and calcium intake was obtained from a single 24-hour recall. RESULTS : Participants were mainly black African (92.9%), male (55.4%) with a mean age of 43.8 ± 8.3 years. Serum 25(OH)D levels were low for the group as a whole, with a mean of 22.04 ± 12.74 ng/ml. Osteoporosis was more prevalent amongst transplant recipients (20.0%) than transplant candidates (13.9%). Conversely, osteopenia was present amongst transplant candidates (27.8%). T-scores strongly correlated positively, with lean mass and BMD of the spine (r = 0.707, p = 0.007), and moderately, with each side of the total hip BMD (r = 0.455, p = 0.007 and r = 0.420, p = 0.007). There was a significant positive association between dietary calcium and all BMD sites in transplant recipients only. CONCLUSION : The prevalence of osteoporosis was similar, and in some cases, lower than in transplant recipients elsewhere. Lean mass was positively associated with BMD, and in transplant recipients, dietary calcium intake was positively associated with BMD emphasising the role of diet and exercise in preserving BMD.Item Estimation accuracy of bean bags as portion size estimation aids for amorphous foods(NISC (Pty) Ltd and Informa UK Limited (trading as the Taylor & Francis Group), 2024) Wenhold, Friedeburg Anna Maria; Macintyre, Una Elizabeth; friede.wenhold@up.ac.zaOBJECTIVE : A study was undertaken to explore the portion size estimation accuracy of bean bags as low-cost volumetric portion size estimation aids for amorphous foods. DESIGNS : Three observational, cross-sectional and three experimental/quasi-experimental developmental evaluation sub-studies were carried out. SETTINGS : Observational, cross-sectional: one retirement village and four schools. Experimental/quasi-experimental: one South African university. PARTICIPANTS : Observational, cross-sectional: elderly persons, adult women (school educators), schoolchildren. Experimental/quasi-experimental: university students. In total N = 541; > 3 800 observations. VARIABLES MEASURED : Using a standardised set of bean bags (test object; volume range: 60–625 ml), volumes of different amorphous foods (reference objects: actual foods or representations) in varying portion sizes had to be estimated. Accuracy (outcome measure) was perfect if volumes of test and reference object were identical. Acceptable estimation accuracy allowed for misestimation by one bean bag size. Test–retest reproducibility was also assessed. ANALYSIS : Descriptive statistics (proportions perfect and acceptable accuracy). RESULTS : Across the sub-studies, perfect accuracy ranged from 22–65% depending on participants, reference food and portion size. Irrespective thereof, acceptable accuracy was noted in > 70% of observations. Reproducibility varied (range: 28–67% agreement). CONCLUSIONS AND IMPLICATIONS : Perfect portion size estimation of amorphous foods remains challenging. When misestimation by 60–125 ml still serves the purpose of a dietary assessment, bean bags show promise for cost-effective food volume quantification, especially on group level in resource-limited settings.Item Adults living with type 2 diabetes experiences of a randomised adapted diabetes nutrition education programme : a qualitative process evaluation(NISC (Pty) Ltd and Informa UK Limited (trading as the Taylor & Francis Group), 2024) Muchiri, Jane Wanjiku; Gericke, Gerda J.; Rheeder, Paul; jane.muchiri@up.ac.zaAIM : The purpose of this study was to investigate how a randomised controlled trial (RCT) of an adapted diabetes nutrition education programme (NEP) was received by adults with sub-optimally controlled (HbA1c of ≥ 8%) type 2 diabetes in a tertiary setting. This could aid in understanding the small effect of NEP on HbA1c and other outcomes and the high attrition rate. METHODS : This qualitative study was done alongside the year-long RCT. In the RCT, intervention participants received four NEP components, and both intervention and control group participants received education materials (fridge/wall poster). Five focus-group discussions were held with the intervention group participants at two time periods: after they completed the NEP curriculum (7th month) (n = 26; 67% of randomised participants [RP]( and at the end of the study (12 months) [n = 24; 61.5% RP). Nineteen (50% RP) control group participants were individually interviewed at the end of the study. Data were analysed using a thematic framework. RESULTS : All participants (control and intervention) reported high satisfaction with the NEP. Participants emphasised the value of the fridge/wall poster for themselves and their families. Participants (control and intervention) reported various benefits of the NEP: improved diabetes knowledge, skills in dietary self-care, family support for self-care, better health and motivation for appropriate self-care. Some participants also reported positive changes to their diet and physical activity behaviours. The perceived benefits were the main reason for completing the study. CONCLUSIONS : Irrespective of the arm of participation, the NEP was well received, and perceived benefits inspired participation. The limited NEP impact and the sub-optimal programme participation do not appear to be related to participants’ perceptions of the adapted NEP.Item Infant growth by INTERGROWTH-21st and Fenton Growth Charts : predicting 1-year anthropometry in South African preterm infants(Wiley, 2024-10) Nel, Sanja; Feucht, Ute Dagmar; Botha, Tanita; Wenhold, Friedeburg Anna Maria; sanja.nel@up.ac.zaPost-natal growth influences short- and long-term preterm infant outcomes. Different growth charts, such as the Fenton Growth Chart (FGC) and INTERGROWTH-21st Preterm Post-natal Growth Standards (IG-PPGS), describe different growth curves and targets. This study compares FGC- and IG-PPGS-derived weight-for-postmenstrual age z-score (WZ) up to 50 weeks postmenstrual age (PMA50) for predicting 1-year anthropometry in 321 South African preterm infants. The change in WZ from birth to PMA50 (ΔWZ, calculated using FGC and IG-PPGS) was correlated to age-corrected 1-year anthropometric z-scores for weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ) and BMI-for-age (BMIZ), and categorically compared with rates of underweight (WAZ < −2), stunting (LAZ < −2), wasting (WLZ < −2) and overweight (BMIZ > + 2). Multivariable analyses explored the effects of other early-life exposures on malnutrition risk. At PMA50, mean WZ was significantly higher on IG-PPGS (−0.56 ± 1.52) than FGC (−0.90 ± 1.52; p < 0.001), but ΔWZ was similar (IG-PPGS −0.26 ± 1.23, FGC −0.11 ± 1.14; p = 0.153). Statistically significant ΔWZ differences emerged among small-for-gestational age infants (FGC −0.38 ± 1.22 vs. IG-PPGS −0.01 ± 1.30; p < 0.001) and appropriate-for-gestational age infants (FGC + 0.02 ± 1.08, IG-PPGS −0.39 ± 1.18; p < 0.001). Correlation coefficients of ΔWZ with WAZ, LAZ, WLZ and BMIZ were low (r < 0.45), though higher for FGC than IG-PPGS. Compared with IG-PPGS, ΔWZ < −1 on FGC predicted larger percentages of underweight (42% vs. 36%) and wasting (43% vs. 39%) and equal percentages of stunting (33%), while ΔWZ > + 1 predicted larger percentages overweight (57% vs. 38%). Both charts performed similarly in multivariable analysis. Differences between FGC and IG-PPGS are less apparent when considering ΔWZ, highlighting the importance of assessing growth as change over time, irrespective of growth chart.Item Comparison of feeding practices and growth of urbanized African infants aged 6–12 months old by maternal HIV status in Gauteng Province, South Africa(MDPI, 2023-03-21) Tshiambara, Phumudzo; Hoffman, Marinel; Legodi, Heather; Botha, Tanita; Mulol, Helen; Pisa, Pedro Terrence; Feucht, Ute Dagmar; phumudzo.mamphwe@up.ac.zaAppropriate feeding practices are protective against malnutrition and poor growth. We compared feeding practices and growth in HIV-exposed-uninfected (HEU) and HIV-unexposeduninfected (HUU) between 6-12 months of age in urbanized African infants in South Africa. A repeated cross-sectional analysis was used to determine differences in infant feeding practices and anthropometric measures by HIV exposure status at 6, 9, and 12 months in the Siyakhula study. The study included 181 infants (86 HEU; 95 HUU). Breastfeeding rates were lower in HEU vs. HUU infants at 9 (35.6% vs. 57.3%; p = 0.013) and 12 months (24.7% vs. 48.0%; p = 0.005). Introduction to early complementary foods was common (HEU = 16.2 11.0 vs. HUU = 12.8 9.3 weeks; p = 0.118). Lower weight-for-age Z-scores (WAZ) and head circumference-for-age Z-scores (HCZ) were found in HEU infants at birth. At 6 months,WAZ, length-for-age Z-scores (LAZ), HCZ, and mid-upper-arm circumference-for-age Z-scores (MUACAZ) were lower in HEU vs. HUU infants. At 9 months, lowerWAZ, LAZ, and MUACAZ were found in HEU vs. HUU infants. At 12 months, lowerWAZ, MUACAZ, and weight-for-length Z-scores (0.2 1.2 vs. 0.2 1.2; p = 0.020) were observed. HEU infants had lower rates of breastfeeding and poorer growth compared to HUU infants. Maternal HIV exposure affects the feeding practices and growth of infants.Item Dietary patterns and risk of developing asthma among pre-schoolers(Elsevier, 2024-10) Mudau, Rodney; Voyi, Kuku; Shirinde, Joyce; rodney.mudau@up.ac.zaBACKGROUND : Early childhood dietary patterns have been identified as potential factors that can influence the development of asthma in children. The objective of the study was to determine the association between dietary patterns, identified through principal component analysis (PCA), and asthma in pre-schoolers. METHODS : This unmatched case–control study used data from 3145 pre-schoolers participating in the parent population-based observational study conducted in a District Municipality, Province. The study consisted of 189 pre-schoolers (63 with asthma, 126 controls) between 1 and 8 years. We identified primary dietary patterns by conducting a PCA on reported food consumption data from the Quantitative Food Frequency Questionnaire (QFFQ). Multivariate logistic regression models determined the relationship between food patterns and asthma. RESULTS : The results of our study identified four primary dietary patterns that defined the dietary preferences of the pre-schoolers: Meat general and dressings pattern, Healthy dietary pattern, Sugary and/or sweetened drinks pattern, and Mixed dietary pattern. The consumption of sugary and sweetened drinks (adjusted OR 7.0, 95% CI: 2.3-21.1-1; p = 0.00) as well as a Mixed dietary pattern (adjusted OR 4.0, 95% CI: 1.4–11.1; p = 0.03) were positively associated with a higher probability of developing asthma. A Healthy dietary pattern (adjusted OR 0.02, 95% CI: 0.00–0.09; p = 0.00) was negatively associated with an increased likelihood of presenting with asthma. CONCLUSIONS : In the current study, a Healthy dietary pattern was negatively associated with an increased likelihood of presenting with asthma. Diet modification may be a potential intervention to impact the increasing prevalence of this disease.Item Prevalence of asthma and wheeze among preschool and school-aged children in Africa : a meta-analysis(Wiley, 2024-06) Mudau, Rodney; Voyi, K.V.V. (Kuku); Shirinde, Joyce; rodney.mudau@up.ac.zaPlease read abstract in the article.