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Background In South Africa, the occurrence of the double burden of malnutrition is on the rise at a household level predisposing children and their mothers to negative health outcomes. However, few studies have been conducted at a household level. Therefore, we studied a double burden of malnutrition using child-mother pairs in a rural setting. Methods A cross-sectional quantitative survey was conducted among 508 child-mother pairs selected from primary schools using a multistage sampling in a rural Dikgale Health and Demographic Site in Limpopo Province, South Africa. Anthropometric measurements of children and mothers, and socio-demographic data were collected. WHO AnthroPlus was used to generate body-mass-index z-scores of children and the BMI was used to indicate overweight and obesity among the mothers. Mann Whitney test was used to compare the means of variables between sexes and age groups, while the prevalence of thinness and overweight/obesity were compared using a chi-square. Multivariate logistic regression with a stepwise backward elimination procedure, controlling for confounding, was used to determine the association between the thinness and overweight/obesity and the covariates. Results Twenty five percent (25%) of the children were thin, 4% were overweight and 1% obese, while mothers were overweight (27.4%) and 42.3% obesity (42.3%) were observed among the mothers. The odds of being thin were higher in boys than in girls (AOR = 1.53, 95%CI: 1.01–2.35). Overweight/obese mothers were more likely to have thin children (AOR = 1.48, 95% CI: 1.01–2.18) and less likely to have overweight/obese children (AOR = 0.18, 95%CI: 0.07–0.46). Conclusion A double burden of malnutrition was observed on a household level with thinness among children and overweight/obesity among mothers. A need to address the dual problems of undernutrition and rapidly rising trends of overweight/obesity cannot be over-emphasized.

Background: Despite the use of available pharmaceutical drugs, high rates of metabolic diseases and cardiovascular disorders are alarming. This calls for alternative therapies that can attenuate these complications. Therefore, we investigated the beneficial effects of okra on glycaemic control in pre-diabetes and type 2 diabetes mellitus (T2D). Methods: MEDLINE and Scopus were searched for relevant studies. Collected data were analysed using RevMan and reported as mean difference and 95% confidence intervals (CI). Eight studies, including 331 patients with pre-diabetes or T2D, were eligible. Results: Our findings showed that okra treatment reduced the levels of fasting blood glucose: mean difference (MD) = −14.63 mg/dL; 95% CI (-25.25, −4.00, p = 0.007); I 2 = 33%, p = 0.17 compared to placebo. Glycated haemoglobin, however, did not differ significantly between the groups: MD = 0.01%; 95%CI (-0.51, 0.54, p = 0.96); I 2 = 23%, p = 0.28. Conclusion: this systematic review and meta-analysis found that okra treatment improves glycaemic control in patients with pre-diabetes or T2D. The findings suggest that okra may be used as a supplemental dietary nutrient, especially in pre-diabetic and T2D patients due to its potential to regulate hyperglycaemia.

Background: Foundational learning spaces in South Africa, designed to nurture growth and development, continue to grapple with malnutrition, a persistent barrier to the health, cognitive potential, and wellbeing of preschool-aged children, amidst a nutrition transition. Aim: This study assessed dietary diversity, nutritional status, and their associations among children aged 2–5 years attending funded Early Learning Centres (ELCs) in Johannesburg (Region C). Methods: Using systematic random sampling across 33 nutrition-funded ELCs in Region C, we assessed the nutritional status of children aged 2–5 years with WHO Anthro software (z-score cut-offs for undernutrition: stunting, underweight, thinness; overnutrition: overweight, obesity). Dietary diversity scores (DDSs) were derived from a 24 h recall of 16 food groups, classified by primary nutrient contributions (some groups spanning multiple classes), and categorized as low (≤8) or normal (≥9). Associations between DDS and nutritional indicators were analyzed using Poisson regression to estimate adjusted prevalence ratios (aPRs). Results: Despite structured feeding practices, all ELCs reported inadequate nutritional funding, prompting calls for dietitian support. While 27% sourced groceries from wholesalers, most relied on supermarkets and spaza shops; all had cooking infrastructure, but only 12% had food gardens, and 88% expressed interest in establishing them to improve dietary diversity. The mean DDS was 9.47 (±1.07), and 83% of children had a normal DDS (≥9), with common consumption of cereals (100%), vitamin A-rich vegetables (100%), oils (100%), and leafy greens (96%), but limited intake of protein-rich foods like eggs (7%), legumes (19%), and fish (37%). A dual burden of malnutrition was observed: 31% of children were stunted and 30% were overweight or obese. Multivariable analysis showed that boys had significantly lower odds of stunting compared to girls (aPR = 0.38; 95%CI: 0.01–0.74), while younger age (aPR = 0.61; 95%CI: 0.37–0.85) and low DDS (aPR = −0.15; 95%CI: −0.29–−0.06) were independently associated with increased risk of stunting. Age was positively associated with underweight (aPR = 1.27; 95%CI: 0.58–1.96), and thinness was strongly associated with boys (aPR = 17.00; 95%CI: 15.12–18.74), with a marginal association with age. Conclusions: Integrated nutrition strategies are critical to addressing the dual burden of stunting and being overweight in urban ELCs. Strengthening funding, professional dietetic support, and promoting food gardens can enhance dietary diversity and child health outcomes.

Despite improvements in childhood undernutrition through integrated nutritional programs in South Africa, stunting among children remains persistent, and is attributed to poor socio-demographic status. This context has been implicated in disrupting mothers’ decisions regarding effective infant feeding, ultimately meaning that children’s nutritional demands remain unmet. In view of this, we conducted a cross-sectional study to determine the association between socio-demographic factors and infant and young child feeding (IYCF) practices and stunting among children under two years receiving primary health care in informal settlements in Gauteng, South Africa. A validated questionnaire was used to assess mothers’ socio-demographic status and feeding practices using WHO core indicators. Stunting was defined as length-for age z-scores (LAZ) below −2 standard deviation, computed using WHO Anthro software version 3.2.2.1 using age, sex, and anthropometric measurements of children. Univariate and multivariate analyses were stratified by stunting to determine the relationship with socio-demographic, infant, and IYCF factors using STATA 17. The prevalence of stunting was 16% among surveyed children under two years (with a mean age of 8 ± 5 months) living in poor socio-demographic households. Poor feeding practices were characterized by delayed initiation of breastfeeding (58%), sub-optimal exclusive breastfeeding (29%), discontinued breastfeeding (44%), early introduction of solid foods (41%), and low dietary diversity (97%). Significant differences in terms of child’s age, monthly household income, and ever being breastfed were observed (Chi square test and univariate analysis). After controlling for potential confounders, stunting was significantly associated with child’s age [12–23 months: AOR = 0.35, 95% CI: 0.16–0.76], and monthly household income [ZAR 3000–ZAR 5000: AOR = 0.47, 95% CI: 0.26–0.86]. Despite the few aforementioned socio-demographic and IYCF factors associated with stunting, this study reiterates stunting as the commonest poor nutritional status indicator among children under two years, suggesting the presence of chronic undernutrition in these poverty-stricken informal settlements. A multisectoral approach to address stunting should be context-specific and incorporate tailor-made interventions to promote optimal infant-feeding practices. Conducting future nutrient assessments focusing on children is imperative.

Poor nutrition outcomes among children have become one of the major public health concerns in South Africa, attributed to poor feeding practices and maternal nutrition-related knowledge with conflicting data. In view of this, a cross-sectional study was conducted to determine the association of nutrition outcomes of children aged under two years with feeding practices and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers’ nutrition-related knowledge was estimated using an adapted structured questionnaire on colostrum, continued breastfeeding, diarrhea prevention and treatment using oral rehydration solution, immunization, and family planning, and scored as excellent (80–100), good (60–79), average (40–59), and fair (0–39). This was along with questions on socio-demographic factors and obstetric history, as well as anthropometric measurements. Child nutrition outcomes were estimated by WHO classification using z-scores for stunting (length-for-age (LAZ)), underweight (weight-for-age (WAZ)), and thinness (body mass index-for-age (BAZ)). Using STATA 17, 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) participated in the study and were living in a poor socio-economic status environment. Half of children were stunted (50%) and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one third of mothers reporting obstetric complications, two thirds, initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, while 66% had average knowledge, 6% good knowledge, and none of the mothers had excellent knowledge. A chi-square test showed that mothers’ nutrition-related knowledge was significantly associated with child stunting. The final hierarchical logistic regression showed significant associations of stunting with mothers’ nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12–3.29), child’s age (6–11 months: AOR = 2.63, 95%CI: 1.53–4.53 and 12–23 months: AOR = 3.19, 95%CI: 1.41–7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15–0.86). Contextual and intensified interventions on continued education for mothers to gain accurate information on nutrition-related knowledge and feeding practices could ultimately enhance child nutrition outcomes in poorer settings. Efforts should therefore be made to ensure that nutrition knowledge is appropriately provided based on the phases of child growth from 0 to 2 years, even beyond infancy into school age.

Background/Objectives: Despite ongoing national interventions, pockets of acute malnutrition persist in rural settings of South Africa, contributing to disproportionate rates of child morbidity and mortality. This study aimed to identify risk factors associated with acute malnutrition among under-five children attending primary healthcare facilities in Msinga, KwaZulu-Natal Province, with a specific focus on dietary diversity and selected infant and young child feeding indicators. Methods: A cross-sectional, facility-based study was conducted among 415 mother–child pairs attending five randomly selected PHC facilities in the Msinga sub-district. Participants were selected using a multistage sampling design from a sampling frame of 18,797 under-five children. Of the 551 mother–child pairs approached; the final analytic sample comprised 415 observations. Data were collected through structured interviews, anthropometric assessments, and dietary diversity scores (DDS). Data were analyzed using Stata 18, and Poisson regression was applied to identify risk factors. Results: The prevalence of acute malnutrition was 29% based on weight-for-height/length z-scores (WHZ/WLZ) and 27% based on mid–upper-arm circumference z-scores (MUACZ). Children aged ≥36 months had significantly higher prevalence of acute malnutrition (aPR = 1.62; 95% CI: 1.15–2.10). Children from households with five or more members had reduced risk (aPR = 0.66; 95% CI: 0.45–0.74), and those born full-term showed a strong protective association (aPR = 0.39; 95% CI: 0.23–0.64). Maternal age was associated with reduced risk, with children of mothers aged 25–34 years (aPR = 0.67; 95% CI: 0.48–0.93) and ≥35 years (aPR = 0.58; 95% CI: 0.35–0.84) experiencing significantly lower prevalence. Mixed feeding was significantly associated with reduced risk (aPR = 0.86; 95% CI: 0.55–1.17), while a DDS ≥4 was protective (aPR = 0.41; 95% CI: 0.04–0.84). Consumption of protein-rich foods was notably low, with only 21% consuming flesh foods and 10% consuming eggs. Conclusions: Acute malnutrition in under-five children was significantly associated with poor diet quality, older age, low household income, and mixed feeding practices. Protective factors included full-term pregnancy, larger households, older maternal age, and adequate dietary diversity, highlighting the importance of targeted, multisectoral interventions.

Objective: The aim of this study was to assess complementary feeding practices and dietary diversity in relation to the nutritional status of children under five attending health facilities in the Thabazimbi sub-district, Limpopo Province. Methods: A cross-sectional study was conducted among 409 mother–child pairs. Data on socio-demographics, feeding practices, and anthropometry were collected using validated tools. Nutritional status was assessed using WHO growth standards, and dietary diversity was evaluated using WHO infant and young child feeding (IYCF) indicators and a 24 h dietary recall. Associations were analyzed using prevalence ratios in STATA 18. Results: Among 409 children (median age: 18 months, IQR: 12–24), 38% were stunted, 13% were underweight, 5% were thin, and 17% were overweight/obese. Exclusive breastfeeding was reported in 27%, and only 24% met the minimum dietary diversity (DDS ≥ 4). Complementary feeding practices varied significantly by maternal age, with mixed feeding more common among older mothers and younger mothers more likely to receive feeding advice (p = 0.001). Stunting was associated with being a boy (PR = 1.27; 95% CI: 1.00–1.61), age > 24 months (PR = 0.33; 95% CI: 0.16–0.65), and DDS ≥ 4 (PR = 0.72; 95% CI: 0.52–0.99). Underweight was more prevalent among boys (PR = 2.40; 95% CI: 1.40–4.11), but less likely in children with DDS ≥ 4 (PR = 0.43; 95% CI: 0.20–0.92) and those from spouse-headed households (PR = 0.33; 95% CI: 0.13–0.87). Thinness was associated with DDS ≥ 4 (PR = 2.70; 95% CI: 1.13–6.45) and age 12–24 months (PR = 2.80; 95% CI: 1.02–7.64). Overweight/obesity was linked to age 12–24 months (PR = 1.94; 95% CI: 1.25–3.03) and household income > ZAR 15,000 (PR = 4.09; 95% CI: 2.33–7.17). Conclusions: Complementary feeding and dietary diversity deficits contribute significantly to the dual burden of malnutrition in rural Limpopo, highlighting the need for targeted, context-specific nutrition interventions.

ObjectivesCarotid intima–media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the status of carotid health and lipid profile in T2DM.DesignThis systematic review and meta-analysis synthesised data published from clinical studies.Data sourcesGoogle Scholar, PubMed and Scopus were searched from inception to 18 January 2024.Eligibility criteria for selecting studiesStudies conducted in patients with T2DM and those without T2DM were included. Studies conducted in T2DM adults evaluating carotid status and lipid profile were considered.Data extraction and synthesisTwo authors independently used standardised methods to comprehensively search, screen and extract data from all relevant studies. The risk of bias was assessed using the Newcastle-Ottawa checklist. Meta-analysis was conducted using Review Manager and metaHun through random effects models. The random effect model was used due to high heterogeneity.ResultsEvidence was analysed from 57 studies with a sample size of 29 502 (8254 T2DM and 21 248 people without T2DM). There was a significantly higher CIMT, with a standardised mean difference (SMD) of 1.01 (95% CI 0.75, 1.26, p<0.00001). Additionally, there was an elevated triglyceride (TG) (SMD=1.12, 95% CI 0.82, 1.41, p<0.00001), total cholesterol (TC), (SMD=0.24, 95% CI 0.02, 0.46, p=0.03) and low-density lipoprotein-cholesterol (LDL-C), (SMD=0.35, 95% CI 0.11, 0.59, p=0.004) in patients with T2DM compared with those without T2DM. Furthermore, a significant decrease in high-density lipoprotein cholesterol (HDL-C) was observed in the T2DM compared with people without T2DM, SMD=−0.79, 95% CI −0.96, –0.62, p<0.00001). Age, body mass index and hypertension were associated with increased CIMT and TG and decreased HDL-C in T2DM. Additionally, age, gender and hypertension were associated with an increased LDL-C in T2DM.ConclusionOur findings suggest that an increased CIMT is accompanied by increased TG, TC, LDL-C and HDL-C reduction in patients with T2DM.PROSPERO registration numberCRD42023451731.

Tobacco and alcohol use among mothers is associated with numerous adverse consequences for affected offspring, including poor growth and development. This study determined the association between maternal tobacco and alcohol use, and malnutrition, among infants aged ≤ 12 months (n = 300), in selected health facilities situated in Gauteng, South Africa. Data on alcohol and tobacco use were collected using a validated questionnaire, in addition to mothers’ socio-demographic characteristics and obstetric history. Stunting (low height/length-for-age), underweight (low weight-for-age) and thinness (low body mass index-for-age) were calculated using z-scores based on the World Health Organization child growth standards. The association of tobacco and alcohol use with stunting, underweight and thinness was analysed using logistic regression analysis. The results showed a mean age of 29 years (24.0; 35.0) for mothers and 7.6 ± 3 months for infants, and over half of the mothers were unemployed (63%). Approximately 18.7% of mothers had used tobacco and 3% had used alcohol during pregnancy. The prevalence of current tobacco and alcohol use among mothers were estimated at 14.3% and 49.7%, respectively, and almost three-quarters (67.3%) of them were still breastfeeding during the study period. Stunting (55%) was the most prevalent malnutrition indicator among infants, while underweight was 41.7%, and thinness was 22%. Current tobacco use was associated with increased odds of being thin [OR = 2.40, 95% CI: 1.09–5.45), and after adjusting for confounders, current alcohol use was associated with the likelihood of being underweight [AOR = 1.96, 95% CI: 1.06–3.63] among infants. Future prospective cohort studies that examine growth patterns among infants who are exposed to maternal tobacco and alcohol use from the intrauterine life to infancy are necessary to inform, partly, the public health programmes, to reduce malnutrition among children.

BackgroundThe factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities.AimThis study compared the prevalence of PND and associated factors among women attending postnatal services facilities.SettingThe study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa.MethodsA total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children’s characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates.ResultsThe overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p ≤ 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14–0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05–0.40; p ≤ 0.001]). Significant associations of probable PND with several factors – planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events – were more common in the FSP than in the GP.ConclusionThe prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings.ContributionThe results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.