Abstract Background Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32%. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3-14 days, 4-8 weeks, 10-14 weeks and 20-24 weeks. Methods This community-based mixed-methods study collected data within a prospective cohort study on socio-demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6-8 weeks with infant feeding data collected at 4-8, 10-14 and 20-24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6-24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data. Results The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). EBF decreased from 34% at 4-8 weeks to 9.7% at 20-24 weeks. Mixed feeding with infant formula increased from 17.0% to 50.1% and food feeding from 3.1% to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative socio-demographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier , Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions , benefits of breastfeeding , support in the home , access to information and services from health professionals and baby’s health were strong enabling factors. Conclusions Low EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.
The study aimed to determine factors associated with changes in bone mineral density (BMD) and bone resorption markers over two years in black postmenopausal women living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). Women (n = 120) aged > 45 years were recruited from Potchefstroom, South Africa. Total lumbar spine and left femoral neck (LFN) BMD were measured with dual energy X-ray absorptiometry. Fasting serum C-Telopeptide of Type I collagen (CTx), vitamin D and parathyroid hormone were measured. Vitamin D insufficiency levels increased from 23% at baseline to 39% at follow up. In mixed linear models serum CTx showed no change from baseline to end (p = 0.363, effect size = 0.09). Total and LFN BMD increased significantly over two years, but effect sizes were small. No significant change in spine BMD over time was detected (p = 0.19, effect size = 0.02). Age was significantly positively associated with CTx over time, and negatively with total and LFN BMD. Physical activity (PA) was positively associated with LFN BMD (p = 0.008). Despite a decrease in serum vitamin D, BMD and CTx showed small or no changes over 2 years. Future studies should investigate PA interventions to maintain BMD in women living with HIV.
Objective: The purpose of this study was to evaluate the association between pre-pregnancy body mass index
(BMI) and maternal pregnancy weight gain and pregnancy outcomes.
Methods: Ninety-eight pregnant black women were followed up during pregnancy. Pre-pregnancy weight
was recorded or calculated by regression analysis, and weekly weight gain was calculated. The correlation
between pre-pregnancy BMI, weekly weight gain, blood pressure, and the infants’ birth weight, length and head
circumference was assessed, adjusting for gestational age and smoking. Adjustment for HIV status was also done in subjects with known status. Participants were categorised into three groups: pre-pregnancy BMI 26.
Results: According to the Institute of Medicine (IOM)’s weight gain recommendations, women in all BMI
categories tended to gain excessive weight. Pregnancy weight gain was significantly associated with infant
birth weight (χ2=6.25, p=0.04), although no significant correlations were found between weekly weight gain or
mothers’ pre-pregnancy BMI, respectively, and birth outcomes. Pre-pregnancy BMI correlated significantly with
blood pressure at the second clinic visit. Age and parity correlated significantly with pre-pregnancy BMI; and
household income correlated with mothers’ weekly weight gain.
Conclusion: Inadequate weight gain was associated with a significantly lower infant birth weight. No correlation was found between infant birth weight and mother’s pre-pregnancy BMI.
Abstract Background Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32%. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3-14 days, 4-8 weeks, 10-14 weeks and 20-24 weeks.Methods This community-based mixed-methods study collected data within a prospective cohort study on socio-demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6-8 weeks with infant feeding data collected at 4-8, 10-14 and 20-24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6-24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.Results The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). EBF decreased from 34% at 4-8 weeks to 9.7% at 20-24 weeks. Mixed feeding with infant formula increased from 17.0% to 50.1% and food feeding from 3.1% to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative socio-demographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier , Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions , benefits of breastfeeding , support in the home , access to information and services from health professionals and baby’s health were strong enabling factors.Conclusions Low EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.
Background. Waist circumference (WC) is a useful predictor of cardiometabolic risk in children. Published data on WC percentiles of children from African countries are limited. Objectives. To describe age- and sex-specific WC percentiles in black South African (SA) children from different study sites, and compare these percentiles with median WC percentiles of African-American (AA) children. Methods. Secondary data on WC for 10 - 14-year-old black SA children ( N =4 954; 2 406 boys and 2 548 girls) were extracted from the data sets of six studies. Smoothed WC percentile curves for boys and girls were constructed using the LMS method. The 50th percentile for age- and sex-specific WC measurements was compared across study sites and with AA counterparts. Results. Girls had higher WC values than boys from the 50th to 95th percentiles at all ages. The 50th WC percentiles of all groups of SA children combined were lower than those of AA children. When SA groups were considered separately, Western Cape children had median WC values similar to AA children, while rural Limpopo children had the lowest WC values. The 95th percentiles for Western Cape girls exceeded the adult cutoff point for metabolic syndrome (WC ≥80 cm) from age 11 years. Conclusions. The differences in WC values for 10 - 14-year-old children across the six study sites highlight the need for nationally representative data to develop age-, sex- and ethnic-specific WC percentiles for black SA children. The results raise concerns about high WC among Western Cape girls.
We determined the sensitivity of waist-to-height ratio (WHtR) as a marker for high blood pressure in children aged nine to 15 years (n = 1 131), from schools in the North West province, South Africa. Anthropometric and blood pressure measurements were taken. The sensitivity and specificity of the WHtR to identify children with high blood pressure were evaluated. At a cut-off value of 0.5, 7.9% of the girls and 3.4% of the boys had central adiposity. Thirteen per cent of the children were hypertensive. The optimal WHtR cut-off value to identify children with hypertension was 0.41 in both boys and girls. Positive correlations were observed between anthropometric indices. Using linear regression analyses, age and body mass index were significant predictors of high blood pressure in boys, while for girls it was height and weight. Results suggest that adopting a WHtR cut-off value < 0.5 could enhance the use of WHtR as a marker for high blood pressure in children.
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