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Dietary Intake of Children Aged 1 Year To DIETARY INTAKE OF CHILDREN AGED 1 YEAR TO 5 YEARS AND THEIR ANTHROPOMETRIC MEASURES IN KWENENG DISTRICT-BOTSWANA by WANANANI B JOROSI-TSHIAMO Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Dr. Linda C Lewin Frances Payne Bolton School of Nursing CASE WESTERN RESERVE UNIVERSITY August, 2012 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Wananani B Jorosi–Tshiamo candidate for the Doctor of Philosophy degree*. (signed) Dr Linda C Lewin Committee Chair Dr Camille B.Warner Dr Jaclene Zauszniewski Dr Hope Barkoukis Dr Jill F Kilanowski (date) May 1, 2012 *We also certify that written approval has been obtained for any proprietary material contained therein. Dedication This dissertation is dedicated to my loving parents, my mother Kesekile and my late father Jorosi, to my late grandmother Masole, to the memory of my brother Tamuhla, to my siblings Mable, Mbutjili, Boemo and Alphious and to my extended family. You taught me to persevere. Thank you for your love and support. i TABLE OF CONTENTS DEDICATION......................................................................................................... i TABLE OF CONTENTS......................................................................................... ii LIST OF TABLES................................................................................................... vi LIST OF FIGURES................................................................................................. vii ACKNOWLEDGEMENTS..................................................................................... viii ABSTRACT............................................................................................................. xi Chapter 1 Introduction and Background.................................................................. 1 Purpose of the Study........................................................................................... 2 Description of the Problem................................................................................. 3 Selection of the Theoretical Framework............................................................. 5 Social Cognitive Theory..................................................................................... 5 Social Ecological Framework............................................................................. 8 UNICEF Model.................................................................................................. 11 Historical Background................................................................................... 11 Description of Model..................................................................................... 23 Key Model Parts............................................................................................ 25 Research Questions............................................................................................. 31 Significance of the Study.................................................................................... 31 Chapter 2 Literature Review.................................................................................... 33 Introduction........................................................................................................ 33 Theoretical Literature......................................................................................... 34 Empirical Literature............................................................................................ 35 ii Nutritional Status of Infants and Children............................................................ 36 Food Consumption and Dietary Intakes of Young Children.............................. 40 Caregiver’s Role on Children’s Food Consumption………………………….. 45 Anthropometry /Growth Measures..................................................................... 47 Household Food Security................................................................................... 49 Chapter 3 Methods................................................................................................... 57 Introduction........................................................................................................ 57 Research Design................................................................................................. 57 Setting................................................................................................................ 58 Sample................................................................................................................ 60 Measurements..................................................................................................... 63 Recruitment........................................................................................................ 73 Procedures.......................................................................................................... 74 Instrument Administration.................................................................................. 75 Data Management and Cleaning........................................................................ 78 Data Analysis...................................................................................................... 79 Protection of Human Subjects........................................................................... 84 Chapter 4 Results..................................................................................................... 87 Introduction........................................................................................................ 87 Study Sites.......................................................................................................... 87 Caregiver Demographic Data............................................................................. 88 Children’s Characteristics................................................................................... 94 Summary Description of the NDSR 2011 Software........................................... 104 iii Research Question One....................................................................................... 110 Research Question Two...................................................................................... 114 Research Question Three.................................................................................... 115 Research Question Four...................................................................................... 121 Research Question Five...................................................................................... 124 Chapter 5 Discussion.............................................................................................. 128 Introduction........................................................................................................ 128 Discussion........................................................................................................... 130 Core/main foods consumed (RQ 1)................................................................... 130 Energy and protein intake (RQ 2)...................................................................... 133 Energy and protein intake and anthropometric measures (RQ 3)....................... 138 Household food security (RQ 4)......................................................................... 140 Household food security and anthropometric measures (RQ 5)......................... 143 Implications........................................................................................................ 145 Limitations.......................................................................................................... 153 APPENDICES......................................................................................................... 158 Appendix A Case Western Reserve University IRB Approval.......................... 158 Appendix B. Ministry of Health IRB Approval................................................. 160 Appendix C Informed Consent –English........................................................... 162 Appendix C (a) Informed Consent –Setswana.................................................. 165 Appendix D. Recruitment Flyer- English……………………………………... 168 Appendix D (a) Recruitment Flyer- Setswana………………………………… 169 Appendix E Caregiver Demographic Data Form English…………………….. 170 iv Appendix E (a) Caregiver Demographic Data Form-Setswana………………. 174 Appendix F Child Anthropometric Measures and Health Habits Data 178 Form................................................................................................................... Appendix G Permission letter by MacIntyre...................................................... 179 Appendix G (a) Child Food Frequency Questionnaire-English........................ 180 Appendix G (b) Child Food Frequency Questionnaire- Setswana..................... 190 Appendix H Permission Letter by Melgar-Quinonez......................................... 201 Appendix H (a) Household Food Security Scale-Latin American & Caribbean 202 English............................................................................................................... Appendix H (b) Household Food Security Scale-Latin American & 207 Caribbean –Setswana......................................................................................... Appendix I List of Food Items Adjusted for Nutrient Values............................ 211 References...............................................................................................................
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