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The Effect of Seasonal Food Variety and Dietary Diversity on the Nutritional Status of a Rural Community in Kzn

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The Effect of Seasonal Food Variety and Dietary Diversity on the Nutritional Status of a Rural Community in Kzn THE EFFECT OF SEASONAL FOOD VARIETY AND DIETARY DIVERSITY ON THE NUTRITIONAL STATUS OF A RURAL COMMUNITY IN KZN BY Nelisiwe Nsele 20926874 B. Sc. Home Economics (Hons) Dissertation submitted in fulfillment of the requirements for the degree Magister Technologiae: Consumer Science Food and Nutrition in the Department of Food and Nutrition Consumer Sciences, Faculty of Applied Sciences at the Durban University of Technology. February 2014 Supervisor: Prof. C. Napier i ACKNOWLEDGEMENTS My sincere gratitude and appreciation to the following individuals and organisations: • My husband, my best friend, the love of my life, Pastor Simphiwe Nsele, no words could ever express my gratitude towards you. You were my inspiration and my motivation. Thank you so much for assisting me when I was being technologically challenged. I never would have done this project without you. • Professor Carin Napier, the supervisor for this study, for her knowledge, advice, support and encouragement throughout the project and also for her sacrificed holidays and weekends to assist me in my work. • Professor Carin Napier’s family for being patient and understanding while she was busy assisting me with my work at home during holidays and weekends. • My parents, Molly and Obed Hlatshwayo for the love, prayers, support and encouragement they gave me while I was busy with this project. • Professor Wilna Oldewage-Theron for her knowledge, leadership, encouragement and support throughout the project. • Verena for her statistics. • My fieldworkers Thobile, Ntombenhle and Slindile for their patience and support. • To the chief of Malangeni and the community at large for granting me permission to work with them. • To the Department of Consumer Sciences: Food and Nutrition at the Durban University of Technology for accepting my study with them. ii • To Professor Greyvenstein for the language editing of this thesis. • Above all I thank God for giving me strength and courage to do this project. May all glory, honour, power, praise and worship be unto Him forever and ever. iii DECLARATION This work has not previously been accepted in substance for any degree and is not concurrently submitted in candidature of any degree. Signed: Date: STATEMENT 1 This dissertation is being submitted in fulfillment of the requirements for the degree of Magister Technologiae. Signed: Date: STATEMENT 2 The dissertation is the result of my own independent work/ investigation, except where otherwise stated. Other sources are acknowledged by giving explicit references. A bibliography is appended. I did not make myself guilty of any plagiarism. Signed: Date: STATEMENT 3 I hereby give consent for my dissertation, if accepted, to be available for interlibrary loan, and for the title and summary to be made available to outside organisations. Signed: Date: iv ABSTRACT Introduction: Dietary diversity is an indicator of access and measurement of household food security as it relates to income, location and seasonality. Dietary diversity is measured by physically counting the number of individual foods as well as food groups consumed over a given reference period. When dietary diversity is accurately measured, nutrient adequacy will be easily predicted. In order to measure dietary diversity accurately, it is important to determine household food security. Insufficient food and resources often result in food insecurity which leads to little or no dietary diversity. Poor populations suffer most from achieving dietary diversity because they consume a standard diet based on starchy staple food with limited fruits and vegetables resulting in multiple nutrient deficiencies. Rural communities rely on seasonal food variety in order to obtain fruits and vegetables needed by the body to limit nutrient deficiencies. Some seasons are more productive than others. Rural communities also use various coping strategies to deal with food insecurity in all four seasons. High levels of unemployment as well as a lack of nutrition education results in most rural households unable to cater for dietary diversity. Aim: The aim of the study is to determine the effect of seasonal food variety, dietary diversity and nutrient adequacy on the nutritional status of women in rural areas. Method: A hundred women in this community were weighed and measured and BMI determined and classified according to the WHO cut-off points for BMI. Waist circumference was measured in order to determine the waist-to-height ratio indication risk of metabolic syndrome. Twenty four hour recall questionnaires were used to determine actual intake compared to dietary reference intake (DRIs). Food Frequency Questionnaires for a period of seven days were completed captured and analysed using the SPSS version for descriptive statistics in order to determine food diversity. Coping strategies were determined by Focus Group interviews with community members in order to identify the various strategies used in time of food shortages. The severity of these strategies was determined by the community. Seasonal food consumption patterns and dietary intake behaviour were assessed over the four seasons. The highest frequency score (7) x severity weight (1-4) x10 strategies = maximum score of 140. Thus the higher the score the more food insecure the community is. v Results: Food production from crops differs in different seasons. Food insecurity is high in summer and autumn due to a low number of food items harvested from crops. The community cope less in summer and autumn due to less crops available. The community is more food insecure in spring and winter due to the high number of food items harvested from crops. The community cope better in winter and spring due to the high level of available crops. Anthropometric measurements indicated that 41.2% of women between 31 and 50 and 49% of women between 51 and 70 years of age had a BMI of 30 and above. About 44% of total women are obese and 29% are pre obese. Only 26% had a normal weight. The 24 hour recall analysis indicates that the high level of obesity is due to the fact that a high number of participants consume large amount of carbohydrates every day. Conclusion: Overall results in this study indicated that this rural community is food insecure, on a higher level during summer and autumn, which leads to the consumption of undiversified diets. The women are malnourished and obese with a risk of metabolic syndrome. The information obtained in this study can be used to formulate strategies to develop interventions that can be used to access sufficient food in rural area in order to improve food insecurity, dietary diversity and, therefore, nutrient adequacy. vi TABLE OF CONTENTS PAGE ACKNOWLEDGEMENTS ii DECLARATIONS iv ABSTRACT v LIST OF TABLES xiv LIST OF FIGURES xvii LIST OF ABBREVIATIONS xix LIST OF ANNEXURES xviii CHAPTER 1: THE PROBLEM AND ITS SETTING 1.1 INTRODUCTION 1 1.1.1Background to the problem 2 1.1.2 Rational and Motivation 4 1.2 FOOD SECURITY 5 1.2.1 Food security the global perspective 6 1.2.2 Food security the African perspective 8 1.2.3 Food security the South African perspective 9 1.3 FOOD EXPENDITURE PATTERNS 11 1.4 DIETARY DIVERSITY 13 1.5 SOUTH AFRICAN STUDIES CONDUCTED 14 1.6 AIMS AND OBJECTIVES 19 1.6.1 Study Aim 19 1.6.2 Objectives 19 1.6.3 Plan of research activities 20 1.6.4 Structure of dissertation chapters 21 vii 1.7 CONCLUSION 21 CHAPTER 2: LITERATURE SYNTHESIS 2.1 INTRODUCTION 22 2.2 WHAT IS MALNUTRITION? 23 2.2.1 Over nutrition 25 a) Obesity 25 2.2.2 Under-nutrition 28 2.3 CAUSES OF MALNUTRITION 2.3.1 Household food insecurity 29 2.3.2 Lack of nutrition education 34 2.3.3 Inadequate dietary intake 34 2.3.4 High rate of unemployment 35 2.3.5 Lack of nutrition programmes 38 a) Integrated Nutrition Programmes (INP) 38 b) Community based nutrition programmes 39 2.4 STRATEGIES TO ADDRESS MALNUTRITION 2.4.1 Food fortification 41 2.4.2 Food Supplementation 42 2.4.3 Food based dietary guidelines 43 a) Make starchy foods the basis of most meals 45 b) Use food products and drinks containing sugar sparingly 45 c) Eat plenty of fruits and vegetables daily 46 d) Eat dry beans, peas, lentils and soy regularly 46 e) Chicken, fish, meat, milk or eggs can be eaten daily 46 f) Use fat sparingly 47 g) Use salt sparingly 48 viii h) If you drink alcohol, drink sensibly 48 i) Drink lots of clean safe water 49 j) Enjoy a variety of food everyday 49 2.4.4 Millennium Development Goals (MDGs) 50 2.4.5 Food parcels 52 2.4.6 Genetically Modified Food (GMF) 53 2.5 FOOD SECURITY 2.5.1 The role of sustainable agriculture and rural development in increasing household food security 54 2.5.2 The role of seasonal food plantation in increasing household food security 56 2.5.3 The role of the government in ensuring sustainable agriculture and food Security 60 2.6 DIETARY DIVERSITY 2.6.1 Definition of dietary diversity 61 2.7 FACTORS CONTRIBUTING TO POOR DIETARY DIVERSITY IN RURAL AREAS. 2.7.1 Cultural beliefs on food 62 2.7.2 Food purchasing power 63 2.7.3 Lack of food storage facilities 63 2.8 DIETARY REQUIREMENTS FOR WOMEN BETWEEN THE AGES OF 31- 50 AND BETWEEN 51-70 YEARS OF AGE: MACRO NUTRIENTS 2.8.1 The role of dietary reference intakes (DRI’s) and other dietary requirements 64 a) Estimated Average Requirement (EAR) 64 b) Adequate Intake (AI) 65 c) Tolerable Upper Intake Level (UL) 65 d) Recommended dietary intake (DRA) 65 2.8.2 Energy 65 2.8.3 Dietary fiber 66 ix 2.8.4 Carbohydrates 67 2.8.5 Protein 68 2.8.6 Fats 69 2.9 THE ROLE OF MICRO NUTRIENTS IN THE NUTRITIONAL STATUS OF ADULTS 2.9.1 Dietary Requirement Intakes (DRIs) for macro and micro nutrients in women 70 a) Vitamin A 71 b) Vitamin D 73 c) Vitamin C 74 d) Iron 74 e) Calcium 75 f) Zinc 75 g) Vitamin E 76 h) Iodine 77 i) Thiamine 78 j) Riboflavin 78 k) Niacin 78 l) Vitamin B6 79 m) Vitamin B12 79 n) Vitamin K 80 o) Folate 80 p) Biotin 81 q) Magnesium 81 2.3.2.
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