Browsing by Author "Swart, Rina"
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Item The association between Crohn's disease activity, serum 25(oh)- vitamin d status, the disease-associated environmental risk factors and the variability of Crohn's disease phenotype in the Western Cape population, South Africa(University of the Western Cape, 2014) Basson, Abigail Raffner; Swart, RinaBackground: A subtype of inflammatory bowel disease, Crohn' s disease is thought to represent a complex interaction between environmental factors, a defective immune system, the gastrointestinal microbiome and genetic' susceptibility; however; the-prevalence of different susceptibility mutations appears to vary between population groups, implying distinctions in disease pathogenesis or risk. Vitamin D, signaling through the vitamin D receptor, appears to have numerous effects on the immune system, and deficiency has been shown to playa role in both the pathogenesis and severity of experimental inflammatory bowel disease. However, the literature surrounding the association between vitamin D concentrations and disease severity in Crohn's disease is limited, and no such literature exists in South Africa. Furthermore, a paucity of data exists on the racial variability of Crohn' s disease phenotype in the Western Cape population of South Africa, as well as environmental factors in childhood associated with future Crohn's disease development. Aims: The three primary aims of the study were to investigate: 1) the racial variability of, Crohn's disease phenotype, defined by the Montreal classification scheme, as well as Crohn's disease behavior, using predefined definitions, stratified as 'complicated' or 'uncomplicated', based on a cross-sectional study design; 2) the association between childhood environmental exposures and the subsequent development of Crohn's disease, with specific emphasis on the timing of exposure, based on a case-control study design; and 3) the association between serum 25(OH)D concentration with Crohn's disease activity, measured by the Harvey Bradshaw Index, based on a cross-sectional study design; in this process, various vitamin D thresholds for predicting a high disease activity score were investigated, and the serum 25(OH)D concentrations were compared with those of the healthy controls to evaluate the prevalence of vitamin D deficiency. Design: This was a case control study, as well as two cross-sectional evaluations of the case control study data, of all consecutive Crohn's disease patients (ages 18-70 years) seen between September 2011 and January 2013 during their normally scheduled appointments at Schuur Hospital and Tygerberg Hospital. Control subjects for the study were identified from the same populations giving rise to the Crohn's disease cases. An investigator-administrated questionnaire was used to identify numerous demographic and lifestyle variables, as well as childhood environmental exposures during three age intervals; 0-5, 6-10 and 11-18 years. Clinical variables at diagnosis and time of study enrolment were determined via a review of medical and pharmacy records, as well as clinical examination by the consulting gastroenterologist. Serum 25(OH)D was measured using the SIEMENS ADIVA Centaur® XP Vitamin D Immunoassay [Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA]. Vitamin D status was classified as either 'deficient' or 'sufficient', and was analyzed in 2 ways: ~20 ng/mL versus ~21 ng/mL; and ~29 ng/mL versus ~30 ng/mL, respectively. One year after study completion, a total of 40 (10%) randomly selected participants from the cohort completed the interviewer-administered questionnaire for a second time. A kappa statistic was used in order to measure the agreement between repeated data for the questionnaire. Only data pertaining to the three age intervals (0-5, 6-10 and 11-18 years) was extracted in this process. Results: One hundred and ninety four Crohn's disease patients and 213 controls meeting our inclusion criteria were identified; 35 (18%) and 19 (9%) were White, 152 (78%) and 177 (83%) were Coloured, and 7(4%) and 17 (8%) were South African Black, respectively. No subjects reported being of Asian or Indian ethnicity. Overall, 125 (31%) of the cohort were male. On multiple logistic regression analysis, Coloured Crohn's disease patients were significantly more likely to develop 'complicated' Crohn's disease (60% versus 9%, P = 0.023) during the disease course when compared to White Crohn's disease patients. In addition, significantly more White subjects had successfully discontinued cigarette smoking at study enrolment (31% versus 7% reduction, P = 0.02). No additional interracial differences were found. A low proportion inflammatory bowel diseases family history was observed among the Coloured and Black subjects. When evaluating childhood environmental exposures, multiple logistic regression analysis showed that during the age interval 6-10 years, never having consumed unpasteurized milk [(OR = 6.43; 95% Cl, 3.02-14.81), (K =0.79; 95% Cl, 0.39-1.00)] and never having a donkey, horse, sheep or cow on the property [(OR = 3.10; 95% Cl, 1.42-7.21), (K = 0.84; 95% Cl, 0.12-1.00)], significantly increased the risk of developing future Crohn's disease. During the age interval 11-18 years, an independent risk-association was identified for; never having consumed unpasteurized milk (OR = 2.60; 95% Cl, 1.17-6.10) and second-hand cigarette smoke exposure (OR = 1.93; 95% Cl, 1.13-3.35). For the vitamin Danalysis, 186 Crohn's disease patients and 199 control subjects met the study inclusion criteria. Overall, 113 (29%) of the cohort were male. Forty four percent of the cohort had a deficient vitamin D concentration (::;20 ng/ml.), no participants had severely deficient vitamin D concentrations, and 26% of the cohort had sufficient vitamin D concentrations (:::30 ng/mL). Fifty-three percent of the controls and 34% of the cases had vitamin D concentrations ::;20 ng/mL (P < 0.001). On multiple logistic regression analysis, higher Harvey Bradshaw Index scores and not having taken vitamin D supplementation in the six months prior to enrolment were identified as independent predictors of vitamin D deficiency in Crohn's disease patients; defined either as ::;20 ng/mL, or as ::;29 ng/mL (P < 0.001). Compared to patients with Harvey Bradshaw Index <5, those with Harvey Bradshaw Index 2:8 were 2.5-times more likely to have vitamin D concentrations ::;21 ng/mL (PR = 2.5; 95% Cl, 1.30-6.30). The risk was similar, though not as high, if deficiency was defined as ::;29ng/ml. (PR = 2.0; 95% Cl, 1.20-3.50). Conclusions: Coloured Crohn's disease patients were significantly more likely to develop 'complicated' Crohn's disease over time when compared to White Crohn's disease patients. Limited microbial exposures and exposure to second-hand cigarette smoke during childhood is associated with future development Crohn's diseases. However the inconsistencies between each age interval with regards to the identified risk factors may imply that the effect of different viruses or bacteria on the development of immune structures varies according to the timing of exposure. The finding that lower serum 25(OH)D was associated with moderate to severe Crohn's disease activity suggests that this patient population may benefit from vitamin D supplementation in order to achieve, or maintain a serum 25(OH)D concentration of at least 30 ng/mL.Item "Big Food", the consumer food environment, health and the policy response in South Africa(Public Library of Science, 2012) Igumbor, Ehimario U.; Sanders, David; Puoane, Thandi; Tsolekile, Lungiswa; Schwarz, Cassandra; Purdy, Christopher; Swart, Rina; Durao, Solange; Hawkes, CorinnaSummary Points: * In South Africa, as in other jurisdictions, ‘‘Big Food’’ (large commercial entities that dominate the food and beverage environment) is becoming more widespread and is implicated in unhealthy eating. * ‘‘Small food’’ remains significant in the food environment in South Africa, and it is both linked with, and threatened by, Big Food. * Big Food in South Africa involves South African companies, some of which have invested in other (mainly, but not only, African) nations, as well as companies headquartered in North America and Europe. * These companies have developed strategies to increase the availability, affordability, and acceptability of their foods in South Africa; they have also developed a range of ‘‘health and wellness’’ initiatives. Whether these initiatives have had a net positive or net negative impact is not clear. The South African government should act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.Item A comparative analysis and evaluation of the naturopathic curriculum in South Africa(South African Medical Association, 2021) Ericksen-Pereira, Wendy; Roman, Nicolette; Swart, RinaNaturopathy has been taught at tertiary level in South Africa (SA) for 18 years. This research paper examines the naturopathic curriculum to determine whether it is benchmarked to international standards and meets the needs of graduates in practice. It is the first research paper that critically reviews the curriculum of a complementary alternative medicine profession taught at a higher education institution (HEI) in SA.To critically review the naturopathy curriculum taught at an SA HEI. Methods. This research used a sequential two-stage qualitative methodology. In stage one, a comparative document analysis was conducted using the curriculum recommended by the World Health Organization (WHO), the World Naturopathic Federation (WNF) and the University of the Western Cape. Stage two consisted of a graduate review of the curriculum. Eighteen graduates participated in the review by providing input on all the subjects in the curriculum via email. The responses were summarised and thematically analysed.Item Diet-related non-communicable diseases in South Africa: determinants and policy responses(Health Systems Trust (HST), 2016) Spires, Mark; Delobelle, Peter; Sanders, David; Puoane, Thandi; Hoelzel, Philipp; Swart, RinaNon-communicable diseases (NCDs) are the leading cause of death globally and they are on the rise both in low- and middle-income countries, with South Africa being no exception. Implicated in this upward trend in the country is an observed change in diet - a transition from traditional foods, to what has come to be known as the 'western' diet, i.e. more energy-dense, processed foods, more foods of animal origin, and more added sugar, salt and fat. Increasingly, international research links rapidly changing food environment with escalating chronic disease, i.e. it implicates population-level dietary change over individual factors such as knowledge, attitudes and behaviours. Environmental and/or policy interventions can be some of the most effective strategies for creating healthier food environments. This chapter explores the link between the rise in diet-related NCDs, their proximal determinants (specifically an observed change in diet patterns), contributing environmental factors, what is currently being done or recommended to address this internationally, and the most relevant national-level policies for South Africa. The authors conclude that to improve dietary patterns and reduce chronic diseases in South Africa will require a sustained public health effort that addresses environmental factors and the conditions in which people live and make choices. Overall, positive policies have been made at national level; however, many initiatives have suffered from a lack of concerted action. Key actions will be to reduce the intake of unhealthy foods and make healthy foods more available, affordable and acceptable in South Africa.Item Dietary patterns and colorectal cancer risk in Zimbabwe: A population based case-control study(Elsevier, 2018) Katsidzira, Leolin; Laubscher, Ria; Gangaidzo, Innocent T.; Swart, Rina; Makunike-Mutasa, Rudo; Manyanga, Tadios; Thomson, Sandie; Ramesar, Raj; Matenga, Jonathan A.; Rusakaniko, SimbarasheBACKGROUND: The rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. We sought to establish the association between dietary patterns and colorectal cancer in Zimbabwe. METHODS: One hundred colorectal cancer cases and 200 community-based controls were recruited. Data were collected using a food frequency questionnaire, and dietary patterns derived by principal component analysis. Generalised linear and logistic regression models were used to assess the associations between dietary patterns, participant characteristics and colorectal cancer. RESULTS: Three main dietary patterns were identified: traditional African, urbanised and processed food. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 – 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43–1.08), or processed food (OR 0.91; 0.58–1.41) patterns. The traditional African diet was associated with rural domicile, (OR 1.26; 95% CI, 1.00–1.59), and a low income (OR1.48; 95% CI, 1.06–2.08). The urbanised diet was associated with urban domicile (OR 1.70; 95% CI, 1.38–2.10), secondary (OR 1.30; 95% CI, 1.07–1.59) or tertiary education (OR 1.48; 95% CI, 1.11–1.97), and monthly incomes of $201–500 (OR 1.30; 95% CI, 1.05–1.62), and the processed food pattern with tertiary education (OR 1.42; 95% CI, 1.05–1.92), and income > $1000/month (OR 1.48; 95% CI, 1.02–2.15). CONCLUSION: A shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa.Item "Eat dry beans, split peas, lentils and soya regularly": a food-based dietary guideline(Medpharm, 2013) Venter, C.S.; Voster, H.H.; Ochse, R.; Swart, RinaThe objective of this paper is to review recent scientific evidence to support the food-based dietary guideline (FBDG): “Eat dry beans, split peas, lentils and soya regularly”. In this review, legumes are synonymous with the term “pulses”, while soy beans are classified as “oilseeds”. The FBDG was originally introduced to address both under- and overnutrition in South Africa. The nutrient and non-nutrient content, results of recent epidemiological and intervention studies on health effects, recommended intakes and barriers to consumption are briefly reviewed. Legumes are rich and economical sources of good-quality protein, slow-release carbohydrates, dietary fibre (non-starch polysaccharides), various vitamins and minerals and non-nutritive components which may have several beneficial health effects. Pulses have a low energy, fat and sodium content. Therefore, legumes contribute to dietary adequacy, while protecting against noncommunicable diseases through many mechanisms. Evidence is presented that concerns about excessive flatulence from eating beans may be exaggerated, and that there is individual variation in response to different bean types. It is recommended that nutritionists should aggressively encourage consumers to consume more legumes. They should also be advised to evaluate different legume varieties to minimise undesirable symptoms. More research is needed to assess gastrointestinal responses between types of available and consumed legumes in South Africa. The FBDG should be tested in different population groups to determine how to maintain legumes as a traditional food. Increasing familiarity with legumes could help to increase the likelihood that they may be incorporated more regularly into the diet.Item The effect of legislation on the treatment practices and role of naturopaths in South Africa(Springer Nature, 2020) Ericksen-Pereira, Wendy G.; Roman, Nicolette Vanessa; Swart, RinaIn South Africa naturopaths have been practising for over half a century. Over this period, changes in legislation have resulted in different levels of training and registration processes - which has impacted on the profession in various ways. This paper explores the effect of legislation on the treatment practices and role of naturopaths in South Africa. Methods: This was a qualitative study which used an exploratory approach. Participants were sampled from the list of naturopaths registered with the Allied Health Professions Council of South Africa (AHPCSA). A set of 15 openended survey questions were emailed to 59 naturopaths. Twenty one naturopaths participated: 13 responded via email and eight were interviewed. Responses were coded and thematically analysed. Results: It was found that despite differences in training and years of practice experience, four core treatment practices of diet therapy, lifestyle medicine, supplementation and physical therapies were common to all participants with the older, more experienced naturopaths using a wider range of treatment practices.Item Exploring the experiences and challenges of food insecurity in child-headed households in Ingwavuma: A bio-ecological perspective(University of the Western Cape, 2019) Pote, Charity; Swart, RinaChild-headed households (CHHs) are a recent development that has become progressively noticeable not only in South Africa but also internationally. This phenomenon arose as a result of the death of parents or abandonment of children by their primary caregivers. The Acquired Immuno Deficiency Syndrome (AIDS) epidemic has taken away the lives particularly of many adults, leaving children orphaned and having to take on the adults’ responsibilities. In the past, relatives or the extended family would take the responsibility of caring and providing for orphaned children but, with current economic hardships, most families are unable to take the extra responsibility. As a result, older siblings become caregivers to their younger siblings. Unfortunately, when parents die, children often lose access to adequate food, social grants, education and health services. Despite the fact that it is the right of all South Africans, including children, to have access to sufficient food, many households, including CHHs, are living in poverty. As a result, they are vulnerable to food insecurity, leading to developmental, social and emotional challenges. The aim of the present study was to explore and describe the experiences, challenges and coping strategies of CHHs with food insecurity in Ingwavuma, from a bio-ecological perspective. Ingwavuma is a small rural town in KwaZulu-Natal Province, South Africa. The study makes recommendations for social work projects, education and future research regarding CHHs’ experiences of food insecurity. This is a qualitative study that utilised an explorative-descriptive methodological approach. Purposive sampling was used to select 20 children between the ages of 13 and 18 years old from CHHs in Ingwavuma. One-on-one semi-structured interviews were conducted with the participants at their homes in the town.Item Infant feeding practices, knowledge, attitudes, and beliefs of mothers with 0-6 month’s babies attending baby friendly accredited health facility and non-baby friendly accredited health facilities in Blantyre, Malawi(2009) Guta, Janet Naomi; Swart, RinaThe Ministry of Health in Malawi promotes exclusive breastfeeding for the first six months of life and continued breastfeeding with appropriate complementary feeding up to two years or beyond. This policy applies to all children unless there are medical indications. Baby Friendly Hospital Initiative (BFHI) is a strategy that contributes to the attainment of this policy. BFHI is a strategy to increase early and exclusive breast feeding rates among mothers. This study is a pilot to evaluate the success of the BFHI initiative in Malawi.Study design. A cross- sectional cohort study of women and their infants, 0-5 months,attending BFHI and non-BFHI accredited health facilities in Blantyre district of Malawi ] between the period from 28th April to 30th September, 2008 was conducted.Data Collection: An in-depth face-to-face interview using an open-ended structured questionnaire was conducted among 202 mothers of infants within the first week of birth.A convenient sample of 102 mothers was selected from prima gravida mothers at a semiurban BFHI accredited facility while the other 100 were from semi-urban non-BFHI accredited facilities. This sample was used for the descriptive component of the study.From the 202 mothers, 30 from the BFHI and 30 from the non-BFHI Accredited health facility(s) were selected randomly as the sample for the longitudinal cohort of the study at 3 and 5 months respectively.Analysis of results: Data was analyzed using SPSS for Windows. Frequencies were tallied for categorical variables and mean standard deviations were computed for continuous variables. Chi-square p-values with health facility type as classification were computed to determine the difference between BFHI and non-BFHI accredited health facility groups for all relevant variables.Results Exclusive breastfeeding rates differed significantly (p- value, 0.0000) within one week after birth (99% for the BFHI versus 68% for the non-BFHI facilities).Thirty percent of the mothers from the BFHI accredited health facility practiced exclusive breastfeeding up to 5 months as compared to none of the mothers in non-BFHI accredited health facilities.All 202 mothers had ever breast feed in both facilities throughout the 5 months study period.Mothers and mothers-in-law were the significant source of complementing breast milk before 6 months of age,[ 25% more influence of mothers and mothers in-law in the non-BFHI accredited facility when compared to BFHI accredited facility].Conclusion:The BFHI strategy has the potential to successfully influence mothers to adhere to global and national recommendations on optimal breastfeeding practices. Special efforts should be made to continue support of and provide information to new mothers during the first week after delivery and unto few months after birth as mothers seem to introduce complementary foods early and prior to the recommended period of 6 months.Item A matched case control study of the nutritional status of newly diagnosed tuberculosis patients and tuberculosis free contacts in Delft, Western Cape(2011) Lombardo, Candice Clarissa; Swart, Rina; Visser, MarianneBackground: Malnutrition is a risk factor for the development of pulmonary tuberculosis (TB) and may be responsible for the premature deaths of patients with active disease. An adequate nutritional status may therefore be protective in delaying the onset from latent infection to active disease. In South Africa, very little data is available on the nutritional status of adults who present with tuberculosis. This study therefore aims to compare the nutritional status of newly diagnosed pulmonary tuberculosis patients with TB-free controls.Study population & Design: This is a community based case-control study. Forty-three newly diagnosed pulmonary tuberculosis patients were recruited as cases and matched according to age,gender and race to 43 TB-free close contacts. HIV positive subjects were excluded from the study.Methods: Each participant was interviewed and completed a structured questionnaire to obtain demographic information. Weight was measured to the nearest 0.1kg and height to the nearest 1mm. A 24-hr dietary recall method was used to obtain dietary information. Biochemical analysis was carried out to measure concentrations of transferrin, albumin, CRP, ferritin, zinc,copper, vitamin A and E.Results: The median Body Mass Index (BMI) for cases was 18.80kg/m² (IQR 14.35, 32.11) and TB-free contacts 21.17 kg/m² (IQR 16.75, 34.98) with a significant difference between the groups of p=0.001. There was significant difference in weight (p=0.002) and MUAC (p=0.000)between groups. No significant difference in dietary intake of energy (KJ) (p=0.695), protein(p=0.804), CHO (p=0.801) and fat ( p=0.796) was found between groups. There was a statistically significant increase in ferritin (p=0.000) and C-reactive protein (CRP) (p=0.000) in TB patients, while albumin (p=0.000), serum zinc (p=0.000) and serum vitamin A (p=0.000) were statistically significantly lower among cases. Conclusion: There was no significant difference in the macronutrient intake of TB cases and TB-free contacts, although a significant difference was seen in BMI, MUAC and weight between groups, with all these parameters being lower in TB patients. Ferritin and CRP levels were markedly increased in TB cases while serum zinc, vitamin A and albumin are all significantly lower in TB patients than TB free contacts.Item Maternity protection for women and the potential implications for breastfeeding on return to work at a tertiary hospital in the Western Cape(University of the Western Cape, 2022) Jacobs, Crystal; Swart, RinaOptimal maternal health and support in the workplace can have a positive impact on the health outcomes of the mother and baby. Therefore, legislation specifies that women be protected during the pregnancy period as well as on return to work. According to the International Labour Organisation (ILO), maternity protection includes maternity leave, cash and medical benefits, health protection in workplace, non-discrimination, job security, breastfeeding breaks, and access to childcare facilities. Adequate maternity protection in the workplace can result in benefits to the child’s long-term health and positive effects for workplaces. The aim of this research was to determine the availability of maternity protection practices in the workplaces and the potential implications for breastfeeding.Item A model for naturopathy within the South African healthcare system(University of the Western Cape, 2020) Ericksen-Pereira, Wendy; Swart, RinaOne of the sustainable development goals the World Health Organization (WHO) has set for member countries is the implementation of universal health coverage (UHC) in order to ensure all citizens have the right to access healthcare. In recognising that the global demand for traditional and complementary medicine (T&CM) continues to grow, the WHO has encouraged the inclusion of T&CM into the national health systems of member countries as a way of ensuring that UHC can be achieved.Item Nutrient adequacy and dietary diversity of women in the Gauteng and Eastern Cape provinces, South Africa – focus on micronutrients from the national food fortification programme(University of Western Cape, 2021) Fisher, Roxanne; Swart, RinaMicronutrient deficiencies are of public health concern in South Africa. These deficiencies affect pregnancy outcomes, growth, functional and cognitive development of children and, the health and productivity of women. As an intervention, the South African government implemented the National Food Fortification Programme (NFFP), which was mandated in 2003 and according to which, the staple foods consumed by most of the population e.g. maize meal and wheat flour (and thus bread) are fortified with a premix of thiamin, niacin, riboflavin, vitamin A, folate, vitamin B6, iron and zinc. There is limited data which looks at the contribution fortified staple food to the dietary intakes and measures of nutrient assessment among South African women of reproductive age (WRA).Item Nutritional capabilities of young people not in employment, education or training (NEETs) in Langa, Western Cape, South Africa(University of Western Cape, 2021) Rasmeni ,Akhona; Swart, RinaThe opportunities and challenges faced by young people who are not in any kind of employment, education or training (NEETs) are under-reported by scholars in the field of development. In this regard, what NEETs in South Africa know about nutrition and how they pursue nourishment are neglected areas of research. Yet they are important considerations for policymakers. The majority of young people in the age group 18–24 are, strictly speaking, no longer their parents’ responsibility, with the child support grant that their caregiver may have received having terminated when they turned 18. However, many young people have not found jobs and are therefore not financially independent. As a result, they are constrained in being able to access food (or at least the food that they particularly enjoy). This study aimed to investigate the lived experiences of young adult NEETs in terms of food and nutrition, what they do to ensure that they are nourished, and the kinds of nutritional achievements that they have to choose from.Item An observational study of child-directed marketing on prepackaged breakfast cereals in South Africa(University of the Western Cape, 2021) Khan, Alice; Swart, RinaBackground: Childhood obesity is on the rise in South Africa (SA) and child-directed marketing (CDM) is one of the contributing factors to children’s unhealthy food choices and consumption. This study assessed CDM on pre-packaged breakfast cereals available in South African supermarkets and describe the nutrient composition of these pre-packaged products. Methods: A descriptive observational study of CDM on pre-packaged breakfast cereals was undertaken with quantitative analysis of the nutrient composition of these products. Secondary data from the “Researching obesogenic food environments in South Africa and Ghana” study in 2019 was examined. An independently reviewed codebook of definitions of CDM was developed and breakfast cereals were assessed to identify CDM. The CDM questionnaire was developed in REDCap, an online research database and data captured therein. Statistical Package for Social Sciences (SPSS) was used for cross tabulations and one-way ANOVAs. All analysis with p value < 0.05 was taken as significant.Item An overview of the history and development of naturopathy in South Africa(AOSIS, 2018) Ericksen-Pereira, Wendy G.; Roman, Nicolette V.; Swart, RinaBACKGROUND: A huge growth in complementary and alternative medicine (CAM) took place in South Africa in the 1960s which paralleled what was happening in other parts of the western world. Naturopathy has been practised in South Africa for over 60 years, and the history of naturopathy is entwined with the broader history of CAM. No laws existed at that stage to regulate the curriculum, education and training of CAM practitioners. With the passage of time, various statutes were introduced which eventually led to changes in legislation and the establishment of a recognised training programme. Naturopathy became a legally regulated profession, the full history of which has never been documented. OBJECTIVE: This article explores the history of naturopathy in South Africa. METHOD: A two-phase qualitative research design was used, consisting of a document search and semi-structured interviews with key informants who were identified through a process of snowballing. Information collected from the naturopaths who participated in the interviews was triangulated with documentation uncovered in the archives of the Allied Health Professions Council of South Africa (AHPCSA) and other literature available. RESULTS: The result is a history of events which took place and reveals the effect of various legislations on the profession. CONCLUSION: Changes in the political system paved the way for changes in legislation which allowed for the registration and training of naturopathic practitioners. However, the lack of a functioning association and the small number of naturopathic graduates have hampered the growth of the profession, preventing it from becoming a significant contributor to the health care system.Item Perceived effect of warning label on parental food purchasing and drivers of food selection among South African parents–An exploratory study(Frontiers Media, 2022) Bopape, Makoma; Taillie, Lindsey Smith; Swart, RinaHousehold food purchasing decision is a complex process influenced by factors such as marketing, cost, children food preference and parental choices. Most food products targeted toward children are unhealthy and are aggressively marketed to increase desirability among parents and children making healthier food selection even harder. The warning label (WL) is identified as a simple front-of-package labeling format that assist consumers to easily identify unhealthy foods and reduce their purchasing. This was a qualitative study that aimed to investigate the perceived eect of the warning label (WL) on parental food purchasing and drivers of food selection among parents. The study was conducted in a mainly rural part of South Africa, in Limpopo Province.Item The politics of malnutrition: Self-determination and the right to food in the era of Sustainable Development Goals(University of the Western Cape, 2022) Moyo, Busiso Helard; Swart, RinaThis research is about the analyses of power, governance, social capital and social justice in food and nutrition policy processes with the aim of informing efforts to achieve the right to food and address the complex burden of malnutrition in South Africa, and to transform the food system. Too often, malnutrition and the right to food are disconnected from one another, from the food systems practices that systematically generate health risks, and from the underlying environmental and socioeconomic conditions for health - conditions that are currently undermined by food systems activities.Item The relationship between the nutritional status of children within early childhood development centres in delft and their compliance to the expanded programme of immunization and routine vitamin a supplementation(University of the Western Cape, 2022) Jansen, Monique Christelle; Swart, RinaPublic health care interventions namely, the Expanded Programme on Immunizations (EPI) integrated with the Vitamin A supplementation programme (VAS) has been used for many years with the main intentions of preventing and decreasing the prevalence of child morbidity and mortality worldwide. Poor vaccination status has an effect on the nutritional status of children younger than five years. Child malnutrition in South Africa has been a challenge over decades with stunting largely unchanged and above 20% whilst wasting remains prevalent and obesity emerges. Malnutrition in children leads to mental, cognitive and long-term developmental delays.Item South African consumers’ perceptions of front-of-package warning labels on unhealthy foods and drinks(Public Library of Science, 2021) Bopape, Makoma; Taillie, Lindsey Smith; Swart, RinaFront-of-package labeling (FOPL) is a policy tool that helps consumers to make informed food choices. South Africa has not yet implemented this labeling system. The aim of this study was therefore to explore adult South African consumers’ perceptions of front-of-package warning labels on foods and non-alcoholic beverages (referred to as drinks in this paper) and their insights into features that could influence the effectiveness of the warning label. Using a qualitative approach, the study purposively selected consumers diversified by urbanization, gender, socioeconomic status, and literacy. We collected data from a total of 113 participants through 12 focus group discussions. Data were systematically coded and divided into five themes namely, positive attitudes toward warning labels, perceived benefits of warning labels, perceived behavior modification, perceived beneficiaries of warning labels, and effective attributes of warning labels.