SITUATIONAL ANALYSIS OF FREE- LIVING ELDERLY IN UMLAZI TOWNSHIP Nkumbulo Xolile Mkhize BTech: Consumer Sciences: Food and Nutrition Dissertation submitted in fulfilment of the requirements for the degree of 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 2011 Supervisor: Prof. W. Oldewage-Theron Co-supervisor: Prof. C. Napier i Pagei DECLARATION This work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidature of any degree. Signed: Date: STATEMENT 1 This dissertation is being submitted in fulfilment 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: ii Pageii ACKNOWLEDGEMENTS Prof. Wilna Oldewage-Theron, my supervisor for the sound advice, good teaching and assisting with vast expertise. Dr Napier my co supervisor and mentor for her assistance, patience, support and encouragement. rd 3 year students at the Durban University of Technology and University of Kwa-Zulu Natal who acted as field workers, providing valuable assistance that enabled this study to be completed. Ethekwini municipality, ward councillors and South African Social Security Agency for assistance in authorising research to be conducted to in the Umlazi community. My family, friends and all those who contributed towards the end of the project for their support and encouragement iii Pageiii DEDICATION This thesis is dedicated to my grandparents who have been a great inspiration in my life. The great contribution in my upbringing and support has been remarkable. iv Pageiv ABSTRACT A situational analysis of free-living elderly people in Umlazi, KwaZulu-Natal, South Africa Rationale & Objectives The objective of the study was to conduct a situational analysis of elderly people on state pension living in Umlazi, KwaZulu-Natal South Africa. The research focused on the socio- economic status, dietary intake, nutritional status, and health status of this community. Methodology The sample comprised 270 (224 women and 46 men) randomly selected elderly people within the 12 wards of Umlazi. The methods used for assessment included a socio- demographic questionnaire which determined the socioeconomic status. A 24-hr recall questionnaire and food frequency questionnaire were used to determine dietary intake, while anthropometric measurements were conducted to determine the nutritional status. A health questionnaire, including a salt administration questionnaire was used to determine the health status of the elderly in this community. Trained field workers and nurses assisted in data collection and food consumption data was captured and analysed by a qualified dietician using Food Finder version 3.0 computer software program. Descriptive statistics (frequencies, means, standard deviations and confidence intervals) were determined with the assistance of a bio-statistician. Socio-demographic and health data were captured onto an (R) Excel spreadsheet by the researcher. These questionnaires were analysed using the Statistical Package for Social Sciences (SPSS) for Windows version 17, 0 software program. Results The majority of respondents lived in brick houses (84.8%) and the living space generally consisted of more than three rooms (87.4%). However, the majority of respondents who lived with >4 to 10 members were 67.4% whilst only 32.6% of households consisted of less than 4 members. The mean household size was 5.1 (±SD 2.9) people, this further illustrates that the majority of respondents lived with 5 people per household. Grandchildren were present in 70% of the households with a mean of 3 (±SD 5) grandchildren in each household. Results also indicate that 84.6% of the elderly were the bread winners in these households. The vast majority of 87.8% of the population had no other source of income. The majority of v Pagev respondents with an income had a total monthly income of R500- R1500 (82.9%) followed by R1501- R2500 (14.1%) and only 3% had more than R2500 total income. Food expenditure for most (80%) households was >R500 of the total income. Food shortages due to limited income were frequent in 54% of households who regularly experienced this problem, whilst 26% sometimes experienced shortages, 15.4% often encounted shortages whereas 2.6% encounted shortages seldomly and 2.2% never. A large majority of respondents owned electrical assets, the most commonly owned included a televison (80.3%) , a radio (75.5%) and a refrigerator (75.1). The majority of food items consumed were carbohydrate based and the portion sizes were relatively big, on average 1348.5g per day. The energy contribution from carbohydrates was 65% which is considered to be on the high side (WHO goals 55-75%). Protein intake was fairly common, with a 15% contribution to energy from total protein (WHO goals 10-15%). The frequency of vegetable and fruit intake was very low, the portion sizes were also small and did not meet the recommended daily intake. The energy contributions showed that 89.2% of the women consumed a diet that supplied <100% of Estimated Energy Requirements (EERs) and all the men consumed <100% of the EERs for energy. Sixty three percent of the women and 91.1% of the men consumed <100% of the EARs for protein. The mean carbohydrate intake in the sample was significantly higher than the EAR but the women consumed <100% of the EARs for carbohydrates (4.1%) and all men consumed >100% of the EARs. The majority of the vitamins for both genders indicated low intakes except for vitamin B12 and B6 in the case of men only. The majority of minerals indicated low scores for micronutrients except for iron (36.6% for men) and potassium (39.0% for men) which was consumed mostly by men than women. The mean Food Variety Score (FVS) (±SD) for all the foods consumed from all the food groups in a period of seven days was 25.8 (±14.6). The results revealed poor dietary diversity scoring. The cereal group had the highest mean variety score 5.3 (±2.5) followed by vegetables 4.5 (±2.6), fruit 3.5 (±3.1), flesh foods 3.2 (±1.6), vitamin A-rich fruit and the vegetable group 3.1 (±1.7). The anthropometric indices indicated that the mean age was 69.7 years (±SD 7.1) and mean weight of 76.5 kg (±SD 17.3). The BMI scores for the total group indicated that 52% of the respondents fell into the obese category (BMI = obese 1 >30, obese 2 >35 and obese 3> 40) and 24% of the respondents were overweight (BMI = 25-29.9). Only 20% were of moderate weight (BMI 18.5- 24.9). Although more men were overweight (34.2%) compared to 21.9% vi Pagevi of women, more women (60.1%) were obese compared to men (18.8%). The majority (83%) of the women were above the cut-off points for waist circumference (≥88cm) and 17% were within the normal values whilst 74% of the men were within recommended cut-off points (≥102cm) and only 26% exceeded the recommended scores. The results indicate that 77% of respondents were at risk of developing metabolic syndrome exceeding >0.5 waist-to-height- ratio (WHTR) and 23% were at lower risk. However, the women showed a higher risk of 87.4% and men only 47.9% for metabolic risk. The correlation was significant at the p=0.01 level. There was thus as highly significant relationship between BMI and WHTR ratio for women. The health survey results indicated that 90% of the elderly population were in various stages of hypertension and 6% showed signs of developing hypertension. However, hypertension was more prevelant in women (91%) than in the men (83%). There was a statistical significant correlation (p=0.01) between waist circumference and systolic pressure for both women and men. A high percentage (82%) of the participants reported that they were currently on chronic medication whereas 18% were not using any chronic medication at the time. Although hypertension was prevalent in most respondents, it was followed by self reported diabetes (26.7%) and cancer (1.9%). Results show that elderly experienced problems with following ereas in the body skeletal joints (72.6%) as well as eyes and teeth were problematic in 75.9% of the respondents, followed by skin problems (29.6%) and ears and nose problems (28.6%). Results in the salt administrative questionnaire indicate that sodium intakes were below WHO goals <2000mg. Results also show that a high percentage of respondents (60%) generally never added salt to cooked food as the majority saw it as a health risk. Only 13% added it always to cooked food and 21% added it sometimes. Conclusions The results in the study indicate the high prevelance of poverty, food insecurity and poor nutritional and health status that compromises the quality of life of elderly living in this community. vii Pagevii Recommendations Long-term intervention studies must be prioritised to address economic, health, social and demographic factors and future research is needed to cater for the growing needs of this population group. viii Pageviii LIST OF FIGURES PAGE Figure 1.1: Population percentage of South African residents by age group 31 Figure 1.2: Population percentage of Umlazi residents by age group map 31 of Umlazi and surroundings Figure 1.3: Percentage population for both elderly women and men in Umlazi 32 Figure 1.4: The top food imports in South Africa in 2007 33 Figure 1.5: Top exports of commodities in South Af rica in 2007 34 Figure 1.6: Elderly of Umlazi’s largest ward waiting at a payout point on pension 34 day Figure: 1.7: The conceptual frame work of the study 35 Figure 2.1: 110 year-old woman with severe weight loss who was excluded from 38 the study Figure 2.2: Disabled elderly captured on pension day 49 Figure 2.3: Obese and blind woman captured on pension day 61 Figure 2.4: Cooked meals sold on pension day- 2008 85 Figure 2.5: Traditional food sold on pension day- 2008 88 Figure 3.1: Umlazi map with all the wards 111 Figure 3.2: The model of the study variables 112 Figure 3.3: Researcher during a sampling section 115 Figure 3.4: Respondents completing consent forms 115 Figure 3.5: Field worker during an interview with various questionnaires 116 Figure 3.6: An elderly man’s height measurement being taken 119 Figure 4.1: Percentage population reporting major problems with faulty housing 124 Figure 4.2: Households with animal infestation problems 125 Figure 4.3 Percentage of the sample population who are breadwinners 125 Figure 4.4 Number of people having other sources of income 126 Figure 4.5: Mean nutrient adequacy ratio (NAR) of energy and nutrients at different levels of FGDS (women) 141 Figure 4.6: Mean nutrient adequacy ratio (NAR) of vitamins at different levels of FGDS (men) 142 Figure 4.7: Cutoff points for waist circumference in both male and female groups 144 Figure 4.8: Metabolic syndrome risk scores as measured by waist- to- height ratio (WHTR) 144 ix Pageix LIST OF FIGURES-continued PAGE Figure 4.9: Metabolic risk scores for women and men 145 Figure 4.10: Hypertension stages in Umlazi elderly 145 Figure 4.11: Hypertension stages by gender 146 Figure 4.12: The percentage population with self reported lifestyle diseases 148 Figure 4.13: Percentage of respondents currently on chronic medication 148 Figure 4.14: Frequency of the addition of salt when cooking food 149 Figure 4.15: Frequent addition of salt to cooked food 150 Figure 4.16: The relationship between BMI and waist- to- height ratio for women 150 Figure 4.17: The relationship between BMI and systolic BP in women 151 Figure 4.18: The relationship between BMI and systolic BP in men 151 x Pagex