iLembe District Research Articles

Phytochemical screening and antioxidant evaluation of Agave angustifolia and Agave sisalana

Background: Agave angustifolia (AA) and Agave sisalana (AS) are used by local communities for medicinal purposes to treat skin conditions. Small companies add Agave leaf extracts to their cosmetic products, claiming calming and skin-rejuvenating qualities.Aim: The study aimed to assess the phytochemical profiles and antioxidant activities of AA and AS verifying the traditional therapeutic claims about the species and accordingly establishing the assertions of cottage industries.Setting: The AA leaves were collected from the eThekwini Metropolitan Municipality, while AS leaves were sourced from the iLembe district municipality.Methods: The phytochemical extracts were obtained by gradient solvent maceration of the leaves. Qualitative phytochemical screening established the presence of bioactive phytochemicals in the extract. The 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) and the ferric reducing and/or antioxidant power (FRAP) methods measured the bioactive phytochemicals’ antioxidant activity.Results: Qualitative phytochemical evaluation confirmed the presence of secondary metabolites in both plants. AS extracts also contained alkaloids. The DPPH antioxidant activity indicated that Agave extracts had 20% to 80% scavenging activity. AS methanol extract had the maximum antioxidant activity among all the extracts. AA methanol and AS hexane extracts had no antioxidant activity. AA ethyl acetate extract had higher antioxidant activity (64%) than AS (52%). AA hexane extract had 70% activity while AS hexane extract had 30%.Conclusion: The detected phytochemicals indicate potential use for emulsifying, antioxidant, anti-ageing, anti-inflammatory, and broad-spectrum antimicrobial activities.Contribution: This study contributes to the existing knowledge of the therapeutic properties of AA and AS plants.

Stakeholder Perspectives on the School Food Environment: Insights from South African Learners-A Pilot Study.

Leveraging learner-driven insights to enhance the SFE can significantly influence food choices by decreasing the consumption of unhealthy foods and increasing access to healthier options. Using learners' voices as important stakeholders in the school food environment (SFE), this qualitative research study aimed to gain a deeper understanding of their perspectives, identify barriers and enablers to fostering a healthy SFE in South African public schools, and explore the link between the SFE and learners' food choices. Six focus group discussions (FGDs) with 4-6 participants were held in six schools, including three primary and three secondary schools in the KwaZulu-Natal Department of Education's iLembe district, SA, with learners aged 12-14 and 15-18 years, respectively. Learners were asked how schools could help them eat healthier and how their SFE benefitted them. The data were analysed using thematic data analysis methods. The FGDs generated 14 themes and subthemes. Emerging information suggests a lack of control over the sale of unhealthy food despite the existence of guidelines. This is further exacerbated by the marketing of unhealthy foods, which prevents learners from selecting healthier options. Furthermore, they stated that promoting the school food programme (SFP) and changing attitudes towards healthy food intake through comprehensive nutrition education are useful ways to enhance the SFE. The findings of this study underscore the critical role of learner insights in shaping effective strategies to improve the SFE.

Factors Influencing the Use of Digital Personal Banking in South Africa

Financial technology improvements have simplified personal banking, allowing a range of services to be accessed anytime and anywhere. But the impact of digital financial technology on the use by consumers of digital personal banking in developing economies has been little researched. The purpose of this study is, therefore, to examine the link between the use of digital personal banking by consumers and the various drivers of digital banking use in a developing economy, namely South Africa. An online survey of 400 digital banking users in the iLembe district of KwaZulu-Natal, South Africa, was used to collect data. Of the eight drivers identified initially from extant literature, Online service quality, Usability, and Branch service quality were the most important, with Usability and Online service quality having the greatest positive influence, and Branch service quality having a large negative influence, on use of digital banking by the respondents.

Screening for dementia and associated factors in older adults from low socioeconomic communities in iLembe, KwaZulu-Natal.

Dementia is one of the leading non-communicable causes of disability and mortality in older adults, with recent research showing that it is increasing in low-middle-income countries compared to high-income countries. As such, multidisciplinary efforts are needed to effectively reduce the prevalence and risk of dementia through quick screening, diagnosis, and management of those with dementia and those at risk. The study's objectives were to estimate the prevalence of dementia and measure the sociodemographic and clinical risks in older adults in low socioeconomic communities. The study was conducted among older adults aged ≥ 60 years from the iLembe district in South Africa. This cross-sectional, one-phased, household study was conducted to screen for dementia over 8 months between October 2018 and October 2019. Demographic and clinical data were collected using a semi-structured questionnaire. In addition, the Mini-Mental Status Exam, Ascertain Dementia Eight-item questionnaire and Instrumental Activities of Daily Living Scale were administered to a multi-stage cluster sample of 320 participants to ascertain dementia prevalence. Frequencies and multivariate logistic regression were conducted to determine risk factors correlated with dementia. The prevalence of dementia was 13.4%. Participants aged 80 years and above were 2.73 times more likely to develop dementia than participants younger than 80 years. Those with an education level of Grade 1-7 had a 69% less chance of developing dementia than those without formal education. Single participants showed an almost seven-fold increase in dementia. Lastly, depression increased the risk of dementia by two-fold. Dementia was probable in over one-sixth of the sample. Dementia risk factors were both modifiable and non-modifiable. Dementia prevalence in South Africa is increasing and therefore it is crucial to develop a dementia plan that is specific to the South African context which will include strategies for early identification of the disease, reducing modifiable risks and strategic management of dementia associated medical conditions such as depression and vascular diseases.

Psycho-social factors are the key contributory elements toward the academic performance of grade 12 physical sciences learners in the Mandeni circuit in KZN

This study investigated the implications of psychosocial factors (PSFs), a significant determinant of academic achievement, on learners studying physical sciences in grade 12 at Mandeni Kwa-Zulu Natal. In the physical sciences, South African learners are doing poorly. Low socioeconomic status tends to be experienced by the majority of learners pursuing physical sciences, and this has been associated with poor educational achievement in high school. Participants selected using a purposive sampling technique from the accessible population, 105 grade 12 physical sciences from eight targeted schools in the Mandeni circuit of the ILembe district made up the sample. The study used a mixed approach and a triangulation research design. The questionnaires and interviews were used to collect data. Quantitative data collected were analyzed using SPSS version 20 and thematic analysis was used for interviews. The findings revealed that learners studying physical sciences in grade 12 encountered major obstacles due to psycho-social variables, which negatively impacted their academic performance. The findings of this study are diagnostic, and they assist the Department of Basic Education establish a policy that outlines the requirements or guidelines for selecting Physical Sciences as a subject for a particular field of study. To inspire learners and encourage them to share their ideas with influential people in the science area, the department should collaborate with industries. In Secondary schools, school management teams (SMTs) should establish and put into practice effective policies that work closely with parents and other stakeholders to support the creation of a conducive learning environment at all times. This will improve the academic achievement of learners studying the physical sciences.

Perceptions on transitioning from impairment-based to occupation-based practice in public healthcare within KwaZulu-Natal

Introduction:Holistic healthcare service delivery requires rehabilitation personnel to consider all the components of health that influence the client's quality of life. However, there is limited literature on approaches to implementing rehabilitation services within South African public healthcare. This study explored rehabilitation personnel's (such as occupational therapists, speech therapists, physiotherapists) use of occupation-based practice impairment-based practice and the barriers and facilitators associated with their practice choice.
 Methods: A qualitative research design was conducted through semi- structured interviews (13 participants), a focus group (4 participants) and community mapping. Purposive sampling was utilised to select participants in the iLembe district, KwaZulu-Natal, South Africa. Data were analysed using deductive thematic analysis.
 Findings: Three themes emerged from the study; Attitudes towards impairment-based practice, Reflections on OBP, and The way forward. The need to focus on all the components of health rather than just the disease and the benefits of using the occupation-based practice approach were highlighted. Additionally, different factors required to implement holistic rehabilitation services and the barriers to OBP were identified.
 Conclusion: Although the study identified OBP benefits, various barriers associated with its implementation were identified. Rehabilitation personnel, community stakeholders, and clients must work together to improve OBP implementation in public healthcare by combating the barriers identified in the study.
 Implications for practice
 This study has implications for rehabilitation service implementation in the iLembe district public healthcare sector. OBP was perceived to have more quality of life and health outcomes, which leads to implications for practice. There is a need to transition from the medical model with approaches only focusing on body structures and functions into approaches that consider all the components of health, such as the OBP. Even though there are barriers towards OBP implementation, rehabilitation personnel can still promote its implementation through inter-professional practice, continuous professional development and health promotion. Furthermore, there are implications for undergraduate programmes to equip undergraduates with the skills to implement OBP within under-resourced facilities.

The neuro-musculoskeletal health consequences of infant back carrying for mothers and surrogate caregivers in ILembe District of KwaZulu-Natal, South Africa

The neuro-musculoskeletal health consequences of infant back carrying for mothers and surrogate caregivers in ILembe District of KwaZulu-Natal, South Africa

Dementia-Friendly Communities: Exploring Terms used to Describe Dementia, Attitudes and Reactions Towards People with Dementia in Ilembe District, South Africa.

People with dementia often experience stigma, abuse and social exclusion in their communities. Thus, developing dementia-friendly communities is a priority in the fight against dementia. This study investigated communities' attitudes towards people with dementia by exploring the colloquial terms referring to dementia and the social tolerance toward people with dementia. A cross-sectional household study, using individual interviews, was conducted in the iLembe district, South Africa, with 300 participants aged ≥18years. Data was collected between 2018 and 2019. Data was analysed using descriptive and reflexive thematic analyses. Two themes related to local dementia terms were identified: (i) There are no known local terms synonymous with the term dementia; (ii) Communities use inaccurate and stigmatizing terms to describe dementia. The terms identified did not accurately describe dementia, and others had negative connotations toward people with dementia. Although most participants reported being tolerant, neighbourly, and friendly towards people with dementia, their tolerance decreased when personal interaction was required with a person with dementia. Most participants reported a more agreeable attitude when considering being neighbours rather than family members of people with dementia, and 50.3% reported that their communities discriminate against older people with dementia. The identified dementia terms did not promote dementia-friendly societies. Appropriate dementia terms are crucial for changing social intolerance and negative perceptions of people with dementia and promoting a dementia-friendly culture in South African communities. Terms that encourage and perpetuate stigma against people with dementia must be replaced with terms that promote inclusion and tolerance.

The impact of rural–urban migration in South Africa: A case of KwaDukuza municipality

Background: The influx of people to urban areas has strained government resources, increased population-growth and increased housing infrastructure challenges. The government has been slow react in addressing the problems and as a result, crippling the service delivery.Aim: This study aimed to assess the negative impact of rural-urban migration in KwaDukuza municipality to improve the living conditions that have been compromised by rural-urban migration.Methods: The researcher followed the qualitative method of enquiry and the main methods used in data collection were semi-structured interviews. Sampling was done conveniently and purposively. Data was analysed thematically.Results: The high rate of population growth in Ilembe District Municipality is due to the lack of sound economic opportunities in the rural areas. The neglect in regard to the provision of basic infrastructure in the rural areas has also resulted in high rural-urban migration. Rural economic hubs can create rural economic activities and assist in managing rural-urban migration.Conclusion: South Africa continues to see a rise in rural-urban migration due to a lack of suitable and sufficient investment in rural development. Regrettably, due to the country’s economic imbalance, the urban influx of individuals looking for better economic opportunities and employment keep increasing. The study recognises the need of managing rural-urban mobility, which poses a substantial danger to rural development as well as burden on urban infrastructure.Contribution: The study informs the policy makers on labour market adjustment and structural transformation, possibly resulting in economic implications in terms of growth and aggregate welfare of citizens.

The consequence of head-loading on the neuro-musculoskeletal health of the ILembe District youth of KwaZulu-Natal.

Head-loading, as a mode of transporting food, water and firewood, is a longstanding tradition assigned to female South African youth and has been associated with adverse health consequences. This study determined the impact of head-loading on the neuromusculoskeletal health and proprioception of female South African youth. This study comprised a counterbalanced, within-subject, single-factor experimental design which compared the changes that occurred when the same independent variable (head-loading) within two homogenous groups was measured in terms of the dependent variables (outcomes: neuromusculoskeletal pain and proprioception) at two time periods, before and after the introduction of the independent variable. A cohort of South African female youth (n = 100), aged 9-17 years, voluntarily partook in the study. The participants were randomly distributed into an experimental (n = 50) and a control (n = 50) group. The experimental group stood in a head-loaded state with their respective habitual head-load mass. Their proprioception measurements were compared during their unloaded versus loaded states, with the proprioceptive measurements including the total proprioception index, the anterior-posterior (front-back) index and the medial-lateral (side-to-side) index. Participants furthermore completed a head-loading health-related questionnaire. Participants had a mean age of 12.3 ± 2.5 years, body mass of 44.4 ± 13.7 kg, stature of 145 ± 10 cm and a head-load mass of 8.0 ± 2.5 kg. Participants had poorer medial-lateral proprioception during head-loading as compared to their unloaded state (1.4 ± 0.8 as compared to 1.6 ± 0.9) (p < 0.05). Most youth (96%) experienced neuromusculoskeletal pain in their cervical vertebrae (40.9%), shoulders (27.3%), lumbar vertebrae (10.7%), arms (8.3%), legs (8.3%), knees (1.9%), fingers (1.5%), toes (0.5%) and thoracic vertebrae (0.5%) (χ2: p < 0.05). Head-loading adversely affects the medial-lateral proprioception and neuromusculoskeletal health of participants. The findings of this study confirms that head-loading produces musculoskeletal pain.

THE LIVED EXPERIENCES OF WOMEN PRINCIPALS IN RURAL SECONDARY SCHOOLS REGARDING THEIR CAREER PATHWAYS

This interpretivist qualitative study explored lived experiences of rural secondary schools’ female principals' career development. Participants were female principals who were purposively selected from rural schools in South Africa to provide in-depth information to the study. Thus, eleven female principals from 11 public secondary schools within Ilembe District, Limpopo were engaged in semi-structured interviews, which lasted between 20-30 minutes each. The interviews were audio-recorded with permission of the participants to capture exact information. The audio-recorded data was systematically transcribed, coded to generate common themes for the presentation and discussion of findings. Findings revealed that some communities’ cultures continue to dominantly influence women principals’ career pathways, despite policies or efforts to promote gender equality in South Africa. The social attitude or ‘injustice’ against female principals in rural environments has limited their quest to pursue their career further or to aspire top administrative leadership positions in education. It is recommended that necessary government structures and other stakeholders in education sector should provide necessary support to female principals in rural schools.

Nurse managers’ experiences regarding the use of key performance indicators in developing work plans

Apart from monitoring and evaluation, key performance indicators (KPIs) are used for planning of quality healthcare services and are essential for ensuring that work plans are strategic. Nurse managers (NMs) are required to use reports on the KPIs from the District Health Barometer to prepare work plans. The aim of the study was to explore the experiences of NMs regarding the use of KPIs in developing work plans. The study was conducted in one of the four local municipalities of iLembe district in KwaZulu-Natal. A qualitative research design was used. Data were collected through semistructured interviews with 20 NMs from seven primary health care clinics between 16 November 2020 and 24 December 2020; data were then thematically analysed. Nurse managers experienced challenges related to knowledge creation, knowledge sharing and knowledge application regarding the use of KPIs in developing work plans. Possible strategies which, according to NMs, could facilitate the use of KPIs in developing work plans included support in the management role, skills development and orientation, provision of resources and participative management. Relevant knowledge management practices, including knowledge sharing, are essential for knowledge creation so that individuals develop task knowledge to fulfil role expectations. In the case of this study, knowledge creation for NMs could facilitate their appropriate use of KPIs in developing work plans.Contribution: It is recommended that NMs receive ongoing training on, and be actively involved in, data management and that mentoring and support be made available for NMs to facilitate the use of KPIs in developing work plans.

Contextual factors for transnational municipal network's local environmental action: a study of ICLEI Africa's LAB Wetlands SA Programme

ABSTRACT While the existence and significance of transnational municipal networks (TMNs) in the realm of environmental governance have been well documented, the implementation and impacts of their local programmes, especially in sub-Saharan Africa, remain underexplored. This paper contributes to addressing this gap of knowledge by examining what obstructs or facilitates TMNs’ local actions and the extent to which they can catalyse wider transformative impacts on local environmental governance. We focus on an urban wetlands programme implemented by ICLEI Africa from 2015 to 2018 in 9 district and 2 metropolitan municipalities in South Africa – the Local Action for Biodiversity: Wetlands SA (LAB Wetlands SA) Programme. From an insider perspective, this paper reviews the implementation of the LAB Wetlands SA Programme in three locations, namely the Overberg, iLembe, and Frances Baard District Municipalities of South Africa. Based on comparative analysis, the paper identifies three key influential factors – political buy-in, policy champions and institutional capacity – that interact in combination to affect the practices of the LAB Wetlands SA Programme. These three factors are closely interlinked and strongly depend on the social, economic, political and cultural aspects of local context. In advancing local environmental actions and promoting transformative environmental governance, the design and practices of TMNs’ local programmes and projects must be informed by, tailored to, and able to adapt to the local context.

Recognising indigenous vegetables as potential contributors to livelihoods development: a case of two district municipalities in northern KwaZulu-Natal

South Africa is a food sufficient country. Native South Africans, however, continue to suffer from food insecurity at a household level, even under contemporary democratic leadership. Influenced by the COVID-19 pandemic, the study was conducted to determine the role of indigenous vegetables in rural livelihoods in the two selected district municipalities of northern KwaZulu-Natal, namely iLembe District Municipality (IDM) and the King Cetshwayo District Municipality (KCDM). A purposive sample which consisted of 130 participants (n=130) was drawn, and data were analysed descriptively using Microsoft Excel Software. Our findings point in the direction that indigenous vegetables have the potential to contribute to livelihoods development. It was also found that these vegetables can thrive under diverse climatic conditions, including both irrigated and rainfed areas. This is especially important in a country like South Africa which faces major challenges of water scarcity and household food insecurity. Most household heads in the study were unemployed and relied on government monetary incentives for survival. It is concluded that there is a need to include these indigenous crops as part of the main discussions in the food discourse and to recognise them as a tool to enhance livelihood development.

Management of indiscipline among secondary school students in Ilembe District, KwaZulu-Natal, South Africa

South African schools are faced with a serious problem of indiscipline. The available literature reveals that despite the efforts of school administrators and teachers to instil discipline among learners, indiscipline still abounds to the extent of getting out of hand. Based on the intention of this study, a qualitative study was adopted. A qualitative-based study underpinned by the interpretive research paradigm was employed to explore the perspectives of educators in their collaborative roles in managing discipline. The sample comprised twelve educators who were purposively selected from four secondary schools in the Ilembe District, KwaZulu-Natal. A semi-structured interview schedule was used to collect the data. The findings revealed that educators should apply the school code of conduct as a whole-school approach to managing discipline to create meaningful relationships with parents as stakeholders and communicate expected behaviours with learners. It is recommended that in implementing strategies to manage discipline, learners, educators, school managers and the school governing boards of all schools should take a collaborative approach to the management of discipline in secondary schools

Socio-economic Determinants of Increasing Household Food Insecurity during and after a Drought in the District of iLembe, South Africa

ABSTRACT In 2015 and 2016, South Africa experienced a severe drought resulting in water restrictions and food price inflation. A year later, while the proportion of food secure households remained constant, the proportion of those experiencing severe food insecurity increased. This paper investigates the socio-economic determinants of increasing food insecurity during and after the drought. Two cross-sectional household surveys were carried out in the district of iLembe in November 2016 and 2017. Household food insecurity was measured using the Coping Strategies Index. The results indicated changes in socio-economic determinants of food insecurity over time, with the poorest households experiencing the worst levels of food insecurity. After the drought, having a child under-five years was positively associated with food insecurity, while being located in a rural area was negatively associated. Policies that limit household vulnerability to price inflation, and interventions that protect poorer households from the effects of drought should be considered.

Coping through a drought: the association between child nutritional status and household food insecurity in the district of iLembe, South Africa.

To assess and compare the association between household food insecurity and child nutritional status over two time-points taking into consideration the effects of a severe drought. The study used two cross-sectional household surveys during and after a severe drought, consistent with a natural experiment design. The study took place in the district of iLembe, KwaZulu-Natal, South Africa. Households with children aged <5 years were invited to participate in the survey. Anthropometric measures were taken for the respective children in each of the participating households. The results indicated that all forms of poor nutritional status increased over the two time-points, with the most significant increases being for stunting (P < 0·016) and obesity (P < 0·001). There was evidence of an association between increasing food insecurity and stunting (P < 0·003) at the end of the drought, but not wasting, underweight or overweight. The results indicated a strong link between chronic food insecurity and chronic undernutrition. The results also showed stronger evidence of an association between food insecurity and stunting for urban households (P < 0·001) compared to their rural counterparts (P < 0·019). The negative effects of drought appear to contribute to increased rates of child stunting through higher levels of household food insecurity. Future research should assess this relationship through longitudinal studies. Interventions aimed at improving food security may assist in reducing child malnutrition, but policymakers should consider urban-rural differences as well as climatic and environmental events.

Experiences of mental healthcare providers regarding integration of mental healthcare into primary healthcare at the iLembe health district in KwaZulu-Natal province.

BackgroundInstitutionalisation of mental healthcare users was a prevalent treatment approach in the apartheid era in South Africa. The introduction of community-based mental healthcare is aimed at improving mental healthcare services. The integration into primary healthcare improves access to mental health services. This integration is implemented by professional nurses working in the primary healthcare clinics.AimThe aim of this study was to explore and describe experiences of professional nurses regarding integration of mental health into primary healthcare at the iLembe district of KwaZulu-Natal.SettingThis study was conducted at a public hospital in the iLembe health district of KwaZulu-Natal province.MethodsAn explorative, descriptive and contextual qualitative research study was conducted. Semi-structured interviews were conducted with 15 professional nurses. Data were transcribed verbatim, organised into codes and finally analysed thematically using Tesch’s method of data analysis.ResultsThis study revealed that majority of participants experienced and faced challenges regarding integration of mental health into primary healthcare. Professional nurses stated that they require support from the management and training to equip themselves with knowledge and skills to render effective mental healthcare services.ConclusionThe integration of mental healthcare into primary healthcare is pivotal to ensure easy and accessible mental healthcare services to its users. This strategy requires planning and implementations of available policies and guidelines regarding mental healthcare. Furthermore, adequate funding is required to secure human and material resources to aid the integration of mental healthcare into primary healthcare.

‘A creeping phenomenon’: the association between rainfall and household food insecurity in the district of iLembe, KwaZulu-Natal

ABSTRACT The effects of rainfall variability and droughts on food production are well established. However, in South Africa, the association between rainfall, droughts and household food insecurity is not well known. The aim of this paper was to measure and compare household food insecurity during and after a drought, and to assess the association between rainfall and food insecurity. Using a comparative study design, two cross-sectional household surveys took place in November 2016 and November 2017. Food insecurity was measured using the Coping Strategies Index. Data was analysed using descriptive statistics and multiple linear regression. The study found a positive association between increasing rainfall and food insecurity, the strength of which decreased during Round 2 of data collection. The proportion of households facing no food insecurity increased, as did those facing high or severe food insecurity. Households in Round 2 appeared to have better diet diversity, although there was an increase in the frequency of some coping strategies, including those relying on less expensive foods on a daily basis. The study highlights the delayed and prolonged effects of a drought and recommends research be carried out to investigate the socio-economic factors associated with increasing food insecurity in the iLembe district of KwaZulu-Natal.

A behavioural change intervention study for the prevention of childhood obesity in South Africa: protocol for a randomized controlled trial

BackgroundSouth Africa is currently undergoing a nutrition transition, and overweight and obesity is on the increase in South African children. Urbanization and other health determinants have led to reduced physical activity and unhealthy eating that have increased the risk of adverse chronic health conditions. This study aims to provide evidence of the effectiveness of a school-based intervention study that targets diet and physical activity for the prevention of child and adolescent overweight and/or obesity.MethodsWe will employ a mixed method study design which is divided into two phases. Phase 1, namely the qualitative elicitation research phase will inform the development of the quantitative intervention phase (phase 2), consisting of a cluster-randomized trial, based on input from key stakeholders. The study will be undertaken in 16 government-funded primary schools in the iLembe district of KwaZulu-Natal, South Africa. The study will target learners in Grades 4 and 7, their parents, Life Orientation educators, school principals and members of school governing bodies. Assessment for the primary objective (BMI Z scores), and the secondary objectives (change in knowledge, attitudes and behaviours regarding diet and physical activity) in both study arms will be conducted at baseline in March 2020 and at the end of the study in October 2020.DiscussionThe study will be a novel combined mixed methods/RCT design that focuses on diet, physical activity school and family-based interventions in the context of rapidly increasing overweight and obesity prevalence in KwaZulu-Natal. To encourage behaviour change and management of malnutrition, education including diet and physical activity, is an important strategy that must be considered. Nutrition education extends beyond the dissemination of food information; it includes addressing the needs of participants, empowers and encourages decision-making and choice of foods, change in nutrition attitudes, beliefs and influences based on resources available and within cultural boundaries.Trial registrationPan African Clinical Trial Registry PACTR201711002699153. Protocol registered on 16 November 2017.