3.1 Introduction
This chapter presents the research methodology that was used to investigate the prevalence and nutritional status of woman between the ages of 18 to 45 years, practicing and not practicing geophagia women in KwaZulu-Natal under uMgungundlovu and uMzinyathi district. This chapter includes the design of the study, description of the population, sampling, data collection methods and analyses.
3.2 Design of the study
The study design was a cross-sectional, descriptive study. Cross sectional studies are relatively fast and inexpensive and are design to give the prevalence of a disease. Furthermore a descriptive study can provide information about the naturally occurring health status, behavior, attitudes or other characteristics of a particular group (Creswell et al., 2003, p.14). The design of the study is presented in Table 3.1 below.
Table 3.1 Design of the study
Sample Data collection tool Data collected Geophagic
group (n=32)
Questionnaires
• Appendix A
• Appendix B
• Appendix C
• Appendix D
• Appendix E
• Appendix F
• Socio-Demographic information.
• Anthropometric information
• Nutrition knowledge information.
• Soil habit information
• Household Food security information
• Food Frequency Questionnaire
Table 3.1 Design of the study cont.
Sample Data collection tool Data collected Control / non
geophagic group (n=30)
Questionnaires
• Appendix A
• Appendix B
• Appendix C
• Appendix E
• Appendix F
• Socio-Demographic information
• Anthropometric information
• Nutrition knowledge information.
• Household Food security information
• Food Frequency Questionnaire
Integrated research methodology was used to triangulate various data collection instruments with the intension that they would meet the research objectives of the study. The study used a qualitative approach because it tends to give more attention to the subjective aspects of human experience and behavior. The questionnaire developed consisted of closed and open ended questions to enable the understanding of the relationships between human perceptions and geophagia. The quantitative approach allowed patterns of knowledge creation to be thoroughly described (Creswell et al., 2003, p.153). A pilot study was conducted on a purposive sample of ten woman practicing geophagia in uMgungundlovu District.
3.3 Sampling
A convenience sample of 32 women practicing geophagia was used to obtain information regarding the prevalence of geophagia. A convenience sample of 30 women who do not practice geophagia also participated in the study as a control group in order to compare between the two groups. The total sample of 62 women participated in the survey.
3.4 The inclusion criteria were as follows:
Geophagia group
• Women who had been practicing geophagia for at least a month.
• Women who resided in uMgungundlovu District and uMzinyathi district.
• Women between the ages of 18-45.
• Non-pregnant females.
• Females who were willing to participate and gave consent (Appendix G, p.).
Control group
• Females between the ages of 18-45
• Non- pregnant females.
• Women who resided in uMgungundlovu District and uMzinyathi district.
• Females who were willing to participate in the research and gave consent (Appendix G).
3.5 Validity and Reliability
The questionnaires used were directly related to the aim and objectives of the study. All interviews were conducted by the researcher. The socio-demographic questionnaire (Appendix A) was validated by using the indicators of socio-demographic factors described in scientific literature and assessed by previous relevant studies (Msibi, 2013).
All anthropometric measurements were measured according to standard methods as recommended by Hammond and Litchford (2012, p.165). The researcher was trained in methods and techniques to determine accurate anthropometry (Appendix B). A calibrated scale were zeroed before each measurement and the weight recorded by the scale compared with a known weight to ensure that the reading on the scale reflected the same reading when measuring the standard weight after every 20th subject measured by researcher.
A nutritional knowledge questionnaire (Appendix C) consisting of 42 questions was adopted from a previous validated questionnaire (Whati et al., 2005). The Food Based Dietary Guidelines (Vorster et al., 2013) were also included to determine the nutritional knowledge of
the participants. Geophagic habits of the participants were determined by a validated questionnaire (Annexure D, p.) used in previous studies by the Central University of the Free State (Van Onselen, 2013). The Household Food Insecurity Access Scale (HFIAS) was used to determine the food security status of the participants (Appendix E, p.). Validated questionnaires with the recommended instructions and endorsements were used according to United State of America International Development (USAID), Food and Nutrition Technical Assistance (FANTA), Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide, version 3 (Coates et al, 2007). The Food Frequency questionnaire was adopted from (Kassier, 2014) and was chosen to measure food consumption due to its ease of use and low cost. The food items were grouped into eight categories according to the similarity of nutritional content. All the questionnaires for were piloted to ten random women resided in district to ensure validity and reliability and will be discussed further in this chapter.
3.6 Data collection
The researcher used structured interviews to obtain information concerning the prevalence of geophagia and nutritional status of women between the ages of 18 to 45 years, practicing geophagia in KwaZulu Natal under uMzinyathi and uMgungundlovu district. The researcher also used structured interviews to get information concerning the nutritional knowledge and the food security of women who do not practice geophagia between the ages of 18-45 years of age from both districts uMgungundlovu and uMzinyathi district.
3.6.1 Pilot study
A pilot study was conducted by the researcher on a sample of ten women who consumed soil.
The purpose of the pilot was to determine the amount of time required to complete the questionnaire. It also used to identify any mistake in the questionnaires and identify if the questionnaire would be easily understood in order to rectify all the mistakes before the commencement of the actual survey. There were no changes made to the questionnaire, following the pilot study.
3.6.2 Questionnaires
3.6.2.1 Socio-demographic questionnaire
The socio-demographic information was obtained during interviews with respondents by using open- and closed ended questions (Appendix A, p. ). The information was used to collect demographic information such as location of respondents, gender, age, ethnic group, marital status, income, occupation, and educational level.
3.6.2.2 Anthropometric questionnaire
The weight and height measurements were used to calculate the body mass index (BMI) and waist and hip measurements were taken to determine the waist to hip ratio. BMI refers to current weight in kilograms divided by height in m2.
3.6.2.3 Nutrition knowledge questionnaire
Nutrition knowledge of respondents was tested by asking different questions related to food and its nutrition or its nutritional value and health benefits (Appendix C, p. ). Multiple choice questions were asked where respondents were supposed to select the correct answer and some questions were true or false questions.
3.6.2.4 Soil identification questionnaire
During the interviews with participants Appendix D was used to collect information regarding the practice of geophagia. The questions that were asked from the respondents included the following: habit of geophagia, number of years in the habit, reasons for geophagia, side effects associated with the practices, traditional names of substances consumed, price of the substances consumed, processing of geophagic substances, health related problems associated with the practice and types of substances consumed.
3.6.2.5 Household food insecurity access scale (HFIAS) questionnaire
Different questions were asked using a questionnaire (Appendix E, p.) about household food security where respondents were asked about availability of food and money to purchase food in a period of four weeks.
3.6.2.6 Food frequency questionnaire
Questions regarding eating frequency of different types of foods from different food groups were asked (Appendix F, p.). The questions that were asked were based on the food items usually consumed by Black Africans. Respondents were asked about frequency of food which was categorized in the following manner: -
• Never consumed
• Consumed 1-3 times a month
• Consumed once a week
• Consumed 2-4 times a week
• Consumed 5-6 times a week
• Consumed once a day
• Consumed 2-3 times a day
• Consumed 4-5 times a day
• Consumed 6 or more than six times a day.
3.7 Materials 3.7.1 Questionnaires
Questionnaires were used to collect data because they are inexpensive when used and administration costs are low in terms of money and time (Krueger, 1998).
3.7.2 Instruments
The following instruments were used to determine the height, weight and waist measurements of women participating in the study, height stick, weight measuring scale and tape measure.
The purpose was to get correct measurements in order to calculate BMI and WHR.
3.8 Data analysis
Data for both groups control and geophagia was collected using a questionnaire. The tools used for the research were quantitative and qualitative. Data was collected and coded, entered into a spread sheet (Microsoft Excel) and analyzed using statistical package for social science (SPSS) Computer programme. Additionally, from the analysis derived from SPSS, tables, mean frequencies in percentages and correlation tests were also used to describe the level of significance of results from other questions that were asked in the survey. Descriptive statistics included means and standard deviations, where applicable. Frequencies are represented in tables or graphs. Chi-square goodness-of-fit-test: A univariate test, used on a categorical variable to test whether any of the response options are selected significantly more/less often that the others. Under the null hypothesis, it is assumed that all responses are equally selected.
Chi-square test of independence: Used on cross-tabulations to see whether a significant relationship exists between the two variables represented in the cross-tabulation. When conditions are not met Fisher’s exact test is used. Independent samples t-test: tests for significant differences in mean scores across two groups.
3.9 Procedure
3.9.1 Ethical consideration
Ethical approval was obtained from the Humanities and Social Science Research ethics committee of University of KwaZulu-Natal. Protocol reference number HSS/0787/014M (Appendix K, p.). The researcher contacted local ward counselors from both district to get permission to conduct the research in their areas.
The pilot study was conducted in a sample of ten women. The questionnaires were revised and finalized after the pilot study. Informed consent (Appendix I, p.) were given by each participant. The information letter and consent form was available in English and Zulu. Written consent forms were completed and signed prior to data collection.
Participants were informed that participation was voluntary, and of their right to withdraw at any time without detrimental consequences. Data was collected using the revised questionnaires by a Zulu speaking researcher a referral letter (Appendix J, p.) was available if a participant needed to be referred to a medical professional.