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Brenna Marshall

Gligorije Rakocevic

Ahmed Alhashmi

Mohammed Al Khalifa

Saif Alhajr

South Africa: Weekly Report #6

According to the South African National Health and Nutrition Examination Survey (SANHANES), South Africa is considered to be food secure on a national level, yet more than 50% of people are either at risk or are experiencing hunger (Shisana et al., 2014). The population has been fighting malnutrition for many, many years. More than one-third of child deaths are due to malnutrition (Nutrition at a Glance, n.d.). Almost 30% of children under 5 years of age are stunted, 12% are underweight and 5% are wasted. More than half of people that are 15 years and older and also overweight or obese (Nutrition at a Glance, n.d.). South Africa refers to the high amount of people who suffer from undernutrition and obesity in their country as the “double burden”. The progress of developing a better public health system and community infrastructure has been very slow, and at the same time South Africa is beginning to adopt western diets, which are high in carbs, fats and sugars (Nutrition at a Glance, n.d.). Lifestyle in South Africa is much more sedentary. The combination of poor diets and lifestyle are contributing to the rise of disease as well as the cultural factors and beliefs about body weight (Nutrition at a Glance, n.d.)

The problem malnutrition in South Africa is unique as compared to other African countries. The country is much developed, but malnutrition continues to frustrate a good population of its citizens. Children averaging at approximately 15% are born with minimum birth weight while 5% of the total number of children in the country suffer from acute malnutrition. Considering the country’s infrastructural growth, South Africa should be free from malnutrition. The country suffers a loss in their gross domestic product of about US $1.1 billion annually as a result of malnutrition. The finances are directed towards combating the deficiency in minerals and vitamins. The country has enough capacity to completely wipe out this looming disaster but its leaders have been insincere about the issue. Malnutrition across the country is a factor of both the social-economic and geographical factors (Faber & Wenhold, 2007).

The situation is made dire by the fact that approximately 30% of pregnant women in South Africa suffer from AIDS. This makes it impossible to breastfeed their infants yet most mothers cannot afford breastfeeding alternatives. The malnutrition problem has propagated other factors and healthcare issues. The government has however initiated different programs which seek to alleviate malnutrition. These programs include the Integrated Nutrition Program. Malnutrition is the country is a factor of child neglect, AIDS, child abuse and stress. The cultural adaptation of some tribes predispose their children to malnutrition due to the diet they consume. Malnutrition is also heightened by the high poverty rates in the country accompanied by inequality in income. The government should therefore come up with strategies which address the factors which predispose malnutrition. This will be founded on improving the economic situation of its citizens and educating residents living in rural areas about diet and nutrition (Faber & Wenhold, 2007).

The program that has been introduced in South Africa to address malnutrition is the Integrated Nutrition Program (INP) (Brits et al, 2017). The INP was introduced in 1994 to help address malnutrition issues, with the main goal of enabling women to exclusively breastfeed children in the first 4-6 months after birth, and continue breastfeeding after the lapse of that period on top of feeding them with the necessary supplementary foods up to 24 months of age or beyond (Western Cape Government, 2003). The goals of this program were to reduce mortality rates resulting from lifestyle diseases, promote the health of pregnant and lactating women and reduce the rate of malnutrition among children. It also includes the goal to promote optimal infant growth, improve capacity at all levels so as to address the malnutrition issue, improve collaboration between different sectors and promote community ownership to malnutrition-eradication programs (Western Cape Government, 2003).

The INP aims at addressing the underlying factors contributing to malnutrition through direct and indirect measures (Development Bank of South Africa, 2008). Direct measures include education on nutrition, food fortification, counseling and support in nutrition to prevent specific diseases and micronutrient supplementation. Indirect measures include the provision of quality healthcare services; improve access to food and safe, clean water and parasite control to prevent the destruction of food resources. The INP targets the most vulnerable communities as far as nutrition is concerned, individuals with children under five years of age, pregnant and lactating women who are at risk, disabled and elderly people and people suffering from lifestyle diseases (Development Bank of South Africa, 2008). The INP guides the various activities involved in the prevention of malnourishment (Brits et al, 2017). It also guides the work of health promotion workers, supplementary feeding programs on those at risk or are already malnourished, rehabilitation programs on the malnourished and monitoring and evaluation on the success or failures of the program.

There are numerous feeding schemes that are implemented under the INP. These include the Primary School Nutrition Program (PSNP), food parcel and community feeding programs (Brits et al, 2017). A multi-sectoral is applied in the implementation of INP, where different sectors have come together at different capacities to make their inputs towards the program. The sectors involved in implementing the program include the Department of Health, the Department of Agriculture and the Department of Social development (Brits et al, 2017). In 2010, a step was made to make the INP both a project to address malnutrition and also a social welfare project. To capture this social welfare aspect, the Nutrition Supplementation Program, which is a branch of the INP, was renamed to Welfare Therapeutic Program (NTP) (Brits et al, 2017).

Since the commencement of the INP, there have been several reviews to gauge the success and failures of the program and recommend measures for improvement. According to Development Bank of South Africa (2008), one of the major amendments that were made to improve the program was the putting of the National School Feeding Program under the Department of education. However, despite such changes, the program is yet to achieve a lot as anticipated. As Iversen et al. (2012) note in their assessment of the program, several growth indicators have not shown any improvement. One of the failures that Iversen et al. point out is the lack of a systematic evaluation to gauge the performance of clinics in the provision of nutritional services, hence making it difficult to describe the functioning of the INP. Malnutrition rates in some areas have gone up instead of going down. For example, in the Free States, malnutrition rates increased between 2009 and 2013 from 3.9% to 10.7%. Nevertheless, according to the Development Bank of South Africa (2008), INP remains a potential program to accelerate the reduction of malnutrition in South Africa. Thus, a re-assessment to include the recommendations made can go a long way in promoting a positive change.

References

Brits, H., Joubert, G., Eyman, K., De Vink, R., Lesaoana, K., Makhetha, S., & Moeketsi, K. (2017). An assessment of the integrated nutrition programme for malnourished children aged six months to five years at primary healthcare facilities in Mangaung, Free State, South Africa. South African Family Practice, 59(6), 214-218.

Development Bank of South Africa. (2008). Combating malnutrition in South Africa: Input paper for health promotion. Retrieved from

https://www.dbsa.org/EN/About-Us/Publications/Documents/South%20Africa%20Nutrit

on_%20input%20paper_roadmap.pdf

Faber, M., & Wenhold, F. (2007). Nutrition in Contemporary South Africa. Water SA, 393-400.

Iversen, P. O., Marais, D., Du Plessis, L., & Herselman, M. (2012). Assessing nutrition intervention programmes that addressed malnutrition among young children in South Africa between 1994-2010. African Journal of Food, Agriculture, Nutrition and Development, 12(2), 5928-5945.

Nutrition at a Glance. (n.d.). South Africa. [online] Available at:

http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/sou

hafrica.pdf [Accessed 24 Feb. 2019].

Shisana, O., Labadarios, D., Rehle, T., Simbayi, L., Zuma, K., Dhansay, A., ...SANHANES-1

Team (2014). The South African National Health and Nutrition Examination Survey,

2012: SANHANES-1: the health and nutritional status of the nation. [online] Human

Sciences Research Council. Available at:

http://repository.hsrc.ac.za/handle/20.500.11910/2864 [Accessed 24 Feb. 2019].

Western Cape Government. (2003). INP foundation for life. Retrieved from https://www.westerncape.gov.za/text/2003/inp_foundation_for_life_1to12.pdf