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Brenna Marshall

Gligorije Rakocevic

Ahmed Alhashmi

Mohammed Al Khalifa

Saif Alhajr

South Africa: Weekly Report #8

In 2000, South African was one of the 189 countries that committed to reducing by half the prevalence of underweight and malnutrition (which are the major causes of stunting) among children under the age of five years, (Said-Mohamed et al., 2015). Some people are naturally short, but stunting refers to children whose height is not at par with their age due to insufficient nutrition over a long period. Children who do not receive appropriate nutrition by their second birthday or at least the first 1000 days after they are born, will be stunted (Mqadi, 2017)

In South Africa, 53 children of less than five years old lose their life daily (Sanders, Reynolds & Lake, 2017). Most of these deaths are attributed to preventable diseases, malnutrition being among the top causes. According to a survey by the South African Demography and Health Survey, stunting rates among children under the age of five remain stubbornly high at 27% (Mqadi, 2017). 15% of infants in South Africa are born with a weight below the average. Between 2012 and 2013, 31% of children who died when receiving treatment at the hospitals were malnourished, while 30% were underweight. However, despite these worrying stunting rates, the government apportioned only 0.5% of the primary healthcare allocations to nutrition in its 2018/2019 budget (Sanders, Reynolds & Lake, 2017)

The causes for stunted growth, however, go beyond the gaps in the healthcare system (Sanders et al., 2017). Poverty and unemployment are the two major causes of malnutrition in children. According to the Community Survey in 2016, only 23 of infants between 6-23 months of age are given the minimum acceptable diet. This percentage is not surprising owing that 63% of children in South Africa come from families with a monthly income of below R965 (approximately USD $68) (Sanders et al., 2017).

Chronic malnutrition is a recurring issue for young South African children. A huge percentage if malnourished kids experience stunting, which means they do not reach the normal international height standards for a child their age. One social determinant that impacts the risk of a child experiencing stunting is their environment. In study done by Susan Keino, Guy Plasqui, Grace Ettyang, and Bart van den Borne said that the stunting was dependent on the environmental factors. The most common factors that were reviewed in the study were the difference between rural and urban settings. The study found that children who children who went to rural schools were more likely to experience stunting than children who went to urban schools. The amount of healthcare that children in rural and urban communities were a factor that contributed to the number of kids that were stunted. Other environmental factors such as living conditions were also an important influence on the prevalence of stunting in South Africa.

Education impacts the prevalence of stunting in a community because without proper education, children may not be eating, or attempting to eat the correct foods. Being uneducated about a healthy diets can cause a child to become malnourished and put them at a high risk of developmental disease, such as stunting. Not only is eating adequate amount of food an important for a child's diet, but eating the right foods is just as (if not more) important.

Last but not least, another social determinant of stunting in children in South Africa is gender. Many studies have shown that boys living in rural areas were more likely to be stunted. In a study published by the Journal of Nutrition, the overall risk of stunting was 24.5% for boys and 19.4% for girls (Bork, K., & Diallo, A, 2017). In the study, the difference in the amount complementary foods (CF) that was eaten by boys and girls made a difference the the prevalence of stunting in boys vs. girls. The journal states, “The importance of sex in complementary feeding and growth warrants further attention in low-income countries” (Bork, K., & Diallo, A, 2017)

According to Oot et al. (2016), at the global scale, 45% of deaths in children are due to malnutrition and stunting is one of the major contributors. Stunted children have weak immune systems, so they have an increased risk of suffering from repeated infections. They are at risk of dying from conditions, such as measles, pneumonia and diarrhea and are also at risk of chronic diseases during adulthood.

In addition to these diseases, stunted children experience delays in a body and mental development (Oot et al., 2016). They experience difficulties in learning, both during the school years and also after school years. This inability to learn prevents the children from achieving their full potentials. Stunted children have problems with their motor, socio-emotional and cognitive abilities, all of which have a negative effect on the child’s life. For instance, problems in socio-emotional wellbeing make the child have increased negative effects (such as crying), reduced interests in exploring their surroundings and reduced physical activity. Negative behaviors and reduced interest of a child to explore their surroundings reduce a child’s level of stimulation that they receive when they interact with the environment and that impedes their mental development (Oot et al., 2016).

In school, stunting leads to poor performance in tests that involve the use of cognitive abilities (Oot et al., 2016). Stunted children also have deficits in their vocabulary, reasoning and numeracy abilities. This reduces the overall achievement of the child compared to other normal children. As a result, stunted children are likely to enroll in school when they are past the minimum enrollment age, repeat grades, fail to progress to higher grades and drop out of school. The failure to learn has an impact on the quality of their lives due to reduced income-earning potential because such children cannot secure employment in well-paying jobs (Oot et al., 2016).

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.

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:

Keino, S., Plasqui, G., Ettyang, G. and van den Borne, B. (n.d.). Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. [online] Journal Sage Pub. Available at: https://journals.sagepub.com/doi/pdf/10.1177/156482651403500203 [Accessed 10 Mar.2019].

Mqadi, S. (2017). Stunting – the silent killer of South Africa’s potential. Retrieved from https://dgmt.co.za/stunting-the-silent-killer-of-south-africas-potential/

Oot, L., Sethuraman, K., Ross, J., & Sommerfelt, A. E. (2016). The Effect of Chronic Malnutrition (Stunting) on Learning Ability, a Measure of Human Capital: A Model in PROFILES for Country-Level-Advocacy. Food and Nutrition technical Assistance, 3(1), 1-8.

Said-Mohamed, R., Micklesfield, L. K., Pettifor, J. M., & Norris, S. A. (2015). Has the prevalence of stunting in South African children changed in 40 years? A systematic review. BMC public health, 15(1), 534.

Sanders, D., Reynolds, L. & Lake, L. (2017). Hunger is still killing South Africa’s children. Mail & Guardian. Retrieved from https://mg.co.za/article/2017-12-01-00-hunger-is-still-killing-south-africas-children

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

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.

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.

Bork, K., & Diallo, A. (2017). Boys Are More Stunted than Girls from Early Infancy to 3 Years of Age in Rural Senegal. The Journal Of Nutrition, 147(5), 940-947. Doi: 10.3945/jn.116.243246.