the nutritional status of - Health Systems Trust

distributions of weight-for-age and weight-for-height are markedly skewed toward the higher end, reflecting a
substantial level of childhood obesity. This skewness, reflecting an unhealthy characteristic of the reference sample
may result in the misclassification of overweight children as normal.
3.1.4 INFANTS AND CHILDREN, 0-6 YEARS
The percentages of infants and children who fell under the cutpoints as discussed above regarding W-a, H-a and
W-H are given in Tables 1 to 7. The data were collected by several researchers from 1976 to 1996 from more than
60 000 children, divided into approximately 140 subgroups based on age, gender, ethnic group and geographical
location. In addition to tables for white, coloured and Indian children, there are three tables for black children,
giving data for urban and rural children separately and one (Table 6) with data from a study of Solarsh et al. (1994)
which did not distinguish between rural and urban children in the same manner as the other studies. Table 7 gives
data from national studies which did not stratify for ethnicity. This table consists mainly of data from the 1994
national study on vitamin A status of preschool children (SAVACG, 1995), which also reported on the anthropometric
status of these children. The table further includes H-a data from the SALDRU/World Bank study of 1993-1994. In
all 7 tables, the available data for the different provinces are grouped together.
Table 8 summarises some of the information in Tables 1 to 7, and also gives calculated means of percentages of
children under the given cutpoints. These means were not corrected for number of children in each subgroup. The
means given at the bottom of this table are from the SAVACG (1995) study.
From these tables it is clear that the groups most extensively researched and reported on (although not in proportion
to total numbers of South African children) are rural and urban black infants and children, while less research has
been done on Indian, white and coloured children. An important observation is that within each ethnic group there
is a wide range of percentages of children under a given cutpoint, illustrating that the prevalence and severity of
malnutrition differs from area to area and that pockets of malnourished children exist. This wide range was
especially noticeable in rural black children. A direct comparison between rural and urban black children on the
available data is not possible. The SAVACG (1995) study reported slightly higher prevalences of rural children under
the -2 Z-score of the three anthropometric indices than urban children, indicating that on a national basis and
where data is not stratified for ethnic group, the rural areas probably have a larger incidence of malnutrition than
urban areas. Except for the SALDRU and SAVACG studies, not enough comparable data were available to evaluate
the extent of malnutrition in different provinces in the under 6 year old group of children.
From Table 8 it can also be seen that both coloured and Indian children had higher prevalences of low W-a and low
H-a than black children. Unfortunately, especially in the Indian group, no recent data were available. Generally, the
percentages of children who had low W-H were small. Therefore, except for some isolated areas, wasting or acute
malnutrition was not reported as a problem. The SAVACG (1995) study confirmed these results.
In the white, coloured and Indian groups, mean prevalences of children with low W-a were higher than those with
low H-a. This indicates that in these three groups underweight was a more serious problem than stunting. In
contrast, in black children the percentages of children who were stunted exceeded those who were underweight. In
the national survey (SAVACG, 1995), the prevalence of stunting (22.9 %) was also much higher than that of underweight
(9.3 %). The same pattern of much lower degrees of underweight than underheight-for-age, in the absence of
wasting, was observed by Solarsh et al. (1994) in infants and preschool children in KwaZulu-Natal. These authors
mention that this pattern suggests that a substantial number of children are relatively overweight-for-height.
Dannhauser et al. (1996) found that approximately 10 % of the black children in their sample from a rural area in
the Free State had a Z-score of +2 and higher.
Gross & Monteiro (1989) also described differences in prevalences of stunting and wasting in infants and preschool
children in Brazil. They concluded that the high stunting (10-15 % of children) and low wasting (2-5 %) indicated
that malnutrition was caused not by hunger, but by poor sanitation and health facilities.
The growth pattern of South African infants and children has been studied in some detail by several authors on
children from different parts of the country showing very similar results. Coovadia et al. (1977) reported on 5 732
urban black children aged 0-12 years from KwaZulu-Natal. Compared to Harvard reference standards, the younger
children were generally heavier than the international standard. The heights of children aged 0-2 years were
similar to the international standard, but children older than two years were shorter (stunted). Richardson and
Sinwell (1984) monitored the growth of Tswana infants in the rural North West Province. They found that these
babies were short at birth (mean 43 cm, NCHS reference: 50 cm); but that the mean birth weight of 3.3 kg was
comparable to the international standard. Weights were maintained for 7 months but faltered thereafter, despite
continuous breastfeeding, indicating that breastmilk alone was not sufficient and that weaning practices were not
adequate.
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