the nutritional status of - Health Systems Trust

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3.4.3 PRIMARY SCHOOL CHILDREN Table 73 indicates that two of the three studies which reported on clinical variables of nutritional status also found high prevalences (11-40 %) of eye abnormalities in primary school children. Other abnormalities of hair, gums, skin and muscle wasting were also seen. 3.4.4 ADOLESCENTS AND ADULTS Table 74 shows low prevalences in those groups where clinical signs were reported, except for a group of elderly white men and women. In these subjects, the signs were probably related to age rather than nutritional deficiencies (Kruger, 1990). 3.4.5 COMMENTS Traditionally, clinical signs are not used to evaluate prevalences of the consequences of overnutrition such as obesity and hypertension resulting from excess energy and salt intakes. The high prevalences of obesity in South African women has been mentioned (see. 3.1.7). It has been known since the 1950’s that urbanisation in South Africa is accompanied by increases in blood pressure, especially among black (Seedat et al., 1978; Opie, 1995) and coloured (Steyn et al., 1986) ethnic groups. These diseases, as well as other chronic diseases of lifestyle are related to nutritional status and should be considered in strategies, policies and programmes to address malnutrition. 20
CHAPTER 4 DETERMINANTS OF NUTRITIONAL STATUS 4.1 INTRODUCTION To understand malnutrition and to address the problems of undernutrition effectively, it is important that the root causes should be identified. In this section, the internationally accepted causes of undernutrition will be briefly illustrated, using a model developed from the UNICEF conceptual framework (Grant, 1994). The available information on risk factors for and determinants in South Africans will then be discussed. 4.2 CAUSES OF UNDERNUTRITION Figure 5 illustrates the vicious cycle of the causes and consequences of undernutrition. It indicates that, because of the consequences, malnourished communities and individuals cannot benefit fully from developmental actions. It is extremely difficult to escape from this vicious circle of poverty and undernutrition. The multifactorial model further illustrates why it is so important that community based, intersectorial programmes aimed at all possible causes are necessary to address undernutrition in a sustainable way. Undernutrition develops when nutrient intakes do not meet nutrient requirements. Intakes are inter alia determined by household food security defined as access to adequate, affordable, safe and nutritious food. Clearly, many economic, social and cultural factors will influence household food security. In addition, political and ideological factors, coupled with availability and access to potential resources, will also influence food security on a national as well as household level. Nutrient requirements may be increased by infectious diseases and malabsorption. Access to adequate health and other services such as clean, safe water, sanitation and refuse removal is therefore a major determinant of nutritional status. Small children cannot feed themselves. Care, and all factors influencing the care of young children, as well as of the old and the infirm, will also influence nutritional status. The figure further illustrates that the consequences of undernutrition directly aggravate the causes. Inadequate physical, mental and social development of people will lead to chronic ill-health, decreased incentives, low productivity and lack of education. All these factors could contribute to poverty and, therefore, to household food insecurity, lack of care and decreased access to health and other services. Because the causes of undernutrition are so interrelated and further aggravated by the consequences, it can be expected that they will not occur in isolation within a community or household. Usually, a combination of factors, all associated with poverty, will collectively be responsible for undernutrition. Because the causative factors of undernutrition are all interrelated, it is difficult to isolate and classify them. With the available data it is not possible to evaluate the precise contribution of a specific factor to the prevalence or extent of undernutrition in South Africans. The factors that will be discussed here are those that have been examined in different South African ethnic groups. Because it is not possible to conclude from the available literature whether cultural practices contribute to malnutrition, the cultural influences an eating pattern will be discussed in a separate chapter (5). 4.3 RISK FACTORS FOR UNDERNUTRITION IN SOUTH AFRICA 4.3.1 FOOD SECURITY Food insecurity or lack of access to adequate, affordable, safe and nutritious food, is a major determinant of undernutrition. There is general agreement that we have national but not household food security in South Africa. The first is relatively easy to assess by comparing and combining data on population demographics and statistics, production, import and export of food. The latter is more difficult and is often measured by the incidence of poverty and undernutrition, although “poor access to health services and sanitation may be more significant causes of malnutrition than inadequate food access” (Land and Agriculture Policy Centre, 1994). Nevertheless, it is generally accepted (Health Systems Trust, 1995) that inequalities to access of land and other resources and specific agricultural land use and urbanisation policies of the past has led to household food insecurity and has contributed significantly to undernutrition, especially in rural areas and the previous Homelands (TBVC-States) where agriculture currently contributes very little to household income. 21
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Page 27: McLaren et al., 1993). In South Afr
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Page 33 and 34: The complexity of the effects of ur
Page 35: 4.3.10 ALCOHOL INTAKE Moderate drin
Page 38 and 39: 5.5 Black South Africans Traditiona
Page 40 and 41: 6.2.2 PRIMARY SCHOOL CHILDREN Preva
Page 42 and 43: References Agenbag S, Matthée V. 1
Page 44 and 45: Coovadia HM. 1993. Overview of maln
Page 46 and 47: Ijsselmuiden CB. 1984. Nutritional
Page 48 and 49: May J, Carter M, Posel D. 1995. The
Page 50 and 51: Richter LM. 1993. Malnutrition and
Page 52 and 53: Steyn NP, Wicht CL, Rossouw JE, Van
Page 54 and 55: Walker ARP, Walker BF, Duvenhage A,

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