the nutritional status of - Health Systems Trust

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FIGURE 6: COMPARISON OF POVERTY RATES WITH PREVALENCES OF STUNTING E. Cape N. Province Free State 80 70 60 50 40 30 20 10 0 RDP - 1995 (Poverty rate) SALDRU/WORLD BANK STUDY (Prevalence of stunting) 1994 National Survey (Prevalence of stunting) SAVACG Study - 1995 (Prevalence of stunting) N. West N. Cape KwaZulu-Natal Mpumalanga W. Cape Gauteng Poverty rates: % of population who are poor 24
The complexity of the effects of urbanisation on nutritional status is further demonstrated by Bourne et al. (1993) who showed in the BRISK study (n=983 adult Africans, aged 15-64 years from the Cape Peninsula) that although the subjects followed a prudent diet regarding fat and carbohydrate intake, their diet was low in fibre, vitamins and minerals. Compared with rural Africans, their diet was in a transition phase towards a progressively atherogenic diet. The study of Jooste et al. (1990) described the same trends. Ndlovu (1983) identified the disrupting effect of urbanisation on the family unit and family life as a contributing cause of malnutrition. Urbanisation, and especially migration of men from the rural areas to earn money in urban areas, has led to broken homes and destitution with consequent malnutrition in the rural areas (Westcott & Stott, 1977). Gericke et al. (1987) in their studies on urban and rural Vendas, found that urbanisation with its accompanying westernisation and acculturation is a two-way process during which urban influences also spread into the rural areas. 4.3.4 FAMILY UNITY AND COHESION As mentioned above, urbanisation and migration, but also other factors, could lead to changes in family structures. The impact of the low social status of many South African women has not been studied, but several studies have identified family unity to be a major contributor to undernutrition, especially in children. Westcott & Stott (1977), Fincham (1982), Ndlovu (1983), Krynauw et al. (1983), Molteno & Kibel (1989), Howard (1990) and Sive et al. (1993) all found that children who came from disrupted family units and broken homes with less support from the father and exposed to more social problems were more likely to be undernourished than children from stable, cohesive families. It seems that the extended families often seen in some communities provide a social support network that contributes to prevention of undernutrition. Child care competencies and arrangements are major determinants of nutritional status and sharing these responsibilities obviously influences the nutritional status of children. 4.3.5 PHYSICAL ENVIRONMENT The standard of housing, occupational density, access to clean and safe water and sanitation, and easy cooking and refrigeration facilities have been identified in several studies as contributors to malnutrition (Fincham, 1982; Krynauw et al., 1983; Molteno & Kibel, 1989; Howard, 1990; Sive et al., 1993). However, two of these studies (Howard, 1990; Sive et al., 1993) found that the number of people in the household and displacement by a younger sibling did not necessarily contribute to risk of malnutrition. 4.3.6 PREGNANCY Repeated pregnancies may jeopardise nutritional status of both mother and child, but especially of the mother. The total fertility rate in South Africa is high at 4.1 (RDP, 1995). It can therefore be expected that repeated pregnancies could play a role as determinant of nutritional status in South African women. Pregnant women have a high risk for developing iron deficiency anaemia. The global prevalence is 51 % and the World Health Organisation, therefore, advocates the use of iron supplements in developing countries during the second half of pregnancy (De Mayer et al., 1989). The need for this has, however, been questioned (Ross et al., 1981). Table 75 summarises reported prevalences of iron deficient anaemia in pregnant coloured and African women. Kruger et al. (1994) found that in the coloured women, primigravidas of 18-22 years of age who were unemployed, single and not related to the household head, were at the greatest risk for developing anaemia. Except for the study on the Gazankulu women (Baynes et al., 1986) which showed a higher prevalence of folate than iron deficiency, the other studies reported adequate folate and vitamin B12 status. Most authors agree that blanket iron supplements are justified during pregnancy, especially in the 3rd trimester in women from a poor socio-economic background. Baynes et al. (1986) also recommend folate supplementation in the form of the fortification of maize meal with folic acid. Vitamin A fortification may also be indicated. Fairney et al. (1987) reported that vitamin A status of rural black mothers and their babies was low. Vitamin D status, measured as 25-hydroxy-vitamin D, was adequate, suggesting that actinic synthesis maintained Vitamin D status. 25
Page 2 and 3: THE NUTRITIONAL STATUS OF SOUTH AFR
Page 4 and 5: PREFACE In this review, the Nutriti
Page 6 and 7: 6. Recommendations It is suggested
Page 8 and 9: CHAPTER 4 DETERMINANTS OF NUTRITION
Page 10 and 11: 1.3 EVALUATION OF NUTRITIONAL STATU
Page 13 and 14: RESULTS CHAPTER 3 3.1 ANTHROPOMETRY
Page 15 and 16: distributions of weight-for-age and
Page 17 and 18: Table 17 shows that the Northern Ca
Page 19 and 20: Table 31 indicates that urban black
Page 21 and 22: 3.3 NUTRIENT INTAKES 3.3.1 INTRODUC
Page 23 and 24: FIGURE 1: ENERGY DISTRIBUTION OF TH
Page 25 and 26: 3.3.10 IRON INTAKES Tables 54 (a),
Page 27 and 28: McLaren et al., 1993). In South Afr
Page 29 and 30: CHAPTER 4 DETERMINANTS OF NUTRITION
Page 31: Not many studies examined the direc
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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