the nutritional status of - Health Systems Trust

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.
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