the nutritional status of - Health Systems Trust

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5.5 Black South Africans Traditional eating patterns and taboos of the different black groups in South Africa have been described by Becker (1975), Beyers (1979), Coetzee (1982), Vorster et al. (1987), and Gresse (1991). Although there are several unique features and taboos of individual groups, there are also common habits and patterns. One is that traditionally, only two meals were eaten daily. Breakfast was eaten late in the morning and originally consisted only of sour milk (amazi), especially in the South Nguni’s. Later, a thin porridge cooked from cereal (sorghum, millet or maize meal) and served with sour milk was added. Wolmarans et al. (1995) found, however, that present day urban African children have breakfast consisting mainly of bread before school. Only 14 % of grade 1 pupils and 17 % of standard 3 pupils in their sample did not eat breakfast. The main meal was usually served after dusk and consisted of two dishes. The first was the main cereal dish such as a thick porridge or a cereal and vegetable mix (maize meal cooked with pumpkin or samp and beans). The second was a side dish of meat, meat gravy or a vegetable stew, in which the cereal (eaten by hand) could be dipped in. It was believed that the side dish should “ease the swallowing” of the main cereal dish. Snacking between meals was common and a fermented cereal beverage (or beer with a low alcohol content) was consumed in huge quantities to quench thirst and to still hunger pangs. Even small children could drink this home brewed beverage. Another common feature is that a bitter and sour musty taste is the favourite taste in African cuisine. To create this taste, gall from slaughtered animals was sprinkled over food. The stomach content or some bitter plants were also used for this purpose. Sweetening agents were not added to foods, although honey and sugar cane were eaten as snacks. Milk was a favourite food. However, its consumption was influenced by numerous taboos and rituals. It was usually used as sour milk. Only small children and the elderly drank fresh milk. Milk consumption indicated kinship. A man could only drink milk in his own household or in that of a paternal of maternal relative. A woman could only drink milk obtained from her husband’s herd, and then only when she was accepted by her new family. An “impure” women, as during menstruation or after a miscarriage, had to avoid milk and all milk containers. Milk played a purification role and was sprinkled around a house (as was bile from a slaughtered animal), to “purify” the house. It is possible that some of the older taboos regarding milk may be responsible for the low milk intake of present day Africans. Pettifor et al. (1979) found that rural black children drank even less milk than urban children and that this led to hypocalcaemia in the rural children. Other taboos which could jeopardise nutritional status were that pregnant women were not allowed to eat vegetables or sweet or hot foods and that during the last month of pregnancy, very little could be eaten to avoid big babies and difficult deliveries. Women were also not allowed to eat eggs because it was believed that it would either make them infertile, or let them acquire extra lovers. Religious beliefs, based in an ancestor cult where ancestral spirits were guarding over the descendants, influenced consumption of certain foods and particular customs during several ceremonies. Nutritionally, some of these beliefs and practices could also limit intakes of certain foods by specific people, while it would favour intakes of others. For example, in the Pedi culture, only the men of the tribe were allowed to eat the “funeral meat” obtained from an ox or goat slaughtered for a funeral feast. It is possible that in the past the traditional attitude towards cattle (Fox, 1979) as well as the land tenure custom contributed to food insecurity and low nutritional status of some Africans. 5.6 Comments It is not known how many of these older customs still influence eating patterns of the modern African. Ramphele & Heap (1991) found that hostel dwellers in urban areas of the Western Cape ate more frequently and regularly than when they were “home-based” in their rural area. Lazarus and Bhana (1984) are of the opinion that lack of nutrition knowledge, exchange of nutritional misconceptions by housewives and traditional practices passed on to the next generation are major causes of community malnutrition. Tables 78 to 83 clearly illustrate that nutrient intakes of all South Africans may be improved by including more milk, milk products, fruits and vegetables in the diet. The dietary (nutrient) intake results shown in Section 3.3 also demonstrate how dietary patterns have changed during urbanisation and that urban Africans now follow a much more westernised diet with more fat and less fibre. In addition, Tables 81 and 82 show that inadequate weaning practices were associated with a deterioration of nutritional status of black infants. The availability of an inexpensive nutrient dense weaning food and knowledge on the correct use of such a food, or increasing energy density of maize porridge by adding oil, sugar or peanut butter could be one way to address the problem of undernutrition in these infants. 30
CHAPTER 6 DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 6.1 LIMITATIONS OF THE REVIEW By definition, in addition to four unrelated National Surveys, data gathered in many small ad hoc studies by a large number of individual researchers and groups, employing different designs and methods, had to be used in this review. Therefore, care should be taken in the integration and interpretation of the results. Conclusions drawn should take into account that results from small studies may be biased and not representative of the total population. A major observation from these studies is that some groups that are perceived as being the most vulnerable to malnutrition, such as children in disadvantaged communities, have been studied in much more detail than other possible groups, such as pregnant and lactating women and the elderly. The data in Tables 1 to 84 show that there are many gaps in our knowledge, not only regarding specific groups, but also regarding specific nutrients. Another observation is that except for the four National Surveys, very little research has been done in some provinces, notably in the Northern and Eastern Cape and in Mpumalanga. The Western Cape and Gauteng have the most comprehensive data. This may be related to the distribution of universities, medical schools, academic hospitals, departments of nutrition/dietetics, MRC laboratories and funding of research projects. Therefore, it is not possible to compare and prioritise the most needy provinces or districts on the available data. 6.2 MAIN FINDINGS: CONCLUSIONS 6.2.1 PRESCHOOL CHILDREN The most important observation is that, on a national basis, between 20 and 25 % of preschoolers are stunted and therefore suffer from chronic undernutrition. Black and coloured children have the highest prevalences (25 and 17 % respectively), with rural black children the most vulnerable group. The most vulnerable age is approximately 2 years and there is substantial evidence that inadequate weaning practices are a major determinant of undernutrition in this age group. It seems that wasting is not a problem, but that in white, Indian and coloured children, underweight is a more serious problem than stunting. There are indications that even in rural black children, overweight could be an emerging problem. The mean prevalences of malnourished children (diagnosed on anthropometric variables) from different studies are in agreement with the one National Survey on preschoolers. However, the ad hoc studies reported a wide range of undernutrition, indicating that there are pockets or areas which have a very serious problem in malnutrition. This is an extremely important finding, because it indicates that intervention programmes will probably have to differ in different areas. Biochemical analyses show that preschool children, especially black children, had high prevalences (up to 20 %) of iron deficiency anaemia, as well as vitamin A and folate deficiencies. The high prevalence of parasitic infections reported by a number of researchers, probably contributes to the iron deficiency problems. The dietary intake data supports the anthropometric and biochemical observations. Rural black children have low mean energy intakes and although total protein intakes seem adequate, the quality of the protein may be jeopardised. The clinical data on eye abnormalities confirms a high prevalence of vitamin A deficiency on a national level among preschoolers. 31
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