the nutritional status of - Health Systems Trust

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PREFACE In this review, the Nutrition Research Group provides a timely and useful overview of the state of knowledge about nutritional status and the causes of malnutrition in South Africa. The review covers a period of 21 years, from 1975 to 1996. Due to shortcomings in the data, it is unfortunately not possible to analyse trends over this period. The review should prove useful to policy makers and programme directors, to establish the key nutritional problems we need to address. The data shows that nutrition problems occur in specific groups and geographical areas. Targeting interventions is therefore critical. The review is as illuminating regarding the gaps in our knowledge. For effective policy development and planning, researchers are challenged to focus on conducting research in these areas. Overall, there is an absence of definitive work on the underlying causes of malnutrition in various circumstances. In depth, small scale studies, linked to planned interventions could make an important contribution in this regard. There are gaps in our knowledge regarding the dietary practices of certain groups, including rural black children under two years of age, and rural adults, particularly in some provinces. The nutritional status and dietary practices of teenage girls, a potentially vulnerable group, also appears as an area in need of study. Nutrition researchers have an opportunity to ensure that the gaps identified in this study are filled. When a review is done, in five or ten years time, we must have the data to be able to indicate improvements in key indicators. Researchers should also seize the opportunity to use the available information to advocate for immediate action to improve the nutritional status of the population. Milla McLachlan Chairperson: Nutrition Society. November 1996 ACKNOWLEDGEMENTS The research, writing and publication of this report were made possible by a grant from the Health Systems Trust. Dr. LA Greyvenstein assisted with the language editing of the report, and Mrs. JM van Rensburg did the typing. Dr. HM McLachlan reviewed the manuscript. Her useful recommendations were incorporated into the text with the hope that it will contribute to a widespread application of the report in the planning of nutrition strategies and programmes in South Africa. We would like to thank all our colleagues (Dr. ARP Walker, Dr. AJS Benade, Prof. N Cameron and members of the SANSS group) for assistance in the collection of the relevant literature. i
1. The problem of malnutrition EXECUTIVE SUMMARY As in most other developing countries, recent literature indicates that South Africa has a problem of malnutrition. However, the exact nature and extent of this problem, as well as the vulnerability of different groups of South Africans, are not known. 2. Ineffectiveness of present programmes There is, at present, a perception that the few national Government programmes, and the many efforts from nongovernment programmes and organisations aimed at addressing malnutrition are not effective. One of the main reasons is probably because these programmes are not based on an analysis and understanding of the real problem and are not targeted at the most needy. To design strategy, policy and programmes to tackle the problem of malnutrition, more should be known about the nutritional status of South Africans. 3. Objectives of the review The objective of this review is to integrate results from four national studies and a large number of ad hoc studies by individual researchers and groups in a scientifically responsible manner, in order to evaluate and describe the existing nutritional status of South Africans. 4. Data used Results from published and unpublished reports which give information on the anthropometry, biochemical profiles, dietary patterns, nutrient intakes, and clinical signs of malnutrition were used to compile 84 tables. Results are stratified for ethnic group, age, gender, and province of domicile. Data which describes the impact of various determinants of nutritional status (food security, poverty, urbanisation, family unity and cohesion, physical environment, pregnancy, breast feeding and weaning practices, education, parasitic infections and alcohol intake) are summarised in a separate chapter. A number of studies concerning the cultural influences on eating patterns of South Africans are also included in this review. 5. Results The results indicate that on a national level 20 - 25 % of preschool children and at least 20 % of primary school children are stunted and therefore suffer from chronic undernutition. Prevalences of wasting and underweight in school children are low. The vitamin A, iron and folate deficiencies observed in pre-school and primary school children, are also seen in adolescents and adults. Rural black and coloured children are the most vulnerable groups. The calculated mean prevalences of stunting in pre-school and primary school children observed in a large number of ad hoc studies, were in agreement or slightly higher for particular groups than found in the national surveys. However, there were wide ranges reported, varying, for example, from 3-64 % in urban black preschool children to 0-12 % in white primary school children. This clearly indicates that there are pockets or areas with more serious problems of undernutrition than others. The dietary and nutrient intake data supported the anthropometric and biochemical observations. In addition to low intakes of several micronutrients (calcium, iron, magnesium, zinc, riboflavin, vitamins A, B6, C and folate), the low fibre intakes and increases in total fat intake are of concern. An analysis of dietary patterns and determinants of malnutrition showed that, although cultural influences may explain some differences in nutrient intakes between ethnic groups, other factors such as poverty, food insecurity, disruption of the family unit, parasitic infections and lack of education are probably more important determinants. In all reports which examined dietary patterns, there was consensus that the low energy density of weaning foods and the low intake of milk (or milk products), fruits, vegetables and legumes by many South Africans are responsible for most of the nutrient imbalances in the diets. ii
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Page 46 and 47: Ijsselmuiden CB. 1984. Nutritional
Page 48 and 49: May J, Carter M, Posel D. 1995. The
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Walker ARP, Walker BF, Duvenhage A,
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