the nutritional status of - Health Systems Trust

6.2.2 PRIMARY SCHOOL CHILDREN
Prevalences of wasting and also of underweight are low in primary school children. However, it is estimated that on
a national basis, at least 20 % of primary school children are stunted and suffer from chronic malnutrition.
The mean prevalence of stunting calculated from results of the ad hoc studies is higher than in the 1994 National
Survey. The wide range of results indicate that pockets of extreme malnutrition exist in some areas.
The growth pattern of children from different ethnic groups differs and there is not enough evidence to attribute
this to dietary intake patterns only. Clearly, other environmental determinants also play a role.
The same micronutrient deficiencies observed in the preschoolers, namely iron, vitamin A and folate are also
present in primary school children. There are indications that low calcium intakes could also be a problem.
6.2.3 ADOLESCENTS
Much less research has been done on this age group.
Iron and folate deficiencies are common amongst all ethnic groups and black children seem to have low vitamin
A, E, B6 and also calcium status.
6.2.4 ADULTS
Indications are that the same differences between ethnic groups observed in children are present in adults.
Obesity (and associated diseases of lifestyle) is common among South African adults. From the limited data
available it seems that especially black women have a very high prevalence of obesity.
The iron and folate micronutrient deficiencies observed in children are also present in adults.
6.2.5 DETERMINATIONS OF MALNUTRITION
All the complex, interrelated socio-economic determinants described in the international literature were observed
by a number of authors in South African subjects. Broken family units seem to emerge as an important roleplayer.
Although poverty is identified as a major underlying cause, it is clear that not all poor people are malnourished. It
is suspected that social-support networks within poor communities could play an important role in preventing
undernutrition. This strength, together with the existence of extended families within communities could be
utilised in preventive and intervention programmes. Of concern is the lack of information on the impact of changes
in determinants of nutritional status during urbanisation. To address possible problems of malnutrition in the fastgrowing
informal housing areas and throughout South Africa, much more research on these changes are necessary.
6.2.6 DIETARY PATTERNS AND NUTRIENT INTAKES
The available data on dietary patterns showes that cultural influences could explain some of the differences
observed in the different ethnic groups. However, it is suspected that poverty, household food insecurity and other
factors dictated by socio-economic realities, are more important determinants of nutrient intakes. It is clear that
low energy density of weaning foods and of the diets of rural black primary school children, coupled to a low intake
of fruits, vegetables, legumes and milk by many individuals of all ethnic groups, are the main deficiencies in the
South African diet.
The nutrient intake data supports these observations. There are adequate intakes of protein, total fat, sodium
chloride (table salt), potassium, phosphorus, thiamin, riboflavin and vitamin B12. All other nutrients are deficient in
the diet of many groups. The low intakes of dietary fibre, calcium, iron, magnesium, zinc, riboflavin, vitamin B6,
vitamin C, folate and especially vitamin A by many groups, is a matter of serious concern, as is the increasing
tendency towards westernisation of prudent traditional diets. The latter is associated with higher fat and lower fibre
intakes, increasing the risk of chronic diseases of lifestyle.
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