the nutritional status of - Health Systems Trust

More documents

Recommendations

Info

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. 32
6.3 DISCUSSION AND RECOMMENDATIONS The aim of this discussion is not to consider all possible solutions to South Africa’s nutritional problems, but only to highlight the major findings of this review and how they should influence our thinking in the design of future nutrition policy and programmes. Firstly, with a quarter of South Africa’s children stunted, coupled to high prevalences of micronutrient deficiencies across all age groups, as well as very high prevalences of obesity, we clearly have the double burden of both under and overnutrition. This means that our strategies to address undernutrition should not lead directly to overnutrition in later life. The nutrition “message” of adequacy should be accompanied by one of prudency. While addressing energy deficiency in vulnerable groups and micronutrient deficiencies in the total population, education on healthier food choices should be a focus point. The second important observation is that, within a specific age and ethnic group, wide ranges in prevalences of undernutrition were seen. This means that although national strategies and policies are extremely important in addressing the problem, specific programmes should be based on the real need in a specific area or group. Programmes should be flexible and adaptable. For example, children in a Gauteng school could only need education on how to choose healthy snacks from a tuckshop, while children in a remote rural school could need a total school meal programme. The third observation of importance is that some (vitamin A and folate), but not all (iron) of the micronutrient deficiencies could be addressed by a fortification programme. The danger of iron overload should be considered. It is suggested that to address the iron problem, an expert committee should advise Government on both the advantages and disadvantages of fortification and that targeting of inexpensive weaning foods should be considered. In conclusion, although malnutrition on a national level may only be a mild problem of coexisting under and overnutrition, it may be a serious problem of outspoken undernutrition and even hunger in specific areas. Our strategies, policies and programmes to address this problem should take these differences into account and be flexible enough to adapt to specific needs. 33
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 and 32: Not many studies examined the direc
Page 33 and 34: The complexity of the effects of ur
Page 35: 4.3.10 ALCOHOL INTAKE Moderate drin
Page 38 and 39: 5.5 Black South Africans Traditiona
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,

the nutritional status of - Health Systems Trust

Create successful ePaper yourself

Delete template?

Save as template?