the nutritional status of - Health Systems Trust

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Results from published and unpublished reports which give information on the anthropometry, biochemical profiles,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.
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