the nutritional status of - Health Systems Trust

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CHAPTER 4 DETERMINANTS OF NUTRITIONAL STATUS 4.1 INTRODUCTION 4.2 CAUSES OF UNDERNUTRITION 4.3 RISK FACTORS FOR UNDERNUTRITION IN SOUTH AFRICA 4.3.1 Food Security 4.3.2 Poverty 4.3.3 Urbanisation 4.3.4 Family Unity and Cohesion 4.3.5 Physical Environment 4.3.6 Pregnancy 4.3.7 Breastfeeding and Weaning Practices 4.3.8 Education, Ignorance and Psychological Factors 4.3.9 Parasitic Infections 4.3.10 Alcohol Intake 4.4 COMMENTS CHAPTER 5 CULTURAL INFLUENCES ON DIETARY PATTERNS 5.1 INTRODUCTION 5.2 WHITE SOUTH AFRICANS 5.3 COLOURED SOUTH AFRICANS 5.4 SOUTH AFRICAN INDIANS 5.5 BLACK SOUTH AFRICANS 5.6 COMMENTS CHAPTER 6 DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 6.1 LIMITATIONS OF THE REVIEW 6.2 MAIN FINDINGS: CONCLUSIONS 6.2.1 Preschool Children 6.2.2 Primary School Children 6.2.3 Adolescents 6.2.4 Adults 6.2.5 Determinations of Malnutrition 6.2.6 Dietary Patterns and Nutrient Intakes 6.3 DISCUSSION AND RECOMMENDATIONS v
INTRODUCTION CHAPTER 1 1.1 BACKGROUND Our health and well-being, quality of life and ability to learn, work and play depend on how well we are nourished. Good nutrition or nutritional status is the outcome of many complex and interrelated determinants such as access to adequate, safe, affordable and nutritious food, care and health services. Although good nutrition is universally accepted as a basic human right, it is estimated that globally, more than 800 million people suffer from malnutrition and that in developing countries, more than 20 % of the populations are hungry. Grant (1993) estimated that in 1990, 193 million preschool children were underweight South Africa is a middle-income, developing country. According to the literature widespread outspoken hunger may not a major problem, but the health and nutritional status of millions of South Africans are far from optimal. A recent comparison of a few health indicators (infant mortality rate, life expectancy at birth and incidence of tuberculosis) and the money spent on health services compared with those of other countries at similar levels of economic development (McIntyre et al. 1995), indicate that we are not using our resources optimally. The high rates of malnutrition among South African children reported by a number of authors during the past 20 years (Kotzé, 1978; Wyndham & Irwig, 1979; Hansen, 1984; Richardson, 1986; Coovadia, 1993) have motivated the Department of Health to implement various national nutrition intervention programmes. These are the National Nutrition and Social Development Programme (NNSDP), the Protein Energy Malnutrition Scheme (PEM) and the Primary School Nutrition Programme (PSNP). In addition, several non-government organisations also implemented intervention programmes. Although the outcome of these programmes have never been evaluated in a scientific and satisfactory way, there is a perception that they are not cost-effective and do not contribute to general improvement of nutritional status and health. The reasons for their “failure” have been discussed in detail by McLachlan & Marshall (1995). These include inter alia that they were designed without adequate information, that their designs reflect a limited understanding of the problems of malnutrition, that goals were ill-defined and activities unfocused, that the emphasis on delivering of specific services such as the handing out of food was wrong, that they were not targeted to the most needy and that participation and involvement of communities were inadequate. However, in 1994 a nutrition committee appointed by the Minister of Health compiled a draft report on an integrated nutrition strategy for South Africa, which addresses these problems in a constructive and positive manner (Nutrition Committee, 1994). 1.2 MOTIVATION AND AIMS OF THIS REVIEW It is obvious from the above that in order to design better and more effective nutrition intervention programmes that will lead to improved nutritional status and health, we need adequate information on the existing nutritional status and specific nutritional problems of South Africans. We also need to know which of the many interrelated determinants of nutritional status contribute most to malnutrition in South Africa. To target programmes effectively we need to know more about the most vulnerable and disadvantaged. In addition, we need to know where the gaps in our knowledge are to plan more effective and relevant research in nutrition. The main objective of this review is to provide baseline data on the existing nutritional status of South Africans. Except for four national studies from 1980 to 1994, which provided data on the anthropometry of young children and of which one gave information on vitamin A and iron status of preschool children, the only other available scientific data on nutritional status are results from small regional ad hoc studies published by individual researchers. This review therefore aims to combine, integrate and interpret the results of these studies. Because of the structure of the South African population, as well as previous political policies, most of the above mentioned studies stratified and reported results for specific ethnic groups. To identify the most vulnerable and needy it was thought that further stratifications for gender, age, province and rural or urban locality in the case of Africans would be necessary, and were therefore made in the compilation of the tables. 1
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
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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
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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 40 and 41: 6.2.2 PRIMARY SCHOOL CHILDREN Preva
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,

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