the nutritional status of - Health Systems Trust

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.
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