Chapter 13 - Children in need of special protection - Children's ...

538there are significant regional variations in the incidence of malnutrition. While PEM is highest inthe rural areas of the former homelands and in the peri-urban informal settlements, 1987 figuresshow a fluctuation from a low of 5.5 per cent among Africans in the Western Cape, to a high of34 per cent in the former Transkei. Although the incidence of PEM has remained constant inthe rural areas, the rates appear to be declining in the urban areas.Under-nutrition in South Africa is the result of PEM as well as micronutrient deficiencies. PEM isassociated with cerebral atrophy, which may be detrimental to intellectual and psychomotordevelopment. In 1990 it was estimated that some 2.3 million South Africans were nutritionallycompromised and that the majority of these were black (87 per cent) children under 12 years ofage. Although comprehensive national data are lacking, it is generally accepted that thosehouseholds living in rural, peri-urban and informal settlements are the most vulnerable. Thefragmented survey data available suggest that approximately 16 per cent of children under 5years of age are under weight for their age and between 20 per cent and 30 per cent arestunted (low height for age) which is an indication of chronic under-nutrition. These indicatorsare higher than the norms set by the WSC, which specify a reduction in the rate of low birthweight (2.5 kg or less) to less than 10 per cent by the year 2000.13.2.4.1 Child feedingThe pattern of weight gain in young South African children is such that growth faltering oftensets in during the weaning period, thereafter children tend to gain weight such that few arewasted, though a significant percentage are stunted. This is itself a strong indication that childfeeding during weaning is problematic. Young children are not fed often enough to satisfy theirenergy requirements and the food they do receive is not energy-dense. Their older brothersand sisters with larger stomachs can eat enough with only one or two main meals a day tosatisfy their energy requirements.A further implication of this pattern of weight gain is that a shortage of food in the household isoften not the cause of malnutrition. The additional food which is required by young children isan extremely small proportion of the total consumed by their older brothers and sisters and22 National food consumption survey in children aged 1 - 9 years: South Africa April 2000.