One of the biggest challenges facing the public health system in South Africa is malnutrition in young children. One in four children is stunted and many are deficient in vitamins and minerals essential to preventing disease and disability. Malnutrition is also a major contributing factor to child death.
Combatting it will involve a systemic approach to improving nutrition services and changing behaviour.
What is malnutrition?
Malnutrition is the name given to a wide spectrum of symptoms caused by the inadequate intake of energy, protein and nutrients in the diet. Among children, this is known as primary malnutrition and can cause a number of nutrition-related diseases such as kwashiorkor or marasmus.
Primary malnutrition is particularly prevalent in poor communities which have low levels of food security, education and income, such as marginalised rural villages, urban informal settlements and refugee camps. The effects of primary malnutrition include stunting and slowing of physical and mental development because a lack of nutritents strips a child’s ability to fight off infection and rapidly weakens the body.
Childhood diseases, and especially those caused by HIV infection, are made worse by poor nutrition and can be considered a major underlying cause of illness and death in young children — 11.4% of deaths of South African children under five can be attributed to low weight.
The factors encouraging primary malnutrition are varied, though a lack of adequate health services and poverty are considered the major contributors.
Malnutrition in infants
Sufficient nutrition in early childhood is critical in maintaining healthy growth, proper organ formation and functioning, a strong immune system, and neurological and cognitive development in children.
Children who are undernourished, not optimally breastfed, or suffering from micronutrient deficiencies have substantially lower chances of survival than children who are well nourished.
The pattern is reinforced when undernourished teenagers fall pregnant and give birth to underweight infants, perpetuating the cycle of malnutrition for many generations.
Overwhelming scientific evidence supports the belief that exclusively breastfeeding infants helps protect them by providing optimal nutrition and protection against common but life-threatening early childhood infections. Evidence also indicates that infants who are exclusively breastfed for six months and continue to be breastfed for up to one year could lead to a 13% reduction in deaths of children under five.
In South Africa, approximately 50% of children under six months are either bottle-fed, or mixed-fed, meaning that breastmilk is substituted with water or other liquids not suitable for children so young.
There are a number of factors that influence the way infants are fed, but one of the primary concerns for mothers who are HIV positive is that they can pass the virus to their offspring through their milk. This creates a difficult situation in which preventing malnutrition must be weighed up against preventing infection. The situation is exacerbated if the mother is able to breastfeed, but is undernourished herself.
Methods for combatting malnutrition
Ideally, the best way to avoid malnutrition in infants is for babies to be breastfed exclusively till six months and continue breastfeeding, while adding complementary foods, for up to two years.
For at-risk mothers, turning to baby formula instead of breastmilk is one of the easiest ways of combatting some of the risk of infection because of breastfeeding. However, the high cost of this method is not well-known and when utilised by itself, baby formula does not provide enough nutrients to sustain a child.
If, however, formula is the only option, the following conditions must be considered:
- that mothers/caregivers know how to properly prepare the formula
- enough formula be provided to support normal growth and development of the infant
- safe water and sanitation needs to be available at a household level and in the community
The country has adopted a set of WHO/UNICEF recommendations for a single infant feeding strategy — promoting breastfeeding in the context of HIV, based on new evidence indicating that when HIV positive mothers take their ARVs, the risk of transmission via breastmilk is almost entirely prevented.
South Africa is also making efforts to fight malnutrition and has made substantial progress in transforming its health sector, with more than 4000 clinics across the country and state health services provided free to children under five and pregnant and breastfeeding women.
Key vitamins and minerals have been added to wheat flour, maize flour and retail sugar in accordance with mandatory regulations, and salt for human consumption is also iodised. The folic acid fortification has resulted in birth defects dropping by more than a third.
Education on what constitutes a balanced diet, as well as poverty alleviation, are important tools in combating hunger and thus malnutrition. The Department of Health has established various special programs and initiatives, like the Integrated Nutrition Program, to combat the detrimental effects of malnutrition.
Links / References:
Unicef South Africa – Child and maternal health – Nutrition. Retrieved from http://www.unicef.org/southafrica/survival_devlop_755.htm
Unicef South Africa – Overview: Child and maternal health. Retrieved from http://www.unicef.org/southafrica/survival_devlop_343.htm
Child Safety, Peace and Health Promotion – Child Malnutrition. (March 2013). Retrieved from http://www.mrc.ac.za/crime/ChildMalnutrition.pdf
Voice of Amerika – Malnutrition Cripples Child Development in South Africa. (October 29, 2014). Retrieved from http://www.voanews.com/content/malnutrition-cripples-child-development-in-south-africa/2501211.html
Health24 – Malnutrition. (22 May 2015). Retrieved from http://www.health24.com/Medical/Diseases/Malnutrition-Client-20120721
Wikipedia – Malnutrition in South Africa. (1 June 2016). Retrieved from https://en.wikipedia.org/wiki/Malnutrition_in_South_Africa
Unicef – Young Lives – Statistical Data on the Status of Children Aged 0-4 in South Africa. Retrieved from http://www.unicef.org/southafrica/SAF_resources_younglives.pdf
Department of Health – Province of KwaZulu-Natal – Implementation guidelines for nutrition intervations at health facilities to manage and prevent malnutrition. (July 2013). Retrieved from http://www.up.ac.za/media/shared/62/ZP_Files/implementation_guidelines_for_nutrition_interventions_at_health.zp70745.pdf