HSRC Review Sept 2013.pdf - Human Sciences Research Council

32 Pages·2013·2.07 MB·English

REVIEW
VOLUME 11 NUMBER 4 SEPTEMBER 2013
The Limpopo
textbook saga
The menace of
lifestyle diseases
We are what
we eat
A
The CEO Notes
Contents Massive and
complicated:
NewsRoundup 1
BRICS in South Africa, 3 The SA National
and the think tank in BRICS
Mapping the health and 4 Health and Nutrition
nutritional status of South
Africans Survey (SANHANES)
Non-infectious diseases 5
pose an economic threat
to healthcare
Stunting, overweight and 8 In 2008, former KwaZulu-Natal premier, Dr Zweli Mkhize, and the then-chair of the
obesity in the very young Board of Development Bank of Southern Africa, Jay Naidoo, organised a health
stakeholder’s group to initiate a process to turn around the South African healthcare
You are what you eat… and 11
system in preparation for the new administration that would take office in 2009.
you eat what you can afford
There were robust debates from public and private sector participants about
Understanding the Limpopo 14 how to reverse the downward trend of the healthcare system. This process was
textbook saga finalised in December 2008, and it was agreed to recommend 10 priority actions
to President Jacob Zuma’s administration to consider for implementation. Two
Listening before telling 16
successive ministers, Barbara Hogan and Dr Aaron Motsoaledi, embraced the ten-
Incomprehension follows 19 point plan and initiated improvements in the healthcare system. One of the key
the Comprehensive Rural
objectives was to strengthen research and development by introducing a health and
Development Programme
nutrition examination survey to track the health of the population.
Reforming the land 22
Mammoth undertaking
Policy research 24
The HSRC, represented by four principal investigators – myself, Dr Olive Shisana
Shouldering the burden 25 and Professors Demetré Labadarios, Thomas Rehle and Leickness Simbayi –
planned the study. We invited scientists from the Medical Research Council to join
The young and the 28
us in the undertaking.
discontented
This was going to be an expensive exercise and required multidisciplinary teams
of researchers to conduct a bio-psycho-social survey. We expected challenges,
CORRESPONDENCE since the infrastructure was limited for undertaking such a survey that included
Ina van der Linde
Corporate Communication physical examinations, laboratory tests and administering questionnaires. It was
Private Bag X41 in this light that the HSRC, with the support of Minister Motsoaledi, reached out
Fax: [phone]
to the US Centers for Disease Control which sent Dr Clifford Johnson, the director
For feedback, questions, or copies of the
original articles, please email of the US National Health and Nutrition Examination Survey (NHANES), to advise
[email protected]
us. This move proved to be critical in strengthening our resolve to undertake this
View an electronic version on
www.hsrcpress.ac.za massive survey.
Pretoria
Tried-and-tested approach
Private Bag X41, Pretoria, South Africa 0001
Tel: [phone], Fax +27: 12 302 2001 Taking a well-proven scientific approach and applying it in a new setting to answer
emerging social and public health problems often results in benefits for the country
Cape Town
Private Bag X9182, Cape Town, South Africa that were not previously imagined. This was the case when we decided to review
8000
the experience of the USA in implementing the NHANES, which has been running
Tel: [phone], Fax: [phone]
for the last 50 years.
Durban Using a well-proven concept to address the emerging non-communicable
Private Bag X07, Dalbridge, South Africa 4014
Tel: [phone], Fax: [phone] diseases and the concomitant risk factors arising from a changing population
lifestyle and diet that mimic those of industrialised countries was crucial to the
PRODUCTION
success of undertaking the South Africa version of NHANES, i.e. SANHANES.
The HSRC Review is produced by Corporate
Communication, HSRC With the financial support of the South African Department of Health and the
Editor: Ina van der Linde
UK’s Department for International Development (DFID), we successfully undertook
Production: Blue Apple
this mammoth study. Most South Africans opened their houses to our researchers
Copies of all HSRC Press published titles are and with the help of many scientists, medical doctors, nurses, nursing assistants
available from leading booksellers nationally,
and from the sales agent, Blue Weaver at and nutritionists we successfully interviewed 25 532 individuals in their homes,
[email protected]. physically examined 12 025 individuals and obtained blood samples from 8 078
Orders can also be placed via
individuals for analysis to estimate the prevalence of specific diseases, assess
[email protected]
health and nutritional status of the population and understand the risk factors of the
population.
NewsRoundup
HSRC, Fort Hare
The study was able to assist the
assigned review
country to evaluate the:
• Health status of South Africans of highest
with respect to the prevalence
courts
of non-communicable diseases
(specifically cardiovascular disease,
diabetes and hypertension) and
their risk factors (diet, physical
activity and tobacco use).
• Knowledge, attitudes and
behaviour of South Africans with
respect to non-communicable
and communicable infectious Professor Narnia Bohler-Muller
diseases.
• Nutritional status of South
Africans as an outcome of food
security, dietary intake/behaviour The Democracy, Governance and Service Delivery (DGSD) research programme
including the consumption of the HSRC, together with the Nelson R Mandela School of Law of the
of alcohol and body weight University of Fort Hare (UFH), have been awarded a contract in response to a
management. research tender by the Department of Justice and Constitutional Development
• South Africans’ general (DOJCD).
perceptions of health and According to the terms of reference specified in the tender of April 2013, the
healthcare services. scope of the research is limited to the following:
• Health status of children under the • an assessment of access to the courts;
age of five years with respect to • costs of litigation;
early childhood development, care • speed of finalisation of cases;
of illness, immunisation and the • the constitutional transformation of common and customary law;
use of the Road to Health Booklet. • the complexities involved in the practical implementation of court decisions
• Health status of children between by the other two branches of government;
2-9 years with respect to physical • new value-oriented interpretive methods and jurisprudential transformation;
and/or mental disabilities. and
The study results were presented • the pro-poor orientation of courts in other developmental states such as
to the minister of health, members Brazil and India.
of executive councils responsible The overall aim of the proposed 18-month research project is to assess the
for health, and to senior staff in the impact of the two highest courts, the constitutional court and the supreme court
Department of Health nationally. of appeal, on the lived experiences of all South Africans, says Professor Narnia
It was gratifying to see that the Bohler-Muller, the project leader and deputy executive director of DGSD.
study recommendation immediately Professor Bohler-Muller, a legal academic for 16 years and a South African
informed policy; the Department advocate of the High Court, will work with a team of legal researchers and social
of Health invited research staff scientists on the project. The study will have a particular focus on the adjudication
to contribute specifically to food and implementation of socioeconomic rights within a developmental and capable
security and nutrition policy. We state, and pertinent issues relating to access to justice with a view to addressing
expect the data to be used to set inequality and the eradication of poverty. The DOJCD will officially launch the
standards in the areas of nutrition, project mid-September 2013.
weight, height, body mass index and Bohler-Muller said the bidding team undertook to produce high quality research
a range of important biomarkers, outputs in accordance with the mandate of the department. Together with UFH,
such as glycosylated haemoglobin the HSRC has the experience and the skills, resources and networks to conduct
(HBA1C), cholesterol, vitamin A, large-scale, evidence-based cross- and trans-disciplinary research projects,
iron and cotinine, and also to inform including empirical assessments and surveys, aimed at social, economic and
the development of interventions community development.
to reduce risk factor for non- ‘Furthermore, the HSRC is internationally renowned for its research
communicable diseases. independence, integrity and ethics, while UFH adds value with the UNESCO
In this HSRC Review we represent Oliver Tambo Chair of Human Rights, established in 1996. The main objective of
three survey topics included in the the UFH Research Chair is to promote an integrated system of research, training,
survey (pages 4 to 13), with others information and documentation in the field of human rights and democracy,’
scheduled to follow in forthcoming Bohler-Muller explains. The government is in the process of assessing the impact
editions. of court decisions on the socioeconomic conditions of all South Africans.
‘Among others, the research will determine through a mixture of methodologies
Dr Olive Shisana what remedies the courts have developed to ensure that court decisions are
CEO HSRC implemented in the spirit of the Bill of Rights,’ concludes Bohler-Muller.
1
NewsRoundup
New@HSRC
Prof. Oladele Arowolo, who has vast experience in population policy formulation in various African countries and
different institutions, has been appointed chief research specialist in the Research Use and Impact Assessment unit.
He obtained his PhD in demography from the University of Pennsylvania, Philadelphia, USA. Before joining the HSRC
he served as a consultant to UNFPA, UNDP, FAO, UNECA and the World Bank, among others, on population and
development projects in various countries, including Namibia, Mozambique, Botswana, Malawi, Swaziland, Ethiopia,
Liberia, Malawi, Lesotho, Uganda, South Africa, Sudan and Syria.
Dr Bongani Bantwini has been appointed as senior research specialist and acting director in the Research Use
and Impact and Assessment unit. He obtained a PhD in science education from the University of Illinois at Urbana-
Champaign in the USA. Before rejoining the HSRC in June 2013 he was an assistant professor of science education
at Kennesaw State University. He previously held a position in the Education and Skills Development programme at
the HSRC.
Ms Safiyya Goga, a former English second-language teacher in Japan, has taken up a position as senior researcher
and PhD intern in the Human and Social Development programme. She holds an MA in political sociology from
Rhodes University in Grahamstown. She also worked as a junior researcher at the Community Agency for Social
Enquiry (CASE) in Johannesburg.
Prof. Charles Hongoro has been appointed research director in the Population Health, Health Systems and
Innovation programme. He holds a PhD in health economics and policy from the London School of Hygiene and
Tropical Medicine, University of London. Before rejoining the HSRC in July 2013 he was unit director of the Health
Systems Research Unit at the South African Medical Research Council. He previously held a position as a director in
the former Policy Analysis Unit at the HSRC.
Dr Benita Moolman has been appointed research specialist in the Human and Social Development programme.
She obtained a PhD in feminist geography from the University of California, Davis, in the United States. Before
joining the HSRC she was project co-ordinator at Heinrich Boell Stiftung.
Dr Andrew Paterson, who has been appointed as a research director in the Education and Skills Development
research programme, holds a PhD in Social History at the University of Cape Town. Before re-joining the HSRC he
worked as a lecturer, senior lecturer and research specialist at universities in South Africa and Thailand.
Ms Il-haam Petersen has been appointed chief researcher in the Education and Skills Development programme. She
obtained a PhD in sociology from the University of Dublin, Trinity College in Ireland. Before joining the HSRC she was
a teaching assistant in sociology at Trinity College, Dublin and research intern at LIRNEasia in Sri Lanka.
Prof. Jane Rarieya has taken up a position as senior research specialist and African research fellow in the Human
and Social Development programme. She obtained an EdD in gender and educational management from Keele
University in the United Kingdom. Before joining the HSRC she was an associate professor and associate director
and head of teaching and learning at the Aga Khan University in Dar es Salaam.
Dr Khangelani Zuma, previously a research director and head of biostatistics in the HIV/AIDS, STIs and TB
programme at the HSRC, has been promoted to executive director of the Research Data Management Centre.
He holds a PhD in statistics from the University of Waikato, New Zealand.
2 HSRC Review
BRICS in South Africa,
and the think tank in BRICS
Earlier this year, the South African Cabinet designated the HSRC as the incubator of the
South African BRICS Think Tank for the 2013/14 financial year. In this capacity it is supported
by the Department of International Relations and Cooperation (DIRCO) and the Department
of Higher Education and Training (DHET). What led to this development, and why is it
important? Michael Cosser explains.
South Africa was formally welcomed into the BRICS shape the strategic visions of individual BRICS countries, as
(Brazil, Russia, India, China, South Africa) fold through well as the grouping as a whole.
the Sanya Declaration, the official proceedings of the
meeting of BRICS countries that took place in Hainan, China, It is imperative that the fast-growing
on 14 April 2011. This development signalled an important
milestone in South Africa being recognised as a key player countries of the (BRICS) grouping
in the emerging and developing group of countries and as a
regional powerhouse in sub-Saharan Africa. have a platform – the think tank –
Even before South Africa’s admission to BRICS however,
Brazil, Russia, India and China had acknowledged the for the exchange of ideas and the
significance of think tanks, formally welcoming the
establishment of a conference of think tanks in their joint generation of evidence-based policy
statement, issued after the second BRIC Summit of Heads
of State and Government on 15 April 2010 (Brasilia, Brazil). recommendations.
South Africa needs a think tank The South African context
As a member of the BRICS grouping, South Africa needs
to provide strategic vision for the a think tank to provide strategic vision for the country as it
negotiates its role within a changing world order, and also
country as it negotiates its role within to give it a voice within the BRICS Think Tanks Council, a
formation of the think tanks of the five countries, formally
a changing world order and to give it recognised through the eThekwini Declaration of 27 March
2013 (the proceedings of the fifth BRICS summit held in
a voice within the BRICS Think Tanks Durban). Hence the decision to establish a South African
think tank and to appoint the HSRC as incubator of the South
Council. African BRICS Think Tank, given the HSRC’s pre-eminence as
a social science body with a strong evidence-based approach
to research and policy formation.
The importance of think tanks Since South Africa is the BRICS chair for 2013/14, its think
Think tanks have played a major role in explaining the tank has assumed responsibility for spearheading the agenda
phenomenon of global political and economic change over of the BRICS Think Tanks Council (BTTC). A major item on
the past three-quarters of a century. The UN Development this agenda is the drafting of a long-term vision and strategy
Programme, for example, regard think tanks as organisations for BRICS, and the HSRC has been tasked to oversee and
‘engaged on a regular basis in research and advocacy on finalise the process. Having drawn up a schedule for this
any matter related to public policy… [building] the bridge process, the HSRC is collating comments from the five
between knowledge and power in modern democracies’. countries into the next draft of the vision and strategy
From a BRICS perspective it is imperative that the fast- document, which will be finalised at the mid-term meeting of
growing countries of the grouping have a platform – the the BTTC in November. ■
think tank – for the exchange of ideas and the generation of
evidence-based policy recommendations. Given their location Author: Michael Cosser, HSRC and member, BRICS Secretariat, interim
at the research-policy nexus, think tanks are well placed to South African BRICS Think Tank.
3
South African National Health and Nutrition Survey (SANHANES-I)
Mapping the health
and nutritional status
of South Africans
The first South African National Health and Nutrition Examination Survey (SANHANES-1), a
400-page report of a population health survey that will be regularly repeated, was released
in August by the HSRC. The aim: to address the changing health needs in the country, and
provide a broader and more comprehensive platform to study the health and nutritional
status of the nation on a regular basis.
The study was compiled by a research
consortium comprising the HSRC and the
Medical Research Council (MRC), and was
financed by the national Department of Health,
the UK Department for International Development
(DFID) and the HSRC.
SANHANES-1 provides critical information to map
the emerging epidemic of non-infectious or non-
communicable diseases (NCDs) in South Africa,
and to analyse the underlying social, economic,
behavioural and environmental factors that
contribute to the population’s state of health.
Study methods
SANHANES-1 included individuals of all ages living
in South Africa, except the homeless and those
living in educational institutions, old age homes,
hospitals and uniformed-service barracks. The
study, conducted during 2012, included 25 532
individuals (92.6% interview response rate) who
completed a questionnaire-based interview; 12 025
participants had a physical examination completed
by a medical doctor; and 8 078 participants
provided a blood specimen for biomarker testing.
A biomarker is a measurable characteristic that
reflects the severity or presence of the state
of some disease, in the context of this article,
vitamin A and iron deficiencies. This first round
of SANHANES will provide baseline data of a
representative sample of the population for future
analysis over long periods of time (longitudinal
surveys). ■
The following three articles cover the findings on the status of non-
communicable diseases among adults and children, food security
and the food choices people make that impact on their health.
4 HSRC Review
South African National Health and Nutrition Survey (SANHANES-I)
Non-infectious diseases
pose an economic threat
to healthcare
No country can afford the economic burden placed on its health system by the rise in non-
communicable diseases – not even the rich ones – proclaimed Minister of Health Aaron
Motsoaledi at the launch of the results of the South African National Health and Nutrition
Survey (SANHANES-I). He was referring to the rise in the prevalence of cardiovascular
diseases and diabetes among South Africans. Demetré Labadarios, Olive Shisana and
Lucinda Dalais explain further.
In that assumption the minister is not alone. The World High blood pressure
Economic Forum’s 2009 Global Risks Landscape High blood pressure is associated with high stress, smoking,
Assessment Report claimed that NCDs were ‘the most high salt intake, diabetes, older age, cholesterol, physical
significant threats facing global and local economies.’ South unfitness and overweight.
Africa is no different. This study found that the South African population had high
In terms of the national strategic plan, NCDs include rates of post-traumatic stress disorder, diabetes, overweight
cardiovascular diseases, diabetes, chronic respiratory and obesity, cholesterol, and lack of exercise, suggesting that
conditions, cancer, mental disorders, oral diseases, eye the population was at increased risk of non-communicable
disease, kidney disease and musculoskeletal conditions. diseases. At the provincial level, the Free State, followed
The good news is that much can be done to prevent or by North-West and Gauteng, had the highest occurrence of
improve the management of these conditions by addressing hypertension (Figure 2). The reasons for these findings require
the underlying causes of NCDs through focusing efforts on further investigations.
reducing smoking, alcohol consumption and overweight The study’s clinical examination confirmed the high
among South Africans while increasing exercise frequency, occurrence of pre-hypertension and hypertension as shown
and eating a wider variety of foods. in Figure 1. Overall, 10.4% of participants aged 15 years
This is where the comprehensive SANHANES study comes and older were pre-hypertensive (blood pressure between
in; it provides policy makers and programme managers with 120-139/80-89mmHg) and a further 10.2% had hypertension
critical information on emerging epidemics of NCDs, and the (blood pressure ≥ 140/90mmHg).
underlying social, economic, behavioural and environmental
factors that drive these diseases in the South African Figure 1: Prevalence of pre-hypertension and hypertension by age,
population. SA 2012
Two non-communicable diseases
35
Selected findings of SANHANES-I on cardiovascular disease
30
and diabetes in relation to some risk factors are summarised
in this issue of HSRC Review. 25 19.5
stuInd yr edlaettieornm tion ethde tshee tnwoon -NmCoDdsifi aanbdle trhisekir fraisckto frasc, tsoursc,h t ahsis ntage 20 12.2 21.5
family history, as well as modifiable risk factors such as blood Perce15 4.4 18.9
pressure, body weight, blood cholesterol and blood sugar. 10
16.0 15.5
In terms of family history, during the interviews, 1.0 12.5
5 8.8
respondents were most likely to report a family history of 5.6 4.4
high blood pressure (30.9%), followed by high blood sugar 0
(20.7%), while fewer respondents reported a family history of 15-24 25-34 35-44 45-54 55-64 65+
stroke (8.9%) and heart disease (heart attack, angina, chest Pre-hypertension (BP 120-139/80-89 mmH g) Hypertension BP>=140/90mmHg
pain: 7.6%).
5
South African National Health and Nutrition Survey (SANHANES-I)
Figure 2: Hypertension by province, SA 2012 Figure 4: Diabetes by province
20 25

17.3 20 21.7
15
Percentage 105 13.0 11.4 10.8 10.4 9.4 9.1 8.4 6.6 10.2 Percentage 1105 12.5 11.2 10.1 10.0 8.5 7.9 9.5
5
5.6
4.6
0 0
Free State North West Gauteng Northern Cape Eastern Cape Western Cape Mpumalanga Kwazulu-Natal Limpopo Total Northern Cape North West Western Cape Free State Kwazulu-Natal Eastern Cape Gauteng Mpumalanga Limpopo Total

Diabetes Cholesterol
Figure 3 shows that almost one out of five participants Of equal concern was the overall finding of high blood
(18.4%) had impaired glucose homeostasis, largely due to the cholesterol in almost a quarter of the population (Figure
body’s ineffective use of insulin due to excessive body weight 5). There were gender differences in the prevalence of
and physical inactivity. These individuals could potentially be high total cholesterol, with females found to have higher
considered as pre-diabetic and need further diagnostic follow- prevalence when compared with males. Indians had the
up. Diabetes was diagnosed in 9.5% of participants. highest prevalence, whereas black Africans had the lowest
prevalence. Although high blood cholesterol does run in
Figure 3: Prevalence of pre-diabetes and diabetes by age, families, the more common associated cause includes the
SA 2012 excessive dietary intake of foods high in saturated fat, being
overweight or obese, and inadequate physical activity.
35 Figure 5: Prevalence of hypercholesterolaemia (high total blood
30 19.0 cholesterol) by race, SA 2012
24.4
25
100
ntage 20 16.7 90
Perce15 80 45.3
4.3 19.9 70
10
13.9 ge 60 40.6
05 30..83 32..85 9.0 11.2 Percenta 4500 28.1
24.9 41.2
15-24 25-34 35-44 45-54 55-64 65+ 30
HbA1c > 6.1% & < 6.5% HbA1c > 6.5% 20 27.2
10 15.3 18.9
Note: Green is pre-diabetes and red is diabetic 0
African Coloured Asian/Indian Total
Furthermore, diabetes and impaired glucose homeostasis Males Females
appeared to have increased when compared with the findings
of other, older, national surveys. In analysing the data per
province, it showed that the figure for the Northern Cape was
significantly higher than in the other provinces (21.7%), while
Limpopo showed the lowers prevalence at 4.6%.
6 HSRC Review
South African National Health and Nutrition Survey (SANHANES-I)
A weighty matter high blood pressure, heart problems, and stroke, were of
On the weighty matter of excessive body weight, many major concern.
factors (including genetics) are known and claimed to be the Comparing the results of overweight and obesity in
cause to a greater or lesser extent. But the basic principle SANHANES-1 with those of the 2003 SA Demographic and
still remains, namely that the equation of energy ingested Health Survey (SADHS), the results indicated an increase
in the form of food should balance the energy expended in the mean body mass index (BMI) across almost all age
through physical activity and bodily function maintenance. categories, provinces and race groups since 2003.
Disturbances in this equation lead to weight changes This increase was significant in the body measurements
(weight gain or weight loss). Excessive eating, be it in the of adults, particularly females (Table 1). The BMI, waist
form of energy dense foods or large portion sizes in relation circumference, and waist-hip ratio all showed the same
to energy expended (physical activity/inactivity) is generally trend, namely that obesity levels have increased in South
accepted as the main cause of overweight and/or obesity. Africa and with that the risk of metabolic complications
In this study, the findings of overweight and obesity in the associated with chronic disease.
population, which may contribute to various NCDs such as
Table 1: Overall comparison between SADHS 2003 and SANHANES-1 2012, of anthropometry (study of the measurements and proportions of
the human body) of adult men and women
Variable (units) Men Women
SADHS 2003 SANHANES-1 SADHS 2003 SANHANES-1
Mean BMI kg/m2 23.3 23.5 27.0 28.9
Underweight (%) 12.5 13.1 6.2 4.0
Overweight (%) 21.0 19.6 27.5 25.0
Obese (%) 8.8 11.6 27.4 40.1
Waist Circumference ≥ 102cm (%) 5.0 9.9
Waist Circumference ≥ 88cm (%) 33.7 50.5
Waist-hip ratio ≥ 1.0 (%) 6.4 7.0
Waist-hip ratio ≥ 0.85 (%) 32.0 47.4
Lazy bones Females tend to live a sedentary lifestyle compared to males,
In terms of physical activity, our nation is not doing much with differences pronounced in urban formal residents and
better. A significant proportion of adults in the country were rural formal areas.
found to be unfit (Figure 6). This has not improved since the
2003 international study completed in 51 countries, which What to do?
included South Africa. The trends reported in the current The SANHANES team recommended several measures to
survey were in line with those in other studies in Africa, the Department of Health, including:
developed countries, and at the global level. • Strengthen the current NCD strategy while making
available the necessary financial support for this purpose.
Figure 6: Prevalence of aerobic fitness: percentage of unfit • Launching a national awareness campaign that address
participants aged 18-40 years old by sex and locality, SA 2012 risk factors in this domain at the home (awareness,
practices, and healthy choices), workplace (enabling
environment to promote awareness and physical activity)
100
and community level (an environment that affords safety
90
and is conducive to recreational activities), in collaboration
80 52.9
with all other relevant government departments and
70
45.2 employers to formalise a road map for the immediate-,
Percentage 456000 34.8 37.3 41.4 medium-, and longer-term future. ■
Authors: Professor Demetré Labadarios, executive director, research
30
33.5 programme on Population Health, Health Systems and Innovation, HSRC;
20 27.9
22.6 Professor Olive Shisana, CEO, HSRC; Lucinda Dalais, PhD intern, PHHSI,
10 17.9 18.2
HSRC.
0
Urban Formal Urban Informal Rural Formal Rural Informal Total
Males Females The full report is available on http://tinyurl.com/klvx5ud
7
South African National Health and Nutrition Survey (SANHANES-I)
Stunting, overweight and
obesity in the very young:
two sides of a coin
South African children have a major problem of stunting as well as overweight and obesity,
already starting as young as two years old. On the positive side, the South African National
Health and Nutrition Examination Survey (SANHANES-1), shows that there is a clear
decrease in wasting and underweight as well as an improvement in the iron and vitamin A
status of children aged 2-5, report Muhammad Ali Dhansay, Demetré Labadarios, Olive
Shisana and Whadi-ah Parker.
Nutrition, in general, is an important prerequisite to both Figure 1: Trends in the prevalence of undernutrition in children aged
individual and national development. More specifically, 1-3 years, SA 2005-2012.
nutrition early in life is considered to be an important
determinant of health and disease patterns in adulthood. As 30 26.5
such, nutrition during the first 1 000 days – right from the start 23.4
25
of pregnancy up to the child’s second birthday – is considered
critical to the child’s development and health in adulthood. ge 20
unVdaerrinouutsr intiaotnio, neaslp seucriavellyy ss thuanvtein sgh (ocwhrno nthica tu nchdieldrn utrition), has Percenta 1105 6.4 9.5 11 6.1
remained unacceptably high in South Africa. Although other 5.1
forms of child undernutrition occur less frequently, they are of 5 2.2 0.9 1.1 1.2 1.7
equal importance. 0
StohvueeTr vhrpneeruye St v(roSaitulAieotNnnhc, HA eoAf vorNeifc rEamwSnae -N1ling)a uhpttitror oiantvniaoiddln eH,o diebn aemclsltuohitdr yeai.n n rgde cuNenundtter iirtnniofuontr rmEitxiaoatnmio aninn oadnt io n Stunting Stunting Severe stunting NFCS 2005 Wasting SANHANESevere Wasting S 2012 Underweight Severe Underweight
There was an increase in both Figure 2: Trends in the prevalence of undernutrition in children aged
4-6 years, SA 2005-2012.
stunting and severe stunting among
18 16.4
toddlers aged 1-3 years. 16
14 11.9
12
Findings ntage 10 8.6
Perce 68 5.1 05 4.5
Stunting, overweight and underweight 4 2.2 02 1.5
When compared to the previous national data of the National 2 0.8 0.8 0.6
Food Consumption Survey (NFCS) in 2005, bearing in mind 0
ta(13hn)..e 1 iI n%nlicm tr)he iatiasams taieoog nniengs g btoroofod tuchdop lsem, trousptn ahatreiginsreg ofd on( 3r1sm.- 13bs% ey toew)f aa ercnshed iniln d ss etuuhvnreevd receeyor snsu,tun uttthnrrieyttii rno(eFgn i w guarse Stunting Stunting Severe stunting NFCS 2005 Wasting SANHANESevere Wasting S 2012 Underweight Severe Underweight
(underweight and wasting) had improved and remained in the
low severity category of public health importance as defined
by the WHO. In the older age group of children (4-6 years), all
undernutrition indices improved when compared to the NFCS
2005 data (Figure 2).
8 HSRC Review