No. 07: Rapid Urbanization and the Nutrition Transition in Southern Africa

The nutrition transition, including the presence of malnutrition and obesity in poor urban populations (the so-called ‘double burden’ of disease), is occurring in Southern Africa in the context of massive rural-urban migration and rapid urbanization. This seemingly contradictory situation poses one of the major threats to public health in the developing world, and impacts the poor – and therefore the most food insecure – to the greatest extent. This paper reviews the state of knowledge about food insecurity and the nutrition transition in the urban areas of Southern Africa drawing on existing studies and new research conducted by AFSUN. The paper lays out an agenda for future research on nutrition environments and discusses the implications of undernutrition and overnutrition for urban policy making on health and food security in the region

Food System and Food Security Study for the City of Cape Town

Food insecurity is a critical, but poorly understood, challenge for the health and development of Capetonians. Food insecurity is often imagined as hunger, but it is far broader than that. Households are considered food secure when they have “physical and economic access to sufficient and nutritious food that meets their dietary needs and food preferences for an active and healthy life” (WHO/FAO 1996). Health is not merely the absence of disease, but also encompasses good nutrition and healthy lifestyles. Individuals in a food insecure household and/or community are at greater risk due to diets of poor nutritional value, which lowers immunity against diseases. In children, food insecurity is known to stunt growth and development and this places the child in a disadvantaged position from early on in life. Any improvement in the nutritional profile of an individual is beneficial and as the family and community become more food secure, the greater the benefit. It further reduces the demand on health services. In the Cape Town context, food insecurity manifests not just as hunger, but as long term consumption of a limited variety of foods, reduction in meal sizes and choices to eat calorie dense, nutritionally poor foods in an effort to get enough food to get by. Associated with this food insecurity are chronic malnutrition and micronutrient deficiency, particularly among young children, and an increase in obesity, diabetes and other diet related illnesses. Food insecurity is therefore not about food not being available, it is about households not having the economic or physical resources to access enough of the right kind of food. The latest study of food insecurity in Cape Town found that 75 percent of households in sampled low-income areas were food insecure, with 58 percent falling into the severely food insecurity category. Food insecurity is caused by household scale characteristics, such as income poverty, but also by wider structural issues, such as the local food retail environment and the price and availability of healthy relative to less healthy foods. The City of Cape Town therefore commissioned a study based on the following understanding of the food security challenge facing the City. “Food security or the lack thereof is the outcome of complex and multi-dimensional factors comprising a food system. Therefore, food insecurity is the result of failures or inefficiencies in one or more dimensions of the food system. This necessitates a holistic analysis of the food system that than can provide insights into the various components of the system, especially in our context as a developing world city.” The call for a food system study sees the City of Cape Town taking the lead nationally, being the first metropolitan area to seek to engage in the food system in a holistic manner and attempting to understand what role the city needs to play in the food system. The City must work towards a food system that is reliable, sustainable and transparent. Such a system will generate household food security that is less dependent on welfarist responses to the challenge. In this context, reliability is taken to mean stable and consistent prices, the nutritional quality of available and accessible food, and food safety. Sustainability means that the food system does not degrade the environmental, economic and social environment. Finally, transparency refers to the legibility of the system and its control by the state and citizens

Understanding Fruit and Vegetable Consumption: A Qualitative Investigation in the Mitchells Plain Sub-district of Cape Town

Objectives: Many South Africans do not consume enough fruit and vegetables. However, people are generally aware of the benefits of adequate consumption. To understand this gap between knowledge and practice, this study investigated underlying factors influencing consumption through a qualitative, cross-sectional, descriptive case study conducted in Mitchell’s Plain, Cape Town. Methods: Four focus groups to gain broad understanding and 15 interviews with strategically selected individuals influential in food preparation, distribution or consumption, to gain in-depth understanding of specific factors influencing fruit and vegetable consumption were conducted. Results: The study identified a number of drivers of fruit and vegetable consumption patterns. Barriers to consumption included perishability and affordability; that fruit/vegetables are not considered priority food items (inadequate time and effort is allocated to purchasing and preparation); reported negative side-effects of consumption, and that health benefits are not immediately apparent. Consumption was facilitated by personal preference, traditional dishes that include fruit/vegetables, increased availability of fruit/vegetables and discipline in children. Suggestions to improve consumption included providing practical advice to decrease preparation time and cost, and recipes to increase appeal of fruit/vegetable dishes. However, this needs to be understood in the context of the bigger structural issues that help or hinder fruit and vegetable consumption

Understanding fruit and vegetable consumption: A qualitative investigation in the Mitchells plain sub-district of Cape Town

Objectives: Many South Africans do not consume enough fruit and vegetables. However, people are generally aware of the benefits of adequate consumption. To understand this gap between knowledge and practice, this study investigated underlying factors influencing consumption through a qualitative, cross-sectional, descriptive case study conducted in Mitchell’s Plain, Cape Town. Methods: Four focus groups to gain broad understanding and 15 interviews with strategically selected individuals influential in food preparation, distribution or consumption, to gain in-depth understanding of specific factors influencing fruit and vegetable consumption were conducted. Results: The study identified a number of drivers of fruit and vegetable consumption patterns. Barriers to consumption included perishability and affordability; that fruit/vegetables are not considered priority food items (inadequate time and effort is allocated to purchasing and preparation); reported negative side-effects of consumption, and that health benefits are not immediately apparent. Consumption was facilitated by personal preference, traditional dishes that include fruit/vegetables, increased availability of fruit/vegetables and discipline in children. Suggestions to improve consumption included providing practical advice to decrease preparation time and cost, and recipes to increase appeal of fruit/vegetable dishes. However, this needs to be understood in the context of the bigger structural issues that help or hinder fruit and vegetable consumption

Genome-Wide Association Study of Peripheral Artery Disease

Background: Peripheral artery disease (PAD) affects >200 million people worldwide and is associated with high mortality and morbidity. We sought to identify genomic variants associated with PAD overall and in the contexts of diabetes and smoking status. Methods: We identified genetic variants associated with PAD and then meta-analyzed with published summary statistics from the Million Veterans Program and UK Biobank to replicate their findings. Next, we ran stratified genome-wide association analysis in ever smokers, never smokers, individuals with diabetes, and individuals with no history of diabetes and corresponding interaction analyses, to identify variants that modify the risk of PAD by diabetic or smoking status. Results: We identified 5 genome-wide significant (P-associationPeer reviewe

We can’t keep eating like this : food system change for sustainable health

McLachlan, Milla. 2011. We can’t keep eating like this: food system change for sustainable health. Stellenbosch : Stellenbosch University.Inaugural address delivered on 25 October 2011Born in Cape Town, Milla McLachlan attended schools in the city, as well as in Pretoria and Johannesburg, before receiving her undergraduate education at Stellenbosch University. She completed a PhD at Michigan State University in East Lansing in the USA, and recently completed an MA at Naropa University in Boulder, Colorado. Milla has been involved in international social development for more than 30 years, focusing on addressing food and nutrition issues though public policy and community action. As Nutrition Advisor at the World Bank in Washington, DC, she supported policy and strategy development for national nutrition programmes in several countries, including Bangladesh and Ethiopia. She coordinated a team of eminent nutrition researchers in a review of the nutrition work of the World Bank and UNICEF, which led to the publication of an edited volume, Combating Malnutrition: Time to Act. This work contributed to the development of a renewed focus on nutrition in World Bank programmes. Since her return to South Africa in 2006, Milla has consulted widely in Africa, building capacity for community-based action on nutrition and facilitating leadership- and partnership-building activities. With a particular interest in social change as it relates to food systems, Milla now enjoys navigating the interface between research, policy and practice through her leadership and involvement in the SU Food Security Initiative (FSI), the Community Nutrition Security Project of the SU Division of Human Nutrition, and the Southern African Food Lab, a multi-stakeholder initiative using social innovation to shift the food system towards greater sustainability

Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape Province

CITATION: Goosen, C., McLachlan, M. & Schubl, C. 2014. Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape Province. South African Journal of Child Health, 8(2):50-54, doi:10.7196/SAJCH.675.The original publication is available at http://www.sajch.org.za/index.php/SAJCHBackground. Exclusive breastfeeding during the first 6 months of life protects against infant morbidity and mortality. Few studies describe the infant feeding practices of mothers living in low-income areas of the Western Cape Province of South Africa (SA). Objective. To describe the infant feeding practices of mothers of infants younger than 6 months in two low-income communities of SA. Methods. A cross-sectional community-based study using a structured questionnaire, and seven focus group discussions were conducted from February to August 2011 in Avian Park and Zwelethemba in Worcester, an urban area in the Western Cape. Results. Seventy-seven per cent of participants (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four per cent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially and 31% (n=43) did not breastfeed. Ninety per cent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were 1 month old. Forty-four per cent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were 3 months old. Qualitative findings indicated that gripe water, Lennon’s Behoedmiddel and herbal medicines were also given to infants. Nutritive liquids and/or food most commonly given as supplementary feeds were formula milk and commercial infant cereal. Conclusion. Exclusive breastfeeding (EBF) during the first 6 months of life was a rare practice in these low-income communities. Water, non-prescription medicines and formula milk and/or food were introduced at an early age.http://www.sajch.org.za/index.php/SAJCH/article/view/675Publisher's versio

No. 07: Rapid Urbanization and the Nutrition Transition in Southern Africa

The nutrition transition, including the presence of malnutrition and obesity in poor urban populations (the so-called ‘double burden’ of disease), is occurring in Southern Africa in the context of massive rural-urban migration and rapid urbanization. This seemingly contradictory situation poses one of the major threats to public health in the developing world, and impacts the poor – and therefore the most food insecure – to the greatest extent. This paper reviews the state of knowledge about food insecurity and the nutrition transition in the urban areas of Southern Africa drawing on existing studies and new research conducted by AFSUN. The paper lays out an agenda for future research on nutrition environments and discusses the implications of undernutrition and overnutrition for urban policy making on health and food security in the region