Estimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000

Objectives. To estimate the disease burden attributable to being underweight as an indicator of undernutrition in children under 5 years of age and in pregnant women for the year 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. The 1999 National Food Consumption Survey prevalence of underweight classified in three low weight-for-age categories was compared with standard growth charts to estimate population-attributable fractions for mortality and morbidity outcomes, based on increased risk for each category and applied to revised burden of disease estimates for South Africa in 2000. Maternal underweight, leading to an increased risk of intra-uterine growth retardation and further risk of low birth weight (LBW), was also assessed using the approach adopted by the global assessment. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Children under 5 years of age and pregnant women. Outcome measures. Mortality and disability-adjusted life years (DALYs) from protein- energy malnutrition and a fraction of those from diarrhoeal disease, pneumonia, malaria, other non- HIV/AIDS infectious and parasitic conditions in children aged 0 - 4 years, and LBW. Results. Among children under 5 years, 11.8% were underweight. In the same age group, 11 808 deaths (95% uncertainty interval 11 100 - 12 642) or 12.3% (95% uncertainty interval 11.5 - 13.1%) were attributable to being underweight. Protein-energy malnutrition contributed 44.7% and diarrhoeal disease 29.6% of the total attributable burden. Childhood and maternal underweight accounted for 2.7% (95% uncertainty interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and 10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in children under 5. Conclusions. The study shows that reduction of the occurrence of underweight would have a substantial impact on child mortality, and also highlights the need to monitor this important indicator of child health. South African Medical Journal Vol. 97 (8) Part 2 2007: pp. 733-73

Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal provinces, South Africa

Objective: To assess primary health care (PHC) facility infrastructure and services, and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Design: Cross-sectional survey. Setting: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). Subjects: PHC facilities and nurses (EC: n = 20; KZN: n = 20), and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). Methods: Structured interviewer-administered questionnaires and anthropometric survey. Results: Of the 40 PHC facilities, 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20%; KZN: 25%); electricity (EC: 45%; KZN: 85%); flush toilets (EC: 40%; KZN: 75%); and operational telephones (EC: 20%; KZN: 5%). According to more than 80% of the nurses, problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41%; KZN: 25%). Social grants were reported as a main source of income (EC: 33%; KZN: 28%). Few households reported that they had enough food at all times (EC: 15%; KZN: 7%). The reported prevalence of diarrhoea was high (EC: 34%; KZN: 38%). Undernutrition in 0 to younger than 6 month-olds was low; thereafter, however, stunting in children aged 6 to 59 months (EC: 22%; KZN: 24%) and 60 to 71 months (EC: 26%; KZN: 31%) was medium to high. Overweight and obese adults (EC: 49%; KZN: 42%) coexisted. Conclusion: Problems regarding infrastructure, basic resources and services adversely affected PHC service delivery and the well-being of rural people, and therefore need urgent attention.Keywords: primary health care facilities; nutritional status; children; caregivers’ rural; South Afric

Enriching diets for childhood mental and physical development

The original publication is available at http://www.hsag.co.za/Malnutrition is a public health problem in South Africa, especially among rural black children. Intakes below 67% of the Recommended Dietary Allowance (RDA) are common for calcium, iron, zinc, selenium, vitamin A, C, D, E, riboflavin, niacin and vitamin B6. Key nutrients for growth and development include calcium, iron, zinc, vitamin A, folate and other B-vitamins. Calcium is essential for bone mineralisation during the adolescent growth spurt. Iron deficiency is associated with impaired growth, delayed psychomotor development and impaired immunity. Zinc is associated with normal growth, bone mineralisation and neuropsychological function. Vitamin A is essential for normal growth, eyesight and immunity. Folate is necessary for the development of new cells, especially during phases of accelerated growth. Other B-vitamins are linked to a variety of behavioural and cognitive outcomes. Factors compromising the nutritional status of children include amongst others, an inadequate nutrient intake due to poverty, inadequate nutrition education, diarrhoeal diseases, teenage dieting and allergies. To ensure optimal growth and development, strict diets should be discouraged and sound meal patterns should be encouraged, including starting the day with breakfast, and eating a variety of foods to ensure adequate intakes of nutrients and fibre. Regular physical activity promotes a healthy body weight and normal bone mineralisation.Wanvoeding is ‘n openbare gesondheidsprobleem in Suid-Afrika, veral onder plattelandse swart kinders. Mikronutriënt innames laer as 67% van die Aanbevole Dieettoelae (ADT) is algemeen vir kalsium, yster, sink, selenium, vitamien A, C, D, E, riboflavien, niasien en vitamien B6. Belangrike nutriënte vir groei en ontwikkeling sluit kalsium, yster, sink, vitamien A, folaat en ander B-vitamiene in. Kalsium is essensieel vir beenmineralisering tydens die adolessente snelgroeifase. Ystertekort word met belemmerde groei geassosieer, asook met vertraagde psigomotoriese ontwikkeling en verswakte immuniteit. Sink word met normale groei, beenmineralisering en neuropsigologiese funksie geassosieer. Vitamien A is essensieel vir normale groei, sig en immuniteit. Folaat is nodig vir die ontwikkeling van nuwe selle, veral tydens fases van versnelde groei. Ander B-vitamiene speel ‘n rol in ‘n verskeidenheid gedrags- en kognitiewefunksies. Faktore wat die voedingstatus en gesondheid van kinders kan benadeel, sluit ‘n onvoldoende nutriëntinname as gevolg van onder andere, armoede, onvoldoende voedingsvoorligting, diaree, tienerdiëte en allergieë in. Om optimale groei en ontwikkeling te verseker, moet streng diëte en oorslaan van maaltye ontmoedig word en ‘n gebalanseerde maaltydpatroon gevestig word. Ontbyt moet gereeld geëet word, tesame met ‘n verskeidenheid voedselsoorte, om voldoende innames van nutriënte en vesel te verseker. Gereelde fisiese aktiwiteit bevorder ‘n gesonde liggaamsgewig en normale beenmineralisering.Publishers' versio

Factors affecting body composition in preterm infants: Assessment techniques and nutritional interventions

Limited research has been conducted that elucidates the growth and body composition of preterm infants. It is known that these infants do not necessarily achieve extra-utero growth rates and body composition similar to those of their term counterparts. Preterm infants, who have difficulty in achieving these growth rates, could suffer from growth failure. These infants display an increased intra-abdominal adiposity and abnormal body composition when they achieve catch-up growth. These factors affect the quality of weight gain, as these infants are not only shorter and lighter than term infants, they also have more fat mass (FM) and less fat-free mass (FFM), resulting in a higher total fat percentage. This could cause metabolic syndrome and cardiovascular problems to develop later in a preterm infant's life. The methods used to determine body composition in preterm infants should be simple, quick, non-invasive and inexpensive. Available literature was reviewed and the Dauncey anthropometric model, which includes skinfold thickness at two primary sites and nine body dimensions, is considered in this review the best method to accurately determine body composition in preterm infants, especially in resource-poor countries. It is imperative to accurately assess the quality of growth and body composition of this fragile population in order to determine whether currently prescribed nutritional interventions are beneficial to the overall nutritional status and quality of life—in the short- and long-term—of the preterm infant, and to enable timely implementation of appropriate interventions, if required. Key Words: body composition, developing country, nutritional interventions, preterm infant, skinfold thicknes

Stunting, overweight and obesity in the very young: two sides of the coin

Nutrition, in general, is an important prerequisite to both individual and national development. More specifically, nutrition early in life is considered to be an important determinant of health and disease patterns in adulthood. As such, nutrition during the first 1 000 days right from the start of pregnancy up to the child's second birthday is considered critical to the child's development and health in adulthood. Various national surveys have shown that child undernutrition, especially stunting (chronic undernutrition), has remained unacceptably high in South Africa. Although other forms of child undernutrition occur less frequently, they are of equal importance. The South African National Health and Nutrition Examination Survey (SANHANES-1) provided more recent information on the prevalence of malnutrition, including undernutrition and overnutrition, overweight and obesity.

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South-African infants

The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status, linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape, South Africa. The study was designed as an intervention study. In both the experimental and control groups, serum retinol concentration showed a decline over the intervention period of 6 months. The decline was less pronounced in the experimental group. This resulted in a significantly (P <005) higher serum retinol concentration at 12 months in the experimental group (26.8+/-5.8 mug/dl) compared with the control group (21.4+/-5 mug/dl). Serum iron concentration also declined over the intervention period. The decline was less pronounced in the experimental group. No difference was observed in haemoglobin levels between the groups at 12 months. Serum zinc concentration did not differ significantly between the two groups at follow up. Weight gain over the 6 months period did not differ significantly between the experimental (2.1+/-0.9 kg) and control groups (2.1+/-1.2 kg). There was no difference in linear growth between the experimental (10.0+/-1.5 cm) and control group (10.1+/-2.1 cm) at the end of the follow-up period. Weight and length at 6 months significantly predicted weight and length at 12 months. No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention. Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group. No benefit was observed in serum zinc concentration, linear growth and psychomotor development

Smoking and alcohol use during pregnancy affects preterm infants' docosahexaenoic acid (DHA) status

This study investigated the effect of alcohol consumption and smoking during pregnancy on the fatty acid composition of the infants. A total of 40 very-low-birth-weight (VLBW) infants, weighing between 750 and 1500g, were enrolled in the study after being hospitalized and ventilated for respiratory distress syndrome (RDS). Maternal and infant demographic information was recorded. Questions regarding maternal smoking (none, <10 and ≥10 cigarettes/d) and alcohol consumption (none, occasionally, moderate and severe) were recorded. Erythrocyte membrane (EMB; n = 40) total fatty acid analyses were performed at birth (baseline) and on days 14 and 28 postnatally. During pregnancy, 42% of mothers consumed alcohol and 50% smoked. At birth, infants of mothers who smoked and consumed alcohol during pregnancy, had significantly higher blood docosahexaenoic acid (DHA; p < 0.05) than infants of mothers who abstained from both alcohol and smoking. The consequences of this finding remain unknown.Articl

Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal provinces, South Africa

OBJECTIVE: To assess primary health care (PHC) facility infrastructure and services, and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. DESIGN: Cross-sectional survey. SETTING: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). SUBJECTS: PHC facilities and nurses (EC: n = 20; KZN: n = 20), and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). METHODS: Structured interviewer-administered questionnaires and anthropometric survey. RESULTS: Of the 40 PHC facilities, 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20%; KZN: 25%); electricity (EC: 45%; KZN: 85%); flush toilets (EC: 40%; KZN: 75%); and operational telephones (EC: 20%; KZN: 5%). According to more than 80% of the nurses, problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41%; KZN: 25%). Social grants were reported as a main source of income (EC: 33%; KZN: 28%). Few households reported that they had enough food at all times (EC: 15%; KZN: 7%). The reported prevalence of diarrhoea was high (EC: 34%; KZN: 38%). Undernutrition in 0 to younger than 6 month-olds was low; thereafter, however, stunting in children aged 6 to 59 months (EC: 22%; KZN: 24%) and 60 to 71 months (EC: 26%; KZN: 31%) was medium to high. Overweight and obese adults (EC: 49%; KZN: 42%) coexisted. CONCLUSION: Problems regarding infrastructure, basic resources and services adversely affected PHC service delivery and the well-being of rural people, and therefore need urgent attention