The 'slow violence' of malnutrition in South Africa

The Covid-19 pandemic, and the ongoing measures to contain it, have revealed a stark divide between those who have access to adequate, nutritious, affordable diets and essential nutrition services and those who do not.

Launched last week, the 2020 South African Child Gauge, focusing on nutrition and food security, reminds us that despite South Africa being classified as an upper middle-income country, high stunting rates, micronutrient deficiencies, and overnutrition in the form of overweight and obesity in children are prevalent.

Over the past two decades, the world has reduced the proportion of children under 5 suffering from undernutrition by one third – that’s some 55 million children who are no longer missing out on the nutrients they need to develop and thrive in life.

This remarkable achievement proves that positive change in improving the health and well-being of children is possible. Action is however urgently needed to prevent the undoing of the gains of the past decade as the effects of the pandemic continue to be felt.

The United Nations Children’s Fund (Unicef) estimates that, in the absence of decisive and timely action, Covid-19 will result, globally, in a 15% rise in the number of children needing critical nutrition services, throw an additional 140 million children into poverty and see up to 10 000 more child deaths per month.

The most recent estimates indicate that 144 million children under 5 suffer from stunting, and 47 million children under 5 suffer from wasting. At the same time the number of overweight children continues to grow.

Two in three children in low-and middle-income countries cannot afford a nutritious diet and with Covid-19, we expect to see an increase in the risk of all forms of malnutrition.

In South Africa, acute malnutrition (including moderate and severe forms) remains a significant underlying cause of child mortality, being associated with one-third of all child in-hospital deaths.

Children suffering from acute malnutrition are known to have weak immune systems and are prone to infections which could lead to death. If they survive, they are more susceptible to being stunted and having long-term developmental delays.

The statistics are a call to action. In South Africa, 27% of children are stunted, meaning that these children will likely not reach their full growth and developmental potential because of the irreversible physical and cognitive damage caused by persistent nutritional deprivations.

The country is on track to meet some of the World Health Assembly 2025 targets but there is a need to accelerate our work. South Africa would have 1.7 million stunted children in 2025, which is nearly twice as high as the 900 000 children target for 2025.

Unicef recognises that preventing and reducing acute malnutrition or wasting requires that children are born to healthy, well-nourished mothers who receive appropriate antenatal care, access to adequate food and care practices, safe water, sanitation and good hygiene, as well as functional primary health care services.

This is especially critical during the first 1 000 days from when a child is conceived, through to infancy and early childhood, but remains vital throughout the entire life cycle because healthy children grow into healthy adolescents, adults and parents.

Despite the evidence of the importance of breastfeeding, with an exclusive breastfeeding rate at 32%, South Africa still lags the World Health Organization global target of 50% which member states should reach by 2025.

Through the Unicef “Nutrition Strategy 2020–2030: Nutrition, for Every Child”, we envision a South Africa and world where all children, adolescents and women realise their right to nutrition.

This vision is guided by the UN Convention on the rights of the child, which recognises the right of every child to adequate nutrition.

To support this vision and goal, we focus on five systems – food, health, water and sanitation, education, and social protection – with the greatest potential to deliver nutritious diets, essential nutrition services and positive nutrition practices for children, adolescents and women.

Unicef’s nutrition focus shares a universal premise: “prevention comes first, in all contexts; if prevention fails, treatment is a must”. This means that the primary objective should be to prevent maternal and child malnutrition in all its forms across the life cycle.

When it is not possible to prevent malnutrition, we need to intensify our early detection and treatment services for children suffering from life-threatening malnutrition.

Mothers and caregivers at community level should be empowered and equipped to conduct growth monitoring and early detection of malnutrition.

It is encouraging that there have been initiatives to scale-up and implement child nutrition interventions in South Africa including growth monitoring and promotion, nutrition supplementation, management of acute malnutrition in healthcare facilities.

More investment is still needed at community level including in growth monitoring sites, early childhood development centres, community nutrition development centres, and primary healthcare centres.

Interventions to prevent and treat acute malnutrition should be part of the essential health package for children in the National Health Insurance.

We need to safeguard the gains that were made before the onset of Covid-19, while continuing working with all our partners for better nutrition for every child.

With nine years remaining in the pursuit of the sustainable development goals, it is time for renewed action on ending child malnutrition in all its forms, everywhere.

* The Child Gauge is an annual report on the status of South Africa’s children. It is published by the Children’s Institute at the University of Cape Town in partnership with the DSI-NRF Centre of Excellence in Human Development; University of the Witwatersrand; Unicef South Africa; the Standard Bank Tutuwa Community Foundation and the DG Murray Trust.