More than a quarter of children under five in South Africa are affected by stunting
The government, private sector and civil society need to prioritise child nutrition and work together to address the causes of unhealthy eating in all its forms.
‘Despite all the technological, cultural and social advances of the past few decades, we have lost sight of this most basic fact: if children eat poorly, they live poorly.” This is the message from Henrietta Fore, the executive director of the United Nations Children’s Fund (Unicef), on the release last week of the organisation’s report titled The State of the World’s Children 2019: Children, Food and Nutrition.
The report finds that at least one in three children under five — or 200-million — is either undernourished or overweight. Almost two in three children between six months and two years of age are not fed food that supports their rapidly growing bodies and brains. This puts them at risk of poor brain development, weak ability to learn, low immunity, increased infections and death. In the long term, this threatens the survival, growth and development of children, young people, economies and nations.
The report provides the most comprehensive assessment yet of 21st century child malnutrition in all its forms. It describes a triple burden of malnutrition: undernutrition, hidden hunger caused by a lack of essential nutrients, and obese among children under the age of five.
- About 149-million children suffer from stunting (too short for their age);
- Almost 50-million suffer from wasting (too thin for their height);
- At least 340-million children (or one in two) suffer from deficiencies in vitamins and essential minerals; and
- About 40-million children are overweight.
In too many countries, we are losing ground in the fight for healthy diets. We need governments, the private sector and civil society to prioritise child nutrition and work together to address the causes of unhealthy eating in all its forms.
South Africa’s children
South Africa is battling undernutrition (stunting and wasting), hidden hunger (deficiencies in vitamins and other essential nutrients) and obesity. About 2.2-million (38%) children under five are stunted, wasted and overweight. Of these, one in four (or 1.7-million) are stunted, 100 000 are wasted and 800 000 are overweight. Millions of children are eating too little of what they need, and millions are eating too much of what they don’t need.
Stunting is a symptom of past deprivation and a predictor of future poverty. Wasting can be lethal for children, particularly in its most severe forms. This hidden hunger also harms women. Iron deficiency reduces children’s ability to learn and iron deficiency anaemia increases women’s risk of death during or shortly after childbirth.
For children, being overweight can lead to the early onset of type 2 diabetes, stigmatisation and depression, and is a strong predictor of adult obesity, with serious health and economic consequences. Childhood overweight rates have increased to 13%, which is more than two times the global average and the highest in the Eastern and Southern African region. The adolescent overweight (26%) too is higher than the global prevalence (17%).
The report warns that poor eating and feeding practices start from the earliest days of a child’s life. Exclusive breastfeeding for the first six months of a child’s life increased to 32% in 2016 from 8% in 2003, but a quarter are still not breastfed at all. This is of great concern as it infers that breast milk — the best start to the child’s life — is being increasingly replaced with infant formula. Only two in five children aged six to 23 months consume diverse diets (foods from at least five out of eight food groups) and about a third (37%) do not consume any vegetables or fruits.
Children, especially adolescents, are increasingly consuming more of the unhealthy foods and sugar-sweetened beverages.
South Africa has made progress through the development of national policies, programmes and strategies for improved food systems. Last year, South Africa became the first African country to implement a sugar tax on sugar-sweetened beverages that included sodas, fruit drinks, energy drinks and vitamin water, which contain sucrose, high-fructose corn syrup or fruit juice concentrates. The tax is part of the department of health’s strategy to reduce obesity by 10% by next year.
More must be done to address the triple burden of malnutrition. Improving children’s nutrition requires food systems — everything and everyone involved in bringing food “from farm to mouth” — to deliver nutritious, safe, affordable and sustainable diets.
There needs to be rapid implementation at scale, co-ordination, monitoring and evaluation of the government’s national food security and nutrition plan.
To achieve this, Unicef is supporting the government to enforce and monitor the recommended actions in guidelines and the regulatory framework, including monitoring the marketing of breast milk substitutes and the programme for the fortification of complementary foods with micronutrients.
Unicef also supports the government in designing and implementing nutrition communication plans for encouraging caregivers, adolescents, households and policymakers to adopt good nutrition practices and to promote optimal feeding practices for infants and children.
The reality is that millions of children subsist on an unhealthy diet because they do not have a better choice. The way we understand and respond to malnutrition needs to change. It is not just about getting children enough to eat, it is about getting them the right food.
Dr Mariame Sylla is chief of health and nutrition for Unicef in South Africa