The new government must ensure nutritious food is affordable and accessible to all children, pregnant women and mothers of young children. File photo
Regardless of our political positions, we all want a better future for South Africa. Imagine the new unity government celebrating two years in office with a generation of children set for a bright future, symbolised by the healthy growth of their bodies and brains.
How do we measure this progress? One key indicator stands out: by closely monitoring stunting rates in children we can gauge the government’s effectiveness. A two-year-old’s birthday, once a personal milestone, now becomes a testament to our commitment to nurturing South Africa’s future.
Research in South Africa shows that a child’s height at two years old is the best predictor of their future potential. This potential, known as human capital, includes knowledge, skills, and health that help people succeed. A two-year birthday marks the end of the first 1 000 days of life, the most critical days during which the foundation of a child’s entire life is laid.
This period, from conception to a child’s second birthday, is crucial for brain and other vital organ development. During this period, starting in the womb, the brain undergoes rapid growth and development, laying the foundation for a child’s cognitive, emotional, and social abilities. By the age of two, a child’s brain is about 80% to 90% of the size of an adult brain. This time is also vital for the development of the pancreas, which plays a crucial role in digestion, and blood sugar regulation and is vital for ensuring proper metabolic function throughout life.
Stunting is a form of malnutrition where children are too short for their age, which also indicates that their brain development is running behind, and is closely tied to social determinants of health. Factors such as access to nutritious foods, safe housing, quality education, and employment opportunities play a significant role in the prevalence of stunting. By addressing these determinants, a government can make significant progress in reducing stunting rates, serving as a crucial indicator of its effectiveness in improving the overall health and well-being of its population.
An undeniable precondition for genuine national unity is the eradication of inequity. Stunting is one of the major factories for inequality and rectifying this can break the intergenerational cycle of poverty in which many in South Africa are trapped. Stunted children grow up to be adults who are most likely to be poor, unskilled, unemployed, and suffer from chronic diseases such as hypertension and diabetes, linked to the poor development of the brain and organs such as the pancreas in the first 1 000 days of their lives.
The 2023 National Food and Nutrition Security Survey shows that stunting levels in children are increasing in South Africa. In 2016, stunting affected 27% of children under five, but this has risen to nearly 29%, with about 35% of children under two years old affected. That means of the more than 1.5 million children who are stunted a significant number is those under two years old.
The conditions of stunting and wasting are deeply interconnected, sharing common causes and frequently co-occurring in the same child. Wasting represents a severe and potentially fatal form of malnutrition where children exhibit extreme thinness to their height, signalling acute weight loss and insufficient nutrition intake.
This condition encompasses both Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM). In South Africa, the monitoring of these is critical due to their grave consequences, which can lead to hospitalisation and even immediate death of a child. Shockingly, in 2023 alone, in South Africa, 1 000 children lost their lives directly because of these conditions.
Stunting serves as the early indicator signalling the presence of malnutrition risks. Neglecting these initial signs like stunting while concentrating solely on severe cases results in missed chances for prompt intervention. Early attention to stunting can avert the progression to severe malnutrition, emphasising the value of prevention over treatment.
According to the current guidelines from the department of health, all children should be routinely and comprehensively monitored for growth at every health visit. Comprehensive anthropometric measurements, including weight-for-height, height-for-age, head circumference, and body mass index (BMI), are crucial for assessing children’s growth and development. These measurements and their corresponding charts are included in the Road to Health Booklet given to each child at birth.
Despite these guidelines, many children in South Africa are not being adequately monitored for growth because of various problems that could be addressed through cost-effective interventions. Height-for-age is particularly neglected by health workers dealing with long queues in public-health facilities. Considering that stunting is the most prevalent non-communicable disease of early childhood, it is surprising that this critical measure is not even tracked in the District Health Information System, contributing to its non-prioritisation by healthcare workers.
Stunting acts as the smoke that warns of the fire of MAM and SAM. If we focus only on severe cases and ignore early indicators like stunting, we miss the opportunity for timely intervention. Addressing stunting early can prevent the more severe forms of malnutrition, reinforcing the principle that prevention is better than cure.
By the time malnutrition manifests as MAM or SAM, it is often too late to intervene. Early detection and intervention are crucial, studies show that children who catch up on height later in childhood, after the age of two, have similar cognitive outcomes to those who continue to be stunted. Identifying children at risk of all forms of malnutrition early and acting immediately is fundamental to securing a brighter future for all South Africans.
We must use every opportunity to monitor growth and identify children at risk. Clinicians, including doctors and nurses, should prioritise this task during any health facility visit. It should be non-negotiable for every healthcare worker who works with children to be trained and given the equipment to monitor growth, including all community health workers. Additionally, parents and caregivers should be sensitised, taught and equipped to perform basic screening for malnutrition where feasible.
By focusing on the screening of stunting, community healthworkers play a crucial role in early intervention and prevention of malnutrition.
Most recently other countries such as Ethiopia have committed to achieve zero stunting by 2030 and successfully reduced stunting through coordinated efforts, including comprehensive growth monitoring and addressing food insecurity. Ethiopia improved its stunting reduction rate from 1% to 3% a year, demonstrating that progress is possible.
The new government must prioritise this crucial period to build a better tomorrow for everyone by:
- Making zero stunting a funded national priority;
- Ensuring nutritious food is affordable and accessible to all children, pregnant women and mothers of young children;
- Reducing rates of low birth weight by supporting vulnerable pregnant women;
- Equip vulnerable mothers of young children with the necessary tools and confidence to provide optimal care and stimulation to their infants; and
- Identifying and responding to children at risk through regular monitoring of weight and height.
As toddlers blow out their second birthday candle, we witness the tangible effect of policies and programmes not implemented. Their well-being reflects our collective success and their growth charts become the scorecards of our nation’s progress.
Dr Edzani Mphaphuli is the executive director of the Grow Great campaign.