Stunting remains a challenge in South Africa
Stunting remains stubbornly persistent in South Africa, despite economic growth, political and social transitions, and national nutritional programmes, says a Wits-led research team.
Stunting refers to a reduced growth size in human development and is a chronic form of undernutrition. This issue has several significant public health implications due to increased morbidity and mortality.
It is also associated with delayed cognitive development, impaired physical growth, and a greater risk of poor health including the development of cardio-metabolic disease that may be transmitted to the next generation. This in turn leads to negative impact on the health and economics at individual, household and community levels.
Dr Rihlat Said-Mohamed (Wits University); Dr Lisa Micklesfield (University of Cape Town); Professor John Pettifor (Wits University); and Professor Shane Norris (Wits University) investigated the changes in the prevalence of stunting in South Africa over 40 years. The study entailed a systematic review of publications selected from PubMed, Science Direct and Scopus and included studies and surveys published between 1970 and 2013.
In a study published in BMC Public Health, researchers say that in South Africa the prevalence of stunting has been between 20-30% for the past 20 years despite the move in 1996 to implement the Integrated Nutrition Programme to combat the prevalence of early life malnutrition.
This research indicates that stunting is higher in children under three years of age which is a critical period for child development and growth.
"Some provinces are more affected than others which questions the implementation of the intervention programme within provinces. In addition it highlights the need to coordinate and scale-up these programmes between and within provinces.
"Over the last decade, the national prevalence of stunting has decreased. However, between and within provincial, age and ethnic group disparities remain. Unlike other countries in sub-Saharan Africa, no sex or rural/urban differences were found in preschool children," the researchers noted in the study.
The researchers recommend that a multi-sectoral and public health approach is needed to address stunting and would require stakeholders to better monitor stunting over time, combat malnutrition during the first thousand days of life through continued efforts and improve maternal nutrition during pregnancy and infant feeding practices.
Methodological issues make it difficult to use of the wealth of South African nutritional data to draw the trends in the prevalence of stunting. Thus, the researchers suggest that one growth standard for the assessment of stunting is adopted and that there is agreement on the sampling methodology for national surveys. In addition, the researchers advocate that a representative data at provincial levels to improve the national sampling framework is generated.
"The experience of South Africa, the most developed economy in sub-Saharan Africa, highlights the difficulties in tackling malnutrition on the sub-continent. The persistence of early life malnutrition is fuelling the burden of non-communicable disease, an emerging public health concern in sub-Saharan Africa," states the researchers.
Stunting prevalence can decline, as in the case of developing countries such as Brazil and India, if there are interventions such as strong political commitments, promotion of behavioural changes and active participation of the community, improved public water and sanitation and access to basic health care.