Malnutrition continues to be a problem in the Republic of South Africa, although it is not as common as in other countries of Sub-Saharan Africa.
15% of South African infants are born with a low birth weight. 5% of South African children are so underweight they are considered to be wasted (a child is considered wasted when they are too thin for their height). Since the 1990s South Africa's malnutrition problem has remained fairly stable. It is estimated that South Africa loses about US$1.1 billion every year in gross domestic product to vitamin and mineral deficiencies arising from malnutrition, although it would only cost an estimated US$55 million to alleviate this problem through micronutrient nutrition interventions.
The prevalence of malnutrition in South Africa varies across different geographical areas and socio-economic groups. Many infants in Africa suffer from malnutrition because their mothers do not breastfeed them. The mothers in South Africa that do not breastfeed their children do not do it mainly to avoid the risk of passing on AIDS. The 2010 South Africa Department of Health Study found that 30.2% of pregnant women in South Africa have AIDS. Malnutrition can cause several different health problems, such as pellagra.
The specific consequences of malnutrition vary depending on the individual and the specific nutrients the individual's diet is lacking. South Africa's Department of Health has established various special programs and initiatives, like the Integrated Nutrition Program, to combat the detrimental effects of malnutrition. All programs and initiatives have faced copious challenges and their individual success rates vastly vary as a result.
Health effects Malnutrition can lead to an onslaught of additional health complications, and eventually even death. In fact, UNICEF found that 11.4% of deaths of South African children under five can be attributed to low weight, making low birth weight the second most prominent cause of children's death in South Africa. According to 2008 statistics, out of 10 million children's deaths, 5.6 million can somehow be attributed to malnutrition. Although all cases of malnutrition in South Africa will not necessarily lead to death, they will most likely lead to a decline in health. The most easily preventable yet most prominent detrimental health conditions associated with malnutrition are nutrient deficiencies.
Vitamin and mineral deficiencies A deficiency in iron levels can lead to anemia, which is a condition classified by decreased hemoglobin levels in the blood. 21.4% of pre-school children have anemia in South Africa. Anemia is also a major cause of maternal mortality. Approximately 50% of pregnant women in South Africa have anemia. Anemia causes tiredness and weakness. If left untreated for long periods of time, it can damage the heart, brain, and other vital organs.
Another common nutritional problem among South Africans is hypocalcemia, a deficiency in calcium. In a study of a randomly chosen rural South African community, 13.2% of children were found to have abnormally low levels of calcium in their blood. Additional studies done on South African children show that this deficiency can lead to Rickets. Rickets causes weakness and pain in bones and dental structures, impaired growth, muscle cramps, and skeletal deformities.
Many South Africans also have a Thiamine (Vitamin B1) deficiency. A serious deficiency in this vital nutrient can cause beriberi, which has the immediate symptom of severe lethargy. If left untreated, Beriberi can cause inflammation of the nervous system and even heart failure. Heart failure associated with beriberi is especially prominent in Johannesburg, the capital of South Africa.
Another disease common to South Africa is pellagra. Dr. D Blumhson, a physician, notes a high rate of pellagra among the patients of a hospital in Soweto, South Africa. Pellagra seems to be especially common in patients with corn-based diets. The disease itself is caused by a niacin deficiency. Pellagra's symptomatology is described by the "4 D's: "dermatitis, diarrhea, dementia, and death". Pellagra causes gastrointestinal discomforts like diarrhea, nausea, vomiting, abdominal pain, and poor appetite.Rook, Ed A; Wilkinson, DS; Ebling, FJB; Champion, RH; and Burton, JL. Textbook of Dermatology: 4th Edition. Blackwell Scientific Publications, cited by "Pellegra." DermNet New Zealand. 26 August 2012 Unfortunately, this downward spiral often causes further malnutrition, which in turn further amplifies the magnitude of pellagra.
An additional malnutrition problem is a deficiency in vitamin A. It is especially prominent in the Northern Province, the KwaZulu/Natal, the Mpumalanga, the North West Province, and the Eastern Cape of South Africa. The South African Vitamin A Consultancy Group (SAVACG) conducted a national survey for the South African Department of Health that showed that one out of three children under the age of six have a Vitamin A deficiency. Vitamin A is necessary for good vision, and a shortage of this substance can lead to visual impairments and potentially even blindness. The World Health Organization showed that half of Vitamin A-deficient blind children die within the year, due to the detrimental effects of Vitamin A on the immune system.
Vitamin C deficiency also has detrimental effects on the South African population. Scurvy, a disease that develops from an extended shortage of Vitamin C, has previously been found prevalent in certain South African mining populations. This disease causes weakness, anemia, skin hemorrhages, and gum disease (gingivitis).Cotran, R. S., Kumar, V., & Robbins, S. L. (1994). Environmental and nutritional diseases.Robbins Pathologic Basis of Disease, 5, 379-430.Coller BS, Schneiderman PI. Clinical evaluation of hemorrhagic disorders: The bleeding history and differential diagnosis of purpura, cited by Hoffman R, Benz EJ, Shattil SS, et al, eds. (2008). Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone, chap 9. Because Vitamin C plays a vital role in the formation of connective tissues, a deficiency in it may also cause complications with the immune system, iron absorption, cholesterol metabolism.Hirschmann JV, Raugi GJ. (1999). Adult scurvy. Journal of the American Academy of Dermatology. 41:895-906, cited by "Scurvy."DermNet New Zealand.12 June 2012.
Causes An individual in South Africa may develop malnutrition because of several factors, not all of them necessarily having to do with diet. According to UNICEF, factors that can cause malnutrition include but are not limited to stress, trauma, poor psychological care, neglect, and abuse.
For example, a woman with psychological problems may not have the cognitive abilities to recognize that she needs to feed her children, and thus may neglect to do so, causing her children not to obtain the sufficient nutrients they need to thrive. However, even mothers with full cognitive abilities may still cause their children to suffer from malnutrition by not partaking in breastfeeding.
Breastfeeding and HIV transmission avoidance
Breast milk contains many vital nutrients and minerals that protect against infant mortality. Many infants in Africa suffer from malnutrition because their mothers do not breastfeed them. The mothers in South Africa that do not breast feed their children do not do it mainly to try to avoid the possibility that in doing so, their children may contract AIDS. The 2010 South Africa Department of Health Study found that 30.2% of pregnant women in South Africa have AIDs.
Thus, these women pose a huge risk to their infants because infants drinking breast milk infected with the HIV virus may contract the virus as well. Infants with the HIV virus are more likely to pass away if they are breast fed than if they are formula-fed. A study published in the Journal of the International AIDS Society found that the mortality for infected infants was 19% for exclusively breast-fed infants, 13% for mixed-fed infants, and 0% for formula-fed infants.
Thus, many conflicted South African mothers are faced with the morally difficult decision of whether to prevent malnutrition in their children by breastfeeding them at the risk of them contracting HIV, or preventing HIV in their children at the risk of them not being properly nourished. Because the health cost of not breastfeeding a child is not widely known, most South African women chose the latter option and turn to baby formula to replace breast milk as the main nutritional source for their infants. In fact, according to the South African Demographic Health Service, out of all 3-month-old babies in South Africa, only 10% were exclusively breast-fed and 48.3% were bottle-fed.
The formula readily available to the average South African woman does not provide the sufficient nutrients necessary to sustain an infant when utilized by itself. Thus, many infants are not provided with the necessary nutrients they need to thrive, and this can lead to severe cases of malnutrition. The first two years of a person's life constitutes the most vulnerable period for malnutrition, making this lack of nutrients especially detrimental to an infant's health.
However, the problem of malnutrition isn't simply solved by a mother choosing to breastfeed her child. Many infants who are breastfed have mothers who are severely undernourished themselves. If a mother doesn't have sufficient nutrients for herself, she is much less likely to have sufficient nutrients in her breast milk. Thus, breast milk from undernourished women is often lacking sufficient quantities of several vital vitamins and minerals like vitamin B6 and folic acid. This lack of nutrients can lead to a nutritional deficiency in the child being breastfed as well.
Additional factors Another main determinant of malnutrition is culture and lifestyle. Various rural South African groups lead agricultural cultivation-based lifestyles that only allow them to live on the very limited amount of resources given to them by their land. The food resources they have access to lack several vital nutrients, making malnutrition among these people more prevalent than among pastoral people and other people with more animal-based diets. In comparison to the average American diet, rural South African groups like the South African Bantu consume a diet with less than half of the fat content.
A lack of fat often accompanies a lack of protein. A lack of protein in a South African's diet can lead to a form of severe malnutrition known as "kwashiorkor." Research was done to compare the frequency of kwashiorkor among five African groups: the Maasai, the Kikuyu, the Batussi, the Bahutu, the Pieraerts, and the Wakamba. The Masai are pastoral people who consume milk and on occasion, meat. The Wakamba, Kikuyu, and Bahutu are non-pastoral agricultural people who cultivate the foods that they eat. The Batussi people are livestock raisers who consume large amounts of curdled milk. The Pieraert people are lake-side dwellers who consume fresh fish and dried fish. The research found no incidences of kwashiorkor among the Masai, Batussi, the Pieraert, and a small part of the Bahutu who in addition to vegetables and grains, also cultivate beans.
However, numerous incidences of kwashiorkor were found among the Wakamba, Kiyuku, and solely grain and vegetable-consuming Bahutu. This shows that South African people who have an agricultural cultivation-based lifestyle are at high risk for malnutrition. In addition to those living in desolate, rural areas, those living in South African slums and other poverty-stricken conditions also only have access to a high-starch, low protein diet. The typical undernourishing South African diet is based on the main staples of rice, porridge, and maize.
Poverty