Friday 16 October was World Food Day, and I hope that all of us who have enough to eat celebrated and gave thanks. Those of us who are well-nourished should spare a thought for the millions who “go to bed hungry every night”.
What about South Africa?
Ask most people what they believe are the biggest nutritional issues in South Africa, and the yuppies will probably mention things like obesity, Banting and carbs. I was, therefore, heartened by a recent article on Prof David Sanders, published in MedicalBrief, entitled “SA’s real nutrition problems ‘Not Carbs vs. Fats’”. The article emphasises that instead of worrying about the 2 grains of sugar in diet cold drinks, we should be improving the diets of our children, and the first thing all our children should be given is mother’s milk.
The real nutrition problems
Prof Sanders is a paediatrician and emeritus professor at the University of the Western Cape and is a highly respected scientist in the fields of child health and nutrition. Prof Sanders lists the most important problems we face in South Africa as low birth weight, malnutrition, obesity and the diseases that follow, such as diabetes, cancer and heart disease.
Prof Sanders points out that the most recent data obtained from the SA National Health & Nutrition Examination Survey (SANHANES) shows that 28% of our nation’s households were at risk of hunger and 26% actually suffered from hunger in 2012. It is probable that this figure has grown in the past 3 years.
This may mean that by now, 30% or more of our population do not have enough food to eat. It also makes sense that these people also do not obtain the nutrients they need to grow, develop and remain healthy.
The children in any society should always be priority number one because they are our future. The SANHANES 2012 data showed that 27% of our children under the age of 3 years suffer from under-nutrition which causes stunting, and 6% of the under-14s were underweight. Along with this malnutrition, caused by a lack of kilojoules, macro- and micronutrients, 19% of children between 2 and 5 years were overweight and 5% were classified as obese.
This stark contrast between starvation and malnutrition and obesity in our children should be our first priority – and will certainly not be addressed by unbalanced fad diets. The majority of affected households also do not have the means to follow fad diets, which differ greatly from the traditional diets of our indigenous populations. These traditional diets were based on high-fibre starches (sorghum, millet, unsifted maize meal) as staples, fermented milk, modest quantities of lean meat, vegetables, veld fruits and nuts.
Low birth weight
One of the primary factors that lead to these childhood problems, is the fact that too many babies are born prematurely or with a low birth weight. Prof Sanders lists the following causes:
-Poor nutrient intake of the mother before conception and during pregnancy. Mothers who lack a diet which provides adequate energy, protein of plant and animal origin, high-fibre, minimally processed, low-GI carbohydrates, healthy mono- and polyunsaturated fats, as well as the essential fatty acids omega-3 and omega-6, and micronutrients like vitamins, minerals and phytonutrients tend to have small, underweight babies that are often born before term. Low birth weight and premature birth are factors that can hamper a child’s future growth and development.
- Pregnant women who have to do hard physical labour on an energy-deficient diet are not able to channel sufficient energy to their unborn babies to fuel adequate growth.
- Substance abuse (alcohol, drugs and smoking) can retard foetal growth and result in low birth weight, as well as foetal alcohol syndrome, and foetal addiction and withdrawal symptoms.
- HIV, sexually transmitted diseases and tuberculosis can all affect foetal growth and disadvantage a child from birth.
- Iron-deficiency anaemia is linked to an increase in low birth weight and 23% of South African women were found to be suffering from anaemia according to the 2012 SANHANES data.
Recent media reports of infant deaths in South African hospitals illustrate how dangerous premature birth and low birth weights are. Last Sunday, Ahmed Areff of News24 reported that the Free State Health Department had issued a statement that an investigation into the deaths of 5 neonates at the Bongani Hospital in Welkom had found that “four had low birth weights and died from pulmonary haemorrhage, which is bleeding in the lungs and one baby died from birth asphyxia”.
The vicious cycle
Prof Sanders describes how the vicious cycle of under-nourishment and nutrient deprivation continues because low birth weight babies are not strong enough to suck strongly and therefore cannot breastfeed properly. These babies do not receive adequate nourishment at the breast and may not receive invaluable protective antibodies from their mothers’ milk. Consequently they tend to be more susceptible to infections. If these children survive infancy they are more inclined to become undernourished and stunted children.
South Africa has the lowest breastfeeding rate in the world, which means those children who need them most, are once again deprived of vital nutrients for the first year of their lives.
If there is a solution to this problem then it is education to encourage mothers to exclusively breastfeed their babies for the first 6 months of life, and then to add high-energy foods such as oils and peanut butter, as well as proteins like sour milk and legumes (dry beans and lentils) to the weaning diet. Education should also concentrate on teaching mothers who do most of the shopping and receive child support grants to select foods that give them and their families the most nourishment at the lowest cost.
This kind of education should start at schools because many of the mothers who have low birth weight babies are undernourished teenagers who have not yet finished growing themselves.
Let’s honour World Food Day and spare a thought for the millions of young women and their babies who struggle to survive and also keep in mind never to deprive your own children of breastmilk, breastfeeding and a balanced diet.