Impact assessment of the integrated nutrition programme on child malnutrition in South Africa.
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Date
2009
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Abstract
The Integrated Nutrition Programme (INP) was implemented in 1995 to target child malnutrition
in South Africa. This study assessed the impact of the INP on child malnutrition by province and
age group using secondary data. Data from three national nutrition surveys, conducted in 1994,
1999 and 2005, were used to describe trends in child stunting, underweight, wasting, vitamin A
deficiency and iron deficiency. The relationship between the prevalence of the human
immunodeficiency virus (HIV) in prenatal women and child nutritional status; challenges and
constraints to implementing the INP at provincial level; and government responses to nutrition
recommendations by lead experts in the 1994 and 1999 surveys were also investigated.
Child nutritional status varied across provinces. In some provinces such as the Northern Cape,
stunting, underweight and wasting remained consistently high. Stunting decreased in the Eastern
Cape, but rates of wasting increased between 1994 and 2005. On the other hand, Gauteng and
the Western Cape generally had lower rates of malnutrition compared to the other provinces.
This may be due to these provinces being the most economically active in the country thus more
opportunities for employment and higher purchasing power of foods rich in micronutrients. By
2005, vitamin A deficiency had doubled in most provinces despite mandatory food fortification
being implemented in 2003. KwaZulu-Natal had the highest rates of vitamin A deficiency, while
Limpopo had the highest rates of iron deficiency. By 2005, malnutrition had decreased in
children aged seven to nine years, but had increased in those aged one to three years. There was
a significant positive correlation (p<0.01) between the prevalence of HIV in prenatal women and
vitamin A deficiency nationally. The prevalence of HIV in prenatal women was positively
correlated (p<0.05) with rates of wasting in children aged one to three years.
Limited skills, inadequate monitoring and evaluation, and limited infrastructure were common
challenges and constraints to implementing the INP at provincial level. The effect of HIV on
human resources and the higher demands of HIV infected patients also posed a challenge to
provinces as they implemented the INP. Government responded to most recommendations made by
nutrition experts. Supplementation,food fortification, growth monitoring and nutrition promotion
programmes were implemented. Based on the data, it would appear that INP activities targeted at
school-going children were more effective than those targeting children under-five. Although food
fortification was implemented in 2003, the vitamin A content of fortified products might not have
met legislative requirements. Additionally, because vitamin A is unstable to heat and light, if
vitamin A fortified foods are cooked or stored this may also influence the bioavailability of
vitamin A. Maternal HIV status might have attenuated child nutrition outcomes due to the negative
effect of HIV on related health conditions such as child caring and feeding practices. Some of
the challenges and constraints at provincial level might have negatively affected the
implementation of the INP and consequently its impact. Although government responded to most
recommendations made by nutrition experts, ongoing monitoring and evaluation of child
nutritional status were not adequately done, which might have also negatively affected INP
outcomes. In addition, factors in the macro-environment such as food inflation and access to
basic sanitation, could have lessened the impact of the INP on child malnutrition.
Interventions directed at malnutrition in children under-five need to be prioritised. There needs
to be rigorous monitoring of micronutrient content, especially vitamin A, of fortified foods.
Future studies need to include assessment of nutritional status in HIV affected and infected
children to help identify specific needs and develop appropriate policies. Frequent nutrition
surveillance to assess key child malnutrition indicators is required.
Description
Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009.
Keywords
Malnutrition in children--South Africa., Malnutrition--South Africa., Children--Nutrition--South Africa., Nutrition policy--South Africa., Nutrition surveys--South Africa., Nutrition disorders in children--South Africa., Vitamin A deficiency in children--South Africa., Children--Nutrition--Evaluation., AIDS (Disease)--Nutritional aspects., Theses--Food security.