South Africa faces a critical challenge: a child stunting rate that has stubbornly remained around 25% since the 1990s. This chronic malnutrition, where children are too short for their age, doesn't just impact physical development. It significantly hinders intellectual growth, potentially reducing the country's per capita GDP by a staggering 10%. While the Child Support Grant (CSG) has proven effective, its impact is waning due to rising food inflation. However, as seen in Peru and Chile's remarkable progress, immediate, impactful strategies can be implemented to reverse this trend.
Making Protein More Affordable
A significant contributor to chronic malnutrition is a lack of essential proteins and micronutrients. Children admitted to hospitals with severe acute malnutrition often lack access to protein-rich sources, such as fish or lentils. Alarmingly, the proportion of underweight children under five is 7.7%. Yet stunting, usually linked to poor brain development, is almost four times higher. This disparity is partly due to parents, facing financial constraints, opting for cheaper processed foods and starches, leading to an increase in children who are both overweight and stunted.
Solving this requires a united front from government, businesses, civil society, and trade unions to reduce the cost of protein-rich staples. Retailers like Shoprite are already making strides by offering affordable options such as ox liver burgers. Furthermore, immediate action is needed to cap manufacturer and retail margins on infant formula at 10%. While this may raise concerns about undermining breastfeeding, the reality is that over half of all infants are not exclusively breastfed by three months. Therefore, ensuring affordable access to fortified infant formula, alongside strict enforcement of marketing regulations, is crucial.
Ensuring Micronutrient Fortification
Micronutrients are vital for growth and development, and their deficiency can lead to life-threatening illnesses. Fortifying staple foods, such as maize meal and wheat flour, has been mandatory since 2002; however, compliance remains a significant issue. Studies reveal that a large percentage of maize meal in provinces like Gauteng and the Eastern Cape is either unfortified or insufficiently fortified. Stricter enforcement is paramount. However, the industry must also prioritise compliance without constant policing.
Beyond food fortification, targeted micronutrient supplementation during pregnancy and early childhood is highly effective in addressing nutritional deficiencies. Instead of separate iron and folate pills, pregnant mothers should receive a single daily pill containing 15 essential minerals and vitamins. For at-risk children aged six to 24 months, small-quantity lipid nutrient supplements can reduce stunting by up to 20%. These supplements should be made available through community health worker (CHW) programmes.
Supporting Pregnant Women with Grants and Supplements
Low birth weight (below 2,500g) significantly increases the risk of stunting. Ensuring good healthcare and nutrition for pregnant women is crucial in preventing this. Balanced protein-energy supplementation has been shown to reduce the risk of low birth weight by a third, especially among underweight mothers. It also improves breastfeeding ability. The Western Cape's pilot programme offering nutritional support to at-risk pregnant women is a commendable step. Nationally, a maternal support grant, though slow in policymaking, would be a highly cost-effective intervention. This grant would help in reducing healthcare costs and improving infant health.
Equipping Community Health Workers
Countries that have successfully reduced stunting share a common thread: the ability to monitor children's growth effectively. Community Health Workers (CHWs) are ideally positioned to identify growth faltering early due to their regular family visits. However, they lack basic scales to weigh babies, relying instead on coloured tapes that only detect acute malnutrition. Equipping South Africa's approximately 60,000 community health workers (CHWs) with mechanical scales would cost an estimated R60 million. Training them to identify at-risk children would yield significant health benefits, easily outweighing the initial investment. Successful programmes, such as the Philani Health and Nutrition Project and Grow Great, have already demonstrated the effectiveness of CHWs using scales.
Limiting Unhealthy Food Advertising
Parents strive for their children's well-being, yet they are constantly bombarded with messages from the "Big Food" industry promoting unhealthy eating habits. The government must convene dominant food players to forge an agreement for a healthier nation. This agreement should critically include restricting the advertising of unhealthy foods.
These five objectives are attainable even in a fiscally constrained environment; however, their implementation hinges on strong leadership and effective coordination. The delayed constitution of the National Food and Nutrition Council and the relatively junior position of departmental officials underscore the need for a more authoritative driving force. Appointing a "nutrition tsar" with sufficient authority could galvanise a national programme to reset South Africa's developmental trajectory for the next decade.
- David Harrison is a medical doctor and CEO of the DG Murray Trust, which focuses on early childhood development.