HEALTHY EATING
3.1 DEVELOPMENT PROCESS OF THE SOUTH AFRICAN FBDGs
3.1.2 Nutrition-related public health concerns
In South Africa, the co-existence of under- and over-nutrition is evident between populations, but also within populations and even within the same household. A nutrition status survey, undertaken in a semi-rural village of Lebowa (Northern Province), revealed that of659 pre-school children, 12% were underweight and 28% stunted. Of their siblings, 21 % were underweight and 36% stunted. In contrast, 31 % of their carers (mother or grandmother) were overweight (Steyn, Nel, Tichelaar, Prinsloo, Dhansay, Oelofse &
Benade 1994).
The nutrition-related public health concerns of both children and adults were investigated to determine any similarities and/or differences. The main nutrition-related public health concerns of South Africans (see Tables 3.2 and 3.3) can be summarised as follows:
• high maternal mortality rate among (rural) Black women (Health Systems Trust 2001; 1998)
• high infant mortality rate among (rural) Black infants (Health Systems Trust 1998)
• low life expectancy for Black and Coloured adults (Health Systems Trust 1998)
• under-nutrition, especially among Black and Coloured children under 5 years of age in the form of low birth weight, wasting, underweight for age, stunting, and low micronutrient (in particular, vitamin A, iron and folate) intakes
(Labadarios et al. 2001; Benade, Oelofse, Van Stuijvenberg, Jooste, Weight & Benade 1997; Vorster et at. 1997; SAVACG 1995; Dhansay & Hendriks 1994; DOH 1994)
• overweight and obesity among children (aged 1-9years) and adults (aged 15-64years) (Labadarios et at. 2001; Health Systems Trust 2001)
• chronic diseases of lifestyle among adults (aged 16-64years), in the form of hypertension, heart disease, stroke, non-insulin dependent diabetes mellitus (NIDDM), and cancer; and dental decay among the total population
(Health Systems Trust 2001, 1996; Fritz 1995; Levitt & Mollentze 1995; NOHS 1994)
• "risky" lifestyle behaviours among the total population, in the form of smoking, excessive alcohol consumption, inactivity and HIV / AIDS
(Dorrington, Bourne, Bradshaw, Laubscher & Timaeus 2001; Health Systems Trust 2001, 1996; CASE 1995; Noakes & Lambert 1995; Yach 1995)
Table 3.2 Nutrition-related public health concerns of South Africans - Consequences of under-nutrition
NUTRITION-RELATED PUBLIC HEALTH CONCERN Life Expectancy at Birth
(if current mortality trends were to continue for rest of person's life) Projected Life Expectancy due to impact ofHIV infection
Maternal Mortality Rate (expressed as number of maternal deaths per I 00 000 I ive births per annum)
Infant Mortality Rate
(expressed as number of infant deaths per 1000 live births per annum) Under 5 Mortality Rate (expressed as number of under 5 deaths per 1000 live births per annum) Low Birth Weight
«2.5kg) Wasting
(>2SD below mean weight for height) Underweight for Age
(>2SD below mean weight for age)
Stunting
(>2SD below mean height for age)
Anaemia
(Hb <II gldl; serum ferritin <12mcgll) Low Folate Status
Vitamin A Deficiency (serum vitamin A <20mcg/l) Iodine Deficiency
(visible goitre)
*
SD - standard deviations*
Hb - haemoglobinSOUTH AFRICAN DATA
Black adults 55.5 years Coloured adults 58.4 years Indian adults 61.5 years White adults 65.52'ears Year 2000 55 years Year 2010 40 years
Black women estimated at 150 Coloured women 22
Indian women 5 White women 8 Black infants 47.0 Coloured infants 18.8 Indian infants ---- White infants 11.4 Black infants 63.6 Coloured infants 28.2 Indian infants ---- White infants 15.3 Neonates - 12-19%
(mostly rural B lack neonates 18-24%) Under 5 years - 2-3%
Primary school - 2.6%
(N West, N Cape, N Province) All children - 3-19%
Under 5 years - 16% (9-15% Blacks) Primary school- 9%
(mostly rural areas, especially N Cape) All children - 25-35%
Under 5 years - 20-30%
Primary school- 13.2%
(N Cape, E Cape, N Province) Urban Black infants
Girls and women (aged 11-65 years) Infants, children, adolescents - 8-31 % (areas unspecified)
Under 5 years - 25-38%
(N Province, KZN, Mpumalanga) All children - 1%
(N Province, N Cape, KZN, east Gauteng)
REFERENCES
Health Systems Trust (200 I)
Dorrington et al (200 I ) Health Systems Trust (200 I );
Health Systems Trust (1998)
Health Systems Trust (200 I )
Health Systems Trust (200 I)
Dhansay & Hendriks (1994) Labadarios et al (200 I);
Vorster ( 1997);
Vorster et al (1997);
SA V ACG (1995);
DOH (1994)
Vorster et al ( 1997) Vorster et al (1997) Vorster et al ( 1997);
SAVACG (1995) Benade et al (1997);
Vorster et al ( 1997)
Table 3.3 Nutrition-related public health concerns of South Africans - Chronic diseases of lifestyle & "risky" behaviours NUTRITION-RELATED
PUBLIC HEALTH CONCERN Obesity
(W/H =>2SD)
(South African children - 1-9 years) Obesity
(BMI>30)
(South African adults - 15-64 years)
Hypertension
(blood pressure> 160/95mmHg) (South African adults - 16-64 years)
Hypercholesterolaemia (total cholesterol >5.7mmoIlL) (South African adults)
Cancer
(age standardised incidence rate per 100000 population)
(South African adults - 16-64 years) Non-Insulin Dependent Diabetes Mellitus
(South African adults - 16-64 years) Dental Decay
Mean DMFT
% no teeth (35-44years)
% no teeth (60-64years) HIV Prevalence
(% total South Africa population estimated to be HIV+)
Smoking Rates
(% South African adults who smoke)
Alcohol Consumption
(% South African adults who consume alcohol)
*WIH - waist to hip ratio
*
SD - standard deviations*
BMI - body mass indexSOUTH AFRICAN DATA
National average 6.0%
Urban children (1-9y) 7.5%
Rural children (1-9y) 2.5%
Males Females Black adults 7.7% 30.5%
Coloured adults 9.1% 28.3%
Indian adults 8.7% 20.2%
White adults 19.8% 24.3%
Males Females Black adults 10.3% 13.0%
Coloured adults 12.4% 17.1%
Indian adults 9.9% 9.3%
White adults 15.2% 12.0%
Rural Black adults 15%
Urban Black adults 31%
Urban Coloured adults 74%
Urban Indian adults 72%
Urban White adults 86%
Men 163
(skin, prostate, oesophagis, lungs) Women 146
(cervix, breast, skin)
Urban Black adults 6.0%
Urban Coloured adults 8.7%
Urban Indian adults 11-13%
Urban White adults 3.7%
Black Coloured Indian White
1.7 2.1 1.3 1.8
2.0 51.0 2.0 17.0
10.0 67.0 20.0 40.0
1995 -4.5%
1998 -9.9%
1999-12.9%
Males Females Black adults 46.0% 6.0%
Coloured adults 63.0% 49.0%
Indian adults 48.0% 8.0%
White adults 40.0% 34.0%
Males Females Black adults 46.0% 13.0%
Coloured adults 56.0% 27.0%
Indian adults 32.0% 3.0%
White adults 77.0% 58.0%
*
DMFT (decayed, missing due to decay, filled teeth)REFERENCES
Labadarios et at (200 I )
Health Systems Trust (2001)
Health Systems Trust (2001 )
Fritz (1995)
Health Systems Trust (1996)
Health Systems Trust (1996);
Levitt & Mollentze (1995)
NOHS (1994)
(more recent 1998/99 data not yet available)
Health Systems Trust (200 I )
Health Systems Trust (1996);
Yach (1995)
CASE (1995)
With urbanisation and industrialisation, it is predicted that mortality from infectious diseases and undernutrition will decrease among the younger age groups, and life expectancy will rise along with an increased risk of chronic diseases of lifestyle (CDL). As South Africa's life expectancy improves, mortality from CDL, currently estimated at 28.5% of all adult mortality, can therefore be predicted to increase (Murray & Lopez 1997; Health Systems Trust 1996; Popkin, Siega-Riz
& Haines 1996; Bradshaw, Bourne, Schneider & Sayed 1995).
The effect of HIV/AIDS, however, is predicted to decrease life expectancy considerably if transmission prevention and treatment programmes are not intensified. It is currently estimated that 40% of South African adult (15-49 years) deaths during the year 2000 were due to HIV and 20% due to AIDS. When this figure is combined with deaths in childhood, it is estimated that AIDS accounted for about 25% of all deaths in the year 2000 (Dorrington et al. 2001).