Call for action to address malnutrition in all its forms
Good nutrition is an essential part of an individual's defence against disease. Malnutrition, in the forms of both over- and undernutrition, is closely related to an increased risk of illness and death, which has a considerable economic and societal impact. The coronavirus pandemic has emphasised the importance of food security and nutritional wellbeing for all South Africans and has exposed the vulnerability and weaknesses of our food systems. In view of this, we call on the government to address malnutrition in all its forms.
The nutrition challenges facing South Africa are complex and underpinned by historical and current inequalities. Undernutrition co-exists with the rising incidence of overweight and obesity (frequently in the same household) and resultant non-communicable diseases (NCDs) such as type 2 diabetes mellitus and hypertension. The availability and affordability of highly processed foods are considered important drivers of poor nutrition (1). On the other hand, dietary patterns characterised by higher intakes of unprocessed foods are linked to more positive health outcomes (2).
In South Africa more than a quarter of the female adult population is overweight and more than a third obese, with the highest prevalence (42%) among urban women (3–6). Moreover, it is estimated that 269,000 NCD related deaths occur in the country annually (7). Obesity and NCDs are regarded as major risk factors for Covid-19 hospital admissions and complications (8). While the prevalence of overweight among children is increasing (13% of children under the age of five years) and of concern, child undernutrition persists, with stunting rates of children under 5 years of age (an indicator for chronic undernutrition and lack of food) showing no reduction (27% stunted children <5 years in 2016), mostly affecting poor and rural communities (6,9,10). In this context it is concerning that South Africa has a lower ratio of nutrition professionals per 100 000 people (5.4 professionals) than other African countries (8.4 professionals) (11,12).
The United Nations recognises the threat of the Covid-19 pandemic to food security and nutrition of millions of people and warns of a looming global food emergency unless immediate coordinated action is taken (13). Nationally, efforts to contain the spread of Covid-19 have resulted in worsening of food shortages, nutrition deficits, and an interruption of social and other nutrition support services on which the most marginalised groups of our country rely (14). The lockdown also poses challenges with regard to the accessibility and affordability of healthy food which has increased the chances of food secure households becoming food insecure.
While hunger has been reduced and food access in South Africa has improved over the past 15 years, 1.7 million households still experienced hunger in 2017, and the pace of addressing inadequate food access has been too slow to achieve the goal of zero hunger by 2030 (15). Early indications now suggest a rapid rise in hunger prevalence since the lockdown was imposed, with up to 24% of residents not having money to buy food (16). In addition, in this context, food prices have increased by as much as 30% over the past two months, further adding to the financial strain on households (17). It is anticipated that maternal and child mortality is likely to increase directly and indirectly as a result of the Covid-19 outbreak (18).
Tackling malnutrition in all its forms requires political commitment and actions across multiple sectors that goes beyond the Covid-19 pandemic. We are therefore calling on government to:
President: Prof Corinna Walsh
President: Dr Christine Taljaard-Krugell
President: Mr Tshilidzi Nageli
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2. Wrottesley S V., Pisa PT, Norris SA. The influence of maternal dietary patterns on body mass index and gestational weight gain in urban black South African women. Nutrients. 2017 Jul;9(7):e732.
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12. World Health Organization. Global nutrition policy review 2016-2017 - country progress in creating enabling poilcy environments. Geneva; 2018.
13. United Nations. Policy Brief: The Impact of Covid-19 on Food Security and Nutrition, June 2020. United Nations; 2020.
14. Vermeulen H, Muller C, Schonfeldt HC. Food aid parcels in South Africa could do with a better nutritional balance [Internet]. The Conversation. 2020. Available from: https://theconversation.com/food-aid-parcels-in-south-africa-could-do-with-a-better-nutritional-balance-136417
15. Statistics South Africa. Towards measuring the extent of food security in South Africa. Pretoria: Statistics South Africa; 2019.
16. Engaging communities regarding their knowledge, beliefs, practices and attitudes in response to the Covid-19 outbreak in South Africa. 2020.
17. Abrahams M, Smith J. Covid-19: Families living on low incomes may be spending 30% more on food than they did two months ago. Pietermaritzburg; 2020.
18. Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the Covid-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Heal. 2020 May;e30229.