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Acute malnutrition robbing children of their full potential

Malnourished children also have little energy, further diminishing their ability to learn and escape poverty, says the writer. Picture: Unicef

Malnourished children also have little energy, further diminishing their ability to learn and escape poverty, says the writer. Picture: Unicef

Published May 23, 2022

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Nkosikhulule Nyembezi

Cape Town - Whenever I hear community elders warning unmarried traditional leaders of the danger of stunting or dying from hunger and starvation if they do not get married soon, I wonder whether this counselling denies the young the freedom of choice on marital issues.

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Among these leaders are AmaRharhabe King Vululwandle Sandile, iNkosi Zanoxolo Ngwabeni of amaGubevu in Butterworth, and iNkosi Bazindlovu Matanzima of abaThembu in Cofimvaba.

Does anyone remember how former president Jacob Zuma once provoked anger by claiming that it is “not right” for women to be single and that children are important to give them “extra training” in a 2012 TV interview with Dali Tambo?

My wondering was rudely interrupted by the shocking revelations in Parliament last week that there were 3 886 under-five deaths in South African hospitals associated with severe, acute malnutrition nationally in the past five years, as reported in the district health information system. Additional figures presented by the health department underpinned the severity of the situation.

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The number of deaths includes children who died from severe acute malnutrition, a rapid condition where wasting, or dramatic weight loss, leads to death.

These numbers can almost double in some parts of the country if they were to include children dying outside healthcare facilities.

Indeed, health and population statistics conducted on my traditional community using the Ndabakazi clinic in Mnquma Municipality tell a grim truth about starving children and the adults in the same households.

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Ncityana village women in Mnquma Municipality are neither especially diminutive nor remarkably lofty. With a mean height of 160.3cm, they are 13.5cm taller than their neighbouring Lengeni village peers and 8.5cm shorter than Komkhulu village women.

But they are easy to notice for one reason: they are 25cm taller than their ancestors half a century ago. That collective growth spurt puts in the picture for us something important: height differences often ascribed to genetics owe a considerable amount to nutrition, hygiene and healthcare.

South Africa’s rapid development in the past 25 years in the form of massive provision of basic services such as water, electricity, roads, and social grants to vulnerable household members meant hunger no longer hindered the growth of women as it had been.

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In contrast, under-nourished household members in the pockets of villages and peri-urban areas not yet receiving these basic services are still associated with “shortness”. Cultural factors – such as the eldest son’s preference in the household food consumption practices – can lead to marked differences in height outcomes even within a community.

These height differences are not a question of mere vanity, and what matters most is not how tall one can grow but whether one fails to grow as expected.

Only the North West province showed a significant decrease in child deaths due to severe malnutrition – from 154 in 2019 to 56 and 62 in the next two years.

The worst-affected provinces were KwaZulu-Natal, followed by the Eastern Cape and Gauteng. There are concerns that the situation will worsen as more people sink into poverty with little sign of relief or economic upturn.

With interest rates set to rise again and the war likely to continue for some time in Ukraine — a major grain exporter — we can predict steeper prices and more hardship.

Though stunting is a physical measure and is associated with the increased risk of some chronic diseases such as diabetes in future, it is also an important indicator that mental development may have been affected. “Malnourished children are more likely to die due to infection as infections worsen the severity of the malnutrition. Most deaths from acute malnutrition are linked to infections such as diarrhoea, pneumonia, tuberculosis and HIV/Aids,” said health department spokesperson Foster Mohale.

Their brains cannot make the neural connections as they should. Their cognitive ability does not blossom. Malnourished children also have little energy, further diminishing their ability to learn and escape poverty. Research suggests they are less likely to be enrolled in school and learn less when they are there.

This tragic situation bothers the South African government and ordinary people like you and me.

Given a disturbing level of under-nutrition in children and their developmental vulnerability during early childhood, providing adequate nutrition is crucial for a quality, national, early childhood development programme (ECD).

The majority of ECD facilities operate between five to 10 hours per day, and the provision of meals is therefore essential.

The current government subsidy to ECD facilities is inadequate and does not reach the most deserving children.

This disservice to the future generation has resulted in many children having to bring a snack or one of their meals from home, especially in unsubsidised facilities.

The nutritional quality of this arrangement is of concern, and in facilities where children have to bring their food, some go hungry.

Schools in impoverished areas should be part of the National Schools Nutrition Programme, meant to provide daily nutritious meals to learners in the most disadvantaged areas but is failing because of corruption and maladministration.

The Grades R to Grade 3 learners at these public schools should have benefited throughout the year from this programme.

But they could not do so because of programme stoppages during the lockdown period of the Corona-virus pandemic. Swift action to end poverty and hunger by reprioritising available public resources could bring immense benefits to a generation.

Bodies and brains develop more quickly in the womb and the first two years after birth. It is hard for those who fall behind to catch up later.

When we talk of children growing to their full potential, we speak more literally than we realise.

Nyembezi is a policy analyst and human rights activist.

Cape Town

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