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17 September 2020 | Story Prof Corina Walsh | Photo Sonia du Toit (Kaleidoscope Studios)
Prof Corinna Walsh is from the Department of Nutrition and Dietetics and an NRF C-rated researcher at the University of the Free State.

The COVID-19 pandemic highlighted the challenges of food insecurity, hunger, and malnutrition that existed prior to the outbreak, but which are now affecting more individuals and households. During June 2020, three organisations – the Nutrition Society of South Africa (NSSA), the Association for Dietetics in South Africa (ADSA), and Dietetics-Nutrition is a Profession (DIP) – joined forces to call on the government to address malnutrition in all its forms. Prof Corinna Walsh from the Department of Nutrition and Dietetics at the University of the Free State (UFS) is the President of the Nutrition Society of South Africa, which aims to advance the scientific study of nutrition to promote appropriate strategies for the improvement of nutrition well-being. 

The call confirms that good nutrition is an essential part of an individual’s defence against disease and explains that 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 well-being for all South Africans and has exposed the vulnerability and weaknesses of our food systems. 

How big is the problem of malnutrition in South Africa and what impact has the Coronavirus had on this situation?

The call highlights that 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. In South Africa, more than a quarter of the female adult population is overweight and more than a third is obese; it is estimated that 269 000 NCD-related deaths occur in the country annually. Obesity and NCDs are regarded as major risk factors for COVID-19 hospital admissions and complications. Over the past 20 years, the prevalence of chronic undernutrition in children has not improved, with 27% of children under the age of five being chronically undernourished. Chronic undernutrition in children manifests as impaired growth, referred to as stunting. By the age of two, this impaired growth and deficits in development become more difficult to reverse, resulting in intellectual impairment that compromises children’s school performance and employment prospects. Chronic undernutrition in children furthermore increases their future risk of obesity and non-communicable chronic diseases in adolescence and adulthood.

Although the nutrition situation in the country had been of concern prior to the pandemic, the acute nature and vast extent of the lockdown brought the plight of individuals and communities to the forefront. In addition to hunger and food insecurity and the resultant undernutrition, the pandemic also placed a focus on non-communicable chronic diseases such as obesity, hypertension, and diabetes. These comorbidities, mostly related to overnutrition, are seen to be associated with a more severe form of COVID-19 infection, as well as an increased risk of hospitalisation and death.

 With South Africa’s current economic challenges and the rise of unemployment, is the situation of malnutrition and food insecurity bound to worsen?

Food, water, sanitation, and social security are under severe pressure due to the pandemic. All of these factors are directly related to an increased risk of malnutrition. Further underlying causes of malnutrition include poverty, unemployment, and inequality, which require interventions over the medium and long term. 

The initial hard lockdown had an immediate and acute impact on households and communities in many ways. With regard to food and nutrition, these include interrupted access to food due to restrictions on travelling and informal trading; discontinuation of food and nutrition social programmes such as the National School Nutrition Programme and feeding at early childhood development programmes; increases in food prices and food expenditure; and reduced or lost income.

The pandemic came at a time when global food security and food systems were already under strain due to natural disasters, climate change and other challenges, exacerbating the need to transform food systems to be sustainable and resilient. 

What interventions are suggested to address the problem of malnutrition?

Food relief and social relief interventions, such as food parcels and social grants, could address the more immediate needs, but broader actions are required to address the underlying causes of malnutrition. 

An important first step in the fight against malnutrition will be to recognise the severity of the situation and the need for coordinated strategic efforts to address the underlying factors that contribute to malnutrition, such as insufficient access to food, affordability of fresh foods, poor health services, and a lack of safe water and sanitation. Food security and nutrition should therefore be addressed collectively with interventions aimed at tackling these factors. It will require concerted efforts from the government, the private sector and civil society to address the immediate, underlying, and structural causes of undernutrition. In view of this, the call proposes that interventions include the following:
-           Prioritise nutrition on policy agendas related to health and social security, including a regulatory framework to support access to healthy and affordable foods. Consideration can be given to a basket of subsidised healthy foods and greater regulation of prices of basic foodstuffs.
-           Provide strategic direction and ensure coordinated and aligned programming to address food and nutrition security in collaboration with other sectors, including civil society organisations. Interventions to ensure optimal nutrition should extend beyond the health-care system and should draw on complementary sectors such as agriculture, social protection, early childhood development, education, water, and sanitation.
-           Coordinate an adequate and targeted food and social relief approach, prioritising the most vulnerable and needy for short-term mitigation. Food relief should be standardised and tailored to the nutritional needs of targeted beneficiaries, especially children. 
-           Progress towards universal health coverage to ensure access to quality, essential health care. Focus on delivery of preventive nutrition services as part of the transformation and strengthening of the health system, integrating nutrition into universal health coverage as an indispensable prerequisite for longer-term benefit.
-           Prioritise the challenges faced by specific populations, including the elderly, women (especially women of childbearing age), children, and those with pre-existing medical conditions (most notably HIV/AIDS, TB, and NCDs), drawing on local structures to identify those most in need. 
-           Implement well-funded coordinated strategies to actively address the main drivers of malnutrition, paying attention to food, nutrition, and health, backed by responsive social protection mechanisms.
-           Improve access to quality nutrition care through investment in human resources to increase the number of qualified nutrition professionals, as well as education opportunities for other cadres of workers who provide nutrition services in primary care settings. Each point of contact with the health system should be recognised as an opportunity to direct caregivers to nutrition care and support services, with efficient referral pathways between sectors.
-           Promote nutrition education of the public through targeted and relevant nutrition messaging and communication campaigns.

Opinion article by Prof Corinna Walsh of the Department of Nutrition and Dietetics and an NRF C-rated researcher, University of the Free State.

 

News Archive

Top matriculants for Kovsies
2014-01-24

 

 
From left are: Saneliswe Khambule, Lungile Mkhungo, Jannie de Wet, Anje Venter, Siqiniseko Buthelezi and Abrille Beukes.
Photo: Hannes Pieterse

Hailing from top schools in KwaZulu-Natal (KZN), Naushad Mayat, Lungile Mkhungo and Siqiniseko Buthelezi share 20 distinctions between them. Leaving the province of the Zulu Kingdom for Bloemfontein, all three are at Kovsies to study as doctors.

Naushad obtained eight distinctions, an achievement that placed him in the top ten matriculants in KwaZulu-Natal. The former learner from Glenwood High School in Durban came fourth in the Umlazi District and tenth overall in the province. Enrolling for a degree in Medicine, he will join the list of outstanding health professionals Kovsies produce every year.

Lungile, who matriculated from Kingsway High School, attained seven distinctions and her average percentage was 90%. She received distinctions in English – 90%, IsiZulu – 94%, Mathematics – 83%, History – 92%, Physics – 89%, Life Sciences – 89% and Life Orientation – 93%. Lungile is not only clever, but also performed well in sports at her school, participating in netball, soccer and athletics. This future doctor is a proud resident of Wag-'n-Bietjie residence. 

Siqiniseko made history at his school, Maritzburg College, becoming the first black Head Prefect at the 150-year-old school, the oldest boys' high school in KZN and one of the oldest schools in South Africa. A gifted learner excelling in sport, culture and academics, Siqiniseko obtained five distinctions (English, Afrikaans, Life Orientation, Accounting and Life Sciences). His sporting prowess has seen him captaining Maritzburg College's first rugby team, as well as the KZN Academy team.

The three are joined by fellow KwaZulu-Natal resident, Saneliswe Khambule, Namibian Abrille Beukes and Free Staters Anje Venter and Jannie de Wet.

Saneliswe, a former learner of Menzi High School in Umlazi, received five distinctions in her final-year exams. The Emily Hobhouse resident registered for a Forensic Science degree and plans on doing her doctoral studies in this exciting career field.

Abrille Beukes is another future doctor and is all the way from Windhoek in Namibia. Abrille obtained a ‘one’ in all her subjects, the highest possible mark in the Namibian school system. The Windhoek-born student received high levels in Mathematics, Accounting, Physical Science, Biology, Afrikaans and English. As second best student in her home country, she will register for a Medicine degree.

Anja, the Free State’s top achiever, received an average percentage of 93% in the matric final exams. The former Eunice student obtained nine distinctions, an achievement that placed her in the national top 100 matriculants.  Anja enrolled for a BSc Actuarial Science degree and will be joined in class by former school friend, Jannie de Wet, who obtained a whopping ten distinctions. Jannie and Anja attended Universitas Primary School together, with Jannie finishing his school career at Jim Fouché High School, and just like Anja, he will also enrol for a BSc Actuarial Science degree.

Jannie obtained distinctions in Afrikaans, English, Mathematics, Mathematics (third paper), Life Orientation, Accounting, Physical Science, Life Science, Economics and Information Technology. Jannie is also the Volksblad and the University of the Free State’s 2013 Matriculant of the Year.

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