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18 March 2022 | Story Dr Chantell Witten | Photo Supplied
Dr Chantell Witten is from the Division Health Science Education, Faculty of Health Sciences, at the University of the Free State

Opinion article by Dr Chantell Witten, Division Health Science Education, Faculty of Health Sciences, University of the Free State (UFS). 
As we count down to Human Rights Day commemorated annually on 21 March, we are acutely aware of the failures of the state to realise and satisfy the human rights enshrined in our Constitution and Bill of Rights, especially for children.
Since the dawn of democracy in South Africa in 1994 the country has struggled with a persistent high level of child malnutrition measured as stunting, when children are too short for their age.  This is not just shortness of height but it is a proxy for compromised health and a risk factor for lower cognitive development, lower education attainment and lower future productivity both in work output and in earning capabilities. Unhealthy children are likely to be our future unhealthy adults and compromised human development.

Protect children from hunger

It is for this reason that all efforts must be explored to protect children from hunger. Since the outbreak of the COVID-19 pandemic more than two years ago, there have been huge negative impacts on global health and development which are bearing down on the youngest members of the planet, our children. These impacts on children are costing their lives now and well into the future. South Africa has the largest social protection programme for children on the African continent with a child support grant that benefits more than 12 million children under the age of 18 years. On 23 February 2022, Finance Minister Enoch Godongwana announced that the child support grant would increase from R460 to R480 per month as from 1 April. A mere 4% increase, against a year-on-year food and non-alcoholic beverages inflation of 5.5%, rendering the already measly child support grant ineffective to keep hunger at bay, much less to address the nutrition that children need to grow and be healthy. In Section 28 of the Bill of Rights in our Constitution states that “every child has the right to basic nutrition, shelter, health care and social services, as well as the right to be protected from maltreatment, neglect, abuse or degradation”. But the high levels of child malnutrition, almost one in three children are stunted, while one in four households reported child hunger. This is a result of the failure to protect children.

One of South Africa’s leading civil society organisations, the Black Sash, undertook research with the South African Medical Research Council to explore how households receiving the child support grant managed with respect to food procurement and dietary patterns. I was approached to assist with child nutrition data interpretation and policy implications. It was not surprising to find that all 12 households included in this qualitative study were not able to cope or meet their food needs. These households’ food purchasing patterns were insufficient in quantity and in dietary quality. All household members were not able to eat regularly or sufficiently to keep hunger at bay. Even for children, hunger was a norm. Even for a household of a single mother and her five-year-old child, the child support grant was not enough to buy enough food, and other essentials like electricity, toiletries and cleaning materials. This was a huge cause for concern, given the context of COVID and the need to wash hands and surfaces regularly.

Trauma of  caregivers to provide food

The nutrition evaluation of the foods that were purchased was lacking in diversity, nutrient-density and low-quality foods, raising the issue of food safety as well. Poor households dependent on the child support grant, even with multiple grants, was not enough to buy enough food for all the household members. Many adults are forced to go without meals or reduce the amount of food they eat and to rely on food relief efforts like soup kitchens, food packs and food charity. The most heart-wrenching finding is the constant experience of trauma faced by caregivers to provide food for their hungry children. Caregivers expressed feelings of shame and guilt knowing that their children are hungry, for sending their children to ask for food from neighbours and community members. The constant cries for food would drive caregivers to ‘hit the children and send them to bed’. Sleeping is an escape from hunger and having to deal with hunger. These households are under severe psychological strain, re-emphasising that hungry people are angry people. This is not conducive for optimal child care and highlights hunger as a driver of child ‘maltreatment, neglect, abuse or degradation’ as listed in the Bill of Rights.

While caregivers are resourceful in trying to stretch the food budget by buying cheaper, smaller quantities of food products, giving small children many smaller snack foods and taking cash loans to buy foods, these efforts do not shield or protect children from the physical and psychological harm of hunger. A whole-of-society response is needed to create more provision efforts like community out-reach kitchens, food drives and donations, macro-policy initiatives to subsidise food for grant recipients, promotion and support of food gardens and to push government to institute a Basic Income Grant for unemployed persons 18-59 years of age. The child support grant is not enough to protect children from chronic hunger which itself is ‘maltreatment, neglect, abuse or degradation’ as enshrined in the South African Bill of Rights.

News Archive

Fighting the tuberculosis battle as a collective
2015-09-28



The team hard at work making South Africa a
healthier place

Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. More than 95% of TB deaths occur in low- and middle-income countries. Despite being more prevalent among men than women, TB remains one of the top five causes of death amongst women between the ages of 15 and 44 years. While everyone is at risk for contracting TB, those most at risk include children under the age of five and the elderly. In addition, research indicates that individuals with compromised immune systems, household contacts with pulmonary TB patients, and healthcare workers are also at increased risk for contracting TB.

According to the Deputy Director of the Centre for Health Systems Research and Development (CHSR&D) at the UFS, Dr Michelle Engelbrecht, research has found that healthcare workers may be three times more likely to be infected by TB than the general population.

The unsettling fact

“Research done in health facilities in South Africa has found that nurses do not often participate in basic prevention acts, such as opening windows and wearing respirators when attending to infectious TB patients,” she explained. 

In response to this concern, CHSR&D, which operates within the Faculty of Humanities at the the University of the Free State (UFS) Bloemfontein Campus has developed a research project to investigate TB prevention and infection control in primary healthcare facilities and households in Mangaung Metropolitan.

Action to counter the statistics

A team of four researchers and eight field workers from CHSR&D are in the process of gathering baseline data from the 41 primary healthcare facilities in Mangaung. The baseline comprises a facility assessment conducted with the TB nurse, and observations at each of the facilities. Individual interviews are also conducted with community caregivers, as well as TB and general patients. Self-administered questionnaires on knowledge, attitudes, and practices about TB infection control are completed by all nurses and facility-based community caregivers.

Healthcare workers are the main focus of this research, given their increased risk of acquiring TB in healthcare settings. At clinics, interventions will be developed to improve infection control practices by both healthcare workers and patients. TB patients’ households are also visited to screen household contacts for TB. Those found to have symptoms suggesting TB infection are referred to the clinics for further assessment and treatment.

The findings of this study will serve to inform the development of an intervention to address TB prevention and infection control in primary healthcare facilities. Further funding will be sought to implement and evaluate the intervention.

Curbing future infections and subsequent deaths as a result of TB is the priority for the UFS. The cooperation and collaboration of the community, government, and sponsors will ensure that this project is a success, hence prolonging life expectancy.


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