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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

Childhood obesity should be curbed early
2017-03-15

Description: Child obesity Tags: Child obesity

Serious intervention by parents is required to deal
with childhood obesity. Prof Louise van den Berg and
a group of final-year PhD students worked on a study
about the prevalence of obesity in six-year-olds in
South Africa.
Photo: Supplied

If your child is overweight when they start school at the age of six, unless you do something about it at that point, the indications are they are going to be overweight teenagers and obese adults. This is according to University of the Free State’s Prof Louise van den Berg.

Evidence has shown that overweight children and teenagers have a greater risk of developing lifestyle diseases such as type 2 diabetes, hypertension and cardiovascular disease later in life, and dying prematurely.

Obesity is a global pandemic rapidly spreading among adults and children, in developed and developing countries alike.

Dr Van den Berg worked with Keagan Di Ascenzo, Maryke Ferreira, Monja-Marie Kok, Anneke Lauwrens, all PhD students with the Department of Nutrition and Dietetics, to conduct the study. Their research found that children who are overweight by the time they turn six should be screened for weight problems.

Why six-year-olds?
Children who are overweight between the ages of two and five are five times more likely to be overweight when they are 12. There are two periods in a normal life cycle when the body makes new fat cells. The first is in the uterus and the second is around the age of six. The second phase lasts from the age of six to puberty.

The study assessed the prevalence of obesity in six-year-olds as part of a campaign in South Africa to raise awareness of the problem among parents and educators.

A total of 99 children were chosen from seven schools in Mangaung, the capital city of Free State. The schools were chosen from quintile four and five schools, which when measured by their own resources and economic circumstances, are well resourced and serve largely middle-class and wealthy communities.

The children’s weight, height and waist circumference were measured and used to calculate a body mass index score and waist-to-height ratio. Both these figures are good predictors for future lifestyle disease risks such as type 2 diabetes, hypertension and cardiovascular disease. A person with a good waist-to-height ratio can wrap a piece of string equal to their height around their waist at least twice.

When the children had a higher body mass index, they also had an increased waist to height ratio. The study found one in four children from the schools surveyed were overweight when they started primary school.

Nipping the fat in the bud
Although there are many factors that play a role in preventing childhood obesity, parents’ perceptions of their children’s weight play an important role. A recent study found that more than 50% of parents underestimate the weight of their obese children. These parents remain unaware of the risks their children face and are not motivated to take any action.

At least half of the parents whose children are overweight struggle to recognise their children’s weight problems fearing that they will be labelled or stigmatised. By the time they turn six overweight children should be referred to dieticians and nutritionists who are qualified to guide their parents in getting them to eat well and be more physically active at pre-primary and primary school.

The high prevalence of weight problems among six-year-olds found in this study is an urgent call to healthcare professionals to step up and empower parents, educators and children with the necessary skills for healthy dietary practices and adequate physical activity.

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