Overweight among children decreased, but obesity prevalence remained high among women in South Africa, 1999-2005.

OBJECTIVE: The aim of the present study was to assess anthropometric status in South African children and women in 2005 in order to document temporal trends in selected anthropometric parameters. DESIGN: Heights and weights were measured in a cross-sectional study of children aged 1-9 years and women aged 16-35 years. The WHO reference values and BMI cut-off points were used to determine weight status. SETTING: South Africa, representative sample based on census data. SUBJECTS: Children (n 2157) and women (n 2403). RESULTS: Stunting was the most common nutritional disorder affecting 21·7% of children in 1999 and 20·7% in 2005. The difference was not statistically significant. Underweight prevalence remained unchanged, affecting 8·1% of children, whereas wasting affected 5·8% of children nationally, a significant increase from 4·3% of children in 1999. Rural children were most severely affected. According to the international BMI cut-off points for overweight and obesity, 10% of children nationally were classified as overweight and 4% as obese. The national prevalence of overweight and obesity combined for women was 51·5%. The prevalence of overweight in children based on weight-for-height Z-score did not change significantly (8·0% to 6·8%, P = 0·138), but the combined overweight/obesity prevalence based on BMI cut-off points (17·1% to 14·0%, P = 0·02) decreased significantly from 1999 to 2005. CONCLUSIONS: The double burden of undernutrition in children and overweight among women is evident in South Africa and getting worse due to increased childhood wasting combined with a high prevalence of obesity among urban women, indicating a need for urgent intervention.

Running before we walk: how can we maximise the benefits from community service dietitians in KwaZulu-Natal, South Africa?

INTRODUCTION AND AIM: The Department of Health in South Africa, instituted compulsory community service (CS) as one strategy to overcome the chronic shortage of health professionals in underserved and rural areas. A number of articles have listed the reasons for the lack of willingness of health professionals to practice in rural areas. Amongst others they listed the lack of career opportunities, the recruitment of students into health professions from incongruous backgrounds, inappropriate training, bureaucratic problems, poorly equipped hospitals and social isolation. The aim of this study was to examine and explore the factors affecting the professional development of dietitians during CS. METHODS: Thirteen of the 15 community service dietitians (CSDs) currently (2005) undertaking CS in KwaZulu-Natal participated in focus group discussions. Each member of the group was also required to answer a short written questionnaire before the discussions to establish whether there was congruence between the written answers and the verbal discussions. The large group was divided into two sub groups and each session lasted one and a half hours. A list of topics was discussed by each group. The sessions were taped and transcribed and further analysed using the qualitative analysis programme, "QSR NVivo". RESULTS: Analysis of the transcripts revealed a number of thematic areas and included the evaluation of the placement process, obstructions and constraints, the developmental progress of the CSD and means of enhancing professional development. The discussion on the placement process was not contentious, with only three CSDs having reservations about the process. Many obstructions and constraints to service delivery and professional development were revealed and included the lack of supervision and support, the lack of preparedness of the institutions receiving CSDs and the lack of clarity of the CSDs' perception of community service, unhappiness of some CSDs being placed a long way from home, work and role overload, not being part of a team, lack of understanding the CSDs role and the under utilisation of their services. Developmental progress of the CSDs was enhanced by some positive aspects which included the social interactions experienced in the community setting, learning new skills and support that they received from other community service professionals. DISCUSSIONS AND RECOMMENDATIONS: Comparison of the written answers with verbal discussions showed the same results. A number of issues raised in this study have been recorded by other authors. It is recommended that the issue of supervision and support be addressed so that the professional development of CSDs is enhanced. The lack of preparedness of the receiving institutions is a problem that is relatively easy to address and should be made a priority. The training institutions also need to be more proactive in preparing dietetic students for CS. CONCLUSIONS: Compulsory community service as a method of addressing the problems of underserved population has merit. To maximise the benefits the DOH would do well to heed the recommendations by ensuring that there are structures in place to provide adequate resources for and support and supervision of CSDs.

Added Sugar, Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context.

OBJECTIVE: The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1-8.9 years of age in South Africa. METHODS: Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined. RESULTS: Added sugar intake varied from 7.5-10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1-3 years) (Q1) to 19.3% in Q4 (4-8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1-3 years), phosphorus, iron (4-8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4-8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2-29.8)% in Q4 compared to 13.0 (8.7-17.3)% in Q1, p = 0.0063]. CONCLUSION: Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4-8 year old children.

What is the nutritional status of children of obese mothers in South Africa?

OBJECTIVE: To evaluate the anthropometric status of children of obese (body mass index [BMI] ≥30 kg/m2) mothers who participated during the 2005 National Food Consumption Study. METHODS: The survey population consisted of children 1-9 y of age and their mothers 16 to 35 y of age living in the same households (n = 1532). A national sample of households was drawn, representative of all nine provinces and urban and rural areas. Trained fieldworkers measured the heights and weights of participants at their homes. RESULTS: The prevalence of obesity was high in the mothers (27.9%), particularly in the 26- to 35-y-old (older) group (32.3%) and in urban areas (29.1%). Children of older mothers had a significantly (P < 0.05) higher mean height-for-age Z-score (-0.91) than those of younger mothers (16 to 25 y old, -1.06). Mean weight-for-age and weight-for-height Z-scores were significantly higher in children of obese women compared with those of non-obese women (BMI <30 kg/m2, P < 0.001). Furthermore, obese mothers had significantly more overweight children than non-obese mothers (P < 0.0001). Eighty-four percent of overweight children also had mothers with a BMI ≥25 kg/m2 and 52% had mothers with a BMI ≥30 kg/m2(∗ indicates statistical significance of confidence interval). Stunted mothers had a 1.5 times higher risk of being overweight (BMI ≥25 kg/m2, odds ratio 1.45, confidence interval 1.06-2.01). CONCLUSION: Overall, children of obese mothers had significantly higher mean Z-scores than those of mothers who were non-obese. Overweight and obese women were significantly less likely to have stunted or underweight children, whereas underweight women and stunted women were significantly more likely to have underweight and stunted children, respectively.