World Library  
Flag as Inappropriate
Email this Article

Malnutrition in South Africa

Article Id: WHEBN0037751387
Reproduction Date:

Title: Malnutrition in South Africa  
Author: World Heritage Encyclopedia
Language: English
Subject: Malnutrition, Health in South Africa, The End of Eden, Version 1.0 Editorial Team/Sociology articles by quality log, South Africa
Collection: Health in South Africa, Malnutrition
Publisher: World Heritage Encyclopedia

Malnutrition in South Africa

15% of South African infants are born with a low birth weight.[1] 5% of South African children are so underweight they are considered to be wasted.[1] Since the 1990s South Africa's malnutrition problem has remained fairly stable.[1] It is estimated that South Africa loses about US$1.1 billion every year in GDP to vitamin and mineral deficiencies arising from malnutrition, although it would only cost an estimated US$55 million to alleviate this problem through micronutrient nutrition interventions.[1]

The prevalence of malnutrition in South Africa varies across different geographical areas and socio-economic groups.[1] Many infants in Africa suffer from malnutrition because their mothers do not breastfeed them. The mothers in South Africa that do not breast feed their children do not do it mainly to try to avoid the possibility that in doing so, their children may contract AIDS.[2] The 2010 South Africa Department of Health Study found that 30.2% of pregnant women in South Africa have AIDs.[3] Malnutrition can cause several different health problems, like anemia and pellagra.[4][5]

The specific consequences of malnutrition vary depending on the individual and the specific nutrients the individual's diet is lacking. South Africa's Department of Health has established various special programs and initiatives, like the Integrated Nutrition Program, to combat the detrimental effects of malnutrition.[6] All programs and initiatives have faced copious challenges and their individual success rates vastly vary as a result.


  • Health effects 1
    • Vitamin and mineral deficiencies 1.1
  • Causes 2
    • Breastfeeding & HIV transmission avoidance 2.1
    • Additional factors 2.2
    • Poverty 2.3
    • Apartheid 2.4
  • Treatment 3
    • Integrated nutrition program 3.1
  • Epidemiology 4
  • References 5

Health effects

Malnutrition can lead to an onslaught of additional health complications,[7] and eventually even death.[8] In fact, UNICEF found that 11.4% of deaths of South African children under five can be attributed to low weight, making low birth weight the second most prominent cause of children's death in South Africa.[9] According to 2008 statistics, out of 10 million children's deaths, 5.6 million can somehow be attributed to malnutrition.[10] Although all cases of malnutrition in South Africa will not necessarily lead to death, they will most likely lead to a decline in health. The most easily preventable yet most prominent detrimental health conditions associated with malnutrition are nutrient deficiencies.[7]

Vitamin and mineral deficiencies

A deficiency in

  1. ^ a b c d e "Nutrition at a Glance: South Africa". The World Bank. 
  2. ^ a b c d e Bobat, Raziya; Moodley, Dhayendree; Coutsoudis, Anna; Coovadia, Hoosen (11 November 1997). "Breastfeeding by HIV-1-infected women and outcome in their infants: a cohort study from Durban, South Africa". AIDS 11 (13): 1627–1633.  
  3. ^ a b "South Africa HIV & AIDS Statistics". Avert: International HIV & AIDS Charity. Retrieved 9 December 2012. 
  4. ^ a b c d e f "Malnutrition in South Africa". Retrieved 10 December 2012. 
  5. ^ a b c Kale, Rajendra (29 April 1995). "Impressions ofhealth in the new South Africa: a period of convalescence". South Africa's Health 310 (1): 1119–22.  
  6. ^ a b c d e "Combating Malnutrition in South Africa". Input Paper for Health Roadmap. September 2008. Retrieved 10 December 2012. 
  7. ^ a b c d e f g h i j k l Food and Agriculture Organization of the United Nations (1998). The Right to Food in Theory and Practice. Rome: Food & Agriculture Organization. 
  8. ^ Gomez, Federico; Rafael Ramos Galvan; Silvestre Frenk; Joaquin Cravioto Munoz; Raquel Chavez; Judith Vasquez (1956). "Mortality in Second And Third Degree Malnutrition". Journal of Tropical Pediatrics 2 (2): 77–83.  
  9. ^ a b c Bradshaw, Debbie; David Bourne; Nadine Nannan (December 2003). "What Are the Leading Causes of Death Among South African Children?". MRC Policy Brief 3. 
  10. ^ a b c De Lange, Johanna Christina (2010). Factors Contributing To Malnutrition In Children 0-60 Months Admitted To Hospitals In The Northern Cape (M. Sc.). University of the Free State. 
  11. ^ National Heart, Lung, and Blood Institute. "What Is Anemia?". National Institutes of Health. 
  12. ^ Pettifor, J. M.; P Ross; G Moodley; E Shuenyane (December 1979). "Calcium Deficiency In Rural Black Children in South Africa--a Comparison Between Rural and Urban Communities".  
  13. ^ Pettifor, JM; Ross P; Wang J; Moodley G; Couper-Smith J (1978). "Rickets in Children of Rural Origin in South Africa: is Low Dietart Calcium a Factor?". Journal of Pediatrics 92: 320–324.  
  14. ^ Kaneshiro, Neil K. "Rickets Osteomalacia in children; Vitamin D Deficiency; Renal Rickets; Hepatic Rickets". Pub Med Health. 
  15. ^ Vorvick, Linda J. (10 August 2012). "Beriberi". The New York Times. Retrieved 10 December 2012. 
  16. ^ Isaacson, C. (5 November 1977). "The Changing Pattern of Heart Disease South African Blacks". South Africa Medical Journal 20. 
  17. ^ Bradley, Walter G.; Robert B. Daroff, MD, Gerald Fenichel, MD and Joseph Jankovic, MD. "Disorders of the Nervous System". Neurology in Clinical Practice. 
  18. ^ Rook, Ed A; Wilkinson, DS; Ebling, FJB; Champion, RH; and Burton, JL. Textbook of Dermatology: 4th Edition. Blackwell Scientific Publications, cited by "Pellegra." DermNet New Zealand. 26 August 2012
  19. ^ Nutrition Information Centre University of Stellenbosch. "Vitamin A". NICUS. Retrieved 10 December 2012. 
  20. ^ Faber, Mieke; Wenhold, Friede (2007). "Nutrition in Contemporary South Africa". Water SA 33 (3): 393–400. 
  21. ^ West Jr., K. (1 September 2002). "Extent of Vitamin A Deficiency Among Preschool children and Women of Reproductive Age". The Journal of Nutrition 132 (9): 2857S–2866S. 
  22. ^ "Micronutrient Deficiencies". World Health Organization. Retrieved 10 December 2012. 
  23. ^ Van der Merwe, A. E.; M. Steyn; G. J. R. Maat (May–June 2010). "Adult Scurvy in Skeletal Remains of Late 19th Century Mineworkers in Kimberley, South Africa". International Journal of Osteoarchaeology 20 (3): 307–316.  
  24. ^ Cotran, R. S., Kumar, V., & Robbins, S. L. (1994). Environmental and nutritional diseases.Robbins Pathologic Basis of Disease, 5, 379-430.
  25. ^ Coller BS, Schneiderman PI. Clinical evaluation of hemorrhagic disorders: The bleeding history and differential diagnosis of purpura, cited by Hoffman R, Benz EJ, Shattil SS, et al, eds. (2008). Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone,chap 9.
  26. ^ Hirschmann JV, Raugi GJ. (1999). Adult scurvy. Journal of the American Academy of Dermatology. 41:895-906, cited by "Scurvy."DermNet New Zealand.12 June 2012.
  27. ^ Heinig, Jane (February 2001). "Host Defense Benefits of Breastfeeding for the Infant : Effect of Breastfeeding Duration and Exclusivity". Pediatric Clinics of North America. Breastfeeding 2001, Part 1: The Evidence for Breastfeeding 48 (1): 105–123.  
  28. ^ Faber, Mieke; Wenhold, Freid (2007). "Nutrition in Contemporary South Africa". Water South Africa 33 (3): 393–400. 
  29. ^ Sneed, S M; C Zane; M R Thomas (July 1981). "The Effects of Ascorbic Acid, Vitamin B6, Vitamin B12, and Folic Acid Supplementation on the Breast Milk and Maternal Nutritional Status of Low Socioeconomic Lactating Women.".  
  30. ^ a b c d e Niedzwiecki, A. "Malnutrition: The Leading Cause of Immune Deficiency Diseases Worldwide". Dr. Rath's Cellular Health Series. Dr. Rath Research Institute. Retrieved 9 December 2012. 
  31. ^ a b c Walker, Alexander R. P.; Ulla B. Arvidsson (October 1954). "Fat Intake, Serum Cholesterol Concentration, and Atherosclerosis in the South African Bantu. Part I. Low Fat Intake and the Age Trend of Serum Cholesterol Concentration in the South African Bantu". The Journal of Clinical Investigation 33 (10): 1358–65.  
  32. ^ a b c d Brock, J. F.; M. Autret (1952). "Kwashiorkor in Africa". Bull World Health Organ 5 (1): 1–71.  
  33. ^ a b c d e f g h i Aliber, Michael (March 2003). "Chronic Poverty In South Africa: Incidence, Causes and Policies". World Development 31 (3): 473–490.  
  34. ^ Armstrong, P., Lekezwa, B., & Siebrits, K. (2008)."Poverty in South Africa: A profile based on recent household surveys". Matieland: Stellenbosch Economic Working Paper text, 4(08)
  35. ^ (2008). Statistics South Africa. a: 25-28.
  36. ^ a b c d e Oldewage-Theron, Wilna H.; Emsie G. Dicks; Carin E. Napier (September 2006). "Poverty, household food insecurity and nutrition: Coping strategies in an informal settlement in the Vaal Triangle, South Africa". Public Health 120 (9): 795–804.  
  37. ^ Chopra, M.; Drimie, S.; Witten, C. (2009). "Combating Malnutrition in South Africa. Global Alliance for Improved Nutrition". Global Alliance for Improved Nutrition (GAIN), Working Paper Series 1. 
  38. ^ UNICEF. (1998). The State of the World's Children 1998: A UNICEF report. Malnutrition: causes, consequences, and solutions. Nutr Rev, 56(4 part I), 115-123.
  39. ^ Central Intelligence Agency. "Country Comparison: Death Rate". The World Factbook. 
  40. ^ a b The World Factbook. "Africa: South Africa". Central Intelligence Agency. Retrieved 10 December 2012. 
  41. ^ a b "South Africa HIV & AIDS Statistics." AVERT. Web. 3 Mar. 2012. .
  42. ^ May, J., & Govender, J. (1998). "Poverty and inequality in South Africa." Indicator South Africa, 15, 53-58.
  43. ^ "South Africa - October Household Survey 1999". Statistics South Africa. 
  44. ^ Ardington, E. M. (1988). Nkandla revisited: A longitudinal study of the strategies adopted to alleviate poverty in a rural community. Durban: University of Natal.
  45. ^ Kowal, Paul R.; Lopez A.D.; Norton M.; Berman P.; Belizan J.M.; Cafferata M.L.; Belizan M.; Cunha A.L.A. (2003). "Child Survival [1] (multiple letters)". The Lancet. The Child Survival Series 362 (9387): 915–917.  
  46. ^ a b c d e f g h i j k l m n o Swart, R., Sanders, D., & McLachlan, M. (2008). Nutrition: A Primary Health Care Perspective. South African health review, 129-148.
  47. ^ World Health Organization. (1981). International Code of Marketing of Breast-milk Substitutes. World Health Organization.
  48. ^ Meyer, A. (October 2007). "The Rationale for Adopting Current International Breastfeeding Guidelines in South Africa". Maternal & Child Nutrition 3 (4): 271–280.  
  49. ^ a b Schoeman SE, Hendricks MK, Hatting SP, Benade AJ, Laubscher JA, Dhansay MA. (2006). "The targeting of nutritionally at risk children attending a Primary Health Care facility in the Western Cape Province of South Africa." Public Health Nutr. 9(8) 1007-1012.
  50. ^ Schofield, C., & Ashworth, A. (1996). , 74(2), 223.Bulletin of the World Health Organization"Why Have Mortality Rates for Severe Malnutrition Remained So High?"
  51. ^ "IMCI Integrated Management of Childhood Illness". Centre for Rural Health. 
  52. ^ Lambrechts T, Bryce J, Orinda V. (1999) "Integrated Management of Childhood Illnesses." A Summary of First Experiences. Bull World Health Organization. 77(7) 582-594.
  53. ^ World Health Organization. (2005). Handbook: IMCI Integrated Management of Childhood Illness. Geneva: WHO.
  54. ^ Annalynn, Skipper (May 2012). "Agreement on Defining Malnutrition". Journal of Parenter Enteral Nutrition 36 (3): 261–26. 
  55. ^ "Census 2001: Census in Brief". Statistics South Africa. Retrieved 9 December 2012. 
  56. ^ World Health Organization."Global Database on Childhood Growth and Malnutrition". UNICEF/WHO Joint Global Malnutrition Analysis Set, cited in "South Africa-Malnutrition Prevalence."Index Mundi."
  57. ^ Scrimshaw, Nevin S. (1967). "Malnutrition, Learning, and Behavior".  
  58. ^ "Global Database on Child Growth and Malnutrition."World Health Organization, cited in "South Africa-Malnutrition Prevalence."Index Mundi."
  59. ^ Mamabolo, Ramoteme L; Marianne Alberts, Nelia P Steyn, Henriette A Delemarre­van de Waal and Naomi S Levitt (August 2005). "Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa". Public Health Nutrition 8 (5): 501–508.  


Also, although only 13.6% of South African households have no toilet facilities, 30% of Eastern Cape residents lack toilet facilities.[9] Similar statistics are true for the rural areas of the Limpopo Province in northern South Africa. The prevalence of malnutrition in Limpopo is so vast that 48% percent of children in the Limpopo Province evaluated in a 2005 study were shown to have stunted growth.[59] Thus, the high levels of poverty and the rural state of these two areas reflect back through high levels of malnutrition.

The World Health Organization showed that over the span of thirteen years (1995 to 2008), the deviation from the average height of children under age five in South Africa has slightly decreased from 28.7% to 23.9%.[58] These decreases in deviation show that the problem of malnutrition in South Africa has decreased over recent years. However, it remains a prevalent problem, notably in the regions of Eastern Cape and the Limpopo Province. These two areas are especially poor and rural as compared to the rest of South Africa. According to UNICEF, although 84.5% of South Africans have access to piped water, only 62.4% of Eastern Cape residents have access to piped water.[9]

[57].stunts growth of each child from the average height for their age. This is because malnutrition height Malnutrition can also be individually assessed through the deviation of [56] The problem of malnutrition in South Africa can be individually assessed through the deviation of weight of each child from the average weight for their age. According to the [4] Thus, the fact that 25% of pre-school children and 20% of primary school children in South Africa suffered from malnutrition in the year 2000 means that the future population of South Africa is being endangered by the problems of malnutrition

The article Agreement on Defining Malnutrition defines malnutrition as affecting individuals whom "food and nutrient intake is consistently inadequate to meet individual requirements."[54] By the standards of this definition, malnutrition is a prevalent problem in South Africa. In the year 2000, 39% of the country's population suffered from malnutrition.[4] Children are the most affected by this problem, especially young children. South Africa's problem of malnutrition is unique to other countries' malnutrition problems because South Africa is a primarily young country, with one third of the population being under the age of 15.[55]


This presents a problem because most ill South African children are never seen by a nutritionist so they have no other way of learning how to have a proper nutrition. [53] However, there are various vague generalities in IMCI's guidelines that make it difficult for South African health providers to know exactly how to train mothers to provide food for their children.[52] IMCI aims to achieve this through a combination of improved management of common childhood diseases and proper nutrition and immunization.[51] Nutrition management during disease is an another method used by the INP to prevent malnutrition. South Africa's Department of Health adapted the

In order to address the problem of nutrient supplementation on a community-wide level, the INP helped establish the short-term program "Nutrition Supplementation Program" (previously known as the PEM Scheme).[46] This program has been fairly effective because of the well-trained nutritionists that assist it.[46] However, various shortcomings remain. The program has struggled with community based interventions and with properly reaching out to and enrolling all malnourished children without misusing resources on children that are not truly malnourished.[49] If the Child Support Grant was extended to apply to all families of malnourished children, all at risk children could be reached and enrolled at hospitals, clinics, and other places that participate in growth monitoring.[46]

The INP has not failed to recognize the challenges that arise in the hospital-based management of severe malnutrition. South African hospitals admit numerous children for severe malnutrition, yet many of these children end up suffering easily avoidable deaths.[50] Even after the 2006 South African amendment of the District Health Information System, which was supposed to provide the case fatality rates of severe malnourishment among children in hospitals, the lack of identification of malnutrition-related deaths remains high.[46] However, there has been a notable drop of malnutrition-related deaths among hospitals due to training and capacity development geared at the hospital staff.[46]

In order to directly address nutrient deficiencies, the INP established a mandatory food fortification program in 2003, which is interrelated to the micronutrient supplementation program.[46] However, the programs have not reached their anticipated success rates.[46] The food fortification program has created a food fortification mix imbedded in maize meal and other complementary foods. The mix's high Folate content seems to have eradicated Folate deficiencies.[46] The food fortification program also made the iodization of salt mandatory since 1995.[46] This seems to have halted incidences of iodine deficiencies.[46] However, any micronutrients lacking in the food fortification mix can still cause malnutrition. Unfortunately, it has been difficult for the micronutrient supplementation program to provide all the lacking micronutrients to those in need. The program faces various limitations in the forms of supply, supplement quality, bio-availability, outreach, and compliance.[46] For example, the Vitamin A supplementation program has been criticized for its struggles with reaching its most vulnerable target: children and post-partum women.[46]

The INP has implemented growth monitoring in South Africa through the following measures: the provision of growth cards to all caretakers of children under two years old, the constant monitoring of growth and detection of malnutrition, the provision of counsel to caretakers, and the promotion of growth.[46] However, there are various shortcomings in Africa's approach to growth monitoring and promotion. These include inaccurate weight assessment, lack of weight plotting, nurses not trained sufficiently to detect malnutrition, inability to supply growth cards to all infants, and lack of sufficient communication with caretakers.[49]

Since the establishment of the INP in 1995, South Africa has adopted the UNICEF during the thirty-third World Health Assembly.[47] It aims to provide nutrition to malnourished infants through the facilitation of breast-feeding and proper use of breast-feeding substitutes only when absolutely necessary. Unfortunately, there has been a delay in the legislation of the code. If it does get passed, it will need to promote intensive training that follows along the national breastfeeding guidelines for health workers, so that they can reach out to individuals that are doubtful of the benefits of breastfeeding their children.[6] It will also need to promote the extension of maternity leave benefits to give working South African mothers sufficient time and resources to breastfeed.[48]

In accordance with the goal of the United Nations, the South Africa Department of Health established the Integrated Nutrition Program in 1995.[6] The INP aims to mainly help the people most prevalently at risk for malnutrition: children six years old and under, pregnant women, and lactating women. The main foci of the INP are breastfeeding promotion, growth monitoring and promotion, food fortification, micronutrient supplementation, hospital-based management of severe malnutrition, nutrition rehabilitation in communities, and nutrition management during illness.[6] The INP addresses these foci through nutritional education, nutrition counseling services and support for specific ailments, and indirect provision of healthcare services.[6]

Integrated nutrition program

Since the 1990s, the first Millennium Development Goal of the United Nations has been to eradicate world hunger and malnutrition. According to the United Nations, there are certain steps that could be especially beneficial in combating malnutrition.[7] It is estimated that by simply increasing Vitamin A and C intake along with improving breastfeeding methods, the lives of 2.4 million children throughout the world could be saved annually.[45] Various programs in South Africa have been established since then to help achieve this, all with different success rates.


This is because while wealthy urban residents have access to better education and food, their rural, chronically poor counterparts are less educated, have lower literacy levels, and have limited food access.[7][33] In 1997, 900,000 households that were located in formal reserves had no arable land access, 1.4 million had no access to any livestock besides chickens, and 770,000 households had access to neither arable land or other livestock.[43] Unfortunately, many of the rural households that did have access to livestock had to sell the livestock in order to alleviate poverty.[44] All this results in a severe shortage of food among the rural poor, thereby leading to a shortage of nutrients.[7]

While 72% of the South African population considered poor live in rural areas, 86.9% of the chronically poor in Kwazulu-Natal live in rural areas.[33][42] Whereas people in wealthy urban areas tend to have a better nutritional status, rural and agriculturally based people in South Africa tend to have the most inadequate diet.[7][36]

The poorest South African provinces today are those that encompass former African reserves. ( Eastern Cape, Limpopo Province, and Kwazulu-Natal).[33] These places are especially known for their higher rates of malnutrition as compared to the already high rates of South Africa. These Black areas also have the highest rates of AIDS in South Africa[41] - 13.6% of black Africans in South Africa are HIV-positive, whereas only 0.3% of whites living in South Africa have the disease.[41]

In the 1960s, the Apartheid-centered government created African reserves where blacks could live and have a chance at "separate development."[33] Although the majority of South Africans were (and continue to be) black, the reserves compromised a disproportionally small amount of land (13% of South Africa).[33] The reserves were geographically isolated and had poor healthcare, infrastructure and irrigation.[33] Although the first multiracial election in 1994 brought an immediate end to Apartheid, the detrimental effects of Apartheid in South Africa continue to be felt today.[40]

South Africa is unique from other African countries in its particular experience with Apartheid and colonialism.[33] South Africa has numerous rich natural resources like diamonds and gold, yet it has the number one highest death rate in the world (17.23 out of 1000 people die annually).[39] When diamonds and gold were discovered in 1867 and 1886, instead of causing widespread richness for the African people, it caused widespread subjugation to the Boers (Dutch Settlers).[40] Upon their arrival, the Dutch forced black farmers to either abandon their land, become share-croppers, or become farm laborers.[33] Subjugation from non-native groups continued until South Africa became a Republic. This long period of subjugation eventually lead to the establishment of Apartheid in South Africa in 1948 by the National Party ( the ruling political party of the time).[36]

According to 2008 statistics, South Africa has the third most unequal economy in the world.[37] The widespread poverty in Africa can be traced to many factors, one of the most prominent being Apartheid. UNICEF states that the main causes of malnutrition are “household food insecurity, inadequate care for the vulnerable groups such as maternal and childcare, insufficient essential human services including health, education, water and environmental sanitation and housing.[7][38] According to the effects of South African Apartheid listed in the World Fact Book, Apartheid has helped create many of these issues, especially housing, healthcare, and education. Issues like education (i.e. poor performance in school, poor cognitive development) are directly connected to malnutrition in children.[36]


The unemployment rate partly stems from South Africa's unstable macroeconomic status that regardless of modern attempts, is yet to be effectively controlled. The nation-wide economic instability causes income instability for many Africans, which is reflected in a drop of food and beverage purchases. Statistics have shown the percentage of South African incomes being spent on food and beverage purchases have dropped drastically from 27.4% in the year 2000 to 16.6% in the year 2005.[35] These statistics are reflected in poverty-stricken South African households, where the main food providers have to change their food consumption patterns to cope with economic instability. [7][36] This is a detrimental change that compromises nutrition.[7][36]

Malnutrition is an underlying cause of severe poverty.[7] According to statistics from the year 2000, 50% of the South African population is under the poverty line.[33] South Africa's per capita GDP is only $11000, and 21% of people live on a dollar or less a day. In 2008, 27.9% of youth between ages fifteen and twenty-four were unemployed, and the amount of overall unemployment was even higher (33.2%).[34]


However, numerous incidences of kwashiorkor were found among the Wakamba, Kiyuku, and solely grain and vegetable-consuming Bahutu.[32] This shows that South African people who have an agricultural cultivation-based lifestyle are at high risk for malnutrition. In addition to those living in desolate, rural areas, those living in South African slums and other poverty-stricken conditions also only have access to a high-starch, low protein diet.[31] The typical undernourishing South African diet is based on the main staples of rice, porridge, and maize.[31]

A lack of fat often accompanies a lack of protein. A lack of protein in a South African's diet can lead to a form of severe malnutrition know as "kwashiorkor."[32] Research was done to compare the frequency of kwashiorkor among five African groups: the Maasai, the Kikuyu, the Batussi, the Bahutu, the Pieraerts, and the Wakamba.[32] The Masai are pastoral people who consume milk and on occasion, meat. The Wakamba, Kikuyu, and Bahutu are non-pastoral agricultural people who cultivate the foods that they eat. The Batussi people are livestock raisers who consume large amounts of curdled milk. The Pieraert people are lake-side dwellers who consume fresh fish and dried fish. The research found no incidences of kwashiorkor among the Masai, Batussi, the Pieraert, and a small part of the Bahutu who in addition to vegetables and grains, also cultivate beans.[32]

Another main determinant of malnutrition is culture and lifestyle.[7] Various rural South African groups lead agricultural cultivation-based lifestyles that only allow them to live on the very limited amount of resources given to them by their land. The food resources they have access to lack several vital nutrients, making malnutrition among these people more prevalent than among pastoral people and other people with more animal-based diets. In comparison to the average American diet, rural South African groups like the South African Bantu consume a diet with less than half of the fat content.[31]

Malnutrition may also be caused by physical and psychological trauma.[30] These types of trauma are often brought on by personal, political, economic and social unrest, which is not uncommon to South Africa.[30] Trauma increases the body's need for certain nutrients. (i.e. Vitamin C)[30] It can also cause the body difficulties in digesting food properly.[30] In addition to that, it may have a detrimental effect on the immune system.[30]

Additional factors

However, the problem of malnutrition isn't simply solved by a mother choosing to breastfeed her child. Many infants who are breastfed have mothers who are severely undernourished themselves. If a mother doesn't have sufficient nutrients for herself, she is much less likely to have sufficient nutrients in her breast milk. Thus, breast milk from undernourished women is often lacking sufficient quantities of several vital vitamins and minerals like vitamin B6 and folic acid.[29] This lack of nutrients can lead to a nutritional deficiency in the child being breastfed as well.

The formula readily available to the average South African woman does not provide the sufficient nutrients necessary to sustain an infant when utilized by itself. Thus, many infants are not provided with the necessary nutrients they need to thrive, and this can lead to severe cases of malnutrition. The first two years of a person's life constitutes the most vulnerable period for malnutrition, making this lack of nutrients especially detrimental to an infant's health.[28]

Thus, many conflicted South African mothers are faced with the morally difficult decision of whether to prevent malnutrition in their children by breastfeeding them at the risk of them contracting HIV, or preventing HIV in their children at the risk of them not being properly nourished. Because the health cost of not breastfeeding a child is not widely known, most South African women chose the latter option and turn to baby formula to replace breast milk as the main nutritional source for their infants. In fact, according to the South African Demographic Health Service, out of all 3-month-old babies in South Africa, only 10% were exclusively breast-fed and 48.3% were bottle-fed.[10]

Thus, these women pose a huge risk to their infants because infants drinking breast milk infected with the HIV virus may contract the virus as well.[2] Infants with the HIV virus are more likely to pass away if they are breast fed than if they are formula-fed.[2] A study published in the Journal of the International AIDS Society found that the mortality for infected infants was 19% for exclusively breast-fed infants, 13% for mixed-fed infants, and 0% for formula-fed infants.[2]

Breast milk contains many vital nutrients and minerals that protect against infant mortality.[27] Many infants in Africa suffer from malnutrition because their mothers do not breastfeed them. The mothers in South Africa that do not breast feed their children do not do it mainly to try to avoid the possibility that in doing so, their children may contract AIDS.[2] The 2010 South Africa Department of Health Study found that 30.2% of pregnant women in South Africa have AIDs.[3]

Breastfeeding & HIV transmission avoidance

For example, a woman with psychological problems may not have the cognitive abilities to recognize that she needs to feed her children, and thus may neglect to do so, causing her children not to obtain the sufficient nutrients they need to thrive. However, even mothers with full cognitive abilities may still cause their children to suffer from malnutrition by not partaking in breastfeeding.

An individual in South Africa may develop malnutrition because of several factors, not all of them necessarily having to do with diet. According to UNICEF, factors that can cause malnutrition include but are not limited to stress, trauma, poor psychological care, neglect, and abuse.[10]


Vitamin C deficiency also has detrimental effects on the South African population. Scurvy, a disease that develops from an extended shortage of Vitamin C, has previously been found prevalent in certain South African mining populations.[23] This disease causes weakness, anemia, skin hemorrhages, and gum disease (gingivitis).[24][25] Because Vitamin C plays a vital role in the formation of connective tissues, a deficiency in it may also cause complications with the immune system, iron absorption, cholesterol metabolism.[26]

[22] An additional malnutrition problem is a deficiency in

Another disease common to South Africa is pellagra. Dr. D Blumhson, a physician, notes a high rate of pellagra among the patients of a hospital in Soweto, South Africa.[5] Pellagra seems to be especially common in patients with corn-based diets. The disease itself is caused by a Niacin deficiency.[5] Pellagra's symptomatology is described by the "4 D's:"dermatitis, diarrhea, dementia, and death[17] Pellagra causes gastrointestinal discomforts like diarrhea, nausea, vomiting, abdominal pain, and poor appetite.[18] Unfortunately, this downward spiral often causes further malnutrition, which in turn further amplifies the magnitude of pellagra.

Many South Africans also have a Thiamine (Vitamin B1) deficiency.[15] A serious deficiency in this vital nutrient can cause beriberi, which has the immediate symptom of severe lethargy. If left untreated, Beriberi can cause inflammation of the nervous system and even heart failure. Heart failure associated with beriberi is especially prominent in Johannesburg, the capital of South Africa.[16]

Another common nutritional problem among South Africans is hypocalcemia, a deficiency in calcium. In a study of a randomly chosen rural South African community, 13.2% of children were found to have abnormally low levels of calcium in their blood.[12] Additional studies done on South African children show that this deficiency can lead to Rickets.[13] Rickets causes weakness and pain in bones and dental structures, impaired growth, muscle cramps, and skeletal deformities.[14]


This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.