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Kruger HS, Visser M, Malan L, Zandberg L, Wicks M, Ricci C, Faber M. Anthropometric nutritional status of children (0-18 years) in South Africa 1997-2022: a systematic review and meta-analysis. Public Health Nutr 2023; 26:2226-2242. [PMID: 37800336 DOI: 10.1017/s1368980023001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To conduct a comprehensive systematic review and meta-analysis of the available literature on the anthropometric nutritional status of South African infants and children, 0-18 years old and to report on trends of changes in nutritional status over the period 1997-2022. DESIGN Systematic review and meta-analysis. SETTING Review of the available literature on the anthropometric nutritional status of South African infants and children, 0-18 years old, over the period 1997-2022. PARTICIPANTS South African infants and children, 0-18 years old. RESULTS Only quantitative data from ninety-five publications that described the nutritional status in terms of anthropometry were included. Most recent studies applied the WHO 2006 and 2007 definitions for malnutrition among children 0-5 years old and 5-19 years old, respectively. Meta-analysis of all prevalence data shows the highest stunting prevalence of 25·1 % among infants and preschool children, compared to 11·3 % among primary school-age children and 9·6 % among adolescents. Furthermore, the overweight and obesity prevalence was similar among children younger than 6 years and adolescents (19 %), compared to 12·5 % among primary school-age children. In national surveys, adolescent overweight prevalence increased from 16·9 % in 2002 to 23·1 % in 2011. Meta-regression analysis shows a decrease in stunting among children 6-18 years old and an increase in combined overweight and obesity in the 10-19 years age group. CONCLUSION The double burden of malnutrition remains evident in South Africa with stunting and overweight/obesity the most prevalent forms of malnutrition among children.
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Affiliation(s)
- Herculina Salome Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Marina Visser
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study. Nutrients 2022; 14:nu14214459. [PMID: 36364722 PMCID: PMC9654662 DOI: 10.3390/nu14214459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
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Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
- Correspondence: or
| | - Theresa Jeremias
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC 27707, USA or
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
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Estimating the changing disease burden attributable to iron deficiency in South Africa, 2000, 2006 and 2012. S Afr Med J 2022; 112:684-692. [DOI: 10.7196/samj.2022.v112i8b.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/08/2022] Open
Abstract
Background. Worldwide, iron deficiency, and consequent iron-deficiency anaemia, remains the most common nutritional disorder. Iron-deficiency anaemia mostly affects young children and women of reproductive age, especially in Asia and Africa. Iron deficiency may contribute to disability directly or indirectly as a risk factor for other causes of death, and may rarely contribute to death.Objectives. To estimate the changing burden of disease attributable to iron deficiency in males and females (all ages) for the years 2000, 2006 and 2012 in South Africa (SA).Methods. The comparative risk assessment methodology developed by the World Health Organization (WHO) and the Global Burden of Diseases, Injuries, and Risk Factors Studies was used to estimate the burden attributable to iron deficiency in SA for the years 2000, 2006 and 2012. We attributed 100% of the estimated iron-deficiency anaemia burden across all age groups by sex to iron deficiency. For maternal conditions, the attributable burden to iron deficiency was calculated using the counterfactual method and applied to all women of reproductive age. The population attributable fraction calculated for these selected health outcomes was then applied to local burden estimates from the Second SA National Burden of Disease Study (SANBD2). Age-standardised rates were calculated using WHO world standard population weights and SA mid-year population estimates.Results. There was a slight decrease in the prevalence of iron-deficiency anaemia in women of reproductive age from ~11.9% in 2000 to 10.0% in 2012, although the prevalence of anaemia fluctuated over time (25.5% - 33.2%), with a peak in 2006. There has been a gradual decline in the number of deaths from maternal conditions attributable to iron deficiency in SA between 2000 (351 deaths (95% uncertainty interval (UI) 248 - 436)) and 2012 (307 deaths (95% UI 118 - 470)), with a peak in 2006 (452 deaths (95% UI 301 - 589)). Furthermore, our analysis showed a 26% decrease between 2000 and 2012 in the age-standardised burden rates from maternal conditions (truncated to 15 - 49 years) attributable to iron deficiency. Between 2000 and 2012, the age-standardised disability-adjusted life year (DALY) rate from iron-deficiency anaemia attributable to iron deficiency markedly decreased by 33% in males, and increased by 3% in females of all ages. Approximately 1.1 - 1.4% of all DALYs in SA from 2000 to 2012 were attributable to iron deficiency.Conclusion. Iron-deficiency anaemia prevalence can be markedly reduced if iron deficiency is eliminated. Hence it is essential to encourage, reappraise and strengthen the measures that have been put in place to address iron deficiency, especially in women of reproductive age and children.
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Du Y, Durstenfeld A, Dill SE, Wang Q, Zhou H, Xue H, Kache S, Medina A, Rozelle S. Prevalence of Anemia and Associated Factors among Infants under Six Months in Rural China. Public Health Nutr 2022; 26:1-27. [PMID: 35920295 PMCID: PMC9989709 DOI: 10.1017/s1368980022001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine haemoglobin level and anaemia status among infants under six months of age in rural China. DESIGN A cross-sectional survey collected data among infants under six months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). SETTING 80 townships were selected in Sichuan, China from November to December 2019. PARTICIPANTS 942 infants under six months, while haemoglobin level were tested for 577 infants. RESULTS The overall mean (±SD) haemoglobin level was 106.03 (± 12.04) g/L. About 62.6% (95%CI: 58.5, 66.6) of sample infants were anemic using the WHO threshold, and 20.5% (95%CI: 17.3, 24.1) were anemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower haemoglobin levels were significantly associated with lower birth weight (<4 months: b = 4.14, 95% CI: 0.19, 8.08; 4-5 months: b = 6.60, 95% CI: 2.94, 10.27) and delivery by cesarean section (<4 months: b = -4.64, 95%CI: -7.79, -1.49; 4-5 months: b = -4.58, 95%CI: -7.45, -1.71). CONCLUSION A large share of infants under six months in rural western China are anemic. Infants with low-birth-weight and cesarean-delivered should be prioritized for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between cesarean-section and anaemia to promote health and development in infancy.
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Affiliation(s)
- Yefan Du
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Anne Durstenfeld
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA, USA
| | - Sarah-Eve Dill
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Hao Xue
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Saraswati Kache
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
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Turawa E, Awotiwon O, Dhansay MA, Cois A, Labadarios D, Bradshaw D, Pillay-van Wyk V. Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children under 5 Years of Age in South Africa (1997-2021): A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312799. [PMID: 34886524 PMCID: PMC8656986 DOI: 10.3390/ijerph182312799] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022]
Abstract
Using a systematic review method, the prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) in women of reproductive age (WRA) and children under 5 years of age was obtained to inform priorities in health planning and policy in South Africa. We searched electronic databases for articles published between 1997 and 2021. A total of 713 articles were identified, of which 14 articles comprising 9649 WRA and 4085 children were included. Since most of the included studies were of low quality, we did not pool data in a meta-analysis due to heterogeneity (I2 > 75%). In WRA, anaemia prevalence ranged from 22.0% to 44.0%; ID from 7.7% and 19.0%; and IDA from 10.5% to 9.7%. The prevalence of anaemia in pregnancy was 29.0% to 42.7%; and 60.6% to 71.3% in HIV-infected pregnant women. Three national surveys reported anaemia in children at 28.9%, 10.7%, and 61.3%, respectively. Overall, among the children under 5 years old, anaemia was more prevalent in 1-year-olds (52.0%) compared to the other age groups. Between 2005 and 2012, ID increased by 3.8% and IDA decreased by 83.2% in children. Anaemia in WRA and children under 5 years in South Africa was a moderate public health concern. Therefore, interventions addressing anaemia should be intensified, and policies on iron supplementation and food fortification need to be revised and aligned to the WHO multiple micronutrient supplementation recommendations.
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Affiliation(s)
- Eunice Turawa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (O.A.); (M.A.D.); (A.C.); (D.B.); (V.P.-v.W.)
- Correspondence: ; Tel.: +27-219380802
| | - Oluwatoyin Awotiwon
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (O.A.); (M.A.D.); (A.C.); (D.B.); (V.P.-v.W.)
| | - Muhammad Ali Dhansay
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (O.A.); (M.A.D.); (A.C.); (D.B.); (V.P.-v.W.)
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
| | - Annibale Cois
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (O.A.); (M.A.D.); (A.C.); (D.B.); (V.P.-v.W.)
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (O.A.); (M.A.D.); (A.C.); (D.B.); (V.P.-v.W.)
- Division of Epidemiology and Biostatistics, Department of Family Medicine and Public Health, University of Cape Town, Cape Town 7925, South Africa
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (O.A.); (M.A.D.); (A.C.); (D.B.); (V.P.-v.W.)
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Parker WA, Mchiza ZJ, Sewpaul R, Job N, Chola L, Sithole M, Labadarios D. The impact of sociodemography, diet, and body size on serum retinol in women 16-35 years of age: SANHANES-1. Ann N Y Acad Sci 2017; 1416:48-65. [PMID: 29125179 DOI: 10.1111/nyas.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 11/30/2022]
Abstract
To determine the current vitamin A status of a nationally representative sample of women aged 16-35 years, compare it with previous national data, and determine the impact of sociodemography, diet, and body size on vitamin A status, we performed secondary analysis of data on South African women who participated in the first South African National Health and Nutrition Examination Survey (SANHANES-1). Vitamin A status was assessed by serum retinol, and the findings are reported as means and prevalences with corresponding 95% confidence intervals. Overall, the age-standardized vitamin A deficiency prevalence was 11.7%, a decrease from previous national data, but serum retinol levels remained lower than in other developing countries. Overall, unweighted, multilevel, multivariate logistic regression showed that vitamin A deficiency was influenced by race only (odds ratio (OR) = 1.89, P = 0.031), while weighted multiple logistic regression for 16- to 18-year-olds showed that vitamin A deficiency was influenced by locality (OR = 9.83, P = 0.005) and household income (intermediate (OR = 0.2, P = 0.022) and upper (OR = 0.25, P = 0.049)). Despite the decreased prevalence, vitamin A deficiency remains a moderate public health problem in the country. Opportunities for targeted interventions have been identified.
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Affiliation(s)
- Whadi-Ah Parker
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Zandile J Mchiza
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Ronel Sewpaul
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Nophiwe Job
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Lumbwe Chola
- PRICELESS SA, University of Witwatersrand School of Public Health, Parktown, South Africa
| | - Moses Sithole
- Centre for Science, Technology and Innovation Indicators, Human Sciences Research Council, Cape Town, South Africa
| | - Demetre Labadarios
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
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Kim HJ, Kim DH, Lee JE, Kwon YS, Jun YH, Hong YJ, Kim SK. Is It Possible to Predict the Iron Status from an Infant's Diet History? Pediatr Gastroenterol Hepatol Nutr 2013; 16:95-103. [PMID: 24010113 PMCID: PMC3760699 DOI: 10.5223/pghn.2013.16.2.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/09/2013] [Accepted: 06/16/2013] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Iron deficiency remains a very common nutritional problem despite the improvement in nutrition and increased understanding of methods for its prevention. Thus, we try to create a new method for screening iron nutrition through infant nutrition history. METHODS Among the children who visited Inha University Hospital from March 2006 to July 2012, 181 children with iron deficiency anemia (IDA) and 52 children without IDA ranging from 6 to 36 months of age were reviewed in this study. We used the age when they began to wean food, the type of sort weaning foods, the time required for successful weaning, iron content in weaning foods, and the duration of breastfeeding for scoring infant nutrition history based on a questionnaire. RESULTS The mean score of the IDA group was 7.8±2.6 points, which was significantly higher than that of the control group (5.6±2.1) (p=0.000). If we set up the cutoff value at 6 points, this screening has 86.8% sensitivity and 36% specificity. In addition, as the IDA score increased, there was a falling trend of hemoglobin. CONCLUSION The IDA score does not have high specificity or high sensitivity. However, this study conveys that those patients who record a high score have low hemoglobin. Therefore, we suggest this score system for screening more IDA patients via nonpainful techniques.
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Affiliation(s)
- Hyung Jin Kim
- Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Bibliography of papers from studies undertaken in Africa and published in Public Health Nutrition, 1998 to date. Public Health Nutr 2005. [DOI: 10.1079/phn2005817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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