Nutritional Status of Children 24-60 Months Attending Early Child Development Centres in a Semi-Rural Community in South Africa

Biochemical assessment of the nutritional status of infants, children and adolescents in South Africa (1997-2022): a systematic review

OBJECTIVE

To conduct a systematic review of the published peer-reviewed articles on the biochemical assessment of nutritional status of South African infants, children and adolescents in 1997-2022.

DESIGN

Online databases (Pubmed, CINAHL, EbscoHost and SAePublications) were used to identify thirty-nine papers.

SETTING

South Africa, 1997-2022.

PARTICIPANTS

Infants, children and adolescents.

RESULTS

Vitamin A deficiency prevalence was 35-67 % before 2001 and mostly below 16 % after 2008. Anaemia ranged from 5·4 to 75·0 %, with 36-54 % of infants below 1 year being anaemic. Among 0- to 6-year-olds, iron deficiency (ID) was 7·2-39·4 % in rural and 16-41·9 % in urban areas. Zn deficiency remained high, especially among 0- to 6-year-olds, at 39-48 %. Iodine insufficiency (UIC < 100 µg/l) was between 0 and 28·8 %, with excessive levels in two areas. Vitamin D deficiency was 5 % for 11- to 17-year-olds in one urban study but 33-87 % in under 10-week-old infants. The 2005 national survey reported sufficient folate status among 0- to 6-year-olds, and vitamin B12 deficiency was 0-21 %. Low-grade inflammation was between 5 % and 42 % depending on the biomarker and cut-offs.

CONCLUSIONS

Vitamin A status may have improved meaningfully during the last 25 years in South Africa to below 16 %, and iodine and folate deficiency appears to be low particularly among 0- to 6-year-olds. However, confirmation is needed by a national survey. Anaemia, Fe and Zn deficiencies still pose severe problems, especially among 0- to 6-year-olds. Sufficient data on vitamin D and B12 status are lacking.

Results From South Africa's 2022 Healthy Active Kids' Report Card on Physical Activity, Body Composition Proxies, and Nutritional Status in Children and Adolescents

BACKGROUND

Physical activity (PA) and nutrition in children have an impact on overall physical and mental well-being, cognitive, and social development. This study aims to report on the best current available evidence on PA, body composition proxies, and nutritional status of South African children and adolescents, based on the published findings between 2018 and 2022, which comprise the 2022 Healthy Active Kids South Africa Report Card.

METHODS

A comprehensive literature search of online databases, along with hand searching and a gray literature search, was conducted based on PA, body composition proxies, and nutrition indicators defined, in part, by the Active Healthy Kids Global Alliance.

RESULTS

Compared with the 2018 report card, there was an improvement in the majority of PA indicators which include overall PA (B-), active transportation (B-), physical fitness (B-), and government policy and programs (C). Body composition proxies and most of the nutrition indicators remained unchanged. The indicators that regressed from 2018 to 2022 included community and environmental influences (D), as well as participation in organized sport (D-).

CONCLUSIONS

Despite the apparent improvement in overall PA levels in children and adolescents, there is a lack of tangible evidence of actual implementation of policies and programs. There was also a lack of nationally representative data for most indicators. Overall, there is a need to identify intersectoral, equitable approaches for promoting PA and healthy eating in South African children and adolescents and ongoing monitoring and surveillance.

Assessment of growth monitoring among children younger than 5 years at early childhood development centres in Nelson Mandela Bay, South Africa

Introduction

Early childhood development (ECD) centres are important community hubs in South Africa and act as sites for community detection of childhood nutrition problems. This study aimed to assess the ability of trained ECD practitioners with optimal support to correctly classify the nutritional status of infants and young children at ECD centres in the Nelson Mandela Bay.

Methods

A descriptive, cross-sectional study was used to collect data from 1645 infants and children at 88 ECD centres. Anthropometric measurements were taken by trained fieldworkers and growth monitoring and promotion infrastructure was audited at ECD centres.

Results

Of the sample, 4.4% (n = 72) were underweight by weight for age Z-score (WAZ < -2) and 0.8% (n = 13) were severely underweight (WAZ < -3). Results showed that 13.1% (n = 214) were stunted by height for age Z-score (HAZ < -2) and 4.5% (n = 74) were severely stunted (HAZ < -3). The prevalence of moderate acute malnutrition was 1.2% and severe acute malnutrition was 0.5%, while the prevalence of overweight was 9.2% and the prevalence of obesity was 4%. A significant level of agreement between the correct interpretation and the ECD practitioners' interpretation was observed across all the anthropometric indicators investigated. The true positive wasting cases had a mean mid-upper arm circumference (MUAC) of 14.6 cm, which may explain the high false negative rate found in terms of children identified with wasting, where ECD practitioners fail to use the weight for height Z-score (WHZ) interpretation for screening.

Conclusion

By using ECD centres as hub to screen for malnutrition, it may contribute to the early identification of failure to thrive among young children. Although it was concerning that trained ECD practitioners are missing some children with an unacceptably high false negative rate, it may have been due to the fact that wasting in older children cannot be identified with MUAC alone and that accurate WFH plotting is needed. Onsite mentorship by governmental health workers may provide ECD practitioners with more confidence to screen children for growth failure based on regular WFH measurements. Moreover, ECD practitioners will be more confident to monitor the Road to Health booklets for missed vaccinations, vitamin A and deworming opportunities.

Malnutrition in children under the age of 5 years in a primary health care setting

In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

Obesity Prevention within the Early Childhood Education and Care Setting: A Systematic Review of Dietary Behavior and Physical Activity Policies and Guidelines in High Income Countries

As a strategy for early childhood obesity prevention, a variety of dietary behavior and physical activity policies and guidelines published by leading health agencies and early childhood education and care (ECEC) licensing and accreditation bodies exist. Given the potential diversity in recommendations from these policies, this narrative review sought to synthesize, appraise and describe the various policies and guidelines made by organizational and professional bodies to highlight consistent recommendations and identify opportunities to strengthen such policies. An electronic bibliographic search of seven online databases and grey literature sources was undertaken. Records were included if they were policies or guidelines with specific recommendations addressing dietary behavior and/or physical activity practice implementation within the ECEC setting; included children aged >12 months and <6 years and were developed for high income countries. Recommended dietary behavior and physical activity policies and practices were synthesized into broad themes using the Analysis Grid for Environments Linked to Obesity framework, and the quality of included guidelines appraised. Our search identified 38 eligible publications mostly from the US and Australia. Identified guidelines were largely consistent in their recommendation and frequently addressed the physical and sociocultural environment and were well-aligned with research evidence. Broader consideration of policy and economic environments may be needed to increase the impact of such policies and guidelines within the ECEC setting.