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The double burden of malnutrition is still prevalent in South Africa, hence the importance of a dietary survey to identify risks of under-and over-nutrition. A multistage stratified cluster random sampling design was applied in two economically active provinces, Gauteng (GTG) (N = 733) and Western Cape (WC) (N = 593). Field workers completed questionnaires, and a 24 h recall with children taking part aged 1-<10-years (N = 1326). Important findings were that 71% and 74%, respectively, of 3-<6-year-olds and 6-<10-year-olds had an energy intake below the estimated energy requirement (EER), while 66% 1-<3-year-olds had intakes above the EER. The percentage of children with a total fat intake below recommended levels decreased as age increased ((51%, 40% and 5%) respectively, for the three age groups). Similarly, the percentage of those who had a total fat intake above the recommendation increased with increasing age (4%, 11% and 26%, respectively, for the three age groups). Saturated fat intake above 10%E was highest in the youngest and oldest children (33% and 32%, respectively). The percentage of children with a free sugars intake above 10%E was 47%, 48% and 52% respectively, and 98-99% had a fibre intake that was less than recommended. Overall, the diet was not healthy, with the main food items being very refined, and the diet being high in salty snacks and sugary items, and low in fruit, vegetables and legumes. non-communicable diseases (NCDs) [6,7]. Rapid weight gain in infancy is also associated with long-term risk of adult weight gain and development of NCDs [8].In a recent publication of the same children whose dietary results are studied here, nutritional status by means of anthropometry was determined [9]. Stunting was found to be 39% and 23% in 1and 2-year-olds, respectively. Overweight and obesity were found to be 23% and 14% in 1-year-olds, and 11% and 9% in 2-year-olds, and those who were both stunted and overweight were 19% and 6%, respectively, in 1-and 2-year-old children. The double burden of malnutrition is clearly illustrated.The double burden of malnutrition is commonly found in many low-and middle-income countries [10] and much of this can be largely attributed to the nutrition transition taking place, in conjunction with decreased levels of physical activity [10]. The nutrition transition implies moving from a traditional diet which is high in carbohydrate and fibre and low in sugar and fat to a more contemporary Western diet which is high in fats, saturated fats, sodium and sugar [11]. One of the main drivers of this transition is urbanization [10,12].A recent review of dietary studies in developing countries by Ochola and Masibo showed what the typical dietary scenario in developing countries is [13]. This review included 50 studies from 42 countries in children and adolescents. The findings were an overall low energy intake, lack of dietary diversity, low intake of fruit and vegetables and micronutrient deficiencies. At the same time the emerging nutrition transition is stressed. This includ...

The objective of this study was to determine the prevalence and socio-demographic predictors of malnutrition in two urbanized economically active provinces (Gauteng N = 733, Western Cape N = 593) in South Africa. A multistage stratified cluster random sampling design was applied. Fieldworkers visited homes, measured children aged 1-<10-years old (N = 1326) and administered a questionnaire (mother/primary caregiver). In under-five year old children (N = 674) 21.6% were stunted [height-for-age z-score < −2 SD], 5.6 % underweight [weight-for-age z-score < −2 SD], 10.3% overweight (body mass index-for-age z-score) (BAZ)> +2 SD ≤ +3 SD] and 7.0% obese (BAZ > +3 SD). In 5–<10-year olds (N = 626) 6.7% were stunted, 6.8% underweight, 13.4% overweight and 6.8% obese. Stunting and overweight in the same child was present in 5.7% under-five year olds and 1.7% in 5–<10-year olds. Multiple logistic regression analyses identified having a mother with a post-grade 12 qualification (OR = 0.34) and having an obese mother (OR 0.46) as protectors and being in the under-five age group (OR = 3.73) as a risk factor for stunting. Being in the under-five age group was also a risk factor for a BAZ > 1 (OR 2.39), while being in the third wealth quintile was protective (OR = 0.62). Results indicate that stunting and overweight/obesity are still present at concerning levels, especially in the under-five age group.

In 1999, the National Food Consumption Survey found serious risk of dietary deficiency for a number of micronutrients in 1- to 9-year-old children in South Africa. To address these shortfalls, fortification with vitamin A, thiamine, riboflavin, niacin, vitamin B6, folic acid, iron and zinc of maize meal and bread flour was made mandatory in 2003. The aim of this study was to examine micronutrient intakes of 1- to <10-year-old children after nearly 20 years of fortification in two of the most urbanized and economically active provinces, Gauteng (GTG) and the Western Cape (WC). A multistage stratified cluster random sampling design and methodology was used. Households were visited by fieldworkers who interviewed caregivers and obtained dietary intake data by means of a multiple-pass 24-h recall. Two additional 24-h recalls were completed among a nested sample of 146 participants to adjust the single 24-h recall data of the total sample using the National Cancer Institute Method. Results show that median intake of all the fortification nutrients were above the estimated average requirement (EAR), with the only concern being folate in the WC. Between a quarter and a third of children in the WC, where maize porridge intake was significantly lower than in GTG, had a folate intake below the EAR. Nutrients that are not included in the fortification mix that remain a serious concern are calcium and vitamin D, with intake of dairy and vitamin D sources being very limited in both provinces. The improvement in micronutrient intakes of children is encouraging, however the outstanding nutrient deficiency risks need attention.

Background In high-resource countries where maternal mortality is very rare, perinatal mortality and severe maternal mortality have become markers for the quality of care in maternity services. As two of the most adverse pregnancy outcomes, there is a need for in-depth clinical audit of perinatal mortality and severe maternal morbidity in order to understand the causes, to guide clinical practice and to improve prevention. Methods Under the guidance of two national groups, we developed the audit methodologies from those of the UK Centre for Maternal and Child Enquiries Perinatal Mortality Audit and the Scottish Confidential Audit of Severe Maternal Morbidity. Severe maternal morbidity was defined as experience of major obstetric haemorrhage, eclampsia, renal/liver dysfunction, cardiac arrest, pulmonary oedema, acute respiratory dysfunction, coma, cerebrovascular accident, status epilepticus, septicaemic shock, anaesthetic complications, pulmonary embolism, peripartum hysterectomy, Intensive Care Unit (ICU) admission or interventional radiology. Both audits were implemented in 2011 with all 20 Irish maternity units providing anonymised data on cases of perinatal death and severe maternal morbidity via paper notification form or custom-designed online data entry system. Results For 2011, 491 perinatal deaths were reported, 318 (65%) stillbirths, 138 (28%) early neonatal deaths and 35 (7%) late neonatal deaths, giving a perinatal mortality rate of 6.1/1000 births (95% CI=5.6–6.7/1000), stillbirth rate of 4.3/1000 births (95% CI=3.8–4.8/1000) and early neonatal death rate of 1.9/1000 live births (95% CI=1.5–2.2/1000). Fourfold variation in the perinatal mortality rate was observed across the 20 maternity units. The common causes of death in stillbirth were congenital anomaly (26%), placental conditions (17%) and ante/intrapartum haemorrhage (11%), 20% were unexplained. Early neonatal deaths were generally due to congenital anomaly (51%) or respiratory disorder (33%) - primarily severe pulmonary immaturity. Just 4% were unexplained. Low birthweight was common, below normal range for 53% of stillbirths and 40% of early neonatal deaths. In 2011, 260 women experienced severe maternal morbidity, a national rate of 3.8/1000 maternities (95% CI=3.4–4.3/1000). Almost half (42.3%) experienced two or more severe morbidities. Major obstetric haemorrhage was the most frequent morbidity (61.2%, 2.3/1000 maternities) followed by ICU admission (42.7%, 1.6/1000 maternities), renal/liver dysfunction (10.0%, 0.4/1000 maternities) and peripartum hysterectomy (8.8%, 0.3/1000 maternities). Major obstetric haemorrhage was associated with Caesarean section and peripartum hysterectomy was associated with a history of Caesarean section and a morbidly adherent placenta. Conclusion While limited international comparisons can be made, the incidence of perinatal mortality and severe maternal morbidity in Ireland compares favourably to other European countries.