Estimating the changing burden of disease attributable to childhood stunting, wasting and underweight in South Africa for 2000, 2006 and 2012

Abstract


 
 
 
 Background. National estimates of childhood undernutrition display uncertainty; however, it is known that stunting is the most prevalent deficiency. Child undernutrition is manifest in poor communities but is a modifiable risk factor. The intention of the study was to quantify trends in the indicators of child undernutrition to aid policymakers.
 Objectives. To estimate the burden of diseases attributable to stunting, wasting and underweight and their aggregate effects in South African (SA) children under the age of 5 years during 2000, 2006 and 2012.
 Methods. The study applied comparative risk assessment methodology. Data sources for estimates of prevalence and population distribution of exposure in children under 5 years were the National Food Consumption surveys and the SA National Health and Nutrition Examination Survey conducted close to the target year of burden. Childhood undernutrition was estimated for stunting, wasting and underweight and their combined ‘aggregate effect’ using the World Health Organization (WHO) 2006 standard. Population-attributable fractions for the disease outcomes of diarrhoea, lower respiratory tract infections, measles and protein-energy malnutrition were applied to SA burden of disease estimates of deaths, years of life lost, years lived with a disability and disability-adjusted life years for 2000, 2006 and 2012.
 Results. Among children aged under 5 years between 1999 and 2012, the distribution of anthropometric measurements <‒2 standard deviations from the WHO median showed little change for stunting (28.4% v. 26.6%), wasting (2.6% v. 2.8%) and underweight (7.6% v. 6.1%). In the same age group in 2012, attributable deaths due to wasting and aggregated burden accounted for 21.4% and 33.2% of the total deaths, respectively. Attributable death rates due to wasting and aggregate effects decreased from ~310 per 100 000 in 2006 to 185 per 100 000 in 2012.
 Conclusion. The study shows that reduction of childhood undernutrition would have a substantial impact on child mortality. We need to understand why we are not penetrating the factors related to nutrition of children that will lead to reducing levels of stunting.
 
 
 

ApoE Mimetic Peptides to Improve the Vicious Cycle of Malnutrition and Enteric Infections by Targeting the Intestinal and Blood-Brain Barriers

“…The close follow-up of this at-risk population by health professionals has led to improved child mortality through oral rehydration therapy, helping to reduce diarrheal burdens. Even with this emergency measure, enteric infections may persist, disrupting intestinal absorption and resulting in barrier functions and sustained growth stunting [11,61,62]. Early diet restrictions and enteric pathogens influence the active remodeling of the intestinal microbiota in the first months of life when the characteristics of the microbiota of adults develop.…”

Overview

“…[30] In cases where the characteristics of the exposure and/or the availability of data made the meta-regression approach unsuitable or unnecessary (namely for low physical activity, childhood undernutrition, interpersonal violence, household air pollution, and unsafe water, sanitation and hygiene) we recovered the estimates of interest directly from data collected on, or close to, the reference years. [31][32][33][34][35] For the estimation of concentrations of ambient air pollution (particulate matter with an aerodynamic diameter ≤2.5 µm (PM 2.5 ) and ozone) in 2012, we employed a regionally optimised fully coupled climate-chemistry model along with locally informed model forcing datasets. [36] Fine-scale regional models allow for the generation of more realistic small-scale climate information, chemical processes and patterns compared with global coarseresolution models.…”

“…The detailed evaluation of each risk factor and the quantification of the resultant attributable burden [19][20][21][22][23][24][25][26][27][31][32][33][34][35][36] revealed insights into trends. Key observations for each risk factor are summarised in Table 3.…”

“…[60] In addition, brief interventions during clinic or hospital visits should encourage all patients who smoke to quit smoking, and should refer high-risk patients, including TB and HIV/AIDS patients, for more intensive cessation support. [61] 8 Childhood undernutrition [32] • The study revealed little change in the prevalence of stunting, wasting and underweight between 2000 and 2012, and that in 2012 an estimated 33% of child deaths in SA were attributable to undernutrition. [32] • In order to reduce the prevalence of child undernutrition, a multisectoral approach is needed.…”

“…[61] 8 Childhood undernutrition [32] • The study revealed little change in the prevalence of stunting, wasting and underweight between 2000 and 2012, and that in 2012 an estimated 33% of child deaths in SA were attributable to undernutrition. [32] • In order to reduce the prevalence of child undernutrition, a multisectoral approach is needed. [62] Aside from input from the health sector, addressing undernutrition must include measures that address household poverty and food security, fixing prices of basic foodstuffs and ensuring nutrition as a basic human right as enshrined in the Constitution.…”