Has Food Security and Nutritional Status Improved in Children 1–<10 Years in Two Provinces of South Africa between 1999 (National Food Consumption Survey) and 2018 (Provincial Dietary Intake Study (PDIS))

Abstract

The 1999 National Food Consumption Survey in South Africa showed that food insecurity (hunger) was prevalent in households with children aged one to &lt;10 years. A repeat of the survey in two provinces: Gauteng (GTG) and the Western Cape (WC) was undertaken in 2018. Results showed that in all domains (living areas) in GTG, food shortage prevalence decreased between 1999 and 2018, from 55.0% to 29.6% in urban informal areas, from 34.1% to 19.4% in urban formal areas and from 42.1% to 15.6% in rural areas. While the prevalence of food shortage in urban formal areas in the WC remained similar in 2018, prevalence decreased from 81.8% to 35.7% in urban informal areas and from 38.3% to 20.6% in rural areas. Energy and macronutrient intakes improved significantly in GTG between 1999 and 2018 but not in the WC; intakes were significantly higher in the WC at both time points. The only significant change in stunting, wasting, overweight and obesity prevalence was that 7–&lt;10-year-olds in GTG were significantly more likely to be wasted (BAZ &lt; 2SD) in 2018 than in 1999 (20.2% versus 6.9% respectively). In the WC, 1–3-year-olds were significantly more likely to be obese in 2018 than in 1999 (8.1% versus 1.7% respectively) and 7–&lt;10-year-olds were less likely to be stunted (14.5% versus 4.9% respectively). There were significant negative correlations between the hunger score and dietary variables in both provinces in 1999. In GTG in 2018, only the correlation with fat intake remained while there were still several significant correlations in WC in 2018. Changes in top 12 energy contributors reflect a shift to high or moderate energy foods low in nutrients from 1999 to 2018. Nutrient dense (high micronutrients, low energy/g) foods (e.g., fruit) fell off the list in 2018. Logistic regression analyses reflect the importance for food security of having a parent as head of the household and/or caregiver, and parents having grade 12 or higher education and being employed. We conclude that food security nutritional status indicators improved amongst 1–&lt;10-year-old children especially in GTG between 1999 and 2018. However, the shift to poorer food choices and increase in wasting in older children and overweight in younger children are of concern.

Dietary Patterns, Socio-Demographic Predictors Thereof, and Associations of Dietary Patterns with Stunting and Overweight/Obesity in 1–<10-Year-Old Children in Two Economically Active Provinces in South Africa

“…In the five-to younger than 10-year-old group, 6.7% were stunted, 6.8% underweight, 13.4% overweight, and 6.8% obese [7]. A comparison of anthropometric indicators in 1-9-year-olds in the Western Cape (WC) province between 1999 and 2018 shows no increase in stunting in the total group of children (14.9-13.7%), but an increase in overweight/obesity (13.5-21.8%) [8]. The 2022 Obesity Atlas projects that 28.2% of 5-9-year-old children in South Africa will be obese by 2030 [9].…”

“…In South Africa, little data are available regarding the diet of children and how the nutrition transition has affected their dietary intake. The only national survey in children was undertaken in 1999, the National Food Consumption Survey (NFCS), with no follow up for comparison to show trends and changes in diet [8]. The PDIS study was a follow-up of the NFCS study in two rapidly urbanizing and economically active provinces, Gauteng and the Western Cape, to investigate dietary intake and growth status in children aged 1-<10-years [8].…”