Infant feeding, growth monitoring and the double burden of malnutrition among children aged 6 months and their mothers in KwaZulu‐Natal, South Africa

Abstract

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual-, household-or population level, has implications for both health and the economic development of a community and country. This paper describes a large-scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu-Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0-29.9] and 28.4% had obesity grade 1 (BMI: 30-<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children.

How Is Context Addressed in Growth Monitoring? A Comparison of the Tanzanian, Indian, and Dutch Manuals

“…Findings from the analysis of the GM manuals from these countries may not apply to other countries. However, we hope that our reflections on the differences between the 3 countries in terms of their growth measurements, interpretations of these measurements, growth counseling approaches, and inclusion of context will be relevant for other countries, and can help them adapt the current GM materials to address the double burden of malnutrition ( 72 ). In our analysis, we did not take a gender perspective.…”

Complementary Feeding Practices and Childhood Malnutrition in South Africa: The Potential of Moringa Oleifera Leaf Powder as a Fortificant: A Narrative Review

“…Regardless of regular GMP attendance, some caregivers still lack knowledge of appropriate infant feeding practices and/or lack support at the household level to implement the recommended infant and young child feeding practices [42]. Additionally, in SA, healthcare workers face challenges that prevent the implementation of the GMP, such as work overload, vaccine shortages, insufficient staff training on GMP, and inadequate supply of health booklets used to record immunizations and growth trends [43]. As in other developing countries, in SA, the vitamin A supplementation program is part of the GMP program; infants are routinely supplemented with vitamin A during their GMP clinic visits to prevent deficiencies that can negatively affect growth.…”

Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions

“…Stunting, in particular, is a major public health concern in many low- and middle-income nations, especially in Sub-Saharan countries, including South Africa. The country has one of the world’s highest stunting rates, with one in four children facing stunted growth due to malnutrition (Kaldenbach et al, 2022 ).…”

“…These programs particularly focussed on implementing community-based initiatives to promote a healthy and balanced diet worldwide. In addition to emphasizing the importance of exclusive breastfeeding for the first six months, mothers were also provided with the necessary micronutrients and educated on hygiene and nutritional food preparation (Bahl et al, 2005 ; Black et al, 2013 ; Horta et al, 2015 ; Kaldenbach et al, 2022 ). Given the intense efforts made to reduce maternal and child malnutrition over the past decade, assessing their impact on growth deficiencies in children is crucial.…”