The double burden of malnutrition in a rural health and demographic surveillance system site in South Africa: a study of primary schoolchildren and their mothers

Abstract

Background: In South Africa, the occurrence of the double burden of malnutrition is on the rise at a household level predisposing children and their mothers to negative health outcomes. However, few studies have been conducted at a household level. Therefore, we studied a double burden of malnutrition using child-mother pairs in a rural setting. Methods: A cross-sectional quantitative survey was conducted among 508 child-mother pairs selected from primary schools using a multistage sampling in a rural Dikgale Health and Demographic Site in Limpopo Province, South Africa. Anthropometric measurements of children and mothers, and socio-demographic data were collected. WHO AnthroPlus was used to generate body-mass-index z-scores of children and the BMI was used to indicate overweight and obesity among the mothers. Mann Whitney test was used to compare the means of variables between sexes and age groups, while the prevalence of thinness and overweight/obesity were compared using a chi-square. Multivariate logistic regression with a stepwise backward elimination procedure, controlling for confounding, was used to determine the association between the thinness and overweight/obesity and the covariates. Results: Twenty five percent (25%) of the children were thin, 4% were overweight and 1% obese, while mothers were overweight (27.4%) and 42.3% obesity (42.3%) were observed among the mothers. The odds of being thin were higher in boys than in girls (AOR = 1.53, 95%CI: 1.01-2.35). Overweight/obese mothers were more likely to have thin children (AOR = 1.48, 95% CI: 1.01-2.18) and less likely to have overweight/obese children (AOR = 0.18, 95%CI: 0.07-0.46). Conclusion: A double burden of malnutrition was observed on a household level with thinness among children and overweight/obesity among mothers. A need to address the dual problems of undernutrition and rapidly rising trends of overweight/obesity cannot be overemphasized .

Global Prevalence of Malnutrition: Evidence from Literature

“…To further tackle the double and triple burdens of malnutrition, early screening and identification of at risk children, including those already with malnutrition, is essential at healthcare facilities [76]. Thus, a more holistic, context-specific approach is required, whereby interventions not only take into consideration the risk factors, but also consider the inclusion of nutritionists and educating mothers on self and childcare regarding nutrition [77]. Furthermore, child malnutrition research and interventions must be up-scaled from community level to provincial and national levels so that it informs policy on the intervention strategies that can address the burden of child malnutrition.…”

Dietary Diversity and Nutritional Status of Preschool Children in North West Province, South Africa: A Cross Sectional Study

“…The study adapted a questionnaire that was used in nutritional status studies [ 34 , 35 ], which considered the UNICEF conceptual framework for malnutrition [ 36 ]. The questionnaire was validated through content and face validity and a pilot study.…”

Persistent Malnutrition and Associated Factors among Children under Five Years Attending Primary Health Care Facilities in Limpopo Province, South Africa

“…A structured interviewer-administered questionnaire was adapted from studies conducted in a population living in a similar socioeconomic context in Limpopo Province [ 21 , 33 ]. The questionnaire considered the UNICEF conceptual framework for malnutrition [ 34 ] and data were collected on socio-demography, obstetric history and children’s characteristics.…”

“…Certainly, the inefficiency in our study might be less, since multiple missing values occurred within the same questionnaires ( n = 11) [ 69 ]. We acknowledge the limitation of not testing the reliability of the questionnaire statistically, as one of the characteristics of a valid questionnaire [ 70 ], which was not done in the original studies [ 21 , 33 ] from where we adapted the questionnaire used in the current study. The questionnaire was, however, piloted before use to ensure its reliability.…”

“…Recall and reporting biases from mothers on obstetric information, children’s feeding indicators and their history of illness events happening in the past are also acknowledged. Nonetheless, the adapted questionnaire was previously used in the population with a similar socioeconomic context [ 21 , 33 ], and was validated through content and face validity, use of independent translators for forward and backward translations, as well as by an expert committee.…”