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The Impact of a Nutrition Education Programme on the Anthropometric Nutritional Status of Low-Income Children in South Africa

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The Impact of a Nutrition Education Programme on the Anthropometric Nutritional Status of Low-Income Children in South Africa Public Health Nutrition: 5(1), 3±9 DOI: 10.1079/PHN2001204 The impact of a nutrition education programme on the anthropometric nutritional status of low-income children in South Africa CM Walsh1,*, A Dannhauser2 and G Joubert3 1School of Tourism, Hospitality and Sport, Technikon Free State, Private Bag X20539, Bloemfontein 9300, South Africa: 2Department of Human Nutrition, University of the Free State, Bloemfontein, South Africa: 3Department of Biostatistics, University of the Free State, Bloemfontein, South Africa Submitted 10 December 1998: Accepted 30 May 2001 Abstract Objective: The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years. Design and setting: The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for- age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined. Subjects: Initially 536 children were measured and, after two years of intervention, 815. Results: Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area. Keywords Conclusion: The education programme in combination with food aid succeeded in Anthropometry improving the weight status of children, but was unable to facilitate catch-up growth Integrated nutrition education in stunted children after two years of intervention. programme According to the United Nations (International) Children's less attention has been given to prevention. Yet, informa- (Emergency) Fund (UNICEF)1, all people have the right to tion about prevalence is of little value unless related to be free from hunger and malnutrition. Despite this basic action. human right, about 150 million children under 5 years old The Nutrition Education Intervention Programme are underweight, and another 20 million suffer from (NEIP) has been developed based on the nutrition severe malnutrition1. In South Africa, the previous lack of education programme of the previous Administration: a national nutrition surveillance programme has made it House of Representatives, to address the malnutrition difficult to determine the prevalence of malnutrition. problem of low-income children of mixed race in the Free Single studies seem to indicate, however, that it is as high State and Northern Cape Provinces. as 30% in African and mixed-race children. The extent of nutritionally related diseases in African2±15 and mixed- Subjects and methods race4,11,16±20 communities in South Africa seems to indicate that dietary practices leave much to be desired. The NEIP consisted of an intensive nutrition education The implications of malnutrition are considerable, not programme implemented with the help of nutrition only as a health problem, but also as a developmental and advisors, appointed as community health workers and economic problem. While considerable effort has been remunerated by the government. Advisors are local made to determine the prevalence of malnutrition, much respected members of communities with nutrition as *Corresponding author: Email [email protected] q The Authors 2002 Downloaded from https://www.cambridge.org/core. 27 Sep 2021 at 11:15:30, subject to the Cambridge Core terms of use. 4 CM Walsh et al. first priority. Advisors were trained and supervised in the use, and again after every 20 children were weighed. community, with each month in the two-year implemen- Height was measured using an accurate, non-stretchable tation period devoted to a different topic of nutrition (all measuring tape that was securely fastened to a wall. topics were covered twice). The programme was adapted Children were measured without shoes, standing against to local conditions, depending on specific needs. While the wall with heels touching the wall. A 908 triangle was nutrition advisors were in training they were visited every used to read the standing height accurately, to the nearest second week by a supervisor and at least once a month 0.1 cm. after training was completed. Indices used for the interpretation of weight and height Nutrition advisors concentrate on improving nutritional include weight-for-age, height-for-age and weight-for- knowledge about a variety of relevant topics such as height21. Results were compared with the National Center balanced meals, food purchasing and preparation, and for Health Statistics (NCHS) references, which were nutrition during the different life cycles. Advisors are also developed using data from the Fels Research Institute involved in nutrition monitoring (growth and breast- and US Health Examination Surveys22. Below minus two feeding) and community development. An objective of standard deviations (,22SD) from the NCHS median has the NEIP is to equip communities with knowledge been used as cut-off point to identify low weight-for-age through practical instruction including demonstration, (underweight), low height-for-age (stunting) and low role-play, exhibitions, workshops and home visits. Com- weight-for-height (wasting). The differences in the munities are encouraged to participate by planning percentage of children with anthropometric indicators actions to generate income and improve household below 22SD before and after intervention were deter- food security. Such plans include women's sewing groups mined in accordance with World Health Organization and vegetable gardening projects. (WHO) recommendations21 and the 95% confidence At the time of the study a food aid programme, The interval (CI) calculated to indicate significance of differ- National Nutrition and Social Development Programme ences. (NNSDP), was implemented by the government. Needy families were provided with food parcels including staple Results foods such as corn meal, oil, legumes and milk powder. The food aid programme and the NEIP were implemen- Weight-for-age ted in study areas. In the two control areas the food aid Initially, the percentage of children in Heidedal with a programme was implemented, but no nutrition education weight-for-age below 22SD (severely underweight) was was given. 34.8% for boys and 32.2% for girls. In the rural areas it The townships that were included are all relatively ranged from 23.8% in Jagersfontein to 45.5% in Ritchie for uniform as regards climate, socio-economic status and boys and from 15.0% in Bethulie to 65.0% in Trompsburg health services. No major nutrition interventions had for girls. Also cause for concern is the large percentage of previously been implemented in the sample areas. An boys and girls in each area that have a weight-for-age urban area (Heidedal), a large rural area (Ritchie) and two between 22SD and 21SD, and who are thus at risk of small rural areas (Jagersfontein and Fauresmith) com- becoming more seriously underweight (Table 1). prised the study areas. For practical reasons, two rural The percentage of severely underweight children control areas (Trompsburg and Bethulie) were included decreased quite dramatically between the two surveys because they are relatively close to the other towns and in most sample areas (significantly for boys and girls in the NNSDP had not been launched in these areas at that Heidedal and for boys in Ritchie) (Table 4). In Heidedal, it time. An urban control area was not included. This may had more than halved after two years of nutrition be considered a limitation of the study, but since nutrition intervention. The same trend was observed in the boys advisors had been appointed in all other urban areas in in Ritchie, where severe underweight decreased from the two provinces, no urban control area remained. In 45.5% to only 23.9% (Table 1). In the remaining two study addition, the results of a representative household survey areas and control areas an improvement was also indicated that the level of nutritional knowledge in the observed (with the exception of girls in Bethulie). The urban area was generally no different from that in the small sample sizes make it difficult, however, to interpret rural areas. the data in these areas. All children aged 2 to 5 years were included (mean age As a result of the decrease in severely underweight ranged from 3.7 years in Bethulie to 4.2 years in children, the percentage of less severely underweight or Trompsburg for boys and from 3.8 years in Bethulie to normal weight children (weight-for-age above 22SD) 4.3 years in Fauresmith for girls). Initially 536 children increased. were weighed and measured and, after two years, 815 children were included. Height-for-age Children were weighed to the nearest 0.2 kg without During the initial survey 27.6% of boys and 23.8% of girls shoes and heavy clothing. Scales were calibrated before in Heidedal were stunted (height-for-age below 22SD). Downloaded from https://www.cambridge.org/core. 27 Sep 2021 at 11:15:30, subject to the Cambridge Core terms of use. Anthropometry before and after nutrition
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