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INCIDENCE of UTRITIONAL DEFICIENCY DISEASES AMONG the BANTU and COLOURED Populanons in SOUTH AFRICA AS REFLECTED by the RESULTS of a QUESTIONNAIRE SURVEY*

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INCIDENCE of UTRITIONAL DEFICIENCY DISEASES AMONG the BANTU and COLOURED Populanons in SOUTH AFRICA AS REFLECTED by the RESULTS of a QUESTIONNAIRE SURVEY* 504 S.A. MEDICAL JOUR AL 18 June 1966 N22 (Supplemenr-SlJIl1h African Jo//mal of Nurririun) INCIDENCE OF UTRITIONAL DEFICIENCY DISEASES AMONG THE BANTU AND COLOURED POPULAnONS IN SOUTH AFRICA AS REFLECTED BY THE RESULTS OF A QUESTIONNAIRE SURVEY* J. F. POTGIETER,** S. A. FELLINGHAM.t AND M. L. ESER** Although it is today generally conceded by nutritionists (vii) Crireria for rhe clillical diagllosis of the specific IIl11ri­ that malnutrition is a major problem in the Republic and rional diseases, and assumes serious proportions in the younger non-White (viii). Descripriolls of 1I01l-specific sigm alld symprol1ls. In­ formatIon under (vii) and (viii) was provided in order t age-groups, no reliable information is at present available facilitate the diagnosis of the various diseases and the recoo­ which gives a true picture of the extent of the problem nition of signs and symptoms referred to in the questionnair~. throughout the country. This information was considered necessary as, without it, the cnteria adopted by different practitioners and their evaluatior To obtain detailed and accurate information on the of the severity of the diseases might vary considerably. prevalence of nutritional disease in all areas of the coun­ In an accompanying letter, the doctors were asked to keer try, it would be necessary to conduct field surveys on records for a 4-week period during May/June and anotheI samples from all sections of the population-a large and during NovemberfDecember 1960. An additional copy of the unwieldy task. As it was thought that medical practitioners questionnaire was included for use during the latter period. could be of assistance in obtaining a general indication Data were requested for the 2 periods as it was thought that there might be seasonal differences in the incidence of mal­ of the prevalence of nutritional diseases in South Africa, nutrition. a questionnaire relating to the incidence of these diseases The questionnaire was sent to all general practitioners in was forwarded to all registe~ed doctors. It was hoped the Republic and to specialists in the fields of medicine. that the replies received would reveal the areas in which obstetrics and gynaecology and paediatrics. It was not possible to exclude the following from the list: doctors recenth nutritional diseases were most rampant and would give an deceased; doctors retired from active practice; doctors em­ indication of the most suitable immediate remedial ployed by research institutions and Government departments: measures which might be taken. Field surveys could later women doctors who were not in practice and doctors who be carried out by the ational Nut~ition Research Insti­ were temporarily out of the country. The questionnaire was thus sent to many who were not in a position to reply. To tute to study these areas more intensively. avoid duplication, it was further requested in the questionnaire that only one doctor should reply on behalf of institutions, FORMULATION OF 1l-lE QUESfIO ' 'AIRE provincial hospitals, mission hospitals and joint practices. Un­ In formulating the questionnaire it was borne in mind that fortunately, it appeared that this request was not always met. heavy calls are made upon the time of the average doctor. Furthermore, the number of doctors on whose behalf a given The questionnaire was, therefore, made as concise as possible. questionnaire was completed was not always stated as this The type of data requested was such that it could be accumu­ information had not been clearly requested. It was therefore lated relatively easily. A prototype of the questionnaire was not possible to express the number of replies received as a sent to doctors, specialists and professors for criticism, and percentage of the possible total or to ascertain the number of modifications were made according to suggestions received. doctors represented by the returned questionnaires. The questionnaire was divided into 8 sections. Approximately 6,100 pairs of questionnaires were sent out, (i) Backgro//nd dara. Information was requested as to the of which 203 were returned for the first period and 172 for district in which the doctor practised, the name of the institu­ the second. tion at which he worked (where applicable), the nature of his METIlODS OF ANALYSIS practice or appointment, the number of patients under and over 12 years of age seen by him in each racial group, the Two methods were used in the evaluation of the questionnaires. areas from which these patients were drawn, and the main The first consisted of a general review of doctors' opinions food items in the diet of his non-White patients. on the applicability of the diagnostic criteria, the value of the (ii) Incidence of specific nutritional deficiency diseases data submitted, the probable incidence and causes of malnutri­ among non-Whites. Details were requested of the numbers tion and the varieties of food eaten by the populations con­ and age range of patients in various racial groups who had cerned. The findings are presented in the form of a general been treated for known nutritional diseases. discussion illustrated by quotations. No attempt is made to (iii) Incidence of /lon-specific signs and symproms among discuss the validity of the doctors' impressions. non-Whiles. The same arrangement of data was requested as in The second method consisted of an analysis of the detailed (ii) above. information supplied by the doctors. Owing to the poor (iv) Incidence among nOIl-Whites of diseases in which mal­ response to the survey, the results presented and the conclu­ n//rririon may be a contrib//lOry factor. This category included sions drawn have a limited application. Very little information such diseases as gastroenteritis, bronchopneumonia and tuber­ was given on malnutrition among Asiatics and almost none on culosis. Whites. Consequently no information on these 2 racial groups (v) Maln//tririon among Whites. The doctors were asked to has been included in the present report. state whether there was evidence of malnutrition among their The detailed analysis presented many difficulties and a White patients. number of decisions, sometimes of an arbitrary nature, had (vi) General remarks. Here the doctors were asked to give to be taken. Some doctors based the figures they submitted on information on the accuracy of their data and the applic­ actual records kept for each patient; others stated that the ability in their areas of the criteria provided under sections figures given were merely estimates. Although it had been (vii) and (viii) (see below). requested that the survey should cover two 4-week periods, the figures submitted covered periods varying from an afternoon 'This report was published by the CSIR in 1962 in the form of a bulletin to a year; in a majority of questionnaires, however, the periods (CSIR Research Report No. 190. Pretoria. 1962). The number of copies covered ranged from 27 to 33 days. It was finally decided to printed \Vas small and the circulation limited; the medical profession of analyse only the questionnaires which covered an interval South Afrlca. which furnished the data presented in the report. is there­ fore not acquainted as a body with its COntents. As it is unlikely that falling within the periods May - July and November - January, the nutrition situation in South Africa has changed substantially since and which ranged in length from 2 weeks to 2 months. If the the report was compiled. and as its contents are deserving of notice. it period covered was shorter than 27 days or longer than 32, is presented herewith in an abridged and modified form. ** Tational Nutrition Research Institute, CSIR. Pretoria. the data presented were adjusted so as to be representative of tNational Research Institute for Mathematical Sciences, CSIR. Pretoria. a period of 30 days. 18 Junie 1966 S.A. TYDSKRIF VIR GENEESKU 'DE 505 (Byvoegsel-Suid-Afrikannse Tydskrif vir Voeding) V23 Only 253 of the returned questionnaires proved suitable for that a good deal of subclinical malnutrition was over­ detailed analysis (155 for the first period and 98 for the looked, as inability to identify the early stages of malnutri­ econd): A. numbe~ of questionnaires which contained very interestIng mformation could not be used as mistakes had been tion seemed to be a general problem. The conclusion may made in com.pleting the questionnaires. For example, in some thus be drawn that as estimates of the incidence of malnu­ cases the penods covered by the survey had not been men­ trition the figures presented in the questionnaires are too tioned; in others no distinction had been made between conservative. Coloured and Bantu; and there were cases where doctors had listed many more patients as suffering from nutritional disease With regard to the over-all incidence of malnUlrition, than they had actually seen during the survey period. the general opinion was that the vast majority of non­ Whites in the rural as well as in the urban areas was GE.NERAL REVIEW OF DOCTORS' OPINIONS probably malnourished. A number of very detailed replies were received. Most of In the opinion of a general practitioner from alal, these were sent in by doctors who frequently come across most of the Bantu in the small reserves and on some of malnutrition and nutritional diseases and who are aware the small farms were on the verge of starvation. Another of the extent and seriousness of the problem. Many of doctor from atal observed that the Bantu diet was often these replies were received from the Bantu reserve areas, distressingly inadequate. e.g. the Transkei, Zululand and the orthern Transvaal. A representative of a health centre in Johannesburg Only a small number of doctors commented specifically stated: '... marked malnutrition in children up to 5 on the validity of the criteria described in sections (vii) years is seen in about 25% of cases.
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