Mothers and Children -as Targets for Two Nutrition Supplementation Programs in South Africa

Abstract

Executive summary Background: South Africa is affected by the nutrition transition as one of many countries, with high prevalence of both over and undernutrition. Differences are sharp throughout the population, rural and poor suffering most frequently from underweight, stunting, vitamin A deficiency and hunger. Several initiatives have been implemented in order to improve the nutrition status. Among these are i) the Nutrition Supplementation Program, which targets children with growth problems and their mothers and ii) the Vitamin A Program, which targets all children under 5 years of age and breastfeeding mothers. Both programs have specified criteria to classify the children as eligible or not. National surveys performed after implementation of the programs have revealed a prevalence of undernutrition that was still high. Only a few studies have been evaluating the programs, implying several difficulties with the programs. These facts suggest that further monitoring and more evaluations are needed. Aim: The main aim of the study was to evaluate the current Nutrition and Vitamin A Supplementation Programs for children and their mothers in the rural and urban areas of the Western Cape Province in South Africa and to describe the target groups. Methods: A random sample of children 2-59 months and their mothers were included from 10 clinics in each of a rural and an urban area. Anthropometric measurements were performed on both children and mothers. The mothers were interviewed about the programs and socioeconomic factors. Medical records and Road To Health Charts were studied to gather information about growth, birth data and participation of the programs. Findings: Compared to the urban, the rural mothers 1) had the lowest household income and level of education, 2) had children with the lowest vitamin A coverage rates, 3) were more often underweight and less often overweight, 4) had children who were more often undernourished and 5) were more often classified as hungry. Among the children, 11% was stunted, 9% underweight and 6% overweight/obese. In contrast, 59% of the mothers were overweight/obese and 8% underweight. Knowledge about the Vitamin A Program among the mothers and the vitamin A coverage of their children were highest in the urban area. The children whose mothers had tertiary education had higher coverage rates than those with lower levels of education. More than half of the children who were eligible for the Nutrition Supplementation Program were not on the program and half of the children who were on the program were not eligible. Several children were classified as undernourished without being eligible for NSP. Conclusions and recommendations: The target for vitamin A coverage set by the Department of Health was reached for the oldest age group of children as well as the mothers. Continued monitoring and education of the mothers about vitamin A are important factors in order to further improve the program and increase the coverage rate. The high rates of undernutrition and hunger suggest that both elements of the NSP should continue, which include nutrition counselling of the mothers and distribution of products. The criteria for eligibility should also be kept, although more components of demands from the mothers, as well as economic benefits if meeting these could be considered integrated in the program. To increase the level of education among the mothers in general and about nutrition should be the higher goal, as education level seemed to predict vitamin A coverage rate positively and that the mothers thought of receiving information as helpful. To be able to do this, more staff needs to be available for counselling. All suggestions for improvements are most needed in the rural areas.