A key indicator to measure progress by government, writes Dr Edzani Mphaphuli in Mail & Guardian, is by closely monitoring stunting rates in children. A two-year-old’s birthday, once a personal milestone, now becomes a testament to our commitment to nurturing this country’s future.
Research in SA shows that a child’s height at two-years-old is the best predictor of their future potential. This potential, known as human capital, includes knowledge, skills, and health that help people succeed. A two-year birthday marks the end of the first 1 000 days of life, the most critical days during which the foundation of a child’s entire life is laid.
This period, from conception to the second birthday, is crucial for brain and other vital organ development. During this period, starting in the womb, the brain undergoes rapid growth and development, laying the foundation for children’s cognitive, emotional and social abilities.
By two, a child’s brain is about 80% to 90% of the size of an adult brain. This time is also vital for the development of the pancreas, which plays a crucial role in digestion, and blood sugar regulation, and is vital for ensuring proper metabolic function throughout life.
Stunting is a form of malnutrition where children are too short for their age, which also indicates that their brain development is running behind, and is closely tied to social determinants of health. Access to nutritious foods, safe housing, quality education and employment opportunities play a significant role in the prevalence of stunting.
By addressing these determinants, a government can make significant progress in reducing stunting rates, serving as a critical indicator of its effectiveness in improving the overall health and well-being of its population.
An undeniable precondition for genuine national unity is the eradication of inequity. Stunting is one of the major factories for inequality and rectifying this can break the intergenerational cycle of poverty in which many South Africans are trapped.
Stunted children grow up to be adults who are most likely to be poor, unskilled, unemployed, and suffer from chronic diseases like hypertension and diabetes, linked to the poor development of the brain and organs – such as the pancreas – in the first 1 000 days of their lives.
The 2023 National Food and Nutrition Security Survey shows that stunting levels are increasing in South Africa’s children. In 2016, stunting affected 27% of under-fives, but this has risen to nearly 29%, with about 35% of children under two-years-old affected. That means of the more than 1.5m children who are stunted, a significant number is under two-years-old.
Stunting and wasting are deeply interconnected, sharing common causes and frequently co-occurring in the same child. Wasting represents a severe and potentially fatal form of malnutrition where children exhibit extreme thinness to their height, signalling acute weight loss and insufficient nutrition intake.
This condition encompasses both Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM). In South Africa, the monitoring of these is critical due to their grave consequences, which can lead to hospitalisation and even immediate death of a child.
Shockingly, in 2023 alone, in South Africa, 1 000 children lost their lives directly because of these conditions.
Stunting also serves as the early indicator of the presence of malnutrition risks. Neglecting these initial signs while concentrating solely on severe cases results in missed chances for prompt intervention.
Early attention to stunting can avert the progression to severe malnutrition, emphasising the value of prevention over treatment.
Current guidelines from the Department of Health are that all children should be routinely and comprehensively monitored for growth at every health visit.
Comprehensive anthropometric measurements, including weight-for-height, height-for-age, head circumference, and body mass index (BMI), are crucial for assessing growth and development.
These measurements and their corresponding charts are included in the Road to Health Booklet given to each child at birth.
Despite these guidelines, many children are not being adequately monitored for growth because of various problems that could be resolved through cost-effective interventions.
Height-for-age is particularly neglected by health workers dealing with long queues in government facilities. Considering that stunting is the most prevalent non-communicable disease of early childhood, it is surprising that this critical measure is not even tracked in the District Health Information System, contributing to its non-prioritisation by healthcare workers.
Stunting acts as the smoke that warns of the fire of MAM and SAM. If we focus only on severe cases and ignore early indicators, we miss the opportunity for timely intervention.
Addressing stunting early can prevent the more severe forms of malnutrition, reinforcing the principle that prevention is better than cure.
By the time malnutrition manifests as MAM or SAM, it is often too late to intervene. Early detection and intervention are crucial, studies show that children who catch up on height later in childhood, after the age of two, have similar cognitive outcomes to those who continue to be stunted.
Early identification of children at risk of all forms of malnutrition, and acting immediately, is fundamental to securing a brighter future for all South Africans.
Clinicians, including doctors and nurses, should prioritise this task during any health facility visit. It should be non-negotiable for every healthcare worker who works with children to be trained and given the equipment to monitor growth, including all community health workers.
Additionally, parents and caregivers should be sensitised, taught and equipped to perform basic screening for malnutrition where feasible.
By focusing on the screening of stunting, community healthworkers play a crucial role in early intervention and prevention of malnutrition.
Most recently, other countries, such as Ethiopia, have committed to achieving zero stunting by 2030 and successfully reduced this through co-ordinated efforts, including comprehensive growth monitoring and addressing food insecurity.
South Africa’s new government must prioritise this crucial period to build a better tomorrow for everyone by:
• Making zero stunting a funded national priority;
• Ensuring nutritious food is affordable and accessible to all children, pregnant women and mothers of young children;
• Reducing rates of low birthweight by supporting vulnerable pregnant women;
• Equipping vulnerable mothers with the necessary tools and confidence to provide optimal care and stimulation to their infants; and
• Identifying and responding to children at risk through regular monitoring of weight and height.
As toddlers blow out their second birthday candle, we witness the tangible effect of policies and programmes not implemented. Their well-being reflects our collective success and their growth charts become the scorecards of our nation’s progress.
Dr Edzani Mphaphuli is the executive director of the Grow Great campaign.
See more from MedicalBrief archives:
Lack of breastfeeding stunts growth in SA’s children
SA study flags growth stunt from paediatric TB
Poor diet puts SA children at risk of lifestyle diseases – Gqeberha study
Child poverty associated with smaller, slower-growing subcortical regions — 17-year study
UFS: Child malnutrition – human rights violation and slow violence against children