More accountability and urgent action have been called for after Health Minister Aaron Motsoaledi admitted that so far this year, 155 children under five have already died of malnutrition in South Africa.
Experts, however, say this number is not the full picture and are demanding a shift in strategy to avoid the tragedy of stunting and moderate and severe acute malnutrition.
In answer to a parliamentary question by the DA, Motsoaledi said that since January 2025, 155 children have died in public health facilities, with moderate or severe acute malnutrition as an underlying condition.
Most were in Limpopo (32), Gauteng (30) and KwaZulu-Natal (29).
DA MPs Michele Clarke and Bridget Masango have since issued a statement calling for multidisciplinary action. “The solution is a cross-cutting intervention, because both the departments of Health and Social Development must collaborate to address this,” they said
The DG Murray Trust, which has done extensive work to advocate for and help create food security for children, told Daily Maverick that South Africa has to increase national accountability for child nutrition.
“Countries that have successfully reduced stunting have one thing in common: they track child growth rigorously. South Africa needs to shift from crisis response to prevention. That means measuring, reporting and acting on early signs of child growth falling behind the curve at community level,” said the non-profit organisation’s chief executive, David Harrison.
Severe acute malnutrition in children under five has risen by 26% over the past five years, despite a number of programmes in the Health and Social Development departments.
Explaining why so many children are still dying from moderate to severe acute malnutrition, Harrison said: “Mainly, children who get moderate or severe malnutrition have no access to social safety nets.”
Safety nets such as the Child Support Grant did not reach these children because of administrative failures or problems with documentation.
“There are about 2.2m children who are eligible for the grant but don’t get it.”
Regarding the children of foreign citizens who are not entitled to the grant, he added that “we know from hospital studies that they present sicker and die more from severe acute malnutrition than South African children”.
There were also cases of extreme neglect, often when the caregiver had a drug or alcohol dependency problem, but extreme poverty and exclusion from social support were the primary reasons children presented with moderate or severe malnutrition.
The DA called this a serious and growing tragedy, correlating with a legacy of increasing unemployment and rising cost of living, and demanded that the Department of Social Development ensure caregivers receiving the Child Care Grant are thoroughly informed about the best and most nutritious foods the grant should buy every month.
“This is not a passive obligation, but one that the Social Development Department and (the South African Social Security Agency) must do actively for all mothers, fathers and carers who struggle to nourish their children in trying economic circumstances,” it says.
“The Department of Health must address childhood malnutrition deaths with vastly enhanced public information campaigns on the signs of malnutrition and clear direction on seeking treatment, before it is too late. This must be stopped with greatly improved public information campaigns that reach millions of mothers and carers.”
Drop in numbers
Lori Lake, an education and communications specialist at the Children’s Institute, said data dating back to 2013 show that child deaths from malnutrition have decreased in South Africa – “from the high of 2000 in 2014 to 574 in 2024”.
“You would think this is a good news story. Yet more than 50% of all child deaths occur outside healthcare facilities, and the chances are that those children who died without being able to access healthcare are as likely, if not more likely, to have been suffering from severe acute malnutrition than those dying in facilities. So what we are seeing in these data is really just the tip of the iceberg.”
The prevalence of wasting in South Africa is estimated at 5%, which means about one in every 20 children is wasted.
“Wasting is an acute form of malnutrition that indicates either recent or severe weight loss and is often caused by inadequate food intake or frequent and or prolonged illness,” Lake said, while stunting not only compromises physical growth, but also brain development, in ways that have a lifelong impact on children’s health and educational outcomes.
“The third area of concern is the very rapid increase we’ve seen in overweight and obese children under five, which increased from 13% in 2016 to 23% in 2022, almost doubling in less than 10 years – and that’s a very frightening trend for anybody concerned not just about child health but the growing burden of non-communicable diseases in South Africa.”
Statistics showed that 40% of children were living in households below the food poverty line which cannot afford to meet the basic nutritional needs of the children in their care, while 38% of poor infants (under one year) were not receiving the Child Support Grant.
Solutions
To boost the fight against severe acute malnutrition, Harrison said the first strategy must be to make a basket of basic, protein-rich staples more affordable.
“Most children get pap or rice, but what’s lacking from their diets are proteins and micronutrients, which are essential for growth. This strategy is most important because of the 2.5m children who are at risk but have no social safety net.”
Then, close the gap between the buying power of the Child Support Grant (R560) and the food poverty line (R796 in 2024). The grant covered only 70% of the basic food requirement, and very poor families had no other way to plug the gap.
“Improve maternal nutrition. Babies born with low birthweight are three times more likely to be stunted later. Providing food or cash to pregnant women who are underweight, especially through antenatal services, could break the cycle of malnutrition before it begins. Global studies show that balanced protein-energy supplements during pregnancy significantly reduce low birthweight and improve breastfeeding outcomes,” Harrison said.
Echoing this, Lake said this was why civil society organisations and academic research units like the Children’s Institute have been begging the government to restore the value of the Child Support Grant to the food poverty line, “so that we provide children and families with resources they need to not only survive but thrive and reach their full potential”.
In addition, Harrison said, for just R40mn, South Africa’s 60 000 community health workers could be given a basic mechanical scale and training to identify children who are starting to fall behind their growth curves. “This is one of the most cost-effective ways to catch and treat malnutrition early.”
Another solution would be to encourage local food production and supply and increase national accountability for child nutrition.
“There are now many examples of local schools, clinics and community organisations growing food and selling to or sharing it with children in home-visiting programmes and ECD centres. We need to keep growing these initiatives.”
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Nelson Mandela Bay: Acute malnutrition cases increase while R67m distress grant remains unspent